CHRONIC
PAIN MANAGEMENT PROGRAMS:
A
MARKET ANALYSIS
(November 2003 – 6th Edition)
TABLE
OF CONTENTS
Introduction:
Study Scope, Objectives, Sources Used
1-11
* How information was obtained, list of sources used, sample cover
letter and
questionnaire
used for mail survey, forecasting methodology
Executive
Overview of Major Findings ($300) 12-32
* Summary/discussion: definition of chronic pain, prevalence among
Americans,
characteristics
of the field, patient demographics (who suffers, estd.
no.), market
structure
& types of providers (clinics, programs, anesthesiologists, others), status
of
pain management in 2003 vs. 2001-key trends of past 2 yrs., most important
issues
faced
by pain programs, outlook for the field by major trade groups, insurance
reimbursement,
emergence of new pain drugs, operating measures/results of 2003
Marketdata mail survey
(caseloads, cost of treatment, mix of clients by pain condition,
concern
over opioids regulation, treatment methods, data for:
1992, ‘94, ‘97, ‘99,
2001, 2003 outcome data
tracking, caseloads by type program, $ market size &
growth
estimates (1985-2007F), 2003 outlook, 2007
4-year projections.
Nature & Structure
of The Field ($200) 33-59
* National cost of lost workdays, drugs, due to pain
* Definition of chronic pain vs. acute pain, types of pain
conditions, cost of pain
in
the workplace, number of: accredited vs. non-accredited pain clinics, solo
practitioners,
years when pain clinics first appeared
* Accreditation
& Industry Standards
* CARF (Commission on
Accreditation of Rehab. Facilities)—its mission, criteria
for
accreditation, what accreditation means, categories of pain programs
* IASP (Intl. Assn. for
the Study of Pain) trade group, definitions for: pain facilities,
multidisciplinary
centers, modality-oriented clinics, etc., desirable characteristics
of pain
clinics/operating guidelines
*
certification
requirements, types of programs
List: 2003 directory
of CARF-accredited multidisciplinary pain clinics/programs
in
the
inpatient/outpatient
category.
Patient
Demographics - What Conditions Do Chronic Pain Patients
Suffer From? ($200) 60-80
* Findings of 2002 American
Pain Foundation study “Pain in Maryland 2002” (attitudes
toward pain, frequency
of pain, etc.)
* Findings of 2000 Merck
study “Pain in
drugs/other
therapies, referrals by MDs, effectiveness of medical profession, actions
taken,
time to get pain under control, etc.
* Findings of Prevention
Magazine/CBS News poll, Jan. 2003 study (type/severity of
pain,
relief, use of drugs, alternative therapies used, etc.)
* Analysis of number of Americans with pain-related
conditions—scope of the
affected
population (why some estimates are inaccurate): back pain, arthritis, RSIs,
migraines,
TMJ, etc., opinions of accuracy of
figures from pain associations/societies
* Discussion of repetitive
stress injuries/carpal tunnel syndrome, BLS data
* Discussion of back pain
patients, no. of Americans with back pain (ACA), back
surgeries,
no. of patient-visits for chiropractors, percentage who are realistic
candidates
for pain clinics
* Headaches -
discussion of types (vascular, migraine, cluster) number of sufferers,
new
& traditional treatment methods, new drug developments
* Arthritis - number of
sufferers, (by sex, race, age), by types of arthritis
* TMJ/TMD (temporomandibular joint disorders) - discussion of condition,
causes,
misdiagnoses, treatment
options, patient demographics,
trigeminal neuralgia
* Cancer patients - no.
of new cases in 2002, for 16 types of cancer (by male/female)
Pain Management
Treatment Methods & Status Report of
The Pain Drugs
Market ($300) 81-102
* List of most common methods used to treat chronic pain,
discussion/analysis of each:
multidisciplinary
programs, drugs/opioids, TENS, trigger point
injections, nerve
blocks,
psychotherapy, brain stimulation, acupuncture, work hardening, physical
therapy,
biofeedback, stimulators, pumps, radiofrequency, etc.
* Typical staff of a multidisciplinary pain clinic team, goals of
a treatment program,
number
of anesthesiologists certified in pain therapy, their treatment methods
* Inpatient vs. outpatient programs--typical costs, length,
mix--percent of a pain clinic's
total
patient population
* How pain programs work - typical phases/patient activities,
example: Mensana Clinic
Status report of the U.S./World pain management pharmaceuticals
market, 1996-2002
* Discussion of new drugs in development, COX-2 inhibitors, sodium
channel blockers
* Summary of the pain drugs market: prescription/non-pres. drugs
used for pain relief:
* Anti-seizure drugs, Cox-2 inhibitors, joint injections, soft
tissue injections, NSAIDS,
opioids, etc.
* Discussion of controversy about the regulation of opioids,
discuss. Of analgesics, tri-
Cyclic
antidepressants, other antidepressants
* World and US $ value of prescription/nonpres.
drugs market (2000-2008 forecast), by
type
drug class (NSAIDS, analgesics, etc.).
Major Findings of 2003 Proprietary
Marketdata Mail Survey
Chronic Pain
Programs ($300) 103-127
Summary of Results by Major Group: Combined Total,
Multidisciplinary Programs, Anesthesiologists
Table: total group vs. multidisciplinary and anesthesiologists
separately: 2002 & 2001:
no.
of patient visits, 2002 % chg., 2003 expected growth rate, new patient visits,
2002
% chg., no. of procedures
performed, 2002 % chg.
- Patient caseloads: 2001, 2002 avg., 2002 increase, 1990-96 growth,
explanation of
actual
patients vs. patient-visits data, adjustments made
- Major findings and comparisons among groups.
- Accreditation rate for all programs, multidisciplinary programs.
- Most critical problems
facing pain programs in 2003, 2001, 1999, 1997, 1994, 1992
Table: Pain conditions
patients are treated for: 2003, 2001, 1999, ranked
- Average program treatment
costs: 2003, 2001, 1998, 1997, 1994, 1991, accredited vs.
non-accredited
programs costs - possible reasons for declining costs.
- Average program length-time patient spends in treatment: 2003,
2001, 1998,1996
Table: Treatment methods
used (% of programs using: 1992 - 2003):
multidisciplinary,
psychotherapy,
physical therapy, TENS, nerve blocks, saline injections, medications,
acupuncture,
implantable pumps, at-home pca, others)
Table: Percent of payments by:
Medicare, Medicaid, cash, managed care entities,
Private insurance, workmen’s compensation:
2003, 2001, 1999, 1997.
- Documentation & tracking of outcome data – 2003, 2001, 1999, 1997, 1994: % of pain
programs
that can document it, % with a tracking
system, what measures are tracked,
how
programs use data (with payors, etc.), patient
follow-up methods, by type.
- Who pain programs compete
with most often, ranked order: 1994 - 2003
(MDs,
other clinics, chiropractors, hospitals, biofeedback centers, etc.).
- The most commonly denied modalities by insurers: 2003, 2001, 1999.
- Opioids regulation: % of program
directors concerned about regulation.
- Attitude of anesthesiologists about giving up pain practice if
their O.R. hrs. were to rise
- Opinions re new JCAHO standards, whether they have improved
quality of pain
programs
- Patient access: do program directors feel that patients know how
to find/access pain
programs?
If not, how can access be improved?
Historical Data: One-Time Questions
- Most important needs
of pain programs, tools desired: 1999, 1997
- Typical number of operating staff: 1999, 1997, 1994, 1992
- Professional specialty of physicians on staff
- Intentions to join future pain clinic national network: 1997
- Most popular advertising
/marketing methods used by clinics: 1999
- Age mix of patients - 1999, 1996, 1994
- Type of pain facility chosen most often: 1992 (hospital-based,
university,
free
standing)
- Alliances with other
healthcare professionals - who?: 1997
- Year pain clinic was established
- Capability/expertise of pain program staff- % using:
therapists,
social workers, etc.: 1994.
The Role of
Anesthesiologists in Pain Management ($250)
128-144
* Why anesthesiologists’ income has been squeezed, why they are
seeking other
subspecialties
such as pain therapy, number practicing, avg. income
* Share of total anesthesiologists active in pain therapy: 1989,
1999, 2001, 2003, typical
caseloads
of pain patients, high/low volume practices
* Number of anesthesiologists certified in pain management to
date.
* Training and A.B.A. certification requirements
Results of Marketdata’s 2003 Mail Survey: Anesthesiologist Group
Tabulations
(comparisons to multidisciplinary
programs when relevant)
- List: the organization where they received certification in pain
mgmt., schools attended.
- Physical location of their program (hospital, freestanding
clinic, MD office, university,
other
- %).
- Percent of the anesthesiologist’s time spent in: hospital/ER vs.
their pain program.
- No. of total
patient visits annual avg. in 2001, 2002, 1990-96
historical growth.
- 2002 percent increase in patient visits
- 2001, 2002 percent of visits related to NEW patients.
- 2001, 2002 no. of procedures performed annually
- 2003 expected increase in caseloads/no. of patient visits
- Most critical problems faced, most frequently denied modalities
- 2003
- Percent concerned about increased regulation of opioids.
Table: Percentage of pain patients treated, by condition - 1997,
1999, 2001, 2003
-
Avg. total and per-visit cost of treatment - 1997, 1999, 2001, 2003 - discussion.
- Avg. length of time patients in treatment: 1997, 1999, 2001,
2003
Table: Methods of payment by patients (Medicare, Medicaid, HMO,
private insurance,
workman’s
comp.) - 1999, 2001, 2003
- Single most denied modality - list of.
- How their practice has changed: list of changes, discussion
Table: Treatment methods used by anesthesiologists, ranked by %
using: 2003, 2001,
1999,
1997.
- Documentation of outcome data – 2003, 2001, 1999
- Methods of patient follow-up, how information is used - 1999
Table: Who do anesthesiologists compete with most often? – 2003,
2001, 1999, 1997
- Attitude of anesthesiologists about giving up pain practice if
their O.R. hrs. were to rise
Historical Data/Questions (1997 & 1999 surveys)
- Percent of their programs accredited
- Patients by age group
- Number of physicians in their program
- Top marketing methods used - 1999
- Expected future effects of managed care.
Market Size,
Growth Rates, Forecasts & Outlook ($150) 145-155
* Discussion/analysis of total no. of pain programs, clinics, solo
practitioners in
2003 vs. 2001, annual
patient caseload: 2002 estimates for CARF accredited,
JCAHO accredited,
programs,
anesthesiologists, chiropractors, discussion of inpatients/outpatients
mix,
overlap between types of programs
* Dollar Market potential, by type treatment facility or
solo provider (see above)
* Historical estimated $ market value 1985-2007 forecast
* 2003-2004 outlook &
2007 forecasts, rationale for estimates, caseload volume vs.
declining
cost of treatment, relative weightings, factors affecting demand
Profiles of Some
Leading Pain Programs ($200) 156-176
(In-depth descriptions of how programs work, outpatient vs.
inpatient programs,
costs,
estimated caseloads, services offered, type specialists on staff)
* The
* The Mayo Clinic
* Mensana
Clinic
* Norman Marcus Pain
Institute
*
*
* Pain Control &
Rehabilitation Inst. of
* The
* Johns
*
Status Report of
the Chiropractic Services Industry ($100) 177-190
* Discussion of the profession, competition with pain programs for
same clients, federal low
back
pain guidelines, industry receipts
(1985-2001)
* Patient demographics--survey results, patients by: sex, age,
race, occupation
* Controversial new research/study by the Annals of Internal
Medicine, other recent studies
* ACA Statistical Study results: avg. number patient-visits
per doctor per week,
no.
of new patients, referrals, gross & net income, historical new patients
& patient-
visits
(1984-1996), type conditions patients treated for (1995, ‘97, ‘89), age of
patients,
sources
of chiropractor revenue by type insurance
* Future trends - the
major issues likely to affect the profession, current state legislative
actions,
diagnostic testing, outcome assessment, etc.
Reference
Directory of Chronic Pain and Related Associations, Societies,
Groups,
Institutes 191-197
* Name/address/phone, director, description, no. of members,
mission, activities,
journals/newsletters/directories