Most of the final rates remained close to the proposed rates. The physician payment rate changed from a 4.4% cut to 4.5% cut. Consequently, we have identified additional reductions. Here are the sample pages for fee schedules:
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Great news! Representatives Larry Bucshon (R-Ind.) and Ami Bera (D-Calif.), are introducing a bill that would prevent a 4.4 percent Medicare physician fee payment cut from taking effect on January 1, 2023, through the introduction of the Medicare Access and CHIP Reauthorization Act of 2015 and associated payment mechanism.
This is the bill we have been requesting from members of the Congress to introduce for some time for the last few months. ASIPP has supported this and ASIPP members have sent over 5,000 letters to Members of the Congress to date.
Representatives Bucshon and Bera are supported in this endeavor by six additional representatives, Kim Schrier M.D. (WA-08), Michael Burgess, M.D. (TX-26), Earl Blumenauer (OR-03), Brad Wenstrup, D.P.M. (OH-02), Bradley Schneider (IL-10), and Mariannette Miller-Meeks, M.D. (IA-02). Together they sent a Request for Information: Medicare Payment System Reform letter to members of Congress. Click here to view the RFI Letter.
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Overprescribing a continuing problem, Benjamin Davies tells urologists
While urology and other medical specialties have taken steps to rein in opioid overprescribing, the skyrocketing death rate in the U.S. due to opioid overdose indicates urologists -- and other healthcare providers -- are not being aggressive enough in implementing safe prescribing practices, according to Benjamin Davies, MD, of the University of Pittsburgh School of Medicine.
"It is almost shocking to say that in 2022, 100,o00 people have died over the past year from opioid use," said Davies during a session at the Society of Urologic Oncology annual meeting. "We are on a slope we have never seen before, and it doesn't seem to be stopping."
Davies, who is also chief of urology at the University of Pittsburgh Medical Center Shadyside/Hillman Cancer Center and director of the Urologic Oncology Program, noted that opioid prescribing patterns in the U.S., as well as in Canada, have clearly contributed to the problem. He pointed to a recent study comparing international postoperative opioid prescribing patterns showing that 91% of U.S. patients were prescribed opioids postoperatively compared with just 5% of non-U.S. patients.
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Resident/Fellow News and Updates |
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When Kazi Kalam, a second-year student at Georgetown University School of Medicine, says that his childhood best friend didn't make it past high school, he doesn't mean that he did not not pursue college. His friend was murdered before having the opportunity.
"I grew up in Bedford-Stuyvesant in Brooklyn in the early '90s," says Kalam. "I worried more about my safety than I worried about school grades." Kalam moved with his parents from Bangladesh to the US when he was 4. His father was a bricklayer, and the family struggled to get by.
Kalam was the first in his family to graduate from college. He quickly took a job as a respiratory therapist to help with finances. Once his younger brother completed college, Kalam felt he could focus on what he really wanted to do, which was to practice medicine. But getting there would prove to be challenging.
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While COVID still distinguishes itself from other illnesses, those days may be numbered
Before the pandemic, people often didn't think twice about going about their daily lives and heading into public spaces with a runny nose, sore throat, or even a bit of a cough.
Now, years into living with COVID-19 and with a herd of other respiratory viruses hitting hard, people may be questioning whether they should still subject themselves to quarantine or isolation if they contract COVID. Most people wouldn't do as much with an unidentified case of the sniffles, but is COVID still a different story?
Public health expert Leana Wen, MD, an emergency physician and professor at George Washington University in Washington, D.C., explained to MedPage Today that people should follow the CDC's guidelines for isolation when testing positive for COVID. Generally speaking, that means at least 5 days of isolation followed by 5 days of mask wearing.
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THE LAST PART I EXAM THIS YEAR IS
Saturday, December 17
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MIPS doesn't consistently correlate with process, outcome measure performance in primary care
Physicians' rankings by the Medicare Merit-based Incentive Payment System (MIPS) only occasionally correlated with process and outcome measure performance, a large primary care study showed.
Physicians whose MIPS scores fell in the range to qualify for "exceptional bonus" payments actually had significantly worse mean performance on three of five process measures compared with those whose MIPS scores qualified for penalties, according to the study of a 20% sample of primary care physicians in the U.S. participating in the program.
In terms of risk-adjusted acute patient outcomes, the high-scoring physicians had fewer patients require emergency department visits but more all-cause hospitalizations compared with the low scorers, while there was no difference on four other admissions measures sensitive to ambulatory care.
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Submit your abstracts by December 31, 2022
Questions should be directed to Savannah Gold at
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Sharp increase driven by deaths involving fentanyl and other synthetics
Drug overdose deaths in pregnancy or the postpartum period increased sharply in the U.S. in recent years, with the rise most pronounced at the start of the COVID-19 pandemic in 2020, researchers reported.
From 2017 to 2020, overdose deaths in this population rose from 6.56 to 11.85 per 100,000 individuals, representing an 81% increase, according to Emilie Bruzelius, MPH, and Silvia S. Martins, MD, PhD, both of Columbia University Mailman School of Public Health in New York City, who reported their findings in JAMA.
By comparison, overdose deaths among non-pregnant females of reproductive age increased from 14.37 to 19.76 per 100,000, a relative increase of 38%.
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ASIPP is pleased to announce that the
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Week-over-week admissions doubled, 40 times higher versus last year at this time
Influenza hospitalizations this early in the season are higher than they have been in a decade, according to the CDC, with 14 pediatric deaths reported so far.
"Since October 1, there have already been at least 8.7 million illnesses, 78,000 hospitalizations, and 4,500 deaths from flu," said CDC Director Rochelle Walensky, MD, MPH, on a call with reporters on Monday, held in part to kick off National Influenza Vaccination Week.
Flu hospitalizations nearly doubled the week of Thanksgiving (19,593) compared with the prior week (11,378) and are close to 40 times higher than the same week last year (495).
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- ASIPP Members Only Site Information - |
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To log in for the first time you will need to click “forgot password” at the bottom of the login window.
- Check your email and then log in as directed.
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If you have problems logging into your account, click here.
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Cleveland Clinic's billing plan has sparked much-needed conversation about physician compensation
The Cleveland Clinic recently announced they will begin charging patients a fee for online correspondence with physicians through their online portal. Such fees are perhaps a necessary response to the ever-growing volume of portal messages, through which patients seek advice outside of the traditional structure of a billable visit.
As a busy clinical cardiologist, my hope is that such a move will initiate long overdue conversation about how physicians are paid for their time. The traditional outpatient fee-for-service structure, centered primarily on office visits, is an anachronism better suited to the days when physicians managed one-off, acute illnesses. In the modern era, physicians deal primarily with chronic illnesses and must make frequent changes to the treatment plan.
As a result, my portal inbox is always full of messages in which patients tell me about their evolving symptoms or self-measured vital signs, looking for answers. Many of you likely have had a similar experience. What is the correct response? To spend a few minutes reading the patient's note, perhaps exchanging another one or two messages, and then proposing a solution? Or to make the patient carve an hour out of their day to come to my office so we can have an in-person discussion?
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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.
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New Edition Now Available! |
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| CASE REPORT |
Sarfaraz Ahmad, MD, Ajeet Kumar, MD, Kunal Singh, MD, and Shagufla Naaz, MD
Abstract
BACKGROUND: Epidural steroid injection is challenging in patients with diabetes due to its associated complications including metabolic endocrine changes and osteoporosis. Dexmedetomidine is a highly selective alpha-2 agonist that has analgesic effects without affecting respiratory depression; its analgesic effect is achieved by on and above the spinal cord level.
CASE REPORT: Under fluoroscopy-guided transforaminal injection of dexmedetomidine 50 µg with 0.2% ropivacaine, 2 mL were administered in 10 patients with diabetes mellitus. After the procedure, the Numeric Rating Scale score, Oswestry Disability Index, motor power, and sensory examination were assessed at one-week, one-month, and 3-month intervals.
CONCLUSIONS: The use of dexmedetomidine for transforaminal injection in treating lumbosacral radicular pain appears to show encouraging results: it is feasible, safe, and associated with minimal adverse effects.
KEY WORDS: Dexmedetomidine, lumbosacral radicular pain, neuropathic pain, neuroprotective
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| RANDOMIZED CONTROLLED TRIAL |
Yu Si Chen, MD, Botao Liu, MD, Fang Gu, MD, and Lei Sima, MD
Abstract
BACKGROUND: Lumbar facet joint (LFJ) pain is the most common cause of low back pain in the elderly. Denervation of the medial branch of the spinal dorsal ramus can theoretically achieve long-term pain relief. Yet there is little evidence of high-level prospective randomized controlled research.
OBJECTIVES: To observe the effect of radiofrequency (RF) denervation of the medial branch of the spinal dorsal ramus on LFJ pain in the elderly.
STUDY DESIGN: A prospective randomized controlled study.
SETTING: The study was performed in the National Pain Management and Research Center of China-Japan Friendship Hospital.
METHODS: A total of 270 patients over 60 years old with LFJ pain were randomly divided into an RF group (n = 135) and a control group (n = 135). They received radiofrequency denervation intervention and a conventional conservative approach, respectively. The follow-up was 6 months. The main outcome was the NRS pain score (0-10 points) and the proportion of patients with a pain reduction of more than 2 points (minimum difference of clinically significant difference). The secondary outcome was the Oswestry Disability Index (ODI), the proportion of patients whose ODI decreased by more than 15 points, and the Macnab standard efficacy evaluation. The factors that influenced the excellent and good Macnab rates were analyzed by univariate and multivariable regression analysis.
RESULTS: There were more women than men who suffered from LFJ (171/99) pain based in these 270 patients. The numeric rating scale (NRS) pain score changes in the RF group were significantly different from those in the control group at the 1st, 3rd, and 6th months (-2.3 vs -1.2, -2.0 vs -1.2, -2.0 vs -1.1, P < 0.001), and the proportion of patients whose NRS decreased by ? 2 was higher than that in the control group at the 3rd and 6th months (61.1% vs 26.0%, 52.9% vs 22.5%, P < 0.001). The ODI score changes in the RF group were significantly different from that in the control group at the 1st, 3rd, and 6th months (-15.2 vs -10.1, -14.6 vs -8.6, -13.6 vs -7.7, P < 0.001), and the proportion of ODI reduction ? 15 was also higher than that in the control group at the 3rd and 6th months (45.8% vs 34.1%, 36.4% vs 27.0%, P < 0.05). The excellent rate and efficiency of the Macnab evaluation in the RF group at the 6th month was significantly higher compared to the control group (60.3% vs 36.0%, 81.0% vs 54.1%, P < 0.001). The independent factor affecting the excellent and good rate is failed back surgery syndrome.
LIMITATION: The limitation of this study is that it was only performed in one unit of the National Pain Management and Research Center. It needs to be further carried on in multiple centers in the future.
CONCLUSIONS: Radiofrequency denervation can effectively reduce LFJ pain and improve movement disorder. The effect is good until 6 months later.
KEY WORDS: Elderly, radiofrequency denervation, lumbar facet joint, medial branch
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| RANDOMIZED CONTROLLED TRIAL |
Naglaa Fathy Abdelhaleem, MD, Sherien E. Abdelatiff, MD, and Sara M. Abdel Naby, MD
Abstract
BACKGROUND: Appropriate postoperative pain management in shoulder surgeries is the mainstay of rehabilitation therapy and subsequent improved functional outcomes. However, adequate pain control either with opioids or interscalene brachial plexus block is often challenged by their side effects. In this context, this study compared the suprascapular nerve block (SSNB) to the newly emerging erector spinae plane block at the second thoracic vertebral level (high thoracic-ESPB) as an alternative pain therapy.
OBJECTIVES: This study aimed to compare the efficacy of high thoracic-ESPB with SSNB as analgesic options for arthroscopic shoulder surgery.
STUDY DESIGN: Prospective randomized, double-blinded, controlled, clinical trial.
SETTING: This clinical trial was performed at Zagazig University.
METHODS: This prospective, randomized controlled clinical trial was registered at ClinicalTrials.gov (NCT04669639, December 15, 2020). Patient enrollment was initiated after the registration date (December 20, 2020), and the study was conducted from December 2020 to November 2021. Ninety-six adult patients who prepared for arthroscopic surgeries were assigned to the high thoracic-ESPB group, SSNB group, and control group; all with 32 patients each.
RESULTS: A significant difference was found between the control group and block groups concerning the Numeric Rating Scale (NRS-11) at recovery, 2, 4, 6, 8, and 12 hours postoperatively at rest and with shoulder movement. However, the NRS-11 was significantly higher in the SSNB group than in the high thoracic-ESPB group only with movement both at recovery and 2 hours postoperatively. Otherwise, no significant difference between the 2 block groups was found throughout different time points of the study. The doses of fentanyl given intraoperatively were significantly higher in the control group than in the high thoracic-ESPB and SSNB groups (mean ± standard deviation [SD], 326.6 ± 45.8, 224.7 ± 17.1, and 232.8 ± 17.8; P value < 0.001, respectively). A significant difference also was observed concerning postoperative morphine use, where the mean ± SD was 18.8 ± 2.9 in the control group vs 5.7 ± 1.02 and 6 ± 0.81 (P value < 0.001) in the high thoracic-ESPB and SSNB groups, respectively.
LIMITATIONS: A continuous local anesthetic (LA) infusion catheter can be used either in the high thoracic-ESPB or SSNB to provide extended periods of analgesia. However, our investigation was confined to a single LA injection.
CONCLUSIONS: SSNB is not inferior to high thoracic-ESPB in the context of phrenic nerve sparing pain control for arthroscopic surgeries. Moreover, SSNB is a more established technique with more predicted sensory distributions and a lower risk of LA toxicity.
KEY WORDS: Arthroscopic shoulder surgery, erector spinae plane block, suprascapular nerve block
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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.
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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.
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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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up-to-date news related to you, your practice, and your patients!
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