The high cost of chronic pain does not deliver the quality of care that over a million Minnesotans need. We are not alone. More than 100 million Americans suffer every day, and the incidence of chronic pain is rising. It is higher for women, minorities and individuals with lower socioeconomic resources. Chronic pain is a chronic disease and needs attention.
Individuals with chronic pain are less healthy and productive. They use more social, medical and governmental services, including Medicaid. A patient with chronic pain spends seven to 10 times more on health care per year than a similar person without pain (from “Analysis of Longitudinal Data from the Medical Expenditure Panel Survey,” Health Services Research). This equates to almost $635 million dollars per year nationally, combining health care costs and lost productivity (“The Economic Costs of Pain in the United States,” Journal of Pain).
Occurrence is rising
We spend more money treating chronic pain than we spend treating cancer, diabetes and heart disease combined. But the occurrence of chronic pain is rising. This is not a sustainable situation. The consequences of not addressing this issue can be fatal.
There are several issues that have led to costly, ineffective care for individuals with chronic disease. Physicians poorly utilize mental and behavioral health services, thus not addressing the psychosocial connections to pain. Patients and providers do not understand the nature and causes of pain. They search without focus for answers without employing good pain education resources. Patients tend to seek out more technologically advanced and costly treatments even when there is no evidence to support them as the best options.
Consequences include substance abuse, overdoses, death
There are many consequences to our broken system. There has been a significant increase in use of opioids, with tragic and ineffective outcomes. The rate of substance abuse, overdose and death is rising. The rate of costly interventional and injection procedures for pain in Minnesota has continued to rise without producing results. Patients have limited incentives to seek out less costly interventions and self-care. The diagnosis of chronic pain continues to have a negative stigma. It is costing our communities too much not to address our failed system.
Minnesota’s Medicaid program has an opportunity to do more to address this problem. How health care services are paid drives up the cost of care. We still use a fee-for-service model that promotes fragmented care without emphasis on outcomes, preventive care or long-term management. These are all things needed to address a chronic disease.
Previous national and state-level policies have been shortsighted. Decreasing payments to rehabilitation and mental health services providers limits short-term spending, but does not control our long term costs. Decreased regulation of pain clinics have led to “pill mills,” which are facilities that focus solely on the distribution of medication not the holistic control of pain. This model leads to increased narcotic output, without regard to the personal, political or social consequences. Increased focus on pain ratings at point of service improves awareness of pain but does nothing to address pain in a long term, meaningful way. After a physician asks about pain, they are required to treat it, even if they are not qualified.
The multidisciplinary model
Chronic pain must be treated as a chronic disease. Pain must be treated in a systematic and holistic way, like diabetes. The best option is the multidisciplinary pain management clinic. The multidisciplinary model teaches self-care and pain education, employs complementary or alternative treatments, addresses the psychosocial aspects of pain and provides safe, effective medical management of pain. Multidisciplinary pain clinics are more cost effective and provide better long-term outcomes for those with chronic pain.
If Medicaid reimbursed for multidisciplinary pain clinic services, we could put the pieces of our fragmented care system together again. Support for one discipline or one educational program does not go far enough. This is a complex problem. We need creative, multifaceted solutions to address our health and fiscal goals.
Minnesota needs Medicaid to support individuals who suffer from chronic pain. Medicaid reimbursement of the multidisciplinary model will address the treatment and cost of chronic pain management in a more complete way. It can create a successful model of chronic disease management for the many Minnesotans who suffer in silence or have been cast aside for malingering. It can control costs and deliver better outcomes. Medicaid can be a social driver for financial stability in the quality treatment of chronic pain.
Sara Chapo Rippe, MPT, is a physical therapist who earned her master’s degree in physical therapy from the Mayo School of Health Related Sciences.
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