ORLANDO -- An intensive, personalized approach to high-utilizer pain patients that integrated psychiatric and pain care lowered overall healthcare costs at one health system, researchers reported here.
Referral to Duke University's Medical Pain Service saved the system about $9,000 per patient per year, according to , of Duke in Durham, N.C., and colleagues.
"Being able to have a psychiatric approach to this population is very beneficial, and the multidisciplinary approach is helpful," Prakken said at the American Academy of Pain Medicine meeting. "We can ask, 'What do we do with the patient who is having a bad response to their antidepressant and, at the same time, needs to have their opioid adjusted because their pain is worse?'"
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"It's difficult when that's not integrated. To have that all-in-one physician's mind offers a much more optimal outcome," he added.
Prakken said that 21% of healthcare costs are incurred by 1% of the total medical population, and chronic pain patients make up a substantial proportion of these high utilizers. Psychiatric comorbidity usually runs high in these groups, he noted.
The Medical Pain Service was set up to manage both pain and psychiatric comorbidity simultaneously. The outpatient clinic is run by Prakken and four advanced practice clinicians who have training in both pain management and psychiatry. The team focuses on optimizing pharmacologic management for these patients, but can refer patients to staff psychologists for behavioral interventions.
"We call this a functional pharmacology approach," Prakken explained. "We do an extensive look into what the pharmacology actually does for that patient -- not what it's assumed to do [or] even necessarily what the data show, but what actually occurs with each pharmacological intervention for the patient."
Prakken said he is fully integrated into the anesthesia department, and bills as "med surgery," which enables him to have 45-minute appointments with patients.
"We have 45-minute revisits every month, going through the process of using their medications," he said. "If they stabilize, we do every 3 months. We get the chance to take our time."
Prakken's group assessed 31 patients who were identified as high utilizers by Duke hospitalists, and looked into their expenditures and utilization before and after enrollment in the pan service.
Looking at various cost centers -- inpatient, outpatient, emergency department, labs -- they found a 55% reduction in charges and a 45% drop in costs after patients came to their program.
Total charges fell from $11.3 million before enrollment in the program to $5.1 million thereafter, and total costs fell from $2 million down to $1.1 million. When broken down annually, charges fell from $2.8 million to $1.2 million and costs fell from $509,000 to $278,000.
On a per-year, per-patient basis, charges dropped from $91,000 to $41,000, and costs from $16,000 to $7,000, they reported.
"Intensive outpatient treatment can be effective with this difficult population, and this multidisciplinary clinic is a unique element of this," Prakken said.
Prakken added that he is honest with patients when he describes the program to them. "I tell them 'I'm not going to be able to make your pain go away. I can manage your pain, but not to the point that you're going to have your life back the way you knew it. But I will get you to feel like you want the life you have ... that you can make it something you still enjoy,'" he said.
Disclosures
Prakken disclosed relevant relationships with Radius.
Primary Source
American Academy of Pain Medicine
Prakken S, et al "Cost savings associated with intensive outpatient pain management of Duke health system high utilizers" AAPM 2017; Abstract 181.