Medicare Finalizes 3.4% Payment Cut for Physician Fees in 2024

Specialty groups decry "untenable" payment cuts

Physicians would receive a 3.4% cut in their Medicare reimbursement under a final rule released Thursday by the Centers for Medicare & Medicaid Services (CMS).

Overall, the finalized calendar year 2024 physician fee schedule conversion factor is $32.74, a decrease of $1.15, or 3.4%, from 2023, CMS said in a press release.

CMS's Positive Spin

The press release cast the final rule in a generally positive light, noting that it would "support primary care, advance health equity, assist family caregivers, and expand access to behavioral and certain oral health care ... [The] final rule also provides payment for principal illness navigation services to help patients and their families navigate cancer treatment and treatment for other serious illnesses."

"CMS remains steadfast in our commitment to supporting physicians and ensuring that people with Medicare have access to the care they need to stay healthy as well as navigate health conditions they are facing," said CMS Administrator Chiquita Brooks-LaSure in a statement. "CMS is taking important steps toward those goals in this rule."



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Medscape Physicians and AI Report 2023: A Source of Help or Concern?

With each passing day, a future with artificial intelligence (AI) playing a significant role in medicine seems more assured. Some physicians may be enthusiastic about a future in which AI takes over many administrative tasks, but others have misgivings. Medscape surveyed US physicians about their expectations for AI in their workplace - and how they anticipate their employers harnessing the technology.

How Physicians Feel About AI's Future in Their Workplace

At this still-early stage of adoption of AI algorithms in the medical workplace, 58% of practicing US physicians told Medscape they're not yet enthusiastic about AI's future.

"To see over 40% enthusiastic is great," says Eric J. Topol, MD, Medscape editor-in-chief and co-host of the Medicine and the Machine podcast. "There's very little penetration of AI in the medical workplace yet, not a lot of data about it, so it's a very significant percentage."

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Mind-altering ketamine becomes the latest pain treatment, despite little research or regulation

As U.S. doctors scale back their use of opioid painkillers, a new option for hard-to-treat pain is taking root: ketamine, the decades-old surgical drug that is now a trendy psychedelic therapy.

Prescriptions for ketamine have soared in recent years, driven by for-profit clinics and telehealth services offering the medication as a treatment for pain, depression, anxiety and other conditions. The generic drug can be purchased cheaply and prescribed by most physicians and some nurses, regardless of their training.

With limited research on its effectiveness against pain, some experts worry the U.S. may be repeating mistakes that gave rise to the opioid crisis: overprescribing a questionable drug that carries significant safety and abuse risks.

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Acceptance and Commitment Therapy Improves Chronic Pain Outcomes

Key Point

After receiving treatment, various studies showed that depression symptoms, anxiety symptoms, psychological inflexibility, and pain catastrophizing were reduced.

Acceptance and Commitment Therapy (ACT) improves outcomes related to chronic pain, according to a study published in The Journal of Pain.

One in 3 people in the United States suffers from chronic pain, producing a substantial economic impact. Due to the complexity of chronic pain and the involvement of many biopsychosocial factors, interdisciplinary pain management may be the best coping option for patients. Biopsychosocial management involves cognitive-behavioral therapies (CBT), including ACT. The number of clinical trials and systematic reviews assessing the benefits of ACT has increased. Thus, researchers conducted a systematic review to summarize and critically analyze ACT’s benefits for pain intensity, pain-related functioning, psychological factors, and quality of life in adults with chronic pain. The study evaluated 9 systematic reviews covering 84 meta-analyses of interest.

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Virtual

December 9 & 16, 2023

ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam;

ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine

January 20, 2024

ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam;

ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine;

Controlled Substance Management (CSM) Competency Exam

February 17, 2024

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

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June 21, 2024

ABIPP Part II Practical Examination

Lab Venue: Oquendo Center, 2425 E. Oquendo Rd, Las Vegas, NV 89109

VA says it's open to exploring the use of psychedelics to treat PTSD



A military veteran says psychedelics have allowed him to get his life back. He's among a growing number of vets using them to treat PTSD, but the idea is not without controversy.  

Potential dangers and the likelihood of VA allowing their use

"I was homeless. My tent and the materials I was living in was about 250 yards that way. I was living in the woods," John Lewandowski said.

Lewandowski returned from Afghanistan with a traumatic brain injury and a drinking problem. He had left the war but an IED explosion and the horrors of combat remained in his head, leading him deeper into addiction and isolation. But he says the help he got from the Veterans Administration failed to break his downward spiral.  

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Excellent opportunities for Residents & Fellows

at ASIPP's 2024 Annual Meeting:



1. Resident & Fellow Scholarship - Limited to 100!
2. Abstract Session (April 4, 3:30-5:30pm) and Podium Presentation for Best Abstracts during General Session (April 5, 3:30-4:15pm)
3. Half-Day Session dedicated to Young Physicians in Interventional Pain Management

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Can Thermal Biofeedback Reduce Pain and Anxiety?





Top Line

A novel handheld tool may hold promise for reducing anxiety and pain and improving sleep quality, according to research presented at Lifestyle Medicine 2023, the annual meeting of the American College of Lifestyle Medicine.

Methodology

• Franklin Somchith Ly, a PhD candidate in mechanical engineering at the University of California, Santa Barbara, developed CalmStone, a product that assesses blood flow to the hand with an infrared temperature sensor and changes color as blood vessels expand during relaxation.
• Exercises such as intentional breathwork, visualization, and muscle relaxation change the color displayed by the device.
• Ly examined how measures of anxiety, sleep quality, and chronic pain changed after participants used the instrument. Ten participants completed a study assessing anxiety. Eight participants were enrolled in a sleep study where they completed biofeedback sessions before bed for 2 weeks, and 15 participants performed biofeedback twice daily and reported their levels of anxiety and pain.

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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 |

CDC unveils first federal campaign to address health care worker burnout

Key Takeaways

• The campaign’s resources will help hospital leaders improve workflow and reduce burnout.
• These resources will teach leaders to speak publicly about mental health and understand their workforce.

The CDC’s National Institute for Occupational Safety and Health, or NIOSH, announced the launch of the first federal campaign aimed at providing resources to hospitals amid worsening health care worker burnout.

“Even before the pandemic, [health care workers (HCWs)] faced challenging working conditions that lead to burnout. This includes long work hours, risk for hazardous exposures, stressful work, and high administrative burdens,” John Howard, MD, director of NIOSH, said in a press release. “Hospital leaders need support to implement organizational changes. Practical adjustments can reduce burnout and strengthen professional well-being within their hospitals.”

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practice management webinar, December 12!

AI 'Sees' When Patients Are in Pain

When a patient cannot say how much pain they are in, such as when they are sedated, have dementia, or are nonverbal, clinicians turn to facial expressions to guide treatment.

Tension, frowning, or grimacing may indicate pain, and bedside assessment scales consider those elements.

Clinicians typically must be with patients to complete those measures, however, which is not always possible in a busy hospital or nursing home, and this can lead to delays in administering care.

That's one reason researchers are training artificial intelligence (AI) models to take up the task.



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| CASE REPORT |

PRP Therapy for the Treatment of Sacral Fracture and Coccydynia: A Case Report

Gary Charliyan, MS, and Joseph Pejman Enayati, DO

Abstract

BACKGROUND: Platelet-rich plasma (PRP) therapy has shown promising results in promoting healing and reducing inflammation in musculoskeletal injuries. This case report highlights the successful use of PRP injection therapy in a 37-year-old woman pedestrian with a sacral fracture and coccydynia from a pedestrian-vehicle accident.

CASE REPORT: The patient underwent traversing sacral S3 anterior cortex vertebral fracture and sacrococcygeal PRP injection under fluoroscopic guidance. PRP injection therapy led to significant improvement in tailbone pain, and subsequent injection led to further improvement in residual symptoms. Follow-up evaluations showed complete healing of the S3 fracture with good bony fusion and alignment.

CONCLUSIONS: PRP injection therapy can be a safe and effective treatment option for bone fractures and injuries, especially those that may be difficult to manage with traditional approaches. As more clinical studies and case reports are conducted, the full potential of PRP in bone healing and regeneration may be further elucidated.

KEY WORDS: Platelet-rich plasma, sacral fracture, coccydynia, case report, minimally invasive

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| RANDOMIZED CONTROLLED TRIAL |

Analgesic Effect of Addition of Pectointercostal Block to Serratus Anterior Plane Block in Breast Surgeries: A Randomized, Controlled Trial

Adel Ibrahim Hozien, MD, Amr Mohamed Helmy, MD, Hala Mohamed Koptan, MD, Yasser Esaam Elfeil, MD, Maha Mahmoud Soliman Yakout, ., and Hatem Bahgat Ahmed Abo Elwafa, MD

Abstract

BACKGROUND: Ultrasound-guided serratus anterior plane block (SAPB) is an efficient perioperative analgesic modality for breast surgeries. SAPB does not block the anterior cutaneous branches of the intercostal nerves; thus, it does not provide adequate analgesia for the parasternal region and the medial side of the breast. A new parasternal block, the pectointercostal fascial plane block (PIFB) has been developed to overcome this issue.

OBJECTIVES: The study aimed to evaluate the perioperative analgesic effect of using PIFB in addition to SAPB. The primary outcome was to evaluate the postoperative pain score. The secondary outcomes were to assess perioperative opioid requirements, hemodynamic stability, and the satisfaction of the patient and surgeon.

STUDY DESIGN: The current study was a prospective, double-blinded, randomized controlled study. The current study was registered at the Pan-African Clinical Trials Registry (PACTR202001789968542) and was designed after obtaining ethical institutional approval (Institutional Review Board No 00012098, Federalwide Assurance No 00018699).

SETTING: The study involved 60 women between 21 and 69 years old with breast cancer who were scheduled for modified radical mastectomy or conservative breast surgeries in a university hospital.

METHODS: After verbal and informed written consent, the patients were allocated to Group 1, which received SAPB, and Group 2, which received SAPB with PIFB. We assessed the Visual Analog Scale (VAS), perioperative opioid requirements, intraoperative hemodynamic stability, rescue analgesia, and complications. Patient and surgeon satisfaction were surveyed using a questionnaire where one is very dissatisfied and 5 is very satisfied.

RESULTS: Intraoperative mean arterial blood pressure (MABP) and heart rate were significantly lower in Group 2 (SAPB+PIFB). The number of patients who needed intraoperative fentanyl was also significantly lower in Group 2 (SAPB+PIFB) (P value = 0.010). Postoperative VAS showed no significant difference in both groups. The number of patients who needed postoperative rescue morphine, time for the first rescue analgesia, first morphine dose (mg), and total opioid consumption were also comparable for both groups. Patient satisfaction and surgeon satisfaction were comparable for both groups (P values = 1.000 and 0.496, respectively).

LIMITATIONS: VAS was not recorded during movements and no follow-up was done to detect the potential effect on chronic postmastectomy pain. Moreover, after reviewing the literature, there was no efficient data about adding PIFB with different regional blocks for breast surgery.

CONCLUSIONS: The number of patients who needed intraoperative fentanyl, as well as the MABP and heart rate were significantly lower in Group 2 (SAPB+PIFB). Postoperative vital signs, VAS, postoperative analgesic requirements, and opioid consumption were comparable for both groups. Patient satisfaction was comparable for both groups, while surgeon satisfaction was higher in Group 2 (SAPB+PIFB) but statistically not significant.

KEY WORDS: Pectointercostal, fascial plane block, serratus anterior plane block, breast surgery, regional analgesia for mastectomy

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| SURVEY |

Comparative Descriptive Analysis of Physician Versus Patient-Directed Gabapentin Usage In Chronic Pain – A Preliminary Report

Qing Zhao Ruan, MD, Christopher L. Robinson, MD, Thomas T. Simopoulos, MD, James C. Burns, MD, Sravya V. Madabhushi, MD, and Jatinder S Gill, MD

Abstract

BACKGROUND: Gabapentin is one of the most common medications employed in Pain Medicine, specifically targeting the management of neuropathic pain. We are most familiar with the incremental dosing strategy where a ceiling dose is eventually attained guided by efficacy and patient tolerance, after which a fixed dosing regimen is prescribed. We propose that autonomous short-term dose variations per patient could have rapid clinically significant effects in the management of chronic pain.

OBJECTIVES: This study examines the frequency at which patients take gabapentin on a fixed vs variable schedule and how the pattern of gabapentin use correlates with efficacy, side effects, and patient satisfaction.

STUDY DESIGN: Single institution, cross-sectional observational survey study with data collection performed over 2 phases as a pilot for proof of concept.

SETTING: Remote contact via telephone with researchers calling from a quiet, private location within the hospital complex conducive for confidential conversation.

METHODS: Patients recently prescribed gabapentin were queried on the patterns of use and self-perceived efficacy, satisfaction, and side effects in accordance to a standardized oral script. Patients selected met the criteria of being new patients freshly prescribed gabapentin who have been consistently on the medication for at least a month, while having chronic pain symptoms for over 3 months. Responses were collected in the form of a 5-point Likert scale. Statistical analyses were performed using GraphPad Prism.

RESULTS: Of the 222 patients, 92 patients agreed to participate in the survey for a response rate of 41.4. Of these, 51% had terminated the medication for various reasons. Of the patients still taking gabapentin, 73% were on a fixed schedule, while 27% were on a variable dosing schedule. Variable dosing cohort reported better efficacy (P = 0.027) and satisfaction (P = 0.036), while the side-effect profile between the 2 groups was similar.

LIMITATIONS: The study is limited by its nature of being a pilot, single-institution study performed on a relatively small sample size. None of the patients we surveyed had been given the autonomy to adjust gabapentin doses by their providers and this could significantly reduce the proportion of patients who would be encouraged to run a variable dosing regimen.

CONCLUSIONS: This pilot study suggests that a significant portion of patients choose to administer variable doses of gabapentin and associate this with better efficacy and satisfaction. A larger study is needed to confirm this supposition. Based upon this pilot study, the variable dosing option may be an option for improved therapeutic efficacy or as an alternative to those whose lifestyles do not allow for fixed dosing regimens. Discussion of the risks of gabapentin, including respiratory depression, and clear dosage parameters of use, would need to be outlined when considering a variable dose regimen.

KEY WORDS: Gabapentin, chronic pain, physician directed, patient directed



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