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http://www.sciencedirect.com/science/article/pii/S1934148215009673
Current Concepts in Physiatric Pain Management
Controlling the Midfield: Treating Patients With Chronic Pain Using Alternative Payment Models
Received 5 May 2015, Accepted 15 August 2015, Available online 12 November 2015
doi:10.1016/j.pmrj.2015.08.006
Abstract
The entire American health care system is turning upside down, except for the parts that aren't— yet. For physiatrists who manage pain problems, the future is complex. The usual challenge of treating these devastating and costly problems that cannot be measured physiologically is compounded by the requirement to do so in a health care system that doesn't know what it wants to be yet. Payment, regulation, and the very structure of practice are changing at a pace that is halting and unpredictable. Nonetheless, knowledge about some structures is necessary, and some themes almost certainly emerge. I propose that the role of the pain physiatrist is best understood through a soccer analogy. Whereas the casual spectator of the past might note the goals scored by surgical colleagues and shots missed by primary care partners, sophisticated health care systems of the future will learn that the pain game is won by creating a strong physiatry midfield. Physiatrists can reach to the backfield to help primary care with tough cases, send accurate referrals to surgeons, and reorganize the team when chronic pain complicates the situation. Current and emerging payment structures include insurance from government, employers, or individuals. Although the rules may change, certain trends appear to occur: Individuals will be making more choices, deductibles will increase, narrow groups of practitioners will work together, pricing will become important, and the burden on primary care colleagues will increase. Implications of each of these trends on pain medicine and specific strategy examples are addressed. A general concept emerges that, although procedure- and activity-based practice is still important, pain physiatrists can best prepare for the future by leading programs that create value for their health care system.
Recently the best-performing accountable care organization in the United States suffered financially because it succeeded too quickly in moving away from the fee-for-service model [1]. The practice of pain medicine is also moving toward but not quite approaching value-based care. This article looks at the way forward, focusing on building resiliency that will serve pain physiatrists and their patients best in the current world and in the future.
A major framework of this discussion will be reflected in the soccer adage, “Control the midfield” (Figure 1). The reality is that physiatrists are midfield players. We don't score big financially or clinically as often as our offense-minded surgical colleagues do, nor do we often take on the role of the primary care “defense players” who block all types of bad things from happening but often cannot advance the patient to full success. Midfield players must have a holistic perspective on the field, certain technical skills unique to the midfield, and the judgment required to redirect the flow of the game. By taking a critical look at the flow of patients back and forth from primary care to surgical care, the PM&R pain physician can find important unmet needs. Vision, skill, and flexibility create resilience, or the ability to respond optimally to any challenge. This position of resilience is the reason why PM&R might lead pain management in the future
Current Concepts in Physiatric Pain Management
Controlling the Midfield: Treating Patients With Chronic Pain Using Alternative Payment Models
- Andrew J. Haig, MDa, b, c, ,
- a Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower, Ann Arbor, MI 48103∗
- b E-Health Center, University of Michigan Health System, Ann Arbor, MI
- c Haig et al., Consulting, Ann Arbor, MI
Received 5 May 2015, Accepted 15 August 2015, Available online 12 November 2015
doi:10.1016/j.pmrj.2015.08.006
Abstract
The entire American health care system is turning upside down, except for the parts that aren't— yet. For physiatrists who manage pain problems, the future is complex. The usual challenge of treating these devastating and costly problems that cannot be measured physiologically is compounded by the requirement to do so in a health care system that doesn't know what it wants to be yet. Payment, regulation, and the very structure of practice are changing at a pace that is halting and unpredictable. Nonetheless, knowledge about some structures is necessary, and some themes almost certainly emerge. I propose that the role of the pain physiatrist is best understood through a soccer analogy. Whereas the casual spectator of the past might note the goals scored by surgical colleagues and shots missed by primary care partners, sophisticated health care systems of the future will learn that the pain game is won by creating a strong physiatry midfield. Physiatrists can reach to the backfield to help primary care with tough cases, send accurate referrals to surgeons, and reorganize the team when chronic pain complicates the situation. Current and emerging payment structures include insurance from government, employers, or individuals. Although the rules may change, certain trends appear to occur: Individuals will be making more choices, deductibles will increase, narrow groups of practitioners will work together, pricing will become important, and the burden on primary care colleagues will increase. Implications of each of these trends on pain medicine and specific strategy examples are addressed. A general concept emerges that, although procedure- and activity-based practice is still important, pain physiatrists can best prepare for the future by leading programs that create value for their health care system.
Recently the best-performing accountable care organization in the United States suffered financially because it succeeded too quickly in moving away from the fee-for-service model [1]. The practice of pain medicine is also moving toward but not quite approaching value-based care. This article looks at the way forward, focusing on building resiliency that will serve pain physiatrists and their patients best in the current world and in the future.
A major framework of this discussion will be reflected in the soccer adage, “Control the midfield” (Figure 1). The reality is that physiatrists are midfield players. We don't score big financially or clinically as often as our offense-minded surgical colleagues do, nor do we often take on the role of the primary care “defense players” who block all types of bad things from happening but often cannot advance the patient to full success. Midfield players must have a holistic perspective on the field, certain technical skills unique to the midfield, and the judgment required to redirect the flow of the game. By taking a critical look at the flow of patients back and forth from primary care to surgical care, the PM&R pain physician can find important unmet needs. Vision, skill, and flexibility create resilience, or the ability to respond optimally to any challenge. This position of resilience is the reason why PM&R might lead pain management in the future
