The Seven Essentials for Pain Practice Success* …Sailing the Seven C’s

cloudmpc

Success is counted sweetest by those who ne’er succeed.
~Emily Dickinson

You treat chronic pain? Thank goodness someone does.
~My physician colleagues … on numerous occasions

I have treated chronic pain in a variety of practice settings, large and small, for almost thirty years. It has not always been easy. But I have found that success in this specialty is possible when the practice foundation consists of seven basic elements:

Cost-effective
Cooperation
Compliance
Consensus
Culture
Cause
Care

Chronic pain is not an exotic clinical niche. It is a chronic illness and should be approached step-wise as one would approach other chronic illnesses:

(1) Gather information;
(2) Make a diagnosis;
(3) Implement a plan of care;
(4) Assess the results; and
(5) Make adjustments.

A physician is generally comfortable with this paradigm when it applies to caring for an individual pain patient. However, regardless of one’s clinical confidence, when the practice’s primary mission is to treat chronic pain, overriding concerns about economic viability, community safety, and regulatory scrutiny become major stressors for a physician. More than just a paradigm is needed.

By embracing The Seven Essentials for Pain Practice Success a healthcare organization of any size or complexity can meet this need and provide quality pain care that is valued by the patient and professionally satisfying to the provider.

The Seven Essentials for Pain Practice Success

1. COST-EFFECTIVE

There’s no escaping the fact that healthcare costs are prodigious and resources are finite. Care providers may feel compelled to offer expensive treatments and order technologically advanced tests, regardless of the cost, out of a desire to provide the best care possible. But “best care” is not equivalent to “most-expensive care.” The success of any pain care practice is dependent upon use of resources – of the patient and the practice- in a manner that optimizes value.

2. COOPERATION

Do not tell patients what you will do to them. Instead, figure out how you can work with them. Providing care in a climate of draconian pain regulations, dogmatic practice guidelines, and dearth of evidence to support treatment options, is optimized by patient-practitioner partnerships. Success requires positive outcomes for the: (1) patient, (2) caregiver, and (3) community. If any of these three stakeholders have bad outcomes, failure is the sum total. With cooperation and teamwork, success is more likely achieved.

3. COMPLIANCE

Be a follower. In addition to an ever-increasing database of clinical guidelines, there are numerous regulations and statutes governing how healthcare providers may treat pain, particularly when treatment involves controlled substances. Some of the rules are federal statutes that apply universally. Other rules are only specific to individual states or communities. Rules governing pain care delivery may not necessarily reflect the best clinical practice, but are usually based upon sound principles. Search for the reason behind the rule. But if all else fails, go ahead and “teach to the test.” Compliance is mandatory. Even if you think “outside the box” do not act outside the box. Know the rules and follow the rules.

4. CONSENSUS

A successful pain practice must agree on how they will operate. Do some providers allow early refills, while others will not? Are some quick to discharge a patient who has an abnormal drug screen, while others give second chances? How often do we drug screen? Do we prescribe drugs on the first visit? Through honest communication the group must reach a consensus on “our way” of doing things.

5. CULTURE

Every organization has its own culture. A successful pain practice understands its culture, knows its weaknesses and knows its strengths. For example, if the group’s dominant culture is intuitive, then it needs safeguards (i.e. objective and detail-oriented policies and procedures) to focus on specifics. Success requires that individuals not only understand their roles, but also are willing to perform in a manner that supports the group’s dominant culture.

6. CAUSE

Successful pain practices know their cause, their mission, the reason the practice exists. Even the most mundane task can be passionately undertaken when team members understand how their actions contribute to the cause. In addition, successful practice managers make sure team members feel appreciated for their efforts.

7. CARE

Caring is the foundation for success. In all decisions, successful pain practices first ask: “Is it in the patient’s best interest?” Beyond that, every human encountered by the organization -patients, family members, hospital administrators, government regulators, insurance brokers, pharmaceutical representatives, colleagues, etc.- is worthy of dignity, respect, and care. The “golden rule” always comes before the rule of gold. Remember that no one cares how much you know until they know how much you care.

Each of the seven essentials for pain practice success is vital. Ignore one and the organization is on thin ice. Embrace them all and the practice, regardless of its size, can be on economical, clinical and ethical solid ground.

Then no one will have to “thank goodness” for what you do.
Instead, you can be thanked for the goodness that you do.

That is sweet success.

*

we are great

https://vimeo.com/channels/glms/68703810

James Patrick Murphy, MD, MMM is a Past President of the Greater Louisville Medical Society, Medical Director of Murphy Pain Center, and an Assistant Clinical Professor at the University of Louisville School of Medicine. He is board-certified in Pain Medicine, Anesthesiology, and Addiction Medicine and has a Master of Medical Management from the USC Marshall School of Business.

*Note: This article was originally titled: The Five Essentials for Pain Practice Success. “Cost-effectiveness” was added on July 30, 2015; “Cooperation” was added on September 30, 2015; each prompting a change in the title.

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Continuity of Care

TourtheTower

On June 1, 2014 at Louisville’s historic and newly renovated Water Tower, the Greater Louisville Medical Society held its annual Presidents’ Celebration.

crowd at watertower

As outgoing president I had the honor of introducing Dr. Bruce Scott – my esteemed colleague and childhood friend – as our new President. I also thanked some of the many great folks who worked so hard to make this the most satisfying year of my professional life.

pat and bruce screen

Before I handed over the President’s gavel to Bruce and assumed my new role as Chair of the GLMS Board of Governors, I had this to say…

pat podium

A year ago, as your newly elected President, the last words I said on that stage were:

The Greater Louisville Medical Society is our organization, our tribe, our road to a place where medicine is both science and art, where our community enjoys wellness, and the sacred bond between our patients and us is secure. And my goal this year is to see us united.

murphy speech at pres celeb

It’s one year later, and our profession is under attack as never before. Physician burnout is an epidemic. This is why, more than ever, we must be united.

Back in the day, physicians were a more homogenous group. There were fewer specialists. We shared common values and common goals.

Now government, employers, specialties, patients, and family pull us in many directions. There is an ever-increasing burden for maintenance of board certifications and licensure. Each separate payer and practice facility requires its own credentialing. Medical liability risks keep mounting. The insatiable quest for quantifying quality with data points and benchmarks threatens to crush our creativity and mandate cookbook-style care. Rival non-physician tribes continuously grab pieces of what used to be our acknowledged scope of practice.

How do we respond? All too often by retreating to presumed “safe houses” provided by the one, two, three or more specialty societies each of us believes offers the most protection of our turf.

Got to survive, you know.

The irony is that these refuges are not safe at all. They are static. Stationary. It makes us benign targets for attack by all who would prefer a leaderless mechanized conveyor belt of universal one-size-fits-none healthcare. This sanctimonious deconstruction of our profession is done in homage and servitude to the inscrutable holy trinity of cost-effectiveness, quality, and value.

Survive?

Why not thrive!

Regardless of where your professional journey has led, you and I and our colleagues remain connected at our roots. We still share common values and must share common goals. We are physicians by education, oath, and calling.

And more…

We love our profession.

We love humanity.

And we love each other.

That is why we get up every day, put on our white coats, and go out to save the world.

Because it must be saved.

And we know…

We are the ones who must do it.

United.

gavel trophy

‘Twas The Audit Before Christmas

surgeon santa

‘Twas the day before Christmas, and all through the clinic,
My patients were fuming, and I was a cynic.
My routine was stung by Affordable Care.
I’d hoped the ridiculous rules would be fair.

In precerting drugs, how the auditors hovered.
Prescriptions for sugar pills only were covered.
The managed care mischief and benefits cap,
That sounded so good, was merely a trap.

Then out in the foyer arose such a clatter,
A patient’s co-pay was the crux of the matter.
Away to the window I flew like a flash,
Shut down the computer and asked him for cash.

He wasn’t abreast of the new plan in place,
That had cut off his nose in spite of his face.
When what to my wondering eyes did appear,
But a government man, just a tiny bit weird.

He showed me a warrant so lively and quick,
That I prayed to the Lord, “This must be a trick.”
More than just illegal, this wasn’t a game.
And he whistled and shouted transgressions by name.

“You downcode! You miscode! You don’t even fix ‘em!
You’re sloppy! You’re stupid! More crooked than Nixon!
I will file my report! From on top you will fall!
Now cash you’ll pay! Cash you’ll pay! Cash you’ll pay! All!”

As dry heaves, that before a wild emesis fly,
When I met this obstacle, thought I would die.
So onto his ribcage, my fingers they flew,
Which gave him no joy. He ain’t ticklish too.

And then in a twinkling, he wanted the proof,
And documentation for each little goof.
So I drew in my head what I thought would astound,
But this audit’s ridiculous claims did abound.

He addressed all inferred, and he read what was put,
In our policy manual, which was thick as a foot.
A bundle of charges he wanted paid back,
‘Cause this was an audit, and he was a RAC.*

His knee, now it bucked! It’s simple, so very.
It started to hemorrhage and looked downright scary.
It no-mattered at all was he friend or a foe,
For the loss of his blood made his suffering show.

His stump of a leg I held tight, no conceding.
My hands they encircled his thigh to stop bleeding.
He’d had a bad cut, from his leg to his belly.
His bandage was only petroleum jelly.

I asked why he’d only done something to soothe.
“ ‘Cause that’s all,” he said, “that my plan would approve.”
An i.v. for fluids and lowering his head,
Soon gave him to know he had nothing to dread.

He spoke not a word, nor called me a jerk.
Physicians just do this. It’s just how we work.
Then thinking about his life saved, I suppose,
Giving a nod, from the stretcher he rose.

He then took his report, his scathing epistle,
And into the trash, threw it down like a missile.
And I heard him exclaim, as he drove out of sight,
“Don’t ever give up. We need you in the fight.”

doctor santa

Adapted by James Patrick Murphy from the poem “A Visit from St. Nicholas,” a.k.a. “‘Twas the Night Before Christmas” by Clement Clarke Moore

*RAC stands for Recovery Audit Contractor

TWITTER at @jamespmurphymd