Planning for Pain Patients

Pain patients do not all present the same.  While pain is the primary complaint in approximately 80% of patients who visit a doctor, there is vast diversity in why those patients are experiencing pain.  Practically speaking, it’s important to understand which of these kinds of patients will be most common and which will consume more resources.  

Identifying cost centers

High utilizers – patients that use a lot of medical services - account for disproportionate costs in your practice - as much as 21% of expenditures spent treating the top 1% of patients.1 Chronic pain patients account for a large proportion of high utilization patients.  As we’ve discussed previously, the demand for pain treatment is projected to increase and your practice will experience it in one way or another.  Without thoughtful planning, chronic pain patients can place strain on your practice.  Medical practice management leaders should take steps to develop operational protocols for managing this kind of patient.   

Planning for chronic pain patients

A recent study by Duke University found that by funneling high utilization pain patients into a specific program designed to meet their needs, costs of treatment dropped 45%2  In this example, the hospital system developed protocols for identifying these patients and managing them through an outpatient program.  Within a practice that is already in an outpatient setting, practice leaders need to think about corollary strategies that make sense from the perspective of their own practice environment.  

1.    Location – Is telemedicine an option?  How are these patients handled by front office staff?  Does it make sense to prepare a room more suited to their conditions?  It may make sense to bring this kind of patient into a room immediately upon arrival to avoid upsetting other patients in your waiting room, due to their distress.  Doing things to manage the environment, such as keeping lights low, may help to keep the patient comfortable until your staff can see them.]

2.    Offer treatment options – chronic pain patients are not good candidates for pharmacological intervention, at least long-term.  Your clinicians should be trained on which interventions have the best potential to treat the different kinds of chronic pain patients you may see.

3.    Know the cost of treatment - It’s practical to remember that chronic pain falls into the disease management camp, so it’s useful to know the financial implications of the treatments you recommend.  After all, your patient is going to have to live with them for a long time.  If a surgically implanted medical device costs tens of thousands of dollars, your patient may be appreciative if you try something else first.   
4.    Compliance and follow-up: Clear communication is critical to both their satisfaction and consumption of your resources.  Use of devices should be accompanied by clear instructions, ideally printed out for their reference later.  Instructions and scheduling of follow-up visits are also key to successful management of a successful pain management practice.

Ultimately, you’re going to deal with patients that present with complaints of pain.  Better to be prepared.

1.    H. Joanna Jiang, Ph.D., Audrey J. Weiss, Ph.D., Marguerite L. Barrett, M.S., and Minya Sheng, M.S. Characteristics of Hospital Stays for Super-Utilizers by Payer, 2012. Agency for Healthcare Research and Quality H-CUP Nov 2014  
2.    Steven Prakken, MD, steven.prakken@duke.edu1; Thomas Buchheit, MD1; Solomon Aronson, MD MBA1; Padma Gulur, MD1; Julie Westover, BS1, Cost Savings Associated with Intensive Outpatient Pain Management of Duke Health System High Utilizers, Duke University 2017

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