New care measures and their impact on pain medicine: One pain specialist's perspective

Value-based purchasing (VBP) goes into effect this year and it links the quality of care to payments for care. Starting in fiscal year 2013, the Centers for Medicare and Medicaid Services reduces all inpatient prospective payment system reimbursements by 1%. This money then can be returned to hospitals in the form of a bonus through VBP. Value-based purchasing holds hospitals accountable for both cost and quality. With VBP, hospitals get a score that is based on the process of care, the outcomes, and patient-centeredness. This means that reimbursements in health care, which keep hospitals in business, are transitioning from "volume of services" to VBP. Although VBP sounds like a great idea, particularly to politicians in Washington tasked with managing out-of-control health care expenditures, there is very little high-quality evidence that VBP will actually improve care. Nevertheless, this is the way we are going to be moving forward. The perception of pain is a highly personalized phenomenon, and chronic pain affects every aspect of a patient's life. The biopsychosocial model and the concept of utilizing an interdisciplinary team approach in the management of chronic pain make sense, but there are concerns that it could result in higher overall costs and no measurable improvements in the patient's perception of care. Both results. could have a negative impact on pain specialists.