A Letter from ASIPP
After being made aware that several physicians are being audited, we are concerned that some members are having difficulty conforming to the LCDs and medical policies. In response, ASIPP is providing you with an algorithmic approach and a checklist.
Regardless of the opinions you hold and the evidence that exists, it is crucial to follow the LCDs. Whatever is quoted in the LCD or medical policy is final and we must abide by those
Any changes you believe are warranted should be presented for consideration through a redetermination process for LCDs or medical policies for private insurers or Medicaid. They can be submitted during the next cycle of revisions.
You can use this algorithmic approach whenever you see your patients by utilizing these checklists for each patient prior to performing epidural steroid injections and facet joint interventions.
|
|
Percutaneous adhesiolysis has faced multiple issues related to coverage in the past few years. Initially, Noridian issued a noncoverage decision, followed by Palmetto issuing an experimental procedure decision.
Since then, we have incorporated into discussions on epidural LCD. While it was discussed in epidural LCD, it was not issued in the final consideration. We continued our efforts for coverage of this procedure and general consensus was that they all will be covering as any other Medicare services in the absence of a particular policy. We continue to face questions with Palmetto and Noridian.
After many years of advocacy, we have finally succeeded in getting coverage for this important procedure in all states, including all Palmetto and Noridian states in the United States.
We are very grateful to the Multijurisdictional Committee that convened considering epidural injections on 2/11/2021 for considering percutaneous adhesiolysis. We are also grateful to the Medical Directors of Palmetto and Noridian MACs for their prompt response.
It is crucial to perform these procedures based on appropriate indications and medical necessity. ASIPP epidural guidelines show the evidence basis, as well as indications and medical necessity, in addition to numerous other systematic reviews and randomized controlled trials.
|
|
NEXT EXAM DATES:
Part I
July 30, August 27, September 17, October 22, November 19 & December 17
Part II
September 23
|
|
In this study, we were examining the benefit of a brief digital pain education intervention that might help people recover from surgery with less pain. Most pain after surgery is treated with medications, and we want to deliver a whole-person pain care approach.
Our intervention is called "My Surgical Success" (MSS), and we compared MSS to a digital health education control group. We enrolled patients who were undergoing orthopedic trauma surgery at Stanford University. After orthopedic trauma surgery, patients often have quite a bit of pain that they can manage for months, and up to 10% of people have moderate to severe pain for 2 years later. So, having multimodal pain management approaches are really important.
We enrolled 84 patients undergoing orthopedic trauma surgery, randomized them either to MSS or our digital control intervention, and we followed them after surgery for 3 months to understand how our intervention might change pain intensity, as well as use of medication.
|
|
Proposal calls for a lead organizer and $8 billion annually in new funding
The U.S. needs a more coordinated public health system with a steady supply of funding to states and localities to help them shore up their public health departments, several experts said Tuesday.
"The COVID-19 crisis shone a very harsh spotlight on many of the longstanding gaps in public health and its ability to respond to both day-to-day concerns and to a crisis such as COVID-19," said Margaret "Peggy" Hamburg, MD, former commissioner of the FDA, at an online briefing hosted by the Bipartisan Policy Center. "It really reminded us that public health may not lack for effort and commitment, but it does lack for structure, resources, and coordination ... We really need to build a strong, robust, sustainable system of public health, a system led at the national level that will promote and protect health day in, day out, but also better prepare us to respond to emergencies."
Report Proposes a National Public Health System
Hamburg was chair of a nine-person commission sponsored by the Commonwealth Fund that released a 30-page report on Tuesday called "Meeting America's Public Health Challenge."
|
|
A guide for ensuring financial stability
We all know that physicians can make a good amount of money every month, but they're not exempt from financial blunders at some point in their lives.
It is essential for both young and experienced physicians to understand what possible mistakes they can make and how to avoid them.
Here are some of the most common financial mistakes that doctors make:
- Fulfilling delayed satisfaction all at once. When you first start getting your paychecks, this can lead to an enormous boost in standard of living. While this may seem like the ideal time to buy all the things you have been wanting for a long time, this is a common financial mistake.
|
|
"Tracking more than about five licenses becomes very cumbersome, time-consuming, and expensive," says Andrew Wilner, MD, internist, neurologist, and epilepsy specialist. "At one point, I had 10 licenses, and I've cut it back to about four to be more manageable. I wasn't using them and it didn't look like I ever would."
Wilner, who has worked in locum tenens for decades, says he kept these state licenses because he has a permanent job in Tennessee; he worked before in Arizona and might work locum tenens and/or retire there; he might retire in Florida; and he has worked in South Dakota before and might work locum tenens there.
Theresa Rohr-Kirchgraber, MD, professor of clinical medicine at AU/UGA Medical Partnership in Georgia, holds licenses in that state, Indiana, and North Carolina.
|
|
|
|
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 October 2022.
|
|
For meeting or exhibitor/sponsor information:
|
|
- ASIPP Members Only Site Information - |
|
-
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.
|
|
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 |
Richard Graf, MD, Ashley Katsarakes, BA, and Michael Fishman, MD
Abstract
BACKGROUND: Minimally invasive interspinous spacer insertion is commonly performed with the assistance of radiopaque instrumentation (e.g., ring forceps). Long-handled radiolucent forceps optimize image clarity, anatomy visualization, and reduce radiation dose when using automatic brightness control.
CASE REPORT: A 65-year-old woman with primary lumbar spinal stenosis with neurogenic claudication underwent interspinous spacer placement at L3-L4 and L4-L5 after failed conservative therapy. Radiolucent forceps from the Minimally Invasive Lumber Decompression (mild) (Vertos Medical, Aliso Viejo, CA) procedure kit were used for instrument stabilization.
CONCLUSION: Repurposing of the radiolucent forceps from the mild procedure kit is an optimized technique for the implantation of interspinous spacer devices. Future studies should be performed to see if this technique results in relevant reductions in radiation dose or operative time.
KEY WORDS: Case report, IDS, mild, radiolucent forceps, spinal stenosis
|
|
| NARRATIVE REVIEW |
Michael Suer, MD, Sayed Emal Wahezi, MD, Alaa Abd-Elsayed, MD, and Nalini Sehgal, MD
Abstract
Background: Cancer pain prevalence remains high with more than 60% of patients with advanced cancer experiencing cancer-related pain. The undertreatment of pain due to concerns of opioid dependence or diversion, as well as the potential effect of opioids on tumor neogenesis, add to the suffering among cancer populations.
Objectives: The aim of this narrative review was to assess evidence on the effectiveness, safety, cost-effectiveness, and advances of Intrathecal (IT) Drug Delivery Systems (IDDS) for the management of cancer pain.
Study Design: The present review was performed by searching for articles indexed in PubMed, MEDLINE, SciELO, Google Scholar, and Scopus.
Methods: Studies were included if they investigated patients with chronic cancer-related pain treated with IDDS and assessed experienced pain. We performed a narrative synthesis.
Results: IDDS have demonstrated efficacy in relieving cancer pain even in the challenging treatment of head and neck cancer pain. IDDS is also associated with a large reduction in serum opioid concentrations limiting adverse effects. When combined with other analgesics commonly used in the spinal space, but not systemically, pain relief may be dramatically improved. Advances in IT drug diffusion, including mixtures created with pharmaceutical compounding, improve the safety and accuracy of this therapy. IDDS is cost-effective and safe yet remains underutilized in this patient population.
Limitations: Despite numerous clinical studies, only a small number of randomized trials have been conducted to evaluate the effectiveness of IDDS for cancer pain.
Conclusions: This article presents an overview of the current state of evidence on the effectiveness, safety, cost-effectiveness, and advances of IDDS for the management of cancer pain. Despite current evidence, IDDS remains underutilized for people with cancer pain. Potential areas to facilitate its use are discussed. A shift in the paradigm of cancer pain treatment should be considered given the undertreatment rate, lack of benefits, and considerable risks associated with oral opioid medication in many patients who suffer from chronic cancer pain.
Keywords: intrathecal drug delivery systems; narrative review; opioids; undertreatment; Cancer pain.
|
|
| RANDOMIZED CONTROLLED TRIAL |
Xiao-Hua Wang, Si-Yuan Zhang, MD, Yi Huang, MD, Qian Wang, PhD, Luwen Zou, MD, Guoguang Zhao, PhD, and Tian-Long Wang, PhD
Abstract
Background: Percutaneous nephrolithotomy (PCNL) is the first-line and guideline-recommended treatment for large renal calculi. Multimodal analgesia (MMA) comprising a combination of different analgesics is an increasingly popular method for pain control as it has been shown to reduce postoperative pain and reduce opioid use and the risk of opioid misuse, with a shorter recovery time in various procedures and patient populations.
Objective: In this study, we tested the hypothesis that MMA with propofol and sevoflurane (PS) can decrease pain intensity during surgery and used IoC2 as a real-time index of the analgesic effect of sevoflurane.
Study Design: Prospective, single-center, double-blind, randomized controlled clinical trial.
Setting: Xuanwu Hospital of Capital Medical University.
Methods: Patients scheduled for elective percutaneous nephrolithotomy from January 2020 to July 2020 were randomized into 2 groups, standard multimodal analgesia (propofol + sevoflurane group) and control (propofol [P] group). The PS group received propofol 2.5 mg/kg/h along with 1% sevoflurane after induction for 30 minutes during the main anesthetic procedure, and the P group received propofol 5 mg/kg/h by intravenous infusion during the operation. Index of consciousness 2 (IoC2), namely nociception index, intraoperative hemodynamic fluctuation, bispectral index (BIS), electromyography, postanesthesia care unit (PACU) length of stay, visual analog scale (VAS) score, and Aldrete and Steward scores were recorded.
Results: A total of 153 patients undergoing PCNL were enrolled. The demographic and clinical characteristics were similar between the 2 groups. IoC2 was reduced in the PS group compared to the P group at T10, T11, T12, T13, T14, and T15 time points, indicating that analgesia was more effective in the former. The BIS of the PS group did not differ significantly from that of the P group except at T12, T13, T14, and T15. PACU length of stay was shorter in the PS group than in the P group (mean [SD]: 54.35 [16.61] vs 47.39 [13.15], P = 0.04). VAS pain scores did not differ significantly between the 2 groups.
Conclusion: MMA with propofol and sevoflurane provided better analgesia than propofol alone and may be an effective method to reduce stress and the intraoperative nociceptive stimulus response in patients undergoing PCNL, thereby promoting rapid postoperative recovery.
Keywords: analgesia; index of consciousness 2; nociception index; propofol; Sevoflurane.
|
|
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.
|
|
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.
|
|
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!
|
|
|
up-to-date news related to you, your practice, and your patients!
|
|
|
|
|
|
|
