Important News!
Most of the final rates remained close to the proposed rates. The physician payment rate changed from a 4.4% cut to 4.5% cut. Consequently, we have identified additional reductions. Here are the sample pages for fee schedules:
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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. Click here to view the RFI Letter.
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An unintentional consequence of opioid prescribing restrictions?
Overlapping prescriptions of gabapentin and opioids grew over a 12-year period, pharmacy claims data showed.
Concurrent prescriptions increased from 1.9% in 2006 to 7.6% in 2018, a relative increase of 344%, reported Evan Peet, PhD, of the RAND Corporation in Washington, D.C., and co-authors, in a research letter published in JAMA Internal Medicine.
"As the opioid crisis continues throughout the country, clinicians are facing increasing restrictions on prescribing opioids," Peet told MedPage Today.
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In support of pain management residents and fellows,
this ASIPP webinar is COMPLIMENTARY
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Fellows, don't miss this career growth opportunity to make connections on a national stage.
This two-hour webinar is a wonderful opportunity for attendees to earn 2 AMA PRA Category 1 Credits™. Learn how Fellow Program Directors operate their fellowship programs and receive practice management advice from experts.
OBJECTIVES:
- Discuss treatment options for a typical patient with complex head/neck pain pathology.
- Review pertinent anatomy of common head and neck blocks and methods of accessing neural targets
- Explore fluoroscopic imaging techniques, views, and potential pitfalls
- Present practice management concepts for starting private practice
- Understand modern solo practice pain points and new opportunities for growth beyond employment models
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Resident/Fellow News and Updates |
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When Arjun Arya, MD, mingles socially with people he doesn't know, he doesn't usually say he's a doctor when careers come up. "My go-to answer tends to be, 'I work in healthcare,' and I just leave it at that," he said. That's not because he doesn't love his job — he does — but it's only been 6 months since Arya became an attending physician in emergency medicine at Riverside Medical Center in Kankakee, Illinois.
"It doesn't feel quite real yet," he says. He feels very confident and competent as a physician, but he's still figuring out what it means to be a doctor in his new post-residency life.
Arya is part of a generation of doctors who came of age professionally during the pandemic, a time when the field of medicine has been changing rapidly and dramatically. The importance of social determinants of health has begun to receive more attention; the repercussions of burnout have become clearer; and work-life balance and maintaining an identity outside of work have become non-negotiable priorities.
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Register today for these 2023 Virtual Review Courses and Competency Certification Exams |
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Additional steps are needed to calibrate opioid access and undo harm
Before the CDC suffered a loss of trust over its handling of the COVID-19 pandemic, the agency had fumbled its response to the overdose crisis. Under its leadership, overdose deaths have continued to spiral, as people living with pain have lost access to vital medications.
One of its key missteps was the formulation and implementation of its 2016 prescribing guideline for chronic pain. On November 3 this year, the agency took partial corrective action, revising its approach that contributed to so many harms to people with pain.
In its update, the 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, the CDC emphasizes flexibility in pain pharmacotherapy. It also rejects controversial dose and duration limits that had been widely misinterpreted by policymakers. For this welcome change to have meaning, however, the CDC must work proactively with regulators to rescind harmful policies that resulted from its prior guideline.
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THE LAST PART I EXAM THIS YEAR IS
Saturday, December 17
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Study Suggests New Vaccine Could Prevent Deadly Opioid from Entering the Brain
A research team led by the University of Houston has developed a vaccine targeting the dangerous synthetic opioid fentanyl that could block its ability to enter the brain, thus eliminating the drug’s “high.” The breakthrough discovery could have major implications for the nation’s opioid epidemic by becoming a relapse prevention agent for people trying to quit using opioids. While research reveals Opioid Use Disorder (OUD) is treatable, an estimated 80% of those dependent on the drug suffer a relapse.
The findings, published in the journal Pharmaceutics, could not be timelier or more in demand: Over 150 people die every day from overdoses of synthetic opioids including fentanyl, which is 50 times stronger than heroin and 100 times stronger than morphine. Consumption of about 2 milligrams of fentanyl (the size of two grains of rice) is likely to be fatal depending on a person’s size.
“We believe these findings could have a significant impact on a very serious problem plaguing society for years – opioid misuse. Our vaccine is able to generate anti-fentanyl antibodies that bind to the consumed fentanyl and prevent it from entering the brain, allowing it to be eliminated out of the body via the kidneys. Thus, the individual will not feel the euphoric effects and can ‘get back on the wagon’ to sobriety,” said the study’s lead author Colin Haile, a research associate professor of psychology at UH and the Texas Institute for Measurement, Evaluation and Statistics (TIMES), and a founding member of the UH Drug Discovery Institute.
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Anakinra indicated for patients with pneumonia who are at risk of severe respiratory failure
These patients include those with pneumonia who require supplemental oxygen (low- or high-flow) and are at risk of progressing to severe respiratory failure and are likely to have an elevated plasma soluble urokinase plasminogen activator receptor.
Anakinra is an interleukin-1 (IL-1) receptor antagonist that is currently FDA approved for treatment of rheumatoid arthritis, cryopyrin-associated periodic syndromes, and deficiency of IL-1 receptor antagonist.
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Please plan to join us at the 2023 ASIPP Annual Meeting
March 16-18 National Harbor, Maryland
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For meeting or exhibitor/sponsor information:
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Risk heightened for people with a recent prescription opioid-fill
Using benzodiazepines for sleep disorders was tied to a higher risk for overdose in the 6 months after starting treatment versus other treatments for commonly used treatments, researchers reported.
In a cohort study of over 23,000 young adults (mean age 23), those who newly initiated benzodiazepine treatment had a 44% higher risk of drug overdose at 6 months versus other treatments in an as-treated adjusted analysis (HR 1.44, 95% CI 1.14-1.80), according to Greta A. Bushnell, PhD, of Rutgers Institute for Health in New Brunswick, New Jersey, and colleagues.
Because the risk for overdose may continue even after treatment ends, Bushnell's group also found that there was a 25% higher overdose risk in an intention-to-treat analysis (HR 1.25, 95% CI 1.03-1.51), they stated in JAMA Network Open.
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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 |
Mariano Ferandez-Baena, MD, PhD, Laureano Delange-Segura, MD, PhD, Maria Teresa Palomino-Jimenez, MD, PhD, and Maria Luisa Rodriguez Padilla, MD, PhD
Abstract
BACKGROUND: Ependymoma is the most common spinal tumor in adults. Its treatment is surgical and consists of maximum possible tumor resection. Although the recurrence rate is low, painful sequelae are also common. Electrical spinal cord stimulation (SCS) has demonstrated efficacy in neuropathic and postsurgical pain, and the efficacy and duration of relief can be improved through the use of new modalities, such as burst stimulation.
CASE REPORT: A 27-year-old woman with chronic severe painful sequelae in her lower limbs and thoracic region was found to be refractory to pharmacological treatment after total thoracic ependymoma resection. The successive use of spinal cord and/or peripheral nerve stimulation in tonic and burst modalities has provided consistent pain relief for approximately 10 years.
CONCLUSION: Our experience suggests that SCS, in its various modalities, can be an adequate and long-lasting therapy for patients with pain secondary to resection of spinal cord tumors.
KEY WORDS: Case Report, ependymoma, intramedullary tumors, neuropathic pain, spinal cord stimulation
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| SYSTEMATIC REVIEW |
Meng-Chen Tsai, MD, Geng-Hao Bai, MD, Tsung-Yu Hung, MD, Yi-No Kang, PhD, and Wen-Hsuan Hou, MD, PhD
Abstract
Background: Single-injection regional analgesia techniques can provide effective analgesia for abdominal hysterectomy. However, few randomized controlled trials (RCTs) have directly compared these techniques for total abdominal hysterectomy (TAH), and the best strategy remains unknown.
Objectives: In this network meta-analysis, we compared the analgesic efficacy of single-injection regional analgesia techniques in patients who underwent TAH.
Study design: A systematic review and network meta-analysis.
Methods: We searched the PubMed, Embase, Cochrane, and CINAHL databases for relevant trials from inception until April 2022. RCTs that examined single-injection regional analgesia techniques for TAH were included. Random-effects network meta-analyses were performed using the frequentist approach. The primary outcome was 24-hour cumulative morphine equivalent consumption. The secondary outcomes were pain scores, time to first request for rescue analgesia, and rates of postoperative nausea and vomiting (PONV).
Results: In total, 36 RCTs were included. Network meta-analyses indicated that the erector spinae plane block provided superior analgesia in terms of reduced morphine consumption, low PONV incidence, and longer time to first analgesia request. Moreover, compared with control (i.e., sham or placebo), the quadratus lumborum block provided superior analgesia in terms of time to first analgesia request and resting pain scores.
Limitations: (1) Few studies have examined single-injection regional analgesia techniques other than the transversus abdominis plane block (TAPB) and wound infiltration, leading to a few indirect effect estimates. (2) Heterogeneity existed due to analgesic type/dose, plane block timing, and injection site. (3) Objective outcomes, such as length of hospital stay, were lacking; most studies only included the patient-reported subjective pain score.
Conclusion: Single-injection blocks are effective analgesic techniques for TAH. Among them, the erector spinae plane block and quadratus lumborum block seem to have superior effects. Further studies should evaluate techniques other than TAPB and wound infiltration to draw definitive conclusions.
Keywords: erector spinae plane block; morphine consumption; network meta-analysis; postoperative nausea and vomiting; quadratus lumborum block; rectus sheath block; total abdominal hysterectomy; transversus abdominis plane block; wound infiltration; Single-injection regional analgesia.
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| NARRATIVE REVIEW |
Eric J. Wang, MD, Lauren E. Berninger, DO, Olga Komargodski, MD, and Thomas J. Smith, MD
Abstract
Background: First-line medications for the treatment of painful diabetic neuropathy (PDN) are associated with a substantial rate of discontinuation due to adverse effects or insufficient efficacy. Neuromodulation techniques have been used for PDN, but a comprehensive review of the literature that incorporates several distinct device categories has yet to be undertaken.
Objectives: We aimed to summarize the evidence regarding 4 major types of neuromodulation devices for the treatment of PDN. We focused on spinal cord stimulators (SCS), peripheral nerve stimulators (PNS), transcutaneous electrical nerve stimulators (TENS), and scrambler therapy devices (ST) because they are often used for refractory neuropathic pain.
Study design: Narrative Review.
Methods: A comprehensive and reproducible literature search was performed using PubMed with no search restrictions applied. The available Medical Subject Headings were used. Inclusion criteria included prospective studies, retrospective studies, case series, and case reports indexed from database inception to the search date (September 14, 2021).
Results: Seventeen studies met inclusion criteria, 10 of which were regarding SCS. Only 3 of the 10 were randomized controlled trials. We found no studies assessing contemporary PNS. Four studies assessed TENS, but the devices varied widely in voltages and waveforms. Two case reports described ST.
Limitations: Potential selection bias due to the nature of a narrative review, although a reproducible search strategy was utilized. Several neuromodulation modalities have minimal published evidence available.
Conclusions: The evidence for neuromodulation devices for the treatment of PDN mostly comprises open-label prospective trials or case reports. SCS has the most volume of evidence for efficacy. Studies regarding TENS show mixed results, possibly due to numerous device varieties. PNS and ST may hold promise based on their proposed mechanisms of action, but prospective controlled trials are needed.
Keywords: neuromodulation; neuropathic pain; pain medicine; painful diabetic neuropathy; peripheral nerve stimulation; scrambler therapy; spinal cord stimulation; transcutaneous nerve stimulation; Chronic pain.
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ASIPP is now in collaboration with Curi Medical Liability Program
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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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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