President

  

In a stunning upset, Donald Trump was elected President of the United States yesterday. He is projected to win an estimated 306 electoral votes, with Secretary Hillary Clinton winning an estimated 232. (As of this morning, 41 electoral votes are unofficial, but it is not enough to affect the outcome.)

  

Ironically, Secretary Clinton appears to have won the popular vote, making her the second Presidential candidate in the last five elections and the fifth in United States history to win the popular vote but lose the election. Earlier this morning it was estimated that Secretary Clinton had received 59.1 million votes, with Mr. Trump receiving 59.0 million. These numbers are not final. It is also unclear whether the total popular vote will exceed the 2012 total of 129 million.

  

Mr. Trump had significant, unexpected wins in several Midwestern states. He won all of the states that Republicans carried in 2012, and also picked up the following states won by President Obama in 2012: Florida, Ohio, Pennsylvania, Iowa, Michigan, and Wisconsin. He also won the 2nd District in Maine, which allocates its electoral votes by Congressional district. These six states plus the Maine district added 100 votes to the Republican column compared to 2012.

 (NOTE: Arizona, Michigan, Minnesota, and New Hampshire are still unofficial.)

  

  

Senate

  

Despite all of the "battleground" Senate races and predictions of possible Democratic control of the chamber, there will be little overall change in the makeup of the Senate. We expect that the Senate ratio, which is currently 54-46 (including two "independents" that Caucus with the Democrats) will change by only two seats. The 52-48 ratio will leave Republicans in the majority.

  

As expected, Illinois Senator Mark Kirk (R-IL) lost to Congresswoman Tammy Duckworth (D-IL). In the closest Senate race of the year, Governor Maggie Hassan (D-NH) narrowly defeated incumbent Senator Kelly Ayotte (R-NH). In addition, Louisiana will have a runoff election on December 10th to replace retiring Senator David Vitter (R-LA). We expect that seat to remain in Republican hands.

  

Senate Republican leadership elections may occur next week. Senate Democrats are expected to hold their leadership elections on November 16th. The table below summarizes projected leadership positions.

  

  

House

  

We expect that House Republicans will retain 240 or 241 seats, down only six seats from the 2014 election. Many analysts had projected democrats to gain 10 to 20 seats. Nine races have not yet been made official, although Republicans are expected to win in six of these.

  

New Members will travel to D.C. next week for orientation, and House Republicans will tentatively hold their leadership elections on November 15th, although this is subject to change. It is also expected that House Republicans will finalize their Steering Committee next week, which will be responsible for selecting the new committee leadership. House Republican Committee Chairmen will tentatively be announced during the week of November 28th. House Democrats are not expected to finalize their Steering Committee until the week of the 28th.

  

The projected new leadership team will look very similar to the current Congress.

  

  

  

Lame Duck Agenda

  

Funding of Government Operations. There is one item that the Congress absolutely must address before the end of the year, and that is providing funding to avoid a government shutdown. Prior to the end of the fiscal year in September, Congress passed a Continuing Resolution extending existing funding levels for discretionary programs through December 9th. Congress will attempt to pass appropriations bills for full fiscal year 2017 funding prior to that date, either in a single "Omnibus" bill or as a series of smaller bills. Such bills are subject to overall spending caps. (If this is not possible, we expect Congress to pass an additional Continuing Resolution, extending either into early next year or through September 30, 2017 when the fiscal year ends.)   Congress also faces pressure to authorize additional spending above these caps for defense programs, storm damage caused by recent hurricanes and flooding in Florida, Louisiana, Texas, North Carolina, and West Virginia, and the water quality crisis in Flint, Michigan.

  

NDAA. Congress has successfully passed a National Defense Authorization Act for 54 straight years. In the remaining weeks of the session, Congress will attempt to reconcile differences in competing bill that have already passed the House (in May) and Senate (in June). Only a few issues remain outstanding for the leaders to resolve.

  

Other. Several other issues may be considered during the lame duck session of Congress if consensus can be reached. The potential list includes legislation dealing with biomedical innovation, Iran sanctions, modifications to recently passed legislation allowing individuals to sue foreign governments related to terrorism, extension of expiring provisions of the tax code, water projects, energy policy, and mental health. Prior to the election the Obama Administration had been gearing up to pass the Trans-Pacific Partnership agreement. That seems highly unlikely in light of the election results, as does any attempt to confirm Judge Merrick Garland to serve on the Supreme Court.

CMS Publishes Final Rule for Hospital Outpatient Department and ASC Final Payment Rates

 

As you see below, the news is not good for interventional pain management. Overall both ASCs and hospital outpatient departments are facing significant cuts as high as 11.5% for most commonly performed interventional techniques compared to the proposed rule and 2017 payment rates.

 

Click HERE to see Pysician Payment 2017 Final

 

Click HERE to see Physician Payment 2017 Proposed

 

Most importantly it is disheartening to see that they plan to reimburse same amount for surgery centers or HOPDs for epidural injections with or without imaging guidance. There is a significant difference between hospital rates. Hospitals are reimbursed more than 85% higher than ASCs. Please click here to see analysis of interventional pain management for ASCs. Please click here for HOPD. To see the entire group please click here.

We cordially invite you to be a part of ASIPP's newest journal: Interventional Pain Management Reports

 

The American Society of Interventional Pain Physicians is proud to announce a new journal that will be an important addition to the body of interventional pain management literature: Interventional Pain Management Reports. This is your chance to be one of the first to publish in this journal dedicated to the clinical practice of IPM.

  

Led by Editor in Chief Kenneth Candido, MD, Chairman and Professor, Department of Anesthesiology, Advocate Illinois Masonic Medical Center in Chicago, IPM Reports will focus on the promotion of excellence in the practice of interventional pain management and clinical research.

 

Interventional Pain Management Reports is an official publication of the American Society of Interventional Pain Physicians (ASIPP) and is a sister publication of Pain Physician. Interventional Pain Management Reports is an open access journal, available online with free full manuscripts.

 

So submit today your:

 

Click HERE to read the Instructions for Authors for article submission

 

Click HERE  to submit a manuscript

  

Innovation in healthcare is a funny thing.  On the one hand you have a world where scarcely a day goes by where a new innovation isn't announced, whether it's the use of big data and machine learning to examine medical scans and imaging, or the rise of telemedicine or even the increasing use of robotics, whether in surgical or care home scenarios.  

On the other, you have an industry that still struggles with Baumol's cost disease and has not benefitted from technology to the extent that other industries have.  Indeed, the volume of innovation presents it's own challenges, as integrating them into the standard ways of working can be challenging, especially in an environment where time is such a precious commodity.

The Children's Hospital of Philadelphia (CHOP) are one facility that seem to have cracked the nut though.  They have a long and prestigious history of groundbreaking innovations, including recent breakthroughs in lymphatic imaging, cancer immunotherapy and inflammatory bowel disease.

  

  

Forbes

  

The FDA placed the Phase IIb study of fasinumab (Regeneron/Teva) on clinical hold and requested an amendment of the study protocol after observing a case of adjudicated arthropathy in a patient receiving high-dose fasinumab who had advanced osteoarthritis at study entry. 

Fasinumab is designed to block nerve growth factor (NGF), a protein involved in transmission of pain signals, and has the potential to be an alternative to opioids.

As a result of the FDA decision, Regeneron completed an unplanned interim review of results of the lower back pain study and has stopped dosing because the analysis showed clear evidence of efficacy with improvement in pain scores in all fasinumab groups compared with placebo at the 8- and 12-week time points (nominal P<0.01). 

  

Pain Medicine News

October Podcast Now Available!

 

On the October podcast we'll learn what medical scribes are and what they do; in the news segment we'll have stories about which NSAIDs have the greatest cardiac risk, acetaminophen's effect on fetal neurodevelopment, a new prophylactic treatment for migraine, and much more; and we'll wrap things up with a study about whether women find beards attractive.

 

Cick HERE to listen.

   

Start Planning NOW!
ASIPP® Abstracts Submission for 2017 Annual Meeting OPEN

  

Registration will be open for Abstract Submissions is now available.

  

The American Society of Interventional Pain Physicians will hold its 19th Annual Meeting April 20-22 in Las Vegas at Caesar's Palace.

  

This year, we will be making significant changes to the Abstract and Poster Sessions. Submissions will be in two categories: Resident/Fellow and Physician.  Selected posters will be on display forall meeting participants during all breaks and meal times.

  

The Abstract Committee will select the top 25 for publication in Pain Physician and of those 10 will be selected for Abstract presentation and judging during the Annual Meeting. The top 3 will receive cash prizes.

Submit and review this year's rules.

  

HealthDay News -- For patients with chronic migraine, peripheral nerve stimulation of the occipital nerves reduces the number of headache days, according to a study published online October 25 in Pain Practice. 1

Nagy A. Mekhail, MD, PhD, from the Cleveland Clinic, and colleagues implanted 20 patients at a single center with a neurostimulation system, and randomized them to an active or control group for 12 weeks. Patients received open-label treatment for an additional 40 weeks.

The researchers observed a reduction in the number of headache days per month (8.51 days; P <.0001). Sixty and 35 percent of patients achieved a 30 and 50% reduction, respectively, in headache days and/or pain intensity. All patients had reductions in Migraine Disability Assessment and Zung Pain and Distress scores. At least 1 adverse event was reported by 15 of the patients, with a total of 20 adverse events reported.

  

Clinical Pain Advisor

  

For patients with peripheral neuropathic pain (PNP), the adjusted cost per patient is lower for treatment with pregabalin than gabapentin, according to a study published online September 27 in the Journal of Evaluation in Clinical Practice. 1

Antoni Sicras-Mainar, MD, from the Papaciet Primary Care Centre in Barcelona, Spain, and colleagues conducted a retrospective observational study with electronic medical records for patients enrolled at primary care centers who initiated PNP treatment with pregabalin or gabapentin. Data were reviewed for 1163 electronic medical records (764 for pregabalin and 399 for gabapentin).

The researchers found that the duration of treatment was slightly shorter for pregabalin than gabapentin (5.2 vs 5.5 months; P=.124), with mean doses of 227.4 mg and 900 mg, respectively. Per patient, the average study drug cost was higher for pregabalin than gabapentin (€214.6 vs €157.4: P<.001), although there was a lower cost of concomitant analgesic medication (€176.5 versus €306.7; P <.001). 

  

  

Clinical Pain Advisor

No one wants to toil away at a health care improvement effort only to see that progress disappear as systems and processes revert to the old way of doing things. Leading health care organizations recognize that improving care isn't enough; having a systematic approach to sustaining improvement is equally important.

To learn how to build systems that sustain improvement, the Institute for Healthcare Improvement studied health care organizations that were able to achieve standout results and then build on them - organizations such as Intermountain Healthcare in Salt Lake City; Saskatoon Health Region in Saskatchewan, Canada; and Virginia Mason Health System in Seattle. These high-performing health systems offered a key insight: To sustain change, you need a strong strategy for engaging and standardizing the work of frontline managers. From their efforts, we derived four steps on how to get started with introducing new standard work processes for point-of-care staff.

  

Harvard Business Review