American Society of Interventional Pain Physicians | November 8, 2017
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
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ASIPP Abstract Submission for 2018 Annual Meeting is Open
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.
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.

Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016
Preliminary estimates of U.S. drug overdose deaths exceeded 60,000 in 2016 and were partially driven by a fivefold increase in overdose deaths involving synthetic opioids (excluding methadone), from 3,105 in 2013 to approximately 20,000 in 2016 ( 1 , 2 ). Illicitly manufactured fentanyl, a synthetic opioid 50–100 times more potent than morphine, is primarily responsible for this rapid increase ( 3 , 4 ). In addition, fentanyl analogs such as acetylfentanyl, furanylfentanyl, and carfentanil are being detected increasingly in overdose deaths ( 5 , 6 ) and the illicit opioid drug supply ( 7 ). Carfentanil is estimated to be 10,000 times more potent than morphine ( 8 ). Estimates of the potency of acetylfentanyl and furanylfentanyl vary but suggest that they are less potent than fentanyl ( 9 ). Estimates of relative potency have some uncertainty because illicit fentanyl analog potency has not been evaluated in humans. This report describes opioid overdose deaths during July–December 2016 that tested positive for fentanyl, fentanyl analogs, or U-47700, an illicit synthetic opioid, in 10 states participating in CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program.* Fentanyl analogs are similar in chemical structure to fentanyl but not routinely detected because specialized toxicology testing is required. Fentanyl was detected in at least half of opioid overdose deaths in seven of 10 states, and 57% of fentanyl-involved deaths also tested positive for other illicit drugs, such as heroin. Fentanyl analogs were present in >10% of opioid overdose deaths in four states, with carfentanil, furanylfentanyl, and acetylfentanyl identified most frequently. Expanded surveillance for opioid overdoses, including testing for fentanyl and fentanyl analogs, assists in tracking the rapidly changing illicit opioid market and informing innovative interventions designed to reduce opioid overdose deaths.

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
Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty “sham” trials?

Ong KL, Beall DP, Frohbergh M, Lau E, and Hirsch JA. Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty “sham” trials? Osteoporos Int. 2017 Epub ahead of Print

Abstract :
Summary The 5-year period following 2009 saw a steep reduction in vertebral augmentation volume and was associated with elevated mortality risk in vertebral compression fracture (VCF) patients. The risk of mortality following a VCF diagnosis was 85.1% at 10 years and was found to be lower for balloon kyphoplasty (BKP) and vertebroplasty (VP) patients.
Introduction BKP and VP are associated with lower mortality risks than non-surgical management (NSM) of VCF. VP versus sham trials published in 2009 sparked controversy over its effectiveness, leading to diminished referral volumes. We hypothesized that lower BKP/VP utilization would lead to a greater mortality risk for VCF patients.
Conclusions Changes in treatment patterns following the 2009 VP publications led to fewer augmentation procedures. In turn, the 5-year period following 2009 was associated with elevated mortality risk in VCF patients. This provides insight into the implications of treatment pattern changes and associated mortality risks.
Officials nationwide finally appear to be tackling America's opioid crisis. Last week, President Trump declared the epidemic a public health emergency, which will give states more flexibility in responding.
A bill that would limit initial opioid prescriptions to one week is before the Florida state legislature. Maryland is making it more difficult to prescribe opioids, and Arizona is collecting data on the scope of the problem.
These efforts are commendable. But they're unlikely to bring an end to the crisis because they fail to address one of the opioid epidemic's root causes -- chronic pain. Fortunately, there are plenty of new ways to treat patients suffering from chronic pain. It's time to embrace them.
By the Numbers: Insurance Consolidation
Competitive markets rare; most highly concentrated
There's been plenty of talk about competition in healthcare over the last few years, but a new  study from the American Medical Association  shows that, when it comes to health insurance markets, competition is more the exception than the rule.
The AMA looked at the  Herfindahl-Hirschman Indices  for each state and metropolitan area in 2016. HHI of 10,000 means that an area is perfectly noncompetitive, with only one provider. Lower HHIs, meanwhile, indicate varying degrees of competition. HHIs over 2,500 are considered highly concentrated, that is, with one or two insurers dominating the market.

CMS Announces Initiative to Examine Provider Regulations
The Centers for Medicare & Medicaid Services (CMS) has launched an initiative to examine which provider regulations should be discarded or revamped amid concerns that the regulations are reducing the amount of time that physicians spend with patients, according to an article published in  Modern Healthcare .
The article notes that primary care physicians are spending 27% of their time on clinical activities and 49% on administrative activities. In light of this,  CMS officials  are traveling the country to gather information on the impact of their regulations on physicians as part of the Patient over Paperwork initiative.
The initiative was announced the day after the American Hospital Association released a report about regulatory burden.
How Accurate are Online Physician Reviews?
A doctor investigates, with himself as subject
In theory, of course, it's a great idea for people to give their opinions and rate their experiences with any goods or services they buy. The notion goes back long before the Internet with publications like  Consumer Reports , which is now itself online. Sites such as  Angie's List  are very popular and can give you testimonials about providers of everything from home renovations to car repair to daycare. So it's not surprising several entrepreneurs have started physician rating sites. A huge issue is the sample size is so tiny; many physicians get only a single review. Also, the reviews are anonymous, and there have been several well-known examples of stalkers trashing a physician's reputation out of some animus to the person. It's also well known that perhaps a fifth or so of reviews at sites like this are fake anyway.
So I wondered. I've been practicing for 35 years and cared for thousands of patients. I have moved a few times and now work at several hospitals, so perhaps I'm hard to track down correctly, but maybe not. Also, rating pediatric critical care providers for patient choice reasons seems silly on the face of it because nobody shops around and plans for things when their child is suddenly critically ill or injured. You just go to the nearest place and are treated by whoever is there. Still, I thought it would be interesting to look. I would imagine I was a parent looking to get the inside scoop on that Johnson guy. The sites generally contain some biographical information about the physician: address, insurance accepted, where he or she trained, and if he or she had ever been disciplined by an official body. I wondered how accurate that would be for me. So here we go.

Department of Justice News

Michigan Doctor and Owner of Medical Billing Company Sentenced to 15 Years in Prison for $26 Million Health Care Fraud Scheme
A Detroit-area doctor was sentenced to 180 months in prison today for his role in a $26 million health care fraud scheme that involved billing Medicare for nerve block injections that were never provided and efforts to circumvent Medicare’s investigation of the fraudulent scheme. A co-conspirator who owned a medical billing company was previously sentenced to 10 years in prison. 
Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Daniel L. Lemisch of the Eastern District of Michigan, Special Agent in Charge David P. Gelios of the FBI’s Detroit Division, 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 and Special Agent in Charge Manny Muriel of Internal Revenue Service Criminal Investigation (IRS-CI) made the announcement.

Owner of Florida Pharmacy Pleads Guilty in $100 Million Compounding Pharmacy Fraud Scheme; Real Properties, Cars and a 50-Foot Boat Will Be Forfeited
Seven Others Previously Pleaded Guilty
The president and owner of a Florida pharmacy that was at the center of a massive compounding pharmacy fraud scheme, which impacted private insurance companies, Medicare and TRICARE, pleaded guilty today for his role in the scheme. Seven other individuals have previously pleaded guilty in connection to the scheme. Various real properties, cars and a 50-foot boat will be forfeited as part of the guilty pleas. 
Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney W. Stephen Muldrow of the Middle District of Florida, Special Agent in Charge Eric W. Sporre of the FBI’s Tampa Field Office, Special Agent in Charge Robert F. Lasky of the FBI’s Miami Field Office, Special Agent in Charge Shimon Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office and Resident Agent in Charge Brooke Harris of the U.S. Defense Criminal Investigative Service’s (DCIS) Tampa Regional Office made the announcement.
State Society News 
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

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