2016 Pain Management Challenges

interventional2016 is here and Physicians in all aspects of the healthcare field are ready to tackle the challenges and opportunities that await them in the next year.  The Ambulatory M&A Advisor has created a series of articles that examines the 2016 points of view from physicians in various areas of the industry.  The next area to be examined in the series is Pain Management.  With government regulations, reimbursement issues, M&A challenges, the pain management community says that this year poses some challenges, but they have plans to face them head on.

Robert Twillman, Executive Director of the American Academy of Pain Management says that one of the largest challenges for pain management comes through sharp increases in the amount of regulatory activity coming out of state legislatures, other regulatory agencies within states, and even the Federal Government.

“Most of that is related to the attempt to address prescription drug abuse around the country.  We are seeing a lot of things come down the pipe that make it more challenging for people to operate those types of practices.  We are also seeing some continued challenges in terms of working with pharmacies to get patient’s medications that they need.  We have seen that problem most acutely in Florida, but in other places as well.  It seems as though some pharmacies don’t even have adequate supplies to fill all of those prescriptions and many of them are also turning away a number of patients on the basis of their assessment of the patients,” Twillman says.

Twillman adds that pain management challenges also come through in what the industry is continuing to see in reimbursement for pain management practices especially if those practices want to do something other than write prescriptions or do procedures.  Even those that are doing procedures are having more challenges getting those paid for; so it is  a really challenging environment right now, Twillman says.

Harold Cordner, MD, Florida Pain Management Associates says that the declining reimbursements in pain management can present challenges for physicians looking to sell in 2016.  According to Cordner, physicians will have to keep a close eye on ancillary services and employee management in order to be successful and grow in profit.

“With the reimbursement cuts that pain management had in 2014, reimbursement is very difficult.  The regulations that we have now to meet for Medicare is actually requiring a lot of extra personnel.  With most of the insurance companies increasing their denials in authorizations, that takes a lot of personnel as well.  That eats up a lot of money,” Cordner says.

“So, I think positioning yourself is going to be efficiently getting your patients in and out, making sure that coding and billing is done correctly the first time, a clean claim on the first pass.  Office visits are not that profitable, procedures are, but ancillary services such as urine drug screening and dispensing workers comp medications may turn that from being in the red to being in the black.”

Twillmain explains that some of the ways pain management can overcome issues like regulation and reimbursements are through efforts that are currently being implemented in the industry.

“We are very active in terms of tracking regulations and legislation that are being proposed and trying to weigh in on those in ways to have them altered so that they don’t unnecessarily restrict practice,” Twillman says.

“For example, we have seen a lot of legislation in Tennessee last year and this year both, trying to really restrict the practice of pain management.  We have done everything that we have possibly can to try to say to folks, “Look, we understand what you are trying to accomplish in addressing prescription drug abuse, but you also have to think about the fact that there are a lot of people with chronic pain, and if you do these things, they are not going to have access to the best care either.  So, we have to really find a balance between all of that .”  We are really active in tracking all of those issues and trying to respond the best that we can.  We also have lots of partners that we work with to try to do that.  The practice of working with partners has brought some successes.  It is obviously a challenging environment and we have got a lot of work to do. I would say we have had some successes and some cases where we haven’t succeeded and we are anticipating and monitoring what the fallout of that is going to be.”

As far as reimbursements, Twillman gives a jarring example of current challenges with the example that  one of his members told him that Medicare is now at the point where it is refusing to pay for trigger point injections in patients.

“There are a lot patients with miofacial pain syndromes for whom a trigger point injection is very effective, very cheap and avoids the need to put them on opioids and other dangerous medications.  But, Medicare is now apparently refusing to pay for those in some places.  What that leaves us with is a situation in which the payment systems is really pushing us toward the things that a lot of policy makers want to avoid.   It would not surprise me to see that practice of limiting payment for those kinds of things, be expanded even further into things like epidural steroid injections, nerve blocks and those types of things.  I think there are some real serious issues in terms of limiting the kind of care that we can provide.  Again, that limitation pushes us in directions that policy makers just don’t want us to go in,” Twillman says.

COO of Kure Pain Management Bill Hughes says that when looking at M&A, even though the market is currently favorable, there will be challenges based on the way the pace of M&A has quickened over the last few years with more activity, more players, and larger players with national goals.

“Going forward successfully will be a test for some. Those centers that take the necessary measures to allow for success will find it,” Hughes says.

Hughes says to be best positioned going forward, pain management centers should look to provide the best quality care with a focus on the customer service experience, to diversify revenue streams, and to stay nimble and flexible as an organization.

“The most promising prospects will be for those owners willing to place the focus on patient satisfaction, as well as an emphasis on financial management,” Hughes says.

One final challenge that Twillman discusses is the issue of new physicians entering the pain management field.

“There are so many requirements now that it really makes you wonder almost, why people would want to go into a pain management practice.  I think we have got a lot of work to do with residents and fellows that are interested in that area and to convince them that this is something that is really worth doing,” he says.


If you have an interest in learning more about the subject matter covered in this article, the M&A process or desire to discuss your current situation, please contact Blayne Rush, Investment Banker at 469-385-7792 or Blayne@AmbulatoryAlliances.com.

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