What the U.S. needs to do to provide compassionate care in hard times to combat serious illness of COVID-19 epidemic: Expanded Mesenchymal Stem Cells may offer hope

COVID-19 has affected the United States leading it to a national emergency with health care and economic impact, propelling the country into a recession with disrupted lifestyles never seen before in recent history. COVID-19 is a serious illness leading to multiple deaths in the United States. The article in JAMA from Arentz et al published the picture of COVID-19 in the United States serious illness which is not pretty. The mortality looked similar to other countries with some additional issues. A small proportion of patients develop serious illness leading to septic shock and multiple organ dysfunction syndromes. The presently approved treatments are supportive, but not curative for the disease. Dr. Manchikanti one of the authors of the manuscript stated that, “The cure of COVID-19 is essentially dependent on the patient’s own immune system.” In coronavirus infection, the immune system is over activated as the body attempts to kill the virus, which in fact leads to the production of large number of inflammatory factors. This results in a severe cytokine storm like a tornado.” This induces organ damage, starting with changes in air exchange, leading to acute respiratory distress syndrome, followed by cardiac injury and eventually multi-system organ failure and death.

Dr. Manchikanti also stated that “countries are facing extraordinary circumstances.” The article by Atluri, Manchikanti, and Hirsch to be published in Evolutionary Therapeutic Strategy section of Pain Physician , deals exactly with this problem and shows a potential solution with infusion of expanded umbilical cord mesenchymal stem cells. Authors are requesting the President and Coronavirus Task Force to take a 3-pronged approach and provide on a specific and limited basis for permission to give patients expanded umbilical cord mesenchymal stem cells by minimizing regulatory burden and instituting appropriate safeguard to avoid negative consequences from unscrupulous actors. Dr. Manchikanti stated that, “even though there is very limited evidence, the evidence is emerging and what is shown in these Chinese reports is very encouraging.”

Be encouraged, stay positive, and do all you can to remain healthy!
The manuscript is in press in the Pain Physician.
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ASIPP ® Members and Friends:
Registration is Back Online . All Previous Registrations carry over to the New Meeting Dates.
ASIPP ®  is now Accepting
Visit for more details.
We will update this site frequently with new information as it becomes available.
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.
Learn About Protecting Family
and Employees and Managing Financial Issues and Burnout
in this time of COVID-19

We are pleased to offer this coronavirus webinar that is designed for
Interventional Pain Management and covers medical and business aspects.
Webinar Agenda
3:05pm – 3:30pm
Laxmaiah Manchikanti, MD
3:30pm – 3:45pm
Managing Stress and Burnout for Healthcare Professionals in Private Practice
Maurya W. Glaude,
Associate Director of Field Education & Professor of Practic
3:45pm – 4:15pm
Update on Financial Support for Physicians and Practices
Amol Soin, MD
4:15pm – 4:30pm
Protecting Family, Friends, and Employees During COVID-19
Amit Mahajan, MD
Assistant Professor of Radiology and Biomedical Imaging, Yale School of Medicine
4:30pm – 5:00pm
Discussion and Question and Answer Forum
Question and Answers
Register for this informative webinar early. There is limited space. During the webinar you will be able to text questions to speakers. If you prefer send your questions before the webinar to . The webinar will be recorded and made available to all registrants. Once you register webinar access info will be sent to you.
Dr. Devi 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?

This book discussed the fundamentals behind the coronavirus epidemic.
For the latest guidelines, please always check:
FDA Wants All Ranitidine
Products Off the Market 
Finds levels of probable carcinogen increase during storage
WASHINGTON -- All ranitidine products should be pulled from shelves immediately, the FDA said Wednesda y , including brand-name Zantac as well as generic versions of the prescription and over-the-counter antacid. 

Notably, this was not because of direct evidence of N-Nitrosodimethylamine (NDMA), a probable human carcinogen , being present in particularly high concentrations in the drug itself. 

"We didn't observe unacceptable levels of NDMA in many of the samples that we tested. However, since we don't know how or for how long the product might have been stored, we decided that it should not be available to consumers and patients unless its quality can be assured," Janet Woodcock, MD, director of the FDA's Center for Drug Evaluation and Research, said in a statement. 
Using Stem Cells To Combat COVID-19 Pneumonia 
When news of the coronavirus emerged from Wuhan, China, Kunlin Jin, PhD , and a team of international researchers quickly joined forces to fight the mysterious disease. 
Dr. Jin relied on his more than 20 years of knowledge about stem cells to work with an international team driven to save lives. He used the messaging app WeChat to bridge the distance between his laboratory at The University of North Texas Health Science Center at Fort Worth , and experts in China. 
“A lot of people are trying find the answers,” said Dr. Jin, who spends most of his time working alongside graduate students on stem cell therapies to fight strokes at the HSC Institute for Healthy Aging
Announcing A New ASIPP ® Partnership - 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 
CMS Relaxes Rules on
Scope of Practice, Telemedicine During COVID-19
But won't preempt limits imposed by states 
WASHINGTON -- Clinicians could be freed to practice at the top of their license as part of new flexibilities granted by the Centers for Medicare & Medicaid Services (CMS) in the wake of the COVID-19 pandemic. 

For example, "nurse anesthetists could help with anesthesia during essential surgeries and procedures, which frees up anesthesiologists for ICU care," CMS Administrator Seema Verma said on a Monday evening phone call with reporters. 

But there's also a catch: "States may have laws that prohibit them from taking advantage of our flexibility, and that would need to be resolved at the local level," she said. 
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 l   

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!
Presymptomatic Transmission
of SARS-CoV-2 — Singapore, January 23–March 16, 2020 
Wycliffe E. Wei, MPH1,2; Zongbin Li, MBBS1; Calvin J. Chiew, MPH1; Sarah E. Yong, MMed1; Matthias P. Toh, MMed2,3; Vernon J. Lee, PhD1,3 

What is already known about this topic?  
Preliminary evidence indicates the occurrence of presymptomatic transmission of SARS-CoV-2, based on reports of individual cases in China. 

What is added by this report?  
Investigation of all 243 cases of COVID-19 reported in Singapore during January 23–March 16 identified seven clusters of cases in which presymptomatic transmission is the most likely explanation for the occurrence of secondary cases. 

What are the implications for public health practice?  
The possibility of presymptomatic transmission increases the challenges of containment measures. Public health officials conducting contact tracing should strongly consider including a period before symptom onset to account for the possibility of presymptomatic transmission. The potential for presymptomatic transmission underscores the importance of social distancing, including the avoidance of congregate settings, to reduce COVID-19 spread. 
COVID-19 threatens to close physician offices nationwide 
The COVID-19 pandemic is creating a cash crunch for primary care physician practices and forcing some to lay off employees and others to close, according to the Los Angeles Times .  

Primary care physicians are counseling patients who may have COVID-19 and helping keep patients out of hospitals that are already struggling with a surge of patients. As the virus continues to spread, many physician practices are telling patients to stay home to avoid exposure for themselves and medical staff.  

Primary care physicians are increasingly turning to telehealth to counsel patients who may have COVID-19 and to treat patients with other ailments. Reimbursement for online visits is often 30 percent less than in-person appointments, creating financial stress for many physicians, according to Bloomberg
Anesthesiologists 'Ready to Jump In' to Help With COVID-19 
Anesthesia gas machine ventilators could be
repurposed too, expert says 
Adequate supply of ventilators is crucial for hospitals trying to care for patients during the COVID-19 coronavirus outbreak, but attempting to "split" ventilators to meet the demand would be detrimental for patient care, several medical organizations said. 

Instead, Mary Dale Peterson, MD, president of the American Society of Anesthesiologists (ASA), encouraged more creative solutions, where both anesthesia equipment and anesthesiologists can help to support their colleagues treating COVID-19 patients. 
Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12 – March 28, 2020 

What is already known about this topic?  
Published reports from China and Italy suggest that risk factors for severe COVID-19 disease include underlying health conditions, but data describing underlying health conditions among U.S. COVID-19 patients have not yet been reported. 

What is added by this report?  
Based on preliminary U.S. data, persons with underlying health conditions such as diabetes mellitus, chronic lung disease, and cardiovascular disease, appear to be at higher risk for severe COVID-19–associated disease than persons without these conditions. 

What are the implications for public health practice?  
Strategies to protect all persons and especially those with underlying health conditions, including social distancing and handwashing, should be implemented by all communities and all persons to help slow the spread of COVID-19. 
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.
Essentials of Regenerative Medicine in Interventional Pain Management | ORDER |
Pain Physician March/April
2020 Articles Available Online Now
The March/April issue of Pain Physician  features
Evolutionary Therapeutic Strategies
Sairam Atluri, MD, Laxmaiah Manchikanti, MD, and Joshua A. Hirsch, MD

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

Laxmaiah Manchikanti, MD, Mahendra R. Sanapati, MD, Vidyasagar Pampati, MSc, Amol Soin, MD, Sairam Atluri, MD, Alan D. Kaye, MD, PhD, Joysree Subramanian, MD, and Joshua A. Hirsch, MD

Sanjeeva Gupta, MD, and Manohar Sharma, MD
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