According to a panel of pain management physicians and billing experts, there is plenty to be excited about in the world of pain management in the ASC setting.
A panel of three physicians and a billing expert convened during the Becker's ASC 22nd Annual Meeting in Chicago on Oct. 23. Panelists included Amish Patel, MD, interventional pain physician and anesthesiologist with Premier Pain Physicians; Scott Glaser, MD, co-founder and president of Pain Specialists of Greater Chicago; Jayen Patel, MD, physician owner of Tulsa Ambulatory Procedure Center; and Lisa Rock, president of National Medical Billing Services. Scott Becker, publisher of Becker's Healthcare and partner with McGuireWoods, moderated the discussion.
"The biggest change in pain management reimbursement is the removal of the add-on codes by Medicare for the ASC. This change has reduced revenue and it's possible other carriers will follow," said Ms. Rock.
"Denials are very common in pain management, more so than any other specialty," she said, and she pointed to two reasons in particular for the difficulty: meeting medical necessity and inaccurate documentation.
Despite the billing challenges facing the pain management specialty, the physicians on the panel were excited about a few up-and-coming trends in pain management in the ASC setting. Here are three developments they discussed:
1. Neuromodulation. Dr. Amish Patel noted that opioid prescription is starting to be "frowned upon" in the industry, and he is therefore starting to look at non-narcotic options for managing patient pain. One such option he was especially interested in was neuromodulation.
Dr. Jayen Patel also noted that neuromodulation is an exciting prospect for pain management physicians and ASCs. "We are looking at that reimbursement schedule for 2016, and it is quite impressive," he said.
2. Toxicology screening. Another area that can be lucrative for pain management physicians and beneficial for patients is toxicology labs. Dr. Jayen Patel called toxicology labs an "essential part" of his business.
Dr. Amish Patel agreed, called toxicology labs and urine screens "vital to the financial health of a practice."
When Mr. Becker noted some payers are becoming weary of reimbursing for urine screens — Cigna recently pulled out of the Florida market, citing excessive testing — Dr. Glaser said that urine and toxicology screens are great now, "but not for always."
3. More involvement in patient management. As the industry shifts away from fee-for-service and toward value-based reimbursement, pain management physicians can position themselves to play a larger role in patient care, the panelists said.
"We've been working to try to get interventional pain management physicians to be at the start of the chain of events so that we're managing patients right off the bat," Dr. Glaser said. Pain management physicians can keep patients comfortable and out of the operating room, he said, which can help lower costs.
Dr. Amish Patel also sees pain management physicians' role growing as the industry advances. "[There will be] more of a role for pain management physicians to provide initial evaluation and treatment," he said.