8 Benefits for Spine Practices of Adding Pain Management FeaturedWritten by Laura Miller | September 04, 2012
As the healthcare industry continues to change, spine surgeons and practices are increasingly partnering with pain management and physical medicine specialists to grow their practice and remain independent. However, some groups, such as Southeast Spine Institute in Mt. Pleasant, S.C., incorporated that model years ago because of its clinical and economic strengths.
"We started with a philosophy that we weren't just going to be a group of spine surgeons — we were going to practice spine medicine," says Don Johnson, MD, medical director at Southeastern Spine Institute. "Practicing spine medicine means we are treating all patients with back pain and spinal disorders, not just patients who need surgery. In the past, surgeons wouldn't see patients if they didn't need surgical procedures; I think that's old school and most practices don't do that anymore."
Here are eight benefits spine practices realize after adding pain management.
1. Pain management physicians can improve practice revenue. Spine practices will boost their revenue by keeping specialists and services in-house. "It makes economic sense to keep everything under one roof," says Hal Blatman, MD, founder of The Blatman Pain Clinic in Cincinnati.
Besides bringing in additional patients and keeping referrals in-house, partnering with a pain management physician can increase revenue because surgeons can spend more time in the operating room with surgical patients while pain management physicians treat the pain patients.
"The practice becomes more lucrative because the surgeon makes more money doing surgery, so they should spend time doing that," says Dr. Blatman. "The pain physicians have their own expertise and can deal with patients who don't need surgery."
2. More services allow the practice to compete with the hospital. For physicians and surgeons who wish to remain independent, a large multispecialty spine and back pain practice offers an alternative option to hospital employment. By capturing the non-operative back pain patients in addition to the surgical patients, as well as revenue from ancillary services, spine surgeons and pain physicians can remain independent and even compete with the hospital.
"Part of what all physicians have to do is compete with the hospital and the way you do that is by providing traditional hospital services," says Dr. Johnson. "For physician recruitment, usually hospitals are able to offer bigger bonuses and larger guaranteed salaries that are loosely tied to production. However, when the contract comes up for renewal the physicians are paid less money, expected to work harder and have less autonomy. The best time to recruit is after physicians have finished a three year contract with the hospital because they are unhappy and ready to try their hand at the private practice of medicine."
Revenue from ancillary services allows The Southeastern Spine Institute to pay competitive starting salaries to new physicians.
3. Surgeons will have more time with surgical patients. When spine surgeons partner with pain management physicians, they may see fewer patients but the patients they do see will likely need surgery.
"Spine surgeons would rather do surgery than talk to non-surgical patients about pain management, and they have time to do that if there is a pain physician in the practice," says Dr. Blatman. "The pain physician is going to be up to date on the latest and most innovative treatment for pain and trained to work with pain patients. As a result, pain physicians could be much better suited to handle these patients."
Pain physicians are also trained to care for pain patients, who often want someone to listen to their story. "The pain patient is a difficult patient to care for and it takes a certain breed of person to listen to their complaints every day and help them," says Dr. Blatman. "While surgeons focus on surgical cases, pain patients can spend time with the pain physician."
4. Patient outcomes will improve. Spine surgeons can consult with pain management partners about their cases to make sure there aren't any other options before performing surgery. "There are some patients who have a lot of pain and surgeons are wondering whether they need surgery," says Dr. Blatman. "The pain physician can serve as a consult to see if there is something else they can try, or if proceeding to surgery is the best option. Just having another voice on the team to confer with under the same roof facilitates a quality improvement."
When the spine surgeons and pain management physicians are truly integrated, the surgeons will experience higher success rates because they are only performing surgery on patients with the best indications; other patients are seen by the pain physician.
"Success rate goes up because surgeons aren't doing surgery when it won't help," says Dr. Blatman. "Sometimes the surgery might be perfect but the patient is still miserable because they needed a different treatment. With other specialists, surgery will be performed less often but be more focused and highly successful."
5. Pain management fills in the treatment gaps. When Dr. Johnson first launched his practice with one other spine surgeon partner, they quickly realized a significant number of patients coming through the door didn't need surgery. "Rather than not taking care of these folks or referring them back to their primary care physicians, we decided to fill the gaps with non-surgical treatment such as physical medicine and rehabilitation," says Dr. Johnson. "Two years after that we brought on a pain management physician to fill the remaining treatment gap."
Now, the practice includes four spine surgeons, three physical medicine and rehabilitation physicians, three pain management physicians and an anesthesiologist. The pain management physicians perform spinal cord stimulators, pain pumps and minimally invasive lumbar decompressions, among other procedures.
"Most patients want to see surgeons first and then the other doctors, but we put them on the right pathway to see the non-operative physicians first," says Dr. Johnson. "They go to see the PM&R physicians for injections and almost ever patient sees the pain management physicians before they see a surgeon. Our pain management is almost a practice within a practice."
Additionally, you can create an integrative medicine program that focuses on all aspects of care, including nutrition and diet as well as prolotherapy and trigger point injections. "That is a much more successful practice from the standpoint of patients getting better," says Dr. Blatman. "An integrative approach reduces pain and helps patients heal."
6. Pain physicians can assist with surgical procedures and prescriptions. The pain management physicians at The Southeastern Spine Institute are all fellowship trained and credentialed to put in all of the diverting lumbar drains for spinal fluid leaks before surgery.
"In our hospital, we were able to get them credentialed to put in lumbar drains," says Dr. Johnson. "They manage the lumbar drains and they also have privileges to be the co-surgeon for laminotomy. They are very self-sufficient and can do spinal cord stimulators without the surgeon present."
Additionally, laws are changing in some states, requiring anyone who prescribes medication to relieve chronic pain to have a license. If surgeons don't have this license, they cannot prescribe medication after the post-operative period.
"In the state of Ohio, a surgeon can't prescribe pain medication for chronic pain unless they have a license," says Dr. Blatman. "Having the pain physicians do this is easier for the surgeons as well. States are changing their laws and requiring a higher level of monitoring for patients with chronic pain medication, which is another aspect of the practice pain physicians can take over. The surgeon doesn't need to be responsible for making sure the patient is using their prescriptions appropriately; instead, he can focus on making sure surgery is indicated and delegate pain management to someone else on the team."
7. Additional services increase patient flow. Bringing on pain management physicians and other back pain specialists can increase patient flow to the practice. At The Southeastern Spine Institute, physicians do more than 1,000 injections and rhzotomies per month. Overall, the pain management physicians have performed spinal cord stimulator implantations for 7,000 patients since joining the practice.
The increased patient flow means additional revenue, and if the patients reach a point where non-operative care isn't effective, they will use your surgical services as well.
"It's convenient because we are in the same building, so the surgeons will send patients to the pain management physicians, but it's also not unusual for pain management physicians to send us their patients who have developed more complex problems, such as disc degeneration," says Dr. Johnson. "When their patients have a new trauma, I get a call from the pain management physician saying they have a patient they need the surgeon to see right away. We can deal with those patients here as well, so it's not a one-way referral street."
8. Bringing colleagues and services in-house is more convenient for the patient. Spine surgeons are only one of several specialists back pain patients see, and there are several services beyond the traditional physician practice they need. Bringing those specialists and services in-house is more convenient for the patient and keeps revenue in-house.
"When I see patients who need pain management, we are able to have the patient seen by the pain physician the same day because they have an adjoining building on the same campus," says Dr. Johnson. "Since we are in a rural place in South Carolina, 60 percent of our patients come from more than 60 miles away. We are set up so that when someone comes a long way to see us, they can get an MRI, injection, brace and see the pain management physician all in the same day."
As part of the pain management services, the practice has hired a psychologist to work with patients who have chronic pain. "Our pain management physician works closely with our psychologist to see chronic pain patients with depression," says Dr. Johnson. "Most insurance companies require patients have a psychological evaluation before implanting a spinal cord stimulator pain pump. It's helpful to have her at the office for those patients who need her services."
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