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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.
 
Reserve Your Hotel Now for ASIPP 2020 Meeting in Dallas

The ASIPP 2020 Meeting April 2-4 will be in downtown Dallas at the Hyatt Regency. The room block is now open for reservations. You may book online or by phone. Discounted rates end after March 17.

DISCOUNTED ROOM RATES FOR NIGHTS OF MARCH 31 – APRIL 5
Reserve by Phone
1-877-803-7534
Group Discount Code: G-SIPP

Reserve Online
Click here to reserve your room.

If you have questions about the room block or the meeting, contact Karen Avery at kavery@asipp.org / 270-554-9412 x 4210
Join the AMA to help us keep our seat in the House of Delegates
 
The American Medical Association (AMA) requires all societies to requalify for membership in the AMA House of Delegates (HOD) every five years. In order for ASIPP to retain our seat, the AMA requires that 20% of ASIPP’s physician members also be members of the AMA. Unfortunately, ASIPP is at risk of losing representation in the AMA because we have fallen below the 20% membership minimum threshold.
 
Membership in the AMA gives us a voice in shaping policy that affects our practice and patients.
We encourage you to join or renew your membership in the AMA. Joining the AMA will further strengthen our specialty’s representation at the national level through the AMA House of Delegates, the AMA’s policymaking body, and strengthen our ability to meet the challenges in health care today with thoughtful, well-organized responses.
 
We strongly encourage you to join the AMA today to help us keep our seat at the table. Right now, you can become a member and pay only half the dues.
 
The stronger our membership, the more we can advance issues that are important to our specialty including improving the Medicare Quality Payment Program, reducing administrative burdens and ensuring accurate coding and reimbursement of our services.
 
Thank you for supporting ASIPP!
 
Click HERE to join today and pay only half price! 


Blog: Why Are Insurance Executives Treating Our Patients?
Kevin Campbell believes that peer-to-peer consults waste time and harm patients
 
In two recent surveys, physicians said that pre-authorizations are burdensome to their practice and that they could lead to adverse patient outcomes. Kevin Campbell, MD, agrees that the insurance companies shouldn't be part of patient practice, and says that the peer-to-peer review process is even worse.
The opinions expressed in this commentary are those of the author. The following transcript has been edited for clarity.

Insurance companies have been granted far too much control over patient care over the last several decades. Nowhere is it more apparent than when physicians are asked to obtain "pre-approval" for guideline-based, medically necessary procedures. According to one survey from the Medical Group Management Association, 83% of those surveyed said prior authorizations are "very" or "extremely" burdensome to their practice and their staff. Another survey conducted of physicians found that nearly one-third of doctors believe that spending time obtaining pre-authorizations actually led to adverse patient outcomes.
 
Hearings on Single-Payer Health-Care Plans Draw Crowds Around New York

New Yorkers are waiting hours and lining up down the street to tell state legislators the same refrain: fix health care.

Workers, physicians, nurses, parents, business owners, the elderly and the infirm have been testifying at hearings around the state about the New York Health Act, which would establish universal, guaranteed health care across the state with a single-payer plan. During the most recent forum, at a public library in the Bronx last week, people filled a 150-seat auditorium to hear testimony that ultimately ended when the library closed for the day.

Allison Marotta, a 25-year-old New Yorker with Type 1 diabetes, said that in a few weeks she will no longer be carried under her parents’ insurance. She isn’t eligible for Medicaid and said she can’t afford a state-sponsored program. Her monthly care costs will exceed $2,000 a month without insurance for insulin alone, with supplies and doctor’s appointments quadrupling that number, she said.

Access to this article may be limited.
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.”

As described in the warning letter issued to Rooted Apothecary, the company used product webpages, through its online store and social media websites, to make unfounded claims about its CBD products, and some of the products were also unlawfully marketed as dietary supplements. The agency has determined that CBD products cannot be marketed as dietary supplements.
 
FDA 
Blog:
Medicare for All––the Bernie Sanders and Elizabeth Warren Health Care Plans
The Question That Single-Payer Medicare for All Advocates Need to Answer

You are probably thinking that question is, how are you going to pay for it?
Ultimately, yes.
But, I will suggest there is another critically important issue that is part of the overall question about how it will be paid for––What will your plan do to our existing health care system?
Medicare and Medicaid cost less than commercial insurance because Medicare and Medicaid pay providers––doctors, hospitals, and other health care providers–– a lot less for their services.
 

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

Pharma's 700 MD Millionaires

More than 700 physicians have made at least $1 million from industry since the government's Open Payments database started publicly tracking those relationships five years ago, a ProPublica investigation found.

Over 2,500 physicians received at least $500,000 each from drugmakers and medical device companies during that time.

The ProPublica analysis covered more than 56 million payments made from 2014 to 2018, the first 5 years of Open Payments data.

Some experts have mused that making such data publicly available might cause companies to think twice about the payments they dole out, and make doctors rethink taking that money. But the analysis shows little change, with companies still hiring doctors for dinner talks, sponsored speeches, and consulting. There's been almost no change in how much industry spends, with each of the five years tallying $2.1 to $2.2 billion in payments, and about the same number of doctors (600,000) receiving payments in any given year.
 
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

The Full Cost of the Opioid Crisis: $2.5 Trillion Over Four Years
 
October 26 marked National Prescription Drug Take Back Day, which provided Americans an opportunity to prevent drug misuse and theft by ridding their homes of potentially dangerous expired, unused, and unwanted prescription drugs. One of the most tangible examples of the dangers of misusing prescription drugs comes from the opioid crisis, which the Council of Economic Advisers (CEA) estimates cost $696 billion in 2018—or 3.4 percent of GDP—and more than $2.5 trillion for the four-year period from 2015 to 2018. These massive costs point to the nationwide economic destruction from America’s very human “crisis next door.”

In 2017, CEA published a report that measured the full cost of the opioid crisis by considering the value of lost lives, as well as increases in healthcare and substance abuse treatment costs, increases in criminal justice costs, and reductions in productivity. The updated estimates for 2018 were calculated using a similar methodology as the 2017 report.

CEA’s cost estimates are more than three times higher than the findings from a recent Society of Actuaries study , because CEA accounts for the value of a statistical life (VSL). VSLs are commonly used by regulators for benefit-cost analyses and regulatory impact analyses. CEA prefers this comprehensive measure because the opioid crisis not only increases costs and lowers productivity throughout the economy, it also prematurely ends lives, which have value beyond their effect on economic output. (For more information on calculating VSL, see Section 2 of CEA’s 2017 report .)

A Doctor Who Prescribed 500,000 Doses of Opioids Is Sent to Prison for 40 Years
Dr. Joel Smithers was convicted of more than 800 counts of illegally prescribing opioids, and jurors found that the drugs he prescribed caused the death of a woman.
 
 
A Virginia doctor who prescribed more than 500,000 doses of opioids in two years was sentenced to 40 years in prison on Wednesday for leading what prosecutors called an interstate drug distribution ring.
The overprescription of painkillers is one of the roots of the nation’s opioid crisis, and patients of Dr. Joel Smithers traveled hundreds of miles from neighboring states to pick up oxymorphone, oxycodone, hydromorphone and fentanyl, according to law enforcement officials. They said he prescribed controlled substances to every patient in the Martinsville, Va., practice he opened in August 2015.

Dr. Smithers, 36, was convicted of more than 800 counts of illegally prescribing opioids, and jurors found that the drugs he prescribed caused the death of a woman from West Virginia. He faced a maximum sentence of life in prison.

DOJ NEWS

Sanford Health Entities to Pay $20.25 Million to Settle False Claims Act Allegations Regarding Kickbacks and Unnecessary Spinal Surgeries

The Department of Justice announced today that hospital entities Sanford Health, Sanford Medical Center, and Sanford Clinic (collectively, Sanford), of Sioux Falls, South Dakota, have agreed to pay $20.25 million to resolve False Claims Act allegations that they knowingly submitted false claims to federal healthcare programs resulting from violations of the Anti-Kickback Statute and medically unnecessary spinal surgeries. The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally-funded programs. 

“Kickbacks can compromise a physician’s medical judgment, result in unnecessary procedures, and increase healthcare costs for everyone,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “We will continue to hold healthcare providers accountable when they violate the rules intended to safeguard the integrity of federal healthcare programs and the welfare of their beneficiaries.”

The settlement announced today resolves allegations that Sanford knew that one of its top neurosurgeons was improperly receiving kickbacks from his use of implantable devices distributed by his physician-owned distributorship (POD). Sanford allegedly received warnings from the neurosurgeon’s physician colleagues and others about the alleged kickback scheme and was aware of the heightened compliance risks associated with PODs. In addition, the neurosurgeon’s colleagues and others repeatedly warned Sanford that the neurosurgeon was performing medically unnecessary procedures involving the devices in which he had a substantial financial interest. The United States alleged that, despite these repeated warnings, Sanford continued to employ the neurosurgeon, continued to allow him to profit from the devices he used in surgeries performed at Sanford, and continued to submit claims to federal healthcare programs for these surgeries, including procedures that were medically unnecessary. 

DOJ



Tennessee Medical Doctor and Advanced Practice Registered Nurse Charged in Scheme to Unlawfully Distribute Controlled Substances

A Tennessee medical doctor and an advanced practice registered nurse were charged in an indictment unsealed today for their roles in unlawfully distributing controlled substances.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Don Cochran of the Middle District of Tennessee, Special Agent in Charge Derrick L. Jackson of the Atlanta Regional Office of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Special Agent in Charge M.A. “Mo” Myers of the FBI’s Memphis Field Office and Director David B. Rausch of the Tennessee Bureau of Investigation (TBI) made the announcement.
Hemal V. Mehta, M.D., 49, of Brentwood, Tennessee, and Heather L. Marks, APRN, 36, of Murfreesboro, Tennessee, were charged in an indictment filed Oct. 23, 2019, in the Middle District of Tennessee with one count of conspiracy to unlawfully distribute controlled substances and nine counts of unlawful distribution of controlled substances.

According to the indictment, between 2016 and 2018, Mehta and Marks, whom Mehta supervised, conspired to distribute Schedule II controlled substances, including oxycodone, morphine sulfate and oxymorphone, to patients outside the usual course of professional practice and without a legitimate medical purpose. Mehta and Marks also allegedly dispensed and distributed oxycodone and oxymorphone on various occasions between 2016 and 2018.
 
DOJ
State Society News 


Send in your state society meeting news to Holly Long, hlong@asipp.org
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