ADDRESSING DEPARTMENTAL PAIN MEDICINE ISSUES 19972002

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ADDRESSING DEPARTMENTAL PAIN MEDICINE ISSUES
1997-2002

• Raymond C. Roy, PhD, MD
• Professor Chair of Anesthesiology
• Wake Forest University School of Medicine
• Bowman Gray Campus
• Winston-Salem, NC 27157
• rroy_at_wfubmc.edu

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PAIN MEDICINE - 1997

• CHRONIC
• Outpatient (PCC)
• Inpatient Consults
• ACUTE
• Acute Pain Service (APS)

• Number of FTEs
• Fac Fel Res Empl
• 4 3 1-2 26
• 1 1 1-2 2
• includes clinical research FTEs
• divided between PCC APS

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PAIN MEDICINE ISSUES - 1998

• PCC losing
• Faculty accountability
• Compliance
• Inconsistent acute pain service (APS)
• Uninspired APS
• Disconnect between OR, PACU APS

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PAIN COLLECTIONS (millions)
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PAIN BOTTOM LINE (millions)
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OPPORTUNITIES TO REVERSE PAIN LOSSES

• Renegotiate contracts
• Billing collecting
• documentation, coding
• Management employees
• Faculty behavior
• Patient mix
• EM vs procedure, study vs non-study, good vs
  bad insurance
• Facility fees
• MD- vs hospital-based

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FACULTY BEHAVIOR

• Unacceptable clinic cancellation rate
• Conflict of interest
• WFU salary/time vs consulting fees/time
• Inaccurate accounting for time
• clinical, academic, meeting, vacation
• Documentation
• compliance (Medicare audit risk)

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STEPS TAKEN

• Reduced pain faculty on payroll 7 -gt 2
• Established private practice relationship
• New (excellent) clinic manager
• Reduced PCC employees 27 -gt 8
• Weeding out inappropriate patients
• Improved documentation, coding
• Dept Chair regular Friday am pain clinic
• Negotiating to be hospital-based clinic

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RELATIONSHIP WITH PRIVATE GROUP (Hospital-based)

• Private group head former PCC head
• Non-salaried clinical appointments
• Academic support
• Malpractice - consults, vacation coverage
• Joint conferences
• 2 Fellows per month
• Private group head Co-I NIH Pain Center Grant

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ADVANTAGES OF BEING HOSPITAL-BASED

• Facility fee to cover overhead
• Hospital provides ancillaries
• Better equipment
• More better space

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PAIN MEDICINE - 2001

• Number of FTEs
• Fac Fel Res Empl
• 1 2 1-2 7
• 4 2 0
• 1 0 2 (1)
• 1 0 2 1

• CHRONIC
• Outpatient (PCC)
• Inpatient Consults
• Private Clinic
• ACUTE
• Reg Anes Block
• Acute Pain Service (APS)

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SUMMARY

• PCC losses decreased
• Pain Fellowship
• Much better! (fellows)
• RRC visit in 2000 5 yr approval
• Seamless - regional anesthesia block, OR, PACU,
  and APS
• Outstanding regional anesthesia block
• Sustained relationship with private sector
• Hospital-based clinic negotiations
• Ready to recruit pain MD FTE in 2002