American Society of Interventional Pain Physicians | November 29, 2017
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Epidural Use Takes a Dip, Opioid Deaths Due to Heroin and Fentanyl Increase Astronomically
Laxmaiah Manchikanti, MD, Amol Soin, MD, Dharam P Mann, MD, Sanjay Bakshi, MD, Vidyasagar Pampati, MSc, and Joshua A. Hirsch, MD. published statistics showing decline in utilization of interventional techniques with reductions in reimbursement, with reductions in reimbursement. Opioid prescription reductions, increasing deaths, with increasing heroin and fentanyl correlate with decline in interventional techniques, despite promotion of nonopioid techniques.
In the November/December of Pain Physician , Manchikanti and Joshua Hirsh have assessed with an in-depth look at growth of interventional techniques over the past 17 years. Interesting, they have divided the periods prior to 2009 – enactment of Obamacare, and after 2009, that is, i.e. pre- and post-Obamacare.
This analysis showed overall reduction of interventional techniques from 2009 to 2016 of 0.6% per year; however, startling statistics show the following:
Epidural injections and adhesiolysis procedures declined at an annual rate of 1.7% per 100,000 Medicare population. It appears that there may be slight increase for facet joint interventions, specifically in the cervical spine without substantial increase in the lumbar spine. There is also annual decrease of 2.2% for disc procedures and other types of nerve blocks.
Dr. Manchikanti commented that this is happening since enactment of Obamacare with multiple regulations, with increased insured, but with less access. At the same time, opioid prescriptions have declined approximately 25%, but opioid deaths specifically related to heroin and fentanyl have increased astronomically.
President's Commission and all other recommendations continue to state to provide nonopioid techniques, yet CMS and others continue to reduce payments for interventional techniques and make it extremely difficult for patients to receive these.

President Trump commented that opioid deaths, specifically related to heroin an fentanyl, have increased astronomically with fentanyl deaths alone increasing by 540%.
Drug overdoses are expected to remain the leading cause of death for Americans under 50, as synthetic opioids — primarily fentanyl and its analogues — continue to push the death count higher. Drug deaths involving fentanyl more than doubled from 2015 to 2016, accompanied by an upturn in deaths involving cocaine and methamphetamine. Together they add up to an epidemic of drug overdoses that is killing people at a faster rate than the H.I.V. epidemic at its peak.
Recent data shows that illicit fentanyl is responsible for 20,100 deaths compared to 14,400 for prescription opioids, 15,400 for heroin, 10,600 for cocaine, 7,660 for meth, and 3,260 for methadone .It is so sad that methadone with the number of prescriptions at just 1% is contributing to as many as 19% of all deaths due to prescription opioids
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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.

March 15, 2018
Raj-Racz Distinguished Lecture Series
  • Arnold Caplan, PhD Mesenchymal Stem Cells: Today, Tomorrow, and Future of Pain Management
  • Laxmaiah Manchikanti, MD: Evidence Synthesis in IPM: Evolution of EBM or Death of Expertise and Truth

Afternoon:
  • Jerome Adams, MD, Surgeon General: Addressing National Opioid Epidemic
  • Vanila Singh, MD: Update on Committee on Pain Management Best Practices Inter-Agency Task Force
  • Breakout sessions: Resident/Fellow Section, Imaging for Interventionalists, Regenerative Medicine Guidelines, Concepts in IPM


March 16, 2018
Manchikanti Distinguished Lecture Series
  • Robert Laszewski: State of Health Care in the US: Past, Present, and Future
  • Congressman Ed Whitfield: Health Care Advocacy: ASIPP Involvement with Grass Roots Advocacy
  • Sen. Tim Hutchinson: Health Care Reform: A View from Washington
  • DISCUSSION FORUM
  • Panel: Robert Laszewski, Ed Whitfield, Tim Hutchinson, Laxmaiah Manchikanti, MD, Amol Soin, MD
Breakout Sessions: Compliance, Billing and Coding; Role of Marijuana in IPM Practice: Pros and Cons; Managing Physician Burnout; Endoscopic Decompression; Opioids

Breakout sessions in the morning and in the afternoon.
March 17, 2018
Senator Cassidy and other keynotes and 8 panel discussions on various subjects of interventional pain management until 5 pm.

Start Planning NOW!
ASIPP Abstract Submission for 2018 Annual Meeting is Open

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.

Health-Care Clashes Loom Over Republican Legislative Agenda
Congress is headed for a showdown on whether to insert several pressing health measures in year-end bills, reviving partisan fights that threaten to derail Republicans’ goal to close out the year with a raft of legislative successes.
The looming health-care issues include funding for a children’s health program, the possible delay of certain taxes by the Affordable Care Act and the fate of a bipartisan plan to bolster fragile insurance markets.
With just weeks left in the 2017 legislative calendar, Republicans hope to push through  a tax overhaul , reach a two-year budget agreement, enact a spending bill for the remainder of 2018 fiscal year, provide more hurricane-relief funds, and potentially  find a fix for the so-called Dreamers , undocumented immigrants who entered the U.S. as children.
Access to this article may be limited.
Christie Urges Mandatory CME on Opioid Prescribing
BALTIMORE, Md. -- Physicians should be required to take continuing education classes on opioid prescribing in order to maintain their Drug Enforcement Administration (DEA) prescribing licenses, New Jersey Governor Chris Christie (R) said Tuesday at a congressional field hearing here on the opioid crisis.
"This drug epidemic didn't start on the street corners of Baltimore; it started in doctors' offices and hospitals across the nation," Christie, who led President Trump's commission on the opioid crisis, said at the House Oversight and Government Reform Committee hearing at Johns Hopkins Hospital. "And while some of it is done by folks who have bad intent, most is done by those with no intent. Why no intent? Because they're not educated on this issue."

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

Click HERE to submit
Researchers May Be at Risk for Legal Action From Medical Device, Pharmaceutical Companies
Scientists continue to be the targets of legal action from pharmaceutical, medical device, and nutraceutical companies when published studies frame these companies' products in an unfavorable light, according to a paper published in  JAMA Internal Medicine .
Researchers who publish trial results that show no effect or negative impacts of medical products are at risk of receiving backlash from executives of companies selling these products. This backlash can often be in the form of an editorial or a company-published rebuttal. In some cases, company executives may pursue legal action against study investigators in an effort to reduce the likelihood of future trials.
Siemens Tees Up Health-Care IPO in One of Biggest European Deals in Years
BERLIN—  Siemens  AG  SIEGY +0.17%  , the German engineering conglomerate, is readying the most significant step yet in its yearslong restructuring: the listing of a big chunk of its health-care business, estimated to be worth up to $47 billion.
The company’s board is expected Wednesday to hammer out more details for its plan—first disclosed last year—to float a minority stake in the unit, which makes medical equipment and provides services for hospitals and diagnostics laboratories. It competes with similar, large units at  General Electric  Co.  GE +0.33%  and Koninklijke Philips NV of the Netherlands.
A decision on where to list the health division could come as soon as Wednesday. The company is leaning toward Frankfurt after initially favoring New York, according to people familiar with the matter.
 
Access to this article may be limited.
Drug Test Documentation and Coding Webinar
Improve Your Documentation and Billing for Narcotic Management and Survive Audit
Newspapers and the internet blast the headlines when pain management practices and providers are the subjects of legal action related to narcotic management. In addition, physicians, especially those with in-house labs, have been prosecuted based on statistical analysis of their claims submission which indicated overbilling for urine drug testing.
Will your practice survive an audit of this highly scrutinized aspect of pain management or do your current records put you at risk? With governmental and media’s focus on the “opioid crisis”, compliant documentation and billing for the provision of narcotics is essential.
Webinar Fee: $185
Webinar Date: December 6, 2017
Time: 11am-12:30pm CST
Speaker: Judith Blaszczyk, RN, CPC, ACS-IPM, ICDCT-CM


*This program has been submitted to the American Academy of Professional Coders (AAPC) for 1.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by the AAPC of the program content or the program sponsor.
Physician Burnout Linked to High Costs for Organizations

 Physicians who are  experiencing burnout  are more than twice as likely to leave their organization within 2 years, and this is associated with significant economic costs, according to a report from the American Medical Association.
Maryam Hamidi, PhD, and Mickey Trockel, MD, PhD, from the Stanford Medicine WellMD Center, note that almost 60  physicians would leave  Stanford Medicine within 2 years if nothing were done to address burnout. For the 58 physicians who would leave Stanford, the economic loss over 2 years would range from $15.5 million to $55.5 million.
Registered Clinical Trials More Likely to Be Published Without Outcomes Discrepancies
A study published in  JAMA  found that the prospective registration of clinical trials is associated with publication without discrepancies in primary outcomes.
An-Wen Chan, MD, DPhil, of the Women's College Research Institute, University of Toronto in Canada, and colleagues conducted a cohort study of all initiated clinical trial protocols approved in 2007 by the research ethics committee for the region of Helsinki and Uusimaa, Finland.
The researchers included registry records and articles published up to February 2017. They used descriptive statistics and multivariable logistic regression to determine the prevalence of and variables associated with prospective registration, the proportion of trials with one or more discrepancies between the protocol and the registry and publications, and the association between prospective registration and subsequent publication without discrepancies in the primary outcomes compared with the protocol. Discrepancies were defined as a new primary outcome being reported that was not specified as such in the protocol or as a primary outcome defined in the protocol that was left out or demoted to a secondary or unspecified outcome in the registry or publication.
Naproxen Plus Muscle Relaxants vs Naproxen Monotherapy for Low Back Pain
The combination of naproxen with skeletal muscle relaxants, such as orphenadrine or methocarbamol, is not superior to naproxen alone or placebo in patients with low back pain who are admitted to the emergency department, according to findings from a randomized double-blind trial published in the  Annals of Emergency Medicine .
For this comparative trial, researchers assessed the functional outcomes in patients with acute, non-radicular, non-traumatic  low back pain receiving naproxen plus placebo (n=79), naproxen plus orphenadrine (n=80), or naproxen plus methocarbamol (n=81). The primary outcome was improvement on the Roland-Morris Disability Questionnaire (RMDQ) at 1 week compared with baseline
Pain Processing: Examining the Role of Oxytocin
The role of oxytocin (OT) in pain perception has been extensively studied, mainly in animal models; however, a limited number of studies have examined the analgesic effects of OT in humans. A review recently published in  Neuroscience  explores the evidence and findings that have uncovered OT sites of action along pain processing pathways. 1
A neuropeptide that has been evolutionarily conserved across species, OT is synthesized within the paraventricular, supraoptic, and accessory nuclei of the hypothalamus. These magnocellular neurons send projections to the posterior lobe of the pituitary, where OT enters the bloodstream, and to other areas including the amygdala, hippocampus, cerebral cortex, and ventral tegmental area.
Biotin (Vitamin B7): Safety Communication - May Interfere with Lab Tests
AUDIENCE: Laboratory, Health Professional, Patient
ISSUE: The FDA is alerting the public, health care providers, lab personnel, and lab test developers that biotin can significantly interfere with certain lab tests and cause incorrect test results which may go undetected.
Biotin in blood or other samples taken from patients who are ingesting high levels of biotin in dietary supplements can cause clinically significant incorrect lab test results. The FDA has seen an increase in the number of reported adverse events, including one death, related to biotin interference with lab tests.
Biotin in patient samples can cause falsely high or falsely low results, depending on the test. Incorrect test results may lead to inappropriate patient management or misdiagnosis. For example, a falsely low result for troponin, a clinically important biomarker to aid in the diagnosis of heart attacks, may lead to a missed diagnosis and potentially serious clinical implications. The FDA has received a report that one patient taking high levels of biotin died following falsely low troponin test results when a troponin test known to have biotin interference was used.
Former General Counsel of Company That Operates Health Maintenance Organizations in Several States Sentenced to Prison for Role in $35 Million Health Care Fraud Scheme
The former general counsel of a company that operates health maintenance organizations in several states was sentenced to six months in prison today for his role in a $35 million health care fraud scheme.
Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney W. Steven Muldrow of the Middle District of Florida, Special Agent in Charge Shimon Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Field Office, Special Agent in Charge Eric W. Sporre of the FBI’s Tampa Field Office and the Florida Attorney General’s Medicaid Fraud Control Unit made the announcement.
Thaddeus M.S. Bereday, 52, of Tampa, Florida, was sentenced by U.S. District Judge James S. Moody of the Middle District of Florida, who also ordered Bereday to serve three years of supervised release that includes one year of home confinement following his prison term and to pay a fine in the amount of $50,000. Bereday pleaded guilty on June 27, to one count of making a false statement in connection with health care matters.
 
DOJ
 
Married Folks Seem to Have Lower Dementia Risk
Widowed, lifelong singles tend to be underdiagnosed in routine clinical practice
Being married was associated with a lower risk of developing dementia compared with being a lifelong single or a widow, British researchers reported.
A meta-analysis that included 15 studies and more than 812,000 participants from Europe, North and South America, and Asia showed that compared with married people, the risk of dementia was increased by 42% in those who were lifelong single and by 20% in the widowed. The relative risk for divorced versus married people in seven studies was 0.99 (0.71 to 1.37), according to Andrew Sommerlad, MD, of University College London, and colleagues.
Stratified analyses indicated that less education partially confounds the risk in widowhood, and that confounding by worse physical health explains part of the increased risk of dementia in lifelong single people, authors reported online in the  Journal of Neurology, Neurosurgery & Psychiatry.
State Society News 
April 18-22, 2018
GSIPP 2018 Annual Meeting
Georgia Society of Interventional Pain Physicians
Thursday, April 18, 2018 - Sunday, April 22, 2018
The Ritz Carlton Reynolds, Lake Oconee

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

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