Rockville, Md.-based National Spine and Pain Centers added Gainesville, Ga.-based Specialty Spine and Pain and Chicago-based Millennium Pain Center to its national network last week.
CEO Doug Wisor, MD, elaborated on the transactions to Becker's Spine Review and shared perspective on plans for the company's future.
Note: Responses were edited for style and clarity.
Question: What drove you to make these transactions?
Dr. Doug Wisor: We're obviously on a mission;what we discuss internally is that our mission is to end the needless suffering associated with chronic pain. The more high-caliber physicians and practices we can bring under the umbrella, the more we can execute on that mission to help more people.
For several different reasons, our national growth activity was really [focused on] the Amtrak corridor. It focused from North Carolina in the South all the way to Connecticut in the North trying to build regional densities in the states we were in.
Specialty Spine and Pain is not the next square geographically, but it's not too far from North Carolina. Partnering with [Keith Robinson, MD] — who is a former Georgia Society of Interventional Pain Physicians president and someone who already owns and operates two ASCs ... and can help other pain providers [set up their own centers] — was an easy decision. He's a physician leader and can help others add ASCs so we can execute on some of the higher-caliber procedures that can't be done in the office setting. We see entering in partnership with Specialty as an opportunity to help build regional density in Georgia under his leadership.
On the flip side, [Millennium Pain Center President Ramsin Benyamin, MD] is a two-time past president of the American Society of Interventional Pain Physicians. His national presence on the leadership side, attracting likewise high-quality physicians, adds a lot of strategic value to what we're already doing.
Equally important, [Ricardo Vallejo, MD], his partner, is internationally known for research. He's won the North American Neuromodulation Society (NANS) Conference Best Scientific Poster in Neuromodulation for the last two years. We wanted to add his research experience ... the ability to add clinical trials — whether investigations with pharma or device — [and the ability] to test various opportunities or technologies to reduce dependence on opioids.
Q: How did you negotiate these partnerships?
DW: [Pain is] such a small industry. There's just over 3,000 of us nationwide, and there's a much smaller number of people who are considered leaders in the field.
With Dr. Benyamin, we'd been lobbying Congress in various roles with ASIPP for the last several years. We'd been talking about the potential to do this and come together. It's long since been a goal of his to join like-minded physicians. ... We kicked the tires on this for probably five years, until we felt the timing was right on both sides; both for us to enter into Illinois and for his group to partner with a bigger organization.
In the case of Dr. Robinson, we met at our Business of Pain Conference. He liked what some of our panel speakers had to say and that led to further discussions.
Q: Three years down the road, what does National Spine and Pain Centers look like to you?
DW: I think it probably depends on the day you ask me. Obviously we see, not only [managing patient] pain at our individual centers as our core mission, but also being able to facilitate our highly trained physicians to deliver the newer and higher-end procedures in our own cost-conscious surgical centers – like permanent implantations of stimulators and pumps - as critical to maximizing patient value and organizational health.
We see higher-end procedures that require an ASC setting ... as the natural evolution of the interventional pain business. As we build centers of the future, they will have full surgical capacity. I could also see us being in strategic partnerships with higher-caliber spine surgeons so we can offer a continuum of care and not just comprehensive pain management. That's a different business and delivery model, so whether that comes to fruition, it remains to be seen.
Q: Do you believe Medicare will eventually cover total joint replacement in the ASC setting?
DW: Hospitals are quickly aggregating primary care and specialists to keep them under the umbrella, but I think we're at the day of reckoning on healthcare costs. The idea [that hospitals are] going to sneak by the goalie the costs of the delivery of care is pretty audacious considering their cost is three times higher than average, while some ASCs [are just getting paid slightly] over Medicare rates.
[Procedures like that are] going to give us such a competitive advantage on the ASC side once we start to deliver more fully on those services. It's going to be difficult for hospital systems to compete. You're seeing it as many start to wither on the vine. The math doesn't work in the HOPD or inpatient space. Even a simple follow-up visit comes with a tax to be done at the hospital office building. As patient’s deductibles increase they're going to become more educated consumers.
Q: What else would you like people to know about National Spine and Pain Centers?
DW: We are a mission-focused organization. Our mission is to end the needless suffering associated with chronic pain. It starts by aggregating the highest-quality physicians we can find. For every state, like Florida that had that the pill mill controversy, it makes it harder for patients to gain access to high-quality providers. We see that with some commercial payers putting up barriers to access. The opiate epidemic is just one of what we believe is a trifecta of epidemics occurring simultaneously.
1. The opioid epidemic
2. Poorly managed chronic pain, where a third of Americans are reporting chronic pain
3. Spiraling healthcare costs
We feel that we're the only organization with the comprehensive tools to address all three problems; the only specialists with the tools in our bag that could make a difference.
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