Celéri Partners with Guam Regional Medical City for a First-of-its-Kind Pain Safety Net Pilot

January 2024 – 

PRESS RELEASE – January 8, 2024. Conshohocken, PA – Celéri Health is pleased to announce its collaboration with Guam Regional Medical City on a first-of-its-kind pain safety net program.

Guam Regional Medical City treats a large population of pain patients experiencing neuropathy, musculoskeletal pain, cancer pain, etc across its various service lines such as neurosurgery,  orthopedics, cancer, cardiovascular, endocrinology – and interventional & chronic pain.  The Pain Safety Net Program at Guam Regional Medical City will pilot in the neurosurgery service to comprehensively engage with patients receiving spinal cord stimulation treatment.  The Safety Net Program will dynamically connect with patients experiencing pain to uniquely connect them with their provider and their pain recovery program.  The “safety net” portion of the program alerts providers when patient’s pain hits certain thresholds. Through the Celéri Health technology platform and products, patients can share their daily pain, how pain is interfering with their daily lives, pain improvement and much more. They can also share real-time needs with their care team and receive in-application education around spinal cord stimulation.

Spinal cord stimulation (SCS) is a proven long-term and effective therapy for managing chronic pain.  SCS disrupts pain signals traveling between the spinal cord and the brain. The potential benefits of SCS can be improved ability to function, and often more effective than repeat surgeries for pain,
Multiple studies have provided clinical evidence to suggest some patients treated with spinal cord stimulation (SCS) may be able to reduce oral opioid consumption.  Patients often experience profound pain relief of 80% or more through the use of spinal cord stimulation .1

About Guam Regional Medical City. The Guam Regional Medical City is a 136-bed privately run acute care hospital in Dededo, Guam. It is managed under the Philippines-based hospital network, The Medical City. It serves the US territory of Guam as well as neighboring Micronesia, the Northern Marianas, Palau and the Marshall Islands. Read about them here: https://www.grmc.gu/

1 Fishman M, Cordner H, Justiz R, et al. 12-Month Results from Multicenter, Open-Label, Randomized Controlled Clinical Trial Comparing Differential Target Multiplexed Spinal Cord Stimulation and Traditional Spinal Cord Stimulation in Subjects with Chronic Intractable Back Pain and Leg Pain. Pain Pract. 2021. Aug 7. doi: 10.1111/papr.13066. Epub ahead of print.

Celéri Research Group Partners with Averitas Pharma on Post-Market Clinical Study

December 2023 – 

PRESS RELEASE – December 1, 2023. Conshohocken, PA – Celéri Health’s Research Group is pleased to announce its collaboration with Averitas Pharma on a post-market observational multi-center study.

Neuropathy is one of the most common long-term complications of diabetes mellitus (DM) and successful treatment can be challenging. Approximately 60% of diabetic patients have some form of peripheral neuropathy, with the highest prevalence among people who have had the disease for longer. It is believed that exaggerated activity of capsaicin-sensitive nerve fibers is involved in mediating the pain of peripheral neuropathies. Application of low concentration capsaicin creams (0.025% and 0.075%) have demonstrated efficacy in the treatment of painful diabetic peripheral neuropathy (PDPN) [Tandan et al, 1992; Mason et al, 2004] but these low concentration capsaicin creams require continued, multiple daily applications and are associated with repeated burning sensations at the application site and the risk of contamination of sensitive areas, which may lead to poor patient compliance. QUTENZA is an FDA approved, high-concentration capsaicin dermal patch (capsaicin, 8% weight/weight) developed to rapidly deliver a therapeutic dose of capsaicin into the skin. QUTENZA is currently indicated for the treatment of certain types of peripheral neuropathies, including PDPN of the feet.

The Celéri Research Group includes the award-winning Clinical Research Strategies, as our CRO partner. Clinical Research Strategies is a contract research organization and executive management consultancy for start-up and mid-size life sciences companies. Project-specific, fit-for-purpose, ad hoc consulting, and staffing your clinical trials is what we do best no matter where you are in your clinical development program. Read more about them here

If you are interested in participating in this Study or others like it, reach out to us at team@celerihealth.com for more information. 

About Averitas Pharma. Averitas Pharma was formed in 2018, as the US commercial subsidiary of The Grünenthal Group. Grünenthal and is a multinational pharmaceutical company headquartered in Germany, with a presence in more than 30 countries across Europe, Latin America, and the USA. For more than 70 years, Grünenthal has been a global leader in the research and development of therapeutics for pain, gout, and inflammation. Now, Averitas becomes a new chapter in the company’s global growth. Read about Qutenza here: https://www.averitaspharma.com/our-products/

Celéri Labs Partners with Google to Explore Pain Data ML, NLP and AI

October 2023 – 

PRESS RELEASE – October 24, 2023, Conshohocken, PA – Celéri Health’s technology innovation team, Celéri Labs, is pleased to announce its collaboration with Google to leverage their Firebase and Google Cloud Platform Services such as BigQuery and Cloud Run, and select Google Cloud Offerings like Looker.  Celéri Labs’ projects include research areas such as examining data in the electronic health record (EHR) to provide an important resource for measurement of pain intervention quality and treatment response; AI algorithm testing; NLP examination of longitudinal record’s raw notes; and much more.  How we work with Google: Google products can assist researchers like those inside Celéri Labs through the application our NLP extraction algorithms to extract quality indicators and summary data from clinical progress notes.  If you are interested in partnering with Celéri Labs, reach out to us at team@celerihealth.com. 

Psychological Assessments and Pain Care Planning: Use & Coding Considerations

The Role of Screening Tools

According to The National Institute of Mental Health, “People with other chronic medical conditions have a higher risk of depression.”1  To that end, there is a high probability that any person with a chronic pain condition has a concomitant psychological disorder, most notably depression and/or anxiety. The relationship between chronic pain and depression/anxiety is well established. The causal link between pain and these disorders can point in either direction and over time may form a positive feedback loop between these two elements.

Screening tools are available that will aid in the detection of potential depression/anxiety, and when indicated, a referral may be most appropriate for more extensive evaluation and treatment. In addition, lesser psychological factors such as catastrophizing and fear avoidance behavior may interfere with a patient’s recovery and should be recognized by the clinician. Recognizing indicators of patient psychosocial health behavioral factors can affect a patient’s recovery and/or compliance with treatment and may decrease the risk of developing chronic illness/pain. Tools such as the PROMIS-29, Pain Catastrophizing Scale, and PHQ-9 depression scales are examples.

  • The clinically-validated PROMIS-29 multidimensional pain scale is used to detect changes in pain, anxiety, depression, physical function, sleep and quality of life.
  • The Pain Catastrophizing Scale is broken into three sub-scales being magnification, rumination, and helplessness. The scale was developed as a self-report measurement tool that provided a valid index of catastrophizing in clinical and non-clinical populations.
  • The PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.

CPT Considerations

(NOTE: These are not coding recommendations by Celéri Health.  Please verify with your revenue cycle consultant, revenue cycle team,, provider manuals/policies per carrier contract, etc)

  • 96127 – Brief emotional/behavioral assessment (eg, depression inventory, attention deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument
  • G0444 – Annual depression screening, 15 minutes (ALERT – Only an annual report is allowed)

Regardless of the code used, the following information should likely be included in the documentation:

  • Type of screening tool used (e.g., PROMIS-29, PHQ-9)
  • Results of the screening.
  • Some payers may want to see the member’s responses in addition to the score so be sure to keep the responses in case the payer requests that information.
  • Your Impression/plan, considering the results from the screener. If the screening is positive, there needs to be documentation of the planned treatment and how the known result of anxiety or depression or other behavioral interference plays into your pain management care plan.

Other Common Questions

  • Can You Use CPT 96127 With Telemedicine Services?
    Using this code for telemedicine depends on the conditions of the payer. For many providers, including Medicare, you can bill CPT 96127 through telemedicine services. Keep in mind that for some, this is a temporary addition due to COVID-19 and may change in the future.
  • How Should I Bill CPT 96127 if the Test Was Scored on Another Day?
    Since this code encompasses administration and scoring, you should report it with the date those services were completed.
  • Should I Use Modifiers With CPT 96127?
    Depending on the payer, you may need to use modifier 59 to indicate the screening was distinct or independent from other non-evaluation and management services. Include documentation to support.

1 https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health#pub1

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CDC’s Opioid Guidelines (Pischke, USA Today): A Response from Celéri Health

The CDC has abandoned pain patients. Its new opioids guidelines are all for show.

Ironically, the CDC is likely to find out that far from closing the book on the opioids question, the updated guidance will create even more suspicion among the public. (View Full Article)

Peter Pischke
– Opinion contributor, USA TODAY

Official Celéri Health Response

Over the past two decades, we have had significant shifts in the number and effectiveness of opioid policies at state and federal levels.(1) This includes access to Prescription Drug Monitoring Programs (PDMPs), access to naloxone, limits on prescribing, and required referral to pain specialists, among others.(1) Opioid dispensing rates peaked at 2012 at 81.3 prescriptions per 100 persons. Due to a variety of factors, the nation saw opioid dispensing rates fall to a low of 43.3 prescriptions per 100 persons, the lowest rate in the past 15 years, though some counties had levels nine times that.(2)

In 2016, the Centers for Disease Control (CDC) issued guidelines for the use of opioids in the treatment of chronic non-cancer pain, also colloquially known as the “CDC Guidelines”. However, these guidelines did not give recommendations for the treatment of chronic pain, but rather simply created lines in the sand for primary care physicians prescribing opioids in their clinic. In fact, no level I recommendations appeared in these guidelines, and the only level II recommendation was that patients suspected of opioid use disorder be referred for treatment. (3)

Despite the contraction and increased selectivity of opioid prescribing, the nation saw a rise in overdose death rates involving opioids over the past 20 years. This was not fueled by a change in the overdose rates associated with commonly prescribed opioids, or even heroin. Rather, it has been fueled by illicit synthetic opioids, primarily in the form of fentanyl.(4)

The principle of non-maleficence is core to the bioethics taught to our physicians as a component of the Hippocratic Oath. Primum non nocere is the principle of doing no harm, to guide physicians and patients along the pathway to shared decisionmaking regarding the risks, benefits, and alternatives to any treatment. This includes opioids, steroids, biologic agents, chemotherapy, surgery, and more. The 2016 CDC Guidelines for primary care physicians, made some specific recommendations for specific clinicians. However, these guidelines were grossly misapplied by a variety of stakeholders, including pharmacists, insurers, health systems, physicians, and more. The American Medical Association House of Delegates called out the misapplication of the 2016 Guidelines in 2018 formally as House Resolution 235. The misapplication of these guidelines was then specifically called out in 2019 (a little late) in the New England Journal of Medicine by the same authors who wrote the 2016 Guidelines. (5) Unfortunately, the 2016 Guidelines were taken up highly by pharmacies, physicians afraid of violating guidelines, and health systems with the same fear. Patient-centric opioid care was not emphasized by these guidelines, and many clinicians and clinical settings took a NIMBY (Not In My Backyard) approach to opioids, creating pain care deserts for many opioid patients.

The 2022 CDC Guidelines contains pretty specific language focusing on patient-centered decision making that occurs between the patient and their physician.(6) But much of the damage here has been done. Large numbers of patients were exposed to prescription opioids for years and years by their well-meaning physicians over the past thirty years, and this multiyear systematic abandonment of many patients did not have the intended effect of these policies, which is to save lives. What we have seen is an increase in synthetic opioid deaths, and a stigmatization of chronic pain at home, the pharmacy, the clinic, the hospital, and more.

The intersection of chronic pain, opioid use disorder, social isolation, and mood disorders contains numerous intermingled variables.(7) Quantifying the contribution of these various parameters is critical to assessing risk, benefits, and alternatives in each individual patient. Opioids are not appropriate for elimination from modern medicine – they are essential medicines to a functioning society. Medical reversal is the concept that new evidence should result in a paradigm shift in care to the abandonment of a prior therapy is not rational in this instance.(8) What we really need to understand is the components of the problem, so that we can appropriately deploy solutions. This could be a variety of tailored therapies that incorporates the old (opioids, acupuncture, physical therapy, tai chi, you name it), with the new (neuromodulation, biologics, monoclonal antibodies, regenerative therapies).

Expert pain care is a discipline that is a calling to me and to many pain providers worldwide. Understanding the profile of our patients and their response to all treatments and treatment-combinations is the next step to success in this field. The next steps are not to create static guidelines, but to invest in identifying quantitative markers that can aid in the accurate and effective treatment of pain in our patients, which may require an opioid in some cases. Clinical decision support based on real world outcomes data is our best hope to informing these decisions in the future. Today, unfortunately, many of those decisions are dictated by coverage policies, not science, and surely not common sense.

1. Lee B, Zhao W, Yang KC, Ahn YY, Perry BL. Systematic Evaluation of State Policy Interventions Targeting the US Opioid Epidemic, 2007-2018. JAMA Netw Open. 2021;4(2):2007–18.
2. U.S. Opioid Dispensing Rate Maps | Drug Overdose | CDC Injury Center [Internet]. [cited 2023 Jan 4]. Available from: https://www.cdc.gov/drugoverdose/rxrate-maps/index.html
3. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recommendations and Reports [Internet]. 2016 Mar 18 [cited 2019 Jan 21];65(1):1–49. Available from: http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
4. Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019. MMWR Morb Mortal Wkly Rep. 2021;70(6):202–7.
5. Dowell D, Haegerich T, Chou R. No Shortcuts to Safer Opioid Prescribing. New England Journal of Medicine [Internet]. 2019 Apr 24 [cited 2019 Jun 7];NEJMp1904190. Available from: http://www.nejm.org/doi/10.1056/NEJMp1904190
6. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain – United States, 2022. MMWR Recomm Rep. 2022;71(3):1–95.
7. Sheng J, Liu S, Wang Y, Cui R, Zhang X. Review Article The Link between Depression and Chronic Pain : Neural Mechanisms in the Brain. 2017;2017.
8. Prasad V, Cifu A. Medical reversal: why we must raise the bar. Yale Journal of Biology and Medicine. 2011;84:471–8.

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Using RWD In Everyday Pain Practice: An Overview

Our most innovative Celéri client providers use RWD from our Real World Outcomes Engine™ in their everyday practice to support care planning and population health.  Here are a few ways they do it:


We engage with your patient’s on your behalf over SMS or email or iPads provided in your office – or mobile.  Our digital engagement understands that patients need to know they are providing key information directly and securely to their provider. Our messages can look something like this: “Hello Susan, this is Dr. Smith. I am reaching out to understand more about how your pain is impacting your daily life.  I want to help.  These questions are essential to our custom plan for your pain recovery. Please take a moment to answer them with full candor and then we can discuss your answers when we see each other soon.”  Or, your choice of introductory wording. (English and Spanish, available, too)

New patients.

The majority of our provider clients ask us to gather PROMIS-29 to understand fatigue, pain intensity, pain interference, physical function, sleep disturbance, anxiety, depression, and ability to participate in social roles and responsibilities – as an outcomes baseline and a starting point for patient collaboration in their patient’s pain recovery. Additionally, our Body Map offers visuals for patients to indicate pain areas by primary, secondary and so on – for downstream assessment triggers by body area.  Body Map use also helps our provider patients understand our engagement questions are by pain area and not generalized pain – thereby mitigating a possible skewing of PRO results. Of course, ODI or NDI or other validated instruments can be initially gathered also.  Our provider clients customize the validated assessments they want and at what cadence. Set it and it works quietly in the background.  We deliver the new patient’s PROMIS-29 report (and others) directly to their appointment in your EHR/EMR for your reference before walking in the exam room and as a teaching tool (See Patient Education and Care Planning).

Pathways by intervention type.

As the patient moves on in their clinical pathway, we gather PRO assessments for our provider’s, based on the intervention in play.  At Celéri, it is all about the provider’s choice – based on their preferred PROs by intervention.  We have default pathways – or clients can customize their own. For example, many of our client’s SCS patients receive a Zurich Claudication Questionnaire (ZCQ) at -7 days, 7 days out, and 30 days out from trial.  Then, at Implant, a cadence of -7 days, 7 days out, 30 days out, 60 days out, 90 days out, 180 days out,  1 year,  2 years, etc. Assessment cadence stops if a known explant occurs, of course.  You can change that pathway to add PGIC or PROMIS-29 at any point,  if that is your preference.  Or, use the IMMPACT  recommended outcomes for SCS. For RF or SI Fusion, many of our providers receive ongoing ODIs at -7 days, 7 days out, 30 days out, 60 days out, 90 days out, 180 days out, 1 year, 2 years, etc. Medical management patients can receive our Schedule Substance Abuse Panel (PROMIS Pain Prescription Med Misuse, PROMIS Alcohol Use, PROMIS Appeal of Substance Use, PROMIS Severity of Substance Use) at first appointment and every six months – or Opioid Risk Tool or any of our other 20 validated assessments.  Once the intervention pathways are set, they run automatically – yet, can be stopped at any time or augmented to included an ad hoc gather of a GAD-7 or PHQ-4 for example.

Patient Education and Care Planning.

Our client providers use the individual PRO assessment result reports (pdfs) that are available in their EHR/EMR from us –  for education in the exam room and lean on them for medical decision making support. Please note that both time in education and MDM considerations may have E&M level implications and therefore revenue cycle implications.

Pain Command Center.

After gathering PROs and other custom data elements on patients to support in-clinic visits and pre + post surgical interventions, client providers have access to a Command Center that shows a variety of population-level data elements: a heat-map of pain severity across their market for hot-spotting, patient improvement by appointment type/intervention type (look at what device or technique is performing best in what category), patient response by PRO, patient improvement % by PRO type and much more.

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RWD, RWE and Pain Big Data – What is the difference?

Real world data (RWD) involves data collected outside of clinical studies and their scientific constraints. It often comes from EHR,  EMR, registries, and claims data.  Yet, it is often been ignored over trial data. That is, until recently, when ‘big data’ became a household manta.

What is amazing about RWD is that it produces real world evidence (RWE) that is truly representative of live disease progression, patient cases, device or drug experience and patient impact.  It can tell stories at the patient level, practice level, life science level and more. RWE is incredibly actionable when powered by analytics, machine learning & artificial intelligence (AI). It provides insight beyond traditional time-delayed clinical trial data, making it possible to use RWD to support real-time care planning, disease hot-spotting and even post-market clinical reporting.

Moreover, there is the potential to link data from different sources; improve trial efficiency; identify new indications, and a real-world perspective of risks/benefits to make informed decisions beyond traditional clinical trials. RWE also has regulatory and market impact including the updated FDA guidelines requiring RWE use in regulatory decisions and how AI and information exchange can be securely managed. There are ethical and privacy concerns, recent big data consent guidelines and best practices for clinically integrating RWD in the form of data aggregation and more.  Watch for our Data Team to talk more about how RWD can morph into RWE for those in the pain community seeking real-time use of RWD, its evidence and ultimate data storytelling.

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The Pain Patient and the Value of Their Social Determinants

Pain severity and poverty level. Adverse pain outcomes and their association with unemployment and lower education.  

These ‘social determinants of health’ (SDoH) refer to the economic, environmental, and social conditions of individuals’ lives that impact the health outcomes of individuals. The amplification factor of  inequities in power, money, and resources is where the knowledge of a person’s SDoH can help pain care providers have an awareness that tailors their recovery plan to meet the patient in the middle of their social and clinical circumstances. There is a deep lack of understanding about how the social circumstances of individuals’ lives shape their pain care experiences. In a study involving interviews with 18 physicians, all described situations in which their clinical management decisions were influenced by their patient’s SES.1

What we need is to better understand the complex interconnection of factors involved in the delivery of high-quality pain care, its relationship to care outcomes, and patients’ care experiences. The perspectives of socially disadvantaged individuals, in particular, are likely to have important implications for understanding inequities in pain care and what to do about them.  At a minimum, a starting place is to create an awareness of SDoH for the pain provider. Here’s one path.

Step 1: Gather the patient’s social determinants. Do that through proven tools like PRAPARE or Health-Related Social Needs (HRSN) Screening Tool.

Step 2: Make sure you have the SDoH results in front of you when forming a care plan.

Step 3: Look at the SDoH across your entire practice so have a deeper understand of who your patients are. This helps your entire practice support them, such as your front office in appointment compliance and your back office in revenue cycle activities.  And finally,

Step 4, keep up a regular cadence of gathering SDoH to be sure you are alerted to a change in social circumstances.

Do you want to talk more about these steps or how to actualize them for you? Reach out to our data team here.

1 Bernheim SM Ross JS Krumholz HM Bradley EH. Influence of patients’ socioeconomic status on clinical management decisions: A qualitative study. Ann Family Med. 2008; 6: 53-59

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Pain Outcomes and MIPS Requirements…#182

Those that choose to voluntarily report do not receive a payment adjustment regardless of how well, or poorly, they score. However, those that opt-in are eligible to receive a payment incentive or penalty based on their performance. Opt-in eligible clinicians may also choose to voluntarily report instead.  Choosing to opt-in requires your EMR or outcomes/data technology partner to partner with you to gather the right data, in the right cadence and to reveal your results to you in a transparent manner.  Which MIPS measures did you choose?  Here is one of our favorites. Under the Quality category ( 30% of total score: Report 6 measures, including one Outcome or other High Priority measure for 12 months on at least 70% of eligible encounters to receive a score against 2022 National Benchmarks). #182: Functional Outcome Assessment.  

MIPS Measure #182: Functional Outcome Assessment. Percentage of visits for patients aged 18 years and older with documentation of a current functional outcome assessment using a standardized functional outcome assessment tool on the date of the encounter AND documentation of a care plan based on identified functional outcome deficiencies on the date of the identified deficiencies. A standardized tool is a tool that has been normed and validated. Examples of tools for functional outcome assessment include, but are not limited to: Oswestry Disability Index (ODI), Roland Morris Disability/Activity Questionnaire (RM), Neck Disability Index (NDI), Patient-Reported Outcomes Measurement Information System (PROMIS), Disabilities of the Arm, Shoulder and Hand (DASH), and Western Ontario and McMaster University Osteoarthritis Index Physical Function sub-scale (WOMAC-PF). Click here to hear more about how Celéri can help with gathering the assessment of your choice.  Note: A functional outcome assessment is multi-dimensional and quantifies pain and musculoskeletal/neuromusculoskeletal capacity; therefore the use of a standardized tool assessing pain alone, such as the visual analog scale (VAS), does not meet the criteria of a functional outcome assessment standardized tool.

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A Patient’s Own Vital Signs – Using RWD for Pain Care Planning

Earlier this year (and quietly, we might add) a group of Northwestern University engineers published a study that focused on how to leverage data hiding in plain sight for pain care.  The scientists developed and applied artificial intelligence (AI), or machine-learning, algorithms to physiological data.  They used respiratory rate, blood pressure, heart rate, body temperature and oxygen levels from patients with chronic pain from sickle cell disease. Their approach outperformed baseline models to estimate subjective pain levels.  It also detected changes in pain – atypical pain fluctuations.

Sickle Cell Anemia Infographic showing endothelial damage, vaso-occlusion and hemeolysis

Pain is subjective, so it’s tricky to assess when trying to treat patients,” said Northwestern’s Daniel Abrams, senior author of the study. “Doctors don’t want to undermedicate patients and not provide enough pain relief. But they also don’t want to overmedicate their patients because there is a risk of side effects and addiction.

The study was published March 11 in the journal PLOS Computational Biology. Find it here. Boom! This is the first paper to demonstrate that machine learning can be used to find clues to pain hidden within data from patients’ own vital signs.  Watch for more blog posts on pain RWD.

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Leveraging Pain Data for Optimal Managed Care Participation

Healthcare providers are the ultimate data contributors. Here’s why. 

Health care providers submit medical claims to payers (Medicare, Medicaid, commercial insurers, etc) that generally include a Current Procedural Terminology (CPT) code, which describes the medical, interventional, surgical, or diagnostic service that was provided to a patient.

Additionally, they submit a series of International Classification of Disease (ICD-10) diagnostic codes that describe the condition the patient presented with or that was determined during the encounter. Under the typical fee-for-service reimbursement, the focus of health care organizations and managed care organizations has been on accurate CPT coding to ensure that reimbursement accurately corresponds to the services provided. In other words, document what occurred and be sure that it meets the requirements of the codes chosen. The CPT codes are eventually used in downstream data crunching for monitoring national costs of care for conditions, and healthcare usage rates.

In recent years, the medical diagnoses that support the CPT codes have taken top billing in the data world. They have taken on increasing importance because diagnosis codes have become the principal basis for risk-adjusting payments to providers and health plans under capitated or risk-based payment arrangements. The purpose of such adjustments is to fairly compensate health plans and providers for caring for sicker patients. For example, health plans participating in the Medicare Advantage (MA) program receive higher rates for enrolling individuals with multiple conditions and more complex diagnoses and those fees can be shared with the providers of care to those populations.

Pain Providers and Data

Pain providers, both interventional and management, typically find themselves square in the center of this kind of risk-based and data-driven thinking by managed care payers. Pain providers are likely to have multi-morbid patients in their offices (multiple ICD-10 codes in use). They also must manage high-risk patients who are at risk of ongoing morbidity. After all, pain is a disease of suffering.

Pain providers already leverage subjective data and physiological elements in their care planning. It’s the reason that simple pain scales emerged. Providers needed patients to explain the severity of their pain. Then, later, more sophisticated assessments were born to understand the nuances of pain, its drivers and its downstream effects such as impacts on sleep, work, quality of life and mental health. What can be done to maximize those efforts in the eyes of their managed care partners is to organize the gathering of the data, reference the data in provider documentation and use the data in practice-level population health and care management strategies.

Medical Complexity, Decision Making and Data

Medical decision making is currently part of the Evaluation and Management selection components and decision-making naturally relies on data. The medical decision-making elements associated with codes 99202-99215 consist of three components:

1) Problem: The number and complexity of problems addressed,

2) Data: Amount and/or complexity of data to be reviewed and analyzed,

3) Risk: Risk of complications and or morbidity or mortality of patient management.

In order to select a level of an E/M service, two of the three elements of medical decision making must be met or exceeded. Often, pain providers gather data from proven scientific instruments that provide subjective patient reported outcome measures (e.g PROMIS-29, GAD-7, PHQ-9, VAS, etc) Together, a bundle of these PROs – as well as other data elements like biometrics or even biomarkers – can serve as data elements to support medical complexity requirements. Providers should reference their use of data in all of their documentation – shout it to the rooftops. Data is everything. These instruments can also create visual reports that serve as intra-exam room tools for educating and self-vesting the patients in their own care plans.

Risk is also a key component in medical decision-making for pain providers. Risk of ongoing suffering, risk of possible opioid dependence, risk of complications from interventions, risk of care plan failure. Pain patients are complicated. Their conditions often involve social determinants or conditions, physiological conditions, behavioral health conditions and much more. All must be risk-balanced within the specific case. What assists with that risk balance? Data. It can help everyone rest easy. The patient knows that data (their own and proven care paths for similar patients) was used to plan for their specific circumstance. The provider rests easy that the patient’s care plan is bolstered by data and less at-risk of failure. The patient’s managed care provider knows that their investment in the member’s care team is one based on fact-based, risk-mitigation.

Value-Based Care and Pain

Value-based care is a payment system offering financial incentives to medical providers for meeting health outcomes. It is the opposite of fee-for-service, the traditional model that reimburses providers for each procedure. MIPS participation for pain providers can also include a requirement for outcomes (e.g data) gathering.

Also, value-based care is a big fan of conservative care. Again, smack dab where the pain provider lives in their execution of clinical care. Unresolved pain can result in opioid misuse and other tragic consequences. The CDC reports that around 20.4% of adults have chronic pain, with 7.4% reporting pain that frequently limits life or work activities. To manage the pain, many Americans resort to opioids, whose short-term use can lead to addiction. It is estimated that 21%-29% of patients prescribed opioids for chronic pain misuse the drug. Beyond the human toll of the opioid misuse epidemic, the average cost to treat an opioid use disorder is $221,000. That’s just for treatment of this largely preventable disorder. The total “economic burden” of prescription opioid misuse in the United States is around $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The pain provider who leverages data to manage patients on opioids – to prevent misuse and other downstream costs – is of high value to their managed care partners. Data from tools like Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R)12, Opioid Risk Tool (ORT), Current Opioid Misuse Measure (COMM®), and Patient Medication Questionnaire (PMQ) are likely appreciated by those shouldering the cost of care.

Managed care organizations are likely to bet on providers who share a love of data-driven care. Providers can lean into the instruments mentioned in this blog post, execute them across their patient base, talk about their results in their documentation, share the results with the patients to collaborate on a recovery plan – and partner with managed care organizations around a data-driven pain strategy in your practice. It’s a win-win.

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Celéri Health Announces Enrollment of First Patient in Study of Real World Outcomes® for Medtronic DTM™ Spinal Cord Stimulation (SCS)

February 2021 – 

PRESS RELEASE – February 22, 2021, Conshohocken, PA – Celéri Health, a leader in using Real World Outcomes® to change the paradigm of care for people living with chronic pain, today announced the first patient has been enrolled in the UPGRADE Study, which is a large registry of patients using DTM™ Spinal Cord Stimulation (SCS) available only on the Medtronic Intellis™ platform. The first patient was enrolled on January 29, 2021 at Jax Spine & Pain Centers in Jacksonville, Florida by Dr. Michael Hanes.  The UPGRADE registry will capture long-term, real-world outcomes to understand the effect of DTM SCS programming in the SCS implanted population on the management of chronic pain, primarily on its use for trunk and/or limb pain. The clinical study is sponsored by Celéri Health and is supported by Medtronic’s External Research Program. The registry study will be conducted across approximately 20-30 centers in the United States with up to 1700 patients enrolled. here: https://www.globenewswire.com/news-release/2021/02/23/2180427/0/en/Cel%C3%A9ri-Health-Announces-Enrollment-of-First-Patient-in-Study-of-Real-World-Outcomes-for-Medtronic-DTM-Spinal-Cord-Stimulation-SCS.html 


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