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Pain Physician
September/October 2019 Issue Features
The September/October issue of Pain Physician features a cost utility analysis of cervical interlaminar epidural injections as well as several systematic reviews, randomized trials and original research.
Cost Utility Analysis
Laxmaiah Manchikanti, MD, Vidyasagar Pampati, MSc, Allan Parr, III, MS, Maanasa V. Manchikanti, Mahendra R. Sanapati, MD, Alan D. Kaye, MD, PhD, and Joshua A. Hirsch, MD.

Narrative Review
Inna Blyakhman, MSc, and Krishnan Chakravarthy, MD, PhD.

Comprehensive Review
Ajay B. Antony, MD, Anthony J. Mazzola, MD, Gurpreet S. Dhaliwal, MD, and Corey W. Hunter, MD.

Narrative Review
Gabriel Fregoso, MD, Annie Wang, MD, Kelly Tseng, MD, and Jingping Wang, MD, PhD.

Retrospective Review
Leonardo Kapural, MD, PhD, Nicholas Lee, ., Kevin Neal, MD, and Michael Burchell, MD.
June 27 - June 28, 2020 | Memphis, TN
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.
ABIPP now offers the only competency certification program for regenerative medicine.
For complete information about the examination requirements and to obtain an application packet, visit www.abipp.org or call 270-554-9412 x4217 or by email at summer@asipp.org.
June 27
ABIPP Part I  
Combined CSM/CCPM Exam for ABIPP Path
Competency Exam in Controlled Substance Management
Competency Exam in Coding, Compliance, and
Practice Management

June 27-28
ABIPP Competency Exam
Regenerative Medicine Competency Exam
Endoscopic Lumbar Decompression Competency Exam

939 Ridge Lake Blvd. | Memphis, TN 38120  
State AGs dangle $18B potential settlement, but fail to delay federal opioid trial
An 11th-hour bid to delay a landmark federal opioid trial failed after a group of state attorneys general tried to persuade U.S. District Court Judge Dan Aaron Polster to give them more time to craft a settlement in their own cases, according to people with familiar with the events.

They told Polster they were trying to reach an $18 billion settlement with the nation’s three largest drug distributors, McKesson Corp., Cardinal Health and AmerisourceBergen, according to the people familiar with the events who spoke on the condition of anonymity because of the sensitivity of the negotiations
The state attorneys general have filed their own lawsuits against the drug industry for saturating their states with highly addictive pain pills. Polster is overseeing more than 2,500 lawsuits against the industry filed by cities, counties and Native American tribes. Those suits have been consolidated into a massive federal case in a Cleveland courtroom, where jury selection is scheduled to begin Wednesday morning .
The Ins and Outs of Health Reform Proposals; Survey Details Patient Wish List
A new report highlights the economic burden of the opioid crisis
A new report from the Commonwealth Fund and the Urban Institute examined eight health insurance reforms, including Medicare for All and a public option, and detailed how each could affect insurance coverage and costs.

The vast majority of consumers want flexible payment plans for high bills, and more than 40% say a bad digital experience would motivate them to switch providers, a recent survey found.

A recent analysis characterized the financial impact of the opioid epidemic, estimating that the U.S. spent $631 billion on the crisis from 2015 to 2018. Breaking down these costs highlights the impact of the crisis on mortality, work productivity, and a range of other factors.
Centene: Approval For WellCare Deal ‘Ahead Of Schedule’

Centene said the approval process for its acquisition of WellCare Health Plans “is ahead of schedule” with just two states and the federal government needed to approve the merger.

The New York State Department of Financial Services and Department of Health “joined 24 other states in issuing approvals,” Centene chairman and chief executive Michael Neidorff  said Tuesday  when the company announced its third-quarter earnings.

Neidorff said the WellCare acquisition, which would give the larger Centene business in all 50 states, still needs approval in Illinois and New Jersey as well as clearance by the U.S. government. The U.S. Justice Department has been reviewing the transaction and some medical care providers, including the American Hospital Association, have  asked the government to take a close look  at the merger, fearing a threat to competition.

Related stories;

Reference Pricing Could Cut Drug Prices, Report Finds
It's not a panacea but "could make a significant impact"

WASHINGTON -- Pegging U.S. drug prices to those paid in other countries is not a cure-all but could help to lower costs for Americans, according to a  report released Tuesday  by the Bipartisan Policy Center (BPC) here.

"Today's report concludes that while reference pricing alone is not a panacea ... in the right setting, focused on the most appropriate drugs, and in combination with additional approaches, it could make a significant impact," said Anand Parekh, MD, MPH, chief medical advisor to the BPC, at a briefing to release the report.

The BPC compiled this report through information and insights derived from extensive literature review; interviews with subject matter experts, Capitol Hill staff, and drug pricing stakeholders; and information shared at a BPC roundtable held in July 2019. It delineated two types of reference pricing: external pricing, which uses international prices as a benchmark to set or negotiate the price of drugs; and internal reference pricing, which could be used in various scenarios to ensure that therapeutically equivalent drugs are priced similarly, and encourages the use of the least costly alternative therapy.

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

FDA grants first-ever modified risk orders to eight smokeless tobacco products
FDA concludes completely switching from cigarettes to these authorized products lowers certain health risks

The U.S. Food and Drug Administration announced today that, for the first time, it has authorized the marketing of products through the modified risk tobacco product (MRTP) pathway. The authorizations are for eight Swedish Match USA, Inc. snus smokeless tobacco products sold under the “General” brand name.
These products had previously been authorized for U.S. sale without modified risk claims by the FDA in 2015 in response to filings of premarket tobacco applications (PMTAs). Today’s action further authorizes the manufacturer to market these specific products with the claim “Using General Snus instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.” The FDA made this authorization after reviewing scientific evidence submitted by the company that supports this claim. In an effort to help prevent youth access and exposure, the agency has also placed stringent advertising and promotion restrictions on the products, including a requirement to restrict advertising to adults. In addition, the products’ packaging and advertising must also bear the warning statements required for all smokeless tobacco products.

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, FTC warn company marketing unapproved cannabidiol products with unsubstantiated claims to treat teething and ear pain in infants, autism, ADHD, Parkinson’s and Alzheimer’s disease
Today, the U.S. Food and Drug Administration and the Federal Trade Commission posted a joint warning letter to Rooted Apothecary LLC, of Naples, Florida, for illegally selling unapproved products containing cannabidiol (CBD) online with unsubstantiated claims that the products treat teething pain and ear aches in infants, autism, attention-deficit/hyperactivity disorder (ADHD), as well as Parkinson’s and Alzheimer’s disease, among other conditions or diseases.

“Cannabis and cannabis-derived compounds are subject to the same laws and requirements as FDA-regulated products that contain any other substance. We are working to protect Americans from companies marketing products with unsubstantiated claims that they prevent, diagnose, treat, or cure a number of diseases or conditions. This is especially concerning when companies are peddling unproven CBD products for use in vulnerable populations like infants and children,” said Acting FDA Commissioner Ned Sharpless, M.D. “We’ve sent numerous warning letters that focus on matters of significant public health concern to CBD companies, and these actions should send a message to the broader market about complying with FDA requirements. As we examine potential regulatory pathways for the lawful marketing of cannabis products, protecting and promoting public health through sound, science-based decision-making remains our top priority. We appreciate the FTC joining us on these and other actions to protect consumers from fraudulent CBD products.”

Down the Rabbit Hole on Medicare

After getting his proposed budget cuts to Medicare stuffed in March (cuts to doctors and hospitals, of course), Pres. Trump zoomed down to hit the Florida hustings to cheer on the continued survival of this beloved program.  He hit the premier gray ghetto in The Villages, promising to protect Medicare from “socialism,’ which is akin to preventing water from getting wet.  

Of course, no national politician has a chance now, without pandering to Baby Boomers still trying to live under some “greatest generation” umbrella, and modern history’s greatest-ever vote buy is the centerpiece of this mechanism.  Neither party or their leaders have any idea how to actually fix the underlying problem, which is the very existence of Medicare.  In the harsh glare of daylight reality, the average aging of the population, coupled with the ever-increasing Medicare budget, welded to an unwieldly, enlarging bureaucratic burden, all against the backdrop of a $22 trillion debt run up by people who think they had a right to run it up, means this is an accelerating disaster.  Until such time as the nation realistically accepts radical, and I mean drastic reforms to this mess, we will remain on the path toward – paradoxically – Medicare For All.  This is not an endorsement, just the political reality, as more in need will have more need, and will denounce doctors, particularly, as the source for their shortages.

Can I Please Just Treat My Patients?
We spend too much time simply documenting that we aren't committing fraud
How sick are our patients?

In the old days, it used to be our job to figure this out.

That's pretty much what a lot of doctoring and nursing and other care is all about.
In fact, that's pretty much what the entire healthcare system was built around.
Who was sick, who needed an immediate medication, procedure, or surgery.
And who needed to make some dramatic lifestyle changes, some slow and steady progress, some small incremental steps towards positive healthy change.


Ohio Doctor Pleads Guilty to Unlawful Distribution of Opioids

The owner of a Cincinnati-area medical practice pleaded guilty today for illegally distributing opioids.  
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, Special Agent in Charge Keith Martin of the Drug Enforcement Administration’s (DEA) Detroit Division and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office made the announcement.

Raymond Noschang, M.D., 59, of Cincinnati, Ohio, pleaded guilty to eight counts of unlawful distribution of oxycodone before U.S. District Judge Susan J. Dlott of the Southern District of Ohio. Sentencing has not yet been scheduled.

As part of his guilty plea, Noschang admitted that he prescribed controlled substances to patients in amounts and for lengths of time that were outside the scope of legitimate medical practice. Noschang also admitted that he routinely prescribed controlled substances to patients even though various “red flags” suggested that he should stop writing those prescriptions, change the prescriptions and/or counsel patients accordingly. Further, Noschang admitted that he prescribed dangerous combinations of drugs known to heighten the risk of overdose and death.


Southern California Doctor Found Guilty in $12 Million Medicare Fraud and Device Adulteration Scheme

A federal jury found a southern California doctor guilty yesterday for his role in a $12 million scheme to provide medically unnecessary procedures to Medicare beneficiaries, upcode claims submitted to Medicare, and re-package single-use catheters for reuse on patients.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Nicola T. Hanna of the Central District of California, Assistant Director in Charge Paul Delacourt of the FBI’s Los Angeles Field Office, Special Agent in Charge Timothy DeFrancesca of the U.S. Department of Health and Human Services Office of the Inspector General’s (HHS-OIG) Los Angeles Regional Office and Special Agent in Charge Lisa Malinowski of the U.S. Food and Drug Administration Office of Criminal Investigations’ (FDA-OCI) Los Angeles Field Office made the announcement.

After a six-day trial, Donald Woo Lee, 54, of Temecula, California, was found guilty of seven counts of health care fraud and one count of adulteration of a medical device. Sentencing has been scheduled for March 19, 2020, before U.S. District Judge George Wu of the Central District of California, who presided over the trial. 

Kentucky Physician Pleads Guilty to Unlawfully Distributing Opioids

A Floyd County, Kentucky-based physician pleaded guilty today for his role in unlawfully distributing opioids by pre-signing blank prescriptions that were ultimately completed by others and delivered to patients not seen by him. 

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Robert M. Duncan Jr. of the Eastern District of Kentucky, Special Agent in Charge Derrick Jackson of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Atlanta Field Office, Special Agent in Charge D. Christopher Evans of the U.S. Drug Enforcement Administration’s (DEA) Louisville Field Division and Director Michelle Rudovich of the Kentucky Medicaid Fraud Control Unit (MFCU) made the announcement.

Mohammed A.H. Mazumder, M.D., 48, of Prestonsburg, Kentucky, pleaded guilty to one count of conspiracy to unlawfully distribute controlled substances. He is scheduled to be sentenced on Feb. 19, 2020, by U.S. District Judge Gregory F. Van Tatenhove of the Eastern District of Kentucky, who accepted his plea. 

Two East Tennessee Doctors Plead Guilty to Opioid Offenses

Two Tennessee doctors each pleaded guilty yesterday to one count of unlawful distribution of a controlled substance.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Doug Overbey of the Eastern District of Tennessee, Special Agent in Charge Joe Carrico of the FBI’s Knoxville Field Office, Special Agent in Charge Derrick L. Jackson of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) and Director David Rausch of the Tennessee Bureau of Investigation made the announcement.

Samuel Mcgaha, M.D., of Sevierville, Tennessee, and Frank McNiel, M.D., of Knoxville, Tennessee, each pleaded guilty to one count of unlawful distribution of a controlled substance. The charges stem from Mcgaha’s and McNiel’s roles in prescribing high doses of opioids with no medical legitimacy – McNiel from his home. From 2015 until March 2018, Mcgaha and McNiel prescribed 212,226 and 59,712 opioid pills, respectively. During this period, Mcgaha admittedly wrote opioid prescriptions that exceeded Centers for Disease Control guidelines and prescribed opioids even when patients tested positive for non-prescribed prescriptions and illicit substances. McNiel admittedly wrote opioid prescriptions without evaluating patients and without obtaining medical records that would have justified the prescription of opioids. Sentencing has been scheduled for March 26, 2020, before the Honorable Thomas A. Varlan.
State Society News 
October 25-27, 2019

California Society of Interventional Pain Physicians 10 th annual meeting
The Resort at Squaw Creek, Lake Tahoe.

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