American Society of Interventional Pain Physicians | April 17, 2019

Time to Make Plans To Attend ASIPP 21 st Annual Meeting
Room Block Extended!
Join Us in Vegas! Come to the Annual Meeting on May 3-5!

The Annual ASIPP® meeting is one the most exciting and educational meetings in the world . We bring to you the most renown speakers who will deliver the highest caliber lectures. Th is year’s A nnual M eeting features 11 exemplary keynote speakers, more than 60 distinguished speakers, nearly 80 key topics – all related to interventional pain management .  
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ABIPP Part 1 Chicago, June 9
June 9 | Chicago, IL
 
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.
 
Register
 
April 1 to April 15, 2019, fee is $2,000
 
April 16 to April 30, fee is total of $3,000
 
No registrations after April 30
 
 
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.
 
JULY ABIPP EXAMS
AND COMPETENCY EXAMS
July 13 - July 14 | 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.

Register

May1 to May 15, 2019, fee is $2,000

May 16 to May 30, fee is total of $3,000

No registrations after May 30.

 
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.

July 13
ABIPP Part I

July 13
ABIPP Part I
 
July 13-14
ABIPP Part II
 
July 14
ABIPP Competency Exam

July 13
Combined CSM/CCPM Exam for ABIPP Path
July 13
Competency Exam in Controlled Substance Management

July 13
Competency Exam in Coding, Compliance, and
Practice Management

July 13-14
Regenerative Medicine Competency Exam
 
July 13-14
Endoscopic Lumbar Decompression Competency Exam

939 Ridge Lake Blvd. | Memphis, TN 38120
 
The cut-off date for our room block with discounted rates is on June 10, 2019 or until sold out, whichever occurs first.
REGISTRATION        HOTEL
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

Cannabis users needed up to twice the sedation for medical procedures, small study says

People who regularly use cannabis may need two times the level of sedation required by nonusers when undergoing medical procedures, a small-scale study finds. Fentanyl, midazolam and propofol, three sedation drugs commonly used during endoscopic procedures, were compared in the research.
With "continued increase in legalization and use of cannabis, the field of anesthesia and sedation needs further studies with greater depth," wrote the authors of the study, published Monday in The Journal of the American Osteopathic Association.

CNN


HHS hit with class-action complaint over suspended Medicare payments

A now-shuttered home health company based in Chicago has filed a proposed class-action lawsuit in federal court against HHS and AdvanceMed, a Medicare contractor.
AdvanceMed is one of several contractors hired by CMS to use data mining techniques to identify possible patterns of fraud in Medicare claims. In 2016, Simply Home Healthcare submitted patient charts to AdvanceMed for review. Roughly nine months later, AdvanceMed had the company's Medicare payments suspended, according to the complaint.
AdvanceMed said Simply Home Healthcare received overpayments from Medicare due to documentation errors and requested additional medical records and a rebuttal letter from the company, according to the complaint. After receiving the additional information, AdvanceMed allegedly told Simply the Medicare payment suspension would continue, and the reason for the suspension had changed from overpayment to fraud.


Breaking Free: More Docs Go Independent
Save time and money and gain happiness like these doctors
 
It may not be skydiving, but the top item on the "bucket list" of Terry Edwards, MD, is a bold leap in an age of ever larger healthcare conglomerates.
This spring, Edwards will launch his own primary care practice in Bozeman, an upscale college and ski town in Montana.
It may not be skydiving, but the top item on the "bucket list" of Terry Edwards, MD, is a bold leap in an age of ever larger healthcare conglomerates.
This spring, Edwards will launch his own primary care practice in Bozeman, an upscale college and ski town in Montana.


CDC clarifies opioid prescribing guideline for cancer groups
 
The CDC clarified aspects of its opioid prescribing guidelines for chronic pain in an April 9 letter to three cancer organizations, reports  Medscape .
Deborah Dowell, MD, CMO of the CDC's National Center for Injury Prevention and Control, penned the  letter  to the following groups:
·                  The American Society of Clinical Oncology
·                  The American Society of Hematology
·                  The National Comprehensive Cancer Network
The groups met with CDC leaders in fall 2018, outlining concerns that payers were denying patients pain medications or reimbursement due to the guideline.
In the clarification letter, Dr. Dowell said the guideline "is not intended to deny any patients who suffer from chronic pain from opioid therapy as an option for pain management." Instead, the guideline is meant to encourage physicians and patients to consider alternative pain management treatments.



FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering

The U.S. Food and Drug Administration (FDA) has received reports of serious harm in patients who are physically dependent on opioid pain medicines suddenly having these medicines discontinued or the dose rapidly decreased. These include serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.
While we continue to track this safety concern as part of our ongoing monitoring of risks associated with opioid pain medicines, we are requiring changes to the prescribing information for these medicines that are intended for use in the outpatient setting. These changes will provide expanded guidance to health care professionals on how to safely decrease the dose in patients who are physically dependent on opioid pain medicines when the dose is to be decreased or the medicine is to be discontinued.


FDA

Medicare Advantage Provider to Pay $30 Million to Settle Alleged Overpayment of Medicare Advantage Funds

Sutter Health LLC, a California-based healthcare services provider, and several affiliated entities, Sutter East Bay Medical Foundation, Sutter Pacific Medical Foundation, Sutter Gould Medical Foundation, and Sutter Medical Foundation, have agreed to pay $30 million to resolve allegations that the affiliated entities submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, which resulted in the plans and providers being overpaid, the Justice Department announced today. Sutter Health is headquartered in Sacramento, California. 
“The Medicare Advantage Program provides benefits to a significant portion of federal health care beneficiaries,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division. “The Department of Justice will help ensure that accurate information is supplied to the Medicare Advantage Program by plans and providers, and to pursue appropriate remedies when it is not.”
Under Medicare Advantage, also known as the Medicare Part C program, Medicare beneficiaries have the option of enrolling in managed healthcare insurance plans called Medicare Advantage Plans (“MA Plans”) that are owned and operated by private Medicare Advantage Organizations (“MAOs”). MA Plans are paid a capitated, or per-person, amount to provide Medicare-covered benefits to beneficiaries who enroll in one of their plans. The Centers for Medicare and Medicaid Services (“CMS”), which oversees the Medicare program, adjusts the payments to MA Plans based on demographic information and the health status of each plan beneficiary. The adjustments are commonly referred to as “risk scores.” In general, a beneficiary with more severe diagnoses will have a higher risk score, and CMS will make a larger risk-adjusted payment to the MA Plan for that beneficiary.


DOJ


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

Escalating Opioid Doses in Chronic Pain
Prospective study looks at outcomes of long-term opioid use

MILWAUKEE -- Increases in prescription opioid doses were unrelated to most clinical outcomes among chronic pain patients, according to a 2-year prospective cohort study.
Moreover, patients who had been prescribed a stable dose of long-term opioid therapy demonstrated few clinically significant changes in pain-related outcomes over time, reported Benjamin Morasco, PhD, of Oregon Health & Science University in Portland, and colleagues, at the American Pain Society Scientific Meeting .
Long-term opioid therapy is a common treatment for chronic pain, and "little data are available about the benefits and harms associated with increasing opioid dose," Morasco told MedPage Today. "It's unclear to what extent escalating opioid doses can improve pain, yet still have the risk-benefit ratio of a lower dose."



Theranos granted 5 new patents

The U.S. Patent and Trademark Office granted Theranos, a biotech company that shuttered last year, five patents in March and April, CB Insights reports.
The patents were filed in 2015 and 2016, after the company came under fire for deceiving investors and the public about the readiness of its technology. They include a system to improve collection and testing of bodily fluids, a method to transport small-volume samples, a process that agitates particles to identify pathogens in samples, a process that can disrupt cells in fluids, and an accelerated red blood cell test.
Theranos has been granted more than 70 patents since 2003. However, Theranos was unable to deliver on its promise to create micro-blood tests that worked.


PBMs Plead Innocent on High Drug Costs
Facing bipartisan criticism at Senate hearing

WASHINGTON -- Senators chastised pharmacy benefit managers (PBMs) for using backdoor tactics and secret schemes that make drugs costlier to patients than they otherwise would be, during a Senate Finance Committee hearing on Tuesday.
PBMs negotiate drug prices with drugmakers and pharmacies to lower drug prices on behalf of their health-insurer clients. In theory that should lower prices, but in practice, critics have argued that patients end up paying more.
"The current system is so opaque that it's easy to see why there are many questions about PBMs' motives and practices. One question we must ask is whether PBMs prefer a high-cost drug with big rebates over a cheaper drug," said committee chair Chuck Grassley (R-Iowa).


My Advice to Early-Career Physicians: Don't Play It Safe!
Milton Packer recommends a contrarian path for career development

For several decades, I spent a large proportion of my professional life being a mentor and counselor to younger physicians, both cardiologists and noncardiologists. In addition to one-on-one meetings, I spent hours giving seminars about how to create the building blocks of a career. At the end of many talks that I give at meetings, I am surrounded by young physicians who are more interested in asking a question about themselves than the topic of my presentation. It is an unbelievable delight.
What advice do I give? My first question is: Do you think of medicine as a job or as a career?




Pain Physician
March/April 2019 Issue Features

Systematic Review
Ian D. Coulter, PhD, Cindy Crawford, BA, Howard Vernon, DC. PhD, Eric L. Hurwitz, DC. PhD, Raheleh Khorsan, PhD, Marika Suttorp Booth, MS, and Patricia M. Herman, ND, PhD

Systematic Review
Nitika Sanger, HBSc, Meha Bhatt, MSc, Nikhita Singhal, BHSc, Katherine Ramsden, MD, Natasha Baptist-Mohseni, BSc, Balpreet Panesar, BSc, Hamnah Shahid, BASc, Alannah Hillmer, BSc, Alessia D'Elia, BSc, Candice Luo, BHSc, Victoria Rogers, BSc, Abirami Arunan, HBSc, Lola Baker-Beal, BSc, Sean Haber, BSc, Jihane Henni, BSc, Megan Puckering, BSc, Sunny Sun, BSc, Kim Ng, BSc, Stephanie Sanger, MLIS, Natalia Mouravaska, MD, M. Constantine Samaan, MD, Russell de Souza, ScD, Lehana Thabane, PhD, and Zainab Samaan, PhD

Randomized Trial
Doo-Hwan Kim, MD, Myung-Su Lee, MD, Sookyung Lee, MD, Syn-Hae Yoon, MD, Jin-Woo Shin, MD, PhD, and Seong-Soo Choi, MD, PhD

Randomized Controlled Trial
Neerja Bharti, MD, John Sujith, MD, Navneet Singla, Mch, Nidhi B. Panda, MD, and Indu Bala, MD.


Link Between Depression and Diabetes?
Keeping tabs on a patient's mental health could be important for disease management

Diabetes is a difficult disease to live with, but it can be even more so for patients who suffer from depression and anxiety. And some scientists believe that the disease itself can cause these conditions.
A November 2018 systematic review and meta-analysis of the risk of depression and suicide in diabetes patients in 13 cohort and 23 cross-sectional studies found an association between depression and diabetes. However, the authors, led by Rasha Elamoshy, MD, of the University of Saskatchewan in Canada, found that while the burden of living with diabetes does lead to some depression, there are other factors: "Other potential physiological contributors include activation of the HPA [hypothalamo-pituitary-adrenal] axis and SNS [sympathetic nervous system], chronic inflammation, and cerebral vascular changes induced by diabetes," the authors wrote. "Additionally, some common medications used for the treatment of diabetes have been linked to a higher risk of depression."



'Unethical Physicians' Aid Surge in Vax Exemptions
Parents and doctors do 'Hail Mary' around vaccine laws

SAN JOSE, Calif. -- At two public charter schools in the Sonoma wine country town of Sebastopol, more than half of the kindergartners received medical exemptions from state-required vaccines last school year. The cities of Berkeley, Santa Cruz, Nevada City, Arcata, and Sausalito all had schools in which more than 30% of the kindergartners had been granted such medical exemptions.
Nearly three years ago, with infectious disease rates ticking up, California enacted a fiercely contested law barring parents from citing personal or religious beliefs to avoid vaccinating their children. Children could be exempted only on medical grounds, if the shots were harmful to health.



Not so Inactive: Excipients in Medications May Trigger Adverse Reactions in Some Patients

An oral drug product contains both the active pharmaceutical ingredient (API) as well as a mixture of inactive ingredients, or excipients. 1 Inactive ingredients are used to alter the physical properties of a medication, while the API is intended to produce the desired pharmaceutical effect of the agent. Excipients may be added to a medication to improve absorption, alter taste, increase stability, or render the medication tamper resistant.
Although there are thousands of known inactive ingredients that have been tested and have established safety at the population level, numerous case reports have been published suggesting some excipients may cause adverse reactions in some patients. 2 Because of this, a team of investigators from both Brigham and Women’s Hospital and the Massachusetts Institute of Technology analyzed data on thousands of inactive ingredients in approved medications to further characterize them and enhance our knowledge of their safety.


MPR


The top insurers all have PBMs: Here's who they are
Pharmacy benefit managers stepped in to help manage prescription claims for insurers when coverage expanded under the ACA and with the creation of the Medicare Part D program.
But today, they handle way more than claims processing, according to Agent Survival Guide . They help with formulary management, drug utilization review, determining which pharmacies are in-network and how much those pharmacies will receive in reimbursement.
Their expanded role in the drug supply chain has made them valuable partners for top insurers.
Below are the five top insurers and their pharmacy benefit management partners:
1. UnitedHealth Group. UnitedHealth created OptumRx, its in-house PBM by combining existing pharmacy and care delivery services within the company in 2011. It also purchased CatamaranRx in 2015, which expanded its PBM capabilities.
2. Anthem. Anthem will launch an in-house PBM called IngenioRx. Initially expected to launch in 2020, the insurer said it will now expedite the roll out. In March, Anthem terminated its PBM agreement with Express Scripts.
3. Aetna. Aetna recently merged with CVS Health. As a result, Aetna now has access to CVS Caremark, the PBM of CVS Health.
4. Cigna. Cigna recently merged with Express Scripts, one of the top PBMs in the nation. It also had Cigna Pharmacy Management, a smaller in-house PBM.
5. Humana. Humana has its own in-house PBM called Humana Pharmacy Solutions.


Pain Persistent after Sexual Assault
First large-scale prospective study reports shows prevalence and pain severity

MILWAUKEE -- Nearly three of four women who experienced sexual assault had new or worse pain a week later and in most cases that pain persisted for weeks, researchers said here.
One week after sexual assault, 76% of women had clinically significant new or worsening pain, reported Samuel McLean, MD, MPH, of the University of North Carolina at Chapel Hill, and colleagues, at the 2019 American Pain Society Scientific Meeting . Six weeks later, 54% of women still were in pain.
The findings are from the first large-scale prospective study of women evaluated soon after presenting at a sexual assault care center, McLean told MedPage Today. While many women who have experienced sexual violence have reported persistent pain, no major longitudinal studies of these women have been conducted to date.



Cannabis Plus Opioids in Chronic Pain: Not a Great Combo
Survey looked at mental health, pain outcomes when marijuana and opioids are both used


MILWAUKEE -- Chronic pain patients who used both prescription opioids and recreational marijuana showed higher levels of mental health and substance abuse problems than those who used opioids alone, survey results presented here showed.
Anxiety and depression scores were significantly higher for patients who used both drugs, as were measurements of opioid-dependence severity and alcohol and cocaine involvement, reported Andrew Rogers, of the University of Houston, and colleagues, at the 2019 American Pain Society Scientific Meeting .
There was no difference between the two groups in pain severity and pain disability, they added.



Ex-physician assistant gets prison time for role in $1B healthcare fraud scheme

A Florida federal judge sentenced Arnaldo Carmouze, a former physician assistant, to 80 months in prison for his role in a $1 billion Medicare and Medicaid fraud scheme.
Mr. Carmouze was one of three defendants charged in 2016 for his involvement in the scam, which involved admitting patients to skilled nursing homes and assisted living facilities owned by Philip Esformes for medically unnecessary care.
Mr. Carmouze was sentenced roughly three months after pleading guilty to one count of conspiracy to commit healthcare fraud.
 


Ohio, Kentucky doctors among 60 charged in pain pill bust 'acted like drug dealers'

Federal prosecutors charged 60 physicians and pharmacists Wednesday with illegally handing out opioid prescriptions in what they say is the biggest crackdown of its kind in U.S. history.
Some of the doctors are accused of trading sex for drugs, giving prescriptions to Facebook friends without proper medical exams and unnecessarily pulling teeth to justify writing pain pill prescriptions.
A special strike force from the U.S. Department of Justice, which led the investigation, began making arrests in five states early Wednesday. One of the doctors charged is Raymond Noschang, an internal medicine specialist with an office in Sycamore Township.
Most of the defendants face charges of unlawful distribution of controlled substances involving prescription opioids. Authorities say they gave out about 350,000 prescriptions, totaling more than 32 million pills, in Ohio, Kentucky, Tennessee, West Virginia and Alabama.



Doctors in five states charged with prescribing pain killers for cash, sex
Doctors, pharmacists, nurse practitioners and other licensed medical professionals were among the 60 people indicted and at least one doctor is charged in connection with a death.

Dozens of medical professionals in five states were charged Wednesday with participating in the illegal prescribing of more than 32 million pain pills, including doctors who prosecutors said traded sex for prescriptions and a dentist who unnecessarily pulled teeth from patients to justify giving them opioids.
The 60 people indicted include 31 doctors, seven pharmacists, eight nurse practitioners and seven other licensed medical professionals. The charges involve more than 350,000 illegal prescriptions written in Kentucky, Ohio, Tennessee, Alabama and West Virginia, according to indictments unsealed in federal court in Cincinnati.


Forest Park Medical Center kickback trial ends in convictions for 4 physicians

The kickback trial involving Forest Park Medical Center owners and physicians ended yesterday with seven defendants receiving convictions and one acquittal, according to a report in the Dallas Business Journal .
Four things to know:
1. The jury found co-administrator Mac Burt guilty in 10 of 11 counts against him. Four physicians were also convicted in the case:
• Douglas Won, MD, was found guilty of one of two counts against him.
• Michael Rimlawi, MD, was convicted in three of four counts against him.
• Shawn Henry, DO, was convicted in three of four counts against him.
• Mike Shaw, MD, was convicted in all four counts against him.
Two other individuals — Jackson Jacob, the owner of companies that Forest Park channeled payments through, and workers compensation insurance consultant Iris Forrest — were also convicted of charges in the case.
2. The trial revolved around a large conspiracy in which the physician-owned hospital received $200 million in "questionable insurance benefits" after compensating physicians for referrals. According to the report, the hospital provided around $40 million in bribes and kickbacks that were described as consulting fees or payment for the physicians to market their practices.
3. The principle founders of Forest Park made plea deals and cooperated with the government.
4. Sentencing has not occurred for the individuals convicted in this case.



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 karrie@theassociationcompany.com or Tara Morrison at tara@theassociationcompany.com or 770-613-0932.

July 26-28, 2019
PAIN 2019
West Virginia Society of Pain Physicians
Loews Miami Beach, FL


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