painfan

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Proposing to a hospital that they should start a pain program.
Wondering what the opinion here is about offering inpt consults for pain mgmt.
I have heard its a good way to get referrals for the clinic, good way to get your name out to the medical staff.
Any cons?

Regards
 

SSdoc33

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Any cons?

none.


-huge time drain
-getting consults 24/7
-having to fight the nurse for the chart
-trying to find the chart
-trying to somehow slide past the unit clerk who is WAY too large for the chair she is in
-ONLY seeing patients who are on ungodly doses on opioids and only want more
-having to f/u these patients in clinic who will only be looking for opioids and already have had them prescribed by someone else
-maybe 1 in 20 patients is a reasonable candidate for a shot. MAYBE
-the PCPs will come to know you as the guy who manages meds. if that is what you want, more power to you.
 

101N

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Huge opportunity cost. You can not control efficiency in the hospital. DO NOT DO IT unless you get a substantial directorship fee to off set all that you will lose from your clinic.
 

Socrates25

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none.
-huge time drain
-getting consults 24/7
-ONLY seeing patients who are on ungodly doses on opioids and only want more
-having to f/u these patients in clinic who will only be looking for opioids and already have had them prescribed by someone else
-maybe 1 in 20 patients is a reasonable candidate for a shot. MAYBE
-the PCPs will come to know you as the guy who manages meds. if that is what you want, more power to you.

Ummm... forgive me if I am wrong, but isnt that what pain medicine is all about to begin with?

I always assumed that seeing patients who didnt need to be on narcs or who were on ridiculous narc regimens was part and parcel of the pain management specialist's job.
 

lonelobo

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Ummm... forgive me if I am wrong, but isnt that what pain medicine is all about to begin with?

I always assumed that seeing patients who didnt need to be on narcs or who were on ridiculous narc regimens was part and parcel of the pain management specialist's job.[/QUOT

I say do it!... It is sounds very Satisfying!
 

PAINISGOOD

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SSdoc is right on! I did inpt consults for 6 months and I wanted to gouge my eyes out! It was ok in the beginning as I was trying to increase my clinic business and establish my new practice but as I am busy in office now, I would not get the time to do inpt even if I wanted to. Also,the ones I "inherited" from the hospital were all crazy and drug seeking who need psych/addictionologist more than us. Plus you will get paged all day and night like you were an intern! Stay Away if you can!

Btw. the comment about the unit clerk was hilarious! So true! :laugh:






none.


-huge time drain
-getting consults 24/7
-having to fight the nurse for the chart
-trying to find the chart
-trying to somehow slide past the unit clerk who is WAY too large for the chair she is in
-ONLY seeing patients who are on ungodly doses on opioids and only want more
-having to f/u these patients in clinic who will only be looking for opioids and already have had them prescribed by someone else
-maybe 1 in 20 patients is a reasonable candidate for a shot. MAYBE
-the PCPs will come to know you as the guy who manages meds. if that is what you want, more power to you.
 

specepic

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Not time efficient. When they really want me to see someone, I often have them wheel them over to my clinic in the next bldg. A lot of the time I simply tell them I do not have the time in my otherwise busy outpatient practice, which is true.

I curbside with the hospitalist here and there

If you were an internist with an interest in pain, perhaps, but if you are interventional it will be PAINFUL
 

algosdoc

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I agree with the above....frequently these are patients that no one else wants to see because they are uninsured or have Medicaid, and getting an inpatient consult is a back door to your clinic. For acute pain, it may be useful if you have some therapy that is unique and not offered by other services in the hospital. For chronic pain- forget it. There is little you can do that will change the course of their pain in the hospital unless you dump local anesthesia into an axial spine block for nearly zero reimbursement, after being delayed for hours by a vascular surgeon and a couple of emergencies that take priority over your case.

While some of the medical staff may be mildly amused at the altruistic motives of the self flagellating young physicians offering voluntarily to take inpatient consults, others will be mystified by your approach, thinking the hospital administration has a gun to your head to force such unorthodox behavior.
 

voltron

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haha yea most of the things said about IP work is true. That being said, we actually provide 24/7 inpatient coverage at 2 hospitals. Our outpatient work is busy, but we do the inpatient stuff for few reasons. One, it brings you to the hospital and forces you to interact with the primaries/orthos/neurosurg on a regular basis. I probably spend half my time there just BS'ing with docs that I run into. Second, hospital admins LOVE having inpatient pain service. It's a service that adds value in their eyes, and can help improve inpatient outcomes on metrics tracked by ACO's (don't get me started on ACO's...not good). Being in good favor with the admins/hospitals is always a plus. Lastly, the money's not that bad. We're lucky in that the hospitals we work at see very little public aid. A level 3 IP consult pays about $200, and follow ups $100. Even the moderate levels pay about $140/70. For about 5-15 mins of work its not bad. That being said, we've had failed forays into hospitals as far as setting up IP services, mostly for the reasons you initaly mentioned. Also if the primaries tend to admit through the hospitalist service, then it prob won't help your OP referrals much.
 

Tenesma

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inpt is not good from a financial point of view because it is not an efficient process to assess a patient

1) never can find the charts...
2) never can find the RN...
3) the patient next door may code - and you are the only doc on the floor
4) the patient's extended family brought chinese food for the patient - and each one of them has 6 different questions and are offended when you ask them to step out so you can examine patient...
5) primary care doesn't do inpatient anymore - so you are really only impressing some hospitalist who is glad to dump his chronic narc inpts on you...

so only do it if
1) strategically it makes sense - and then have your NP do all the scut work...
 

Ducttape

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4) the patient's extended family brought chinese food for the patient - and each one of them has 6 different questions and are offended when you ask them to step out so you can examine patient...


so only do it if
1) strategically it makes sense - and then have your NP do all the scut work...
2) there is a really good chinese restaurant that delivers, and families are willing to share...
 

voltron

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Its also fun when you spend 30 minutes with the patient and then the nurse comes and sheepishly tells you the patient has more questions. I never do my charting/consult in the patient's line of sight...that's a guarantee that they're going to ask you to come back in the room for more questions.
 
OP
P

painfan

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Appreciate all the comments
Thanks
Will get a feel soon if I need to do this or not to get the hospital to buy what I am selling :)
 

Jcm800

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Appreciate all the comments
Thanks
Will get a feel soon if I need to do this or not to get the hospital to buy what I am selling :)
you will absolutely need to do it, if you are trying to get the hospital to buy anything...
 

101N

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I always assumed that seeing patients who didnt need to be on narcs or who were on ridiculous narc regimens was part and parcel of the pain management specialist's job.
This attitude interests me. I think we need to set expectations with both patients AND referring docs early on so everyone is on the same page.

In my experience there are basically 3 types of referring docs.

1. PMDs who have a patient in pain, want's the best for the patient, don't really know what to do, feels out of scope and refers to us to sort it out.

2. PMDs who don't care where the patient goes or what is done to them but just wants them never to come back. i.e., "You are the pain guy and I need to dump this patient on you."

3. PMDs who fits along the continuum somewhere between 1 & 2.

I can deal with 1 and 3 with no problem. I let them know that I'm not a pusher and I'll call it as I see it. Druggies will find no satisfaction with me and I'll write the note in such a way to obviate the PMD from having to prescribe. I'll also do the workup and set realistic expectations with the patient, even when that's not what they want to hear.

PMD's # 2 don't like me because I won't placate their referrals with opioids ad infinitum. Socrates25 post makes him/her sound like PMD #2.
 

Disciple

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This attitude interests me. I think we need to set expectations with both patients AND referring docs early on so everyone is on the same page.

In my experience there are basically 3 types of referring docs.

1. PMDs who have a patient in pain, want's the best for the patient, don't really know what to do, feels out of scope and refers to us to sort it out.

2. PMDs who don't care where the patient goes or what is done to them but just wants them never to come back. i.e., "You are the pain guy and I need to dump this patient on you."

3. PMDs who fits along the continuum somewhere between 1 & 2.
Probably one of the hardest parts about getting to know your local medical community, trying to figure out who is a #1 or #3, and who is a #2.
 

VA Hopeful Dr

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This attitude interests me. I think we need to set expectations with both patients AND referring docs early on so everyone is on the same page.

In my experience there are basically 3 types of referring docs.

1. PMDs who have a patient in pain, want's the best for the patient, don't really know what to do, feels out of scope and refers to us to sort it out.

2. PMDs who don't care where the patient goes or what is done to them but just wants them never to come back. i.e., "You are the pain guy and I need to dump this patient on you."

3. PMDs who fits along the continuum somewhere between 1 & 2.

I can deal with 1 and 3 with no problem. I let them know that I'm not a pusher and I'll call it as I see it. Druggies will find no satisfaction with me and I'll write the note in such a way to obviate the PMD from having to prescribe. I'll also do the workup and set realistic expectations with the patient, even when that's not what they want to hear.

PMD's # 2 don't like me because I won't placate their referrals with opioids ad infinitum. Socrates25 post makes him/her sound like PMD #2.
As a PCP who has done both #1 and #2, if you tell the patient that opioids are not for them, and mention that you said this in your note back to me, I'm happy. Then I get the pleasure of saying "the specialist doesn't think these meds are in your best interest, I will not go against their expertise on this".

Granted its a cowards way out, but after I finish residency (where these patient were started on crazy high doses of narcotics by prior residents), I don't expect this to be an issue anymore.
 

jsaul

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you will absolutely need to do it, if you are trying to get the hospital to buy anything...
agree.

also I know a board certified doc who sees probably 1-2 new pain hospital consults a day and 5-10 follow ups a day. He does this in about 2-3 hours. this is for postop pain, acute pain, pca, etc. He states he does it because it pays well (extra 200,000 income per year) and augments his outpt practice. plus it a a great source of good referrals to the outpt clinic

I rarely see a patient in the hospital-- why? because I am not privaledged there by choice
 
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Pain Applicant1

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Keep in mind that it may become difficult to get reimbursed from payers without having hospital privileges and it may be difficult to maintain privileges without seeing inpatients.
 

Disciple

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also I know a board certified doc who sees probably 1-2 new pain hospital consults a day and 5-10 follow ups a day. He does this in about 2-3 hours. this is for postop pain, acute pain, pca, etc. He states he does it because it pays well (extra 200,000 income per year) and augments his outpt practice. plus it a a great source of good referrals to the outpt clinic

Define "good":laugh:
 

jsaul

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Define "good":laugh:
good meaning--- those that are not already on chronic narcotics for relatively benign conditions and those that would normally be referred to spine surgeon for evaluation and treatment of back pain. his presence in the hospital makes him visible to other docs so that he is in the forefront of pcp thoughts during referrals for back pain
 

bedrock

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Keep in mind that it may become difficult to get reimbursed from payers without having hospital privileges and it may be difficult to maintain privileges without seeing inpatients.
Agree w the first point, not the second.

That's what courtesy privileges are all about.

Any hospital that demands I see their inpatients---I drop privileges with them.
 

Pain Applicant1

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Agree w the first point, not the second.

That's what courtesy privileges are all about.

Any hospital that demands I see their inpatients---I drop privileges with them.
Note the word "may." Depends on the hospital system. Not everyone has the privilege of dropping the privilege.