The health care industry in general and care of chronic pain in particular are described as recessionproof. However, a perfect storm with a confluence of many factors and events —none of which
alone is particularly devastating — is brewing and may create a catastrophic force, even in a small
specialty such as interventional pain management. Multiple challenges related to interventional
pain management in the current decade will include individual and group physicians, office
practices, ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPD).
Rising health care costs are discussed on a daily basis in the United States. The critics have claimed that
health outcomes are the same as or worse than those in other countries, but others have presented
the evidence that the United States has the best health care system. All agree it is essential to reduce
costs. Numerous factors contribute to increasing health care costs. They include administrative costs,
waste, abuse, and fraud. It has been claimed the U.S. health care system wastes up to $800 billion
a year. Of this, fraud accounts for approximately $200 billion a year, involving fraudulent Medicare
claims, kickbacks for referrals for unnecessary services, and other scams. Administrative inefficiency
and redundant paperwork accounts for 18% of health care waste, whereas medical mistakes
account for $50 billion to $100 billion in unnecessary spending each year, or 11% of the total.
Further, American physicians spend nearly 8 hours per week on paperwork and employ 1.66 clerical
workers per doctor, more than any other country. It has been illustrated that it takes $60,000 to
$88,000 per physician per year, equal to one-third of a family practitioner’s gross income, and $23
to $31 billion each year in total to interact with health insurance plans. The studies have illustrated
that an average physician spends $68,274 per year communicating with insurance companies and
performing other non-medical functions. For an office-based practice, the overall total in the United
States is $38.7 billion, or $85,276 per physician.
In the United States there are 2 types of physician payment systems: private health care and Medicare.
Medicare has moved away from the Medicare Economic Index (MEI) and introduced the sustainable
growth rate (SGR) formula which has led to cuts in physician payments on a yearly basis.
In 2010 and beyond into the new decade, interventional pain management will see significant
changes in how we practice medicine. There is focus on avoiding waste, abuse, fraud, and also
cutting costs. Evidence-based medicine (EBM) and comparative effectiveness research (CER) have
been introduced as cost-cutting and rationing measures, however, with biased approaches.
This manuscript will analyze various issues related to interventional pain management with a critical
analysis of physician payments, office facility payments, and ASC payments by various payor groups.
Key words: Interventional pain management, interventional techniques, physician payment
reform, ambulatory surgery center payment, hospital outpatient department payments, sustained
growth rate formula, targeted growth rate formula, fraud, abuse, administrative expenses,
evidence-based medicine, health care costs
Examining Knowledge of Pain Management
