6 Best Practices for Maximizing Efficiency in Pain Management

Here are six best practices for maximizing efficiencies in pain management, according to leaders and owners of pain management practices across the country.

1. Benchmark. Pain management centers, whether standalone or within a multi-specialty surgery center, should benchmark various data from their practice with those of other pain practices. Benchmarking is necessary in order for pain centers to see how they "measure up" against various industry averages for care. Although data for standalone pain centers can be difficult to come by, administrators of pain centers say it is critical enough that ASC should work to find good figures.

"Pain centers should benchmark their staff dollars per case and staff hours per case against ASCs with similar case volume and similar specialty mix," says Jared Leger, RN, CASC, managing partner of Arise Healthcare and executive director of Stonegate Surgery Center in Austin, Texas. "They should also benchmark turnover time. If your ASC is 100 percent pain management, benchmarking data may be hard to find. Call other 100 percent pain management centers and mutually agree to share data. If that fails, use the average of GI and ophthalmology since the turnover time should be similar, and data is easier to find on these specialties."

2. Hire wisely. Hiring the right staff is crucial to ensuring that a pain center is run as efficiently as possible.

"Hire knowledgeable employees who understand pain management procedures," says J. Lowell Haro, MD, owner of Pain Management Consultants in Austin, Texas.

Joel Haro, administrator at Pain Management Consultants, agrees. "You have to hire smart," he says. "Hire employees that can multi-task and will perform job duties other than their responsibilities."

Julien Vaisman, MD, owner of New England Pain Care in Peabody, Mass., adds that hiring a strong director of nursing is also important. "The attributes for a strong director of nursing would be somebody who can coordinate the daily staff activities, makes sure all the supplies are available and has a vision about future trends in the ASC," he says.

3. Focus on teamwork and communication. Once a pain center has hired the right employees, it is important that it focuses on cultivating a culture of teamwork and participation.

"Teamwork is an essential key to success," says Dr. Vaisman. "Communication between all the healthcare providers is of utmost importance. The pain management physician needs to actively involve both the nurses and the radiology technician in the thought process and patient management options. Those employees have to understand not only how we are doing the procedures but why we are doing a certain intervention."

Staffing decisions should be made to maximize teamwork. "Pair the same staff members in the room with the same physician every time," says Mr. Leger. "This allows your C-arm technician and nurses to become familiar with the physician's preference, style of practice and C-arm positioning. Over time this will save you countless hours and make your physician's job easier and quicker."

4. Work to align physician preferences for procedure materials. Pain centers can also improve efficiency by streamlining purchases.

"Get your pain physicians to agree on uniform needle type and pharmaceuticals," says Mr. Leger. "Make custom trays for nerve blocks and ESI's. This is less expensive than pulling everything separately. Make sure your medical supply vendor and pharmaceutical vendor are [with] your GPO."

In addition, centers should use preference cards for each operation performed at the center, says Christine Yoder, director of Wyomissing (Pa.) Surgical Services.

"Use procedure preference cards so you know you have what you need every time," she says.

5. Educate physicians about the importance of turnover time. Ensure that physicians are aware of the importance of turnover time and what types of patient care should and should not occur in the surgery center. ASC administrators should consider educating their physicians about the importance of emphasizing to patients that follow-up and patient education will occur at the doctor's private practice, not at the surgery center.

"There needs to be an emphasis on patient education and follow up at the physician's office to avoid turning the ASC procedure time into an impromptu office visit or prescription refill opportunity, which dramatically slows down efficiency and turnover," says Robert Wills, MD, of Austin (Texas) Pain Associates and physician-owner of Stonegate Surgery Center in Austin.

6. Be prepared for reimbursement challenges. One of the biggest challenges for pain management within surgery centers is reimbursement. This issue, while not unique to pain management, poses significant challenges to ASCs offering pain management. It is critical to take steps before the day of the procedure to ensure the center receives full reimbursement for each procedure it performs.

"Pain management is relatively inexpensive to actually 'do'; the majority of the costs involved are for the personnel, such as the pain specialist and the staff, and the costs of the equipment," says Sandy Berreth, administrator at Brainerd Lakes Surgery Center in Baxter, Minn. "However, with reimbursement being cut dramatically, it has made pain a 'pain.' Therefore, success in pain management is all about the numbers and payor mix."

Surgery centers should verify insurance thoroughly and request payment upfront, if possible. "Verify insurance information prior to the patient coming to your centers and make sure the patient is aware of their financial liability," says Ms. Yoder. "Collect it the day of service if your contract allows" you to do so.

Administrators need to be careful that physicians never perform procedures that have not been pre-approved by the payor. Because the types of procedures that payors will cover vary by insurer and state, it is important that physicians perform only those procedures that have been previously approved by the billing department.

Staff and physicians also need to work together to ensure billing is completed in a timely manner. "You need to work toward same-day completion of operative reports, which are available to both the physician and ASC billing office," says Dr. Wills. "Doing so allows for accurate matching and coding of claims submissions."

Contact Lindsey Dunn at Lindsey@beckersasc.com.

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