Patterson and his physician group were eager to establish protocols in a niche market, especially for patients who were clamoring for lower back pain care. The doctors reached a comanagement agreement with Northern Nevada Medical Center. Both physicians and hospital representatives comprise the leadership team that oversees pain management programs at the hospital's Pain Management Center.
"At the Pain Management Center, our goal is to return patients to a maximum level of functioning and independence by identifying the source pain and using advanced techniques to reduce the level of pain and suffering," says Patterson.
For the Northern Nevada Medical Center, teaming up with the physicians group was a good fit. The hospital was known in the community for its orthopedics program and had launched an outpatient rehabilitation and sports medicine unit, "which has been a fast-growing program," explains Meert, the hospital's COO. "Opening a pain management center was a natural fit for our continuum of care and for the population we serve," she says.
The comanagement program allows the hospital to have "highly respected, fellowship-trained pain management physicians at Nevada Advanced Pain Specialist to comanage quality outcomes and indicators as well as program enhancement and efficiency," Meert says. The hospital "invested capital" in the pain management program, especially with added imaging equipment and surgical staff. Within a year, the hospital began to recoup its investment by especially focusing on patients with lower back pain, she says, adding that "so many patients were in need." It was important that the hospital focus on "enhanced quality," Meert says. "It's a constant state of education."
More than 50% of patients report having knee pain, and when combining that statistic with those reporting low back and neck pain, that represents 85% of patients, according to Patterson. The hospital's pain management program is comanaged by the Northern Nevada Medical Center and a physicians group, the Reno-based Nevada Advanced Pain Specialists, which specializes in stroke, knee replacement, hip replacement, and spine surgery. The program received the Joint Commission's Gold Seal of Approval for low back pain.
At the Pain Management Center, patients undergo an evaluation that may include x-rays, magnetic resonance imaging scans, or nerve studies to find the specific disk, nerve root, joint, or tendon causing pain. After a physician identifies the source of pain, he or she may use image-guided techniques to deliver steroids, burn nerve endings, or perform other targeted therapies at the precise area causing pain.
The physicians group initiated the working relationship with the hospital after seeing the great need for pain care in the Sparks and Reno area of Nevada, say Meert and Patterson. Too often, primary care physicians lack knowledge about pain management, Patterson says. "Part of what we do is educating primary care doctors what patient management is, and that what we are trying to do is in the best interest of the patient."
With the comanagement arrangement, the hospital expanded staff, particularly surgery and imaging. Like other pain management programs, the staff includes therapists and acupuncturists. Physicians have increased referrals for patient care, Patterson says. The message to physicians is: "If it hurts, send them." Once patients are examined, "that allows us to triage them, work up a program, and see what's happening."
For both the hospital and the physicians, it's a good working relationship that allows for more patients into the program and reciprocal incentives for the medical group, Patterson says. The hospital reduces overhead costs for physicians, who bring patients to the facility. "It's nice," he says. "It lowers my overhead and they have a center where we can see patients. In return, we do a lot of cases at the hospital, and the hospital gets a facility fee. They make a profit in the end, and they have supplies for us."
The comanagement program involves leadership from both the physicians group and the hospital, Patterson says. It includes the physician partners and the hospital's CFO and CEO. "It's a win-win situation in the sense [that this is] an underutilized field," he says.
Success key No. 4: Pain management satisfaction
At Massachusetts General Hospital, daily meetings include physicians and administrative staff who review data and results from HCAHPS surveys, which score how patients say the hospital managed their pain. How often was the patient's pain well controlled during the hospital stay? Did the staff do everything they could to help patients with their pain?
MGH officials believe the hospital hasn't scored quite as well as it should, says Gilligan, the pain management director, even though the patients' perception about the hospital's level of care surrounding pain issues is consistently at or above the state average. "I think we score consistently low on that," he says. Most recently, in a survey of 300 patients from 2011 to 2012, 72% of patients reported that the pain was well controlled, which is comparable to the state average of 72%, and above the national average of 71%, according to Hospital Compare.