There are three basic locations to establish or add Pain Management Services;
- An Outpatient Department in a Hospital
- An Ambulatory Surgery Center (ASC)
- The Physician Office
The choice of location will affect everything from patient referral patterns to reimbursement for services provided to patients. In addition, equipment, supplies and staffing will vary by location. Take into account the operational efficiency, the availability of procedure time, staffing and set up costs in each of the settings.
Hospital outpatient department
The advantage of this setting is that the hospital can fund and staff the program. The physician members are those physicians on staff who wish to participate and no physician financial contributions are required. The facility may allow physicians to join the medical staff or the anesthesia group may have an exclusive agreement for pain management. In addition, all policy and procedures, clinical, quality and administrative management is provided by the hospital. All procedures can be performed. Disadvantages may be difficulty getting blocked time, C-arm availability and slow turn around time performing procedures. Reimbursement for the physician under Medicare part B is at a lower rate.
Ambulatory surgery center (ASC)
This setting will also provide policy and procedures, clinical, quality, and administrative management. Most Pain Management procedures in ASC's have quick turnaround with only a short recovery time needed. A pain management physician is generally able to perform as many as four procedures per hour. In adding pain services to an existing ASC, the only significant capital cost is for the C-arm and fluoroscopy table, if they are not already on site for other specialties. If efficiently scheduled, adding pain management services can increase revenue and provide ASC enhancement. If applicable, physicians may participate in ownership of the center. Certain procedures may not be reimbursed in this setting.
When providing services in an office setting, the reimbursement rate by Medicare is greater for the physician. Certain states have detailed regulations governing physician office-based procedures.The physician must be responsible for providing the policy and procedures, clinical, quality, and administrative management. Issues to be addressed are: physical space, staffing, billing and collections, equipment, and computer network.
Keep in mind, in all of the above locations, pain management physicians will have to bill and collect for their services. Knowledge of reimbursement is key in reaching and maintaining profitability. For instance, many pain procedures involve bilateral injections and/or multiple levels, and knowing how to code can maximize reimbursement. The physician will have to obtain provider numbers from the insurance companies (Medicare, managed care companies, workers' compensation, and other local providers) and negotiate contracts for their fees.