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A Cost-Analysis of an Interdisciplinary Pediatric Chronic Pain Clinic

  • Nicole E. Mahrer
    Correspondence
    Address reprint requests to Nicole E. Mahrer, PhD, Children's Hospital Los Angeles, University of Southern California University Center of Excellence for Developmental Disabilities, Department of Anesthesiology Critical Care Medicine, 4650 Sunset Blvd. MS#12, Los Angeles, CA 90027.
    Affiliations
    Children's Hospital Los Angeles, University of Southern California University Center of Excellence for Developmental Disabilities, Department of Anesthesiology Critical Care Medicine, Los Angeles, California
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  • Jeffrey I. Gold
    Affiliations
    Children's Hospital Los Angeles, University of Southern California University Center of Excellence for Developmental Disabilities, Department of Anesthesiology Critical Care Medicine, Los Angeles, California

    Keck School of Medicine, University of Southern California, Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, Los Angeles, California
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  • Michael Luu
    Affiliations
    Children's Hospital Los Angeles, University of Southern California University Center of Excellence for Developmental Disabilities, Department of Anesthesiology Critical Care Medicine, Los Angeles, California
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  • Patricia M. Herman
    Affiliations
    RAND Health, RAND Corporation, Santa Monica, California
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Published:October 17, 2017DOI:https://doi.org/10.1016/j.jpain.2017.09.008

      Highlights

      • Pediatric chronic pain is a costly condition requiring interdisciplinary treatment.
      • An interdisciplinary pain clinic reduced inpatient and emergency department visits.
      • Pain clinic participation resulted in hospital cost savings of $36,228/patient/year.
      • Pain clinic participation resulted in insurance cost savings of $11,482/patient/year.

      Abstract

      Chronic pain is characterized by high rates of functional impairment, health care utilization, and associated costs. Research supports the use of comprehensive, interdisciplinary treatment approaches. However, many hospitals hesitate to offer this full range of services, especially to Medi-Cal/Medicaid patients whose services are reimbursed at low rates. This cost analysis examines the effect on hospital and insurance costs of patients' enrollment in an interdisciplinary pediatric pain clinic, which includes medication management, psychotherapy, biofeedback, acupuncture, and massage. Retrospective hospital billing data (inpatient/emergency department/outpatient visits, and associated costs/reimbursement) from 191 consecutively enrolled Medi-Cal/Medicaid pediatric patients with chronic pain were used to compare 1-year costs before initiating pain clinic services with costs 1 year after. Pain clinic patients had significantly fewer emergency department visits, fewer inpatient stays, and lower associated billing, compared with the year before without interdisciplinary pain management services. Cost savings to the hospital of $36,228 per patient per year and to insurance of $11,482 per patient per year were found even after pain clinic service billing was included. Analyses of pre-pain clinic costs indicate that these cost reductions were likely because of clinic participation. Findings provide economic support for the use of interdisciplinary care to treat pediatric chronic pain on an outpatient basis from a hospital and insurance perspective.

      Perspective

      This article presents a cost analysis of an interdisciplinary pediatric pain outpatient clinic. Findings support the incorporation of a comprehensive treatment approach that can reduce costs from a hospital and insurance perspective over the course of just 1 year.

      Key words

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