Upcoming Seminar

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PainDr

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Anyone heard anything about the upcoming seminar "Building and Streamlining Centers of Excellence for Pain Management"? It's pretty expensive...approx $2500...but looks REALLY good. The web site is: www.worldrg.com. Go to the list of conferences, it's in April.

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Oh come on...80 odd hits and no one has an opinion? :confused:
 
I think it depends on what you hope to achieve by attending such a conference and how current the information is. The organization apparently is a commercial entity that is promoting and sponsoring these mini-meetings. While some of the commercial-for-profit meetings may be excellent, they do not fall into those recommended in the algosresearch conference list due to their commercial nature and lack of university or pain organization sponsorship.
The conference appears to be aimed at administrators more than physicians, especially those on the verge of establishing pain units. It would be interesting to know if will be discussed the fact that ASC overhead, even if the ASC is solely owned by a pain physician, will chew up any excess profits vs simply doing the procedures in your own office for Medicare, Anthem, Wellpoint, and possibly some Aetna plans. Pain medicine is rapidly undergoing a complete paradigm shift from ASC to office based practice due to changing insurance reimbursement patterns, and more insurance carriers are expected to parrot the reimbursement schemes of the above insurers. Performing procedures in hospitals for the above insurance groups is cutting your physician reimbursement by 2/3. The old financial model of pain medicine care used the hospital or ASC as a base of operations for procedures, but this is now a questionable concept.
Call the conference telephone number to achieve more specifics about the conference.
 
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Attending the conference was originally the idea of my new employer...a small community hospital. I'll be attending the meeting with the chief administrator. Since I will be a new grad and they have never had a pain physician, we both thought it would be a good idea. We're still trying to decide the best practice arrangement. They are open to either an office based practice or building an ASC vs using their OR suites. My only concern about an office based practice is the issue of sedation. I'm strongly opposed to doing procedures without good sedation and my personal preference is propofol. Can you bill for anesthesia services if the procedure is done in the office?
 
Yes, you can bill for it, but the reimbursement is variable. We have used propofol in our office for years and have found that sedation is inexpensive with the drug used as small boluses (50mg titrated to effect given every minute). It is very forgiving and wears off quickly as opposed to MAC doses of versed/fentanyl, doesn't leave the patient feeling loopy all day, usually requires minimal airway management with an occasional chin lift, and is associated with rapid discharge. Of course appropriate stretchers and resuscitation equipment is necessary. Of interest is the observation that there is actually a significant reduction in upper airway obstruction using propofol as a sole agent with the patient prone vs in the supine position. I would strongly suggest not mixing anything with the propofol anesthesia such as IV opiates or benzodiazepines since the airway problems are amplified many fold even with small doses.
 
Regarding anesthesia providers in the office, are CRNAs a viable option? I'm not really comfortable with the idea of using an RN.
 
Possibly, but it depends on the insurance payors involved. You would have to check to see which codes are excluded from anesthesia coverage (some pain codes are not eligible for anesthesiology/CRNA services for certain insurers).
 
Are you using RNs or CRNAs? I'm primarily concerned because I'm a neurologist...not an anesthesiologist...and I don't want to compromise patient safety. My office will actually be in the hospital so I will have anesthesiologists/CRNAs close by. I just want to do the right thing. What would you recommend.
 
If you are an employee of the hospital with a minimum guarantee, I would suggest doing your cases in the OR or hospital owned ASC. If the hospital is planning on renting you space, then you may convince the hospital to place a C-arm in your office with tech for your Medicare/Anthem procedures (3 times the physician reimbursement to perform pain procedures in an office vs hospital or ASC). In that case, the hospital may be able to provide anesthesia CRNA/MD coverage in the office. Non-medicare/non-Anthem patients have no differential site of service fee reduction, so it matters little where you perform these procedures with the caveat that hospital ORs tend to run at a glacial pace, and if you have tons of patients it may be prudent to consider ASC utilization for these patients.
 
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