Multidisciplinary Chronic Pain Treatment: Minimizing Financial Risk

Chronic Pain Management: Guidelines for Multidisciplinary Program Development

Volumn , Issue , 2007, Pages 241-262

  Kulich, Ronald J ^a,b,c   Adolph, Michael ^d  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE   (United States)

^c HARVARD MEDICAL SCHOOL   (United States)

^d OHIO STATE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 79953063107     PISSN: None     EISSN: None     Source Type: Book    
DOI: 10.3109/9781420045130-15     Document Type: Chapter

References (73)

1. Studin I. Marketing to managed care organizations. In: Lande SD, Kulich RJ, eds. Managed Care and Pain. Glenview, IL: American Pain Society; 2000:71-86.
2. Lande SD, Kulich RJ. Managed Care and Pain. Glenview, IL: American Pain Society; 2000.
3. Varga CA. Starting a pain clinic. In: Boswell MV, Cole BE, eds. Weiner’s Pain Management:A Practical Guide for Clinicians, 7th edn. Boca Raton, FL: CRC Press; 2006:1531-1540.
4. Tinsley R. Managed Care Contracting: Successful Negotiation Strategies. Chicago, IL:American Medical Association; 1999.
5. Plocher DW. Disease management and return on investment. In: Kongstvedt PR, Plocher DW, eds. Best Practices in Medical Management. Gaithersburg, MD: Aspen Publishers; 1998.
6. Kongstvedt PR, Plocher DW: Best Practices in Medical Management. Gaithersburg, MD: Aspen Publishers; 1998.
7. Banja J. Bad Ethics, bad business. Part II: ethical considerations for achieving economic stability in physician group practices. J Quality Health Care 2002; 1:12-15.
8. Page L. Capitation at the crossroads: the trend back to fee for service. Am Med News 2001; 44:17.
9. Banja J. Bad ethics, bad business. Part I: ethical considerations for achieving economic stability in physician group practices. J Quality Health Care 2002; 1:6-11.
10. Shapiro DE. Ensuring cash flow. In: DeKaye AP, ed. The Patient Accounts Management Handbook. Gaithersburg, MD: Aspen Publishers; 1997:167-182.
11. Schneider RJ, Mandelbaum SP, Graboys K, et al. Process-centered revenue-cycle management optimizes payment process. Healthc Financ Manage 2001; 55:63-66, 68-69.
12. Berger S. Managing the revenue cycle. Patient Acc 2003; 26:4-5.
13. Davison J, Lewis M. Working with Insurance and Managed Care Plans: A Guide for Getting Paid. Los Angeles, CA: PMIC; 1999.
14. LaForge RW, Tureaud JS. Revenue-cycle redesign: honing the details. Healthc Financ Manage 2003; 57:64-71.
15. DeKaye AP. Measuring monthly performance. In: DeKaye AP, ed. The Patient Accounts Management Handbook. Gaithersburg, MD: Aspen Publishers; 1997.
16. Schlesinger M, Quon N, Wynia M, et al. Profit-seeking, corporate control, and the trustworthiness of health care organizations: assessments of health plan performance by their affiliated physicians. Health Serv Res 2005; 40:605-645.
17. Tollison CD, Kriegel ML. Interdisciplinary Rehabilitation of Low Back Pain. Baltimore, MD: Williams & Wilkins; 1989.
18. Kulich R. Functional restoration treatment agreement. In:Wittink H, Hoskins Michel T, eds. Chronic Pain Management for Physical Therapists, 2nd edn. Boston, MA:Butterworth-Heinemann; 2002:157-158.
19. McGeary DD, Mayer TG, Gatchel RJ. High pain ratings predict treatment failure in chronic occupational musculoskeletal disorders. J Bone Joint Surg Am 2006; 88:317-325.
20. Hildebrandt J, Pfingsten M, Saur P, et al. Prediction of success from a multidisciplinary treatment program for chronic low back pain. Spine 1997; 22:990-1001.
21. Chapman S. Chronic pain rehabilitation: lost in a sea of drugs and procedures? Am Pain Soc Bull 2000; 10:8-9.
22. Thompson AA, Strickland AJ. Strategic Management: Concepts and Cases. Boston, MA: McGraw-Hill/Irwin; 2003.
23. Donaldson L. The Contingency Theory of Organizations. Thousand Oaks, CA: Sage Publications; 2001.
24. Turk D. Progress and directions for the agenda for pain management. Am Pain Soc Bull 2004; 14:3-13.
25. Cigich S. Actuarial services in an integrated delivery system. In: Kongstvedt P, ed. The Managed Health Care Handbook, 4th edn. Gaithersburg, MD: Aspen Publishers; 2001:971-976.
26. Pickett JP: The American Heritage Dictionary. New York: Dell Publishing; 2001.
27. Tindall WN. A guide to Managed Care Medicine. Gaithersburg, MD: Aspen Publishers; 2000.
28. Kongstvedt PR. The Managed Health Care Handbook. Gaithersburg, MD: Aspen Publishers; 2001.
29. Kongstvedt PR. Common operational problems in managed health care plans. In:Kongstvedt PR, ed. The Managed Health Care Handbook, 4th edn. Gaithersburg, MD: Aspen Publishers; 2001:886-903.
30. Friedman M. The social responsibility of business is to increase its profits. The New York Times Magazine. New York: The New York Times Company; September 13, 1970.
31. Emery DR, Finnerty JD, Stowe JD. Principles of Financial Management. Upper Saddle River, NJ: Prentice Hall; 1998.
32. Group Health Association of America: HMO Industry Profile, 1994 edn. Washington, DC: GHAA; 1994.
33. Cunningham PJ, Kohn L. Health plan switching: choice or circumstance? Health Aff (Millwood) 2000; 19:158-164.
34. No author listed. Watch out for Medicare HMO disenrollment as high as 42%. Public Sect Contract Rep 1997; 3:13-15.
35. Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: A meta-analytic review. Pain 1992; 49:221-230.
36. Turk DC. Efficacy of multidisciplinary pain centers: an antidote to anecdotes. Baillieres Clin Anaesthesiol 1998; 12:103-119.
37. Blumenthal D. Employer-sponsored insurance-riding the health care tiger. N Engl J Med 2006; 355:195-202.
38. Graziano C. DMAA Details Progress on Predictive Modeling “Buyer’s Guide.” Society of Actuaries/DMAA Predictive Modeling and Risk Adjustment Seminar, Chicago, IL, 2006.
39. Blyth FM, March LM, Brnabic AJ, et al. Chronic pain and frequent use of health care. Pain 2004; 111:51-58.
40. Lippe G. Operational underwriting in managed care organizations. In: Kongstvedt PR, ed. The Managed Health Care Handbook, 4th edn. Gaithersburg, MD: Aspen Publishers; 2001:997-999.
41. Lande S. The Problem of pain in managed care. In: Lande SD, Kulich RJ, eds. Managed Care and Pain. Glenview, IL: American Pain Society; 2000:15-36.
42. Proctor TJ, Mayer TG, Gatchel RJ, et al. Unremitting health-care-utilization outcomes of tertiary rehabilitation of patients with chronic musculoskeletal disorders. J Bone Joint Surg Am 2004; 86-A:62-69.
43. Centers for Medicare & Medicaid Services (CMS) H: Medicare Program; Medicare Prescription Drug Benefit, 42 CFR Parts 400, 403, 411, 417, and 423. Fed regist 1995; 70:4221-4497.
44. Gray BH. Trust and trustworthy care in the managed care era. Health Aff (Millwood) 1997; 16:34-49.
45. Kulich RJ. Comprehensive HMO legislation: an opportunity for better access. Am Pain Soc Bull 1999; July/August 9(4):5-9.
46. Biskupiak JE, Chofoff P, Nash D. Disease management in managed care organizations. In: Todd WE, Nash DB, eds. Disease Management: A Systems Approach to Improving Patient Outcomes. Chicago, IL: American Hospital Publishing; 1997.
47. Gatchel RJ, Polatin PB, Noe C, et al. Treatment-and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study. J Occup Rehabil 2003; 13:1-9.
48. Keel PJ, Wittig R, Deutschmann R, et al. Effectiveness of in-patient rehabilitation for sub-chronic and chronic low back pain by an integrative group treatment program (Swiss Multicentre Study). Scand J Rehabil Med 1998; 30:211-219.
49. Hall MA. Health insurers’ medical necessity determinations for bariatric surgery. Surg Obes Relat Dis 2005; 1:86-90.
50. Murphy-Barron CM. Can we design a fair benefit for bariatric surgery? Manag Care 2006; 15:35-36, 39-40.
51. Choban P, Lu B, Flancbaum L. Insurance decisions about obesity surgery: a new type of randomization? Obes Surg 2000; 10:553-536.
52. Teugels JL, Sundt B. Encyclopedia of Actuarial Science. Hoboken, NJ: Wiley; 2004.
53. Galvin RS, Delbanco S. Between a rock and a hard place: understanding the employer mind-set. Health Aff (Millwood) 2006; 25:1548-1555.
54. Mechanic RE. What will become of the medical mecca? Health care spending in Massachusetts. Health Aff (Millwood) 2003; 22:130-141.
55. Mechanic R, Coleman K, Dobson A. Teaching hospital costs: implications for academic missions in a competitive market. JAMA 1998; 280:1015-1019.
56. Loeser JD. The future. Will pain be abolished or just pain specialists? Minn Med 201; 84:20-21.
57. Loeser JD. Pain and suffering. Clin J Pain 2000; 16:S2-S6.
58. Mayer T, Tabor J, Bovasso E, et al. Physical progress and residual impairment quantification after functional restoration. Part I: lumbar mobility. Spine 1994; 19:389-394.
59. Rogers E. Diffusion of Innovations. New York: Free Press; 2003.
60. Kipp RA, Towner WC, Levin HA. Financial and actuarial issues. In: Todd WE, Nash DB, eds. Disease Management: A Systems Approach to Improving Patient Outcomes. Chicago, IL: American Hospital Publishing; 1997.
61. Cicala RS, Wright H. Outpatient treatment of patients with chronic pain: an analysis of cost savings. Clin J Pain 1989; 5:223-226.
62. Simmons JW, Avant WS, Jr, Demski J, et al. Determining successful pain clinic treatment through validation of cost effectiveness. Spine 1988; 13:342-344.
63. Caudill M, Schnable R, Zuttermeister P, et al. Decreased clinic use by chronic pain patients: response to behavioral medicine intervention. Clin J Pain 1991; 7:305-310.
64. Plocher DW. Fundamentals and core competencies of disease management. In:Kongstvedt PR, ed. The Managed Health Care Handbook, 4th edn. Gaithersburg, MD: Aspen Publishers; 2001:402-412.
65. Simpson JM, Klar N, Donnor A. Accounting for cluster randomization: a review of primary prevention trials, 1990 through 1993. Am J Public Health 1995; 85:1378-1383.
66. Varnell SP, Murray DM, Janega JB, et al. Design and analysis of group-randomized trials: a review of recent practices. Am J Public Health 2004; 94:393-399.
67. Loyd R, Fanciullo GJ, Hanscom B, et al. Cluster analysis of SF-36 scales as a predictor of spinal pain patients response to a multidisciplinary pain management approach beginning with epidural steroid injection. Pain Med 2006; 7:229-236.
68. Fanciullo GJ, Hanscom B, Weinstein JN, et al. Cluster analysis classification of SF-36 profiles for patients with spinal pain. Spine 2003; 28:2276-2282.
69. American Pain Foundation. http//www.painfoundation.org. Accessed 12/1/2006.
70. Partners Against Pain. Your Around-the-Clock Resource for Pain Management. Available at http://www.partnersagainstpain.com/painadvocacycommunity/Accessed 12/1/2006.
71. Pollack R, Slass L. Premium Pay: Corporate Compensation in America’s HMOs. Washington, DC: Families USA Foundation; 1998:24.
72. Schatman M. The demise of the multidisciplinary chronic pain management clinic:Bioethical perspectives on providing optimal treatment when ethical principles collide. In: Schatman M, ed. Ethical Issues in Chronic Pain Management. New York:Informa Healthcare; 2007:43-62.
73. Schatman M. The demise of multidisciplinary pain management clinics? Pract Pain Manage 2006; 6:30-41.