August 14, 2006

NASPER celebrates first anniversary

On August 11, 2005 President Bush signed into law the National All Schedules Prescription Electronic Reporting (NASPER) prescription drug abuse legislation, making it the only statutorily authorized program to assist states in combating prescription drug abuse of controlled substances through a prescription monitoring program (PDMPs).

Through three sessions of Congress, ASIPP made NASPER its legislative priority, making more than 1200 legislative visits, writing thousands of letters to legislators and visiting the White House and other governmental agencies nearly a dozen times. Since NASPER was signed into law ASIPP has continued to work for the effective implementation through effort of advocacy for appropriated funding. Without this appropriation, although authorized, NASPER remains unfunded. 

CMS proposed rule on Physician Fee Schedule calculation method to hurt IPM – ASIPP engages Moran Company for analysis of these services

On June 21st, the Centers for Medicare and Medicaid Services (CMS) released a 449-page notice proposing changes to the Medicare Physician Fee Schedule to improve the accuracy of physician payments for services to Medicare beneficiaries furnished on or after January 1, 2007.

The proposed changes to the physician work are used mainly affect services related to patient evaluation and management, however since CMS is operating on a budget neutral philosophy while potentially physician evaluation and management services payments may increase; the calculation of ASIPP had shown that practice expenses for interventional techniques will reduce from 40% to 50% for majority of the procedures. Thus, ASIPP has embarked on studying of the reasons for these changes and the ways to combat it. ASIPP has retained the Moran Company, a Washington-based healthcare research consulting firm focused on the boundary between the public and private sectors in healthcare to assist us. The Moran Company understands that ASIPP is primarily interested in using findings from the study to identify “technical fixes” that may mitigate some of the decreases in reimbursement that Moran Company would then simulate effect of such identified alternatives.

ASIPP will be publishing an impact analysis white paper on this issue.

For further information on the rule go to:

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1887

Manchikanti - Medicare in Interventional Pain Management: A Critical Analysis

http://www.painphysicianjournal.com/2006/july/2006;9;171-198.pdf

CMS proposed new rule for physician payment for 2007 projects at a reimbursement cut 5.1%

Mark B. McClellan, MD, PhD, Administrator of the Centers for Medicare and Medicaid Services, announced the release of the 2007 Physician Fee Scheduled Proposed Rule (NPRM).

The NPRM indicates that a statutory formula for the update to physician fee schedule will require CMS to implement a negative 5.1% update in payment rates for physician-related services (this was supposed to be 4.6%!) The negative update is projected for 2007 because spending on physician services and other Part B services has been growing at a much faster rate than target spending.

The proposed rule also contains a number of policies for imaging services, expanded preventive services, guidance on how manufacturers should address particular issues related to the reporting requirements under the average sales price system for paying Part B drugs, and other changes.

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1943

In coming weeks ASIPP will be working on multiple issues related in interventional pain management and impact of this payment cuts. We will keep you informed.

For further information on the rule go to:

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1939

For the notice of proposed rule making (NPRM) and other files on the fee schedule: http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=4&sortOrder=ascending&itemID=CMS1185539

Manchikanti - Medicare in Interventional Pain Management: A Critical Analysis

http://www.painphysicianjournal.com/2006/july/2006;9;171-198.pdf

ASIPP will be publishing an impact analysis white paper on this issue.

ASIPP has been working on this issue. We were able to avert the cut last year.

CMS proposes a revised payment system for services provided in ambulatory surgical centers

CMS proposed minimal revisions for ambulatory surgical center payments for year 2007 however, an attempt has been made to align ambulatory surgical center services with hospital outpatient payment services. The proposed rule that recommends 2007 payment rates for procedures in hospital outpatient department (HOPD) includes four proposed changes in ASC payment policy.

Effective January 1, 2007, the ASC rate for 2007 procedures will be cut, if the HOPD rates for 2007 in the proposed rule are adapted. These cuts are the result of legislation enacted in 2006 that limits the maximum ASC payment rate for any procedure to the HOPD payment rate for that same procedure beginning January 1, 2007. These cuts are the result of Deficit Reduction Act enacted in 2006. The cuts may vary from a few cents to a few dollars. Interventional pain management will not be effected in surgical centers significantly with this rule.

CMS also proposes to add 14 codes to ASC list, however these procedures do not include any interventional techniques. If the membership is interested in any interventional techniques to be included please contact either ASIPP or SIPMS so that we can start a letter campaign and lobbying for the changes required.

ASIPP will be publishing an impact analysis white paper on this issue.

Read the CMS news release: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1938

Read MedPAC report to congress: http://www.medpac.gov/publications%5Ccongressional_reports%5CMar06_Ch02a.pdf

Devastating proposed rule for ASC payments starting Jan. 1, 2008 with 40% cuts seen for many interventional pain management procedures

On August 8, 2006, the CMS issued the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center proposed rule. Beginning in 2008, with the implementation of the revised ASC Payment System, CMS is proposed a more significant expansion of the approved list of procedures that can be safely performed in an ASC. However, CMS is also proposing that the payment to an ASC for procedures commonly performed in physicians’ offices would not exceed the physician office payment rate.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) requires CMS to revised the ASC payment system no later than January 1, 2008. The revised ASC payment rates would be based on the Ambulatory Payment Classification (APC) used to group procedures under the Outpatient Prospective Payment System (OPPS), but payments in ASC setting would be lower than the payment for the corresponding procedure in hospital outpatient department for the same procedure, recognizing the lower cost associated with performing procedures in the ASC setting.

For 2008 CMS currently estimates that the revised ASC rates would be 62% of the corresponding OPPS payment rates. However, given the significant payment changes for some procedures under the revised payment system, CMS is proposing a two-year transition from the current ASC payment rates to the new payment rates with a blended system of 50% of ASC payment and 50% of HOPD payment for 2008 and 2009.

According to ASIPP and SIPMS calculations this will be devastating to most interventional techniques resulting in at least a 20% cut for 2008 and 2009 and as high as 40% cut for 2009 onwards.

It will result most likely in 40% cut from 2008, as proposal is “Budget Neutral” according to Dr. Manchikanti.

ASIPP has been working actively on this issue and the proposal is as we have been expecting says Dr. Manchikanti, CEO of ASIPP and SIPMS. In fact, Dr. Manchikanti stated we have met with officials at Government Accounting Office performing the survey, officials at Centers for Medicare and Medicaid Services, staff of House Energy Commerce, and Ways and Means Committees. We also met with numerous legislators and the issue was one of the three legislative issues we presented to the legislature.

Dr. Manchikanti requests membership to look into and get ready for letter campaign and extensive lobbying to preserve interventional pain management in all settings.

See the CMS press release/fact sheet:

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1940

ASIPP will be publishing an impact analysis white paper on this issue.

CMS proposes hospital outpatient department payment rules with a 3.4% inflation update for 2007

CMS issued a proposed rule on August 4, 2006 for Medicare payment for hospital outpatient services in calendar year 2007 that would implement new steps to make payments more accurate and to promote higher quality and value in outpatient care.

Hospitals would receive $32.5 billion in 2007 under the proposed rule that would revise policies and payment rates under the Outpatient Prospective Payment Systems (OPPS) for outpatient services provided to Medicare beneficiaries. The rule includes a 3.4% inflation update in Medicare payment rates for services paid under the OPPS for 2007.

Between 2005 and 2006 hospital outpatient expenditures increased by nearly 12%, mainly due to the growth and the volume and intensity of services (this is similar to growth in physician payment services, but physicians get a cut and hospitals get a raise). CMS also projects that the expenditures under the OPPS in calendar year 2007 will be approximately 9.2% higher than the estimate 2006 expenditures.

CMS news release: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1921

Bill Would Scrap Medicare Formula - Raise Physician Reimbursement

Rep. Michael Burgess, MD (R, Texas), late last month introduced a new House measure that would allow doctors who participate in voluntary quality reporting to balance bill some of their Medicare patients. The Medicare Physician Payment Reform and Quality Improvement Act of 2006, starting in 2007, would scrap the sustainable growth rate formula that helps determine doctor pay. Instead, the Burgess bill would ensure positive annual updates by tying rates to the Medicare Economic Index (MEI) and more closely aligns Medicare rates with the costs of administering care. The MEI is an indicator of how much doctors' cost of caring for patients is increasing.

If lawmakers and the White House can approve the measure before Congress adjourns for the year, physicians would start receiving yearly updates equal to the MEI percentage minus 1%. Instead of a projected 4.7% cut in January 2007, doctors would receive an estimated 1.5% increase in their Medicare rates.

The legislation would establish a voluntary quality reporting program that would be in place by January 2009. Each Physician specialty organization would submit by January 2008 its own set of quality measures.

Subscribers can read more at: http://www.ama-assn.org/amednews/2006/08/14/gvl10814.htm

House Passes Bill Encouraging Health IT

Lawmakers must now reconcile differences between the House and Senate legislation over anti-kickback safe harbors, health IT grant levels and a new coding system. The House late last month approved legislation that would enable physicians to buy and receive donations of health information technology more easily.

The Health Information Technology Promotion Act of 2006 passed the House on July 27 by a largely party-line vote of 270-148. After Congress returns in September from its month-long summer recess, conferees from both houses will attempt to resolve the differences between the House bill and the Wired for Health Care Quality Act, a different version of the health IT bill that passed the Senate last year.

For more information on the Act: http://www.govhealthit.com/article95444-07-27-06-Web

http://www.emrupdate.com/forums/thread/53056.aspx

Subscribers can read more at: http://www.ama-assn.org/amednews/2006/08/14/gvsa0814.htm

Comprehensive Imaging Review Course in IPM – San Diego

ASIPP will offer a Comprehensive Imaging Review Course in Interventional Pain Management on Sept. 14-16 along with ABIPP Competency Certification in Fluoroscopic Interpretation & Radiation Safety (exam for IPM physicians only) on Sept. 17. The 3-day Comprehensive Imagining Review Course is planned as a CME activity to prepare physicians seeking competency certification or as an in-depth review in fluoroscopic interpretation and radiation safety.

The early registration discount date has been extended to Aug. 30, 2006 – Register Today!

For more information or to register online go to: http://www.asipp.org/meetings.htm

State Society News

If your state society would like to announce meetings or share news stories with our readers, send your new items to Melinda Martin - mmartin@asipp.org

Please…Save the Date!!!

The New Hampshire Society of Interventional Pain Physicians Annual Meeting

The New Hampshire Society of Interventional Pain Physicians Annual Meeting will take place on Wednesday, September 27, 2006 at 6:00 p.m.CR Sparks, Bedford, NH

Your nursing and management staff are encouraged to attend as well. Guest speaker to be announced.

To register or for more information, contact:

Kacey Guay 603-577-3003 x31

kguay@painsolutionsusa.com