Statement on Access to Pain Care
Developed by: Committee on Pain Medicine
Original Approval: October 18, 2023
Commercial payors and the Centers for Medicare & Medicaid Services (CMS) continue to implement policies and procedures that increase clinician burden and impact patient access to cost-effective, pain-relieving treatments. Societal access to timely and meaningful pain care across the continuum of acute, subacute, and chronic pain is critical to minimizing the negative impact on individuals and society at large.
The prevalence and impact of chronic pain is enormous. One in five Americans lives in chronic pain and almost 5% of the U.S. population suffers from high-impact chronic pain. High-impact chronic pain lasts greater than three months and has at least one major activity restriction, such as being unable to work outside the home, go to school, or care for their households. A person’s risk of developing chronic pain is higher than the risk of developing the most common health issues such as diabetes, hypertension, or depression.1 Acute pain that fails to resolve after injury is a gateway to persistent pain, suffering, and disability. In a 1-year period, six out of 100 previously pain-free individuals developed severe, activity restricting pain.1
Despite the increase in patients requiring pain care, barriers to care continue to increase and impact access. The complexity of patient needs is increasing while health system capacity to provide such care is strained and, in some cases, non-existent. Social determinants of health, patient vulnerability, and geographical differences further limit access and contribute to adverse clinical outcomes and health disparities.
The American Society of Anesthesiologists (ASA) is committed to minimizing arduous processes placed on practices that do not improve care and improving patient access to benefit-covered, safe, effective, evidence-based physician-led pain care.
- ASA opposes unnecessarily burdensome prior authorization processes that impede beneficiaries’ access to timely treatment and increase costs to clinical practices.
- ASA opposes the misappropriation of the term “experimental” in coverage policies where evidence is established and accepted by the medical profession.
- ASA opposes denials of care where review of patient records was incompletely or never performed or conducted in an automated, non-individualized approach such as in a batch review.
- ASA opposes peer-to-peer review decisions provided by non-trained, non-board-certified pain specialists.
- ASA supports the scaling of telehealth services for pain care to allow patients and clinical teams access to physician-led pain care including across state lines.
Without appropriate oversight, burdensome processes and unethical denials of treatment will place profits and cost-savings over patient and clinician well-being. ASA continues to safeguard patient access to comprehensive pain care that includes non-pharmacologic, pharmacologic, and targeted interventional treatments provided by appropriately trained physicians specializing in pain medicine.
- Nahin, R, et al. JAMA Netw Open 2023; 6(5):e2313563