ASIPP Submits Comments on the 2024 Physician Fee Schedule

ASIPP emphasized multiple factors and issues:

1. Telehealth Services
2. Conversion Factor
3. Determination of Practice Expense (PE) Relative Value Units (RVUs)
4. Treatment of Opioid Use Disorder (OUD)
5. Electronic Prescribing of Controlled Substances (EPCS)
6. CY 2024 Medicare Physician Payment Schedule Updates to the Quality Payment Program (QPP)

For detailed comments, please click here to see ASIPP’s letter.

ASIPP and SIPMS Submit Comments

on the ASC Payment Rule

ASIPP and SIPMS emphasized the following:

1. Average Rate of Data

2. Intensive Procedure Policy for ASCs

• Interspinous Prosthesis

3.  Inadequate Payment for Certain Nerve Block Procedures

• Trigeminal Nerve Block (CPT 64400)
• Greater Occipital Nerve Block (CPT Code 64405)
• Suprascapular Nerve Block (CPT 64418)
• Ilioinguinal/Iliohypogastric Nerve Block (CPT 64425)
• Femoral Nerve Block (CPT 64447)

For the complete letter, please click here.

DHS Homeland Security Investigations Announces Strategy to Combat Illicit Opioids

HSI Strategy Advances President Biden’s Unity Agenda Strategy to Beat the Overdose Epidemic

The Department of Homeland Security’s (DHS) Homeland Security Investigations (HSI) today released the Strategy for Combating Illicit Opioids, an intelligence-driven approach to disrupting and dismantling transnational criminal organizations (TCOs) and keeping dangerous substances, like illicit fentanyl driving the overdose epidemic, off America’s streets. To advance President Biden’s Unity Agenda Strategy to beat the overdose epidemic, DHS is working with partners at every level of government to stop the illicit flow of fentanyl into the country, including through various surge campaigns launched this year. The strategy announced today leverages HSI’s extensive expertise in investigating cross-border criminal activity and its unique access to customs and financial data to prevent illicit shipments of drug precursor chemicals from reaching U.S. borders, in line with President Biden’s National Drug Control Strategy. Interrupting the precursor supply chain further prevents the synthesis of drugs like fentanyl and methamphetamines. 

“For more than five years now, fentanyl has been causing so much loss of life and destruction in our communities,” said Secretary of Homeland Security Alejandro N. Mayorkas. “We in the Department of Homeland Security, along with our federal, state, and local partners, are committed to combatting this scourge and protecting American communities from it. The new HSI Strategy for Combating Illicit Opioids that we are announcing today will help further align our intelligence and field operations to keep fentanyl off the streets and bring ruthless cartels and criminal organizations to justice.”

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HOTEL

Artificial Intelligence May Influence Whether You Can Get Pain Medication

Electronic health records that deliver suboptimal user experience are more likely to lead to alert fatigue and less likely to catch errors that could impact hospital safety, University of Utah Health research shows.

"Hospitals and health systems have spent more than $100 billion on EHRs over the last decade, and most believe that these systems are completely safe and usable but that is not necessarily the case," said Dr. David Classen, a professor of internal medicine at University of Utah Health.

The Larger Trend

Because of this inherent risk in poorly designed electronic health records, all hospitals should "annually perform a safety check on their system to assure it is safe," said Classen, whose EHR research is published in the most recent issue of JAMA Network Open.

Classen worked on the research project with renowned patient safety innovation leader Dr. David Bates, from Brigham and Women's Hospital, as well as scientists at University of California San Diego Health. Researchers at UC San Francisco and KLAS Enterprises also contributed.

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Cancer death rate drops by 33%, AACR report shows

Results from the American Association for Cancer Research’s annual Cancer Progress Report revealed that the age-adjusted overall cancer death rate in the U.S. fell by 33% between 1991 and 2020.

The report also detailed FDA approvals related to anticancer therapeutics over the past year, the impact of immunotherapy on cancer care in the 21st century and key challenges needed to overcome obstacles patients with cancer still face moving forward.

“The advances in cancer research — particularly in the last 2 decades — have been breathtaking,” Philip D. Greenberg, MD, FAACR, president of AACR, said in a press release. “We are in an era of unparalleled opportunity to make even more breakthroughs for patients. For the cancer research community to achieve these breakthroughs, however, our representatives in Congress must continue to prioritize funding for biomedical research — from basic research to clinical trials.”

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Virtual

September 30 & October 28

ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam; ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine

National Study to Document Changes in Physician Practice Expense

The American Medical Association (AMA) is undertaking a new national study, supported by 173 health care organizations, to collect representative data on physician practice expenses. The aim of the Physician Practice Information Survey is to better understand the costs faced by today’s physician practices to support physician payment advocacy. The study will serve as an opportunity to communicate accurate financial information to policymakers, including members of Congress and the Centers for Medicare & Medicaid Services (CMS). The AMA has contracted with Mathematica, an independent research company with extensive experience in survey methods as well as health care delivery and finance reform, to conduct the study.

The Medicare physician payment schedule, maintained by CMS and used by many other payers, relies on 2006 cost information to develop practice expense relative values, the Medicare Economic Index and resulting physician payments. As the U.S. economy and health care system have undergone substantial changes since that time, including inflation and the wide-spread adoption of electronic health records and other information technology systems, practice expense payments no longer accurately reflect the relative resources that are typically required to provide physician services.

The study will rely on financial experts in the practice to complete an online financial information survey. The number of direct patient care hours is a critical component of the Medicare payment methodology. Therefore, thousands of individual physicians will receive a short patient care hours survey from either their practice directly or from Mathematica. The input from physician practices and individual physicians that are randomly selected to participate in this study is critical for its success. Participation will ensure that practice expenses and patient care hours are accurately reflected.

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5 things young physicians should know about mentor relationships

Mentors are vital to making a successful transition from residency to practice, and their role in shaping a doctor’s future and present goes beyond that.

Brandi Ring, MD, is associate medical director for obstetrics and gynecology at The Center for Children and Women in Houston, a practice owned by the Texas Children’s Health Plan that offers a wide range of outpatient medical and dental care. Throughout her career, she has played the role of both mentor and mentee. She offered a few insights on the value of mentor relationships for young physicians.

Seek them out

A good mentor may be harder to find than they were during training where mentor relationships are largely built into the curriculum.

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Weight Loss Supplement Found to Contain Toxic Substance, CDC Says

A toddler landed in the emergency department after consuming the product

After a New Jersey toddler experienced a serious heart complication found to be due to consumption of a weight loss supplement purchased by the child's mother, testing revealed that the product, which was supposed to contain tejocote root, actually contained the potentially highly toxic yellow oleander, CDC researchers reported.

In September 2022, an emergency physician contacted the New Jersey Poison Information and Education System (NJPIES) about a 23-month-old child who had consumed Eva Nutrition Mexican Tejocote Root, marketed as a weight loss supplement, and developed nausea and vomiting, reported Noah Berland, MD, of the NJPIES and Rutgers New Jersey Medical School in Newark, and colleagues.

The child experienced age-specific bradycardia (heart rate of 90 bpm versus a normal range of 98-135 bpm) and was hypotensive (blood pressure 71/60 mm Hg), they noted in the Morbidity and Mortality Weekly Report.

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Abstract submissions are open for

ASIPP's 2024 Annual Meeting!

The submission deadline is January 22, 2024.

Don't miss your chance to be part of an exceptional event,

sharing insights and discoveries that shape the future of pain management.

| Submission Guidelines | Submit Abstract |

Plan Your Participation Now!

Click here to reserve your hotel stay

Exhibitor Prospectus | Meeting Registration Opens Soon!

Medical Debt Is Killing Our Patients

by Arvind Venkat, MD

As an emergency medicine resident in the early 2000s, I cared for a patient in her early 60s with back pain. Prior to the passage of the Affordable Care Act (ACA), approximately 16% of emergency department patients were uninsured. Often their issues were of low acuity, again because they had no other place to see a physician. I assumed that to be the case with this patient, that I would treat her presumably musculoskeletal back pain, and discharge her. However, while treating her, I noticed she struggled to walk and clutched her gown across her chest. It was the clutching that really struck me as unusual.

When I examined her chest, I saw something unexpected, right out of the medical history books. Her entire left breast was as hard as a rock, consumed by cancer that likely developed over months, if not years. She had severe hypercalcemia and was on the verge of going into cardiac arrest as a result.

After I stabilized her, I gently inquired why she had not sought care sooner. She explained that she did not have insurance, had previously sought care for other conditions, gone into debt, and feared that if she again sought care, her debt would only get worse. While I could alleviate her pain, it was too late for my patient to be cured of her illness, and she died shortly after hospital admission.

This story is all too common in the U.S.

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56 hospitals closing departments or ending services

A number of healthcare organizations have recently closed medical departments or ended services at facilities to shore up finances, focus on more in-demand services or address staffing shortages.

Here are 56 department closures or services ending, announced, advanced or finalized that Becker's has reported since Feb. 2:

1. York (Maine) Hospital is closing its birthing center by the end of September. Hospital officials noted that the decision to do so is the result of a decline in births and a shortage of workers, Portland Press Herald reported Sept. 12.
2. Inglewood, Calif.-based Centinela Hospital Medical Center is ending maternal child health services on Oct. 25 amid continued fallout over the death of a patient earlier this year. 
3. The UMass Memorial HealthAlliance-Clinton Hospital Leominster (Mass.) Campus is following through with its plan to close its maternity ward by working with transit officials to redirect patients to other hospitals, despite objections from the state. 

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CDC recommends updated COVID-19 vaccines

The CDC on Tuesday recommended the updated monovalent COVID-19 vaccines for people aged older than 6 months.

“We have more tools than ever to prevent the worst outcomes from COVID-19,” CDC Director Mandy Cohen, MD, MPH, said in a press release after signing off on a recommendation from advisors.

The Advisory Committee on Immunization Practices (ACIP) voted 13-1 on Tuesday to recommend the vaccines after the FDA fully approved them for people aged 12 years or older, and issued an emergency use authorization for people aged 6 months to 11 years.

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Drug Companies, Allies Fight Back on Medicare Drug Price Negotiations

They argue that the government is using coercion while claiming sellers have options

Experts debated the claims made by drug companies and industry allies suing the federal government over its recently launched drug price negotiation program during an online panel discussion hosted by KFF on Tuesday.

At issue is whether the federal government is "coercing" companies into making their drugs available at lower-than-market prices, explained Dan Troy, JD, managing director at the Berkeley Research Group, who currently serves on the litigation counsel advisory board for the U.S. Chamber of Commerce, one of the groups suing.

"The bottom line is this is not a price negotiation. These are price controls by other names," argued Troy, who is not involved in the lawsuit.

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| CASE REPORT |

Intrathecal Baclofen to Improve Functional Status in ALS: A Case Report

Mark P. Pressler, MD, Peter S. Cooper, MD, Whitney Carter, BS, Robert B. Goldstein, MD, and Andrew M. Mendelson, DO

Abstract

Background: Intrathecal pumps are well known to benefit patients with chronic pain as well as spasticity. Intrathecal baclofen (ITB) can offer doses 100-1000 times smaller with similar efficacy, compared to oral baclofen. Only 2 previous reports detailed improvement in functional status after patients with amyotrophic lateral sclerosis (ALS) received ITB.

Case Report: Our patient presented with progressive bulbar palsy, further progressing to ALS. His lower extremity spasticity and tremors continued to progress over 3 years despite increased baclofen. At the time of implant, he expressed whole body tremors and spasticity to bilateral lower extremities, complicated by falls. Prior to the trial, the patient ambulated 50 feet. ITB was started at a rate of 100 mcg/day. After the implant, the patient’s ambulation distance increased to 100 feet.

Conclusion: The patient and his wife reported resolution of his tremors and improvement in spasticity. This report details the functional improvement obtained from ITB in a patient with ALS.

Key words: Amyotrophic lateral sclerosis (ALS), intrathecal, baclofen, functional status, chronic pain, interventional pain

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| OBSERVATIONAL STUDY |

Efficacy of Cervical Facet Joint Radiofrequency Ablation Using a Multitined Cannula, a Technical Note, and Observational Study

Andrea Künzle, BSc, Sander M.J. van Kuijk, PhD, and Eva Koetsier, MD, PhD

Abstract

BACKGROUND: Chronic cervical facet joint pain is a leading cause of pain and disability. In patients nonresponsive to conservative treatment, cervical facet radiofrequency ablation (RFA) has shown to be efficacious. However, the conventional RFA technique can be cumbersome. A novel RFA technique with a multitined cannula allows for a lateral approach and represents an attractive alternative option for cervical facet RFA. It offers a potentially shorter, less cumbersome procedure, with consequently less x-ray exposure and patient discomfort than the conventional cervical RFA.

OBJECTIVES: To describe the novel RFA technique using the lateral approach with the multitined cannula at the cervical facet joints and to assess its efficacy in chronic cervical facet joint pain.

STUDY DESIGN: This is a single-center observational study. 

SETTING: Interventional Pain Management Center, Switzerland.

METHODS: The aim of this study is to describe the RFA technique using the lateral approach with the multitined cannula at the cervical facet joints and to assess its efficacy in chronic cervical facet joint pain. Eligible adult patients with chronic (> 3 months) cervical facet joint pain refractory to conservative treatment and confirmed by dual positive medial branch blocks, received a fluoroscopic-guided cervical facet RFA treatment using the multitined cannula. The primary outcome was pain relief. Secondary outcome measures included the proportion of patients reporting a >= 30% reduction of pain intensity 2 months after RFA, patient global impression of change (PGIC), need for pain medication, sleep quality, and patient satisfaction.

RESULTS: We included 26 patients. The patients showed a clinically meaningful and significant pain relief at 2 months after cervical facet RFA (mean Numeric Rating Scale of 7.5 [1.9] at baseline to 4.2 [2.4]) and 58% of the patients reported >= 30% reduction of pain. An improvement on the PGIC was reported by 88.2% of the patients. No severe side effects or complications were observed. 

LIMITATIONS: Key limitations of our study were the relatively small sample size, the lack of a control group, and a relatively short-term follow-up duration. 

CONCLUSIONS: Our results suggest that cervical facet joint RFA using the novel technique with the multitined cannula results in significant pain reduction and improvement on the PGIC. While the conventional technique requires multiple ablations at each target level, the RFA with the multitined needle requires only a singular ablation, likely sparing time, radiation dose, discomfort, and costs. Our results merit consideration of replacement of the conventional technique with the novel technique using the multitined cannula. However, larger-scale clinical trials with an adequate long-term follow-up period are needed to prove the efficacy of RFA using the multitined cannula in cervical facet joint pain. 

KEY WORDS: Neck pain, facet joint pain, cervical, radiofrequency, ablation, denervation, multitined cannula, lateral approach, observational study

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| OBSERVATIONAL STUDY |

Alpha-Lipoic Acid, Palmitoylethanolamide, Myrrh, and Oxygen-Ozone Therapy Improve Pharmacological Therapy in Acute Painful Lumbosacral Radiculopathy due to Herniated Disc



Eleonora Latini, MD, Giulia Bonasia, MD, Ludovica Petroselli, MD, Melissa Mazzola, MD, Francesca Musa, MD, Flavia Santoboni, MD, Donatella Trischitta, MD, Maria Nusca Sveva, MD, PhD, Mario Vetrano, MD, PhD, and Maria Chiara Vulpiani, MD

Abstract

BACKGROUND: Chronic cervical facet joint pain is a leading cause of pain and disability. In patients nonresponsive to conservative treatment, cervical facet radiofrequency ablation (RFA) has shown to be efficacious. However, the conventional RFA technique can be cumbersome. A novel RFA technique with a multitined cannula allows for a lateral approach and represents an attractive alternative option for cervical facet RFA. It offers a potentially shorter, less cumbersome procedure, with consequently less x-ray exposure and patient discomfort than the conventional cervical RFA.

OBJECTIVES: To describe the novel RFA technique using the lateral approach with the multitined cannula at the cervical facet joints and to assess its efficacy in chronic cervical facet joint pain.

STUDY DESIGN: This is a single-center observational study. 

SETTING: Interventional Pain Management Center, Switzerland.

METHODS: The aim of this study is to describe the RFA technique using the lateral approach with the multitined cannula at the cervical facet joints and to assess its efficacy in chronic cervical facet joint pain. Eligible adult patients with chronic (> 3 months) cervical facet joint pain refractory to conservative treatment and confirmed by dual positive medial branch blocks, received a fluoroscopic-guided cervical facet RFA treatment using the multitined cannula. The primary outcome was pain relief. Secondary outcome measures included the proportion of patients reporting a >= 30% reduction of pain intensity 2 months after RFA, patient global impression of change (PGIC), need for pain medication, sleep quality, and patient satisfaction.

RESULTS: We included 26 patients. The patients showed a clinically meaningful and significant pain relief at 2 months after cervical facet RFA (mean Numeric Rating Scale of 7.5 [1.9] at baseline to 4.2 [2.4]) and 58% of the patients reported >= 30% reduction of pain. An improvement on the PGIC was reported by 88.2% of the patients. No severe side effects or complications were observed. 

LIMITATIONS: Key limitations of our study were the relatively small sample size, the lack of a control group, and a relatively short-term follow-up duration. 

CONCLUSIONS: Our results suggest that cervical facet joint RFA using the novel technique with the multitined cannula results in significant pain reduction and improvement on the PGIC. While the conventional technique requires multiple ablations at each target level, the RFA with the multitined needle requires only a singular ablation, likely sparing time, radiation dose, discomfort, and costs. Our results merit consideration of replacement of the conventional technique with the novel technique using the multitined cannula. However, larger-scale clinical trials with an adequate long-term follow-up period are needed to prove the efficacy of RFA using the multitined cannula in cervical facet joint pain. 

KEY WORDS: Neck pain, facet joint pain, cervical, radiofrequency, ablation, denervation, multitined cannula, lateral approach, observational study

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