THURSDAY | MAY 7, 2020
Checklist and Risk Stratification
for Opening of Interventional Pain Management Practices
There are several steps to take as you open your office to a full schedule, and range of procedures, during the coronavirus pandemic of 2020. Checklist
1. Check with your state 
First, check with your state for when you can resume normal medical office visits and medical/surgical procedures. In some states, medical offices were never shut down. Elective procedures were banned, and emergent cases could only proceed at the physician's discretion in almost all states. Elective procedures can now resume in phase I, with variable dates during May and June 2020, if the patient can be discharged the same day. 
2. Prepare your office and staff for new safety measures
Prepare your office for the new paradigm of social distancing and required use of PPE. Every staff member should be screened on a daily basis for signs of illness and their temperature should be checked and logged. In some states, a ban on mass gatherings of more than 10 people remains in place. Restructure the office to minimize clustering of staff at break areas and patients in the waiting room or check out areas. All business offices can open, but all employees in the offices need to wear masks in most states. There are no clear guidelines that mandate visitors or patients in a doctor's office or hospitals have to wear masks, but it would be prudent to encourage your patients to do so. Only patients should be allowed in your office; drivers and/or family members should not be allowed in the office. Of course, if the patient needs assistance from a family member or the patient is a minor, then one person may accompany them. Patients should be screened for signs of illness, asked about their travel history to any area where COVID-19 is highly prevalent (not just to China or other foreign hotspots), questioned about any loss of smell, and have their temperature checked. Ideally, screening is done outside the building or at the entrance, and any staff member doing the screening would be wearing a mask. Patients may use their own personal mask in your office but if they don't have one, you should provide one. During surgery, they have to wear surgical or N95 masks, in some states.
The office should be prepared for social distancing. The chairs in the waiting room should be spaced 6 feet apart and all excess chairs should be removed from the waiting room. All surfaces in the office that would be expected to come in contact with people should be wiped down at the start of the day, the middle of the day, and the end of the day. Any chair or table used by a patient should be wiped down after each use. The restrooms should be monitored, cleaned and wiped down after each use. Hand sanitizer is required in high traffic areas.
Any work that can be done from home should be encouraged. This might include back office work such as accounting, bookkeeping, insurance authorizations and billing. Staff work hours could be staggered such that work that doesn't require the patient's presence can be done after clinic hours by staff coming in later in the day. Work stations in the office may need to be reconfigured to allow proper spacing between work staff. Telemedicine has gained much more acceptance and is now being used by most offices. This should be continued as offices open to a more regular schedule, as it will help to reduce patient traffic in offices.
Make sure you have an adequate supply of PPE for all medical and clerical staff in the office and for patients. Expect greater utilization of PPE than before due to increased use by staff and patients. You will need to maintain an adequate stock to remain open and be in compliance with Ohio Department of Health (ODH) recommendations. Each office will have to decide on the type of masks their staff will wear and whether face shields are needed.
3. Organize scheduling and maximize telemedicine
Telemedicine was encouraged by the US Government as a way to continue caring for the US population during this pandemic without exposing the patients or healthcare workers to the coronavirus. Just because the country is slowly opening up does not mean the virus is no longer a risk. Telemedicine involves communication with a patient who is not physically in the same room with the provider. The providers and patients who have used it have found it to be a nice way of delivering healthcare in the comfort of their own homes. Patients at home or work can take 15 minutes to do a follow up on the phone with the provider, rather than drive across town for a visit. We should continue to offer telemedicine for these reasons.
Right now, because of a waiver, the reimbursements for telemedicine visits that utilize audio or audiovisual communication can receive the same reimbursement. It is uncertain if this will continue after the waiver period ends, whenever this public health emergency is over. Until then, we should incorporate telemedicine to the fullest in our offices to take advantage of its benefits in terms of social distancing, safety and convenience to the patients and healthcare providers.
If patients will be brought to the office, then scheduled appointments will have to be spaced further apart so that social distancing can be accommodated in the office at least during Phase I and II. When they are checked out this should be done in a way that also minimizes patient crowding. The patient should also be allowed to leave the office quickly and then the follow up visit can be scheduled later over the telephone or by email. During pre-appointment reminder calls, patients should be pre-screened, notified of new in-office measures and encouraged to wear personal masks to their office visit. 
You may also want to consider the risks of performing interventional pain procedures based on the patient's age, medical history, physical condition and residence status (i.e. nursing home, assisted living). The attached American Society of Interventional Pain Physicians (ASIPP) toolkit contains recommendations on risk stratification.
4. Testing
Rules are highly variable for each state. Please look at the Department of Health posting.
If a patient is asymptomatic and has not had a reason to be tested for coronavirus before, what do you do? If the patient is coming in for a routine visit, then routine screening, including a temperature check, should suffice.
For IPM procedures in awake patients where the airway, face and neck are not involved, testing may not be necessary if they are asymptomatic and pass all standard coronavirus screenings, including temperature checks. Risk Stratification
If a person has a history of a positive coronavirus test, elective procedures should be delayed until the patient is considered no longer infectious and has recovered. The CDC uses both test-based and non-test based strategies. 

Test-based strategy

  • No fever without use of fever-reducing medicines.
  • Improvement of respiratory symptoms.
  • Negative results from two SARS-CoV-2 tests >= 24 hours apart.

Non-test-based strategy

  • Afebrile for 72 hours without use of fever-reducing medicines.
  • At least 7 days since the symptoms first appeared.

5. Risk Disclosure
Finally, as you open your offices, you should consider the use of a risk disclosure to explain the risks to your patients in this uncertain time. The risk disclosure should discuss the risks of leaving the safety of their own home to seek medical care and receiving medical treatments that might alter their response to the coronavirus should they get it (i.e., their infection may be more severe). An example risk disclosure can be found in the link below to the ASIPP toolkit for restarting your practice after the recent COVID-19 shutdown.


Surviving the COVID-19 Epidemic: Protecting Family and Employees and
Managing Financial Issues and Burnout
Surviving the Coronavirus Pandemic: Practical Advice
Every Pain Physician Needs to Know
Dr. Devi Nampiaparampil Pens Book
Hospitals and healthcare workers struggle to keep up with the demand as the new coronavirus (COVID-19) spreads across the U.S. and throughout the world. 

Hundreds of millions of people are social distancing, quarantining, and sheltering in place to slow down the spread of the virus. The stock market is plunging and the global economy is heading into a recession because of the virus and because of the measures we are enforcing to stop it. Schools are closed. Restaurants, bars, and gyms are closed in many areas of the country. Major sports events, concerts and shows have been cancelled. Perhaps our greatest asset in this fight against the new coronavirus-- healthcare workers-- are becoming infected on the front lines. In the midst of this crisis, Doctor Devi explains what you need to know in a concise and easy-to-understand Question and Answer format.

Dr. Devi Nampiaparampil, a Harvard-trained doctor and a professor at NYU School of Medicine, breaks down the issues in this clear and compassionate handbook. What makes this virus so dangerous? How can I protect myself and my family? How did this happen?

For the latest guidelines, please always check:

Coronavirus Tests,
Treatment and Vaccines
How the U.S. is faring in the public-health race to
safely reopen schools, businesses and daily life

The U.S. has performed millions of coronavirus tests, but returning the nation to its normal life will require far more.

Some of America’s most prominent public-health doctors say the country must conduct in the range of four million tests a week to capture most cases and prevent the disease from spreading as the public returns to work and schools. That is more than twice the amount the U.S. is doing weekly at this point.

On top of that, the doctors say, the nation needs about 100,000 people to undertake “contact tracing”—getting in touch with those who have had contact with infected people and may now be infected themselves.
Call for COVID-19 Submissions: 
Manuscripts related to COVID-19 and interventional pain management are now being solicited for a special issue of Pain Physician .   
We will publish articles on prevention, diagnosis, treatment, including epidemiology, pathophysiology, pharmacology. Plus articles risks of interventional techniques, risks of anesthesia, precautions, and preventive measures.  
Pain Physician , the official journal of the American Society of Interventional Pain Physicians is and open access journal listed in Embase, SCOPUS, PubMed, and Medline. 
Pain Medicine Case Reports journal is also requesting submissions. PMCR is the sister journal to Pain Physician that focuses solely on Case Reports and Case Series. Articles submitted to PMCR will need to be Case Reports or Case Studies only that relate to COVID-19. 
Pain Medicine Case Reports is an open access journal, available online with free full manuscripts. It is listed in SCOPUS, Embase, ScienceDirect, Evolve, and Clinical Key. 

Articles for both journals will go through rapid review and rapid publication.  
Pain Physician March/April 
2020 Articles
Available Online
The March/April issue of Pain Physician  features 

Position Statement
Laxmaiah Manchikanti, MD, Christopher J. Centeno, MD, Sairam Atluri, MD, Sheri L. Albers, DO, Shane Shapiro, MD, Gerard A. Malanga, MD, Alaa Abd-Elsayed, MD, MPH, Mairin Jerome, MD, Joshua A. Hirsch, MD, Alan D. Kaye, MD, PhD, Steve M. Aydin, DO, Douglas Beall, MD, Don Buford, MD, Joanne Borg-Stein, MD, Ricardo Buenaventura, MD, Joseph A. Cabaret, MD, Aaron K. Calodney, MD, Kenneth D. Candido, MD, Cameron Cartier, MD, Richard Latchaw, MD, Sudhir Diwan, MD, Ehren Dodson, PhD, Zachary Fausel, MD, Michael Fredericson, MD, Christopher G. Gharibo, MD, Myank Gupta, MD, Adam M. Kaye, PharmD, FASCP, FCPhA, Nebojsa Nick Knezevic, MD, PhD, Radomir Kosanovic, MD, Matthew Lucas, DO, Maanasa V. Manchikanti , R. Amadeus Mason, MD, Kenneth Mautner, MD, Samuel Murala, MD, Annu Navani, MD, Vidyasagar Pampati, MSc, Sarah Pastoriza, DO, Ramarao Pasupuleti, MD, Cyril Philip, MD, Mahendra Sanapati, MD, Theodore Sand, PhD, Rinoo Shah, MD, Amol Soin, MD, Ian Stemper, MS, Bradley W. Wargo, DO, and Philippe Hernigou, MD

Health Policy Review
Laxmaiah Manchikanti, MD, Mahendra R. Sanapati, MD, Amol Soin, MD, Maanasa V. Manchikanti, BS, Vidyasagar Pampati, MSc, Vanila Singh, MD, and Joshua A. Hirsch, MD

Systematic Reviews
Jianwei Wang, MS, Zifeng Xu, MD, Zhou Feng, MS, Rui Ma, BS, and Xiaoyu Zhang, MS

Felipe Araya-Quintanilla, MSc, Hector Gutierrez-Espinoza, PhD, Maria Jesus Munoz-Yanez, MSc, Ursula Sanchez-Montoya, MSc, and Juan Lopez-Jeldes, MSc
Coronavirus (COVID-19)
Update: FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment
Today, the U.S. Food and Drug Administration  issued an emergency use authorization  for the investigational antiviral drug remdesivir for the treatment of suspected or laboratory-confirmed COVID-19 in adults and children hospitalized with severe disease. While there is limited information known about the safety and effectiveness of using remdesivir to treat people in the hospital with COVID-19, the investigational drug was shown in a clinical trial to shorten the time to recovery in some patients.

“FDA’s emergency authorization of remdesivir, two days after the National Institutes of Health’s clinical trial showed promising results, is a significant step forward in battling COVID-19 and another example of the Trump Administration moving as quickly as possible to use science to save lives,” said HHS Secretary Alex Azar. “NIH, FDA, and scientists across America and around the world have worked tirelessly with patients to get us this new potential treatment for COVID-19. The seamless cooperation between government and private industry under the President’s all-of-America approach to COVID-19 is getting treatment options to patients in record time.”
Pain Management
Workgroup to Hold Evidence Review Advisory Meeting
Please find the letter  addressed to American Society of Interventional Pain Physicians, along with other pain organizations from the Pain Management Workgroup Evidence Review advisory meeting with important updates.
They are planning an evidence review advisory meeting for LCD policies on facet joint injections and medial nerve branch procedures. The meeting, which will be a combined meeting with all Medicare Administrative Contractors (MACs), is currently planned for May 28th in Nashville and as a teleconference. A link to the meeting and registration information will be posted to each MAC’s website and the CMS Landing Page within the next 2‐3 weeks.  ASIPP will be watching for this posting and will notify you so that you may register to attend.

Some of the ASIPP members are already serving on this committee; however, it is crucial that each state contact their own carriers and try to represent them. We need as many people as you can participate.
It is very crucial that you participate and understand. If you register you should be able to ask questions and give opinions, etc.
Please block your time for May 28 th from 1:00 to 3:00 pm CST.
Stakeholder Views on Pain Management Requested 
June 16 Deadline for Perspectives and Experiences  

The Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services (HHS) announces the opening of a docket to obtain comment concerning perspectives on and experiences with pain and pain management, including but not limited to the benefits and harms of opioid use, from patients with acute or chronic pain, patients' family members and/or caregivers, and health care providers who care for patients with pain or conditions that can complicate pain management ( e.g.,  opioid use disorder or overdose)—hereafter called “stakeholders.” CDC will use these comments to inform its understanding of stakeholders' values and preferences related to pain and pain management options. 

Written comments must be received on or before June 16, 2020. 

Submit written comments, identified by Docket No. CDC-2020-0029 by any of the following methods: 

·  Federal eRulemaking Portal: .  Follow the instructions for submitting comments. 
·  Mail:  Shannon Lee, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop S106-9, Atlanta, Georgia 30329. 

Instructions:  All submissions received must include the agency name and Docket Number. All relevant comments received will be posted without change to ,  including any personal information provided. For access to the docket to read background documents or comments received, go to .  
COVID-19 No Worse
Than the Flu? Hardly
New York City data show dramatic imbalance

The number of confirmed and probable deaths from COVID-19 coronavirus were vastly greater than those due to flu this year in New York City, researchers determined.

From February 1 to April 18, the ratio of excess deaths in New York City was  21 times the number of deaths from seasonal influenza  during this time period, reported Jeremy Samuel Faust, MD, of Harvard Medical School in Boston and Carlos del Rio, MD, of Emory University School of Medicine in Atlanta, in a preprint posted on medRxiv.

COVID-19 has been compared to seasonal flu many times, with annual deaths from seasonal flu often cited in comparison. The CDC estimated a range of 12,000 to 61,000 influenza-associated and pneumonia deaths per year from 2010 to 2019. In fact, the CDC estimated  24,000 to 62,000 Americans have died of influenza  in the current flu season.
Still Want to Be a Doctor
Post COVID-19?
How the pandemic could influence the next generation of healthcare professionals

Every applicant to medical school has to write a personal statement. It does not have a prompt, but the understood question has always been, "Why do you want to be a doctor?"

Being a physician has always been considered a noble and honorable profession, but ever since COVID-19, physicians, along with the nurses and other healthcare professionals working on the front lines, have become bona fide heroes. The public now sees these courageous men and women risking their lives for others (sometimes without the protective equipment they need) while isolating themselves from their own families to do so.
We are currently looking for reviewers for Pain Physician  
We would like to take this opportunity to ask if you would be interested in a position as a Reviewer on the Editorial Board for Pain Physician or if you have a recommendation for someone who might be interested.  
Editorial Board responsibilities are as follows: 
  • Review a minimum of 6 manuscripts per year.  
  • Failure to review 2 manuscripts consecutively or 60% of the manuscripts sent will disqualify one from Editorial Board Membership. 
For more information or to submit your letter of interest, please e-mail: 
Holly Long at or call 270.554.9412 ext 4230.
ASIPP ® Partners with Fedora Billing And Revenue Cycle
Management Company 
After long discussions, in addition to our NorCal liability program for ASIPP ® members, now we are able to offer unique benefits for revenue cycle management with billing, etc.

Fedora is a company known to many of our board members and others. ASIPP ® has reached an agreement with Fedora to provide exclusive discounts on billing or revenue cycle management that will decrease practice costs and promote growth, or at least stop deterioration. It is not just a billing company; they streamline the billing and receivable process and constantly update payor regulations keeping your practice up to on date on a daily basis. 

You may view the ASIPP ® billing program website at the following link:  

Some of the ASIPP ® Billing Program highlights are below:
Up to 50% savings for ASIPP ® members for their billing or revenue cycle management for their offices and surgery centers:
  • Expertise in interventional pain management billing for all types of services
  • 99% Clearing House Rate
  • 95% First-Time Claim Passage
  • 23.4 Average Days in A/R
  • Eligibility and Benefits Verification 
  • Pre-Certification/Prior Authorization
  • Denials and A/R Management 
Join The Group Purchasing Organization Today
ASIPP ® has formed a partnership with Henry Schein and PedsPal , a national GPO that has a successful history of negotiating better prices on medical supplies and creating value added services for the independent physician. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today. While the cost of contrast media has skyrocketed due to the single dose vial issue, because we have partnered with Henry Schein, this could enable you to purchase Omnipaque 240mg/50mL for slightly above $4.50.

It will be easy for  ASIPP ® members in good standing to enroll today and begin to realize the savings this partnership can bring. Members can join or see sample prices by going to    

Click on “view our discounted supplier prices” (Username:ASIPPmember and Password: Save) or click on the words "join for free now" and begin saving today!
Asthma and COVID-19 Risk: Good, Bad or Indifferent?
People with asthma are  classified as being at increased risk  for severe COVID-19 outcomes, although evidence is emerging that may point in the opposite direction.

Under normal circumstances, viral infections are a big driver of flares in asthma patients. But research indicates asthma patients with COVID-19 do not appear to have a higher rate of hospitalization or mortality compared with other COVID-19 patients, Linda Rogers, MD, of Icahn School of Medicine at Mount Sinai in New York City, told MedPage Today.
We are currently looking for reviewers for Pain MedicineCase Reports  
We would like to take this opportunity to ask if you would be interested in a position as a Reviewer on the Editorial Board for Pain Medicine Case Reports or if you have a recommendation for someone who might be interested.  
Editorial Board responsibilities are as follows: 
  • Review a minimum of 6 manuscripts per year.  
  • Failure to review 2 manuscripts consecutively or 60% of the manuscripts sent will disqualify one from Editorial Board Membership. 
For more information or to submit your letter of interest, please e-mail: 
Holly Long at or call 270.554.9412 ext 4230.
Essentials of Regenerative Medicine in Interventional
Pain Management
Essentials of Regenerative Medicine in Interventional Pain Management is a book to bring concise, collective, and comprehensive information to interventional pain physicians practicing regenerative medicine in managing chronic pain. Regenerative medicine is an integral part of interventional pain management within the definitions of interventional pain management and interventional techniques.

Each chapter contains an introduction of the subject, historical context,pathophysiology, applicability of regenerative medicine with its evidence base, indications, anatomy, technical aspects, complications, and precautions for each topic when available and applicable. This comprehensive book consists of 35 chapters, more than 350 figures, and 50 tables.
| ORDER | Essentials of Regenerative Medicine in IPM
Control Your Waiting Room TV

Customized waiting room TV exclusively for ASIPP ® members. Create your own ad-free television broadcasts using our videos, custom informational slides and your own YouTube videos. Even add local weather reports, news and live messages.
Send in your state society meeting news to Holly Long ,
ASIPP ® | Pain Physician Journal | Phone | Fax | Email