Q&A

Dr. Ed Kowlowitz, owner and medical director of the Center for Pain Management in Indianapolis, recently challenged a regional Medicare reimbursement policy and, surprisingly, won. He spoke with IBJ about the experience, as well how his three-physician practice is growing even while many physician practices are selling to hospitals.

IBJ: In 2010, Medicare stopped reimbursing physicians for urine drug tests unless those patients were in an altered mental state, suffering from an overdose or taking medications to treat substance abuse. That meant you weren’t getting paid for checking your pain patients for possible signs of abuse or non-compliance. Explain why and how you persuaded Medicare to change its policy.

A: When you look at the determination and the research that they used to make up this determination, it was pretty much research that they had gathered from emergency room literature. And they didn’t really look at … functional people that had ongoing pain issues. [Medicare] really didn’t cover [drug screenings for] any opiod patients. Unless they came in and said to you, “I am abusing these medications,” you couldn’t get reimbursement from Medicare for drug screenings. But you need to look at their urine and decide whether it lines up or coincides with what they tell you’re taking [because] as many as 20 to 40 percent of patients in a chronic pain setting abuse or misuse their medications. But most physicians don’t know which of their patients are abusing or misusing them. So we cited [to Medicare] a fair amount of literature that supported more frequent screenings. We’re [now] able to test individuals in which the physician suspects misuse, non-compliance or non-adherence to the recommended regimen.

IBJ: The Center for Pain Management is in the midst of expanding its facilities. What prompted you to expand and what kind of growth do you hope to see come from it?

A: We wanted to update our facilities, creating a friendlier and warmer environment for our patients. Even medicine is getting more customer centered. We’ve more than doubled our patient encounters since we opened [the office in 2002]. So we’ve kind of outgrown it. In addition, there have been some treatments that have come up over the past 10 years that involve getting infusions of drugs. So we’re adding an infusion suite to offer these treatments to patients. Basically to better treat their pain or lower their need to rely on daily narcotics. We’re also doubling the size of our pre- and post-operative areas and adding an operating room. Patients are more knowledgeable now. They surf the net and they know everything that’s out there. Patients can come here and get the same treatments that they could get if they went to the Mayo Clinic.
 
IBJ: So many physician practices have been acquired in recent years. Is the Center finding it more difficult to remain independent than before?

A: I’m really not finding it hard to stay independent. Maybe that’s because pain management is kind of a niche market. Essentially, every pain hospital program has either closed or reformatted itself into a spinal or rehabilitative model, designed toward spine diagnostics or procedure driven pain management.