On MedPAC's agenda: Audio-only modifiers and relative payment rates
Should payments for telehealth services continue at the current level once the public health emergency (PHE) ends? A Medicare advisory committee took on that question during a meeting on the future of pandemic-related telehealth expansions.
Potential policy ideas discussed by the Medicare Payment Advisory Commission (MedPAC) on Monday included using an audio-only modifier to help identify where such services are most prevalent, and relative payment rates for in-person visits, audiovisual, or audio-only service.
After the PHE was declared, Congress allowed the Centers for Medicare & Medicaid Services (CMS) to enact a number of changes expanding telehealth services to ensure patient access while limiting potential exposure to the SARS-CoV-2 virus. But many of those policies will expire when the PHE ends.
|
|
Critics concerned over his pharma ties
The White House tapped cardiologist Robert Califf, MD, to once again head the FDA.
In a statement formally announcing his decision, President Biden praised Califf's clinical research expertise and leadership skills, and said he is the right person to lead the agency and the country out of the COVID-19 pandemic.
"As the FDA considers many consequential decisions around vaccine approvals and more, it is mission-critical that we have a steady, independent hand to guide the FDA," he said.
|
|
Multiple MACs Have Released the Final Epidural Policy
This will be effective December 5, 2021. Please check your individual MACs.
While this is a nationwide policy, we are seeing some discrepancies with the various policies. Some have a limit of four (4) epidurals per region and others are stating a limit of four (4) for all regions. We will clarify this soon, but it appears to be four (4) per region.
However, it also says that after the first treatment, a patient must have 3 months of ≥ 50% relief. If that is not achieved, a second procedure may be performed after 14 days using a different approach after appropriate documentation, which is very difficult.
Diagnostic codes do not include disc displacement and disc degeneration. All in all, the policy is extremely difficult to live with, not only for diagnostic coding, but for limitation of procedures limited to 4 per year for all regions combined.
Other issues also include in reference to documentation of at least 2 fluoroscopic views, pre and post pain levels each time.
There are some changes as per the request of ASIPP and other societies in reference to the definition of inclusion criteria:
- This now includes radicular pain, severe degenerative disc disease, and post laminectomy syndrome.
- An objective pain scale or functional assessment must be performed at baseline and repeated at each follow-up for assessment of response.
- Pain duration of at least four (4) weeks, and the inability to tolerate noninvasive conservative care or medical documentation of failure to respond to four (4) weeks of noninvasive conservative care.
- Only one spinal region may be treated per session.
|
|
The NYU Grossman School of Medicine is surveying pain medicine fellowship graduates' perception of their training and level of preparedness for entering the practice of pain medicine. The survey committee is comprised of Christopher Gharibo, MD; Krupali Chokshi, MD; Gopal Desai, MD; and Lisa Doan, MD. Their goal is to publish information on which areas fellowship graduates feel most prepared and where needs are unmet that can provide constructive feedback to fellowship programs and ACGME. IRB approval has been obtained for the survey and all responses will be completely anonymous.
|
|
A review of recent court cases involving kickbacks, false claims, physician self-referral, and under- and over-prescription of opioids, with advice on protecting your practice and patients.
The practice of pain management is often fraught with lawsuits. From illegitimate opioid prescribing to patient abandonment to fraudulent billing practices, pain practitioners have been – and continue to be – versed in all the ways their malpractice insurance may come in handy. However, as intimidating as these lawsuits can be to well-meaning healthcare providers, they can also serve as instructive warnings, helping practitioners to design safe and law-abiding practices that prioritize the needs of their patients. The following provides a look at the clinical takeaways from a few recent cases.
Feds Take Aim at Illegal Kickbacks and Inappropriate Billing
In four cases (listed below) brought by the Department of Justice, providers of pain management are being reminded of their obligations under the most important federal fraud and abuse laws that apply to physicians: the False Claims Act, Anti-Kickback Statute, and the Physician Self-Referral Law commonly known as the Stark Law.1 Respectively, these laws prohibit the submission of claims for payment to Medicare or Medicaid that one knows or should know are false or fraudulent, prohibit payment of "remuneration" to induce or reward patient referrals or the generation of business involving any item or service payable by the federal healthcare programs, and prohibit physicians from referring patients receiving health services payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship.
|
|
Basics
Q: When does this take effect?
A: The emergency regulation was effective as of November 5, 2021.
Q: Why is this rule being issued as an Interim Final Rule without going through notice and comment rulemaking?
A: Ensuring safety and protection from COVID-19 for anyone seeking care is the utmost priority. Given the rapidly evolving public health emergency, the increasing presence of the COVID-19 Delta variant, and the current instability within the health care system, CMS finds good cause to issue an emergency regulation as an Interim Final Rule allowing the agency to take immediate action to protect the health and safety of residents, clients, patients, and staff. Stakeholders will still have an opportunity to comment on the regulation.
Q: Will my feedback be considered?
A: Yes, stakeholders have 60 days to submit formal comment on the emergency regulation. It is important to note that since this is an emergency regulation, the requirements will go into effect immediately and before any additional response is provided on the comments by CMS. The comment period officially closes on January 4, 2022. At that point, CMS will consider and respond to comments as a part of potential future rulemaking, if needed.
Q: Is this a facility-specific or individual-level requirement?
A: The staff vaccination requirements apply to Medicare and Medicaid-certified provider and supplier types (collectively, “facilities”) that are regulated under the Medicare health and safety standards known as Conditions of Participation (CoPs), Conditions for Coverage (CfCs), or Requirements. Facilities are required to have a process or policy in place ensuring that all applicable staff are vaccinated against COVID-19.
Q: What is a Condition of Participation?
A: Conditions of Participation (CoPs), Conditions for Coverage (CfCs), and Requirements for Participation are foundational health and safety standards established by CMS to protect individuals receiving health care services from Medicare and Medicaid-certified facilities. These foundational health and safety standards cover 21 health care provider and supplier types. In order to participate in the Medicare and Medicaid programs, health care providers and suppliers must abide by these regulations.
|
|
-
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.
-
If you have problems logging into your account, click here.
|
|
"Role of social media in amplifying" disinformation docs also needs to be examined, says delegate
Members of the American Medical Association (AMA) House of Delegates adopted a new policy aimed at addressing disinformation during the association's interim meeting on Monday.
Kavita Arora, MD, a delegate for the AMA's Young Physicans Section, who had proposed the policy, said during a discussion online on Saturday that while the AMA had an existing policy focused on the dissemination of accurate medical information to the public, the association lacked a policy to address disinformation -- i.e., "information that is willfully inaccurate," she said.
The new resolutions called for the AMA to: first, take aim at disinformation in all types of media; and second, focus inward and tackle disinformation promoted by members of the medical community.
|
|
'Concerning' Opioid Prescribing in Patients With Cirrhosis
PCPs more than twice as likely as gastroenterologists to prescribe opioids
Nearly one in five patients with cirrhosis were prescribed opioids during outpatient visits, more often than not by a primary care physician (PCP), according to a national analysis of over 10 million ambulatory visits.
From 2006 to 2016, 17% of all outpatient visits for patients with cirrhosis resulted in an opioid prescription, usually, a refill, reported Anna Lee, MD, of the University of California Los Angeles, during a presentation at the virtual American Association for the Study of Liver Diseases (AASLD) meeting.
Among the 1.7 million visits involving an opioid prescription, 68% were with PCPs while 29% were with a gastroenterologist (GI). Of these, 41% involved patients without a documented pain diagnosis, a "concerning" finding that requires further study, said Lee.
|
|
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 |
Theodore C. Hannah, BA, Theodor Di Pauli von Treuheim, BS,
and Brain Jacob, MD
Abstract
Background: Although anterior cutaneous nerve entrapment syndrome (ACNES) classically presents with nerve entrapment along the lateral edge of the rectus abdominis, fascial tears can result in ACNES presenting in other locations within the muscle.
Case Report: Over 4 years, a 26-year-old woman had undergone numerous tests to find and treat the cause of her debilitating abdominal pain. She presented to our clinic, in January 2021, with a history of nausea, vomiting, and shooting epigastric pain. Diagnostic anterior and posterior abdominal wall exploration was performed and a percutaneous nerve was entrapped in a fascial tear of the medial rectus abdominis muscle.
Conclusions: This case report highlights that: ACNES can present at locations other than the lateral border of the rectus abdominis; ACNES is a common and curable cause of serious chronic abdominal pain; and knowledge of this pathology has yet to permeate into most of the medical community leading to detrimental outcomes for patients.
Key words: ACNES, abdominal pain, anterior neurectomy, chronic pain, Carnett’s test
|
|
| META-ANALYSIS |
Zhenxin Hu, MD, Jun Han, MD, Binbin Jiao, MD, Jian Jiang, MD,
Yuefeng Sun, MD, Zhengshuai Lv, MD, Jianhe Wang, MD, Xilaing Tian, MD, and Hong Wang, MD
Abstract
Background: Thoracolumbar interfascial plane (TLIP) block as a novel plane block technique was proposed in 2015 and can be performed in patients undergoing lumbar spine surgery. However, no meta-analysis demonstrates the effects of TLIP block on postoperative pain undergoing lumbar spine surgery.
Objectives: The purpose of this study is to evaluate the postoperative analgesic efficacy of TLIP block with patient-controlled analgesia (PCA) undergoing lumbar spine surgery compared to be given PCA alone after lumbar spine surgery.
Study design: This meta-analysis pooled all data published in randomized controlled trials (RCTs) examining the efficacy of TLIP following lumbar spine surgery.
Methods: We conducted a comprehensive search of PubMed, Web of Science, Embase databases, the Cochrane Library, and Google Scholar for randomized controlled trials (RCTs) up to December 2020. According to the inclusion and exclusion criteria established in advance, "TLIP" and "lumbar spine surgery" related MeSH terms and free-text words were used. All of the data on visual analog scales (VAS) scores, PCA compression frequency, PCA consumption, and nausea rates were reported. All analyses were performed with RevMan 5.4 software.
Results: A total of 9 RCTs with 618 patients meet the inclusion criteria. The results demonstrated that VAS scores for pain during movement and while at rest were markedly lower in the TLIP group than those in the control group in all the postoperative periods (1-2 h, 12 h, 18 h, and 24 h) (P < 0.05). VAS scores at rest 1-2 h postoperatively (MD: -2.16; 95% CI: [-3.86, -0.46]); 12 h (MD: -1.22; 95% CI: [-2.33, -0.11]); 18 h (MD: -1.40; 95% CI: [-1.55, -1.24]); 24 h (MD: -1.38; 95% CI: [-1.94, -0.81]); VAS scores at movement 1-2 postoperatively (MD: -2.26; 95% CI: [-4.28, -0.23]); 12 h (MD: -2.11; 95% CI: [-3.13, -1.10]); 18 h (MD: -1.63; 95% CI: [-1.77, -1.48]); 24 h (MD: -1.47; 95% CI: [-1.98, -0.95]). Meanwhile, PCA compression frequency, PCA consumption, and nausea rates were significantly lower in the TLIP group after lumbar spine surgery (P < 0.05): PCA compressions frequency (MD: -4.08; 95% CI: [-5.28, -2.88]); PCA consumption (MD: -14.30; 95% CI: [-20.68, -7.92]); nausea rates (RR: 0.47; 95% CI: [0.32, 0.68]).
Limitations: Despite 9 RCTs, the sample size was still small, so more high-quality RCTs with large samples will be urgently required for stronger evidence to support TLIP block in lumbar spine surgery.
Conclusions: The TLIP block is an effective strategy to improve postoperative pain at rest/movement and to reduce PCA consumption in patients undergoing lumbar spine surgery, which exerts significant analgesia. In the future, it is worth being applied in lumbar spine surgery extensively.
Keywords: VAS scores; lumbar spine surgery; meta-analysis; patient-controlled analgesia; postoperative analgesia; Thoracolumbar interfascial plane block.
|
|
| RETROSPECTIVE STUDY |
Sung Hyun Lee, MD, PhD, Sung-Ha Hwang, MD, Young-Kwan Moon, MD, Hyun Min Bae, MD, and Dong Eon Moon, MD, PhD
Abstract
Background: Lumbar spinal stenosis (LSS), a common spinal disorder that negatively affects quality of life, is a disabling condition accompanied by back pain, leg pain, and claudication. Lumbar foraminal stenosis (LFS) is often accompanied by lumbar central stenosis (LCS) and conservative treatment is often ineffective. A surgical approach, including a minimally invasive technique, is usually recommended for the conservative treatment of refractory conditions. To achieve effective decompression of LSS, a specially designed new instrument for lumbar transforaminal foraminoplasty (TFFP) can be considered before opting for surgical treatment.
Objective: To evaluate the clinical outcomes and safety of TFFP with a specially designed instrument.
Study design: Retrospective design.
Setting: This research was conducted in a hospital outpatient surgical center.
Methods: The medical records of 112 patients who underwent TFFP from December 1, 2018 to January 1, 2020, were reviewed. Outcome measures were obtained using the numeric rating scale for pain (NRS pain), Oswestry Disability Index (ODI), and walking distance without pain for functional ability at preprocedure and 1, 3, and 6 months postprocedure. The clinical data and radiologic findings were analyzed to evaluate correlations between predictive factors and efficacy of TFFP.
Results: Among 112 patients who underwent TFFP, 110 were accessed and analyzed. The percentage of successful responders was 59.1%, 73.6%, and 74.5 % of 110 patients at one, 3, and 6 months, respectively. The NRS pain score, ODI, and duration of walking without radicular pain were improved significantly at the one-, 3-, and 6-month follow-up periods (all P < 0.001). No serious adverse events occurred during this study.
Limitations: The limitations of this study include the possibility of bias due to nonrandomized patient selection.
Conclusion: TFFP using the Foramoon® device (Mcarekorea, Seongnam-si, Gyeonggi-do, Republic of Korea) appeared to be effective for managing patients with LFS and LCS, who were refractory to conservative care.
Keywords: ligament flavum; lumbar central stenosis; lumbar foraminal stenosis; neural compression; radicular pain; transforaminal foraminoplasty; transverse ligament; Lumbar spinal stenosis.
|
|
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.
Norcal Mutual is 'A' Rated by AM best and is license in all 50 states. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary award-winning risk management CME activities, click here.
|
|
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!
|
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.
|
|
up-to-date news related to you, your practice, and your patients!
|
|
|
|
|
|
|
