Multidisciplinary Transitional Pain Services (TPS) are effective resources in identifying high-risk patients before surgery, resulting in the utilization of reduced health care, according to “Financial Model for a Transitional Pain Service at a Large Tertiary Academic Center in the United States,” a special article published in Regional Anesthesia & Pain Medicine in December 2023.

“Although the upfront fixed costs necessary to launch a TPS are significant, a TPS would be a wise long-term investment because of improved quality of care for high-risk patients and subsequent cost-savings,” the article explains.

With roughly one in ten patients considered to be high risk for poor pain before undergoing surgery, the utilization of hospitalization resources (ie, lengths of hospital stay, readmissions, etc) increases. With the length of hospital stay as a predominant cost driver for health systems, TPS could result in a net positive profit margin. As the quality of patient care is improved, the various operational models of TPS could lead to greatly increased profit margins.

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"In today’s health care environment, it is critical for clinicians to be able to understand cost and revenue drivers for each service line." - Dr. David Provenzano

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“I commend the authors for all their efforts on developing and making available a financial model for a multidisciplinary TPS”, David Provenzano, MD, President of the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine), states. “Managing pain beyond an acute episode successfully requires institutional resources and investments in a clinical service that has associated financial costs. In today’s health care environment, it is critical for clinicians to be able to understand cost and revenue drivers for each service line. No one would argue about the clinical benefits of a TPS, and the service line clearly fits in ASRA Pain Medicine’s mission and vision. Unfortunately, even if a clinical service has a clinically significant benefit, it is hard to get stakeholder buy-in (eg, hospital administration and insurance payors) without a clear financial picture that hopefully demonstrates financial self-sufficiency. This article provides a landscape on the economic considerations for a TPS implementation. I genuinely believe this article and its associated findings will be hopeful to the pain and health care communities as TPS get implemented into more clinical care pathways and health care institutions. As the authors clearly state, we would encourage additional research to find if this model is applicable to other health care situations outside of large academic medical centers.”

While initially somewhat costly, the implementation of TPS would not only eliminate unnecessary expenditures in health systems, but would drastically improve the quality of care for high-risk surgical patients.

President-Elect of ASRA Pain Medicine Steven Cohen, MD, shares, “Medicine is a business. There are interventions for chronic pain such as pulsed and heat radiofrequency that are accompanied by strong evidence but are routinely denied by payers. Inpatient pain and TPS are two areas in which there is clear benefit to patients and institutions—especially in a global marketplace—but which are hard to make profitable. In this study by Zubieta et al, the authors provide a framework by which a TPS can break even, or even be made profitable. For surgical services, patient care advocates, primary care providers, and hospital administrators, finding ways to operationalize a TPS is essential.”