American Society of Interventional Pain Physicians | November 1, 2017
Facet joint injections denied despite great relief for the patient
The coverage for multiple procedures has been limited in recent years. Interventional pain management is one of the subjects under attack. The story HERE shows lack of coverage for therapeutic facet joint injections. This has been going on for several years. This is based on some of the guidelines provided by North American Spine Society with the help of the International Spine Intervention Society.
Click HERE to read the letter we sent to NASS on this issue when they were developing the guidelines without any response from them.
Also, there is extensive literature available on this subject which includes systematic reviews, randomized controlled trials, and cost utility analysis studies.
Boswell MV, Manchikanti L, Kaye AD, Bakshi S, Gharibo CG, Gupta S, Jha S, Nampiaparampil DE, Simopoulos TT, Hirsch JA. A best-evidence systematic appraisal of the diagnostic accuracy and utility of facet (zygapophysial) joint injections in chronic spinal pain. Pain Physician 2015; 18:E497-E533.
Manchikanti L, Kaye AD, Boswell MV, Bakshi S, Gharibo CG, Grami V, Grider JS, Gupta S, Jha S, Mann DP, Nampiaparampil DE, Sharma ML, Shroyer LN, Singh V, Soin A, Vallejo R, Wargo BW, Hirsch JA. A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Physician 2015; 18:E535-E582.
Manchikanti L, Hirsch JA, Kaye AD, Boswell MV. Cervical zygapophysial (facet) joint pain: Effectiveness of interventional management strategies. Postgrad Med 2016; 128:54-68.
Manchikanti L, Hirsch JA, Falco FJE, Boswell MF. Management of lumbar zygapophysial (facet) joint pain. World J Orthop 2016; 7:315-337.
Manchikanti L, Pampati V, Kaye AD, Hirsch JA. Cost utility analysis of cervical therapeutic medial branch blocks in managing chronic neck pain. Int J Med Sci 2017; in press.

ASIPP Successful in Reversing Inappropriate Bundling of Add-On Codes with Radiofrequency Neurotomy Codes
CMS Medicare carriers in multiple jurisdictions instituted a bizarre rule that was implemented April 2017. The rule is regarding add-on codes for transforaminal epidurals, as well as facet joint nerve blocks bundled with radiofrequency neurotomy, even if it was in a different region. These bundling codes are in a manner that you can not unbundle. This has resulted in significant problems. Consequently, ASIPP sent a letter on July 17, 2017 to Niles Rosen who is in charge of National Correct Coding Initiative to resolve the issue.
Yesterday we received a letter from them agreeing with us and they will be reversing this policy. Unfortunately the reversal will not be effective until January 1, 2018, at which time we will be able to unbundle the add-on codes.
We are hoping that we should be able to recapture these reimbursements retroactively. Otherwise, we will be losing reimbursement for 9 months.

Click HERE to read NCCI Response

Click HERE to read to Niles Rosen, NCCI
Annual meeting registration now open!

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ASIPP Abstract Submission for 2018 Annual Meeting is Open
The American Society of Interventional Pain Physicians will hold its 20th Annual Meeting March 15-17, 2018 in Orlando, Florida at Marriott Orlando World Center.
This year, we will be making significant changes to the Abstract and Poster Sessions. Submissions will be in two categories: Resident/Fellow and Physician.  Selected posters will be on display for all meeting participants during all breaks and meal times.
The Abstract Committee will select the top 25 for publication in Pain Physician and of those 10 will be selected for Abstract presentation and judging during the Annual Meeting. The top 3 will receive cash prizes.


Interventional Pain Management Reports is an Open Access online journal, a peer-reviews journal dedicated to the publication of case reports, brief commentaries and reviews and letters to the editor. It is a peer-reviewed journal written by and directed to an audience of interventional pain physicians, clinicians and basic scientists with an interest in interventional pain management and pain medicine. 

We would like to invite you to submit research case reports, brief commentaries and reviews to Interventional Pain Management Reports Journal . Your article will be published FREE’ of charge. 

Led by Editor in Chief: Kenneth Candido, MD, Chairman and Professor, Department of Anesthesiology , Advocate Illinois Masonic Medical Center in Chicago, IPM Reports focuses on the promotion of excellence in the practice of interventional pain management and clinical research. 

Interventional Pain Management Reports is an official publication of the American Society of Interventional Pain Physicians (ASIPP) and is a sister publication of Pain Physician . Interventional Pain Management Reports Interventional Pain Management Reports is an open access journal, available online with free full manuscripts.  

The benefits of publishing in an open access journal that has a corresponding print edition journal are:  
  • Your article will have the potential to obtain more citations.
  • Your article will be peer-reviewed and published faster than other journals.
  • Your article can be read by a potentially much larger audience compared with traditional subscription-only journals.  
  • Open Access journals are FREE to view, download and to print.

So submit today your:
  • Case Reports
  • Technical Reports
  • Editorials
  • Short Perspectives

Click HERE to submit
Pre-clinical study suggests path toward non-addictive painkillers
A pre-clinical study led by Indiana University scientists reports a promising step forward in the search for pain relief methods without the addictive side effects behind the country's current opioid addiction crisis.
The research, which appears in the journal  Biological Psychiatry , finds that the use of compounds called positive  allosteric modulators , or PAMs, enhances the effect of pain-relief chemicals naturally produced by the body in response to stress or injury. This study also significantly strengthens preliminary evidence about the effectiveness of these compounds first reported at the 2016 Society for Neuroscience Conference in San Diego, California.
"Our study shows that a PAM enhances the effects of these pain-killing chemicals without producing tolerance or decreased effectiveness over time, both of which contribute to addiction in people who use opioid-based pain medications," said Andrea G. Hohmann, a Linda and Jack Gill Chair of Neuroscience and professor in the IU Bloomington College of Arts and Sciences' Department of Psychological and Brain Sciences, who led the study. "We see this research as an important step forward in the search for new, non-addictive methods to reduce pain."
Gifts From Pharmaceutical Companies Influence Prescribing Habits Across Multiple Specialties

Receipt of gifts from pharmaceutical companies is associated with more prescriptions per patient and more costly prescriptions, according to a study published online in  PLOS One .
Susan F. Wood, PhD, from George Washington University Milken Institute School of Public Health in Washington, DC, and colleagues examined the correlation between gifts provided by pharmaceutical companies to individual prescribers and prescribing behavior. Data relating to gifts were obtained from the District of Columbia's AccessRx program and the federal Center for Medicare and Medicaid Services Open Payments program.
The researchers found that 39.1% of the 2873 Medicare Part D prescribers received gifts from pharmaceutical companies in 2013, totaling $3.9 million.
Higher Drug Cost Causes Stronger Nocebo Effect

Nocebo hyperalgesia is stronger when an inert treatment is labeled as being an expensive medication rather than a cheap one, according to a study published online in  Science .
Alexandra Tinnermann, from the University Medical Center Hamburg-Eppendorf in Germany, and colleagues examined the impact of value information about a drug, such as the price tag, on its therapeutic effect. Forty-nine healthy people were given a treatment they were told was an anti-itch cream, but it actually contained no active ingredients.
They were randomized to either a group that was told the cream was cheap or a group told it was expensive. A functional magnetic resonance imaging method was used for simultaneous activity measurements in the central pain system.
The Family That Built an Empire of Pain
The north wing of the Metropolitan Museum of Art is a vast, airy enclosure featuring a banked wall of glass and the Temple of Dendur, a sandstone monument that was constructed beside the Nile two millennia ago and transported to the Met, brick by brick, as a gift from the Egyptian government. The space, which opened in 1978 and is known as the Sackler Wing, is also itself a monument, to one of America’s great philanthropic dynasties. The Brooklyn-born brothers Arthur, Mortimer, and Raymond Sackler, all physicians, donated lavishly during their lifetimes to an astounding range of institutions, many of which today bear the family name: the Sackler Gallery, in Washington; the Sackler Museum, at Harvard; the Sackler Center for Arts Education, at the Guggenheim; the Sackler Wing at the Louvre; and Sackler institutes and facilities at Columbia, Oxford, and a dozen other universities. The Sacklers have endowed professorships and underwritten medical research. The art scholar Thomas Lawton once likened the eldest brother, Arthur, to “a modern Medici.” Before Arthur’s death, in 1987, he advised his children, “Leave the world a better place than when you entered it.”
Mortimer died in 2010, and Raymond died earlier this year. The brothers bequeathed to their heirs a laudable tradition of benevolence, and an immense fortune with which to indulge it. Arthur’s daughter Elizabeth is on the board of the Brooklyn Museum, where she endowed the Elizabeth A. Sackler Center for Feminist Art. Raymond’s sons, Richard and Jonathan, established a professorship at Yale Cancer Center. “My father raised Jon and me to believe that philanthropy is an important part of how we should fill our lives,” Richard has said. Marissa Sackler, the thirty-six-year-old daughter of Mortimer and his third wife, Theresa Rowling, founded Beespace, a nonprofit “incubator” that supports organizations like the Malala Fund. Sackler recently told  W  that she finds the word “philanthropy” old-fashioned. She considers herself a “social entrepreneur.”
Making EHRs Doc-Friendly Only Part of the Job in the Feds' Health IT Office

WASHINGTON -- Sure, making electronic health records easier for physicians to use is a big part of the job for John Fleming, MD, deputy assistant secretary for health technology reform at the Office of the National Coordinator (ONC) for Health Information Technology. But it's only part of the picture.
"There has been layer on layer on layer of burden on physicians since the early 1980s, and computers increased it -- one of the biggest burdens is documentation guidelines," said Fleming. "I'd love to tell you that if we made EHRs better in terms of interfacing with them ... that it would solve the physician burden problems, but the plain truth is it's much deeper than that."
Opioid Crisis Declared Public Health Emergency by White House: Implications According to Pain Specialists
On October 26, 2017, President Donald J.Trump declared the opioid epidemic a national public health emergency. “The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don't start, they won't have a problem,” he stated. The President had announced last August that the government's response to the  opioid epidemic would be the object of a national vs public health emergency. Such a status would have warranted a faster and greater allocation of dedicated funds.  
The White House press release states: “President Donald J. Trump is mobilizing his entire Administration to address drug addiction and opioid abuse by directing the declaration of a Nationwide Public Health Emergency to address the opioids crisis.” Actions under this mandate include expansion of access to telemedicine services, including remote drug prescribing, and improved access to addiction specialists and to substance abuse treatments for patients with HIV. The President's Commission on Combating Drug Addiction and the Opioid Crisis was established in March 2017 with the mission “to study the scope and effectiveness of the Federal response to  drug addiction  and the opioid crisis and to make recommendations to the President for improving that response.” 2  This Commission is expected to issue a report with recommendations to guide the administration on a set of measures that will most adequately address the crisis.
Department of Justice News

Founder and Owner of Pharmaceutical Company Insys Arrested and Charged with Racketeering
Defendant and other executives allegedly bribed doctors and pharmacists to prescribe fentanyl spray meant for breakthrough cancer pain
The founder and majority owner of Insys Therapeutics Inc., was arrested today and charged with leading a nationwide conspiracy to profit by using bribes and fraud to cause the illegal distribution of a Fentanyl spray intended for cancer patients experiencing breakthrough pain. 
"More than 20,000 Americans died of synthetic opioid overdoses last year, and millions are addicted to opioids. And yet some medical professionals would rather take advantage of the addicts than try to help them," said Attorney General Jeff Sessions. "This Justice Department will not tolerate this. We will hold accountable anyone – from street dealers to corporate executives -- who illegally contributes to this nationwide epidemic. And under the leadership of President Trump, we are fully committed to defeating this threat to the American people.”
John N. Kapoor, 74, of Phoenix, Ariz., a current member of the Board of Directors of Insys, was arrested this morning in Arizona and charged with RICO conspiracy, as well as other felonies, including conspiracy to commit mail and wire fraud and conspiracy to violate the Anti-Kickback Law. Kapoor, the former Executive Chairman of the Board and CEO of Insys, will appear in federal court in Phoenix today. He will appear in U.S. District Court in Boston at a later date. 

Pittsburgh-Area Doctor Charged With Unlawfully Distributing Opioids
Indictment is first since Attorney General Sessions announced the formation of the Opioid and Abuse Detection Unit, a Department of Justice initiative that uses data to target and prosecute individuals that are contributing to the nation’s opioid crisis
A suburban Pittsburgh physician has been indicted by a federal grand jury in Pittsburgh on charges of conspiracy and unlawfully distributing controlled substances, Acting United States Attorney Soo C. Song announced today. The indictment of Andrzej Kazimierz Zielke, 62, is the first since  Attorney General Jeff Sessions announced the formation of the Opioid and Abuse Detection Unit , a Department of Justice initiative that uses data to target and prosecute individuals that are contributing to the nation’s opioid crisis. 
“Today we are facing the worst drug crisis in American history, with one American dying of a drug overdose every nine minutes,” said Attorney General Jeff Sessions. “An unprecedented crisis like this one demands an unprecedented response—and that’s why President Trump has made this a top priority for this administration," Sessions said. "This summer, I designated a dozen of our top federal prosecutors to focus solely on the problem of opioid-related health care fraud in places where the epidemic was at its worst--including Western Pennsylvania. These cases take on the supply of drugs and stop fraudsters from exploiting people suffering from addiction. Today, as President Trump unveils his plan to fight the opioid epidemic, we have filed the first charges by these prosecutors. We will file many more charges in the months to come—because the Department of Justice will be relentless in hunting down drug dealers and turning the tide of this epidemic.”
“Western Pennsylvania is experiencing some of the highest rates of overdose deaths in the nation,” added Acting U.S. Attorney Song. “In response, we in law enforcement aggressively target drug traffickers – both those who distribute on the street, and those who traffic under the guise of physicians writing excessive prescriptions.”        

State Society News 
July 19-22, 2018
FSIPP 2018 Annual Meeting, Conference, and Trade Show
Florida Society of Interventional Pain Physicians
One South County Road, Palm Beach, FL 33480

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