8 Areas for Pain Management Physicians to Benchmark

Pain Management

Benchmarks are becoming increasingly important for medical professionals across the spectrum of care as payors continue to emphasize evidence-based medical practices.
"Payors are going to require it," says Drew Robertson, MD, founder and president of Wellspring Pain Solutions in Columbus, Ind., who operates both a professional office and an ASC right next to each other. "If they don't see that we're going to at least measure that, they aren't going to want to pay for our services. What they would like to see is improvement."

Surgical Outcomes Information Exchange (SOIX®) benchmarks more than 300 ambulatory surgery centers across the country and has noticed the trend of pain cases moving from the hospital setting to the ASC.

"Managed care companies want to know what your outcomes are and often you will lose a contract because you cannot tell them," says Lou Rossiter, PhD, president of SOIX. "We think that the best measures are procedure-specific and physicians should benchmark apples to apples. Data measurements should be standardized and comparable to provide confidence in the data."

Benchmarks can also be beneficial for research projects. Mitchell K. Freedman, DO, of the Rothman Institute in Philadelphia, along with his colleagues is conducting a research project on pain, decreased movement or decreased sensation in the arm and shoulder due to nerve problems, also know as brachial plexopathy. They hope to evaluate 2,000-3,000 patients before and after surgery by having surgeons and anesthesiologists fill out questionnaires before and after the procedure so his team can track trends. Dr. Freedman sees this approach possibly being applied to other pain management procedures such as epidural steroid injections to see which type of procedure is best for specific injuries and establish whether or not the patient is making functional gains along with diminished pain.

Here are eight benchmarks pain physicians should keep to positively benefit their practices.

1. Outcomes benchmarks.
In pain management, outcomes are benchmarked based on the patient-reported pain levels before and after an intervention. Pain physicians and practices can benchmark:
•    Perioperative pain
•    Percent of patients reporting worse pain immediately after the procedure
•    Post-discharge pain
•    Percent of patients reporting worse pain after returning home
•    Improved pain scores
•    Increased functionality

"For some patients, the treatment can provide short term relief but not long term relief; other patients experience long term relief but are still in pain immediately after the treatment," says Dr. Rossiter. "There are numerous pain measurement scales, ranging from the less complicated to the more complicated, but the important thing is to have a patient-centered measurement scale so you are able to compare your results to others."

In general, SOIX has found that 12 percent of patients report worse pain immediately after a cervical procedure while around 8 percent of patients report worse pain immediately after lumbosacral procedures. The incidence of pain after returning home are similar between the two, says Dr. Rossiter.

"You are going to use these benchmarks to show managed care companies you are good," says Dr. Rossiter. "If your results are favorable compared to the benchmark, you can take a tougher negotiating stance with the managed care company. Too often, surgery centers assert they are excellent, but they really stop the managed care negotiator when they can show they are excellent."

2. Procedure benchmarks.
Keeping track of procedure benchmarks is useful to understand the efficiency of your physicians and whether you are receiving the appropriate reimbursement for your work. Pain facilities can benchmark:
•    Procedure time
•    Recovery time
•    Length of stay
•    Medicare/private payor reimbursement
•    Facility fee
•    Non-facility fee

3. Patient satisfaction benchmarks. Timothy L. Sternberg, MD, Heekin Orthopedic Specialists in Jacksonville, Fla., says tracking patient satisfaction is essential for all practices, but especially so in pain management because the goal is to improve a patient's function, mobility and, ultimately, quality of life. "The patient feedback is probably the most important outcome measure you can use in clinical practice," he says.

Pain physicians can also track patient satisfaction by the symptoms they describe after returning home. These symptoms could include nausea, vomiting, fever, difficulty urinating, bleeding and signs of infection. Dr. Rossiter recommends collecting this and other patient satisfaction data when the ASC nurse places the follow-up phone call at the patient's home.

"We find, for our nationwide network of surgery centers, that the satisfaction rate is very high," he says. "When asking about patient satisfaction, we think it's best to keep the questions short and focused."

Pain physicians can address these areas in patient satisfaction:
•    Overall quality
•    Registration and admission
•    Pre-op care
•    Preadmission testing
•    Recovery

All areas scored 94 percent or better at the SOIX centers this past year. "It's useful to break it down so you can see which processes are relatively the weakest and which ones are relatively the strongest," says Dr. Rossiter. "Most centers new to SOIX find they need to work on at least one of these three areas in order to meet the national benchmarks."

4. Physician satisfaction.
It's important to measure physician satisfaction so you can see where your practice is excelling and where you may need improvement. Physician satisfaction surveys can be done online or through paper surveys asking a series of questions about their experience at the center. Dr. Rossiter says the questions can cover:
•    Scheduling
•    Efficiency of the practice
•    Patient satisfaction from the physician's point of view
•    Anesthesia services
•    Skills of the personnel
•    General appearance of the facility
•    Overall rating

5. Staff satisfaction.
Surgery centers and pain practices want to maintain employees for as long as possible because hiring a new staff member is a drain on practice resources. Maintaining a low employee turnover depends on having a high employee satisfaction. Dr. Rossiter says pain physicians can track employee satisfaction in the following areas:
•    Work and home life
•    Management and communications
•    Work and learning environment
•    Fairness and effectiveness
•    Quality of job design
•    Work pressure
•    Overall job satisfaction
•    Staff exposure to patient safety issues

"You can use the benchmarking data to discover opportunities for improvement and then develop action plans to address those deficiencies," says Dr. Rossiter.

6. Practice management benchmarks. Patient outcomes are the number one priority for many pain physicians, but maintaining practice management norms is a close second. It's important to understand how your practice measures against other practices nationwide to determine whether potential changes to office management are necessary. Pain physicians can benchmark:
•    Patient volume—number of patients they see per month
•    Total number of patients seen annually
•    Number of days spent doing procedures in a surgery center
•    Number of days spent seeing patients in the clinical office
•    Amount of procedures referred to the facility
•    Volume of procedures performed annually

"Those particular benchmarks help us do a couple things," says Dr. Robertson. "They help us project our financial performance over the next one to two months. We also use them as a leading indicator of any problems headed our way. If we see the number of new patients drop off, we know we're going to struggle with financials a month or two down the road."

7. Financial benchmarks. Comparing your practice to others in your area using financial benchmarks can allow you to make sure his ASC is not getting outside industry standards financially. Pain physicians should pay attention to financial benchmarks such as:
•    cost per case
•    collection rates
•    personnel expenses
•    profitability per case

Pain physicians can easily gauge the profitability of each case by dividing the reimbursement per treatment to the amount of time the case takes to perform (per hour). "If you do that, you'll see that cervical cases actually generate more payment than lumbar cases," says Dr. Rossiter.

8. Patient drug test benchmarks.
One of the biggest issues in pain management today is controlling narcotic use and correcting divergence. Physicians can use benchmarks in this area to understand how their patients and practice fit into the local and national spectrum of drug test results. From the lab where they send their specimens, Dr. Robertson's practice receives:
•    Averages for results such as no abnormality detected
•    Illicit substances found
•    Unprescribed medication found
•    Prescribed drug not found
•    Drug above expected range
•    Drug under expected range

He says the national average for no abnormality detected is 29 percent, and his practice results have always been better than the national averages.

Related Articles on Pain Management:

Dr. Scott Gottlieb: 3 Proven Ways to Grow a Pain Practice's Referral Base

6 Points for Physicians on Identifying and Preventing Chronic Pain Medication Abuse

The Future of Evidence-Based Medicine in Pain Management: Q&A With Dr. Laxmaiah Manchikanti of ASIPP

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