Currently, the leading value-based payment outcome is prevention of hospital re-admissions. The reason most likely is that re-admission is an outcome that:
- Both providers and payers could agree on
- Is easily measured
- Holds value by reducing health care costs while assuming improvement in quality care
This goal is not directly patient centric. I have not heard a patient say, “Now that I have survived my heart attack, my goal now is to not come back to the hospital for the next 30 days.”
Would this be the leading value-based campaign that patients chose?
How about “Got Pain?” Wouldn’t resolving a patient’s pain condition while improving functional status be an outcome that patients, providers and payers all agree holds value and is easily measured?. Let’s explore the value proposition of why it makes sense that pain and function should be the leading value-based payment metrics.
According to 2011 Institute of Medicine report, “Relieving Pain in America“, more than 100 million Americans suffer from chronic pain, and the costs are higher than that of heart disease, diabetes and cancer combined. Chronic pain with resultant loss of function is a $600+ billion opportunity for a health care “pay for performance” system. A patient in moderate to severe pain has on average an of over $5000 in excess medical costs per year with lost productivity of over one month per year. And 20% of the U.S. population fit into this moderate-to-severe category. Pain cuts across all demographics, e.g., chronic pain has increased over 800% in children during the past 10 years.
These statistics point out that what health care is doing for chronic pain (e.g. drugs, injections, surgery, physical therapy, chiropractic) is not the solution. Today’s medical care for chronic pain is of low value, high cost, and only marginal outcomes. I would like to focus on opioids, since this is by far the most common form of pain “management” that is utilized and over utilized to the point of crisis. The opioid crisis should be looked at as a symptom of an underlying problem: A Chronic Pain Epidemic! This has been eloquently pointed out in the book, “A Nation in Pain: Healing our Biggest Health Problem” by Judy Foreman.
The CDC reported that in 2012, health care providers in the US wrote 259 million opioid painkiller prescriptions, and that the “increase in painkiller prescribing is a key driver of the increase in prescription overdoses”. What is fueling this demand for painkillers? Is this because we are a nation of addicts and drug seekers? I believe that it is because we are a nation seeking relief from pain. And physicians, with few other tools to effectively impact pain, have responded to this demand by prescribing Vicodin and Oxycontin and other opiates for a noble purpose- to alleviate pain and suffering.
Unfortunately, the unwitting opioid experiment for relief of chronic pain has failed. This is not surprising, give that pain is not caused by an opioid deficiency. The focus should be to resolve chronic pain by finding the elusive “root cause”. (I will cover this in my next post). Living in chronic pain seems to be treated as an inevitable “inalienable right” for more than 30% of citizens in the U.S. I think this a myth that needs to be dispelled. Now what? Continue reading