Pain Management Programs: A Market Analysis (6th Edition)

Table OF CONTENTS

Introduction: Study Scope, Objectives, Sources Used

• 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)

Nature & Structure of The Field ($200)

• 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
• American Academy of Pain Management: types of members, accreditation & certification requirements, types of programs

List: 2003 directory of CARF-accredited multidisciplinary pain clinics/programs in the U.S. (hospital, university, freestanding), by state (name/address/phone), by inpatient/outpatient category.

Patient Demographics

- What Conditions Do Chronic Pain Patients Suffer From? ($200)

• 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 America" study of pain sufferers: use of 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)

• 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)

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, implan

Table 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: Md., psychiatrists, physical therapists, social workers, etc.: 1994.

The Role of Anesthesiologists in Pain Management ($250)

• 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)

• 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, American Academy of Pain Mgmt. Accredited, non-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)

(In-depth descriptions of how programs work, outpatient vs. inpatient programs, costs, estimated caseloads, services offered, type specialists on staff)

• The Cleveland Clinic Foundation
• The Mayo Clinic
• Mensana Clinic
• Norman Marcus Pain Institute
• Scripps Memorial Hospital
• University of Washington Medical Center
• Pain Control & Rehabilitation Inst. Of Georgia
• The Rosomoff Comprehensive Pain & Rehabilitation Center
• Johns Hopkins

  - Blaustein Pain Treatment Center

• Wake Forest Baptist Medical Center (former Bowman-Gray School of Medicine.

Status Report of the Chiropractic Services Industry ($100)

• 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

• Name/address/phone, director, description, no. of members, mission, activities, journals/newsletters/directories