August 23, 2006

Comprehensive Imaging Review Course in IPM – Deadlines near

The cut-off date for discounted hotel reservations is August 25. You must make your reservations with the Coronado Island Resort by 5:00 p.m. on Friday, Aug. 25 in order to receive the special ASIPP room rate. Make your reservations today!

In order to receive the early course/exam registration discount date you must register by Aug. 30, 2006. Don’t miss out on this Comprehensive Imaging Review Course in Interventional Pain Management on Sept. 14-16 and the ABIPP Competency Certification in Fluoroscopic Interpretation & Radiation Safety (exam for IPM physicians only) on Sept. 17. This 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.

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

Proposed Physician Payment Schedule for 2007 With New PE Methodology is Disastrous to Interventional Pain Management

The American Society of Interventional Pain Physicians recently engaged the Moran Company to evaluate the effect of the CMS’s Physician Fee Schedule Proposed Practice Expense Methodology on certain interventional pain management codes. The Moran Company attempted to identify technical fixes that could be applied to mitigate the decrease in reimbursement these codes will experience when the PE methodology is fully implemented in 2010.

Based on their recommendations, ASIPP has written a comment letter to CMS.

The proposed changes mainly affect services related to patient evaluation and management, however since CMS is operating on a budget-neutral philosophy, physician evaluation and management services payments may potentially increase. ASIPP’s calculation indicates practice expenses for interventional techniques will reduce from 40% to 50% for the majority of procedures. Some codes with big losses are: 64413, 64415, 64417, 64421, 64470, 64472, 64475, 64476, 64480, 64483, 27096, 62268, 62280, 62281, 62282, 62310, and 62311.

Base on their recommendations. ASIPP has written a comment letter to CMS. See comment letter

5.1% Cut Seems to be Final Unless We Get Up and Start Working On It

The Centers for Medicare and Medicaid Services (CMS) projects that it will pay approximately $61.5 billion to 875,000 physicians and other healthcare professionals in 2007. The Medicare law includes a statutory formula that will require CMS to implement an expected -5.1% update in payment rates for physician-related services. This formula compares the actual rate of growth in spending to a target rate, which is based on such factors as the growth in number of Medicare fee for service beneficiaries and statutory or regulatory changes in benefits. If they actual rate of growth exceeds the target rate, the update is decreased; if it is less, the update is increased. The negative update is projected for 2007 because spending on physicians’ services and other Part B services has been growing at a much faster rate than target spending with an increase of 10% for 2005 over 2010.

Based on this, numerous pain management codes are losers.  We have shown both modes with a small hope that the formula will be fixed or at least cuts will be averted for 2007, with a reimbursement formula rate of $37.8975, the 2006 rate, along with a 2007 proposed rate with 5.1% cut with $35.9647. With a 5.1% cut, when procedures are performed in a non-facility setting (office setting), the cuts range from as high as 40% to 80%. Some of them face lower cuts and some face higher cuts. Commonly performed procedures such as lumbar and cervical epidural face cuts from 26.1% to 30.4%; transforaminal epidurals face as high as 41% of the cut, facet joint nerve blocks and radiofrequency thermoneurolysis face cuts from 20% to 38%. It is somewhat better for physicians in a facility setting. The cuts range from 1.5%. For some infrequent procedures, as much as 10%. There are some increases for some procedures. The most commonly performed procedures, including cervical epidural, lumbar epidural, and catheterizations face 3% to 6% cut, transforaminal epidurals face 3% to 5% cut, facet joint nerve blocks face 1.4% to 4% cut. For pain management specific schedule with and without proposed cuts click here.

Interventional Pain Management Procedures are Winners in Hospital Outpatient Prospective Payment System and Hospitals are Winners Overall

In the rule CMS proposed on August 11, 2006, for hospital outpatient department payments, CMS proposes that hospitals would receive $32.5 billion in 2007. Outpatient services have increased by 12% in 2005, even then the rule includes a 3.4% inflation update in Medicare payment rates for services paid under the OPPS for 2007 (in contrast, physicians get a cut even though the increase was lower).

Under the new proposed rule, most interventional procedures will see an increase. The only procedures seeing cuts include revision of neural electrodes, implantation of neural receivers, and epidurography. Procedures seeing a substantial increase include percutaneous adhesiolysis, disc decompression, removal of previously implanted intrathecal epidural catheters, etc. Celiac plexus block continues to be at a lower level, which has been mistakenly classified 2 years ago. ASIPP has been trying to correct this mistake and will continue to try and change this. Epidurals and facet joint nerve blocks, etc., will receive a higher payment for the hospital portion with a 7% increase with a payment of $392.62. This will be good news for ASCs when we go on a percentage basis, even though it will still be disastrous. For HOPD payment rate for interventional techniques click here.

ASIPP will prepare a comment letter soon. ASIPP will provide the information to send the letters to CMS and the members of the Congress in the next few weeks.

CMS Proposal for ASC Revised Payment System for 2007 Preserves ASC Payment System for Most Interventional Procedures

On August 11, 2006, the Centers for Medicare and Medicaid Services issued Outpatient Prospective System and Ambulatory Surgery Center proposed rule. This rule includes two aspects, one for 2007 and the second one for 2008. For 2007, the proposed rule would add 14 procedures to the list of the surgeries for which Medicare would make a facility payment to ASCs effective January 1, 2007. The proposed rule would also implement a requirement of the Deficit Reduction Act (DRA) of 2005 that would cap 2007 payment rate to an ASC for a surgical procedure at the hospital outpatient rate for the same procedure.

The proposed adds 14 codes to the ASC list. Among these codes relevant to interventional pain management are vertebroplasty and kyphoplasty codes (CPT 22520, 22521, 22522).

The codes facing cuts under DRA are not significantly relevant as these include spinal puncture, diagnostic and therapeutic, brachial plexus block, axillary nerve block, single intercostal nerve blocks, pudendal neurolytic block. Neurolytic celiac block also faces cut from $446 to $392.62, however, we are working on this issue. For proposed schedule for interventional pain management payments click here.

2008 ASC Payment Schedule with 62% of Hospital Payments is Disastrous for Interventional Pain Management

The revised ASC payment system beginning January 1, 2008 based on Medicare Modernization Act (MMA) requires CMS to revise the ASC payment system no later than January 1, 2008. The revised ASC payment rates would be based on the ambulatory payment classification used to group procedures under the OPPS, but payments in the ASC setting would be lower than the payment for the corresponding procedure in the hospital outpatient department for the same procedure. CMS says this is because of the lower costs associated with performing procedures in the ASC setting.

CMS estimates for 2008, ASC rates would be 62% of the corresponding payment rates. A sliding scale has been proposed to avert losses for 2008 and 2009 by 50% or so. However, since it is a budget neutral arrangement and many new codes will be added, it is highly unlikely that it will be any more than 62% and it is likely that it could be lower than 62% unless the ASC community being affected fights for the cuts very aggressively.

ASIPP and SIPMS will be aggressively launching a campaign against these cuts.

For the effect on interventional procedures, please see the attached schedule

Medicare Posts ASC Payment Information

After a recent directive from President Bush to make more data available to the public, the Centers for Medicare & Medicaid Services (CMS) is making available Medicare payment information for 61 procedures performed in Ambulatory Surgery Centers (ASCs). The directive is part of the Administration’s commitment to make health care more affordable and accessible. The announcement is the second set of geographically-based information made available; information on what Medicare pays for 41 procedures performed in an inpatient hospital setting was posted at the beginning of June.

The new information posted by CMS at http://www.cms.hhs.gov/HealthCareConInit/ will show “Commonly Performed Procedures in ASCs”, and will contain charge and Medicare payment data for ASC facility costs for a limited number of services administered in states and counties. The data is broken down at the county, state and national level. CMS is also concurrently releasing data on “Other Commonly Performed Procedures in ASCs”, which contains similar charge and payment data, but for facility costs related to services of high utilization. 

For the CMS press release click on: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1948

For HHS press release click on: http://www.hhs.gov/news/press/2006pres/20060822.html

CMS to place hold on payment for claims during Sept. 22-30

CMS will place a hold on all Medicare payments to physicians during the last nine days of Fiscal Year 2006, Sept. 22-30.  All claims that would have been paid during this timeframe will instead be paid on Oct. 2, 2006, without interest or late penalties.  Further, payments will not be staggered, and no advance payments will be allowed during this nine-day period.

This one-time delay in Medicare payments was mandated by the Deficit Reduction Act of 2005.

For more information, please view the MLN Matters Article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047.pdf

Visit photo gallery on ASIPP Web site

The first phase of our Photo Gallery is now available. Photos are organized by meeting/event for ease of navigation.

Click here to visit the photo gallery

All issues of Pain Physician now available on PubMed

The Pain Physician journal can now be accessed on PubMed with all 28 issues available. Pain Physician editor Mark V. Boswell, MD, PhD, was notified of the journal’s inclusion in the MEDLARS system in March. For acceptance Pain Physician Journal was evaluated by the National Library of Medicine’s Literature Selection Technical Review Committee and based upon that review, was selected for indexing and inclusion.