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Financial model for a transitional pain service at a large tertiary academic center in the USA
  1. Caroline S Zubieta1,2,
  2. Christina Shabet1,2,
  3. James Lin2,
  4. Aurelio Muzaurieta1,2,
  5. Akul Arora1,2,
  6. Nazanin Maghsoodi1,2,
  7. Chad M Brummett3,4,5 and
  8. Anthony Edelman3
  1. 1University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Michigan Ross School of Business, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
  4. 4Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
  5. 5Opioid Research Institute, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Anthony Edelman, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA; aedelman{at}med.umich.edu

Abstract

Approximately 1 in 10 patients undergoing surgery is considered at high risk for poor pain and opioid-related outcomes due to chronic pain or persistent opioid use prior to surgery, leading to increased hospital lengths of stay, emergency department visits, hospital readmissions, and worse long-term outcomes. Multidisciplinary transitional pain services (TPSs) have been shown to effectively identify and optimize high-risk patients before surgery, leading to a reduction in healthcare utilization. We conducted a series of semistructured interviews, a literature search, and a financial analysis to develop a reproducible business case for establishing a TPS. These interviews involved discussions with clinicians and administrators at Michigan Medicine, as well as leaders of TPS initiatives at peer institutions across the USA and Canada. The aim was to understand possible operational structures and potential sources of revenue and cost savings that needed inclusion in our model. Subsequently, the authors developed a modifiable financial modeling tool, which is freely available for download and adaptable to any healthcare institution. The model suggests that the primary source of cost savings can be attributed to a reduction in length of stay. Furthermore, several operational options exist for incorporating a TPS that performs at breakeven or positive net profit. This tool and these findings are important for informing health systems of operational and financial considerations when implementing a TPS program. Future research should evaluate this financial tool’s reproducibility in community health system contexts.

  • Analgesics, Opioid
  • Opioid-Related Disorders
  • Pain, Postoperative
  • Pain Management
  • Postoperative Complications

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @drchadb

  • Contributors All authors have contributed to all aspects of this work, including the conception and design of the work, the acquisition, analysis, or interpretation of data for the work, drafting the work or revising it critically for important intellectual content, providing final approval of the version to be published, and agreeing to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AE is the guarantor and responsible for the overall content.

  • Funding Funding from the Michigan Department of Health and Human Services.

  • Competing interests CMB is a consultant for Heron Therapeutics, Vertex Pharmaceuticals, Benter Foundation and Alosa Health, and he provides expert medical testimony. AE provides expert medical review and testimony. There are otherwise no disclosures.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.