NEW ORLEANS—More than 20% of patients who are anticipating surgery take preoperative opioids. Such patients have higher rates of surgical complications and consume more health-system resources than those who do not use preoperative opioids. Transitional pain service (TPS) programs, which optimize patients’ pain management before and after surgery, improve outcomes in patients who enter surgery taking opioids and act as a lever for reducing the costs associated with these
FEBRUARY 5, 2024
Can Transitional Pain Services Improve Hospitals’ Bottom Line?
NEW ORLEANS—More than 20% of patients who are anticipating surgery take preoperative opioids. Such patients have higher rates of surgical complications and consume more health-system resources than those who do not use preoperative opioids. Transitional pain service (TPS) programs, which optimize patients’ pain management before and after surgery, improve outcomes in patients who enter surgery taking opioids and act as a lever for reducing the costs associated with these patients.
“Many institutions are considering the adoption of TPS. However, they are unsure of how to assess the potential costs and benefits of such a program,” said Caroline S. Zubieta, MD, an MBA candidate at the University of Michigan Medical School, in Ann Arbor.
Zubieta and her co-investigators presented a modifiable tool that helps hospitals analyze the costs and benefits of implementing TPSs at the 2023 Annual Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine.
The tool is provided to the public free of charge through the Opioid Prescribing Engagement Network at the University of Michigan (https://michigan-open.org/resource/ transitional-pain-service-financial-tool/ ), and assists hospital systems in understanding the potential costs, savings and revenue associated with a TPS. The following quantifiable outputs are generated by its use:
- predicted total cost to implement a TPS program;
- predicted hospital cost reductions from decreasing hospital length of stay (LOS), ER visits and readmissions;
- predicted revenue from health insurance reimbursement of TPSs;
- predicted revenue opportunities for filling additional inpatient beds as a result of reduced hospital LOS; and
- gross profit, net profit and overall return on investment.
To build the tool and train it with the correct information, the researchers consulted doctors, nurses, directors of TPS programs globally and health economists. The model makes several assumptions based on these expert consultations:
- an exponential decline of hospital costs as LOS increases;
- three times the average daily cost of a stay is attributed to the first day of admission, and all additional costs are equally distributed to subsequent days;
- the total cost of a high-risk patient’s stay is 12% higher than the average surgical patient;
- LOS for high-risk patients is 8.4 days;
- LOS reduction from TPS implementation for a high-risk population is 10%;
- readmission rate due to postoperative pain in the high-risk patient cohort is 5%, and LOS of readmission is assumed to be two days;
- the daily cost of readmission is same as average daily cost of initial stay; and
- no revenue loss from reduction in emergency department visit rate after TPS implementation.
“Our conclusion is that, for many operational models, the overall revenue and cost savings to the hospital will be equal to or greater than the total costs associated with the TPS,” Zubieta said. However, she warned that the assumptions that guide her model and the conclusion that TPSs will save hospitals money may not be applicable to all healthcare systems.
“The work by Zubieta and colleagues supports the notion that the primary costs involved in starting a transitional pain service are staffing related. However, this cost will not be the same for every institution and may even represent a marginal increase if transitional pain service functions are added to an existing service (e.g., acute or chronic pain service, pre-anesthesia evaluation),” said Edward R. Mariano, MD, of the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine, in California.
“Since the savings generated by a transitional pain service generally benefit the institution and not the anesthesiology or pain medicine practice directly, the hospital or healthcare system should support the staffing needs of the service,” Mariano said.
—Myles Starr
Mariano and Zubieta reported no relevant financial disclosures.
