“The Refill” is a Q&A column designed to provide Clinical Pain Advisor’s readership with various opinions, beliefs and suggestions on managing a pain management practice.

Today’s expert: Edward R. Mariano, MD, MAS. Besides being board-certified in anesthesiology and pediatric anesthesiology, Dr. Mariano is also an associate professor of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine. He is also the co-director of the Stanford Regional Anesthesiology and Acute Pain Medicine Fellowship Program.

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He currently serves as chief of the Anesthesiology and Perioperative Care Service, and associate chief of staff for Inpatient Surgical Services at the Veterans Affairs Palo Alto Health Care System.

Clinical Pain Advisor: How do you market your practice?

Dr. Edward R. Mariano: As an anesthesiology and perioperative care service within the VA health care system, we do not market in the traditional sense perhaps. On our website, we post information for patients and visitors about our patient care services, research, and educational programs. There are also patient-specific educational pages about our nerve block pain management program for surgical patients, our pain clinic, and a guide for patients having anesthesia for surgery or invasive procedures.

CPA: What other revenue sources are you investigating in order to offset the drop in reimbursements?

ERA: While individual VA facilities to receive some payment from insurance, the great majority of our health care system funding comes from VA Central Office in Washington, DC. As a complex tertiary care and university-affiliated VA hospital, our situation is not the same as private practice. However, we are subject to similar performance metrics in clinical processes, outcomes, and patient experience, and there is a universal demand for the best health care with the highest value and lowest cost across all health care systems in the United States.