At the 2018 American Academy of Pain Medicine Annual Meeting, a panel discussed lessons learned from past use of multidisciplinary pain management programs and how to overcome those barriers in the future. The panel included:
- Kimberly George – Sedgwick (moderator)
- Dianne Flynn, MD, MPH – Madigan Army Medical Centers
- Michael Harris, PhD – Pacific Rehabilitation Centers
- Marcos Iglesias, MD – Broadspire
- Heather Kroll, MD – Rehabilitation Institute of Washington
- Jeffrey Livovich, MD – Aetna Insurance
- Judith Scheman, PhD – Cleveland Clinic
The panel discussed a wide variety of topics. The highlights included:
- Many programs dropped their CARF accreditation but not their program because the regulations around accreditation changed and became very challenging and labor intensive. Thus, the number of accredited programs is not necessarily an accurate reflection on the number of programs out there.
- One big challenge is how little primary physicians and payers know about interdisciplinary pain management programs. They tend to take a piecemeal approach rather than looking at the bigger picture.
- Pain is a very new specialty and because of that it’s harder to fully understand what the guidelines for accreditation should be and what the standards of care are.
- Interdisciplinary pain programs are usually treated as the last resort, and thus they tend to only see the worst patients who have not responded to other treatments over several years. They would be more successful if utilized earlier.
- Payment models for these services needs to change. If the insurance carrier reimburses it on an unbundled basis then the co-payments for the patients become dry high.
- Workers’ compensation payers stopped using interdisciplinary programs because they were not seeing an increase in function. The focus needs to be more than just pain relief, but on increasing the function of the patient.
- Pain management is a huge focus for the Department of Defense and the Veterans Administration and they have been using interdisciplinary pain programs successfully for many years. Because of the single payer model, they do not have the challenges with payment that are in private health insurance models. There is also a single medical record for military personnel so they do not have to chase down the records. They are also better able to get patient compliance with treatment as when it is prescribed, their commanding officers make participating in the program part of their assignment.
- The CARF accreditation standards are developed by the providers of the services. They are considered best practices in rehabilitative medicine.
- Education is a huge challenge. Education for physicians, patients, and payers.