When Outcomes Become Currency: Reconsidering Value in Interventional Pain Management Under Emerging Episode-Based Payment Models.

Abstract

The transition toward value-based care in the United States has introduced episode-based payment models that increasingly tie physician reimbursement to longitudinal costs and standardized outcomes. The Centers for Medicare & Medicaid Services (CMS) Ambulatory Specialty Model (ASM), targeting chronic low back pain (cLBP), represents a pivotal extension of this framework into interventional pain management. While intended to reduce low-value utilization, such models risk redefining clinical success in ways that may not align with the heterogeneous and biopsychosocial nature of chronic pain. This perspective examines the potential for outcome-driven reimbursement to incentivize risk selection, marginalize clinically meaningful but non-durable functional gains, and exacerbate existing health disparities. Based on available literature, we propose a "Value Plus" framework incorporating enhanced risk adjustment and patient-centered composite outcomes to better align economic incentives with the realities of chronic pain care. In conclusion, in the field of interventional pain management, withdrawal of multiple conflicting models (ASM, WISER, etc.), and addition of a payment model including a value plus framework would better align incentives with the realities of delivering care to chronic pain patients.