How will Pain Medicine do during the next recession?

[drusso]

It's been my sense that this specialty is counter-cyclical in nature. If the economy tanks and more people are out of work, filing comp & disability claims, will this be good for the specialty?

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[deleted185747]

I think demand from consumers will increase and payment from insurers will decrease

 

[lobelsteve]

SOS will rule the day and stem sells will disappear.

 

[drusso]

SOS will rule the day and stem sells will disappear.

Column: America's healthcare system is failing because competition is disappearing

The Sutter Health and dialysis monopolies show why America can't get healthcare costs under control.

www.latimes.com

 

[lobelsteve]

Fine, tug of war at next meeting.

 

[drusso]

SOS will rule the day and stem sells will disappear.

Man drives five hours for surgery insurance won't cover

Around the country, middle-class Americans with high-deductible insurance plans are heading to dozens of cash-based surgery centers

www.cbsnews.com

"Around the country, middle-class Americans with high-deductible insurance plans are heading to dozens of cash-based surgery centers like this one."

 

[lobelsteve]

Man drives five hours for surgery insurance won't cover

Around the country, middle-class Americans with high-deductible insurance plans are heading to dozens of cash-based surgery centers

www.cbsnews.com

"Around the country, middle-class Americans with high-deductible insurance plans are heading to dozens of cash-based surgery centers like this one."

Hernia surgery. Not elective ESI/stem cell to the knee.

 

[drusso]

Hernia surgery. Not elective ESI/stem cell to the knee.

What's the difference?

 

[lobelsteve]

What's the difference?

One may not be elective, one always is elective

 

[bronx43]

I’m not a pain doc but what I’ve been seeing is that as the cost of care is shifted to patients, everything that is even somewhat elective is being pushed to the side. People still go get their screening colonoscopies (since usually covered) and see their oncologist, but aches and pains can wait.

 

[drusso]

I’m not a pain doc but what I’ve been seeing is that as the cost of care is shifted to patients, everything that is even somewhat elective is being pushed to the side. People still go get their screening colonoscopies (since usually covered) and see their oncologist, but aches and pains can wait.

The future of IPM is it becoming an elective specialty like plastics or derm. There will be a tier of society that goes to the HOPD facility for their government-approved aliquot of MED +/- MAT and a tier of society that has access to personalized interventional treatment.

 

[bronx43]

The future of IPM is it becoming an elective specialty like plastics or derm. There will be a tier of society that goes to the HOPD facility for their government-approved aliquot of MED +/- MAT and a tier of society that has access to personalized interventional treatment.

Agreed but the former vastly outnumber the latter and everyone is gonna be chasing the latter.

 

[hyperalgesia]

I think our practices will slow down a little during the next recession. People lose their jobs and consequently their employer-sponsored insurance. Cash-based practices will depend on folks who are well enough off.

Everyone suffered a little but many of us survived the last MASSIVE recession and we will survive again.

 

[ateria radicularis magna]

I think our practices will slow down a little during the next recession. People lose their jobs and consequently their employer-sponsored insurance. Cash-based practices will depend on folks who are well enough off.

Everyone suffered a little but many of us survived the last MASSIVE recession and we will survive again.

Just curious, do you know anyone in IPM who has a cash based practice now? If so, how does it work?

 

[bronx43]

I think our practices will slow down a little during the next recession. People lose their jobs and consequently their employer-sponsored insurance. Cash-based practices will depend on folks who are well enough off.

Everyone suffered a little but many of us survived the last MASSIVE recession and we will survive again.

The big difference here is that during the last recession, the people who had jobs had insurances that covered most of the cost of care. I recall seeing multiple specialists with minimal out of pocket.
Nowadays, most people have high deductible plans and are responsible for the entire bill until it is met. They would be far less willing to seek elective care when their financial situation is tenuous/uncertain.

Doctors will ultimately fare better than most others, but we will be harder hit this time around than any time in recent history.

 

[hyperalgesia]

Just curious, do you know anyone in IPM who has a cash based practice now? If so, how does it work?

I don't personally know anyone who is exclusively cash based but I know a few who are heavily weighted to cash. They do procedures that are not covered like SGB for PTSD, prolotherapy, regenerative med, etc. I know one pain doc who started doing cosmetic botox, laser hair removal, etc and does quite well.

Your question is probably more referring to true, evidence based, pain procedures. In that case, I just know of one guy that did ESIs for 1k and accepted no insurance. He was not well known in the community of pain docs.

I think if you have your own fluoro suite and not that much competition you could do cash only interventional. But it would take serious, continued, marketing skills. You are competing against the insurance industry that has already won the pts business.

I know an orthopod that is cash only. Absolutely nothing special about his practice but he's got a radio show on every week and lots of ads...

 

[drusso]

Just curious, do you know anyone in IPM who has a cash based practice now? If so, how does it work?

You post your prices. If the patient wants to pay it, then they write a check or use their credit card.

 

[Gauss]

last recession

Doctors will ultimately fare better than most others, but we will be harder hit this time around than any time in recent history.

docs are great at eating their young for self preservation, last recession was a perfect example

 

[aafisahar]

I'd be more worried about the data coming out that most joint/back/neck injections don't do squat for patients and make their trajectory worse.

 

[lonelobo]

I'd be more worried about the data coming out that most joint/back/neck injections don't do squat for patients and make their trajectory worse.

please share Sahar

 

[Laryngospasm]

I have known several cash only practices.. the DEA was quite interested in them as well. They are all closed now and they are almost all in federal prisons or on their way. If you are cash based controlled substances had better be off the table.

 

[drusso]

I have known several cash only practices.. the DEA was quite interested in them as well. They are all closed now and they are almost all in federal prisons or on their way. If you are cash based controlled substances had better be off the table.

Do you discriminate against patients with high deductible plans or no pharmacy benefits?

 

[Laryngospasm]

No.. the practices I mentioned were solely cash based. They did not take any insurances. I would be ok and have done cash payments for procedures if it was cheaper for the patients but as a rule tried to avoid cash where possible. I have read a lot of the dea investigative notes and releases and they love to use cash against people. While I am sure most of the ones were doing untoward things I have even been told by a former dea agent that if they want to make you look bad they can and will. So I try to avoid things that invite this. Also a cohort was being investigated by the state board and was directly asked how many of your patients are cash pay. He ended up with no sanctions but I have to wonder where he would be if he had a large portion of cash pay patients.