THURSDAY | JULY 16, 2020
Audio-Only Telemedicine: Docs Say Payment Falls Short
— Clinicians wonder why the technology used, not a virtual visit's content or complexity, dictates reimbursement

Months into the COVID crisis, doctors and patients have become accustomed to telemedicine. But some clinicians still face difficulties getting patients on video calls -- and have to pay the price.

Todd Maltese, DO, a neurologist and sleep medicine specialist in Ronkonkoma, New York, closed his brick-and-mortar clinic at the start of the pandemic, maintaining his practice with virtual visits. As months passed, video calls got easier -- but not for all patients.
"You will still get those patients who don't have a computer with a webcam, or who don't have a smartphone," Maltese told MedPage Today. "Most patients are older, and a lot of them have trouble getting on."

When patients are unable to access video technology, Maltese conducts their visit over the phone. But there's one issue: the reimbursement loss is significant.

Maltese said that a 15-minute video call might be reimbursed anywhere between $50 and $75. For a 20-minute phone call, however, he gets reimbursed between $10 and $20.



As you know, ASIPP has been in the forefront and continuing our advocacy to make telehealth permanent for all insurers and all payers. In addition, we have also been trying to keep telephone only at the same price as face-to-face or telehealth visits (see April 9 letter to Alex Azar and Eric Hargan , May 1 letter to CMS Administrator Seema Verma and May 5 letter to HHS Deputy Azar and Assistant Deputy Hargan ).

Good news! Yesterday, HHS Secretary stated that, “HHS will do everything it can to permanently keep telehealth waivers granted during the pandemic” at The Hill virtual event on the future of health care.

Azar’s commitment to push regulatory or legislative reforms to keep the COVID-19 telehealth flexibilities comes as hundreds of provider and patient organizations press HHS to continue telehealth waivers after the pandemic.

“I’ve been traveling all over the country and I visit with doctors and hospitals and nursing homes. I think we’d have a revolution if anyone tried to go backwards on this,” Azar said. “This is now I think an embedded part of our health care system."

Azar said getting Medicare and Medicaid treatment out of its “1960s-style of delivery” was something the department had always wanted to do, but Congress had never been able to change the Social Security Act to make the programs amenable to telehealth.
Virtual learning makes learning and earning credit hours easier and more cost-effective. You get great speakers, informative presentations, and 46.75 credit hours from one virtual meeting. No travel. Just watch from your home or office. ASIPP® is offering a series of virtual courses like the upcoming, Board Review Course, July 17-19 and July 24-26, 2020. We hope you'll review the schedule and decide to register . Please join us.
ASIPP® Converts Annual Meeting 2020 To A Virtual Meeting

Due to unavoidable circumstances related to COVID-19, ASIPP is converting its annual meeting scheduled September 4-6, 2020, in Dallas, Texas to a virtual meeting. This will provide you with many advantages:
  • There will be no traveling, which will save not only expenses, but also on 2 days of working. There is no worry about staying in the hotels and also no worries about contracting COVID-19.
  • This will provide you year-round online experience with a wealth of education and CME’s. Even though we are going to miss seeing you in person, the meeting will provide many of the same great benefits but in a virtual environment.
  • The schedule will remain pretty much the same with world-renowned speakers on relevant subjects of interventional pain management, COVID-19 interfacing with interventional pain management, and many other subjects including opioids and regenerative medicine.
  • The meeting continues to offer popular presentations by the past president, current president, and other presidents, along with the President of Texas Society, and the role of women in IPM.
  • The meeting starts with an excellent presentation on public relations and marketing in the COVID-era by a well-known figure in the industry, Randy Alvarez, President and CEO of Wellness Hour.

We are excited to let you know that ASIPP’s virtual annual meeting will offer a wealth of Continuing Medical Education (CME) opportunities that members value. Further, we will provide you with cutting edge discussions on various subjects. Above all, we will also provide free videos for you to watch for one-month. After that, they will be sold for a small cost, which you can watch for up to twelve months after the meeting.

ABIPP Recognizes Your Knowledge and Expertise
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.
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  or call 270-554-9412 x4217 or by email at .

ABIPP Part I  - Theoretical written exam - TBD
ABIPP Part II  - Oral and Hands-on practical exam - TBD
ABIPP Competency Exam  - includes written, oral, and hands-on practical examinations TBD
Combined CSM/CCPM Exam for ABIPP Path  – TBD
Competency Exam in Controlled Substance Management TBD
Competency Exam in Coding, Compliance, and Practice Management TBD
Regenerative Medicine Competency Exam  - includes written, oral, and hands-on practical examinations – TBD
U.S. Drug Overdose Deaths Hit Record High in 2019

In 1993, the peak year for firearm violence in U.S. history, guns killed nearly 40,000 Americans. In 1995, the deadliest year of the HIV/AIDS epidemic, 43,000 Americans lost their lives to the virus. In 1972, the heyday of the Ford Pinto and nadir of automotive safety in the country, 55,000 died in car accidents. The entire Vietnam War claimed 58,000 American lives.

Last year, drug overdoses killed 70,980 Americans, narrowly beating 2017’s record-setting death toll, according to preliminary data from the CDC .

The new figures shatter the fragile hope offered by 2018’s 4.6 percent decline in fatal overdoses, which marked the first annual reduction in such deaths in 28 years. What’s more, like so many of our nation’s other endemic pathologies, the overdose epidemic appears to have grown even more severe in 2020 than it was one year ago.
The number of suspected overdoses in the U.S. — both fatal and nonfatal — was 18 percent higher this March than it was the same month last year, according to the Overdose Detection Mapping Application Program. In April, overdoses were up 29 percent; in May, 42 percent.

Experimental COVID-19 vaccine safe, generates immune response
NIH-sponsored Phase 1 trial tested mRNA vaccine

An investigational vaccine, mRNA-1273, designed to protect against SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), was generally well tolerated and prompted neutralizing antibody activity in healthy adults, according to interim results published online today in The New England Journal of Medicine. The ongoing Phase 1 trial is supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The experimental vaccine is being co-developed by researchers at NIAID and at Moderna, Inc. of Cambridge, Massachusetts. Manufactured by Moderna, mRNA-1273 is designed to induce neutralizing antibodies directed at a portion of the coronavirus “spike” protein, which the virus uses to bind to and enter human cells.

The trial was led by Lisa A. Jackson, M.D., MPH, of Kaiser Permanente Washington Health Research Institute in Seattle, where the first participant received the candidate vaccine on March 16. This interim report details the initial findings from the first 45 participants ages 18 to 55 years enrolled at the study sites in Seattle and at Emory University in Atlanta. Three groups of 15 participants received two intramuscular injections, 28 days apart, of either 25, 100 or 250 micrograms (mcg) of the investigational vaccine. All the participants received one injection; 42 received both scheduled injections.
In April, the trial was expanded to enroll adults older than age 55 years; it now has 120 participants. However, the newly published results cover the 18 to 55-year age group only.

May/June 2020
Issue Available
In this issue, Pain Physician includes randomized trials on cervical plexus blocks for endarterectomy, pulsed radiofrequency for hemiplegic shoulder pain, ultrasound-guided injection for meralgia paresthetica, and more.
Randomized Trial
Emiliano Petrucci, MD, Vincenza Cofini, MD, Barbara Pizzi, MD, Rosaria Coletta, MD, Angelo Geremia Blasetti, MD, Stefano Necozione, MD, Pierfrancesco Fusco, MD, and Franco Marinangeli, MD.
Randomized Trial
Ebru Alanbay, MD, Berke Aras, MD, Serdar Kesikburun, MD, Selvinaz Kizilirmak, MD, Evren Yasar, MD, and Arif Kenan Tan, MD.

Randomized Trial
Selda Kiliç, MD, Feyza Ünlü Özkan, MD, Duygu Geler Külcü, MD, Gülcan Öztürk, MD, Pinar Akpinar, MD, and Ilknur Aktas, MD.

Randomized Trial
Botao Liu, MD, Yang Yang, MD, Zhongyi Zhang, MD, Haining Wang, MD, Bifa Fan, MD, and
Lei Sima, MD.


Surviving the COVID-19 Epidemic: Protecting Family and Employees and Managing Financial Issues and Burnout – PART 2

Surviving the Coronavirus Pandemic: Practical Advice Every Pain Physician Needs to Know – PART 1
Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020

What is already known about this topic?
Consistent and correct use of cloth face coverings is recommended to reduce the spread of SARS-CoV-2.

What is added by this report?
Among 139 clients exposed to two symptomatic hair stylists with confirmed COVID-19 while both the stylists and the clients wore face masks, no symptomatic secondary cases were reported; among 67 clients tested for SARS-CoV-2, all test results were negative. Adherence to the community’s and company’s face-covering policy likely mitigated spread of SARS-CoV-2.

What are the implications for public health practice?
As stay-at-home orders are lifted, professional and social interactions in the community will present more opportunities for spread of SARS-CoV-2. Broader implementation of face covering policies could mitigate the spread of infection in the general population.

New method performs coronavirus test 10 times faster

Currently, it takes more than two hours to perform and evaluate a test for SARS-CoV-2—meaning that a laboratory can test only a very limited number of people per day. In a study with several cooperation partners, cell biologists at Bielefeld University have now developed a method that delivers results around 10 times faster. "The test takes only about 16 minutes," says Professor Dr. Christian Kaltschmidt from Bielefeld University's cell biology research group. "The method is also cheaper than conventional tests."

More than 10 million coronavirus infections have now been confirmed worldwide. An effective vaccine or therapy for SARS-CoV-2 is not yet available. On top of this: not every infected person develops symptoms. Therefore, testing is currently the most effective method of curbing the spread of the virus: those who are infected are then isolated and no longer spread the virus.

The most common procedure for testing whether someone has become infected with SARS-CoV-2 is a so-called PCR test. These use the genetic material of the virus as a basis. This is also what the Bielefeld scientists did in their study. PCR tests always follow a similar pattern. First, genetic material is needed from a test person. This is usually obtained by a smear test in the mouth, nose, or throat. "If a person is infected with SARS-CoV-2, the sample will also contain genetic material from the virus in the form of what is called RNA," said Kaltschmidt. The RNA molecules are isolated in a chemical process. However, the sample does not contain enough RNA for a test to detect it immediately. Therefore, it has to be amplified.

HHS Upping COVID-19 Relief Funding for Safety-Net and Rural Providers
— $4 billion increase includes $1 billion for suburban hospitals serving rural populations

WASHINGTON -- The Department of Health and Human Services (HHS) is making an additional $4 billion available to safety-net hospitals and rural healthcare providers affected by COVID-19, the agency announced.
"We've been distributing the Provider Relief Funds as quickly as possible to those providers who have been hardest hit by the pandemic," HHS Secretary Alex Azar said in a press release . "Close work with stakeholders informed how we targeted this new round of funds to hard-hit safety-net and rural providers."

This funding is in addition to money distributed earlier in the pandemic, a senior HHS official told MedPage Today Friday afternoon in a "background" phone call with reporters (meaning speakers are not to be named). For example, on June 9, HHS announced plans to distribute $10 billion in Provider Relief Fund payments to safety-net hospitals serving our most vulnerable citizens. However, the agency learned that some acute care hospitals did not qualify for funding from that initial amount.

HHS is now expanding criteria for payment qualification so that certain acute care hospitals meeting a revised profitability threshold -- less than 3% averaged consecutively over two or more of the last five cost reporting periods -- will now be eligible for payment. The agency now expects to distribute over $3 billion more across 215 acute care facilities, bringing the total payments for safety net hospitals from the Provider Relief Fund to $12.8 billion across 959 facilities.

ASIPP ® Partners with Fedora Billing And Revenue Cycle Management Company  
ASIPP is now 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!

New US health crisis looms as patients without COVID-19 delay care

A Texas man who waited until his brain tumor was softball-sized; a baby who suffered an ear infection for six days; a heart patient who died: The resurgence of COVID-19 is creating another health crisis as hospitals fill and patients are fearful or unable to get non-emergency care.

With U.S. coronavirus infections reaching new heights, doctors and hospitals say they are also seeing sharp declines in patients seeking routine medical care and screenings - and a rise in those who have delayed care for so long they are far sicker than they otherwise would be.

"I had one lady who had delayed for five days coming in with abdominal pain that was getting worse and worse," said Dr. Diana Fite, who practices emergency medicine in Houston. "When she finally came in, she had a ruptured appendix."

COVID-19 Claims Data Reveal Real-World Tx Costs
— Median sticker prices in the low-middle five figures; "allowed amounts" around $20,000

Median "charge amounts" for hospital treatment of COVID-19 -- the sticker price for patients without insurance or receiving out-of-network care -- ranged from about $35,000 for those age 23-40 to $46,000 for individuals in their 50s, according to a  report released  Tuesday by  FAIR Health , based on payer data covering more than 150 million Americans.

So-called allowed amounts -- the total estimated to be paid by patients and their insurers -- were lower, however. These ranged from just over $17,000 for patients older than 70 (in this analysis, primarily Medicare Advantage enrollees) to about $24,000 for those ages 51-60.

Some Good Comes Out of COVID-19
— Pandemic presents an opportunity for lasting change

Despite all of the despair brought on by the COVID-19 pandemic, it has been extraordinary to see an unprecedented level of collaboration among healthcare providers as we unite to treat patients and protect others from contracting the disease. There wasn't a clear roadmap to follow or a large body of research on the nature of the novel coronavirus and its accompanying disease. Essentially, the healthcare community across the globe has been working in real-time to "crowdsource" best practices on what's working or not.

Crowdsourcing is commonplace among some businesses and industries -- the Waze app, for example, is only possible because of its ability to compile and process traffic data in real-time from commuters. Crowdsourcing is also a popular way to test product ideas, invent the next toy or game, or bring a new ice cream flavor to market. But in the medical community, crowdsourcing is less common and usually occurs through much more formal channels.

Collaboration among physicians typically happens at conferences or by partnering on research or academic papers, but clinical care is usually designated to a healthcare team at one medical institution. The rapid onset of the COVID-19 pandemic and the resulting worldwide devastation removed any sense of competition. Instead, we have seen unprecedented collaboration as medical providers have forged unique partnerships under the "we are all in this together" mentality. There has been no room for egos or competition -- it is all hands on deck, all ideas welcome, all working toward the same common goals. My hope is that the shift from working in silos to unity and teamwork will be a lasting change in the medical community.

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
Regenerative Medicine for Spine Disease

On Demand Course covering Biologics in the treatment of DDD and Back Pain PRP, Bone Marrow Aspirate ASIPP Guidelines, Theory and Evidence Ultrasound Bone Marrow Aspirate PRP preparation. Video includes 1 CME Credit. Learn More. [ ]

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.
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ASIPP ® | Pain Physician Journal | Phone | Fax | Email