American Society of Interventional Pain Physicians | September 12, 2018
ASIPP Supports Positive Impact of CMS Proposed Rule Implementation for Physicians

Once Centers for Medicare & Medicaid Services (CMS) 2019 Medicare Physician Fee Schedule Proposed Rule is implemented, it will improve access to interventional pain management services and also reduce paperwork and the stress levels with improvement in physician-patient interaction. On September 10, 2018, ASIPP submitted its comments on the proposed rule with strong support for evaluation and management services and a strong request to reassess payments for office procedures, specifically peripheral nerve blocks and neurolytic blocks with comments on quality payment program.

Changes of payment mode for evaluation and management, similar to United Kingdom, with one payment for most levels of services, as proposed by CMS, avoids multiple issues of upcoding, downcoding, reduces documentation difficulties, improves patient interaction, reduces physician stress, and, finally, even increases reimbursement levels for physicians.

Almost all physicians will be affected positively. The only physicians who will be affected negatively include those who use Level 4 and 5 codes extensively.

We have received extensive support from the board and membership

Dr. Manchikanti stated:
"If a physician is using 50% of the time, Level 2 or 3 codes, and 50% of the time Level 4 codes, there will be some benefit. However, if a physician is using Level 2 and 3 codes 75% of the time and Level 4 and 5 codes only 25% of the time, they will benefit significantly. I understand that multiple organizations are voicing their complaints about the collapsing of the codes; however, for interventional pain physicians we will see a small increase, but at the same time, major benefit is reduced stress levels, reduced documentation requirements and increased patient/physician interaction time. But, the only negative aspect is that if a procedure is performed on the same day as evaluation and management service, one of the services will face 50% reduction which is a major disadvantage, which happens very infrequently.”

Dr. Manchikanti also noted that we asked CMS to reassess the office based payments since these are only a fraction of hospital payments. The specific procedures quoted were peripheral nerve blocks and neurolytic blocks which are reimbursed at almost 1,800% higher than in office for peripheral nerve blocks and neurolytic blocks. CMS and RUC should be reassessing these issues and we request that our RUC membership negotiate with AMA to re-evaluate these payment levels.

Click HERE to read ASIPP's comment letter to CMS
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Leveraging the Placebo Effect to Reduce Opioid Requirements

A growing body of evidence indicates that placebos may provide an analgesic effect. 1 Naloxone  was shown to reverse the effects of placebos given in place of opioids, giving rise to the hypothesis that placebos may benefit patients who would otherwise be prescribed opioids. 1  The current debate does not focus on determining whether placebos may have some efficacy but, rather, on whether clinicians should offer open placebos to improve pain or deceive patients into thinking they have been prescribed analgesics. 1
"Since we know that placebos reliably reduce pain, and poor pain management is implicated in  the opioid crisis , then it might be possible to use placebos to minimize the amount of opioid medication patients are taking," said Michael H Bernstein, PhD, from the School of Public Health, Center for Alcohol and Addiction Studies at Brown University, Providence, Rhode Island. "If placebos are shown to be opioid-sparing, they could hold considerable promise as a novel but well-supported strategy to address the opioid epidemic."

The 10 Calif. Docs Accused of Overprescribing Opioids
-Complaints cite "gross negligence," "incredibly high" doses -- and bad penmanship

Last week,  MedPage Today  reported on the California state medical board's investigations of physicians, nurse practitioners, and physician assistants who prescribed opioids for individuals who later overdosed. Here we take a closer look at the 10 physicians who, so far, have been formally accused of wrongdoing. (An earlier version of this story reported on nine physicians. MedPage Today became aware of a 10th after it appeared.)
If one had to identify a physician to symbolize its "Death Certificate Project," an aggressive effort by the Medical Board of California to nab doctors who overprescribe opioids, a likely candidate would be Harold S. Budhram, MD, of Shasta Lake. (All cities named in this article are in California.)

Triggered by deaths of two of his patients attributed to opioid overdoses, the board investigated his practice and, in April, filed a  39-page complaint listing 16 separate accusations .

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

Proposed House Bill Seeks to End Drug Price 'Gag Clause'
-Pharmacists should be able to freely tell patients that a drug will cost less out-of-pocket

WASHINGTON -- Members of the House stumped for a healthcare bill that they said will improve transparency for patients at the pharmacy counter, and reduce their out-of-pocket costs, during a hearing Wednesday.
"Gag clauses" prevent pharmacists from informing patients that a drug will cost less out-of-pocket than it would using the patient's insurance, unless the patient requests the information directly, explained Rep. Michael Burgess, MD, (R-Tex.), chair of a subcommittee to the House Energy & Commerce Committee.
Rep. Buddy Carter (R-Ga.) put forth a draft version of a bill that would ban Medicare and private health plans from including gag clauses in contracts. Burgess called the bill "essential in both lowering drug costs for individuals and freeing the pharmacists to do what many consider the right thing."

Pain Physician
July/August 2018 Issue Features

Health Policy Review
  • Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic
Systematic Reviews
  • Is Unilateral Percutaneous Kyphoplasty Superior to Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures? Evidence from a Systematic Review of Discordant Meta-Analyses
  • Prevalence of Recurrent Herniation Following Percutaneous Endoscopic Lumbar Discectomy: A Meta-Analysi
Randomized Trials
  • Thermal Versus Super Voltage Pulsed Radiofrequency of Stellate Ganglion in Post-Mastectomy Neuropathic Pain Syndrome: A Prospective Randomized Trial
  • Evaluation of an Experimental Pain Model by Noncompartmental Analysis of Results from a Randomized Placebo Controlled Trial
  • Transforaminal vs Interlaminar Epidural Steroid Injection for Acute-Phase Shingles: A Randomized, Prospective Trial

SIS Voices Concerns Regarding Negative Impact of CMS Proposed Rule Implementation

If the U.S. Centers for Medicare and Medicaid Services’ (CMS) 2019 Medicare Physician Fee Schedule Proposed Rule is implemented, continued patient access to beneficial interventional treatments will be at risk.
On September 10, 2018, SIS issued comments to CMS specifically addressing significant concerns relative to the new and revised neurostimulator services CPT code set; the streamlining of Evaluation & Management Guidelines; and aspects of the Quality Payment Program, such as the Meaningful Measures Initiative Framework, virtual groups, topped out measures, and decisions related to certified EHR technology.

DOJ News
South Florida Pharmacist Convicted of Health Care Fraud for Role in $5 Million Compounding Pharmacy Scheme
A federal jury found a South Florida pharmacist guilty today of health care fraud for his role in a $5 million compounding pharmacy scheme.
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Benjamin G. Greenberg of the Southern District of Florida, Special Agent in Charge Robert F. Lasky of the FBI’s Miami Field Office, Special Agent in Charge Shimon R. Richmond of the Department of Health and Human Services Office of Inspector General (HHS-OIG)’s Miami Regional Office, Special Agent in Charge John F. Khin of the Department of Defense Office of Inspector General – Defense Criminal Investigative Service (DCIS)’s Southeast Field Office and Florida Attorney General Pam Bondi made the announcement.
After a four-day trial, Stephen Chalker, 42, of Wellington, Florida, was convicted of one count of conspiracy to commit health care fraud and two substantive counts of health care fraud. Sentencing has been scheduled for Nov. 15 before U.S. District Judge Donald M. Middlebrooks of the Southern District of Florida, who presided over the trial. 
According to evidence presented at trial, from approximately September 2014 to August 2016, Chalker engaged in a scheme to defraud Medicare, TRICARE and Medicaid by submitting false and fraudulent claims for compounded drugs and other prescription medications that were not medically necessary and/or never provided. The evidence established that in his role as the pharmacist-in-charge at Pop’s Pharmacy, a now-defunct pharmacy located in Deerfield Beach, Florida, Chalker submitted or caused the submission of claims in the amount of several thousands of dollars each for a single tube of pain and scar creams that patients did not want, did not need, and in some cases did not receive. Chalker and his co-conspirators ran a nationwide telemarketing and telemedicine scheme in which there was no real patient-prescriber relationship or actual patient care. As a result of claims submitted in connection with the scheme, Medicare, TRICARE and Medicaid made payments totaling nearly $5 million, the evidence showed.


South Florida Doctor Sentenced to 78 Months in Prison for Participating in a Conspiracy to Illegally Dispense Opioids and Other Drugs
Dr. Andres Mencia, 64, of Fort Lauderdale, Florida was sentenced today to 78 months in prison, after having been convicted by a federal jury in South Florida, of participating in a conspiracy to distribute a controlled substance.
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division; U.S. Attorney Benjamin G. Greenberg for the Southern District of Florida; Special Agent in Charge Adolphus P. Wright of the U.S. Drug Enforcement Administration (DEA), Miami Field Division; Special Agent in Charge Shimon R. Richmond of U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG); and Special Agent in Charge Mark Selby of U.S. Immigration and Customs Enforcement’s Homeland Security Investigations (ICE-HSI), Miami Field Office, made the announcement.


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 or Tara Morrison at or 770-613-0932.

Send in your state society meeting news to Holly Long,
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