Amy Mowles is president and CEO of Mowles Medical Management.
Q: Why is pain management a great specialty for ambulatory surgery centers now?
Amy Mowles: As the site-of service differential continues to decrease on professional reimbursement, certainly making it less of any sort of "incentive" to do these procedures in an office-based setting, the ASC setting makes the most sense. It's really not a great differential now. Even more important to note is that the vast majority of pain management procedures are done under fluoroscopic guidance and now the most commonly performed procedures — transforaminals and facets — have bundled the fluoroscopy used for needle localization into the payment so these physicians are not going to get extra money for the use of that C-arm. That's a rather large investment in the equipment and staffing if there is no longer additional payment.
Now is the time that interventional pain management physicians should be looking for alternative sources of income for now and in the future. Investing in their own or another ASC is of benefit to everyone. Medicare additions of even minor typically office-based procedures clearly outlines the view of CMS on where their beneficiaries should be treated with appropriate staffing and emergency equipment.
Q: Why will pain management remain a great specialty for ASCs going forward?
AM: Pain management is clearly moving rapidly out of offices. Twenty-eight state health departments have jurisdiction on office-based surgery and pain management is included in that office-based surgery. Their requirements are rigid. Gone are the days that a physician can just do whatever he wants in his own office. Someone has jurisdiction and that jurisdiction can be onerous. Areas that may come under scrutiny include levels of anesthesia used and complexity of procedures performed. Requirements vary from state to state. Some require offices to be licensed, some require them to be registered and many require the office-based pain centers to be accredited. Office-based accreditation is not an avenue to receive facility fees.
Office-based pain can also be costly; it's not going to gain you any more money when you consider local and state laws and third-party payor policies (commercial and workers' compensation) typically require the facility to be licensed and certified in order for facility fees to be paid.
Q: What other reasons are there for an ASC without pain management that's looking to expand to consider pain management?
AM: There are many benefits to providing pain management in your ASC. It's a high volume specialty with a low cost setup. If the specialty is run well, reimbursement minus cost per case can result in very strong income potential. With pain procedures you want to have room turnover typically about four times per hour and can expect a per-patient average of about 2.5 billable procedures.
Q: What are some of the common challenges associated with adding pain management?
AM: Pain succeeds in an ASC when its operations are kept simple and goals are realistic, which can challenge an ASC eager to capitalize on and grow the specialty. If not approached correctly, adding pain can be risky. You can control your risk by finding the right pain management physician who will buy into the ASC.
You need to look at procedure volume growth versus everything else to justify the investment in adding the specialty.
The bottom line is the volume. You're not going to have a successful pain program if you're not doing 2,700-3,000 billable procedures per year — that will easily support one Class B room and have a very successful pain program. It's as simple as that.
Q: What opportunities exist for ASCs which already offer pain management to grow the success of the specialty?
AM: It's all about capitalizing on their programs strengths — expertise in a certain procedure, culture, language, etc. You can do all the market research you want but in the end it's all about carving a place for yourself and distinguishing your ASC. Patients will be drawn to if you focus on what you do well.
All pain centers vary. Know your community. Speak their language. ASCs that have pain management can capitalize if they have more of a multi-disciplinary approach. Yes they offer interventional pain management procedures in their surgery center but their pain program extends out in to referrals to other alternative venues.
You have to capitalize on what makes you different. Define the objective of the pain program in your ASC in specific terms — create a positive, unique and appealing image and this will ultimately set your program apart from others.
Learn more about Mowles Medical Management.
Read more from Amy Mowles:
- 4 Critical Steps for a De Novo Pain Management Surgery Center
- 5 Truths and Misnomers About Pain Management in Surgery Centers
- Billing Best Practice: Do Your Research Before Negotiating With Payors