RUNNING YOUR PAIN MANAGEMENT AT MAXIMUM EFFICIENCY

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Percival Neal
5 years ago
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1 Becker's ASC 23rd Annual Meeting The Business and Operations of ASCs October 27-29, 2016 Swissotel, Chicago, IL RUNNING YOUR PAIN MANAGEMENT AT MAXIMUM EFFICIENCY Copyright 2016 Mowles Medical Practice Management, LLC. All rights reserved 1

2 This Business of Pain Patient s need to resolve their pain disorder think about the patient's experience in your ASC from scheduling to discharge. You have 1 time to get this right! 2

3 Professional Beyond Appearance You must offer prompt, courteous, compassionate and professional services. AND.. You should be offering the most advanced, market driven, proven techniques at a fair fee. 3

4 Cross Train Staff Train Radiology and/or surgical technicians to: Process sterile supplies Take vital signs Place patients in pre op rooms for RN Assist in PACU to discharge patients. 4

5 Booking An ASC that is accustomed to doing only 2 cases per hour may have trouble keeping up with a specialty such as Pain Management. Don t give up, make adjustments. Above all else, STAY ON TIME. If you are running behind, keep your patients and their responsible party (driver) advised. 5

6 Operational And Business Functions Your Staff Is Key To Keeping Pain Cases If you train your staff to apply the same criteria as you would yourself (by example and full explanations) then they will be exercising your control on your behalf. Communications with staff and how they communicate with your patients, insurance companies and referral sources. 6

7 Efficiency Musts Quickly responding to telephone calls Limiting waiting time Effective and efficient scheduling - Modify hours of availability based on case volume Responding to satisfaction surveys and comments left in suggestion boxes, complaints and complications Paying careful attention to new patients and referrals Always staying focused on your customers 7

8 The 3 A s Availability work out shared call systems, but be careful about who you get in bed with. Affability remember you have many customers: patients, referral sources, hospital personnel, 3rd party payors. Ability stay up to date. SOME SAY, AVAILABILITY, AVAILABILITY, AVAILABILITY 8 8

9 Unique Identity OBJECTIVE Clearly define in specific terms IMAGE State the types of pain you are going to treat and how What specific specialty? With what specific training? 9

10 Unique Identity, Continued Do your pain providers refer patients for ancillary/alternative services? Do your providers have an expertise in certain procedures? Speak a language native of that community? 10

11 Unique Identity, Continued Training, Continuing Education and Board Certification Strengths in clinical operations Patient loyalty - Satisfied patients will spread the word Referring physician loyalty Effective use of staff time and strengths 11

Referrals Serve as a resource to current and potential referring physicians for pain management advice and/or clinical assistance Discuss new techniques, recent successes and

12 Referrals Serve as a resource to current and potential referring physicians for pain management advice and/or clinical assistance Discuss new techniques, recent successes and always serve as team players Keep referring physicians informed and part of the treatment plan Thank them for the opportunity of being involved in their patients overall care. 12

13 Bring On New Physicians Carefully seek out the best providers and then ensure these physicians are a good fit for your ASC Offer ownership/partnership There simply is not the same buy in on time and resources without Obtain mandatory peer references, use web based background checks as well as verification sources 13

of poor care Not returning calls or answering pages,

14 New Providers, Continued Do not be shy about looking over [the recruited] physicians work Watching for warning signs of poor care Not returning calls or answering pages, frequent complaints and mishaps that could be avoided with precautions. 14

15 Privileging If your providers are not Fellowship trained/board Certified, use a specific privileging form to ascertain their training and experience with not just pain management core privileges, but also with the more invasive, provocative procedures. Set up a standard for what their education and experience and ongoing training must be. 15

16 Community Awareness The best marketing is educating. You get more 'bang for your buck speaking to doctors than patients, but some speaking to patient groups can generate lots of good will. 16

17 Awareness Suggestions Give presentations to local groups Volunteer to answer questions on radio or TV talk show Build external creditability through promotional activities and educational public relations 17

18 Continually Measure Efficiency Telephone calls Waiting time Responses to satisfaction surveys Comments left in a suggestion box Complaints Complications New patients and referrals Stay focused on WHO are the customers 18 18

19 Supplies $ PLEASE negotiate on your epidural and nerve block trays GPO s or purchasing organizations can help save significant $ Or, $ Consider picking items off the shelf vs. using packs, the amount of time it takes to pull the 10 things you need for a pain case takes seconds. 19

20 Treatment Options and Outcomes Payor Relations Communicate algorithms', protocols, and then costs and reimbursement QAPI studies Benchmarking mandatory - Outcomes, Procedures, Patient/Physician/Staff Satisfaction and Practice Management Utilize peer review through national clinical outcomes studies. Use demand for types of services in your favor 20

21 Payor Relations, Continued Review all contracts closely before agreeing to any terms. PLEASE re-visit upon termination date! Case Rates Multiple Procedures Carve outs Always inquire as to their reimbursement re changes in CPT codes and descriptions 21

22 Payor Relations, Continued Ensure all payor contracts are loaded into your billing and collection software Drop the payor if they have unilateral changes in product participation Discuss all costs with the payor during contract negotiations Train ALL staff in patient collections 22

23 Payor Relations, Continued CLEAR financial policies on your charges for cancellations or no-shows (PREVENTION is #1) Collect all co pays and co insurance at time of service, offer payment plans and Care Credit. Verify Eligibility Pre Certification/Pre Authorization Valid Referral? Medicare non grouped (off-list) procedures?...discography, Consider self pay for PRP, stem cell, lidocaine infusion, only ASC covered procedures only! 23

24 File Clean Claims Know the nuances of pain billing Bundling issues? Covered diagnosis? Medical Necessity? Know what modifiers apply to the ASC Be aware how each payer wants bilateral and multiple procedures reported. Are there procedure limits? 24

25 Procedure Type Considerations Staffing and equipment or supplies you will need Realistic reimbursement expectations Revenue has to be viewed in context of risk, hours input, etc. 25

26 Procedure Type Considerations Run a utilization report Determine highest paying services Determine lowest paying services Capitalize on this data by: Eliminating services that are not within the facility profile Reducing volume of some procedures that are not reimbursed at a level that covers your costs Increasing volume without increasing staff Promoting procedures with highest payment and best treatment outcomes 26

27 Exodus of Pain Management Procedures to Offices ASC s must understand the site of service differential decline. Be well versed on the service overhead. Know your own State regulations affecting office surgery. 27

28 CPT Reimbursement by Venue MCR NAA Short Descript ion Pro Fee Non-Facilit y Pro Fee Facilit y ASC Facilit y Fee 27096/ G0260 Inject sacroiliac joint $ $87 $ Inject spine l/s (cd) $ $93.15 $ Inj foramen epidural l/s $ $ $ Facet Joint l/s 1level $ $94.94 $ RF l/s 1level $ $ $

29 Cost Reality Item Description Cost/Case Epidural Tray $8 - $15 Contrast Dye $15 - $25 Equipment $60 - $100 Staffing $30 - $50 TOTAL $113 - $190 Payment for Space? Utilities? Physician Payment? What components above are covered separately? 29

30 Pain Management Procedures in Offices 28 State Health Departments have regulations and jurisdiction. Typically driven by: Levels of anesthesia used and/or Complexity of procedure performed $Licensed $Registered $Accredited 30 Source-AAAHC

31 Regulated States for Office Surgery Alabama Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Illinois Indiana Kansas Kentucky Louisiana Maryland Massachusetts Mississippi Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Virginia Washington Wyoming 31

32 Additional Office Regulations Pending: FGI Guidelines Committee have suggested physical environment standards for Accredited Office Surgery practices Radiology Regulations vary from State to State and/or Individual Payor Certified Radiology Technician vs. Other? Mandatory training program (Example: GA) State Certification program (Example: CA) Competency statement (Example: MA) 32

33 Pain Psychology in Practices Extremely important if this is not part of your practice, then have a close working relationship with psychology colleagues Develop pain psychology protocols that allow you to refer your patient for pain treatment rather than for the treatment of psychopathology

34 Multidisciplinary Pain Care Look big and comprehensive while keeping overhead down (CRUCIAL) May involve outside providers (PT, OT, Rehab, Aqua Therapy, Acupuncture, Massage, Chiropractic, Yoga) Must appear as a package Many different possible arrangements Set aside weekly time to meet with the team. 34

35 Pain Practice Expansion Consider expanding your practice into cancer pain and palliative medicine Recognize that this may significantly increase demands for availability. Very rewarding work Know your community resources: Detox programs Inpatient pain programs don t be afraid to refer the very difficult patient A variety of excellent specialists and primary care doctors 35 35

36 Relevant Records Obtain relevant records from referral sources and PMDs Can become crucial if you will prescribe controlled drugs Can help determine the appropriateness for procedures 36

Medication Protocols Follow up with medication patients on regular intervals Physician extenders are a GREAT help with this Track all prescriptions: flowsheets or duplicates of scripts.

37 Medication Protocols Follow up with medication patients on regular intervals Physician extenders are a GREAT help with this Track all prescriptions: flowsheets or duplicates of scripts. Check labs periodically on patients that are on continuous medications. Regarding controlled medications run a tight ship. Refill only when due. Have protocols in place for consent and education regarding pain medications and pain procedures. DETAILED risk/benefit 37 37

38 Prescribing Controlled Substances Must provide a Code of Conduct as a Providers Guide to Pain Management Prescribing Compliance Include Universal Controlled Substance Policies for Providers Medical Staff Rules And Regulation for prescribing Include National and Carrier Specific Proper Coding and Documentation to Establish Medical Necessity for Procedures 38

39 Final Thoughts Expand the hours Expand or even narrow the scope of services Enhance the efficiency Enhance the profitability by Venue Choice Case Cost Management Or: Do not change a thing..depends on your own tolerance for risk 39

40 Helpful Links and Resources o CMS Transmittals Guidance/Guidance/Transmittals/2016-Transmittals.html o American Society of Interventional Pain Physicianshttp:// o Index to State Departments of Health o Medicare State Operations Manual (Conditions for Coverage) (*See appendix L and appendix I) 40

41 Edgewater, Maryland Phone (410) Fax (443)

2015 State Hospice Report 2013 Medicare Information 1/1/15

2015 State Hospice Report 2013 Medicare Information 1/1/15 www.hospiceanalytics.com 2 2013 Demographics & Hospice Utilization National Population 316,022,508 Total Deaths 2,529,792 Medicare Beneficiaries