Article

The entire American health care system is turning upside down, except for the
parts that aren't- yet. For physiatrists who manage pain problems, the future is
complex. The usual challenge of treating these devastating and costly problems
that cannot be measured physiologically is compounded by the requirement to do so
in a health care system that doesn't know what it wants to be yet. Payment,
regulation, and the very structure of practice are changing at a pace that is
halting and unpredictable. Nonetheless, knowledge about some structures is
necessary, and some themes almost certainly emerge.
I propose that the role of
the pain physiatrist is best understood through a soccer analogy. Whereas the
casual spectator of the past might note the goals scored by surgical colleagues
and shots missed by primary care partners, sophisticated health care systems of
the future will learn that the pain game is won by creating a strong physiatry
midfield. Physiatrists can reach to the backfield to help primary care with tough
cases, send accurate referrals to surgeons, and reorganize the team when chronic
pain complicates the situation. Current and emerging payment structures include
insurance from government, employers, or individuals. Although the rules may
change, certain trends appear to occur: Individuals will be making more choices,
deductibles will increase, narrow groups of practitioners will work together,
pricing will become important, and the burden on primary care colleagues will
increase. Implications of each of these trends on pain medicine and specific
strategy examples are addressed. A general concept emerges that, although
procedure- and activity-based practice is still important, pain physiatrists can
best prepare for the future by leading programs that create value for their
health care system.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc.
All rights reserved.

Langue : ANGLAIS