Using Clinical Outcomes to Drive Pain Management Profits

At the 11th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference in Chicago on June 14, Fred Davis, MD, president and co-founder of ProCare Systems,, presented his view on the importance of measuring clinical outcomes in pain management-driven ASCs.

"As I see it, the two biggest challenges we face as independent specialists is securing our volume and securing payment for what we do," Dr. Davis said. Securing referral relationships with private practice physicians and pushing into organized systems of care such as accountable care organizations and medical homes helps ensure those two factors are covered, he said.

Quality measures of both clinical effectiveness and patient experience are the most fundamental drivers of volume and should be the cornerstone of a center's strategy, as well as the first place to look to for improvement opportunities, he said.

Referral development is also critical to emphasize top-line growth. Forming relationships with medical homes and ACOs is helpful, but Dr. Davis said there are many creative ways to tap into these networks through standard models. "There are ways of working with these groups without having to join the big goliath," he said.

"Most patients we treat in pain have a chronic disease, and we need long-term management of their treatment," something lacking in many orthopedic practices, he said. "In addition to providing best quality care, our focus needs to be on adding value to the orthopedic and spine centers that we are involved with. Pain is a complicated thing if looked at it as a chronic disease, especially for a large multispecialty system that must juggle other disciplines." That presents an opportunity for pain management specialists who can fill these value gaps.

"The bottom line is pain is on everyone's radar. In early 1980s when I started our practice, no one knew what pain management was, not even my co-founder. Now 16 million U.S. adults suffer from chronic pain — more than heart disease, cancer, diabetes combined.

Health information systems are useful in assisting pain management physicians in linking and tracking patients' biological and psychosocial risk factors for opioid treatments, measuring their progress frequently on those metrics, he said. His organization completed a successful pilot of such a system that quantifies pain patients' symptoms, risk factors and overall health to inform treatment across their care continuum, and helps give pain management-driven providers leverage with other specialty partners and payers.

The rationale for disease risk assessments, Dr. Davis explained, is that managed care plans reimburse based on the complexity factor of a patient. His organization's scoring system puts patients into a one-to-four rating system that summarizes anatomical pathology and psychosocial health through a multidimensional health and pain assessment tool that combines traditional pain scales with evaluations of functional impairment, opioid risk, functional and social impairments.

The system generates reports formatted to look very similar to lab reports complete with color-coded memory joggers that show patients' pain-related results. These show details of a patient's current and historic pain and whether symptoms are improving or worsening with various treatments.

Another benefit of the electronic system for pain specialists is the aggregate data it collects to inform population health-focused strategy, Dr. Davis said, which are gaining in popularity through risk-sharing groups and referral sources. "You can't manage what you can't measure. We need these kinds of tools," he said, adding "We need more than process measures. We need outcomes measures," in order to really drive the pain management specialty field's quality and value forward.

To collect the data, a one-time 15- to 20-minute survey is given to pain patients on their first visit, usually in the waiting room via a staff member with an iPad, followed by shorter 12-minute updates after that.

More Articles on Pain Management:

Surgery Center Transactions: Outlook for Today's Market
Advanced Pain Management Opens New Location
3 Myths of Out-of-Network Reimbursement

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