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CMS has published the 2024 Physician Fee Schedule, and the news is not good. If Congress does not act, a sequestration order will be issued within 15 days of the end of the congressional session, reducing Medicare reimbursements by 4%, beginning in 2024. Please take action to preserve our patients’ access to care.
Medicare payment cuts for physicians in 2024 include:
Medicare Physician Fee Schedule Cuts = -3.36%
- The Centers for Medicare and Medicaid Services are proposing a -3.36% decrease in payments in 2024 for services under the Medicare Physician Fee Schedule.
- Medicare physician payment has been reduced 26% adjusted for inflation from 2001–2023.
Medicare Sequestration = -2%
- Medicare sequestration of -2% has now been extended through 2032, because of a temporary delay for 1½ years.
PAYGO = -4%
- PAYGO cuts of -4% have never been enacted in the past; however, if Congress leaves without action, these will go into effect.
We encourage every ASIPP member to join us in the effort to contact every member of Congress. You can start by contacting the senators and representatives of your district. It is essential that we act soon and participate in meetings with members of our Congress, as well as starting a letter campaign involving physicians, providers, nurses, staff and most importantly, the patients.
Click here to see the enclosed fact sheet.
If you choose to send your own letters, click here to view a sample physician letter you may want to use.
Click here to submit a physician letter through VoterVoice.
To get your patients involved, we have created a sample patient letter. You can ask your patients to sign the letter and then have them or your staff enter the letter into VoterVoice.
Click here to submit patient letters through VoterVoice.
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ASIPP's Virtual Review Courses begin this weekend. Have you registered?
Time is running out to register!
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Interventional Techniques in IPM
Review Course & Cadaver Workshop
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Regenerative Medicine
Review Course & Cadaver Workshop
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DEA Seeks Input on Telemedicine Prescribing of Controlled Substances
The Drug Enforcement Administration (DEA) held two public listening sessions on Sept. 12 and 13 to explore the possibility of creating special registration that would permit providers to prescribe medically necessary drugs by telehealth. The registration would represent a potential long-term expansion of a policy that began during the federal COVID-19 Public Health Emergency (PHE). The DEA is “open to considering” such a policy, the agency said in a statement announcing the listening sessions.
During the PHE, the DEA granted temporary exceptions to existing regulations, allowing the prescribing of controlled substances via telemedicine encounters, even when the prescribing practitioner had not conducted an in-person medical evaluation of the patient, “in order to prevent lapses in care.”
A proposed rule from the DEA released on March 1 would have significantly modified this policy, allowing for the telemedicine prescription of nonnarcotic Schedule III to V controlled substances with an initial 30-day supply limit and the requirement of an in-person evaluation with the prescribing practitioner for any further prescriptions. A similar policy was proposed for buprenorphine prescribing in May, after a flood of responses—among the highest number of public comments received on a notice of proposed rulemaking in the DEA’s history, the agency reported. The DEA extended its existing policies on telehealth prescribing of these substances until at least November 2023.
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Virtual
October 28, November 4, 11 & December 9
ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam; ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine
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Can Rapid COVID Tests Reveal More Than a Positive/Negative Result?
Experts agree that rapid antigen test kits can show degrees of infectiousness
At-home rapid COVID-19 tests can reveal more about viral load than a simple positive/negative result, according to experts.
"By definition, the basic technology suggests that you somehow have to go from a negative 'zero' line to a dark line, and within that window -- that 0 to 100% -- there's obviously a gradient," Michael Mina, MD, PhD, chief science officer for eMed and a well-known public health expert who shares his expertise and views on the social media site known as X and in numerous publications, told MedPage Today.
Mina recently shared a schematic of rapid COVID test results and the potential implications of their variability. Mina has been a vocal proponent of this testing technology, so people can better understand their own infection, and he has not been alone in highlighting these ideas. Researchers have shown that variations in COVID test results can reveal different aspects about an individual's infection and, critically, how contagious they are at a given moment.
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Excellent opportunities for Residents & Fellows
at ASIPP's 2024 Annual Meeting:
- Resident & Fellow Scholarship
- Abstract Session and Podium Presentation for Best Abstracts during General Session
- Half-Day Session dedicated to Young Physicians in Pain Management
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Everything (Maybe) You Wanted to Know About Sarilumab for PMR
Published details may raise questions about FDA's approval
Clinicians and others curious about the data underlying February's FDA approval of sarilumab (Kevzara) for polymyalgia rheumatica (PMR) can now be sated, at least partially, with publication today of the chief registration trial's detailed results.
In the so-called SAPHYR trial, 28% of PMR patients who had experienced disease flares during a 14-week corticosteroid taper achieved remission sustained over 1 year with sarilumab treatment, versus 10% of a placebo group assigned to a longer tapering schedule, according to Robert Spiera, MD, of the Hospital for Special Surgery in New York City, and colleagues. The difference of 18 percentage points was statistically significant (95% CI 4-32) in the 118-patient trial.
Some adverse events were more common in the sarilumab group, as expected from the drug's mechanism of action (it blocked the interleukin-6 receptor), as were treatment-related discontinuations, the investigators reported in the New England Journal of Medicine.
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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.
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Plan Your Participation Now!
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COVID Vaccine, Infection May Affect Migraine Course Slightly
Researchers compared headache diary data before and after vaccination or infection
COVID vaccination or SARS-CoV-2 infection may play a small role in migraine worsening, preliminary data suggested.
While some patients reported migraine worsening after either vaccination or infection, headache diaries did not reflect significant differences in migraine frequency, reported Patricia Pozo-Rosich, MD, PhD, of Vall d'Hebron Hospital in Barcelona, Spain, and co-authors.
"Our preliminary data point to a negligible role of the infection and vaccination on migraine worsening and to the possible presence of a nocebo effect in these settings, as a remarkable proportion of patients had a clear perception of migraine worsening," Pozo-Rosich and colleagues wrote in the European Journal of Neurology.
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Growing 'Tranq' Threat Poses Challenges for PCPs
The widening threat of the animal tranquilizer xylazine, otherwise known as tranq, which has been found in illegally manufactured fentanyl, necessitates wider testing, a better understanding of its effects, and more research on treatment options, according to a narrative review published Monday in the Annals of Internal Medicine.
"A lot of doctors and providers are asking about this drug," said Joseph D'Orazio, MD, an addiction medicine specialist and medical toxicologist at Cooper University Healthcare in Camden, New Jersey, who led the review.
Xylazine is believed to prolong or intensify the effects of opioids, making it a popular additive to illegally produced opioids, particularly fentanyl, according to the Drug Enforcement Administration. Users end up in a zombie-like state with slowed breathing, and they sometimes develop skin ulcers. Because xylazine is not an opioid, common antidotes such as naloxone are ineffective. The White House has called the fentanyl-xylazine combo an "emerging threat."
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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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Illicit Steroids: If MDs Don't Ask, Patients Won't Tell
Before he attended medical school, Thomas O'Connor, MD, had a not-very-well-kept secret: As a competitive powerlifter, he had used steroids to build strength.
Now an internist and clinical instructor of medicine at the University of Connecticut in Farmington, O'Connor's practice focuses on the needs of men taking testosterone and other anabolic steroids — a group he feels is poorly understood and largely neglected by conventional medical care, perceptions borne out by a 2020 study of steroid users he helped conduct.
"They felt discriminated against, they did not feel comfortable working with their physicians, and they felt that the doctors did not know what they were doing," O'Connor told Medscape Medical News. His patients often express anger and frustration with doctors they had seen previously, he added.
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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 |
Postdural Puncture Headache, Subdural Hematoma, and Sixth Cranial Nerve Palsy Lumbar Following Spinal Drain, Resolved with Epidural Blood Patch: Case Report
Edward M. Walton, MD, and Lisa V. Doan, MD
Abstract
BACKGROUND: Postdural puncture headache (PDPH) is a known potential complication of lumbar drain placement. Data regarding incidence of PDPH after lumbar drain placement varies, with a range of 0% to 47%. Furthermore, spinal drain placement has been associated with a significantly increased risk of debilitating neurologic complications.
CASE REPORT: In this article, we describe the case of a patient who developed PDPH, subdural hematoma, and abducens nerve palsy after lumbar drain. The patient was treated successfully with epidural blood patch. To our knowledge, this is the first case report of a patient who developed all 3 of these complications following spinal drain placement.
CONCLUSION: Dural puncture, whether accidental or purposeful, carries a risk of multiple serious neurological sequelae. After spinal drain placement, close monitoring for symptoms of intracranial hypotension should ensue with a plan for treatment in the event the patient develops a PDPH or other neurologic sequelae.
KEY WORDS: Epidural blood patch, headache, postdural puncture headache
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| SYSTEMATIC REVIEW |
Systematic Review and Meta-Analysis of Effectiveness of Therapeutic Sacroiliac Joint Injections
Rajesh N. Janapala, MD, Emilija Knezevic, Nebojsa Nick Knezevic, MD, PhD, Rachana Pasupuleti, MD, Mahendra R. Sanapati, MD, Alan D. Kaye, MD, PhD, Vidyasagar Pampati, MSc, and Laxmaiah Manchikanti, MD
Abstract
BACKGROUND: The sacroiliac joint is one of the proven causes of low back and lower extremity pain, ranging from 10% to 25% in patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis. Despite the difficulty of diagnosis, multiple therapeutic modalities including surgical and nonsurgical interventions have been utilized. Among the interventional modalities, intraarticular injections are commonly utilized.
OBJECTIVE: To evaluate the therapeutic effectiveness of intraarticular injections in the sacroiliac joint.
STUDY DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies of the therapeutic effectiveness of intraarticular injections of the sacroiliac joint utilizing the Preferred Reporting Items For Systematic Reviews And Meta-Analyses (PRISMA) checklist.
METHODS: The available literature on therapeutic sacroiliac joint intraarticular injections was reviewed. The quality assessment criteria utilized were the Cochrane review criteria to assess risk of bias, the Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials, and the Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for nonrandomized studies. The level of evidence was based on best evidence synthesis with modified grading of qualitative evidence from Level I to Level V.
Data collection was performed including literature published from 1966 through December 2022, as well as manual searches of the bibliographies of known articles.
OUTCOME MEASURES: Primary outcome measures include pain relief and improvement in functional status at 3 months for a single intervention. Only the studies performed under fluoroscopic guidance, with at least 3 months of follow-up were included. Duration of relief was categorized as short-term (< 6 months) and long-term (> 6 months).
RESULTS: Based on the qualitative and quantitative analyses with a single-arm meta-analysis and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system of appraisal, and the inclusion of 11 RCTs (5 positive, 6 negative) and 3 observational studies (2 positive, one negative), the evidence was Level III or fair in managing low back pain of sacroiliac joint origin with sacroiliac joint injections.
LIMITATIONS: This systematic review and meta-analysis are limited by lack of eligible studies, inconsistencies among the available studies, variations in techniques, variable diagnostic standards for inclusion criteria, and finally, the inability to correlate the results and perform an optimal systematic review and meta-analysis.
CONCLUSION: The present systematic review and meta-analysis show an inability to perform conventional dual-arm analysis, whereas a single-arm meta-analysis demonstrated a difference of approximately 3 points on the Numeric Rating Scale (NRS) and 8 points on the Oswestry Disability Index (ODI). However, there were no studies that considered >= 50% relief as the criterion standard. Overall, the qualitative and quantitative evidence combined shows Level III or fair evidence for therapeutic sacroiliac joint injections for managing low back pain of sacroiliac joint origin.
KEY WORDS: Chronic low back pain, sacroiliac joint pain, sacroiliac joint dysfunction, sacroiliitis, sacroiliac joint injection, sacroiliac joint nerve blocks, radiofrequency ablation, conventional radiofrequency, pulsed radiofrequency
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| SYSTEMATIC REVIEW |
Clinical Effectiveness of Posterior Annular Targeted Ablative Decompression as an Alleviative Intervention for Lumbosacral Discogenic Pain: Systematic Review and Meta-analysis
Jung Hwan Lee, MD, PhD, Youn Joo Lee, BS, Hahck Soo Park, MD, PhD, and Jun Ho Lee, MD, PhD
Abstract
BACKGROUND: Various percutaneous intradiscal procedures have been implemented to manage lumbosacral discogenic pain. But most of these procedures simply end up manipulating the central nucleus pulposus or the inner annulus, instead of accessing the posterior outer annulus where the actual, major pain generators exist. Thus, more localized percutaneous techniques, specifically derived to address the pathologic tissues creeped between the torn, posterior annulus and hyperplastic sinuvertebral nerve, have been devised. However, the clinical effectiveness of these “more” accurate procedures is still skeptical.
OBJECTIVES: This study has investigated whether the posterior annular targeted decompression was a useful method to treat lumbosacral discogenic pain in terms of pain control or functional improvement.
STUDY DESIGN: A systematic review and meta-analysis.
SETTING: Primary clinic and tertiary referral center.
PATIENTS: Published past references that have dealt with the issue of clinical effectiveness after the posterior annular targeted decompression as a treatment of discogenic pain in terms of pain control and functional improvement.
METHODS: A literature search was performed using MEDLINE, EMBASE, Cochrane Review, and KoreaMed databases from the studies published until December 2022. After reviewing titles, abstracts, and full texts of 65 studies during the initial database search, 12 studies were included in a qualitative synthesis, and 9 trials from 8 studies were in quantitative meta-analysis. Data, including pain and functional scores, were extracted and were analyzed using a random effects model to obtain statistical significance of mean difference. Quality assessment and evidence level were established in accordance with the Grading of Recommendations Assessment, Development and Evaluation methodology.
RESULTS: Finally, 12 single-arm studies without the control group were included. All studies showed significant pain reduction and functional improvement from a 1-month to 1-year follow-up period. A meta-analysis showed significant reduction in pain scores at 1 month, 3 months, 6 months, and 1 year and functional scores at 1 month, 6 months, and 1 year. The level of evidence was very low because of the nonrandomized study design and inconsistency and imprecision across studies.
LIMITATIONS: Only single-arm studies comparing clinical results before and after treatment without the control group were analyzed. The statistical and clinical heterogeneity, due to different aspect of techniques across the studies and a relatively small number of patients, reduced the evidence level.
CONCLUSIONS: Comprehensive reviews of selected articles revealed posterior annular targeted decompression could be recommended as treatment option in the patients with discogenic pain who have failed in attaining clinical improvement after the conservative managements under weak evidential strength support.
KEY WORDS: Discogenic pain, minimal invasive technique, percutaneous targeted disc decompression, systematic review, meta-analysis
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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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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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