The Medicare Payment and Advisory Commission called for a "major overhaul" of Medicare Advantage policies in its annual report to Congress.
MedPAC, which advises the U.S. government on Medicare issues, published its annual report on March 15. The commission estimated that in 2024 the government will spend $83 billion more on Medicare Advantage beneficiaries than if they were enrolled in fee-for-service Medicare.
According to MedPAC's estimates, higher spending in Medicare Advantage will increase Medicare premiums by $13 billion in 2024, and coding intensity in the program will be 20% higher in Medicare Advantage than in fee-for-service in 2024.
"A major overhaul of MA policies is urgently needed for several reasons," the commission wrote in its report. MedPAC cited several problems that need to be addressed, including the disparity in costs between beneficiaries in fee-for-service Medicare and MA, a lack of information on the use and value of supplemental benefits, and challenges setting benchmark payment rates.
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Join the AMA or Renew your Membership Today!
As of now, ASIPP has two positions available in the House of Delegates and all of the other memberships where they are available, even for the other societies within AMA. The American Medical Association (AMA) requires all societies to requalify for membership in the AMA House of Delegates (HOD) every five years. To keep and hopefully increase ASIPP's membership in these committees, we have to keep at a minimum 20% AMA membership, otherwise, ASIPP will lose the AMA membership with all the available advantages.
We encourage you to join or renew your membership in the AMA. Joining the AMA will further strengthen our specialty’s representation at the national level through the AMA House of Delegates, the AMA’s policymaking body, and strengthen our ability to meet the challenges in health care today with thoughtful, well-organized responses.
As a member of the AMA, you become part of the organization that unites physicians nationwide to tackle the major issues we all face: 47 million uninsured Americans, looming Medicare payment cuts, and the need for medical liability reform. Membership also gives you access to a broad range of practice management resources and award-winning publications such as the Journal of the American Medical Association, AMNews, AMA Morning Rounds, and the Archives journals.
Please take this opportunity to support the critical activities of ASIPP by joining the AMA today. To join or renew the AMA, we encourage you to visit www.ama-assn.org or call (800) 262-3211.
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U.S. Congress Finally Reduced the Cut by Half 1.68% from 3.37% Effective March 9, 2024
In a federal budget deal struck to avoid a government shutdown, the House of Representatives has voted to reduce about half (1.68%) of the 2024 3.37% across-the-board physician pay cut that took effect in January. The Senate is expected to vote soon, and the President is expected to sign which will be effective March 9.
This essentially means Congress has again failed to stop in its entirety a pay cut that threatens Medicare patients’ access to high-quality physician care.
The cut continues to persist over 2% of sequester cuts totaling 3.68%, on top of 4% from last year’s physician pay reduction. Unfortunately, in contrast to prior years, this payment rate is not retroactive.
This was achieved due to enormous effort by all organizations, including ASIPP, with widespread support to block the 3.37% Medicare cuts for physician services permanently.
Our conversations with members of Congress show that they are looking at ways to create a permanent fix for these issues. We need to continue to place pressure on Congress for a permanent fix. The graph below shows 2024 Medicare payment updates before the 50% reduction of the cut as projected by AMA. The only change would be 1.68%, instead of 3.4%.
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This aspect of CDC's guidance is not to be glossed over
On March 1, the CDC announced it was slashing the isolation time for COVID-19 for the general public, from 5 days to 24 hours if people are fever-free without taking fever-reducing medication and symptoms are improving. Just a week before, National Nurses United (NNU) had sent a letter to CDC Director Mandy Cohen, MD, MPH, to express the union's concerns about "weakening isolation guidance" for COVID-19. Once the official news of the weakened guidance broke, NNU condemned this decision for putting public health at greater risk of acute sickness as well as long COVID.
However, these new guidelines don't apply everywhere: the CDC's COVID-specific guidance is still in place for healthcare settings. Healthcare workers with mild to moderate illness who are not moderately to severely immunocompromised should isolate until at least 10 days have passed and at least 24 hours since last fever and symptoms are improving -- however, healthcare workers who test negative by day 7 can return if fever has resolved and their symptoms are improving. The isolation period is potentially longer for those with severe to critical illness.
But it may be only a matter of time before these guidelines change too. In November 2023, the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) voted unanimously to propose updates to CDC's infection control guidance for healthcare settings that would lump COVID-19 in with other respiratory viruses like influenza. In doing so, HICPAC was setting the stage to weaken protections for healthcare workers caring for patients with COVID-19 from an N95 respirator to a surgical mask. But a surgical mask does not sufficiently protect the wearer from inhaling infectious virus, and we all know that COVID-19 spreads through the air.
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Virtual
April 27, May 25, June 29, & July 27
Click here for the complete list of upcoming exams.
ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam;
ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine;
CSM Competency Exam; DCCPM Competency Exam
In Person
October 18, 2024
ABIPP Part II - Practical Examination
Lab Venue: MERI, 44 S. Cleveland Street, Memphis, TN 38104
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Headache episodes during long space travel more common than previously thought
Space flight appeared to provoke headaches in healthy astronauts, a prospective study showed.
Of 24 astronauts who participated in long-haul space flights -- ones that lasted at least 10 days -- 91.7% experienced one or more headaches during a total of 3,596 space days, reported Willebrordus P. J. van Oosterhout, MD, PhD, of Leiden University Medical Center in the Netherlands, and co-authors.
Most episodes (89.9%) were tension-type headaches and 10.1% were migraine, the researchers reported in Neurology. Episodes in the first week of space travel were more likely to have a migraine phenotype, while those in later periods were more likely to be tension-type (P=0.0002).
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In most Western countries, professional standards dictate that physicians should practice medicine with compassion. Patients also expect compassionate care from physicians because it represents a model capable of providing greater patient satisfaction, fostering better doctor-patient relationships, and enabling better psychological states among patients.
The etymology of the term "compassion" derives from the Latin roots "com," meaning "together with," and "pati," meaning "to endure or suffer." When discussing compassion, it is necessary to distinguish it from empathy, a term generally used to refer to cognitive or emotional processes in which the perspective of the other (in this case, the patient) is taken. Compassion implies or requires empathy and includes the desire to help or alleviate the suffering of others. Compassion in the medical context is likely a specific instance of a more complex adaptive system that has evolved, not only among humans, to motivate recognition and assistance when others suffer.
Compassion Fatigue
Physicians' compassion is expected by patients and the profession. It is fundamental for effective clinical practice. Although compassion is central to medical practice, most research related to the topic has focused on "compassion fatigue," which is understood as a specific type of professional burnout, as if physicians had a limited reserve of compassion that dwindles or becomes exhausted with use or overuse. This is one aspect of a much more complex problem, in which compassion represents the endpoint of a dynamic process that encompasses the influences of the physician, the patient, the clinic, and the institution.
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Excellent opportunities for Residents & Fellows
at ASIPP's 2024 Annual Meeting:
- Abstract Session (April 4, 3:30–5:30pm) and Podium Presentation for Best Abstracts during General Session (April 5, 3:30–4:15pm)
- Half-Day Session dedicated to Young Physicians in Interventional Pain Management
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Agency's 2016 guidance may have contributed to reduced access to opioids, and more pain
A downward trend in opioid prescribing practices for patients with sickle cell disease (SCD) followed the CDC's 2016 opioid guidelines for chronic pain, an analysis of claims data showed, but so did a steady increase in pain-related hospitalizations.
Compared with expected pre-guideline trends, the opioid dispensing rate, days of opioids supplied per prescription, and morphine-equivalent dosage all significantly declined from March 2016 to December 2019 among SCD patients (P<0.001 for all), reported researchers led by Hyeun Ah Kang, PhD, of the University of Texas at Austin.
Meanwhile, an upward trend in hospitalizations for vaso-occlusive crises (VOCs) accompanied those changes in prescribing, according to findings detailed in JAMA Internal Medicine. In December 2019, about one in five SCD patients (19.6%) in the study had a VOC-related hospitalization, a full 7 percentage points higher compared with expected trends based on a scenario where the 2016 guidelines were never released (12.5%).
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Alternative pathways to licensing for IMGs spreads beyond Tennessee
Nearly a year ago, Tennessee became the first state in the U.S. to scrap residency requirements for certain international medical graduates (IMGs), opening up an alternative pathway to permanent licensure.
Since then, more states have enacted or are close to enacting similar legislation, and others have shortened residency requirements for some IMGs.
A MedPage Today analysis found a total of 15 states have passed or are considering legislation around establishing alternative pathways to licensure for IMGs.
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ASIPP State Society Meetings | |
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The government has come out on top so far, but pharma vows to fight on, expert says
Over the past year, drugmakers and lobbyists have filed 10 different lawsuits against the federal government's efforts to lower prescription drug costs via the Medicare Drug Price Negotiation Program.
It's still early days for these cases, but so far the government has won "every substantive motion," Zachary Baron, JD, of the O'Neill Institute for National and Global Health Law at Georgetown University Law Center in Washington, D.C., told MedPage Today.
Baron said the industry would like to see their fight continue in the appellate court and ultimately reach the Supreme Court.
Congress passed the Inflation Reduction Act (IRA) in 2022, granting Medicare the authority to negotiate the price of some of the most costly single-sourced, brand-name drugs. In August 2023, CMS announced the first 10 drugs to be negotiated, including blood thinners and treatments for diabetes, arthritis, heart disease, and leukemia. In February, CMS sent initial offers to drug manufacturers. As of March 4, the manufacturers have submitted counteroffers.
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"This model doesn't work" without it, says emergency center CEO
If freestanding emergency centers (FECs) are to survive and help underserved rural communities, they should be allowed to receive Medicare and Medicaid reimbursement, which they cannot currently do, an FEC executive told members of the House Ways and Means Health Subcommittee Monday.
"The model doesn't work unless we can get Medicare and Medicaid," Robert Morris, CEO of Complete Care, a company that runs 15 FECs in Texas and Colorado, said during a subcommittee field hearing held at Global Medical Response, a ground and air transportation service provider in Denton, Texas. "But there's a lot of us in this space that would love to go out to those underserved areas."
Millions in Uncompensated Care
FECs are one type of rural emergency care provider that has sprung up in the wake of many rural hospital closures. They are state-licensed facilities that offer the same level of care as hospital-based emergency departments, with doctors, nurses, and radiology technologists always on site, Morris, who is also president of the National Association of Freestanding Emergency Centers, said in his written testimony.
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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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Eric Xu, DO, Sean Thomas, MD, and Behnum Habibi, MD
Abstract
BACKGROUND: Polyradiculopathy caused by intrathecal methotrexate (IT MTX) is a rare and serious complication of chemotherapy. The pathophysiology involved is likely due to a drug-induced folate deficiency and subsequent local immune reaction in the spinal cord.
CASE REPORT: The authors present a 68-year-old woman with stage I breast cancer and stage III diffuse large B-cell lymphoma who developed low back pain after IT MTX treatment. Further workup revealed diffuse rope-like thickening of the cauda equina nerve roots with subtle linear low-level leptomeningeal enhancement on magnetic resonance imaging and severe primary axonal and motor polyneuropathy affecting the upper and lower extremities on electromyography/nerve conduction studies, likely a result of IT MTX toxicity. Treatment should emphasize conservative measures. Alternatively, intravenous immunoglobulin followed by intravenous methylprednisolone can be considered.
CONCLUSIONS: Polyradiculopathy caused by IT MTX is a rare finding that can be treated. It would be beneficial to further study the effects of IT MTX and create treatment protocols for its adverse effects.
KEY WORDS: Intrathecal methotrexate, polyradiculopathy, cauda equina, cancer, case report
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RANDOMIZED CONTROLLED TRIAL | |
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Gokhan Yildiz, MD, Gevher Rabia Genc Perdecioglu, MD, Omer Taylan Akkaya, MD, Ezgi Can, MD, and Damla Yuruk, MD
Abstract
BACKGROUND: Although there are studies evaluating ultrasound-guided selective nerve root pulsed radiofrequency (ULSD-SNRPRF) and fluoroscopy-guided paramedian cervical interlaminar epidural steroid injection (FL-CIESI) for the treatment of chronic cervical radicular pain, no study has compared the efficacy of these 2 methods.
OBJECTIVES: This study aimed to compare the efficacy of these 2 methods, their superiority to each other, and the incidence of adverse events.
STUDY DESIGN: A prospective, randomized controlled trial
SETTING: Outpatient department of a single-center pain clinic.
METHODS: Sixty patients who did not respond to conservative treatments for lower cervical radicular pain were randomly divided into 2 groups. One group underwent ULSD-SNRPRF (Group U), and the other underwent paramedian FL-CIESI (Group F). Patients were evaluated pretreatment, and 3 and 6 months posttreatment. The Numeric Rating Scale (NRS-11) was used to assess clinical improvement, The Neck Disability Index (NDI) to assess improvement in functional disability, and the Self-Leeds Assessment of Neuropathic Symptoms and Signs Pain Score (S-LANSS) to assess the treatment’s effect on neuropathic pain. Clinically significant pain relief was defined as a 50% or more pain reduction in the NRS-11. The posttreatment reduction in medication consumption was assessed using the Medication Quantification Scale Version III (MQS III). We also evaluated whether there was a difference in treatment-related characteristics, such as procedure time and adverse events.
RESULTS: The procedure time was significantly longer in Group U. Blood aspiration was observed in 2 patients in Group U and vascular spread in one patient in Group F, with no significant difference. At 3 and 6 months posttreatment, NRS-11 and NDI scores showed a significant decrease compared to the pretreatment scores in both groups; there was no difference between the groups. Both treatments effectively improved neuropathic pain, with no significant difference between the S-LANSS scores. There was no difference in the reduction of medication consumption between the groups.
LIMITATIONS: There was no sham or control group, and the follow-up period was limited to 6 months.
CONCLUSIONS: Pain relief, functional improvement, and safety were similar between groups. ULSD-SNRPRF and paramedian FL-CIESI are 2 different effective techniques for chronic cervical radicular pain. The choice of method should depend on various factors, such as patient preference, operator experience, and availability of resources. An advantage of ULSD over fluoroscopy is that patients and physicians are not exposed to radiation.
KEY WORDS: Pulsed radiofrequency treatment, epidural injections, steroids, radiculopathy, neck pain, fluoroscopy, ligamentum flavum, ultrasonography
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Taher Saed Thabet, MD, and Suzan Adlan Khedr, MD
Abstract
BACKGROUND: Post-mastectomy pain syndrome (PMPS) is a persistent post-surgical neuropathic pain. Stellate ganglion (SG) block is used for diagnosis, prognosis, and treatment of pain syndrome.
OBJECTIVES: We aimed to evaluate the efficacy of SG destruction with alcohol versus thermal ablation for PMPS management.
STUDY DESIGN: Randomized, double-blind clinical trial.
SETTING: National Cancer Institute, Cairo University, Egypt.
METHODS: Female patients aged 20-65 years who underwent breast cancer surgery and suffered moderate to severe pain for more than 6 months were categorized equally into 2 groups. SG destruction was with ultrasound (US) guidance and C7 level confirmation by fluoroscopy either by alcohol injection in Group A or thermal ablation with a time of 60 seconds at 80ºC repeated twice in Group B. Follow-up was at 1, 4, 8, and 12 weeks.
RESULTS: Visual analog scale (VAS) measurements after 1, 4, 8, and 12 weeks were significantly lower than pre-procedure measurements in both groups (P value < 0.001). There was a significant reduction in VAS score after 4 and 8 weeks in Group A than in Group B (P value = 0.003 and 0.018). Oxycodone and pregabalin consumption after 4 and 8 weeks were significantly lower in Group A than in Group B. Physical health, mental health, and satisfaction scores were comparable. There were no significant complications in both groups.
LIMITATIONS: The relatively small sample size and short follow-up period are limitations to our study.
CONCLUSION: US-guided SG destruction with alcohol was more effective than thermal radiofrequency for managing acute postoperative pain by decreasing pain score, oxycodone, and pregabalin consumption, which were consumed before the block.
KEY WORDS: Alcohol, mastectomy, neuropathic pain, stellate ganglion, thermal, pain, radiofrequency, PMP.
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ASIPP is now in collaboration with Curi Medical Liability Program
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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.
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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Group Purchasing Organization Offer Better Pricing and Creates Added Value
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, Fedora Billing,
and Revenue Cycle Management Partnership
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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Like and follow ASIPP® on Facebook, X, and LinkedIn for the most
up-to-date news related to you, your practice, and your patients!
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