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Proposed 2025 Physician Fee Schedule
On July 10th, CMS released the proposed rule for the 2025 Medicare physician fee schedule (MPFS). The rule focuses on several key goals of administration, including addressing health disparities, expanding access to behavioral health care, improving transparency in the health system, and promoting safe, effective, and patient-centered care.
The highlights are as follows:
- The rule proposes to cut the conversion factor by 2.8% to $32.36 in CY 2025, as compared to $33.29 in CY 2024.
The cut reflects the expiration of the 2.93% statutory payment increase for 2024, a 0% conversion factor update, and a 0.5% budget neutrality adjustment.
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ASIPP State Society Meeting | |
Earn up to 15 CMEs while learning from experts and exchanging ideas with colleagues in beautiful downtown Cincinnati this August 9–11. | |
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Proposal would cover more than existing codes for limited situations
Remember that physician who wanted to develop a Current Procedural Terminology (CPT) code for prior authorizations? It hasn't happened yet, but he hasn't given up on it, either.
In May, Alex Shteynshlyuger, MD, a New York City urologist in solo practice, spoke with MedPage Today about a proposal he was developing for a new CPT code that would be used to bill insurers for the time physician practices spend obtaining prior authorizations.
Under the current system, "there's a problem of incentives and costs," he explained at the time. "When a medical office does prior authorization, there's a disincentive to do that -- I take money out of my pocket to do it. I'm not compensated for that in any way."
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What’s the news: Medicare physician payment—often called Medicare reimbursement—must be tied to an inflation index called the Medicare Economic Index (MEI). As part of its campaign to fix the unsustainable Medicare pay system, the AMA has outlined in a quick, easily navigable fashion why this payment fix needs to happen now.
The AMA’s two-page explainer on the Medicare Economic Index (PDF) outlines how it incorporates these two categories reflecting the resources used in medical practices:
- Physician practice costs, which includes components for nonphysician compensation such as fringe benefits, medical supplies, professional liability insurance and other expenses. Each component is assigned a weight and various proxy indices are used to estimate price changes.
- Physician compensation, which reflects increases in general earnings and is currently proxied by changes in the wages and benefits of professional occupations in the U.S. from the Bureau of Labor Statistics. The change in the combined practice costs and physician compensation components of the MEI is then reduced by the 10-year average of economywide, multifactor productivity.
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U.S. Senator Bill Cassidy, MD (R-LA), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, is requesting information from federal agencies under the HELP Committee’s jurisdiction on how they will comply with the Supreme Court’s overturning of the Chevron deference and how they plan to implement laws as Congress intended. He also demanded the agencies comply with all Committee oversight, to ensure agencies are held accountable to operate within the bounds of the authorities that Congress has given them and properly use American taxpayers’ dollars.
“For too long, Chevron deference allowed unelected bureaucrats, insulated from political accountability, to exercise power that exceeds their authority. Such unfettered power is a perversion of the Constitution,” said Dr. Cassidy. “The Supreme Court’s decision helps return the role of legislating back to the people’s elected representatives.”
Specifically, Cassidy sent letters to the Department of Health and Human Services, Department of Education, Department of Labor, Food and Drug Administration, National Labor Relations Board, Equal Employment Opportunity Commission, and Employee Benefits Security Administration.
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Virtual
August 31 & September 28
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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Intervention may be as efficacious as pharmacologic treatments, researchers suggest
A novel behavioral pain management program reduced pain severity and pain-related functional interference in people living with HIV, according to a randomized clinical trial.
The Skills to Manage Pain (STOMP) program was associated with a mean difference of -1.25 in the Brief Pain Inventory (BPI) total score (scale of 0-10) when compared with enhanced usual care (P<0.001), Katie Fitzgerald Jones, PhD, ACHPN, CARN-AP, of the VA Boston Healthcare System, and colleagues reported in JAMA Internal Medicine.
"For many patients, this is the difference between being able to visit a loved one, go to the grocery store, do laundry, or attend a child's basketball game," Fitzgerald Jones told MedPage Today.
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Registration is open for
ASIPP's 2025 Annual Meeting
We would love it if you would register and join us in Orlando!
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An estimated two million people in England and Scotland were experiencing symptoms of long COVID as of March 2024, according to the Office for National Statistics. Of these, 1.5 million said the condition was adversely affecting their day-to-day activities.
As more research emerges about long COVID, some experts are noticing that its trigger factors, symptoms, and causative mechanisms overlap with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
ME/CFS is characterised by severe fatigue that does not improve with rest, in addition to pain and cognitive problems. One in four patients are bed- or house-bound with severe forms of the condition, sometimes experiencing atypical seizures, and speech and swallowing difficulties.
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ASIPP State Society Meeting: | |
- 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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Aaran Varatharajan, MD, Stephen Music, DO, and Matthew Jaycox, MD
Abstract
BACKGROUND: Guillain-Barré syndrome (GBS), also called acute inflammatory demyelinating polyradiculopathy (AIDP), is one of the most common causes of acute, acquired weaknesses. GBS is an acute immune-mediated polyneuropathy that presents with progressive weakness of the arms or legs. GBS presents after infection; however, there are few reports that describe acute GBS after chronic pain procedures.
CASE REPORT: A 70-year-old man with a past medical history of spinal stenosis status post anterior cervical discectomy and fusion, sacroiliac joint (SIJ) dysfunction status post SIJ fusion presented with imbalance, weakness, and difficulty walking. The patient underwent SIJ fusion one week prior; his weakness progressively worsened, requiring a walker. He underwent a series of labs and diagnostic tests, which were consistent with AIDP/GBS. He was placed on respiratory and cardiac monitoring and started on intravenous immunoglobulin treatment. He started developing bilateral facial palsies and started on plasmapheresis. His symptoms have improved and he was discharged from our inpatient rehab facility on after 28 days.
CONCLUSIONS: This case report aims to highlight a rare, but potentially dangerous, complication of AIDP/GBS following an SIJ fusion.
KEY WORDS: Sacroiliac joint fusion, sacroiliac joint pain, Guillain-Barré syndrome, case report
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Sang Hoon Lee, MD, Hyun Hee Choi, MS, Sang Gyu Kwak, PhD, and Min Cheol Chang, MD
Abstract
BACKGROUND: The knee joint is one of the most common diseases in elderly individuals. This is a progressive and debilitating condition. The purpose of knee osteoarthritis treatment is to manage pain, increase mobility, and improve the quality of life.
OBJECTIVES: This study evaluated the therapeutic effect of radiofrequency thermocoagulation (RFTC) on the genicular nerves in patients with intractable pain due to knee osteoarthritis, as well as its effects on pain severity and magnetic resonance imaging (MRI) findings.
STUDY DESIGN: A prospective outcome study.
SETTING: The outpatient clinic of a single academic medical center.
METHODS: We conducted a prospective study. Fifty consecutive patients with intractable knee pain due to osteoarthritis were enrolled and underwent ultrasound (US)-guided RFTC of the genicular nerves (medial superior genicular nerve, medial inferior genicular nerve, and lateral superior genicular nerve). Pain severity was measured using the Numeric Rating Scale (NRS), and knee osteoarthritis-associated symptoms were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at pretreatment and one, 3, and 6 months after RFTC treatment. We also analyzed the relationship between therapeutic outcomes and pain severity based on pre-treatment and knee MRI findings.
RESULTS: No dropouts were observed. The most significant reduction in knee symptoms associated with knee osteoarthritis was observed after one month of treatment; however, at 3 and 6 months, there was a rebound effect, leading to a decrease in therapeutic efficacy. Nonetheless, there was still a noticeable decrease in symptoms due to knee osteoarthritis compared to those prior to RFTC treatment. The effect of RFTC treatment was better when pre-treatment pain was relatively less severe, knee effusion was not severe, there were no meniscal tears in the middle or posterior zones, no bone marrow edema in the middle and posterior zones of the femur and tibia, and no severe cartilage defects in the posterior femur and middle and posterior tibia.
LIMITATIONS: We conducted our study without a control or a placebo group.
CONCLUSION: RFTC of the genicular nerve is a good therapeutic option for controlling intractable pain following knee osteoarthritis. In addition, we found that a lower level of pain prior to treatment, along with the absence or lesser degree of knee joint effusion, as well as an absence or less severe middle or posterior knee pathologies associated with knee osteoarthritis, can predict a more favorable therapeutic outcome.
KEY WORDS: knee, osteoarthritis, radiofrequency ablation, genicular nerve, pain, magnetic resonance imaging
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Barbara Pizzi, MD, Vincenza Cofini, MD, Emiliano Petrucci, MD, Gioele Marrocco, MD, Laura Sollima, MD, Daniela Rullo, HT, Giuseppe Calvisi, MD, Marco Cascella, MD, Alessandro Vittori, MD, and Franco Marinangeli, MD
Abstract
BACKGROUND: A thoracic paravertebral block can be a useful opioid-sparing technique for controlling postoperative pain after thoracic and visceral abdominal surgery.
OBJECTIVES: Our aim was to assess dye spread into the ventral branch, connecting branch, sympathetic trunk, thoracic paravertebral space, and epidural space after performing a modified ultrasound-assisted thoracic paravertebral block via the intervertebral foramen.
STUDY DESIGN: This was a nonrandomized cadaveric study.
SETTING: The cadavers were kept at the Department of Anatomopathology of the San Salvatore Academic Hospital of L’Aquila (L’Aquila, Italy).
METHODS: We performed a bilateral thoracic paravertebral block via the intervertebral foramen at the second, fifth, ninth, and twelfth thoracic vertebrae. A linear array ultrasound transducer was used. Then, cadaveric dissection was performed. A Tuohy needle was gently inserted in-plane with the ultrasound beam in a lateromedial direction to contact the spinous process. Subsequently, the needle tip was advanced 2 mm along the transverse process of the vertebra, and 5 mL of methylene blue 1% dye was injected at each level. Then, 2 continuous catheter sets were inserted.
RESULTS: Forty intervertebral foramen blocks were performed in 5 cadavers. For 38 injection sites, we found dye on both sides of the thoracic paravertebral space and epidural space at each level of puncture. The retropleural organs were also stained. In 2 cases, methylene blue accumulated intramuscularly at the level of the twelfth thoracic vertebra.
The spread of dye into the ventral rami, communicating rami, and sympathetic trunk in the thoracic paravertebral space and the epidural space was assessed. We also evaluated the position and the distance (mm) between the catheter tip and the thoracic intervertebral foramen content. Finally, puncturing of intervertebral blood vessels, nerve rootlet and root damage, lung and pleural injuries, and the extent of intramuscular dye accumulation were evaluated and recorded as iatrogenic complications related to the anesthetic procedure. Forty thoracic paravertebral blocks in 5 cadavers were performed. For 38 injection sites, we found dye on both sides of the thoracic paravertebral space and the epidural space at each level of puncture. The ventral rami, the communicating rami, and the sympathetic trunk were also stained. In 2 cases, methylene blue accumulated intramuscularly at the level of the twelfth thoracic vertebra.
LIMITATIONS: The first limitation of this study is its small sample size. In addition, the study design did not consider or measure the width of the transverse processes. Another limitation is that the ultrasound beam could not identify the thoracic intervertebral foramen content or the needle tip behind the acoustic shadow of the transverse and vertebral articular processes.
CONCLUSION: Paravertebral block via the thoracic intervertebral foramen achieved consistent dye spread into the thoracic paravertebral space and epidural space, capturing retropleural organs.
KEY WORDS: Dye spread, epidural space, ventral branch, connecting branch, sympathetic trunk, thoracic paravertebral space, ultrasound guidance, iatrogenic complications
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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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up-to-date news related to you, your practice, and your patients!
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