Biggest Trends in Pain Management: What's Ahead in 2014?

Interventional pain management physicians Glenn M. Lipton, MD, with DISC Sports & Spine Center in Marina del Rey, Calif.; Lowell Davis, DO, DABPM, medical director of South Florida Interventional Pain & Wellness Institute in Miramar and Christopher Centeno, MD, managing director of Centeno-Schultz Clinic in Broomfield, Colo., share thoughts on the big trends in pain management that are shaping the future of the field.

Dr. Glenn LiptonReimbursement
Downward pressure is one of the largest, and most influential, challenges pain management physicians face. "Pain management as a specialty is at a crossroads. We have developed all of these new techniques that have never been available before, but at the same time we are facing draconian reimbursement cuts by third party payers," says Dr. Lipton.

Spinal cord stimulation, a treatment that is a last option for many patients, has experienced reimbursement cuts of up to 80 percent, says Dr. Lipton. The Centers for Medicare and Medicaid Services recently determined not to provide reimbursement for the mild© procedure, a treatment for lumbar spinal stenosis patients. Voices in the industry are speaking up to advocate for improved pain management reimbursement. The American Society for Interventional Pain Physicians sent a letter to CMS in support of reimbursement for mild.

"The problem is that we are a relatively small and young specialty. We have to fight to have our voices heard," says Dr. Lipton.

Final rule on office-based procedures
CMS drastically cut reimbursement for epidural payments to physicians in 2014, making it nearly impossible for physicians to continue with office-based procedures. Physicians now receive around $42 payment for performing cervical and lumbar epidural injections, and additional cuts could be on the way if the sustainable growth rate isn't fixed. As a result, interventional pain physicians are now taking these cases to ambulatory surgery centers or hospitals.

While industry advocates continue to push for improved reimbursements, some physicians are considering converting their office-based practice to an ASC to collect on the facility fee in addition to the professional fee. The conversion is time-consuming and expensive but will ultimately allows physicians to perform these procedures outside of the hospital setting.

Shifting practice models
The continued threat of declining reimbursement brings into question the future of the independent pain management physician. This question has sparked a shift in practice models.

"At DISC, we are all independent private practice physicians, but we have established a multidisciplinary group. We work together to provide care to patients in an efficient, cost-effective manner," says Dr. Lipton. "The solo independent physician model is probably not going to be the way of the future."

"From interventional, functional to physical rehabilitative medicine, our specialties are attempting to take a team approach to obtain better results when treating chronic non Dr. Daviscancer pain," says Dr. Davis. "We are educating them on the many new alternatives to manage their pain outside of medication."

Dr. CentenoOther physicians will step on board with the trend of hospital employment to weather the pressure or turn to alternative payment models. "I suspect that many pain management physicians who stay in the insurance world will find it easier to work for hospitals," says Dr. Centeno. "Successful private practice physicians will cultivate niche markets in high demand where cash services predominate."

Advances in treatment
Though the field of pain management is tasked with a number of challenges, advances continue to be made. "We are constantly aiming to keep patients away from addiction and drug tolerance, while aiming to encourage other modalities such as interventional pain management techniques," says Dr. Davis.

Pain management physicians are constantly refining old treatments to improve care and finding new medications to move away from narcotics. "We are seeing a trend toward minimally invasive and percutaneous techniques. This is the trend the nearly every field is becoming more and more defined by," says Dr. Lipton.

Biologics, such as platelet rich plasma injections, are becoming recognized as effective options to traditional steroid therapies. In the wake of biologics promise, a new specialty is forming.

"Interventional orthopedics is happening all around us like any grassroots phenomenon," says Dr. Centeno. " As a result, we're on the verge of a revolution in orthopedic care that will combine biologic therapies with new tools and devices that will allow most ACL tears, rotator cuff tears, meniscus tears, disc bulges and herniations, non-healing fractures, and arthritis to be healed by walk in-walk out injection procedures performed under exacting imaging guidance."

More Articles on Pain Management:
Dr. Brian Jones Joins Providence Pain Management Center
48 Statistics on ASC Case Volume Mix Across the US
New Tampa Surgery Center Brings in New Back Pain Treatment

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