Pain management procedures are in higher demand than ever, and that demand shows no sign of abating. If you have access to physicians certified in pain management, the high-volume, rapid-turnover procedures may be worth adding. If you already do pain management, you know continuous improvement is key to a well-run and profitable service. Here are 6 tips for safety, cost-effectiveness and operational efficiency from 3 busy pain management facilities.

1. Pursue referral routes
Here's how to keep your pain schedule booked.

• Physicians first. With only 1 physician-owner and a small full-time staff at the New England Pain and Wellness Center in Peabody, Mass., everyone does extra — including the owner. Julien Vaisman, MD, has been actively involved in marketing the facility.

"He gets on the phone to referring MDs to make sure they are happy with our care," says Helen Brownlie, RN, the director of nursing. "He maintains an open dialogue to referring MDs and follows up to maximize patient outcome."

• Specialist skills. Boston PainCare Center in Waltham, Mass., has a medical liaison who travels to physician offices in the region, discusses Boston Pain Care's approach to pain management and distributes literature on the center's behalf. "It helps that we have an active website (www.bostonpaincare.com) that lets physicians follow up and see that we offer other pain-related services, such as sleep studies and functional rehabilitation," says Kathleen Leitao, RN, MHM, CNOR, the director of surgical services.

2. Go on the denials offensive
The injuries that lead a patient to require interventional pain management often mean that workers' compensation is heavily in the payor mix, in addition to CMS and third-party insurers. As such, you have to be on your toes to keep denials from happening in the first place.

• Pre-screening and pre-authorization. The key to preventing denials is to have dedicated insurance staff, even if it's only 1 person, who checks eligibility, deductibles and co-pays. "This person must be able to discuss these issues with patients ahead of time to ensure continuous flow of average patient numbers in the ASC," says Ms. Brownlie.

Sherri Lewis, RN, CASC, the administrator at Advanced Surgical Concepts in Baton Rouge, La., notes that the insurance specialist must also stay on top of pre-authorization requirements to ensure pre-authorization is secured when necessary — and that patients aren't scheduled without it.

• Solid documentation. "In this era, physicians need to be well-educated with billing and codes," says Ms. Brownlie. "You can have a great insurance specialist — and I'm lucky, I do — but physicians can't be ignorant of codes and associated reimbursement." Watch the approved code lists for all payors and compile updates as they are issued, suggests Ms. Lewis.

• Thorough follow-up. Boston PainCare Center actively monitors patients' muscle strength and pain tolerances from Day 1. The facility also performs functional assessments before and at 6 and 12 months for patients receiving spinal cord implants, a newer procedure that may be closely scrutinized by payors. "As they graduate from interventions to functional rehab, the patients can see progress in a digital visual and quantitative data," says Ms. Leitao. "Even better, these are reports you can send to the insurance companies to help avoid denials."

Patients who are prescribed pain medications are thoroughly vetted in advance, and are routinely urine tested "to make sure drugs aren't being deviated from the patient," she says.

3. Structure the schedule
Because pain management procedures are typically short and not all require sedation, you don't have to tie yourself to the 5-days-a-week mentality.

At Boston PainCare, 4 10-hour days are used for procedures in the 2 procedure rooms, and Friday is reserved for administrative tasks and patient follow-up. Spinal cord stimulator implant procedures are done NPO first thing in the morning; patients in the second half of the day having interventional pain procedures either aren't NPO or are NPO for 6 hours pre-procedure if having moderate sedation. Physicians have the flexibility of taking 5- or 6-hour blocks most days, says Ms. Leitao.

At New England Pain and Wellness Center, pain procedures are performed Monday through Wednesday, with the occasional Thursday. Thursdays and Fridays are reserved for patient follow-up, sending reports, scheduling and other administrative tasks. The physician-owner uses that time to see patients in the office. "This model lets us do a lot of procedures and still get everything done efficiently with the most cost-effective use of staff," says Ms. Brownlie.

4. Seek out staff ideas
Because Ms. Brownlie relies on per diems (all of whom have been working with New England Pain Center for 10 or more years), her nurses are working in other facilities and observing other potential best practices when not working in the pain clinic. "This has led to some surprising ideas," she says. "In one case, it was as simple as helping us change our charting by weeding out the overlap and altering the flow to make more sense. In another, a nurse suggested we change to a cheaper slipper for patients to wear — and we actually saved a significant amount of money."

5. Recognize fall risk
Due to their pain and, in some cases, prescription pain medications, pain management patients may be at greater risk for falls. Ms. Leitao developed a fall-risk assessment and protocol as a preventive strike against falls (see "Fall Risk Assessment"). If a patient is deemed moderate- or high-risk:

• Place a notation in the comment section of the pre-assessment nursing record.
• Observe the environment for potential unsafe conditions.
• Place assisting devices within the patient's reach.
• Transport the patient via wheelchair throughout his time in the facility.
• Assign a staff member to accompany the patient to the restroom and remain with him. If the patient refuses assistance while in the restroom, he is instructed to pull the emergency cord before getting up.

6. Distinguish your center
About 3 years ago, 1 of the Boston PainCare Center's 3 board-certified interventionalists pursued training and added spinal cord stimulator implant procedures as a way to set the facility apart from the pain management pack. "Not everyone offers it," says Ms. Leitao. "But there are increasing worries about pain pumps, so it made sense. We do SCS trials, then full insertions if the trials are successful."