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American Society of Interventional Pain Physicians News  | September 9, 2015
IN THIS ISSUE

  1. House Votes to Reconsider NASPER Bill 
  2. Medicare Advantage Plans and lack of Appropriate Payment: To Powerful to Be Accountable 
  3. AHRQ and highly biased and flawed analysis by Chou et al: To Powerful to Be Accountable 
  4. Few Spots Remain for Ultrasound for Regenerative Medicine Workshop and Hands-On Cadaver Workshop for IPM Techniques Held in Memphis 
  5. Part 2: ASIPP ICD-9-CM to ICD-10-CM Webinar Sept. 10
  6. Our Colleagues Honored for British Medical Association Medical Book of the Year
  7. Neurological Complications Caused by "Skinny Jeans"
  8. Common Antibiotic Spurs Rare But Deadly Neurotoxicity
  9. Suggested Response Provided for In-Flight Medical Emergencies
  10. FDA Committees to Discuss Potential Dosing Error for New Oxycodone IR Formulation
  11. Drug-Seeking Behavior Turns Deadly for Patient, Leads to Lawsuit for Provider
  12. Without action, a shortage of doctors stands to get worse
  13. An Esquire writer dressed like a physician for a day: Here's what he learned
  14. ASIPP Call for Abstracts
  15. State Society News 
  16. Physician Wanted 
nasperHouse Votes to Reconsider NASPER Bill
 
The House voted Tuesday on the motion to reconsider passing HR 1725 , National All Schedules Prescription Electronic Reporting Authorization Act of 2015. The vote was: To amend and reauthorize the controlled substance monitoring program under section 399O of the Public Health Service Act, and for other purposes.
 
George W. Bush signed NASPER into law in 2005 which was created by ASIPP and enacted by Congress. This law requires states to collect prescription information for Schedule II, III, and IV medications. It also requires states to have the capability to share this information with each other. This can decrease cross-border narcotic trafficking. With the enactment of NASPER, multiple states are operating physician-friendly programs where pain physicians can identify the risk of overuse and abuse.
 
The Kentucky All Schedule Prescription Electronic Reporting (KASPER), which was the model program for KASPER, is an excellent example of the effectiveness of PMPs in decreasing doctor shopping without jeopardizing pain treatment.
 
NASPER must be reauthorized and funded to successfully curtail prescription drug abuse.
 

mediareMedicare Advantage Plans and Lack of Appropriate Payment: To Powerful to Be Accountable
 
The second issue is related to Medicare Advantage Plans and lack of appropriate payment. We have filed a complaint with all committee chairs and we will be going to Washington in the second week of October with a number of people.
  
As you know, you have been assisting us in reference to inappropriate reimbursement pattern of Medicare. Now this has become a national issue. Consequently, on behalf of American Society of Interventional Pain Physicians (ASIPP) and 51 state societies, we have written to Chairman Hatch, Portman, Chaffetz, Upton, and Ryan to assist us with these issues. As we have stated before the multiple issues, but the main issue related to their insistence on that unless there is an LCD, they are making it as noncoverage issue stating that there is no evidence and it is not medically necessary. However, the Medicare manual does not show that they are expected to cover all fee-for-service procedures in that state.
 
They are also causing numerous issues with contractual negotiations and applications, along with giving misinformation to patients that will cover everything. In fact, their deductibles or copays sometimes exceed the entire fee for the visit.
 
Obviously with Medicaid managed care we are getting paid less, it is costing patients more and we are spending numerous hours in precertification process for approvals. Above all, even after the approval they are reneging on payments.
 
click HERE to read letter
ahrqAHRQ and highly biased and flawed analysis by Chou et al: To Powerful to Be Accountable
 
The third issue related to AHRQ and highly biased and flawed analysis by Chou et al with tax payer dollars. We have filed a complaint and will be discussing this issue further at our meetings.
 
Recently we have noticed multiple issues related to AHRQ whose mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable. However, none of their activities help us to achieve these goals. Instead, it will affect patient access.
 
AHRQ has recently published a Technology Assessment for pain management injection therapies for low back pain. They provided this contract to some physicians with numerous conflicts of interest and intellectual bias. Further, the same report is published in Annals of Internal Medicine as one of the reports.
 
Recently we sent a letter to Chairman Hatch, Cochran, Portman, Chaffetz, Upton, Ryan, and Rogers bringing this issue to their attention. Please look into this issue and let us know if you have any questions. Hopefully you will be helping us in stopping AHRQ's unchecked activities to preserve patient access.
 
Click HERE to read letter

sept
Few Spots Remain for Ultrasound for Regenerative Medicine Workshop and Hands-On Cadaver Workshop for IPM Techniques Held in Memphis  


Objectives for this Intensive Ultrasound for Regenerative Medicine Workshop are:
  • Attain the ability to understand ultrasound interpretation and regenerative medicine.
  • To incorporate ultrasound and regenerative medicine in treating your patients so that patients have better outcomes and reduced side effects.
  • mprove existing skills and/or develop new skills in the delivery of interventional techniques involving ultrasound and regenerative medicine.
  •  Ability to demonstrate skills.
Cadaver Workshop Objectives:
  • To integrate multiple aspects of interventional pain management in treating your patients so that patients have better outcomes and reduced side effects.
  •  Provide high-quality, competent, safe, accessible, and cost-efficient services to your patients.
  •  Improve existing skills and/or develop new skills in the delivery of interventional techniques.
  •  Review multiple areas of interventional pain management including fluoroscopic interpretation and radiation safety.
  •  Demonstrate skills through interactive review of images.
 
Accommodations
The Westin Memphis Beale Street Hotel
170 Lt. George W. Lee Avenue · Memphis, TN, 38103 | 901-334-5900
We have secured a group room rate of $129.
 
Click HERE for link to hotel 



webinar
Part 2: ASIPP ICD-9-CM to ICD-10-CM Webinar Sept. 10
The focus of this two-part webinar will be on ICD-9-CM to ICD-10-CM coding crosswalks and necessary documentation. Regisration is open until the start of webinar.
  
The webinar will be in two parts: Part 1 covered chapters 1-10 and Part 2 will cover chapters 11-21.
Part 2: Thursday, September 10, 11am-12:30pm CDT
  
     WEBINAR FEE:
     $195 
    SPEAKER:
    Marvel Hammer, RN, CPC,
     MJH Consulting, Denver, Colorado
     There will be time for Q&A with the presenter.    
  
  
* This program has the approval of the American Academy of Professional Coders (AAPC) for 3 continuing education hours. Granting of prior approval in no way constitutes endorsement by the AAPC of the program content or the program sponsor.
                           
  
bookOur Colleagues Honored for British Medical Association Medical Book of the Year
 
ASIPP International Members and guidelines committee members Manohar L. Sharma and Sanjeeve Gupta were honored as authors of the British Medical Association Book of the Year.
 
Practical Management of Complex Cancer Pain
by Manohar L. Sharma, Sanjeeva Gupta, Michael I. Bennett, and Karen H. Simpson
Published by Oxford University Press
(ISBN: 9780199661626. £39.99)
 
Manohar Sharma is Consultant in Pain Medicine at The Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, London. Karen Simpson is a Consultant in Pain Medicine at Leeds Teaching Hospitals Trust.  Michael Bennett is St Gemma's Professor of Palliative Medicine at Leeds Institute of Health Services, University of Leeds. Sanjeeva Gupta is a Consultant in Pain Medicine and Anaesthesia at Bradford Royal Infirmary. 
 
The book provides advice on advanced pain management techniques for cancer pains. Emphasis is placed on the suitability and selection of patients for different invasive and complex procedures based on the patient's history. Case histories provide compressive insight into the complexities of holistic management, with pain being only one of the factors that distress patients and families. The book also covers cancer pain management for patients in a community setting including, the collaboration between pain and palliative medicine. This practical guide to managing complex cancer pain provides accessible guidance for patient selection for different invasive and complex techniques in including  advanced pain management techniques for all cancer pains, case histories and suggested pain management plans. 
 
BMA
 
skinny
Neurological Complications Caused by "Skinny Jeans"
  
So-called "skinny jeans" (slim-fitting jeans tapered at the ankle) are a fashion statement to many but could also be a health risk when combined with excess squatting, according to a case report published online in the Journal of Neurology, Neurosurgery & Psychiatry.

A 35-year-old female presented with severe weakness of both ankles; the day before she had been assisting a family member with a move and spent many hours squatting while emptying cupboards. The patient had been wearing "skinny jeans" that felt increasingly tight and uncomfortable as the day progressed. She experienced bilateral foot drop and foot numbness, which led to her tripping and falling. Because she was unable to get up, she spent several hours on the ground until she was found.
  
  
spurCommon Antibiotic Spurs Rare But Deadly Neurotoxicity
  
Metronidazole-induced encephalopathy (MIE) is uncommon but usually reversible with treatment cessation. However, a case study in Neurocritical Care is the second reported death in a patient who developed severe neurotoxicity with widespread MRI abnormalities following treatment with systemic metronidazole.

A 65-year-old woman with hepatitis B cirrhosis with concomitant history of esophageal varices, hepatic encephalopathy, hypertension, and type 2 diabetes was transferred to a hospital for management of cirrhosis-related portal vein thrombus and spontaneous bacterial peritonitis. She was treated initially with intravenous (IV) piperacillin/tazobactam and vancomycin and then metronidazole (500mg IV every eight hours for two days, then orally three times per day for four days) and ciprofloxacin six days prior to discharge. She was also continued on tenofovir, lactulose, insulin, furosemide, potassium phosphate-sodium phosphate, spironolactone, pantoprazole, propranolol, and tramadol, and referred for outpatient evaluation for orthotopic liver transplant.
  
MPR
flight
Suggested Response Provided for In-Flight Medical Emergencies
 
HealthDay News-- In a review article published in the New England Journal of Medicine, guidance is offered for physicians providing emergency in-flight medical care.
 
Jose V. Nable, MD, from the Georgetown University School of Medicine in Washington, D.C., and colleagues discuss the frequency of in-flight medical emergencies and the potential liabilities surrounding the provision of in-flight medical care.
 
 
Clinical Pain Advisors
 
seeking
Drug-Seeking Behavior Turns Deadly for Patient, Leads to Lawsuit for Provider
 
Pain management is a growing problem across the country, often forcing clinicians into the awkward position of trying to determine if a patient is legitimately seeking pain relief or just seeking drugs. This month's case focuses on a vital issue in making that determination - communication. Whether it's communication between providers or between a provider and a patient, the old adage "knowledge is power" holds true, as does the opposite. Without proper communication, and the information that comes from that communication, a clinician may not be able to make the best decision for a patient.

Dr. P, 49, was a physician specializing in pain management. Over her twenty year career, she had worked in various practice settings, but for the past three years she had been working in a pain management clinic. Dr. P's patients were referrals from other practitioners, and Dr. P was highly regarded as a pain management specialist.
  
fdaFDA Committees to Discuss Potential Dosing Error for New Oxycodone IR Formulation
 
On September 10th, 2015, a joint meeting of the Anesthetic and Life Support Drugs Advisory Committee and Drug Safety & Risk Management Advisory Committee will take place to discuss a new immediate-release (IR) formulation of oxycodone (Avridi; Purdue Pharma). This formulation has been designed with properties intended to deter abuse of the product via IV or intranasal routes.
 
The reason for this meeting is to discuss the results of pharmacokinetic studies evaluating the effect of food on the absorption of oxycodone from Avridi and the results of studies describing the abuse-deterrent properties, and to consider these data when determining the overall risk and benefit of this product. Pharmacokinetic studies have shown that the absorption of oxycodone from Avridi can be substantially delayed in the presence of food, and this food effect may impact both efficacy and safety. In response to this, the company proposes include in the labeling that the drug should be taken on an empty stomach. However, because this immediate-release product is intended to be dosed every 4-6 hours, the advisory committees are concerned that patients may have difficulty finding a time window during which to take their medication, and may be unable to comply with the instructions.
 
 
shortageWithout action, a shortage of doctors stands to get worse
 
America is in the midst of full implementation of the federal Affordable Care Act. Among the objectives of that legislation was to expand access to health care for more people. In Michigan, and in many other states, that objective is hampered by a current and looming shortage of primary care physicians.

In a recent study, the Citizens Research Council found that many Michigan counties have insufficient numbers of primary care physicians, including family doctors, internists, pediatricians, obstetricians and gynecologists, general surgeons, and especially psychiatrists. Many of the most severe shortages are in the northern half of the Lower Peninsula, but southeast Michigan is not immune - especially the city of Detroit.

CRC examined shortages using two methods. First, we looked at the U.S. Department of Health and Human Services' Health Resources and Services Administration designated primary care shortage areas where the number of physicians relative to the population is lower than their standard ratio or, alternatively, based on demonstrated need such as economic or cultural barriers.
  

Detroit Free Press
  
esquire
An Esquire writer dressed like a physician for a day: Here's what he learned
 
In a study of the power of the uniform, Esquire's Tom Chiarella donned four different professional ensembles on the streets of Chicago.

Each of his different suits gave him the power to assume an expected persona and elicited specific responses from the outside world, offering a glimpse into a day in the life of a priest, a security guard, a mechanic and a physician.  

No one registered the mechanic uniform. No one registered his security guard uniform either, but it felt different, he said. Dressed as a security guard, he was part of the background in an expected way, guarding a random rack of blouses at Anthropologie, chatting up a janitor. As a priest, everyone registered his uniform and everyone wanted him to know it. People made prolonged eye-contact; they touched his wrist; they wanted selfies with him; they wanted blessings.
  
  

abstracts                           
Make your plans now to participate in the American Society of Interventional Pain Physicians abstract and poster presentation at the 18th Annual Meeting, April 15-17 in Dallas, Texas.
  
We had tremendous success last year with our electronomic poster presentation area and we plan to continue this again for the 18th annual meeting.The top 20 posters will be selected to participate in the electronic poster presentations with Q & A time with poster presenters. These will also be published in Pain Physician journal. In addition the Top 8 posters will be presented for judging during Friday's session. The top three abstracts will receive cash prizes.
  
Posters will be on display during the meeting on both Thursday and Friday in the exhibitor hall.
  
The abstract submission deadline will be February 9, 2016.
  
The annual meeting is a great opportunity to share your abstract with hundreds of physicians who specialize in interventional pain management.
  
Registration will be available soon.
Hyatt 
     
     
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State Society News

 


Save The Date! CASIPP Meeting set for October 2015
The California chapter of the American Society of Interventional Pain Physicians   will hold its 6th Annual Meeting in Monterey, CA at the Monterey Plaza Hotel Resort over the weekend of October 16-18. Agenda and registration can be found online at www.casipp.com or by calling 661-435-3473. 

 

NY and NJ Societies to hold Pain Symposium Nov. 5-8

The New York and New Jersey Societies of Interventional Pain Physicians will host a Pain Symposium titled Evolving Pain Therapies on November 5-8, 2015 at the Hyatt Regency, Jersey City, NJ. Click HERE for Schedule and more information.
 

 

SAVE the DATE: FSIPP Meeting May 20-22, 2016

The Florida Society of Interventional Pain Physicians will hold its annual meeting in 2016 on May 20-22. The meeting will be held at the Orlando World Center Marriott in Orlando.

Watch FSIPP.org for more details.


 

 

 

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

 

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