March 12, 2006

Supply Code SA076 Added to CPT Code 95991

ASIPP joined forces with the American Academy of Pain Medicine and the American Society of Anesthesiologists in petitioning the Practice Expense Review Committee (PERC) to recommend that supply code SA076 (kit, refill for implantable medication pump with a price of $28) be added to CPT Code 95991.

Because of this request, the SA076 supply code was considered and later determined to be a CMS administrative error. Because the addition was handled administratively between AMA and CMS, the code addition was made without being added to the PERC agenda.

Medicaid Anti-Fraud Effort Launched

The federal government is preparing a war on Medicaid fraud, projected to rob federal coffers of up to $39 billion by 2016. This year's budget includes $5 million, which will increase to $75 million by 2009, for a CMS program to tackle abuse in a systematic way. The law instructed the agency to hire 100 people to combat fraud.

A key focus of the federal effort will be on creating a truly national campaign to compare claims filed in Medicaid and Medicare. This identifies patterns of potentially fraudulent behavior that would go unnoticed alone. Dept. of Health and Human Services Inspector General Daniel Levinson said in a hearing on Capitol Hill last month that his office's priorities would be to work more closely with states on this effort. It also plans to initiate more projects that cross state lines to find medical professionals "who abuse this vulnerable population."

Levinson identified priority areas as nursing home quality of care and pharmaceutical manufacturer fraud, including firms' overstatements of the cost of buying drugs, underpayments of rebates and kickbacks for promoting drugs. Also mentioned were "drug diversion," in which pain medications such as Oxycontin are unnecessarily prescribed in exchange for kickbacks or in cases where doctors themselves sell or use the drugs.

The Deficit Reduction Act has allocated funds to bust Medicaid fraud under the new Medicaid Integrity Program. The goal is to provide the resources CMS needs to lead a coordinated effort with states to identify potential abuse and return cash to state and federal treasuries - $5 million in 2006; $50 million in 2007; $50 million in 2008; and $75 million in 2009 and thereafter.

Read testimony a from the federal financial management, government information and international security subcommittee of the Senate Homeland Security and Governmental Affairs Committee: "Bolstering the Safety Net: Eliminating Medicaid Fraud,", March 28 – U.S. Senate Committee

Pain Physician Journal Now Accepting Article Submissions

The Pain Physician Journal, recently included and indexed on MEDLINE, is accepting manuscript submittals for publication consideration. Pain Physician is a peer-reviewed, multi-disciplinary journal written by and directed to an audience of interventional pain physicians, clinicians and basic scientists with an interest in interventional pain management and pain medicine.

Pain Physician is the official publication of the American Society of Interventional Pain Physicians (ASIPP). Pain Physician requires that all manuscripts be prepared in accordance with the uniform requirements for manuscripts submitted to biomedical journals, with the exception of reference citations and format. For specific information go to http://www.painphysicianjournal.com/infoforauth1.php   To Submit manucripts to editor@painphysician.com

Register for Review Courses & Exams – Few Openings Remain – Last Day for Exam Reduced  Price – Thursday,  April 13

Come to the “Windy City” in May! The registration discount for examinations in Controlled Substance Management & Coding, Compliance and Practice Management has been extended to April 13 due to recent changes in qualifications for course and exam attendance. The review courses and exams will be held in beautiful downtown Chicago on May 4-9 at the Westin on Michigan Avenue.

In addition to the recent inclusion of Internists and Family Practitioners, qualified non-physicians now may sit for exams to obtain Associate Competency Certification in Controlled Substance Management through the American Association of Allied Interventional Pain Management Professionals. ARNP’s, PA’s, RN’s, and LPN’s will now be allowed to sit for the Controlled Substance Management exam. Upon successful completion, these non-physicians will earn an Associate Certificate in Controlled Substance Management.

This four-day intensive review course is intended to present interventional pain management specialists and other healthcare providers an in-depth review of multiple areas of interventional pain managements.   To view the May brochure or register online, go to meetings on the ASIPP Web site.

Please note: Thursday, April  13 (5:00 p.m.) also the cutoff date for reduced ASIPP group price. The Westin Michigan Ave. reports no additional available rooms outside of the ASIPP room block, so reserve your room by 5:00 p.m. April 13. The Westin Michigan Avenue

New York to Use IT to Reform Medicaid

HHS Secretary Mike Leavitt and New York Gov. George Pataki (R) announced last month a reform plan for New York’s medicaid program that would include investing in health information technology, according to an HHS press release.

Governor Pataki has proposed the Federal-State Health Reform Partnership (F-SHRP) to reinvest $1.5 billion of federal fund savings that were achieved under New York’s section 1115 waiver, the Partnership Plan. The reform focuses on making long-term systemic improvements to the health care delivery system in New York including investments in health IT such as e-prescribing and electronic medical records.  

New York will submit an amendment to their section 1115 waiver that will allow federal funds to be claimed for F-SHRP. The amendment will be subject to terms and conditions and final approval by HHS.

News in Government & Medicine

Doctor Payment Cut Could Limit Access for Military Families

If medicare cuts proceeds next year, some physicians will have to consider dropping patients covered by TRICARE, the Dept. of Defense insurer, because Medicare and TRICARE pay is linked. Doctors say the military insurance program suffers from red tape, low payments and baffling rules. Difficulty in getting approval for specialty referrals also plagues physicians and patients. In an AMA survey, 43% of physicians questioned said they would limit or stop their acceptance of new TRICARE patients in 2007 when the program’s reimbursement, following suit with Medicare, is expected to decrease 5%

Many physicians see TRICARE’s situation as one example of the perplexing issue of the entire physician payment system. Unfortunately this problem falls on the shoulders of the families of our fighting troops.

The AMA is urging Congress to overhaul the Medicare payment formula, which would in turn improve TRICARE reimbursement.

Web Links of Interest:

The Militiary Officers’ Association of America - http://www.moaa.org/

The TRICARE program - http://www.tricare.osd.mil/

Senate Dismisses Bush’s plan for Medicare Budget Cuts

In last month’s first budget debate for fiscal year 2007, the Senate rejected President Bush’s call to cut billions from planned Medicare growth.

Instead the Senate approved a $2.8 trillion budget resolution that for the most part, leaves Medicare with its current funding. If the House and the Senate agree on a compromise version of the measure, it will serve as a blueprint for those who appropriate and authorize money for the government’s programs. But the House is currently working on a measure that more closely follows the White House plan, thus setting the stage for a fight to come up with the needed blueprint.

The Senate rejected President Bush's call for nearly $36 billion worth of cuts in Medicare growth, instead approving a fiscal 2007 budget resolution that would leave the program virtually untouched.

Allied Health Reinvestment Act

The Allied Health Reinvestment Act, S 473, has been reintroduced in the Senate. While the S 473 and its house counterpart, HR 215, aim to amend the Public Health Service Act to promote and improve the allied health professions, the Senate version, sponsored by Senator Maria Cantwell (D-WA), is more comprehensive. S 473 provides for public service announcements; recruitment grants; grants for health career academics; internships, residency programs, etc. The legislation was referred to the Senate Health, Education, Labor, and pensions Committee but has not yet been scheduled for consideration.

Supreme Court to Rule on Patent Law Boundaries

It has been 25 years since the U.S. Supreme Court examined patient law boundaries. The issue is once again being considered and the opposing side, the medical community and patent lawyers, say the outcome could threaten medical research and testing. At minimum the ruling is expected to affect how medicine is practiced.

On March 21, the high court asked during oral arguments whether Metabolite Laboratories’ patent for testing vitamin B deficiency is so broad that it covers a basic scientific relationship and goes against precedent that “laws of nature, natural phenomena and abstract ideas: are not patentable.  

Organized medicine contends that the patent is too broad, making it possible for a doctor to infringe on a patent in the course of routine care. If the Supreme Court upholds a patient of scientific fact, it could stifle technical innovation in medicine and “prevent physicians from exercising their best medical judgment in treating their patients,” AMA Trustee William A. Hazel Jr., MD, told American Medical News.

The case is Laboratory Corporation of America Holdings v. Metabolite Laboratories Inc. et al., No. 04-607. Read more on the court case on FindLaw.com

Britain Provides Lessons in National Network System

As the United States seeks to implement its own health network by 2014, Britain's experience is providing significant lessons, driving home the point that creating a national network is a complicated, prodigious task, even in a country where, presumably, under a single-payer system, it should be easier. At least based on the anger brought on by the $11 billion plan under way by Britain’s National Health Service.

One lesson the United States has learned is that it's better to build a network from doctors' offices on up, rather than a top-down, government-mandated approach. The U.S. plan calls for doctors to link systems through regional health information organizations, which then would become linked to a national system.

Subscribers can read more about Britian’s National Network system at AMNews

Or go to Britain’s National Health Service’s Connecting for Health program at http://www.connectingforheatlh.nhs.uk/

Health Centers Struggle to Recruit Clinicians

Community health enters face “substantial challenges: in recruiting physicians and other clinicians according to a study recently published in the Journal of the American Medical Association. And it is feared that trends in medical student interests and proposed federal cuts to primary care training programs could worsen the problem.

The study was based on results of a nationwide survey of health center executives in 2004. The survey reveled hundreds of vacancies form physicians, nurses and dentists at federally qualified health centers. The findings also suggest that some facilities are not adequately staffed to meet the needs of patients.

Read the study abstract

Subscribers can read more on this subject at amnews.com

State Society News

California Society of Interventional Pain Physicians (CSIPP) will hold its Annual Meeting and board elections on Tuesday, May 16, 2006 at 6:30 p.m. at:

Morton's Steakhouse

South Coast Plaza Village

1641 W. Sunflower Ave.

Santa Ana, CA  92704

Guest speaker will be Carl Brakensiek, MBA, JD, Executive VP of the California Society of Industrial Medicine and Surgery. Brakensiek’s topic will be "Upcoming Changes in Workers' Compensation in California.” Workers’ Compensation continues to be volatile, with further legislative changes inevitable and pending. Mr. Brakensiek's expertise in this area is unequaled in the state and should prove to be enlightening

Please RSVP and send nominations to sheri@pcpmc.com

All CSIPP board positions are open.

If your state society has any news you would like to share, please e-mail your news items to mmartin@asipp.org