Friday, February 24, 2012

Moving patients from drugs to independence

Last week I visited two facilities in California that are successfully doing what we all want done – transitioning injured workers to non-narcotic methods to manage their chronic pain.  I often hear a cynicism regarding effectiveness/cost as “pain management clinics” have accumulated a bad reputation over time for high expense and high recidivism rate.   After detailed in-person discussions and evaluation of case studies, I believe these two have shown success that break the mold:
  • Savvy Health Solutions: The F.I.T. Academy (Functional Intervention Training) program works outside of the medical model to restore function by treating the whole person in a fitness environment.  They challenge the physical, intellectual and motivational components of the person, with an ultimate goal of independence and personal responsibility and maximized ADL’s.  As long as the injured worker doesn’t need medical oversight during the detox process, they will work in conjunction with the treating physician and employer and claims adjuster to define the most appropriate path to the goal.  Founder Paul Wright says it takes patience (approximately 40 sessions over 4-5 months), but he showed me several pictorial examples of “before” and “after” (even meeting one of their patients) and their data that showed a 69% decrease in WC claim costs and 65% reduction in the length of open claims.
  • Pacifica Pain Management Services: Dr. Gary Mills has created a comprehensive non-narcotic pain management program that lessens pain by emphasizing pain syndrome management and reducing drugs, depression and dysfunction.  In some cases an in-patient detox with full medical supervision is required, but the residential inpatient approach (with a 60% individual / 40% group model and 2:1 staff to patient ratio) allows their team of MD, PhD, PT and personal trainers to recalibrate how the patient deals with pain through a full daily schedule for 4-6 weeks.  Interestingly, they mandate a 1-year contract of continuous engagement with the treating physician and claims adjuster (and visits every 2 weeks) to be the continued conscience.  Their outcomes (69-72% stay “clean” when they fully exit the program) exceed the industry (typical goal of 50%).
While these two facilities are focused on northern California, there are others (like Solutions Recovery in Las Vegas, whom I’ve also vetted) that likewise have solid methods and positive results.  The key I have found is patience – while guidelines typically suggest 6-8 weeks / 180 hours for a FRP (functional restoration program), that likely isn’t enough time to enact lifetime changes.

When judging a pain management or functional restoration program, the first questions must be:
  1. Show me examples where you’ve been successful
  2. Show me your recidivism rate
Without demonstrated success of transitioning patients to a lifetime of managing their chronic pain without narcotics, you will likely be throwing your money away.

One of my projects this year is to identify centers of excellence because our corporate goal (and my personal goal) is to get patients off harmful drugs, whatever the method.  So if you have suggestions of other successful facilities I would be pleased to hear from you.

In this together – Mark

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