The important aspects of Omnibus include proposed pay cuts of 2% in 2023 for physicians, a reduction from 4.5%, and in 2024, the cuts will increase to 3.5%.
The Wall Street Journal described this as the ugliest Omnibus bill ever with a 4,155-page bill that most members will never read. This bill includes multiple provisions affecting healthcare providers:
1. Reduce the physician fee schedule cut from 4.5% to 2% for 2023 and 3.5% for 2024
2. Prevents the 4% statutory pay as you go sequester for 2 years
3. Provides extension of telehealth services for 2 years
4. The worst news is that:
- There is no mention of a 2% sequester cut from ACA. Consequently, the 2% sequester cut will continue. Obviously, this will result in a 4% cut for the physician fee schedule from 2022 (2% new cut + 2% sequester cut = 4%).
- For facilities, a sequester cut of 2% will be implemented through 2023.
There are also multiple changes to the Medicaid policy, which will remove ineligible of their Medicaid roles in April, regardless of when the COVID-19 public health emergency ends.
As you well know, the American Society of Interventional Pain Physicians (ASIPP) advanced advocacy to prevent all cuts permanently. Obviously, we are extremely disappointed, along with almost all physician organizations. ASIPP will soon be providing you with appropriate activities for upcoming months and years as the new Congress steps in to remove these cuts permanently.
The new fee schedule, based on 2% and 4% cuts for 2023 for physicians and a 2% cut for facilities, is available at asipp.org. Sample schedules are as follows:
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Submit your abstracts by January 31, 2023
Questions should be directed to Savannah Gold at
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The implications for burnout are staggering
Last month, 15,000 nurses went on strike in Minnesota in the largest private-sector nursing strike in U.S. history. They were protesting understaffing and overwork at a time when provider burnout has reached epidemic proportions -- approximately 63% of physicians and 80% of nurses now report symptoms of burnout. Meanwhile, healthcare continues to struggle with overwhelming cost pressures. We still spend more money for worse outcomes than any other developed country. As a surgical resident, I've heard too many structural explanations for cost and burnout problems that overlook a specific, fixable culprit: Our electronic medical records (EMRs) are still hopelessly broken.
In 2022, software is suffocating American medicine.
The 2009 HITECH Act kicked off the modern era of the EMR with federal incentives for EMR use. Unfortunately, the legislation also favored established firms over smaller competitors with its many requirements and short timeframe. Today, many of the top-ranking hospitals use EMRs from one of two vendors, Epic Systems or Cerner Corporation (now part of Oracle). Epic alone has medical records on 250 million people, while Cerner won a $16 billion contract to introduce its EMR to the Veterans Health Administration. These businesses had a combined revenue of nearly $10 billion in 2021, with both reporting double-digit year-over-year growth.
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FASIPP nomination applications are due no later than January 15, 2023. |
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People who take oxycodone need to be careful when also taking antifungal drugs or drinking grapefruit juice. Why? Because both the juice and the drug can result in abnormally high, perhaps dangerously so, oxycodone blood levels. The same goes for fentanyl. But people taking morphine or Dilaudid don't have to worry; neither the juice nor the antifungal drug will have a significant effect on the opioid levels. Believe it or not, this all makes sense.
A 67-year-old man with head and neck cancer who received radiation treatment two weeks earlier was admitted to a palliative care center for treatment of severe pain caused by a massive fungal infection in and around his throat. At the time of his admission, his pain had been treated for one week (with partial success) with a 50 μg/hr fentanyl patch. Shortly after admission, he was given itraconazole, an antifungal drug, to treat the infection. The next day signs of opioid toxicity abruptly appeared. The hospital staff replaced the fentanyl with morphine, the opioid toxicity abated, and the patient was symptom-free two days later. He was later released with a half-dose (25 μg/hr) fentanyl patch, which satisfactorily relieved his pain without causing opioid overdose-like symptoms.
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Resident/Fellow News and Updates |
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A limited number of qualifying residents/fellows will receive a travel scholarship to attend the ASIPP 25th Annual Meeting, March 16-18, 2023 at the Gaylord National Harbor, MD.
Recipients of this scholarship will receive reimbursement for up to three nights' stay at the host hotel at the official ASIPP single-occupancy room block rate. This includes room, tax, and resort fees.
Qualification Requirements:
• Residents and Fellows must register for the meeting to be eligible for reimbursement (The meeting fee is only $25 for Residents and Fellows) Click here to register for the meeting.
• Residents and Fellows must be active participants in their fellowship or residency programs during the meeting dates.
• Residents and Fellows must be active ASIPP members.
• A letter of recommendation from the (non-industry) residency or fellowship program director must include:
- Proof that the resident or fellow is an active participant in the program during the meeting dates.
- A statement verifying that no other travel scholarships for the ASIPP 2023 Annual Meeting have been or will be awarded.
• Must be willing to share your email with sponsoring company of the scholarship program.
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Limited number of scholarships available.
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The first legal sale of recreational weed took place in a dispensary in Manhattan, just meeting the state’s deadline to open a store in 2022.
Kenneth Woodin, a stay-at-home dad, was first in line at the cannabis dispensary in Greenwich Village in Manhattan. He said he wanted to be a part of history after having been arrested on a weed charge in Houston, where he previously lived.
When he finally got inside, after a more than four-hour wait, he bought two bags, each containing an eighth of an ounce of smokable flower called Gorilla Glue for about $90.
It was the kind of transaction that used to take place out of sight. But Mr. Woodin’s purchase on Thursday was made on the first day of licensed sales of recreational cannabis since the state legalized them last year.
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Nurse practitioners (NPs) delivering emergency care without physician supervision or collaboration in the Veterans Health Administration (VHA) increase lengths of stay by 11% and raise 30-day preventable hospitalizations by 20% compared with emergency physicians, says a working paper published by the National Bureau of Economic Research.
That higher preventable hospitalization rate “may reflect two possibilities,” says the working paper, written by David Chan, MD, PhD, associate professor of health policy at Stanford University School of Medicine, and Yiqun Chen, PhD, assistant professor of economics at the University of Illinois at Chicago.
One is that “NPs have poorer decision-making over whom to admit to the hospital, resulting in underadmission of patients who should have been admitted and a net increase in return hospitalizations, despite NPs using longer lengths of stay to evaluate patients’ need for hospital admission.”
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Unlike for many other professions, there is no age limit for practicing medicine. According to international standards, airplane pilots, for example, who are responsible for the safety of many human lives, must retire by the age of 60 if they work alone, or 65 if they have a co-pilot. In Brazil, however, this age limit does not exist for pilots or physicians.
The only restriction on professional practice within the medical context is the mandatory retirement imposed on medical professors who teach at public (state and federal) universities, starting at the age of 75. Nevertheless, these professionals can continue practicing administrative and research-related activities. After "expulsion," as this mandatory retirement is often called, professors who stood out or contributed to the institution and science may receive the title of professor emeritus.
In the private sector, age limits are not formally set, but the hiring of middle-aged professionals is limited.
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Bookmark the ASIPP Annual Meeting Website to stay informed on all announcements and resources related to the meeting.
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Study finds higher earnings and benefits, but unionization still stalled
Labor unionization among U.S. healthcare workers was low in recent years, even though union membership or coverage was tied to higher weekly earnings and better non-cash benefits, researchers reported.
Out of 14,298 healthcare workers surveyed, 13.2% reported union membership or coverage, with no significant trend from 2009 through 2021, according to Xiaojuan Li, PhD, of Harvard Medical School and Harvard Pilgrim Health Care Institute, both in Boston, and colleagues.
Unionized healthcare workers had significantly higher reported mean weekly earnings than non-union workers at $1,165 versus $1,042 (P<0.001), the researchers reported in JAMA.
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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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What this means for neurologic COVID symptoms remains elusive
How can a respiratory pathogen like SARS-CoV-2 cause the nervous system to go haywire? That's the question researchers posed in January, and it's still being asked nearly a year later.
Neurologic complications of COVID are diverse and can be long-lasting, noted Avindra Nath, MD, of the National Institute of Neurological Disorders and Stroke, at the time. "They are largely immune-mediated, the brain endothelial cells being a major target," he told MedPage Today.
Research throughout the year supported this view. In July, an autopsy study of nine COVID patients showed vascular damage with serum proteins leaking into the brain parenchyma, accompanied by widespread endothelial cell activation. Consistent with other studies, SARS-CoV-2 virus was not detected in the brain.
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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 |
Jason L. Chang, MD, Peyton Johnson, DO, Ajay K. Patel, MD, Neal Rakesh, MD, and Amitabh Gulati, MD
Abstract
Background: Intra-articular hyaluronic acid (HA) injections in non-cancer patient populations have shown some positive outcomes in treating avascular necrosis, however outcomes in the oncology population are scarce. This pilot study describes 7 oncology patients who received ultrasound-guided HA injections and their associated outcomes.
Case Report: This study included 4 female and 3 male patients with radiographic evidence of avascular necrosis. Six of the patients had avascular necrosis of the hip, while one patient had avascular necrosis of the shoulder. All patients underwent single or multiple ultrasound-guided injection(s) of hyaluronic acid to the affected joint. Outcomes were tracked using a combination of subjective pain and functional improvement and/or numeric pain scale. Five patients had improvement in their symptoms, while 2 patients did not.
Conclusion: Intra-articular HA may be a viable alternative to the treatment of avascular necrosis in oncology patients.
Keywords: Avascular necrosis, cancer pain, case series, hyaluronic acid, joint pain
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| RETROSPECTIVE STUDY |
Jiao Kuang, MD, Ge Luo, MD, Jiachun Tao, MD, Miao Xu, MD, Jie Fu, MD, Baoxia Zhao, MD, and Huadong Ni, MD, PhD
Abstract
BACKGROUND: Primary palm hyperhidrosis (PPH) is a chronic disease characterized by uncontrolled palm-sweating exceeding physiological needs. It negatively impacts the quality of life of the patients and can lead to different degrees of psychological problems. Currently, there are a variety of treatment options for PPH, of which thoracotomy is a first-line treatment that has shown good efficacy. However, since it is an invasive procedure requiring general anesthesia and is often associated with high costs and serious complications, better alternatives should be explored. Computed tomography (CT)-guided percutaneous puncture of radiofrequency thermocoagulation (RF-TC) of the thoracic sympathetic nerve is a promising alternative treatment. It is a minimally invasive procedure that can be performed under local anesthesia and is associated with rapid recovery. However, the factors affecting the duration of the surgery-related benefits and outcomes of CT-guided percutaneous RF-TC of the thoracic sympathetic nerve are unclear.
OBJECTIVES: To investigate the factors influencing the outcomes of CT-guided percutaneous RF-TC of the thoracic sympathetic nerve in patients with PPH.
STUDY DESIGN: A retrospective study.
SETTING: This study was conducted at the Pain Department of Jiaxing University Affiliated Hospital (Jiaxing, China).
METHODS: After approval by the Ethics Committee of the Affiliated Hospital of Jiaxing College, the data of 232 corresponding patients were assessed. The Kaplan-Meier method was used for survival analysis. Univariate and multivariate analyses were performed to identify factors associated with PPH and to construct a nomogram for predicting postoperative recurrence. Time-independent receiver operating characteristic (ROC) curve analyses were performed to assess the nomogram’s predictive capacity.
RESULTS: In the one-year survival analysis model, gender (HR = 1.573, 95%CI: 0.844 to 2.934), age (HR = 0.965, 95%CI: 0.915 to 1.018), disease course (HR = 0.960, 95%CI: 0.908 to 1.015), palm temperature difference (HR = 0.377, 95%CI: 0.287 to 0.495), perfusion index difference (HR = 0.590, 95%CI: 0.513 to 0.680) and hyperhidrosis disease severity scale (HR = 1.963, 95%CI: 0.769 to 5.011) were identified as statistically significant factors in univariate analysis, while palm temperature difference (HR = 0.589, 95%CI: 0.369 to 0.941) and perfusion index difference (HR = 0.357, 95%CI: 0.588 to 0.968) were the independent factors in the multivariate Cox proportional hazards risk model. In the 2-year survival analysis model, palm temperature difference (HR = 0.353, 95%CI: 0.261 to 0.478), perfusion index difference (HR = 0.589, 95%CI: 0.510 to 0.680) and hyperhidrosis disease severity scale (HR = 1.964, 95%CI: 0.771 to 5.006) were the statistically significant factors while palm temperature difference (HR = 0.507, 95%CI: 0.321 to 0.799) and perfusion index difference (HR = 0.789, 95%CI: 0.625 to 0.995) were the independent factors.
LIMITATIONS: This single-center retrospective study was limited by its small sample size, short follow-up time, and the possibility of bias resulting from the non-random patient selection.
CONCLUSION: Palm temperature difference and perfusion index difference were independent risk factors associated with prolonging the surgical benefits and reducing postoperative recurrence of CT-guided RF-TC of the sympathetic nerves in patients with PPH.
KEY WORDS: Primary palmar hyperhidrosis, radiofrequency thermocoagulation, COX regression, hyperhidrosis disease severity scale
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| RETROSPECTIVE STUDY |
Ji Yeong Kim, MD, Sungwon Yang, MD, Donghyun Kim, MD, Youngkyung Park, MD, and Young Hoon Kim, MD, PhD
Abstract
BACKGROUND: Cervical interlaminar epidural injection (CILEI) is commonly used to treat acute or chronic pain that affects the head, neck, and upper extremities. Thus far, studies on CILEI have focused on determining the optimal volume of contrast medium or analyzing the spread of contrast medium during a CILEI. To our knowledge, few studies have attempted to assess the correlation between epidurogram patterns and clinical outcomes of CILEI.
OBJECTIVES: This study aimed to investigate the relationship between contrast medium spread and pain relief after a CILEI in patients who complained of neck and/or unilateral upper extremity pain.
STUDY DESIGN: Retrospective cohort study.
SETTING: Tertiary university hospital.
METHODS: Patient demographics, pain duration, and radiographic findings, including cervical simple radiograph and magnetic resonance imaging, were reviewed from medical records. The spread pattern of contrast medium during a CILEI was analyzed based on anteroposterior (AP) and lateral fluoroscopic views. The spread pattern in the AP view was classified into 4 categories using predetermined anatomical references, including the medial border, bisector, and lateral border of the articular pillar at the targeted vertebral level. The spread pattern in the lateral view was divided into 2 groups based on whether the contrast medium was present at the ventral epidural space. Every CILEI procedure was performed under fluoroscopic guidance by skilled experts. A responsive outcome was defined as a reduction in the numeric rating scale for pain by more than 50% at one month postoperatively compared to preoperatively.
RESULTS: Among 656 patients, 526 were excluded from the analysis according to predetermined criteria. The remaining 130 patients were analyzed, and 78 (60%) patients showed responsive results one month after a CILEI. According to a multivariable logistic regression analysis, the negative predictors of a CILEI were long symptom duration (P = 0.045), high grade of central stenosis (P = 0.022), and limited spread of contrast medium solely within the central canal in the AP view (P = 0.008).
LIMITATIONS: The limitations of this study include its retrospective design, absence of clinical parameters other than pain intensity, and short follow-up period.
CONCLUSIONS: If the duration of symptoms is lengthy, central stenosis is severe, or contrast medium spread is limitedly solely within the central canal and does not reach the dorsal root ganglion any further, the outcome after a CILEI is likely to be poor. Therefore, efforts should be made to spread injectate around the dorsal root ganglion at the target level.
KEYWORDS: cervical transforaminal epidural injection; contrast medium; dorsal epidural space; dorsal root ganglion; epidurogram; injectate; spread pattern; ventral epidural space; Cervical interlaminar epidural injection.
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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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