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Making a business plan for starting a transitional pain service within the US healthcare system
  1. Eric C Sun1,2,
  2. Edward R Mariano1,3,
  3. Samer Narouze4,
  4. Rodney A Gabriel5,
  5. Hesham Elsharkawy6,7,
  6. Padma Gulur8,
  7. Sharon K Merrick9,
  8. T Kyle Harrison1,3 and
  9. J David Clark1,3
  1. 1 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California, USA
  3. 3 Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
  4. 4 Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
  5. 5 Departments of Anesthesiology and Biomedical Informatics, University of California San Diego, La Jolla, California, USA
  6. 6 Department Anesthesiology, Pain and Healing Center, MetroHealth Case Western Reserve University, Cleveland, Ohio, USA
  7. 7 Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
  8. 8 Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
  9. 9 Director of Payment and Practice Management, American Society of Anesthesiologists, Park Ridge, Illinois, USA
  1. Correspondence to Dr Edward R Mariano, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California 94304, USA; emariano{at}stanford.edu

Abstract

Chronic pain imposes a tremendous economic burden of up to US$635 billion per year in terms of direct costs (such as the costs of treatment) and indirect costs (such as lost productivity and time away from work). In addition, the initiation of opioids for pain is associated with a more than doubling of pharmacy and all-cause medical costs. The high costs of chronic pain are particularly relevant for anesthesiologists because surgery represents an inciting event that can lead to chronic pain and long-term opioid use. While the presence of risk factors and an individual patient’s postoperative pain trajectory may predict who is at high risk for chronic pain and opioid use after surgery, to date, there are few interventions proven to reduce these risks. One promising approach is the transitional pain service. Programs like this attempt to bridge the gap between acute and chronic pain management, provide continuity of care for complicated acute pain patients after discharge from the hospital, and offer interventions for patients who are on abnormal trajectories of pain resolution and/or opioid use. Despite awareness of chronic pain after surgery and the ongoing opioid epidemic, there are few examples of successful transitional pain service implementation in the USA. Key issues and concerns include financial incentives and the required investment from the hospital or healthcare system. We present an economic analysis and discussion of important considerations when developing a business plan for a transitional pain service.

  • acute pain
  • chronic pain
  • economics

Data availability statement

All data relevant to the study are included in the article.

https://doi.org/10.1136/rapm-2021-102669

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    Data availability statement

    All data relevant to the study are included in the article.

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    Footnotes

    • Twitter @EMARIANOMD, @NarouzeMD, @kaohesham

    • Contributors ECS helped develop the project, performed the literature review, drafted and revised the initial manuscript, reviewed and approved the submitted manuscript. ERM helped develop the project, performed the literature review, reviewed and approved the submitted manuscript. SN helped develop the project, drafted and revised the initial manuscript, reviewed and approved the submitted manuscript. RAG helped develop the project, drafted and revised the initial manuscript, reviewed and approved the submitted manuscript. HE helped develop the project, drafted and revised the initial manuscript, reviewed and approved the submitted manuscript. PG drafted and revised the initial manuscript, reviewed and approved the submitted manuscript. SKM drafted and revised the initial manuscript, reviewed and approved the submitted manuscript. TKH drafted and revised the initial manuscript, reviewed and approved the submitted manuscript. JDC helped develop the project, drafted and revised the initial manuscript, reviewed and approved the submitted manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer The contents do not represent the views of the Department of Veterans Affairs or the United States Government.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.