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This change will bring TRICARE reimbursement for ambulatory surgery care into alignment with the statutory requirement that payment methods for institutional care be, to the extent practicable, in accordance with the same reimbursement rules used by Medicare. This change will create TRICARE and Medicare Fee-For-Service ASC reimbursement parity for all authorized ASC procedures. Consequently, access to care in the ASC setting for TRICARE beneficiaries will improve because of this change.

From TRICARE Reimbursement Manual 6010.61-M, Chapter 9, Section 2, POLICY 3.1: "Effective for service dates on or after October 1, 2023, TRICARE is adopting the Medicare ASC reimbursement system including their ASC fee schedule rules, payment rates, payment indicators, list of covered procedures and ancillary services, and wage indices."




In an era of deep political divisions, there are days where it seems impossible for our two major political parties in Washington, D.C., to agree on anything of substance. In reality, the two parties aren’t that far apart on multiple health-related issues that would directly benefit patients by bolstering our physician workforce and expanding access to care beyond the exam room. As a nonpartisan organization, the AMA works with all lawmakers and policymakers who want to advance legislation important to the health of our nation.

Medicare reform
Consider Medicare payment reform. A prime example of a bipartisan effort to help patients and physicians can be found in H.R. 2474, the Strengthening Medicare for Patients and Providers Act. This measure would link the annual Medicare physician payment schedule update to the Medicare Economic Index, an action the AMA has long advocated, and which also ties to the first pillar of the AMA Recovery Plan for America’s Physicians.

Interventional Techniques in IPM
Review Course & Cadaver Workshop
Neuromodulation Techniques Cadaver Workshop & Interventional Techniques in IPM Review Course
Regenerative Medicine
Review Course & Cadaver Workshop




An insurance industry lobbying campaign persuaded federal officials to allow insurers to charge physicians fees for the privilege of being paid electronically, even though it can cost more to mail paper checks, according to a new investigation by the nonprofit news organization ProPublica.

The Affordable Care Act requires that health plans give providers the option of being paid electronically to improve efficiency and save money. In 2017, the Centers for Medicare & Medicaid Services (CMS) issued guidance that prohibited insurers and their payment processing vendors from "engaging in unfair business practices that do not support an efficient healthcare system," according to a recent Medical Group Management Association (MGMA) position paper.



Studies show their potential, but reveal clear issues with treatment information reliability

Chatbots had mixed results when it came to providing direct-to-patient cancer-related advice and treatment strategies for a wide variety of cancers, according to two studies in JAMA Oncology.

When testing GPT-3.5 (OpenAI) with prompts designed to obtain treatment strategies for different kinds of cancers, they found that while most answers were in accordance with National Comprehensive Cancer Network (NCCN) guidelines, one-third were at least partially nonconcordant, reported Danielle Bitterman, MD, of Mass General Brigham and Harvard Medical School in Boston, and colleagues in a research letter.

Virtual
ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam; ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine


Memphis, TN
ABIPP Part II - Practical Portion; ABIPP Competency Exam - Practical Portion; ABIPP Regenerative Medicine Competency Exam - Practical Portion





Andrea Partida, DO, an obstetrician and gynecologist in Enid, Oklahoma, loves her new assistant.

The 15 or 20 minutes she used to spend on documentation for each patient visit is now 3. The 2 to 3 hours she'd spend charting outside clinic hours is maybe 1.

All that time saved allows her to see two to five more patients a day, provide better care to each patient, and get more involved in hospital leadership at Integris Health, where she works.




The blood-thinners Eliquis and Xarelto are among the 10 prescription medicines the Biden administration will seek lower Medicare prices for under a new program allowing the government to negotiate drug prices for America's seniors.

Why it matters: The administration's landmark announcement Tuesday detailed the first-ever set of drugs subject to Medicare price negotiations, a longtime Democratic priority included in last year's Inflation Reduction Act over drug companies' fervent objections.

Abstract submissions are open for
ASIPP's April 4-6, 2024 Annual Meeting!

The submission deadline is January 22, 2024.
Don't miss your chance to be part of an exceptional event,
sharing insights and discoveries that shape the future of pain management.

Funding health communication research can empower the public to make informed decisions

During his final weeks as the director of the NIH, Francis Collins, MD, PhD, proposed an important new project: studying health communication. After watching the profound communication failures during the pandemic, it was finally time for the NIH to invest in fixing this problem -- to study where communication breaks down between the medical community and the public, and how to make it better.

I was in my last year of medical school at the time. Between clinics and residency interviews, I volunteered my free time addressing science rumors online and teaching people to recognize logical fallacies that may trick them into believing false information.


Nurse union, occupational health experts, patients say weaker guidelines help only employers

Nurses, patients, and professional groups are pushing for more rigorous infection control standards from the CDC following a preview of proposed changes to its isolation precaution guidelines and an advisory group meeting this week during which a vote on the changes was postponed.

Opponents have said the changes, detailed in a presentation in June, are based on a flawed evidence review and omit key infection control tools. Some have called attention to a CDC approval process that they say is sometimes inscrutable to the public.

The agency last revised the guidelines, "Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings," in 2007, and now the group that advises the CDC on infection control practices -- the Healthcare Infection Control Practices Advisory Committee (HICPAC) -- is drafting proposed 2024 changes for CDC approval.
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It's no secret that many physicians question the value of Maintenance of Certification (MOC) requirements and are concerned about the amount of time, effort, and money the process takes. Now, they and at least two cardiology societies are starting to speak up.

MOC is an initiative from the American Board of Internal Medicine (ABIM) that requires an initial certification that costs thousands of dollars and must be repeated every 10 years. Annual MOC requirements involve tests that cost $220 for the first certificate a physician holds and about $120 for each subsequent one.

Interventional cardiologists (ICs) and other subspecialists have additional fees and requirements.



Every hospital can strengthen the quality of care delivered to these patients, says CDC director

The CDC issued new guidance to hospitals Thursday for managing sepsis and called on hospitals to do better at treating it.

"Every hospital, regardless of size, location, and resources can strengthen the quality of care delivered to these patients and ensure their survival," CDC Director Mandy Cohen, MD, MPH, said at a press conference. "That's why CDC developed the Hospital Sepsis Program Core Elements to put providers in the best position possible to deliver effective care for patients with sepsis."

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Medical education has changed drastically over the years. As theories and practices continue to change, what was once standard 10 or 20 years ago has been replaced with newer ideologies, processes, or technology. It seems likely, then, that you may disagree with some of the things that you learned as medical school has evolved.

Medscape Medical News asked physicians what they learned in med school that they now contest. Many of their answers include newer philosophies and practice methods.

Treat Appropriately for Pain
Jacqui O'Kane, DO, a 2013 med school graduate, was taught to avoid prescribing controlled medications whenever possible.


Black patients more likely to have an unrecognized need for therapy versus white patients

Overestimation of oxygen saturation by pulse oximetry led to delayed delivery of COVID-19 therapy, and an unrecognized need for therapy among Black patients, according to a retrospective cohort study.

Among over 24,000 patients with concurrent pulse oximeter saturation (SpO2) and arterial oxygen saturation (SaO2) measurements, those with an initially unrecognized need for COVID therapy were 10% less likely to receive therapy (adjusted HR 0.90, 95% CI 0.83-0.97), regardless of race (P=0.45 for interaction), reported Tianshi David Wu, MD, MHS, of Baylor College of Medicine in Houston, and co-authors.






People in England with signs or symptoms of colorectal cancer should be offered a home test with quantitative faecal immunochemical tests (FIT) from one of two named technologies, the National Institute for Health and Care Excellence (NICE) said. It estimated that the new guidance could mean almost 100,000 fewer colonoscopies would need to be carried out, permitting faster investigation for patients needing one the most.

FIT detect small amounts of blood in faeces, and evidence had shown that offering the test in primary care could identify people who were most likely to have colorectal cancer. 

Previous NICE guidance recommended that FIT was offered to some people presenting to primary care with symptoms suggestive of colorectal cancer, while others were immediately referred on the suspected cancer pathway.
Attention LSIPP Members
You are invited to a complimentary member dinner at GW Fins,
sponsored by Saluda Medical with EVOKE SmartLoop Technology!

September 21, 6:30 PM




Government and commercial insurance sectors were early adopters of the term “provider” in health care, with Medicare using it since 1965 to describe entities eligible to receive Medicare payment.

But physician leaders at Delaware-based Bayhealth have had enough, and they are putting a stop to using the term “provider” when referring to physicians.

“Some are unaware of it, but some physicians find it a very negative and derogatory term to address them,” said Thomas Vaughan, MD. “It is felt to have come from insurance companies and others who are trying to make medicine transactional, as opposed to a relationship between patients and physicians.”
Pain Medicine Case Reports (PMCR) and Editor-in-Chief Alaa Abd-Elsayed, MD, PhD would like to invite you to submit case reports and case series to the PMCR journal. Your article will be published free of charge.

Open access journals are freely available online for immediate worldwide open access to the full text of published articles. There is no subscription fee for open access journals. Open access journals are no different from traditional subscription-based journals: they undergo the same peer-review and quality control as any other scholarly journal.

Interested in becoming a member of the PMCR Editorial Board?
Editorial board members are asked to review 2-6 manuscripts per year. Please submit your most up-to-date CV to sgold@asipp.org for consideration.

For more information or to submit your articles, click here.
| CASE REPORT |


Danielle Levin, MD, Travis Schaeffer, DO, Martin Acquadro, MD, DMD, and Frederic Gerges, MD


Abstract
Background: Endometriosis is a debilitating disease that presents with chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Treatment methods include surgery, no treatment, or medical therapy, commonly including nonsteroidal anti-inflammatory drugs, oral contraceptives, androgenic agents, progestins, and gonadotropin-releasing hormone analogs. Unfortunately, many of these patients have pelvic pain refractory to conventional medical treatment. Intravenous (IV) lidocaine infusions have been studied extensively for neuropathic pain, but there is no report available in regards to whether it could be beneficial for those afflicted with chronic pelvic pain secondary to endometriosis.

Case Report: We would like to share the first report of a 37-year-old woman with chronic refractory abdominal pain from endometriosis continuously receiving greater than 3 weeks of pain relief from IV lidocaine infusions.

Conclusions: This case report demonstrates that IV lidocaine infusions may be an effective and safe treatment option for those suffering from chronic abdominal pain from endometriosis.

Key words: Lidocaine infusions, lidocaine, chronic pain, endometriosis, abdominal pain

| EXPERIMENTAL STUDY |


Caroline Purtill, BA, Manraj Dhesi, MD, Daniel Haber, MD, Nicholas D'Antonio, MD, Noreen J. Hickok, PhD, and Jeremy I. Simon, MD


Abstract
BACKGROUND: There is a global shortage of iohexol contrast media, commonly used in epidural injections, as a result of lockdown and decreased production due to COVID-19. Iohexol bottles are designated for single use, which, depending on the vials available, often leads to wasting up to 95% of this limited resource. However, avoiding multiple withdrawals may be unnecessary if withdrawing multiple times using sterile technique does not increase the risk for contamination.

OBJECTIVES: The purpose of our study is to determine whether multiple withdrawals from iohexol injection bottles using a sterile technique poses a greater risk of introducing contaminants than a single withdrawal. Furthermore, we wish to determine the extent to which bacteria can survive and grow in the contrast media.

STUDY DESIGN: Experimental.

SETTING: Outpatient fluoroscopic suite and laboratory.

METHODS: Twenty-one 100 mL 300 mg(iodine)/mL iohexol injection bottles, after one clinical use, were tested after the first and last withdrawals (withdrawal one and withdrawal 9 or 10) for bacterial and fungal specimens using culture media and 3M™ Petrifilms™. To determine the ability of methicillin-susceptible Staphylococcus aureus (MSSA) to survive or grow in the media, MSSA was added to different concentrations (0, 25, 50, 75, and 100%) of iohexol contrast media.

RESULTS: There was no growth observed in cultures or on Petrifilms among the first and last draws of any of the samples. When bacteria were grown in different dilutions of the media, there was a significant, approximately one log decrease in counts from 0% contrast media to 100% contrast media (8.4 x 108 vs 5.6 x 107, P < 0.01).

LIMITATIONS: Our study is limited in the number of samples tested and would benefit from additional investigation before consideration of clinical application.

CONCLUSIONS: Our results suggest that single-use 300 iohexol bottles may be reusable and that the contrast media is mildly antimicrobial, but not enough to retard contamination. In setting of shortages, contrast media bottles can safely be reused. This is valuable for conserving resources and limiting unnecessary health care-associated costs.

KEY WORDS: Contrast media, antimicrobial, infection, antibacterial

| RETROSPECTIVE REVIEW |


Liang Zhou, MD, and Zhenggang Guo, MD


Abstract
BACKGROUND: Intrathecal analgesia (ITA) is a valuable treatment option for refractory cancer-related pain. However, there is still no general consensus on the analgesic effect of movement-evoked breakthrough pain (MEBTP) in the ITA setting. 

OBJECTIVES: This study aimed to conduct a retrospective observational study to examine the effect of ITA via percutaneous port (ITAPP) with patient-controlled ITA (PCIA) on analgesic efficacy, emphasizing MEBTP in patients with refractory lower extremity cancer pain. 

STUDY DESIGN: A retrospective chart review included all patients with refractory lower extremity cancer pain who received ITAPP at our hospital between January 2017 and December 2020.

METHODS: Data on the Numeric Rating Scale scores of spontaneous resting pain intensity (SRPI) and MEBTP intensity (MEPI), opioid doses, and perceived time to onset were collected from medical records prior to ITAPP and at a one-month postimplant visit.

RESULTS: A total of 16 patients were included in the study group. Mean SRPI decreased from 8.75 pre-ITAPP to 3.75 post-ITAPP (P < 0.05); mean MEPI fell from 8.83 pre-ITAPP to 4.25 post-ITAPP (P < 0.05); mean daily morphine equivalent dosing decreased from 360 mg/d to 48 mg/d (P < 0.05); and mean daily morphine equivalent dosing for MEBTP decreased from 87 mg/d to 6 mg/d (P < 0.05). Both total and breakthrough dosing of conventional opioid medications significantly decreased following the initiation of ITAPP with PCIA. The mean perceived time to onset with conventional MEBT medications was 38 minutes, and the mean perceived time to onset with PCIA was 8 minutes (P < 0.05). 

LIMITATIONS: An effective analysis of IT opioid efficacy was not possible because the power of such a small sample size was low. Second, it is a retrospective study without long-term follow-ups.

CONCLUSIONS: In patients with refractory lower extremity cancer pain, ITAPP with PCIA was associated with improved pain control. Compared with conventional MEBTP regimens, appropriate ITAPP with PCIA provided superior analgesia and a much faster onset of action.

KEY WORDS: Movement-evoked breakthrough pain, patient-controlled intrathecal analgesia, lower extremity cancer pain, intrathecal analgesia via a percutaneous port



ASIPP is now in collaboration with Curi Medical Liability Program


Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
 
Curi is a full-service advisory firm that serves physicians and their practices. Their valued advice is grounded in your priorities and elevated in your outcomes. They are driven by a deep understanding of your specific circumstances in medicine, business, and life. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary risk management CME activities, visit our website.

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 independent physicians. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today.

ASIPP® is now offering our members the benefit of a unique revenue cycle management/ billing service.

We have received a tremendous amount of interest in the ASIPP® billing and coding program.

Click here to learn more about the negotiated rate for practices and more!
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