The Pain Management "Team..."

[drusso]

I read a lot about how important it is for MD/DO's to accept the "team approach" in medicine and learn how to function in cross-functional teams. Physiatrists have trained explicitly in this model, but I imagine other specialties may have more difficulty adjusting to collaborative-decision making, distributed responsibilities, information and knowledge sharing, etc.

It seems that the specialty of pain medicine is schizophrenic on the issue: It gives lip-service to the idea, but few pain specialists actually practice this way. In my group, we benefit from PM&R/Addiction/Pain/Occ Med MD's, PA's, NP, MSW, drug/alcohol counselor, and Advanced-Practice Pain/Palliative Care RN. We liaison outside our group for pain psychology, psychiatry, medical & radiation oncology, rheumatology, orthopedics, and spine surgeons.

Who's on your team?

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[emd123]

In my immediate group we have primary care and rheum. Everything else is a refer out.

 

[olafa]

I read a lot about how important it is for MD/DO's to accept the "team approach" in medicine and learn how to function in cross-functional teams. Physiatrists have trained explicitly in this model, but I imagine other specialties may have more difficulty adjusting to collaborative-decision making, distributed responsibilities, information and knowledge sharing, etc.

It seems that the specialty of pain medicine is schizophrenic on the issue: It gives lip-service to the idea, but few pain specialists actually practice this way. In my group, we benefit from PM&R/Addiction/Pain/Occ Med MD's, PA's, NP, MSW, drug/alcohol counselor, and Advanced-Practice Pain/Palliative Care RN. We liaison outside our group for pain psychology, psychiatry, medical & radiation oncology, rheumatology, orthopedics, and spine surgeons.

Who's on your team?

It is a great idea, I like it. One stop "shop" with all the ancillary services. I am not sure why they reality of this concept is hard to produce, management of it all maybe. As private practice by adding everyone "in house" you need more space to accommodate, and moving adding staff seems like a large overhead risk to take on as its hard enough to contain costs as it is. Also probably hard to recruit those specific professionals individually where they may want to just be on their own team. I don't know,,,, my 2c

 

[melancholy]

well, in my "model" we have behavioral specialists (PhD, MFT), pain pharmacist, PT, nurse care manager, LCSW, and physicians. i have to refer out to interventional PM&R or anesthesia for my fluoro inj. We have group-based CBT classes for chronic pain management 8-10 weeks long taught by physical therapist and a behavioral specialist +/- pain pharmacist. We have case conferences 3 times a week. We also teleconference weekly with our chemical dependency colleagues. Those are the positives....

 

[lobelsteve]

well, in my "model" we have behavioral specialists (PhD, MFT), pain pharmacist, PT, nurse care manager, LCSW, and physicians. i have to refer out to interventional PM&R or anesthesia for my fluoro inj. We have group-based CBT classes for chronic pain management 8-10 weeks long taught by physical therapist and a behavioral specialist +/- pain pharmacist. We have case conferences 3 times a week. We also teleconference weekly with our chemical dependency colleagues. Those are the positives....

So what's your role?

 

[melancholy]

Triage consults, evaluate, come up w treatment/management plan, follow up periodically or as needed as patient goes through program. Adjust or trial meds if needed, injections, Etc. Run team conferences. Discharge patients when stable. Answer phones when my MA's are all sick.....

 

[101N]

well, in my "model" we have behavioral specialists (PhD, MFT), pain pharmacist, PT, nurse care manager, LCSW, and physicians. i have to refer out to interventional PM&R or anesthesia for my fluoro inj. We have group-based CBT classes for chronic pain management 8-10 weeks long taught by physical therapist and a behavioral specialist +/- pain pharmacist. We have case conferences 3 times a week. We also teleconference weekly with our chemical dependency colleagues. Those are the positives....

This sounds good. What metrics do you follow as a measure of success? ED/PCP visits pre & post, total health care costs? Do you take Medicaid?

In my area several small - CCO sponsored- 10 -12 week CBT/movement programs are cropping up for about 700$/pt capitated. Goals are to decrease medical expenditures post tx: fewer ED & PCP visits. These groups advertise explicitly: no opioids.

 

[drusso]

This sounds good. What metrics do you follow as a measure of success? ED/PCP visits pre & post, total health care costs? Do you take Medicaid?

In my area several small - CCO sponsored- 10 -12 week CBT/movement programs are cropping up for about 700$/pt capitated. Goals are to decrease medical expenditures post tx: fewer ED & PCP visits. These groups advertise explicitly: no opioids.

What if they still hurt after 12 weeks?

 

[101N]

They will, you can't cure chronic pain. The goals for the patient are to improve their acceptance of this fact, their coping in spite of it, and their function and health behaviors.

The business goals are to reduce harms and costs.

 

[drusso]

They will, you can't cure chronic pain. The goals for the patient are to improve their acceptance of this fact, their coping in spite of it, and their function and health behaviors.

The business goals are to reduce harms and costs.

Have you ever seen failures from these programs? The patients really don't go away. They just become someone else's problem. We don't expect CBT to "fix" mental illness, but we do expect it to "fix" chronic pain...

I wonder how these CCO's vet their programs? I wonder why so much of the program development for these CCO-based initiatives occurs outside the purview of public meeting laws? I wonder whose interests this lack of transparency serves? How are those capitated rates determined? Are vendors for those programs selected by a public RFA process? Or, are they awarded as "no-bid" contracts?

 

[emd123]

I bet neither pain scores nor function are any better with these massive, dollar draining health care pain "teams" than with any other approach. Prove to me I'm wrong.

How many of these "team members" does it take to change a light bulb?

 

[Ducttape]

the opposite approach - the common current one - is really making a huge dent in chronic pain management and the cost to society, isnt it?

$700/patient is what, 1 eval and 1 epidural at an ASC? in some private practice model, that is blown through in 2 days.

recently reviewed the bills for a patient seen at such an office in Nevada. $16,000 in < 6 weeks of care, no change in patients pain (eval, 2 multi level TF, multi-level MBB then RFA, refer back to PCP for meds - ie opioids.)