A BUSINESS PLAN FOR A PAIN CLINIC

Millions of people suffer from chronic or intractable pain. Persistent pain varies in etiology and presentation. In some cases, symptoms and signs may be evident within a few weeks to a few months after the occurrence of an injury or the onset of disease. The cause of pain is not always known or apparent. For many patients, initial medical evaluation and treatments effectively relieve pain that might otherwise become chronic. Like many illnesses that at one time were not well understood, pain and its many manifestations may be poorly treated and seriously underestimated. Inappropriately treated pain seriously compromises the patient's quality of life, causing emotional suffering and increasing the risk of lost livelihood and social integration. Severe chronic pain affects both the pediatric and adult population, and often leads to mood disorders, including depression and in rare cases, suicide … Each physician bears the responsibility to evaluate and treat persistent pain as a serious medical condition. Principal treatment physicians must approach each patient with respect and urgency and provide appropriate and timely referrals to a pain medicine specialist when primary medical care has not been effective. Such referrals are appropriate because pain medicine specialists can provide a more advanced level of treatment to patients suffering from chronic or intractable pain … As physicians, we are trained to preserve patients' quality of life and relieve their pain and suffering. We must use all available resources to achieve these goals for our patients. (Adapted from the American Academy of Pain Medicine. Position Statement. February, 1997.) Pain management is an emerging discipline emphasizing an interdisciplinary approach with a goal of functional restoration, and reduction of pain and suffering. In 1976, the United States Social Security Administration officially recognized chronic pain as a significant form of morbidity in the aging American population. This decision extended benefits to cover chronic pain and rehabilitative treatment, and produced an explosion of providers and centers dedicated to its mission. More than 300 centers opened their doors that first year. Since that time, a diverse group of pain treatment centers have emerged in communities throughout the United States. In 1998, the American Pain Society reports there are more than 3000 clinical entities with the focus of treating chronic pain in the United States, up from an estimated 1500 centers reported in 1987. 1 Only a fraction of these entities are truly multidisciplinary in orientation. Pain centers are specialized entities set up to evaluate and treat patients with complex, intractable, and disabling problems. In designing a pain practice, it is important to keep the following in mind. A pain center has three customers: the patient, the referring physician, and the payer. Many patients are referred to these specialized entities as the "court of last resort." Patients with chronic pain are often bitter, having failed under the care of primary medical providers. They are also cynical about spending large amounts of time in doctors' offices. A successful pain center will be designed to put such patients at ease. The facility will be approachable, provide telephone access between patients and care providers around the clock, communicate frequently with other treating physicians, provide comfortable waiting areas, be accessible to transport teams (including ambulances), and generally make patients feel welcome. Referring physicians want to know that their patients are being cared for effectively. Close communication with other treating doctors is also essential. General questions are asked of the pain physician by first-time referring doctors. It is important for the new pain practitioner to be respectful and accurate when responding to these queries. Additionally, payers are interested in cost-effective care. Patients with pain use a great percentage of health care dollars. 2 Payers are concerned about providing quality care in a cost-effective manner. Strategies for demonstrating to the payer outcomes and benefits of pain therapies will need to be rapidly developed. In summary, a successful pain practice will keep all users satisfied (referring physician, patient, and payer).