American Society of Interventional Pain Physicians | June 5, 2019
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What's Doctor Burnout Costing America?

Doctor burnout is costing the U.S. health care system a lot — roughly $4.6 billion a year, according to a study published this week in the Annals of Internal Medicine.
"Everybody who goes into medicine knows that it's a stressful career and that it's a lot of hard work," says Lotte Dyrbye , a physician and professor of medicine at the Mayo Clinic in Rochester, Minn., who co-authored the study.
She says the medical profession now carries an increasing load of paperwork and bureaucracy, adding stress to doctor's lives. "We want to be able to deliver good quality care to our patients, and our systems get in the way," Dyrbye says.
The study defines burnout as substantial symptoms of "emotional exhaustion, feelings of cynicism and detachment from work, and a low sense of personal accomplishment." This description tracks closely with the World Health Organization's newly updated definition for burnout .
 
NPR
Non-Opioid Analgesic Gets FDA’s Priority Review for Pain Management

A supplemental abbreviated New Drug Application has been submitted by Galt Pharmaceuticals for Orphengesic Forte, a combination analgesic that the Company hopes will provide an opioid-free alternative to prescribers and patients.
Orphengesic Forte consists of orphenadrine citrate 50mg, aspirin 770mg, and caffeine 60mg in an oral tablet formulation. It was previously approved for relief of mild to moderate pain of acute musculoskeletal disorders as an adjunct to rest, physical therapy and other measures, before being discontinued . While the mechanism of action of orphenadrine citrate in pain management is unclear, it is believed to have analgesic properties in addition to anticholinergic actions.
The Food and Drug Administration has set a Priority Review goal date of August 14, 2019.

MPR
Join the specialty's top instructors on July 12-13 in Memphis for an in-depth course in Regenerative
Medicine.This is a course you won't want to miss!



JULY ABIPP EXAMS
AND COMPETENCY EXAMS
July 13 - July 14 | Memphis, TN

  ABIPP now offers the only competency certification program for regenerative medicine.

The American Board of Interventional Pain Physicians ( ABIPP ) has developed certification programs that recognize accepted levels of knowledge and expertise in the interventional pain management
profession, with the goal of improved patient care. Hundreds of qualified physicians have made the commitment to become ABIPP certified.
 
For complete information about the examination requirements and to obtain an application packet, visit www.abipp.org or call 270-554-9412. ext. 4217 or by email at summer@asipp.org.

July 13
ABIPP Part I
Combined CSM/CCPM Exam for ABIPP Path
Competency Exam in Controlled Substance Management
Competency Exam in Coding, Compliance, and
Practice Management

July 13-14
ABIPP Part II
Regenerative Medicine Competency Exam
Endoscopic Lumbar Decompression Competency Exam

July 14
ABIPP Competency Exam

939 Ridge Lake Blvd. | Memphis, TN 38120
 
The cut-off date for our room block with discounted rates is on June 10, 2019 or until sold out, whichever occurs first.
Can CBD Curb Heroin Addiction?
Exploratory trial suggests cannabidiol cuts cravings, anxiety
Cannabidiol (CBD; Epidiolex) reduced opioid cravings and anxiety among heroin users, suggesting it may have a role in curbing addiction, an exploratory trial found.
Compared with placebo, once daily CBD 400 or 800 mg diminished cue-related cravings and anxiety among people who had heroin use disorder, reported Yasmin Hurd, PhD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues in the American Journal of Psychiatry .
Environmental cues are one of the strongest triggers for drug cravings, Hurd noted. "Cue-induced cravings trigger relapse," she told MedPage Today. "For me, this research is extremely promising. If we can find the medication that targets that kind of system, that would be amazing."

Artificial Intelligence in Health Care Will the Value Match the Hype?
Artificial intelligence (AI) and its many related applications (ie, big data, deep analytics, machine learning) have entered medicine’s “magic bullet” phase. Desperate for a solution for the never-ending challenges of cost, quality, equity, and access, a steady stream of books, articles, and corporate pronouncements makes it seem like health care is on the cusp of an “AI revolution,” one that will finally result in high-value care.
While AI has been responsible for some stunning advances, particularly in the area of visual pattern recognition, 1-3 a major challenge will be in converting AI-derived predictions or recommendations into effective action.

New Jersey sues Sackler family for opioid epidemic

The New Jersey attorney general's office filed a lawsuit against members of the billionaire family behind pharmaceutical giant Purdue Pharma, alleging that the company's marketing strategies overstated the benefits of their opioid drugs while also minimizing the health risks and downplaying their potential for addiction.
The suit was filed on Thursday in Essex County Superior Court and names eight members of the Sackler family, which include former chairman and president Richard Sackler. The others are Jonathan D. Sackler; Dr. Kathe Sackler; Ilene Sackler Lefcourt; Mortimer D.A. Sackler; Beverly Sackler; Theresa Sackler; and David A. Sackler.
 
CNN
Association of Increased Youth Suicides in the United States With the Release of 13 Reasons Why

Key Points
Question  Was the release of the Netflix show 13 Reasons Why associated with excess suicides in the United States?
Findings  In this time series analysis of monthly suicide data from 1999 to 2017, an immediate increase in suicides beyond the generally increasing trend was observed among the target audience of 10- to 19-year-old individuals in the 3 months after the show’s release. Age- and sex-specific models indicated that the association with suicide mortality was restricted to 10- to 19-year-old individuals, and proportional increases were stronger in females.
Meaning  The increase in suicides in only the youth population and the signal of a potentially larger proportional increase in young females all appeared to be consistent with media contagion and seem to reinforce the need for safer and more thoughtful portrayal of suicide in the media.



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. 

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

2019 MIPS Reporting? Start Now.
MIPS-eligible clinicians must report a full year of data. Don’t fall behind – keep up with NIPM-QCDR.
 
MIPS 2019 has brought larger payment adjustments and greater reporting requirements, including a 365-day performance period for the Quality and Cost categories. The sooner you start your MIPS reporting for 2019, the better.
Sign up today to use ASIPP’s NIPM-QCDR for MIPS.
This powerful tool makes MIPS reporting easy through the use of our new patient-reported outcomes measures for 2019, which ease the burden on providers and reduces costly EMR integration.

Get started today at ASIPP.ArborMetrix.net

FDA puts company on notice for marketing unapproved stem cell products for treating serious conditions
 
The U.S. Food and Drug Administration has sent an untitled letter to R3 Stem Cell, LLC of Scottsdale, Arizona, and its chief executive officer, David Greene, M.D. The company, through its affiliated centers or clinics throughout the U.S., offers unapproved stem cell products to treat a variety of diseases and conditions, such as Lyme disease, diabetes, Parkinson’s disease, stroke, kidney failure and amyotrophic lateral sclerosis (ALS). The products offered by R3 Stem Cell, LLC are not approved by the FDA.
The FDA has notified each of R3 Stem Cell, LLC’s more than 50 affiliate centers or clinics of this action .

FDA
Supreme Court sides with hospitals in multibillion-dollar payment dispute
In an opinion issued June 3, the U.S. Supreme Court ruled that HHS improperly failed to undergo formal notice-and-comment rulemaking before announcing a new Medicare rate calculation for disproportionate share payments to hospitals.
At issue in the case, Azar v. Allina Health Services, is the federal government's decision to include Medicare Part C enrollees with Medicare Part A enrollees when calculating disproportionate share hospital payments.
In 2004, CMS issued a final rule that included a new methodology for DSH payments that counted Medicare Part C inpatient days, in addition to Part A days in its calculation. This differed from the proposed rule CMS issued in 2003 that excluded Part C days from the calculation.

Pain Physician
May/June 2019 Issue Features

The May/June issue of Pain Physician features guidelines for sedation and fasting in patients undergoing IPM procedures as well as several systematic reviews, randomized trials and original research.

Guidelines
Alan D. Kaye, MD, PhD, Mark R. Jones, MD, Omar Viswanath, MD, Kenneth D. Candido, MD, Mark V. Boswell, MD, PhD, Amol Soin, MD, Mahendra Sanapati, MD, Michael E. Harned, MD, Thomas T. Simopoulos, MD, Sudhir Diwan, MD, Sheri L. Albers, DO, Sukdeb Datta, MD, Frank J.E. Falco, MD, and Laxmaiah Manchikanti, MD

Systematic Reviews
Chia-Shiang Lin, MD, Ying-Chun Lin, MD, Hsuan-Chih Lao, MD, and Chien-Chuan Chen, MD

Yola Moride, PhD, Danae Lemieux-Uresandi, Msc, Genaro Castillon, MD, Cristiano Soares de Moura, PhD, BPharm, Louise Pilote, MD, PhD, Mareva Faure, MSc, Sasha Bernartsky, MD, PhD

Shu-Wei Yeh, MD, Chien-Hsiung Hong, MD, Ming-Chieh Shih, MD, Ka-Wai Tam, MD, PhD, Yao-Hsien Huang, MD, and Yi-Chun Kuan, MD


Association Between Life Purpose and Mortality Among US Adults Older Than 50 Years

Question
Does an association exist between life purpose and all-cause or cause-specific mortality among people older than 50 years participating in the US Health and Retirement Study?
Findings  
This cohort study of 6985 adults showed that life purpose was significantly associated with all-cause mortality.
Meaning
 Life purpose is a modifiable risk factor and as such the role of interventions to improve life purpose should be evaluated for health outcomes, including mortality.

Cannabis Companies Push F.D.A. to Ease Rules on CBD Products
 
WASHINGTON — It was Hempy Pet CBD Soft Chews, Mile High Labs and Women Grow, among countless others, squaring off against the likes of the Marijuana Victims Alliance, concerned primary care doctors and a lawyer who admitted he couldn’t wait to sue — all jammed into an overflowing auditorium for hours Friday on the Food and Drug Administration campus.
F.D.A. hearings are usually tedious affairs. But this one — called to begin the process of figuring out which products in the burgeoning cannabis industry can be legally sold in the United States — was the hottest ticket in the capital. More than 400 applicants, from the U.S. Hemp Roundtable to blue chip law firms, had petitioned the agency for a chance to testify. It had to create a complex lottery system to whittle down the list to a lucky 120.

Hospitals Accused Of Paying Doctors Large Kickbacks In Quest For Patients

For a hospital that had once labored to break even, Wheeling Hospital displayed abnormally deep pockets when recruiting doctors.
To lure Dr. Adam Tune, an anesthesiologist from nearby Pittsburgh who specialized in pain management, the Catholic hospital built a clinic for him to run on its campus in Wheeling, W.Va. It paid Tune as much as $1.2 million a year — well above the salaries of 90% of pain management physicians across the nation, the federal government charged in a lawsuit filed this spring.
In addition, Wheeling paid an obstetrician-gynecologist a salary as high as $1.3 million a year, so much that her department bled money, according to a related lawsuit by a whistleblowing executive. The hospital paid a cardiothoracic surgeon $770,000 and let him take 12 weeks off each year even though his cardiac team also routinely ran in the red, that lawsuit said.
 
Dozens of Doctors in 7 States Charged in Opioid Fraud Bust
(Reuters) - Dozens of medical professionals in Appalachia, a region hard-hit by the U.S. opioid crisis, have been charged with writing hundreds of thousands of illegal prescriptions and committing healthcare fraud, federal prosecutors said on Wednesday.
Sixty people, including 31 doctors, were accused of illegally prescribing opioid drugs in exchange for cash and sexual favors in the rural, mountainous region stretching from Pennsylvania and West Virginia to Alabama and Louisiana.
“The opioid epidemic is the deadliest drug crisis in American history, and Appalachia has suffered the consequences more than perhaps any other region,” Attorney General William P. Barr said in a statement.

Department of Justice News

Darknet Fentanyl Dealer Indicted in Nationwide Undercover Operation Targeting Darknet Vendors Who were Selling to Thousands of U.S. Residents
Undercover Operation Results in Numerous Charges and Convictions of Opioid Distributors
Yesterday, the U.S. Attorney for the Northern District of Texas announced the indictment of a darknet drug dealer who has been indicted for leveraging Bitcoin’s apparent anonymity to sell fentanyl online. The charges against him are the result of the first nationwide undercover operation targeting darknet vendors that the Justice Department announced in June 2018.    
Sean Shaughnessy, 51, of the Dallas Fort Worth, Texas area, was charged by federal grand jury with conspiracy to possess with intent to distribute controlled substances, distribution of a controlled substance, distribution of a controlled substance analogue and eight counts of money laundering. 
According to the indictment, which was unsealed on May 24 following the defendant’s initial appearance, Mr. Shaughnessy allegedly sold fentanyl and fentanyl analogues over the dark web, an unindexed portion of the internet accessible only via specialized software that allows users to conduct transactions with relative anonymity. His buyers purchased the fentanyl and fentanyl analogues, which was shipped to their addresses, using cryptocurrencies like Bitcoin, the indictment alleges. One user, who allegedly purchased a fentanyl analogue from Mr. Shaughnessy, overdosed on the substance and died. Mr. Shaughnessy allegedly transferred his Bitcoin proceeds to other cryptocurrency wallets in exchange for regular fiat currency, which was shipped to his home in Dallas. Unbeknownst to Mr. Shaughnessy, he sent more than $120,000 bitcoin to wallet addresses controlled by federal agents. Yesterday, he was ordered to remain in federal custody. The charges in the indictment are merely allegations, and the defendant is presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

DOJ

 
Pharmaceutical Company Admits to Price Fixing in Violation of Antitrust Law, Resolves Related False Claims Act Violations
Heritage Pharmaceuticals Agrees to Pay More than $7 Million in Criminal Penalty and Civil Damages and to Cooperate with Ongoing Parallel Investigations in the Generics Industry
Heritage Pharmaceuticals Inc., a generic pharmaceutical company headquartered in Eatontown, New Jersey, was charged for conspiring with its competitors to fix prices, rig bids, and allocate customers, the Department of Justice announced today. 
According to a one-count felony charge filed yesterday in the United States District Court for the Eastern District of Pennsylvania in Philadelphia, from about April 2014 until at least December 2015, Heritage participated in a criminal antitrust conspiracy with other companies and individuals engaged in the production and sale of generic pharmaceuticals, a purpose of which was to fix prices, rig bids, and allocate customers for glyburide, a medicine used to treat diabetes. This charge is the third in the Department of Justice’s Antitrust Division’s ongoing investigation; Heritage’s former CEO and its former president were previously charged.
 
 
DOJ


Pennsylvania Anesthesiologist Pleads Guilty to Filing False Tax Return s
Failed to Report Over $3 Million Earned
A Pennsylvania anesthesiologist pleaded guilty today to filing a false income tax return, announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division.
James G. Allen Jr., 53, admitted as part of his guilty plea that he filed false tax returns for himself and his wife for the years 2010 through 2017 with the Internal Revenue Service (IRS). He failed to report more than $3 million that the pair earned as anesthesiologists on their tax returns. According to the plea agreement, the false tax returns that Allen filed caused a loss to the government of more than $900,000.
Allen admitted that the false tax returns were based on a tax fraud scheme promoted by Peter Hendrickson in his book, Cracking the Code. Hendrickson was convicted of filing false tax returns in 2009 and sentenced to prison. 
U.S District Judge Arthur J. Schwab set sentencing for Nov. 12, 2019. Allen faces up to three years in prison and a $250,000 fine. As part of his plea, Allen has agreed to pay restitution to the IRS in the amount of $902,721.45.

DOJ


United States Files False Claims Act Complaint Against South Carolina Chiropractor, Pain Management Clinics, Urine Drug Testing Laboratories, and Substance Abuse Counseling Center
The United States has filed a complaint under the False Claims Act against Daniel McCollum, a chiropractor based in Greenville, South Carolina, and pain management clinics and urine drug testing laboratories that McCollum owned or managed for engaging in illegal financial relationships and providing medically unnecessary services and items, including urine drug testing and steroid injections and prescriptions for opioids and lidocaine ointment, the Department of Justice announced today. The entities named as defendants in connection with McCollum’s schemes are FirstChoice Healthcare P.C.; Labsource LLC; Oaktree Medical Centre P.C.; Pain Management Associates of the Carolinas LLC; Pain Management Associates of North Carolina P.C.; and ProLab LLC. The United States’ complaint also names as a defendant ProCare Counseling Center LLC, a substance abuse counseling center located in Greenville, South Carolina, that the government contends referred medically unnecessary urine drug tests to ProLab, which it co-owned with McCollum.
“Individuals and entities that participate in federal health care programs must comply with the rules intended to safeguard the integrity of those programs,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “We will not tolerate practices such as the ordering of unnecessary items or services and providing illegal inducements to physicians that lead to excessive costs being imposed upon our nation’s health care programs.”


DOJ

State Society News 

July 12-14, 2019
GSIPP 2019 - 15th Annual Meeting & Pain Summit
The Cloister Hotel at Sea Island
Sea Island, GA
For more information, contact Karrie Kirwan at karrie@theassociationcompany.com or Tara Morrison at tara@theassociationcompany.com or 770-613-0932.

July 26-28, 2019
PAIN 2019
West Virginia Society of Pain Physicians
Loews Miami Beach, FL

August 9-10, 2019
Ohio and Kentucky Annual Meeting
Westin Cincinnati
Cincinnati, OH

Send in your state society meeting news to Holly Long, hlong@asipp.org
ASIPP | Pain Physician Journal | Phone | Fax | Email