Clinical Pain Advisor: How have you been affected by the Affordable Care Act (ACA)?

Dr Barelka: Since implementation of the ACA, we have seen an increase in the number of patients coming into the VA system. This is because of many reasons likely to include the ACA’s requirement that everyone have minimum standard coverage, or else face a tax. The coverage offered at the VA meets this requirement.


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Our increased volume of patients has proved challenging to our service. We have met these challenges not only by adding more clinical staff, clinical space, and support staff, but also by implementing innovative approaches to addressing the new patient population.

Our spine clinic has been one such way; another way has been the development of our e-consultation service. Our e-consult service is an electronic health record-based review of patients with complex chronic pain, which is often associated with significant psychosocial dysfunction. It has been successful at reaching those patients who would otherwise be required to travel to our clinic for a face-to-face visit. It is a service that has been received warmly by both patients and providers.

Clinical Pain Advisor: Where do you believe the future of pain management is heading?

Dr Barelka: Like all medical fields, the future of pain medicine is certain to change significantly The recent alteration law governing health care and the varying degree to which that new law is implemented makes for a very fluid environment. One direction that change will likely take us in is the direction of integrating medical services around the patient. The challenge will be to show value and affect change for the betterment of the patient in an efficient manner. If our clinical actions do not significantly change the patient’s clinical outcome, then they may not be what are best for the patient. I foresee that analyzing and assessing clinical outcomes will be a requirement in the future.