scholarly journals Interventional Pain Management at Crossroads: The Perfect Storm Brewing for a New Decade of Challenges

2010 ◽  
Vol 2;13 (1;2) ◽  
pp. E111-E140
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
United States ◽  
Health Care ◽  
Growth Rate ◽  
Pain Management ◽  
Health Care Costs ◽  
The United States ◽  
Physician Payment ◽  
Interventional Pain Management ◽  
Based Medicine ◽  
Care Costs

The health care industry in general and care of chronic pain in particular are described as recessionproof. However, a perfect storm with a confluence of many factors and events —none of which alone is particularly devastating — is brewing and may create a catastrophic force, even in a small specialty such as interventional pain management. Multiple challenges related to interventional pain management in the current decade will include individual and group physicians, office practices, ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPD). Rising health care costs are discussed on a daily basis in the United States. The critics have claimed that health outcomes are the same as or worse than those in other countries, but others have presented the evidence that the United States has the best health care system. All agree it is essential to reduce costs. Numerous factors contribute to increasing health care costs. They include administrative costs, waste, abuse, and fraud. It has been claimed the U.S. health care system wastes up to $800 billion a year. Of this, fraud accounts for approximately $200 billion a year, involving fraudulent Medicare claims, kickbacks for referrals for unnecessary services, and other scams. Administrative inefficiency and redundant paperwork accounts for 18% of health care waste, whereas medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11% of the total. Further, American physicians spend nearly 8 hours per week on paperwork and employ 1.66 clerical workers per doctor, more than any other country. It has been illustrated that it takes $60,000 to $88,000 per physician per year, equal to one-third of a family practitioner’s gross income, and $23 to $31 billion each year in total to interact with health insurance plans. The studies have illustrated that an average physician spends $68,274 per year communicating with insurance companies and performing other non-medical functions. For an office-based practice, the overall total in the United States is $38.7 billion, or $85,276 per physician. In the United States there are 2 types of physician payment systems: private health care and Medicare. Medicare has moved away from the Medicare Economic Index (MEI) and introduced the sustainable growth rate (SGR) formula which has led to cuts in physician payments on a yearly basis. In 2010 and beyond into the new decade, interventional pain management will see significant changes in how we practice medicine. There is focus on avoiding waste, abuse, fraud, and also cutting costs. Evidence-based medicine (EBM) and comparative effectiveness research (CER) have been introduced as cost-cutting and rationing measures, however, with biased approaches. This manuscript will analyze various issues related to interventional pain management with a critical analysis of physician payments, office facility payments, and ASC payments by various payor groups. Key words: Interventional pain management, interventional techniques, physician payment reform, ambulatory surgery center payment, hospital outpatient department payments, sustained growth rate formula, targeted growth rate formula, fraud, abuse, administrative expenses, evidence-based medicine, health care costs

scholarly journals Physician Payment Outlook for 2012: Déjà Vu

2012 ◽  
Vol 1;15 (1;1) ◽  
pp. E27-E52
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Health Care ◽  
Growth Rate ◽  
Pain Management ◽  
Conversion Factor ◽  
The United States ◽  
Sustainable Growth ◽  
Physician Payment ◽  
Interventional Pain Management ◽  
Fee Schedule ◽  
The Impact

Physician spending is complex related to national health care spending, government regulations, health care reform, private insurers, physician practice, and patient utilization patterns. In determining payment rates for each service on the fee schedule, the Centers for Medicare and Medicaid Services (CMS) considers the amount of work required to provide a service, expenses related to maintaining a practice, and liability insurance costs. The value of 3 types of resources are adjusted on a yearly basis of the combined total multiplied by a standard dollar amount, called the fee schedules conversion factor, which was $33.98 in 2011, to arrive at the payment amount. This factor will stay almost the same ($34.03) unless a 27.4% cut in the sustainable growth rate (SGR) takes place or CMS enacts further reductions. With a 27.4% cut, the conversion factor will be $24.67 in 2012 after the first 2 months if Congress fails to act. Since the inception of Medicare programs in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. The SGR was enacted in 1997 to determine physician payment updates under Medicare Part B with intent to reduce Medicare physician payment updates to offset the growth and utilization of physician services that exceed gross domestic product (GDP) growth. This is achieved by setting an overall target amount of spending for physicians’ services and adjusting payment rates annually to reflect differences between actual spending and the spending target. Since 2002, the SGR has annually recommended reductions in Medicare reimbursements. Payments were cut in 2002 by 4.8%. Since then, Congress has intervened on 13 separate occasions to prevent additional cuts from being imposed. The Medicare physician payment rule of 2012, which is still undergoing revisions -- but considered as the final rule-- is a 1,235 page document, released in November 2011. In this manuscript, we will describe important aspects of the 2012 physician fee schedule which include potentially disvalued services under the physician fee schedule, expansion of the multiple procedure payment reduction (MPPR) policy, establishment of the valuebased payment modifier, changes to direct practice expenses (PEs), electronic prescribing, the Physician Quality Reporting System (PQRS), and lab testing signatures, along with their implications. Additionally, the impact of multiple changes on interventional pain management will be described. In conclusion, interventional pain management is facing widespread challenges in the U.S. health care system. A historic reform, which has been passed by Congress and signed into law, whose survivability is not quite known yet, is affecting medicine drastically in the United States. Interventional pain management, like other evolving specialties, will probably most likely suffer under the new affordable health care law and regulatory burden. Key words: Health policy, physician payment policy, physician fee schedule, Medicare, sustained growth rate formula, interventional pain management, regulatory reform

scholarly journals Facts, Fallacies, and Politics of Comparative Effectiveness Research: Part 2 - Implications for Interventional Pain Management

2010 ◽  
Vol 1;13 (1;1) ◽  
pp. E55-E79
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
United States ◽  
Health Care ◽  
Pain Management ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Clinical Excellence ◽  
The United States ◽  
Effectiveness Research ◽  
Interventional Pain Management ◽  
Care Costs

The United States leads the world in many measures of health care innovation. However, it has been criticized to lag behind many developed nations in important health outcomes including mortality rates and higher health care costs. The surveys have shown the United States to outspend all other Organisation for Economic Co-operation and Development (OECD) countries with spending on health goods and services per person of $7,290 – almost 2½ times the average of all OECD countries in 2007. Rising health care costs in the United States have been estimated to increase to 19.1% of gross domestic product (GDP) or $4.4 trillion by 2018. CER is defined as the generation and synthesis of evidence that compares the benefits and harms of alternate methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The, comparative effectiveness research (CER) has been touted by supporters with high expectations to resolve most ill effects of health care in the United States providing high quality, less expensive, universal health care. The efforts of CER in the United States date back to the late 1970s and it was officially inaugurated with the enactment of the Medicare Modernization Act (MMA). It has been rejuvenated with the American Recovery and Reinvestment Act (ARRA) of 2009 with an allocation of $1.1 billion. CER has been the basis of decision for health care in many other countries. Of all the available agencies, the National Institute for Health and Clinical Excellence (NICE) of the United Kingdom is the most advanced, stable, and has provided significant evidence, though based on rigid and proscriptive economic and clinical formulas. While CER is taking a rapid surge in the United States, supporters and opponents are emerging expressing their views. Since interventional pain management is a new and evolving specialty, with ownership claimed by numerous organizations, at times it is felt as if it has many fathers and other times it becomes an orphan. Part 2 of this comprehensive review will provide facts, fallacies, and politics of CER along with discussion of potential outcomes, impact of CER on health care delivery, and implications for interventional pain management in the United States. Key words: Comparative effectiveness research, evidence-based medicine, Institute of Medicine, National Institute for Health and Clinical Excellence, interventional pain management, interventional techniques, geographic variations, inappropriate care.

scholarly journals Physician Payment 2008 for Interventionalists: Current State of Health Care Policy

2007 ◽  
Vol 5;10 (9;5) ◽  
pp. 607-626
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
United States ◽  
Growth Rate ◽  
Pain Management ◽  
The United States ◽  
Ripple Effect ◽  
Physician Payment ◽  
Sustained Growth ◽  
The Us ◽  
Interventional Pain Management ◽  
Fee Schedule

Physicians in the United States have been affected by significant changes in the pattern(s) of medical practice evolving over the last several decades. These changes include new measures to 1) curb increasing costs, 2) increase access to patient care, 3) improve quality of healthcare, and 4) pay for prescription drugs. Escalating healthcare costs have focused concerns about the financial solvency of Medicare and this in turn has fostered a renewed interest in the economic basis of interventional pain management practices. The provision and systemization of healthcare in North America and several European countries are difficult enterprises to manage irrespective of whether these provisions and systems are privatized (as in the United States) or nationalized or semi-nationalized (as in Great Britain, Canada, Australia and France). Consequently, while many management options have been put forth, none seem to be optimally geared toward affording healthcare as a maximized individual and social good, and none have been completely enacted. The current physician fee schedule (released on July 12, 2007) includes a 9.9% cut in payment rate. Since the Medicare program was created in 1965, several methods have been used to determine physicians’ rate(s) for each covered service. The sustained growth rate (SGR) system, established in 1998, has evoked negative consequences on physician payment(s). Based on the current Medicare expenditure index, practice expenses are projected to increase by 34.5% from 2002 to 2016, whereas, if actual practice inflation is considered, this increase will be 90%. This is in contrast to projected physician payment cuts that are depicted to be 51%. No doubt, this scenario will be devastating to many practices and the US medical community at large. Resolutions to this problem have been offered by MedPAC, the Government Accountability Office, physician organizations, economists, and various other interested groups. In the past, temporary measures have been proposed (and sometimes implemented) to eliminate physician payment cuts. At present, the US Senate and House of Representatives are separately working on 2 different mechanisms to address and rectify these cost-payment discrepancies. The effects of both the problem and the potential solutions on interventional pain management may be somewhat greater than those on other specialties. Physician payments in interventional pain management may evidence cuts of 10% to 15%, whereas if procedures are performed in an office setting, such cuts may range from 29% to 39% over the period of the next 3 years if the proposed 9.9% cut is not reversed. Medicare cuts also impact other insurance payments, incurring a “ripple effect” such that many insurers will seek to pay at or around the Medicare rate. In this manuscript, we discuss universal healthcare systems, the CMS proposed ruling and its attendant ripple effect(s), historical aspects of the Medicare payment system, the Sustained Growth Rate system, and the potential consequences incurred by both proposed cuts and potential solutions to the discrepant cost-payment issue(s). As well, ethical issues of policy development upon the infrastructure and practice of interventional pain management are addressed. Key words: Health policy, physician payment policy, physician fee schedule, Medicare, sustained growth rate formula, interventional pain management, regulatory reform, ethics

Attempts to control health care costs: The United States experience

1979 ◽  
Vol 13 (5) ◽  
pp. 529-540
Author(s):  
John F. Newman ◽  
William B. Elliott ◽  
James O. Gibbs ◽  
Helen C. Gift
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Costs ◽  
The United States ◽  
States Experience ◽  
Care Costs

scholarly journals Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016

2020 ◽  
Vol 174 (2) ◽  
pp. 200 ◽  
Author(s):  
Andrea E. Strahan ◽  
Gery P. Guy ◽  
Michele Bohm ◽  
Meghan Frey ◽  
Jean Y. Ko
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Costs ◽  
The United States ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Care Costs

scholarly journals The direct health care costs of obesity in the United States.

1999 ◽  
Vol 89 (8) ◽  
pp. 1194-1199 ◽  
Author(s):  
D B Allison ◽  
R Zannolli ◽  
K M Narayan
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Costs ◽  
The United States ◽  
Care Costs

scholarly journals Estimation of Annual Health Care Costs for Adults with Type 1 Diabetes in the United States

2020 ◽  
Vol 26 (3) ◽  
pp. 311-318
Author(s):  
Vijay N. Joish ◽  
Fang Liz Zhou ◽  
Ronald Preblick ◽  
Dee Lin ◽  
Maithili Deshpande ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Type 1 Diabetes ◽  
Health Care Costs ◽  
The United States ◽  
Care Costs
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