There have been several changes for spine and pain management professionals over the past few years, and leaders in the field are at the forefront of advocating for change.
At the 12th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference in Chicago, a panel of experts discussed new initiatives in spine and pain management. The panel included DISC Sports and Spine Center Medical Director Michael Port, MD; Michigan Pain Consultants President Mark L. Gostine, MD; and Laxmaiah Manchikanti, MD, chairman of the board and CEO of ASIPP and SIMPS and medical director of the Pain Management Center of Paducah. The panel was moderated by Scott Becker, JD, Publisher of Becker’s Healthcare and Chairman of the McGuireWoods Healthcare Department.
Recent changes in the pain management field include:
• Reimbursement cuts to epidural injections
• FDA decision on steroids
• Local coverage determination in all states
• Urine testing costs
"A typical pain management physician's practice depends on epidurals," says Dr. Manchikanti. "Now you have a 30 percent to 40 percent reduction in physician payment for a significant number of the procedures we do. With ObamaCare taking effect, there are an increasing number of patients with government insurance or high deductible plans. The copays are significant — $275 deductibles — and patients don't want to pay for the procedures."
Payer contracting is also a significant challenge. Centers are either out-of-network or increasingly going in-network with lower reimbursements. "It is becoming increasingly difficult to negotiate an out-of-network strategy, but we are doing it," said Dr. Port. "The main issue is that we are a fairly big player in the market, but not as big as even the small hospital next to us."
There have been instances where payers withheld payments from Dr. Port's group and they brought legal action against the payers. "These were things they were paying for a year ago and now they're not," said Dr. Port. "We ultimately prevailed and now have a strategic team to preemptively fight for approval and appropriate reimbursement at the practice. We haven't had it around for long, but it seems to be helping."
There are innovative things going on in the field as well. Dr. Gostine discussed his group's data management system, which has information on around 30,000 patients and close to 130,000 surveys. The data is used for advocacy and marketing.
"Last year we demonstrated that an innovative program we did with the payer's toughest patients still had a cost reduction of several thousand dollars," said Dr. Gostine. "There is a ton of data going through your practice right now and you need to capture it."
His group received a National Institutes of Health grant to develop a data analysis tool showing superior outcome and lower costs with their patients.