American Society of Interventional Pain Physicians | November 15, 2017
Alex Azar Nominated to lead the Department of Health and Human Services

Alex Azar, 50, was nominated to lead the Department of Health and Human Services.

Azar, whose nomination must be confirmed by the Senate, would replace Tom Price, MD, who  resigned in late September.

Azar comes with extensive experience with HHS. He was formerly the  United States Deputy Secretary of Health and Human Services under  George W. Bush from 2005 to 2007.

From 2012 to 2017, Azar was  President of the U.S. division of  Eli Lilly and Company, a major  pharmaceutical drug company, and was a member of the  board of directors of the  Biotechnology Innovation Organization, a  pharmaceutical lobby.

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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
Thursday will open with breakout sessions for Residents and Fellows, Regenerative Medicine guidelines and IPM Guidelines followed by the General Session featuring incoming president Hans Hansen, MD. The Raj-Racz Distinguished Lecture Series will follow. After lunch, there will be a session on the best practices of IPM followed by another series of breakout sessions.
March 16, 2018
Friday’s breakout sessions feature Billing and coding, guidelines for endoscopic decompression and opioid guidelines. The general session will features the Manchikanti Distinguieshed Lecture Series followed by breakout sessions in the afternoon.
March 17, 2018
Saturday’s focus will be on survival strategies for IPM.

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.

CMS Releases Final Rules for Physician Payment, ASC and HOPD Facility Payment Rates
Physician payment rates have not changed significantly from the proposed rule or 2017 payment rates. Similarly, office procedure rates also have not changed.
  • Ironically, a trigger point injection performed in hospital office setting or in an office setting owned by a hospital is reimbursed at $245, whereas, an epidural with fluoroscopy and extensive equipment performed in an office not owned by hospital is reimbursed at $144.
  • It appears that any number of commentaries, meetings are not going to change the attitudes, and flawed analysis.
  • Site-of-service differentials are an extremely important issue. The flawed analysis by CMS is based on hospital clinic procedures comparing to ASC procedures performed in a surgical suite.
  • A new publication by Dieleman et al in JAMA shows the site-of-service differentials contributing to significant increases in health care costs.
  • Please see final rule of physician payment rates for 2018

ASC final payment rates for 2018 has been very disappointing. The declines in payment for commonly performed procedures, namely interlaminar epidural injections, facet joint injections, sacroiliac joint injections, and percutaneous adhesiolysis continued at 13% to 24% decline compared to 2016. We have extensively lobbied to reverse these cuts; however, we have not been very successful with continued reductions.

  • Similar to the above procedures, endoscopic decompression of the lumbar spine CPT 62380 also is facing over 25% reduction along with removal of spinal cord electrodes CPT 63663 facing 30% reduction in reimbursement from 2017.
  • Ironically, procedures performed in a hospital clinic or hospital owned clinic are paid higher than ASC procedures performed in an operating room. Trigger point injections are reimbursed at $245 for facility portion in the hospital or hospital owned facilities, whereas, these are reimbursed at $39.96 in ASC setting, compared to less than $20 in an office setting with a 12-fold difference in payment rates.
  • An epidural injection with fluoroscopy and requirement for extensive equipment, personnel, and sterile setting, is reimbursed at $283 in an ASC setting and $144 in an office setting, compared to $245 for trigger point injection and similar procedures.
  • Please see 2018 ASC final payment rates .

HOPD 2018 final payment rates also shows significant increases in payment rates for multiple procedures

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
Opioid treatment drugs have similar outcomes once patients initiate treatment
A study comparing the effectiveness of two pharmacologically distinct medications used to treat opioid use disorder – a buprenorphine/naloxone combination and an extended release naltrexone formulation – shows similar outcomes once medication treatment is initiated. Among active opioid users, however, it was more difficult to initiate treatment with the naltrexone. Study participants were dependent on non-prescribed opioids, 82 percent of them on heroin, and 16 percent on pain medications. The research, published today in The Lancet, was conducted at eight sites within the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN). NIDA is part of the National Institutes of Health.
Five hundred and seventy opioid-dependent adults were randomized to the buprenorphine combination or the naltrexone formulation, and followed for up to 24 weeks of outpatient treatment. Study sites differed in their detoxification approaches and in their typical inpatient length of stay. Buprenorphine/naloxone (brand name Suboxone) was given daily as a sublingual film (under the tongue), while naltrexone (brand name Vivitrol) was a monthly intramuscular injection. Adverse events, including overdoses, were tracked.
Fibromyalgia Screening in Patients With Chronic Pain: Two Simple Tests
Achilles tendon pressuring and inquiry about "persistent deep aching pain over most of [the] body" may effectively screen for fibromyalgia in patients with chronic pain, according to findings published in the  Journal of Evaluation in Clinical Practice .
This study included participants from 2 primary care centers who were scheduled for routine clinical assessment (n=352). The cohort included patients with a fibromyalgia diagnosis (n=52), patients with  chronic pain  but no fibromyalgia diagnosis (n=108), and patients with no chronic pain or fibromyalgia (n=192).

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
Look for registration information coming soon.

*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.
Ambulatory Patient Safety Hinges on Addressing Clinician Stress
More needs to be done to improve outpatient safety, ACP says
The American College of Physicians (ACP) has called for healthcare organizations and other stakeholders to address physician burnout and stress, among other measures, as a means to improve patient safety in ambulatory settings.
"Burnout and stress may affect patient safety in various ways," wrote the authors of the ACP's new policy paper, Patient Safety in the Office-Based Practice Setting.
"Emotional exhaustion, which is linked to standardized mortality ratios among intensive care units, may affect cognitive and physical ability to perform tasks and diminish memory and attention, lessening ability to attend to details and process highly technical information; mental detachment and deficiencies in personal accomplishment may cause individuals to neglect duties or complete seemingly minor but crucial patient safety activities," the authors continued.
The paper went on to support the National Patient Safety Foundation's recommendations that organizations should strive to improve working conditions and staff resiliency, and that programs should include fatigue management systems, and communication, apology, and resolution skills.
Why Burned Out Physicians Often Don't Seek Help
It has long been known that physicians are at high risk of depression and suicide, and the problem is not getting better. A study published this July in Academic Medicine found that suicide was the second leading cause of death among resident physicians from 2000-2014 (the first in males). And it's clear that burnout can contribute to the problem, experts say. When Michael Myers, MD, was researching his book Why Physicians Die by Suicide: Lessons Learned by Families and Others Who Cared, he interviewed surviving family members of physicians who had killed themselves. "What they described was straightforward burnout," says Myers, professor of clinical psychiatry at SUNY-Downstate Medical Center in Brooklyn, NY, and specialist in physician health.
Real Risks
Despite the high risk, physicians are far less likely than those in other professions to seek help for emotional problems. "Physicians are programmed to think of themselves as being able to handle stress," says Clifton Knight, MD, senior vice president for education at the American Academy of Family Physicians (AAFP). "There is a kind of guilt and shame associated with it—'if I'm suffering from stress, I am weak and a bad physician,' the thinking goes." That attitude makes reaching out for help nigh impossible. It also compounds the suffering. Not only are you depressed, the very fact that you are depressed brands you as a loser.
Department of Justice News

New Orleans Woman Convicted for Role in $3.2 Million Medicare Kickback Scheme
A federal jury found a New Orleans woman guilty today for her role in an approximately $3.2 million Medicare fraud and kickback scheme.
Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Duane A. Evans of the Eastern District of Louisiana, Acting Special Agent in Charge Daniel Evans of the FBI’s New Orleans Field Office and Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Field Office made the announcement.
After a three-day trial, Sandra Parkman, 61, was convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive kickbacks, two counts of health care fraud and five counts of accepting kickbacks. Sentencing is scheduled for Jan. 17, 2018, before U.S. District Judge Kurt D. Engelhardt of the Eastern District of Louisiana, who presided over the trial.
Owner and Manager of New York Medical Equipment Provider Charged for Their Roles in Alleged $3.5 Million Scheme to Defraud Government-Funded Health Plans
The owner and the manager of a purported durable medical equipment (DME) company in the Bronx, New York, were charged in an indictment unsealed today for their roles in an allegedly fraudulent scheme that involved submitting over $3.5 million in claims to private insurers, which included government-sponsored managed care organizations.
Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Bridget M. Rohde of the Eastern District of New York, Assistant Director in Charge William F. Sweeney Jr. of the FBI’s New York Field Office and Special Agent in Charge Scott Lampert of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Office of Investigations made the announcement.
Ikechukwu Udeokoro, 41, of West New York, New Jersey, and Ayodeji Fasonu, 51, of Stamford, Connecticut, the owner and manager, respectively, of Meik Medical Equipment and Supply LLC of the Bronx, were charged with one count of health care fraud in an indictment filed in the Eastern District of New York on Nov. 13. The indictment was unsealed upon the arrest of the defendants this morning, and the defendants are expected to be arraigned this afternoon before U.S. Magistrate Judge James Orenstein of the Eastern District of New York at the federal courthouse in Brooklyn. The case has been assigned to U.S. District Judge Ann M. Donnelly.

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,
ASIPP | Pain Physician Journal | Phone | Fax | Email