One late winter afternoon, an 85 year old previous patient called our office in tears wanting to come back for an evaluation of a new crippling back pain. We were happy to see him the following day. His insurance plan required a primary care provider (PCP) referral. We called the patient’s PCP for the referral and were told – “NO.” The reason provided was that the PCP belonged to a hospital owned provider network and the patient “had” to be referred to the pain management program owned by said hospital. The wait time was months for an appointment.
Thankfully, an exception was made by the PCP’s office, a referral was subsequently obtained, the patient was seen immediately, and a treatment the following day provided 100% relief of his pain. It is most disturbing to imagine one suffering with intractable pain has to then suffer with the anxiety of whether or not he will get the care he needs.
Patients should have open and transparent choices in terms of where they seek care.
Here’s what you need to know when selecting a pain specialist.
Provider Networks are intended to limit your options: Most primary care providers these days are hospital employees or belong to provider networks which severely limit their autonomy and independence. An unspoken reality is that the administrative powers that be monitor closely referral patterns of the employed providers. Consideration of sending patients to the best trained and most experienced specialists is not made.
Incentives are created to keep you in house - Providers typically receive bonuses yearly that are reduced if they send patients to out-of-network providers (i.e. to truly independent practices). Patients are steered to providers that benefit the referring provider, not necessarily the patient.
Higher Costs - Care provided in hospitals and surgical centers is more expensive to the patient then care provided in the office setting. Referring physicians often do not consider this factor when referring their patients to specialists.
All patients should look for the following when seeking a pain specialist:
Level of Expertise includes fellowship training, Board Certification, leadership positions, and publications.
Approach to pain management - i.e. more medications vs non surgical injection type treatments, and comprehensive approach with personalization of care
Office benefits - small office setting provides compassionate care with excellent efficiency. highly skilled staff and getting your treatment approved by your insurance
Comprehensive care - Speedy appointments, office responsibility and follow through, at a lower cost setting.
We owe it to our patients to provide them with options that are going to be best for them in obtaining the specific care they need.
It is concerning and disturbing when PCPs don’t send their patients to our office, but will send themselves personally or family members. Patients should have open and transparent choices in terms of where they seek care. They should be able to determine which expert, which practice setting/location, and wait time is appropriate for their needs. When we purchase a house or a car, we are able to make decisions that best provide for us individually. Decisions regarding one’s health are much more important and patients should have the ultimate say in these matters.