10/18/17. The Nuts and Bolts of an Integrative Pain Management Practice

Transcription

1 The Nuts and Bolts of an Integrative Pain Management Practice Integrative Modalities and the Evidence that Supports them Robert Bonakdar, MD, FACN Selecting the Appropriate Arrow in Your Quiver Matching the Modality to the Condition for Optimal Benefit Jay Sandweiss, DO Tools in the Toolbox: Integrative Medicine Modalities Kim Brower, MHA Good Is the Enemy of Great: Selecting the Right Therapists for the Best Outcomes Chuck Renner, OTR, CHT Getting a Seat at the Financial Table: Outcome Driven/Cost Savings Paradigms and the Role of the Physician as Manager Lance Luria, MD, FACP, ABOIM Overview IPM Philosophy "The good physician treats the disease; the great physician treats the patient who has the disease." -Sir William Osler Overview Integrative Pain Management Team Mind and Body are parallel attributes of the same substance Focuses on the whole person Is informed by evidence Makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing Baruch Spinoza, 17 th century philosopher 1

2 According to the Center for Disease Control s Healthy People 2020: Poorer functional status, or more generally poorer health, should not be equated with poorer quality of life. Quality of life encompasses more than activities of daily living, health status, disease categories, or functional ability because it directs attention to the more complete social, psychological and spiritual being. In other words, quality of life does not reflect people s physical, mental, or emotional functioning or disease status, but instead expresses their ability to participate in the world around them, which is defined here as an ability to participate in activities that are common to most people in a society (7). 4 Healthy People 2020 Foundation Health Measure Report. Health-Related Quality of Life and Well-Being. Healthy People. Revised: November /18/17 The Nuts and Bolts of an Integrative Pain Management Practice Integrative Modalities and the Evidence that Supports them Robert Bonakdar, MD, FACN Selecting the Appropriate Arrow in Your Quiver Matching the Modality to the Condition for Optimal Benefit Jay Sandweiss, DO Tools in the Toolbox: The Kinds and Varieties of Integrative Modalities Utilized Kim Brower, MHA Good Is the Enemy of Great: Selecting the Right Therapists for the Best Outcomes Chuck Renner, OTR, CHT Getting a Seat at the Financial Table: Outcome Driven/Cost Savings Paradigms and the Role of the Physician as Manager Lance Luria, MD, FACP, ABOIM Let the games begin... 2

3 Getting a Seat at the Financial Table & the Role of Physician-as-Manager Lance Luria, MD, FACP, ABOIM Chief Medical Officer, Mercy Care Management Speaker Disclosure: For Presentation at AIPM Accredited Conference I have no financial relationships or affiliations to disclose. Overview 60% Percent of Net Outside of Mercy 40% 20% 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Coventry Medicare HMO Humana All Springfield ACO Lance Luria, MD, FACP, ABOIM Baruch Spinoza, 17 th century philosopher 3

4 PAYORS, INSURORS, GOVERNMENT Cash Indemnity HMO PPO EPO ACO FOLLOW THE MONEY! A NEW PARADIGM 4

5 How To Make Money With Risk Taking? Capitation vs Fee-for-Services? Bundling and Case Rates? 5

6 Full Risk Arrangements? Risk Corridors? Integrative Pain Management!! 6

7 FROM FEE-FOR-SERVICE TO RISK CORRIDORS 10% Client Risk Self-insured Medical Costs Historical Medical Cost Trend (e.g. 10%) 5% Risk Corridor Guarantee Mercy pays the 5% 5% Increase in Med. Spend Shared Savings 50/50 (after Administrative Fees) Cost Savings = Revenue Generating Case Rate or Bundled PMPM Cost+ (10%-20%) Cost+ with added $ incentive if outcome successful and sustainable over time (i.e. 6 months, 1 year) Ex. Cost plus 10% with additional 30% if long term successful outcome Alignment of Incentives is key Everyone should have skin in the game! Lance Luria, MD, FACP The How to of Building a Successful Integrative Pain Management Program nce Luria, MD, FACP 7

8 10/18/17 Integrative Pain Management (IPM) Modalities Outcome driven, high touch/low tech, cost-saving strategies to healthcare Integrative approaches utilize complimentary arrows in their quiver to target chronic conditions Functional medicine addresses underlying root causes of chronic conditions Methods How Do We Make IPM Work? IPM-trained physician specialist providing oversight Go after the, not the Team Approach with team staffing on complex patients High touch/low tech strategies yield highly cost-effective outcomes 8

9 Methods Integrative Pain Management Services Acupuncture Art Therapy Auricular Therapy Breath work Chiropractic Guided Imagery Healing Touch Hypnotherapy Integrative Pain Management Rehab Specialist Psychologist Manual Therapy Medical Nutrition Therapy Mindfulness / Meditation Music Therapy Personal Trainer Purpose/Meaningfulness Tx Reflexology Tai Chi Therapeutic Yoga Touch for Health COST-EFFECTIVE WHO BENEFITS FROM IPM? Those who are capitated by an HMO plan Those who are at full financial risk (i.e. self-funded) Alternative for no-pay and Medicaid patients IPM modalities may decrease LOS or medication usage Alternative for not-for-profit hospitals required to provide indigent care Worker s Compensation cases Government mandates requires cost-effective methods ance Luria, MD, FACP Proctocolectomy/Colectomy Radio Spinal Out Frequency Intrathecal Cervical Artificial Lumbar of Cord Net Stimulator Fusion Referral Disc Ablations Pump to Procedure trying to to to avoid Procedure trying to avoid Total 2 Total Patients Patients Success Success Failure 1 20 Failure 6 0 of 50% % of of of Success Success 75% 67% 90% 71% 78% 100% for $57,365 Hospital & &Clinic Billed Charges for for $69,036 $26,401 $109,112 $22,922 Hospital $36,072 Clinic Billed Charges for $71,070 Avoided Procedure Avoided Procedure Allowable of of $37,287 $44,874 $14,899 $70,923 Allowable Charges Charges = 65% 65% of of Billed Billed $17,161 $46,195 $23,447 Charges Charges IM $8,267 Average IM IM Cost $10,535 $11,936 $10,795 $11,582 Average IM Cost $11,264 $12,564 For All Cases $20,753 Savings Savings Per Per Case Case $34,338 $34,932 $5,225 $59,341 $4,104 $10,883 Savings per Successful Case $29,020 9

10 Cost Savings Spinal Cord Stimulator Savings Per Case Average Integrative Medicine Costs $11,264 Total Savings/case Allowed Charges = 65% of billed charges $34,932 $46,195 Building Bridges Connect with Leadership CEO CFO COO Hospital/System operational VP Senior/Administrative Physician leadership Influential colleagues that can support/endorse what you do (You should have someone else help toot your horn) A New Cost-Saving Strategy The IPM Team Concept Revenue generating through outcome driven cost-savings High Touch/Low Tech 10

11 Setting Up the Team Avoid top heavy provider costs (high cost providers may hurt in cost-saving strategy). Remember! If you approach this as a typical revenue generator/fee for service model, it may undermine a cost-saving strategy. Utilize lower cost highly talented yet personable providers Massage Therapy vs Physical Therapy Contracted vs Employed Setting up a Comprehensive Program Physician/practitioner leads regular team meetings Program coordinator and data collection/tracking to justify/support existence All team members are subordinate to outcome driven goal The buck stops with the outcome. Anything less than that is failure. Individual therapist successes don t count if the overarching goal isn t realized Don t be lulled into a false sense of success by a therapist with an overoptimistic or revenue generating mindset Integrative approach (mind, body, spirit) is much more than the conventional reporting out of multidisciplinary/ interdisciplinary pain management team meetings IPM is... a Paradigm for Success!! 11

12 10/18/17 S.D. IPM Interventions Manual Therapies Medical Massage Therapies IM Pain Rehab Specialist Mind-Body Therapies Guided Imagery/Mindfulness IM Psychologist Nutrition Personal Trainer Pre Intervention 9 year history of low back pain. Avoiding SCS IPM Interventions S.D. Manual Therapies Medical Massage Therapies IM Pain Rehab Specialist Mind-Body Therapies Guided Imagery/Mindfulness IM Psychologist Nutrition Post Intervention Personal Trainer 9 year history of low back pain. Avoiding SCS IPM Outcomes Subject ranked pain as 0/10 on VAS No longer ambulating with cane Began riding motorcycle with no increase in pain Able to mow lawn with no increase in pain 12

13 And One Year Later.. Office/Department Integrative Pain Management... Cost-Saving Techniques We Can t Afford to Ignore!! 13