Important News!
United Healthcare’s new policy reverses the previous policy with a limit of three (3) epidural injections to the ASIPP recommendation of four (4) procedures per year.
As you know, ASIPP has resolutely advocated for a change in the policy on epidural injection limits of three (3) per year through evidence-based presentations and communication. We first sent a letter on June 21, and they responded on June 27. Since then, we have continued with multiple other correspondences. Consequently, they published the new policy effective November 1, 2022, which now provides coverage for four (4) procedures.
As a reminder, after much effort and many correspondences on the part of ASIPP, percutaneous adhesiolysis is now covered in all states, following the reversal of noncoverage policies of Noridian and Palmetto.
We are still awaiting the response from Centene in reference to continuation of the epidural injections when indicated beyond one year. We will keep you posted on the developments. See Letter to Centene.
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Need to catch up on earning your
CME Credits before 2022 is over?
Here is an excellent opportunity offered by ASIPP to earn
15 AMA PRA Category 1 CreditsTM in Newport Beach, October 14-16
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Register today for the CALSIPP Annual Meeting and join us for an Evening Cruise on the Bay!
Saturday, October 15 | 7:30 pm
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Enjoy an entertaining three-hour yacht cruise around Newport Bay on a two-level contemporary yacht. Take in the beautiful sights from the outdoor viewing areas on the large bow, aft deck, or by strolling the walk-around decks.
Limited tickets are available, so do not wait! Tickets are $100 per registered meeting attendee or guest and must be selected on the registration form.
Register for the meeting and select the Cruise Add On.
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Great news! Representatives Larry Bucshon (R-Ind.) and Ami Bera (D-Calif.), are introducing a bill that would prevent a 4.4 percent Medicare physician fee payment cut from taking effect on January 1, 2023, through the introduction of the Medicare Access and CHIP Reauthorization Act of 2015 and associated payment mechanism.
This is the bill we have been requesting from members of the Congress to introduce for some time for the last few months. ASIPP has supported this and ASIPP members have sent over 5,000 letters to Members of the Congress to date.
Representatives Bucshon and Bera are supported in this endeavor by six additional representatives, Kim Schrier M.D. (WA-08), Michael Burgess, M.D. (TX-26), Earl Blumenauer (OR-03), Brad Wenstrup, D.P.M. (OH-02), Bradley Schneider (IL-10), and Mariannette Miller-Meeks, M.D. (IA-02). Together they sent a Request for Information: Medicare Payment System Reform letter to members of Congress. See RFI Letter
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Growing evidence of misuse and overdoses involving gabapentin—often in conjunction with opioids—is drawing attention to substantial off-label prescribing of the anticonvulsant drug.
A recent report from the US Centers for Disease Control and Prevention (CDC) found that between 2019 and 2020, coroners and medical examiners detected gabapentin in 5687, or almost 10%, of the 58 362 overdose deaths in 23 states and the District of Columbia that had available toxicology results. Officials ruled that gabapentin was a cause of death in almost 3000 of these cases. The number of fatal overdoses in which gabapentin was detected or involved increased from 2019 to 2020, apparently tracking with the overall increase in overdose deaths during the COVID-19 pandemic.
In almost 90% of fatal overdoses in which gabapentin was detected, opioids also were involved. The US Food and Drug Administration (FDA) in 2019 warned that gabapentin can cause severe breathing difficulties, especially when used with other central nervous system depressants like opioids, anxiety medications, or antidepressants or when used by older adults and people with respiratory risk factors such as chronic obstructive pulmonary disease. At that time, the agency had received 49 reports of respiratory depression among patients taking gabapentin or pregabalin, including 12 deaths. The agency also reviewed evidence from clinical trials and animal studies that confirmed the risk.
“We think [gabapentin] overdoses are primarily being driven by people with opioid use disorders vs people accidentally taking too much or taking multiple medications that suppress breathing,” Mance Buttram, PhD, an associate professor of public health at the University of Arkansas in Fayetteville who tracks drug misuse trends, said in an interview with JAMA.
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REMAINING PART I EXAM DATES THIS YEAR:
- October 22
- November 19
- December 17
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Guidance applies only when community transmission isn't at a high level
"Updates were made to reflect the high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools," noted the guidance issued on Friday, which the agency said "provides a framework for facilities to implement select infection prevention and control practices." Those practices include universal masking "based on their individual circumstances."
The agency also made several other changes related to infection control among healthcare workers, including recommending that:
- Vaccination status should no longer guide masking, screening, or post-exposure practices
- Testing of healthcare workers who are asymptomatic and have no known exposure is now at the discretion of the facility, with certain exceptions
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Broadly speaking, asymptomatic patients should no longer be required to isolate (or follow "transmission-based precautions") due to close contact with a person who has a SARS-CoV-2 infection
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Dr. Nelson Onaro conceded last summer that he’d written illegal prescriptions, although he said he was thinking only of his patients. From a tiny, brick clinic in Oklahoma, he doled out hundreds of opioid pills and dozens of fentanyl patches with no legitimate medical purpose.
“Those medications were prescribed to help my patients, from my own point of view,” Onaro said in court, as he reluctantly pleaded guilty to six counts of drug dealing. Because he confessed, the doctor was likely to get a reduced sentence of three years or less in prison.
But Onaro changed his mind in July. In the days before his sentencing, he asked a federal judge to throw out his plea deal, sending his case toward a trial. For a chance at exoneration, he’d face four times the charges and the possibility of a harsher sentence.
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Need to catch up on earning your
CME Credits before 2022 is over?
Here is an excellent opportunity offered by ASIPP to earn
19 AMA PRA Category 1 CreditsTM in Chicago, November 11-13
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Some hospital leaders say they'll continue to follow state recommendations for universal masking
Hospitals and healthcare workers aren't pleased with updated CDC recommendations to drop universal masking in healthcare settings.
Late last week, the agency quietly published new guidance that scrapped universal masking for healthcare workers. Now, hospitals and nursing homes in areas without high COVID-19 transmission rates can opt out of requiring doctors, patients, and visitors to mask up.
While the recommendation is tied to local transmission rates rather than the community levels used for public masking recommendations, some 30% of the U.S. currently falls outside of areas with high transmission, according to CDC's COVID Data Tracker.
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Employed physicians are often torn. Many relish the steady salary and ability to focus on being a physician rather than handle administrative duties, but they bemoan their employers' rules and their lack of input into key decisions. And thus, many doctors are leaving employment to start a private practice. Seven physicians talked to Medscape about why they chose private practice.
Leaving Employment Is "an Invigorating Time"
On September 9, Aaron Przybysz, MD, gave notice to his employer, a large academic medical center in Southern California, that he would be leaving to start a private practice.
"It's an invigorating time," said Przybysz, 41, an anesthesiologist and pain management physician who plans to open his new pain management practice on December 1 in Orange County. He has picked out the space he will rent but has not yet hired his staff.
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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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Looming Medicare cuts will force surgeons to do more with less, undermining trainee success
“But you're walking away from your dream!"
"Think about all of the years of hard work you have invested."
"What will you do instead?"
These are common reactions people have when they hear about a surgeon walking away from medicine. It's hard to imagine a surgeon would ever do such a thing. But the past few years may have changed that commitment to medicine for many.
My peers and I have invested nearly a decade to become surgeons. We've spent years in the classroom and hospital rotations, taking various standardized tests, and interviewing for competitive training positions around the country for the privilege of standing in the operating room -- a humbling opportunity to serve patients from all walks of life. This is why it's so disheartening to witness healthcare workers across the country, including residents, walk away from medicine. They are just too frustrated by the challenges of a healthcare system that is crippling surgeons and other doctors from providing effective care.
The Impact of Looming Medicare Cuts
The challenges that impact patients and their care just keep coming. The latest? The impending sky-high Medicare cuts for the surgical field.
While I'm pleased to see that Congress recently passed legislation aimed at lowering the cost of prescription drugs for seniors, there is much more that needs to be done. It's alarming to hear that CMS is planning to make significant cuts to Medicare payments for surgical care starting January 1, 2023.
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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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Now that President Biden has signed the Inflation Reduction Act, which authorizes Medicare to negotiate directly with pharmaceutical companies for some drugs, you can expect policymakers and reporters to shift their focus to the high cost of a stay in the hospital. That coverage must also include how health insurers are forcing millions of Americans to pay thousands of dollars out of their own pockets before their insurers will cover any of their hospital bills.
“Ask every patient, every time,” the [McKinsey] materials said. Instead of using “weak” phrases — like “Would you mind paying?” — employees were told to ask how patients wanted to pay. Soliciting money “is part of your role. It’s not an option.”
If patients did not pay, Providence sent debt collectors to pursue them.
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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 |
Lei Lu, MD, and M. Gabriel Hillegass, MD
Abstract
BACKGROUND: Vision changes are rarely reported as a complication of complex regional pain syndrome (CRPS). Previous research has shown that photophobia and changes in pupil size associated with CRPS are the result of autonomic disturbances. Stellate ganglion blocks relieve pain by altering, at least temporarily, the dysautonomia associated with CRPS.
CASE REPORT: A 30-year-old white woman with a history of cervical disc herniation and progressive radiculopathy was diagnosed with CRPS type 1 after C6-7 arthroplasty. Her case was complicated by ipsilateral acute vision loss in the left eye and left facial pain, which improved after stellate ganglion block.
CONCLUSION: This case broadened our knowledge about CRPS and suggested that associated dysautonomia can adversely affect visual acuity.
KEY WORDS: Case report, complex regional pain syndrome, dysautonomia, stellate ganglion block, visual loss
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| SCOPING REVIEW |
Patricia M. Herman, ND, PhD, Ian D. Coulter, PhD, Ron D. Hays, PhD, Anthony Rodriguez, PhD, and Maria O. Edelen, PhD
Abstract
BACKGROUND: In 2014, the National Institutes of Health Pain Consortium Research Task Force recommended that patients with chronic low back pain (CLBP) be stratified by its impact on their lives. They proposed the Impact Stratification Score (ISS) to help guide therapy and facilitate study comparability. The ISS has been evaluated as a continuous measure, but not for use as a stratification or classification scheme.
OBJECTIVES: Identify the characteristics of successful schemes to inform the use of the ISS for stratification or classification.
STUDY DESIGN: Scoping review of the peer-reviewed literature.
METHODS: Search of PubMed, CINAHL, and APA PsycInfo to identify patient self-report-based classification schemes applicable to CLBP. Data were captured on the methods used for each scheme’s development, the domains covered, their scoring criteria and what the classification has successfully measured. The study was reviewed and approved by the RAND Human Subjects Protection Committee (2019-0651-AM02).
RESULTS: The search identified 87 published articles about the development and testing of 5 classification schemes: 1) The Subgroups for Targeted Treatment (STarT) Back Screening Tool, 2) Multiaxial Assessment of Pain, 3) Graded Chronic Pain Scale, 4) Back Pain Classification Scale, and 5) Chronic Pain Risk Score. All have been shown to be predictive of future outcomes and the STarT Back has been found useful in identifying effective classification-specific treatment. Each scheme had a different classification scoring structure, was developed using different methods, and 3 included domains not found in the ISS.
LIMITATIONS: Expanding the search to other databases may have identified more classification schemes. Our minimum number of publications inclusion criterion eliminated dozens of cluster analyses, some of which may have eventually been replicated.
CONCLUSIONS: The methods used to develop these successful classification schemes, especially those that use straightforward scoring schemes, should be considered for use in the development of a scheme based on the ISS.
KEY WORDS: Back pain, chronic pain, stratification, classification, grading, subgrouping, patient-reported outcome measures, Impact Stratification Score
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| RANDOMIZED TRIAL |
Abdelraheem Elawamy, MD, Mohamed R. Morsy, MD, and Mohamed A.Y. Ahmed, MD
Abstract
BACKGROUND: Rib fractures occur most commonly because of blunt thoracic trauma and occur in up to 12% of all trauma patients. Adequate analgesia is paramount in enhancing pulmonary hygiene aimed at preventing atelectasis and pneumonia. Erector spinae plane block, one of the novel multiple thoracic ultrasound-guided techniques, can provide analgesia to both the anterior and posterior hemithorax, making it particularly useful in the management of pain after extensive thoracic trauma.
OBJECTIVES: This work aimed to compare the analgesic efficacy and safety of ultrasound-guided erector spinae plane block versus ultrasound-guided thoracic paravertebral block in patients suffering multiple rib fractures.
STUDY DESIGN: A double blinded randomized clinical trial.
SETTING: A university hospital.
METHODS: The study was conducted with 60 patients with multiple fracture ribs. Patients were randomly allocated into 2 equal groups of 30 patients.
RESULTS: Both techniques were effective in reducing pain scores and opioid consumption with no significant difference between the 2 groups. Time to first analgesic administration was comparable between the 2 groups. Twenty patients in the thoracic erector spinae plane group required rescue morphine compared to 17 patients in the thoracic paravertebral block group (P > 0.05). Visual Analog Scale scores at rest and on coughing were also comparable between the groups at all measuring points except at 0.5 hours following the block performance. Occurrence of hypertension was higher in the thoracic paravertebral block group compared to the thoracic erector spinae plane group (P = 0.024).
LIMITATIONS: There was no catheter inserted and we use intermittent injections, which is not the ideal, continuous block with fixed catheter is the ideal. We use dexamethasone as adjuvant with local anesthetics, which delay the need for booster dose of local anesthetics and make comparison between the 2 techniques not ideal. The sample size is small to some extent. We did not exclude addict patients.
CONCLUSION: Ultrasound-guided thoracic erector spinae plane block was as effective as thoracic paravertebral block for pain alleviation in patients with unilateral multiple fractured ribs with a comparable duration of analgesic effect, reduction of opioid consumption, and stable hemodynamic profile. However, thoracic erector spinae plane block had the advantage of a lower adverse effect incidence. Clinicians could choose either of the 2 techniques according to their clinical experience and personal choice.
KEY WORDS: Multiple fracture rib, anesthesia, ultrasound-guided erector spinae plane block (ESPB), thoracic paravertebral block (TBVP), rescue analgesia, visual analog scale, pain
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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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