Once again, physician payment, as well as ASC and HOPD rules, are out. The most alarming is physician payment, followed by ASC and HOPD rules. The rules show reductions of 4.4% in the conversion factor even though the makeup was only 3% during last year. In addition to this, we must add, as we have been repeatedly saying, a total of 6% leading to 10.4%. With 9% inflation, we are looking for physician payment cuts of 20%.
Enclosed, please see sample rates compared to 2022. In addition to the 4.4% cuts, some codes have faced higher reductions with very few codes facing increases. The same applies to 10.4% cuts.
In reference to ASCs, as of now, they are not proposing any cuts; however, a 6% cut will remain in effect unless the 2% sequester cut from ACA and 4% statutory PAYGO from the American Rescue Plan Act are eliminated.
The fee schedule remains stable except for a few small increases. Some of the procedures that received major increases include sacroiliac joint arthrodesis and moderate increases for peripheral nerve stimulators.
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The value-based payment crusade is now two decades old. But despite the tens of billions of dollars — perhaps hundreds of billions — spent on these programs, they have done little to improve Americans’ health or lower health care costs. It is time for proponents of value-based care to call a halt to these programs until they have an answer to this question: “Why have the vast majority of value-based payment experiments failed to improve value?”
Advocates of value-based care are not about to do that. Although some of the leading lights of the movement are willing to admit they have little to show for all the money and time sunk into accountable care organizations and kindred value-based entities, none has been willing to call for an end to continued experimentation with schemes that have clearly failed.
The concept of value-based payment became widespread among U.S. health policymakers and analysts during the 2000s. It collectively refers to interventions that offer doctors and hospitals financial incentives that, in theory, induce them to improve both components of health-care value — cost and quality — without generating the hostility provoked by managed care insurance companies during the HMO backlash of the late 1990s.
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Worsening racial disparities are also projected
Millions more Americans are expected to develop cardiovascular disease (CVD) over the next few decades, according to projections.
Large increases in people with CVD are expected from 2025 to 2060 in line with changing demographics:
- Ischemic heart disease: 21.9 million to 28.7 million
- Heart failure: 9.7 million to 12.9 million
- Myocardial infarction: 12.3 million to 16.0 million
- Stroke: 10.8 million to 14.5 million
Moreover, by 2060, there will be 54.6 million Americans with diabetes, 162.5 million with hypertension, 125.7 million with dyslipidemia, and 125.7 million with obesity, reported James Januzzi, MD, of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues.
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Let's keep letting doctors virtually treat patients no matter where either of them is located
Sometimes when I'm doing a video visit, in my head I hear that line near the end of the movie "The Shawshank Redemption," when the brilliant actor Morgan Freeman's character Red says that for the second time in his life, he is going to commit a crime: in this case, breaking parole by crossing state lines.
Why, as we're trying to take care of our patients, should where we are at the moment, and where they are, really matter? Back in the good old days, before video visits and telehealth, when my patients went on vacation and they got sick, they would be able to call our practice, receive some medical advice, and then we would be able to send a prescription to the pharmacy located wherever they happened to be. Did they develop a urinary tract infection while on a ski trip in Utah? We can call in some antibiotics. While hiking near their house in Connecticut, they found an engorged tick embedded in the back of their leg? We can e-prescribe a prophylactic dose to nip this in the bud.
There have even been more complicated cases, where we've had patients go to local facilities for x-rays and labs, and we've participated in co-managing an acute or subacute problem along with specialists on the ground where they were. And much of this is still fair game. But longitudinal care, chronic care, preventive medicine, annual visits? No way.
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Upon introduction of the bill, Rep. Cheney released the following statement:
“This bill will allow Americans to utilize telehealth services even after the emergency declaration has ended. COVID-19 presented unprecedented challenges, including the facilitation of a safe environment for our seniors to receive high-quality health care. Fortunately, Congress was able to remove many of the barriers that prevented seniors from utilizing telehealth services from the comfort and safety of their homes. As a result, telehealth use among seniors has continued to rise and this legislation would continue this successful trend well after the pandemic is over by permanently cutting burdensome red tape while allowing Medicare to adapt to the ever-changing innovation in medical technology.” -Rep. Liz Cheney (WY-AL)
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NEXT EXAM DATES:
Part I
August 27, September 17,
October 22, November 19 & December 17
Part II
September 23
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Two reports paint troubling financial picture, especially for physician-owned practices
Rising inflation and operating expenses are strong headwinds against a slow post-pandemic recovery, signaling tough financial times ahead, particularly for physician-owned practices, according to two industry reports.
Only 60% of medical practices hit their revenue goals in 2021, according to one report, and while revenues rose in the first two quarters of 2022, rising inflation and staff costs chipped away at gains, according to the other.
"Costs have risen to a point where the margins of medical groups are imperiled in ways we haven't seen since the early lockdown months of 2020," Halee Fischer-Wright, MD, president and chief executive officer of the Medical Group Management Association (MGMA), said in a statement.
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Randomized trial shows that guided movement sessions can lessen pain
Graded sensorimotor retraining significantly reduced pain intensity in people with chronic low back pain, according to a single-center randomized trial.
On an 11-point numerical rating scale, the mean pain intensity decreased by 2.5 points from baseline to 18 weeks in the intervention group compared with a decline of 1.8 points in a group that received a sham procedure and attention control, reported James H. McAuley, PhD, of Neuroscience Research Australia in Sydney, and colleagues.
This translated into a between-group minimum clinically important difference of 1.0 point (95% CI -1.5 to -0.4, P=0.001), they noted in JAMA.
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Report characterizes PE involvement by specialty, region
When it comes to private equity investment in physician practices, variations exist across geographic regions and medical specialties, according to research announced by the National Institute for Health Care Management (NIHCM) Foundation this week.
Of the six specialties reviewed, the proportion of physicians working in private equity-acquired practices was highest in dermatology (7.5%) and gastroenterology (7.4%), and in the Northeast region (6.8%), reported Yashaswini Singh, MPA, of Bloomberg School of Public Health at Johns Hopkins University in Baltimore, and colleagues.
Other specialties that saw a higher percentage of physicians working in private equity-acquired practices included urology (6.5%), ophthalmology (5.1%), obstetrics and gynecology (4.7%), and orthopedics (1.9%), the team noted in JAMA Health Forum.
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Please plan to join us at the
2023 ASIPP Annual Meeting
March 16-18 National Harbor, Maryland
Register Early
More details will be posted on our website at asipp.org.
Registration begins November 2022.
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For meeting or exhibitor/sponsor information:
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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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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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| CASE REPORT |
David Bailey, BS, Cameron Brandon, BS, Lekhaj C. Daggubati, MD, and Elias B. Rizk, MD
Abstract
BACKGROUND: Postamputation neuromas are a significant cause of pain and suffering in amputees. In patients who are nonresponsive to medical therapy, open surgery is often required but has limited efficacy.
CASE REPORT: Here we present a case of the successful use of percutaneous peripheral nerve stimulation in a 77-year-old man with a postamputation neuroma that was refractory to medical therapy. He had significant pain reduction allowing a return to his daily activities.
CONCLUSION: This case report demonstrates that peripheral nerve stimulation may reduce pain in patients with postamputation neuroma. Percutaneous peripheral nerve stimulation is a promising treatment to reduce pain and improve patient function without irreversible manipulation.
KEY WORDS: Case report, neuromodulation, peripheral nerve stimulation, postamputation pain, stump neuroma
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| SYSTEMATIC REVIEW |
Faisal M. Hilal, MD, Ahmed Bashawyah, MD, Abdallah El-Sayed Allam, MD, King Hei Stanley Lam, MD, Ahmed Amine El Oumri, MD, Felica Galluccio, MD, Abdullah AlKharabsheh, MD, Alan D. Kaye, MD, PhD, Ammar Salti, MD, and Giustino Varrassi, MD, PhD
Abstract
BACKGROUND: Piriformis syndrome (PS) is a painful condition caused by entrapment of the sciatic nerve within the piriformis muscle. PS is typically unilateral and mainly occurs related to entrapment of the sciatic nerve. Treatments include physiotherapy, analgesics, anti-inflammatory drugs, behavioral modifications, injection therapy with local anesthetics (LAs) and steroids, epidural injection, botulinum toxin (BT) injection, and surgery.
OBJECTIVES: To investigate the efficacy of BT, LA, and corticosteroid (CS) injections in relieving pain in patients affected by PS.
STUDY DESIGN: This systematic review and meta-analysis was conducted according to the “Cochrane Handbook for Systematic Reviews of Interventions” and the “Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA)” guidelines.
METHODS: A systematic search was conducted through PubMed, Cochrane, Web of Science, and Scopus through April 2021 for studies investigating the efficacy of BT, LA, or CS injection in improving pain in patients with PS. After screening retrieved studies, data were extracted from included studies and pooled. Overall results were reported as standardized mean difference (SMD) and 95% confidence interval (CI). Analysis was performed using RevMan software version 5.4.
RESULTS: Sixteen studies were included in this systematic review, and 12 of them were included in the quantitative synthesis. The pain scores decreased significantly after treatment with BT (SMD = -2.00; 95% CI [-2.84, -1.16], P < 0.001), LA and CS (SMD = -4.34; 95% CI [-5.77, 2.90], P < 0.001), LA (SMD = -3.73; 95% CI [-6.47, -0.99], P = 0.008), CS (SMD = -2.78; 95% CI [-3.56, -2.00], P < 0.001), and placebo injection (SMD = -0.04; 95% CI [-0.07, -0.01], P = 0.002). BT injection was less effective than LA and CS together (P = 0.006), more effective than placebo (P = 0.001), and similar to LA (P = 0.24) and CS (P = 0.18), when injected alone.
LIMITATIONS: A wide variety of study designs were utilized to obtain the largest sample size available. Many of the included studies lack randomization, and some are retrospective in nature. These limitations may introduce bias into the analyzed data and affect the results. Many studies had a low sample size and are of moderate quality, limiting the generalizability of the results. Also, we could not conduct a direct meta-analysis due to the lack of sufficient double-arm studies comparing different types of injection therapies.
CONCLUSIONS: In patients with PS, satisfactory pain improvement can be obtained by BT, LA plus CS, LA, or CS injection therapy. Injection of LA plus CS showed the best efficacy.
KEY WORDS: Botulinum toxin, corticosteroids, local anesthetics, meta-analysis, piriformis syndrome, systematic review
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| SYSTEMATIC REVIEW |
Ge Luo, MD, Jiachun Tao, MD, Jianjun Zhu, MD, Keyue Xie, MD, and Chunjue Ni, MD
Abstract
BACKGROUND: Postoperative pain management in breast surgery and video-assisted thoracic surgeries (VATS) remains challenging. Oral or intravenous infusion of opioids were early treatments, but they can result in gastrointestinal reactions, respiratory inhibition, and other adverse reactions. In recent years, various regional block techniques have been employed for postoperative analgesia of these surgeries. However, a pair-wise meta-analysis cannot comprehensively rank and evaluate the analgesic effects and adverse events of various regional blocks.
OBJECTIVE: The purpose of this network meta-analysis (NMA) was to compare the analgesic effects and adverse events of different regional block techniques after breast surgery and VATS.
STUDY DESIGN: NMA of randomized controlled trials (RCTs) for comparing multiple regional block techniques in breast surgery and VATS.
METHODS: Pubmed, Embase, and Cochrane databases were searched systematically for RCTs comparing analgesic effects and adverse events after breast surgery and VATS. After critical appraisal, a random-effects NMA was mainly used to compare all the regional blocks’ analgesic effects and adverse events. The Population, Interventions, Comparators, Outcomes, and Study design (PICOS) framework was used to build the search strategies and present the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The primary endpoint was opioid consumption within 24 hours after the operation; secondary endpoints included dynamic and static pain scores and the incidence of nausea and vomiting. This study is registered in the Prospective Register of Systematic Reviews (PROSPERO) with a PROSPERO number of CRD42021283907.
RESULTS: A total of 21 clinical trials, including 1,284 patients and 6 different regional block techniques (paravertebral block pectoral nerve block serratus anterior plane block [SAPB], intercostal nerve block [ICNB], erector spinal plane block and thoracic epidural anesthesia), were included and analyzed. There was no significant difference between the consistent and the inconsistent models. Based on limited evidence, SAPB may be the most effective regional block technique for relieving postoperative pain, while ICNB had the lowest probability of nausea and vomiting. There was no significant difference in the pair-wise comparisons. In this study, we found no obvious publication bias.
LIMITATIONS: Limitations include: morphine milligram equivalents were not used to calculate opioid consumption; the scales used in the studies were different; the number of studies and total sample size included was limited; non-English literature and gray literature were not included; more databases were not searched.
CONCLUSIONS: After a comprehensive evaluation of postoperative analgesic effects and adverse events based on the NMA, we hypothesize that SAPB and ICNB have distinct advantages in postoperative analgesia and reduce the incidence of nausea and vomiting, respectively. However, conclusions drawn from more RCTs may be more convincing.
KEY WORDS: Network meta-analysis, nerve block, video-assisted thoracic surgery, breast cancer
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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 licensed 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.
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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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