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American Society of Interventional Pain Physicians News  | May 4, 2016
IN THIS ISSUE
  1. CMS Releases Proposed MIPS Payment Structure
  2. MACRA rules for physician payments stacked against small practices, critics say 
  3. FDA Advisory Committee Sends Recommendations to FDA 
  4. ICD-10 Book Now Available: Order Your Copy Today! 
  5. ASIPP to Courses on Disc Decompression, Imaging, Controlled Substance, Practice Management, Interventional Techniques in Memphis in June
  6. Medicare Overpayment Overview Webinar May 25 
  7. Controversy Continues Over Medicare Part B Drug Plan 
  8. Perceived Control Important in Treating Pain, Depression in Older Patients 
  9. Affordable Care Act Enrollees May Have Fewer Choices in 2017 
  10. Editorial: Making money on drugs 
  11. April Podcast now Available 
  12. Counterfeit Norco Poisonings Prompt CDC Warning 
  13. State Society News 
  14. Physician Wanted 
CMSCMS Releases Proposed MIPS Payment Structure
                            
On April 27, 2016, CMS released the anticipated proposed rule concerning the new Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule. The agency had released a request for information (RFI) in late 2015 to gather input from stakeholders before writing the proposed rule.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced the Medicare Sustainable Growth Rate (SGR) formula with the new MIPS methodology. MIPS is intended to consolidate components of the Physician Quality Reporting System (PQRS), the Physician Value-Based Purchasing (VBP) Program and the Medicare Electronic Health Record (EHR) Incentive Program. The proposed rule also establishes incentives for physicians to participate in APMs; CMS has set a goal of moving 50% of Medicare payments to physicians to APMs by 2018.

Comments on the rule are due by 5:00 pm ET on June 27, 2016. We will send more information as it is available.

macraMACRA rules for physician payments stacked against small practices, critics say
 
Proposed regulations released last week by the Centers for Medicare and Medicaid Services are raising concerns that the playing field is uneven, with 87 percent of solo practitioners getting penalized and 81 percent of clinicians in large groups earning bonuses, according to some estimates.

The new proposal includes a compensation formula for Medicare that gives performance bonuses as high as 4 percent to about 412,000 physicians and other clinicians in 2019, according to published reports. But there will also be penalties on an additional 346,000, mostly in practices that have between one and 24 members.
 
 
fdaFDA Advisory Committee Sends Recommendations to FDA


The FDA Anesthetic and Analgesic Drug Products Advisory Committee met on May 3-4, 2016 in Silver Springs, Maryland to discuss results from assessments of extended-release and long-acting (ER/LA) Opioid Analgesics REMS. The Agency sought the expert committee's comments as to whether this REMS assures safe use, is not unduly burdensome to patient access to the drugs, and to the extent practicable, minimizes the burden to the healthcare delivery system. Speakers discussed the development of the 2012 ER/LA Opioid Analgesic REMS, Opioid Morbidity and Mortality data, REMS design, REMS Continuing Education Progress, Metrics, Assessment, and Results, Surveillance Data of Public Health Impact, and different pilot state led programs which have been implemented to help reduce morbidity and mortality associated with prescription pain medications. There was extensive discussion for the future over the two day meeting. Three votes were taken: 

1. With regard to ER/LA Opioid Analgesics REMS, should there be continuation without modification (vote   0 yes   )
2. Should there be elimination of REMS (vote 0 yes  )
3. Should there be modification of REMS (vote 30 yes )

The FDA will discuss the Advisory Board recommendations in the coming weeks.

book
ICD-10 Book Now Available: Order Your Copy Today!

 
The initial impression of ICD-10 implementation was that it went well for both providers and CMS, however, shortly after the October 1, 2015 date when Medicare claims began processing, providers found out otherwise. In some cases, Interventional Pain Management providers continue to struggle with "finding the right code" to report for their patient's condition.

CMS released a publication "Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities" http://tinyurl.com/CMS-ICD-10-ClarifyQ-A that provided additional details as to how this ICD-10 family of codes "free pass" was going to work.
 
In short, CMS stated, "The recent Guidance does not change the coding specificity required by the NCDs and LCDs. Coverage policies that currently require a specific diagnosis under ICD-9 will continue to require a specific diagnosis under ICD-10. It is important to note that these policies will require no greater specificity in ICD-10 than was required in ICD-9, with the exception of laterality, which does not exist in ICD-9. LCDs and NCDs that contain ICD-10 codes for right side, left side or bilateral do not allow for unspecified side."
What this means is that:
  • Interventional Pain Management providers are still being held responsible for reporting the correct ICD-10 code or risk Medicare claims denials.
  • Many Interventional Pain Management procedures are included in the various Medicare contractor's Local Coverage Policies (LCD) and include very specific lists of ICD-10 codes that meet medical necessity for the diagnostic and therapeutic procedures.
  • In some cases, Medicare contractors have separate LCD policies for each type of interventional pain procedure and often multiple pages in length.
Don't be one of the providers that have the misunderstanding if they report a valid ICD-10-CM code in the same family of codes, Medicare will accept that.
 
Busy Interventional Pain Management providers don't have time to check the Medicare LCD each time they perform a procedure.
 
Make your medical practice easier and use the ASIPPĀ® new ICD-10-CM Pocket Guide for assistance navigating through the complexity of ICD-10 coding.

  
This book is 5.25 x 8.25 and can easily be placed in your jacket or any carrying case. For only $400 you will receive both the electronic and paper versions. You can recover your cost by avoiding mistakes in just one single case.
  
Order immediately to avoid any future losses. Get it for yourself and get copies for all your partners and staff. Multiple copies can be transferred to your EMR and save you money.
  
Also take a 10% discount for 5-9 copies or a 20% discount for 10 copies or more.


memphisASIPP Courses on Disc Decompression, Imaging, Controlled Substance, Practice Management, and Interventional Techniques in Memphis in June


Here is an overview of the June schedule of meetings that ASIPP has in store for you! Meeting Brochures and Registration will be available soon!

Lumbar Endoscopic Spinal Decompression Hands-on Cadaver Workshop and Online Lectures
Jun. 11-12

Click HERE  to register

Click HERE to view brochure

Comprehensive Review of Interventional Techniques and Hands on Cadaver Workshop
Basic, Intermediate and Advanced Interventional Techniques
Jun 9-12

Two days of didactics and 1 1/2 days of hands-on training in the cadaver lab. New and revised content!

Click HERE  to register

click HERE to view brochure

Comprehensive Imaging Review in Interventional Pain Management and Competency Examination
Course - Jun. 9-10
Examination - June 11

Click HERE to register

Click HERE to view brochure
 
Comprehensive Review Course of Controlled Substance Management and Practice Management and Competency Examinations
Course - June 9-10
 
Examinations - June 11
Take CSM, CCPM, or a combined examination

Take one or both! Click HERE to Register

Click HERE to view brochure
 
ABIPP Part I Examination - June 11        

250 North Main Street
Memphis , TN, 38103

webinarMedicare Overpayment Overview Webinar May 25

Presenter: Vicki Myckowiak, Esq.of Myckowiak Associates, PC
May 25, 2016  |  11:00am-12:30pm CST 
$175 per registrant  |  Group rates available( rlane@asipp.org)  
 
When physician practice discovers that they have been overpaid by Medicare  
they must report and return the overpayment within 60 days.

Overpayments can include:
  • Payments for services that do not meet medical necessity guidelines
  • Payments for services that are incorrectly coded or billed
  • Payments for noncovered services
  • Duplicate payments
On February 12, 2016 the federal government published new rules on the  reporting and repayment of overpayments.  Failure to comply can lead to significant fines and penalties.

What should you do?
Join Vicki Myckowiak for a hands-on practical webinar dedicated to helping
interventional pain physicians navigate the complicated repayment rules


Click HERE to register

controversy
Controversy Continues Over Medicare Part B Drug Plan
 
WASHINGTON -- The controversy over the Obama administration's proposal to change the way drugs are paid for under the Medicare Part B drug program shows no signs of abating any time soon.

On Monday, 242 House members -- 238 Republicans and four Democrats -- sent a letter to Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), asking him to drop the idea. "CMS's proposed Medicare experiment would impose cuts in Phase 1 that will severely harm patient access to needed drugs," the letter stated. "Under CMS's Medicare drug experiment, numerous physicians would face acquisition costs that exceed the Medicare payment amount for certain drugs." The letter ends by urging CMS to withdraw the proposed regulation.
 
perceived
Perceived Control Important in Treating Pain, Depression in Older Patients
 
Perceived control plays an important role in the association between pain and the presence of depression in older people suggesting that clinicians need to focus on treating both a patient's pain and psychological conditions together, according to research published in the Journal of Affective Disorders.

Dr Margot W.M. de Waal, PhD, and co-authors from the Netherlands found that there is an indirect effect through perceived control on the chance of having a depressive disorder. For each 10-point increase in the pain intensity score, the chance of having a depressive disorder was 1.24 higher as a consequence of changes in perceived control. In older patients with depression, however, the role of perceived control as mediator was much smaller.
 
aca
Affordable Care Act Enrollees May Have Fewer Choices in 2017
 
With the nation's largest health insurer exiting all but a few Affordable Care Act exchanges next year, some Americans may be left with fewer choices and some might see higher monthly premiums.

Experts say that will be the upshot of UnitedHealth Group Inc.'s recent announcement that it will pull out of most of the 34 states where it offers health plans on the public health insurance exchanges. Meanwhile, health insurers stung by the high cost of covering public health exchange enrollees are expected to request sharply higher rates for 2017. In Virginia alone, 9 insurers have proposed average rate hikes ranging from more than 9% to 37%, theAssociated Press reported.
 

Clinical Pain Advisor
editorial
Editorial: Making money on drugs
 
EVERYONE COMPLAINS about the high cost of prescription drugs, but not many people try to do anything about it. An admirable exception is the Department of Health and Human Services (HHS), which recently proposed a pilot program to change the way Medicare reimburses doctors for medications they administer directly to patients, as opposed to those distributed through pharmacies or hospitals.

At present, the doctor gets the average price of a drug plus 6 percent, a clear incentive to use higher priced drugs instead of lower priced equivalents. HHS wants to make the reimbursement 2.5 percent plus a flat fee. The idea is to curb Medicare spending on physician-dispensed drugs - which grew from $9.5 billion in 2005 to $22 billion in 2015 - without harming quality of care.



podcast
April Podcast now Available

The April ASIPP Podcast is a departure from its regular format. This month features a series of short interviews conducted at the recently concluded ASIPP 18th Annual Meeting in Dallas. If you didn't attend the meeting, or even if you did, you are sure to find the interviews informative and interesting. Plus, the featured interview is with Dr. Jeff Petersohn, winner of this year's Best Abstract.

Listen to April Podcast
norco
Counterfeit Norco Poisonings Prompt CDC Warning
 
Officials with the US Centers for Disease Control and Prevention are warning the public about counterfeit Norco pills that have led to to several deaths and overdoses in California.

As of Monday, health officials in Sacramento County reported 12 deaths and 52 overdoses related to the pills. 
 

Hyatt 

     
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state
State Society News

FSIPP Annual Meeting
May 20-22, 2016
The Florida Society of Interventional Pain Physicians will hold its annual meeting in 2016 on May 20-22. 
The 2016 Annual Meeting, Conference and Trade Show Interventional Pain Management: 
A Diagnostic and Therapeutic Pathway to Restoration of Function
 will be held at the  Orlando World Center Marriott,
8701 World Center Drive, Orlando, FL 32821
 
FSIPP is also offering 2 concurrent programs:
  • Safe Opiate Prescribing Course - no charge, but you need to be registered for the annual meeting.
  • The Business of Pain Course on Saturday, May 21 - $150.00 
Registration:

 

 




CASIPP Annual Meeting
November 11-13, 2016
Early Bird Registration is Open for the California Society of Interventional Pain Physicians annual meeting. T he meeting is set for Friday, November 11 - Sunday, November 13, 2016  at the exquisite Bacara Resort & Spa,  Santa Barbara , California. 


 
Please send your State Society meetings and news to: Holly Long at hlong@asipp.org

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Physicians Wanted

 

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