" The Voice Of Interventional Pain Management "

celebrating our 10th anniversary

August 22, 2012







crnaCMS Proposes IPM Privileges for CRNAs: Time to Act Now or Never


The Centers for Medicare and Medicaid Services (CMS) is now accepting public comments on a proposed rule establishing national policy for CRNA pain management services. We NEED your voice now to protect patient safety. Following the comment period (Sept. 4, 2012 deadline), the final rule as it is written, would allow CRNAs to perform IPM techniques. This has sweeping ramifications, from compromised patient safety to an increase in fraud and abuse. I implore you to let CMS know that this proposed rule is unacceptable and dangerous.

It is essential that you submit your comments and opinions on this issue. Medicare officials read and evaluate each INDIVIDUAL comment submitted on the issue. We expect the opposition to submit a substantial number of comments, so your action today is very important. You may submit your comments in a variety of ways.


1. Electronically

You may submit electronic comments on this regulation to: http://www.regulations.gov/#!submitComment;D=CMS-2012-0083-0075 


2. By regular mail

You may mail written comments to the following address ONLY:

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS-1590-P,

P.O. Box 8013

Baltimore, MD 21244-8013

Please allow sufficient time for mailed comments to be received before the close of the comment period.


3. By express or overnight mail

You may send written comments to the following address ONLY:

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS-1590-P

Mail Stop C4-26-05

7500 Security Boulevard

Baltimore, MD 21244-1850


4. Capwiz

Use the following link to send your Capwiz letter to CMS, your senators, and representative. Sample text is provided but you are encouraged to edit and personalize your letter. http://capwiz.com/asipp/issues/alert/?alertid=61589631

It is simple to get your patients involved by customizing the following letter to your state senators and representatives, have your patients sign it before they leave the office, then have your staff enter it in Capwiz for the patient. Sample Patient Letter: ASIPP's Letter to CMS (you may use as a sample for your own)

Our goal is to send approximately 20,000 letters but this cannot happen without your help. Please act immediately on this important issue.



CRNAs Already Acting with Release of Unsubstantiated Survey


The American Association of Nurse Anesthetists and the American Society of Anesthesiologists are waging counter campaigns to sway CMS as the agency develops a national policy on whether nurse anesthetists are paid for chronic-pain management. The current policy is to leave that decision up to regional Medicare Administrative Contractors, and as a result 18 states do not reimburse nurse anesthetists for the services so CMS proposed in the 2013 physician fee schedule to pay nurses for chronic pain management in all states that authorize nurses to practice those services.


The nurse anesthetists insist they should be allowed to practice to the full extent of their license. Anesthesiologists and other physicians say only they are trained well enough manage pain.


Click HERE  to read CRNA survey.


ASIPP also performed a multi-disciplinary survey of pain patients. In this survey of 1,00 patients in our clinic, it was found that there was nota single patient who wanted their procuedres performed by a CRNA. Plans are in the works to expand this survey across the country.


Because surveys should be performed independently, ASIPP considers this study to be unsubstantiated and biased.


asippSpots Still Remain for ASIPP's Vertebroplasty Course and the Comprehensive Review Course and Cadaver Workshop


    The Comprehensive Review Course and Cadaver Workshop - Basic, Intermediate, and ABIPP Preparation will be held Sept. 14-16 at the Hilton Memphis in Memphis, TN and the MERI Center.


Click here to register: https://secure.jotformpro.com/form/12975431212


The Vertebroplasty Comprehensive Review Course and Cadaver Workshop will be Sept. 15-16 at the Hilton Memphis and MERI Center.






Click HERE for Hilton hotel reservations.




starkFederal Court Dismisses Stark Law Challenge


Physician-owned hospitals suffered defeat late last week when a federal court dismissed their challenge to a provision of the Affordable Care Act (ACA) that limits the expansion or building of new physician-owned hospitals.

The ACA expanded Stark self-referral laws, which bar Medicare reimbursement to hospitals owned by physicians who "self-refer" patients there, by ending reimbursements for physician-owned hospitals even if they weren't specialty facilities.


Any physician-owned hospital licensed before Dec. 31, 2010, would still be reimbursed under the previous Stark laws, which say physician-owned hospitals are eligible for payments if they are "whole hospitals," or more than a specialty care facility.



MedPage Today



splitPaul Ryan: 'No Splitting Hairs Over Rape'


Paul Ryan publicly denounced Rep. Todd Akin and also distanced himself from strict anti-abortion legislation he co-sponsored with the embattled Missouri Republican.


In an Tuesday interview with a Pittsburgh television station KDKA that was airing Wednesday, Mr. Ryan said that Mr. Akin - who is running for Senate against Sen. Claire McCaskill - was "outrageous" in saying that women rarely get pregnant as a result of "legitimate rape.


Wall Street Journal


acaHealth Care Costs and the Affordable Care Act


Rapidly rising health costs is the most serious threat to the nation's long-term prosperity. Already, the rapid run-up in federal health entitlement spending is putting tremendous pressure on the federal budget, says James C. Capretta, a visiting fellow at the American Enterprise Institute.

  •    Between 1972 and 2011, federal spending on Medicare and Medicaid rose from 1.1 percent of gross domestic product (GDP) to 5.5 percent, according to the Congressional Budget Office (CBO).
  •   CBO's latest projections indicate that spending on these programs, plus the Affordable Care Act's (ACA) new entitlement spending, will push total health entitlement spending up to at least 8.4 percent of GDP by 2030.
  •  That's a jump in spending of nearly 3 percentage points of GDP compared to today's level -- or the equivalent of another $500 billion in budget outlays.

Unfortunately, the ACA did not lay the foundation for sensible cost control, and did not partially ease budgetary pressures, as has been asserted. Quite the contrary, the ACA will pour an ocean of gasoline on the health entitlement fire, and the supposed cost-control mechanisms are a mirage.





suingState Suing Doctor over Billing Tactics


When Bill Buck accidentally cut off the tip of his finger at his Duarte cabinet workshop two years ago, he headed to Huntington Memorial Hospital's emergency room.


He assumed his insurance company would sort out the $12,630 bill from the plastic surgeon, Jeannette Martello.

But Martello wasn't satisfied with the $3,500 insurance reimbursement, so she returned the check and filed a lawsuit against Buck, his wife and his business for the full amount, according to the state attorney general's office. She also began a process to force the sale of Buck's home to collect the money, records show.


Martello's use of aggressive tactics to collect fees from emergency room patients like Buck - including lawsuits, taking out liens on their homes and damaging their credit - prompted an unprecedented court case by state health officials and a judge's order for Martello to cease the practices.


LA Times



conspiracyLocal and Out of State Pain Clinic Owners and Doctors Charged in Prescription Drug Conspiracies


Federal indictments charge several pain clinic owners and doctors with making millions by illegally distributing prescription drugs to Kentuckians.


Between today and late Thursday afternoon, five indictments have been unsealed charging 22 defendants, including five pain clinic owners and six doctors, with offensesrelated to prescription drugs, money laundering and health care fraud.


One of the indictments alleges that Houston, Texas doctor Linda J. Roos, 46, conspired to unlawfully distribute pills to Pike County residents.


Dr. Roos allegedly prescribed more than 125,000 Oxycodone pills from September 2006 until July 2011. She allegedly faxed many of her prescriptions to a pharmacy in Pikeville so the patients who visited her could pick up the pills on their way home from Texas. To limit traveling, Roos often allowed patients to obtain a prescription by faxing her a form.





epidemicPrescription Drug Abuse Tragedies Impact Many as Epidemic Continues


The May 2004 morning that Pennsylvania residents Phil and Cookie Bauer will never forget began like so many others. It normally took everything and then some to get their 18-year-old son, Mark Bauer, out of bed in the morning. His mother, Cookie, would often resort to sprinkling water on her son's face just to get the athletic 5-foot-9 teenager up and moving.


This morning was different.


Phil was getting ready for work downstairs as usual when he heard his wife's screams. He raced upstairs where Cookie told him she could not wake their son.


"He was lying on his bed looking very peaceful," Phil Bauer said. "There was no pulse and he wasn't breathing. It was frankly quite an out-of-body experience. I can't describe what that feeling is like."

Desert News


ksippKSIPP Hosts First Successful Education Seminar for Doctors, Nurses, and Law Enforcement


More than 70 people attended the Kentucky Society of Interventional Pain Physicians conference titled: Evolution of Responsible Opioid Prescribing: Good, Bad, and Ugly held on Aug. 18 and 19 in Paducah, KY.


The seminar provided a concise and comprehensive review of controlled substance management for primary care physicians and specialists. Guest speakers represented the Drug Enforcement Agency, KASPER, and specialist in the area of pain and prescription medication interactions.



The conference was hosted for physicians, nurses, medical personnel and law enforcement and was designed for those who desired more information on KASPER, the Pill Mill law, pain management facilities, controlled substance guidance, adherence monitoring, and documentation.


HB1 was developed by the Kentucky Board of Medical Licensure with the goals in mind to curb abuse and manage access.


According to statistics provided by the DEA, there are over 15,000 opioid deaths each year and one in 20 US citizens use opioids. Every day 2,500 teens are using prescription drugs for the first time. Sixty percent of teens have used a prescription drug for recreational use by the age of 15. In 2011 1 in 10 adults handed out or took a prescription drug not prescribed to them. HB1 requires all physicians and pharmacies to run KASPER reports before prescribing drugs in KY.


Attendees earned up to 10 hours of AMA PRA category 1 credits.


This meeting will be repeated in November.


pillPill Pain: Some Doctors See Law Targeting Abuse as Excessive and Confusing


Some Kentucky doctors say the new law is so complex they've decided to pack up their prescription pads


Dr. Ralph Alvarado's medical practice has prescribed controlled substances to 1,800 patients in Central Kentucky over the past three years. But he and other doctors in the practice decided to put down their pens four weeks ago.

That's because, he says, the standards imposed under a new Kentucky law designed to crack down on prescription drug abuse are so strict and complex that he would go bankrupt in a month - or worse - if he were to continue prescribing controlled substances.


"I'm not going to be threatened with jail time or criminal charges and lose my career," the Winchester doctor said, instead referring patients to specialists to get pain-pill prescriptions.



Louisville Courier Journal



lawLaw Enforcement Struggles to Control Rising Prescription Drug Abuse


Morganton --North Carolinians searching for answers to the state's growing drug abuse problem won't find what they're looking for in the colloquial meth lab or opium den. According to the most recent research published by the governor's crime commission in Raleigh, the answer to the state's drug problem lies in the medicine cabinet.


When the N.C. Department of Justice released its annual crime report last July, the state celebrated figures that reported the lowest crime statistics since 1977. At the same time though, Attorney General Roy Cooper lamented reports from the N.C. State Bureau of Investigation revealing prescription drug related cases had increased nearly 400 percent statewide in the past five years.



Morgantown News-Herald



romneyThe Romney-Ryan Medicare Plan Compared to the Obama Medicare Plan-Who's Telling the Truth on Medicare?


They both are and they both aren't.

I've never seen a week in health care policy like last week. The media reports have to be in the thousands, all trying to make sense of the furious debate between Obama and Romney over Medicare.

As someone who has studied this issue for more than 20 years, it has also been more than exasperating for me to watch each side trade claims and for the press to try to make sense of it.

This blog post is quite long because the subject matter is complicated. If you want to cut to the chase, see my conclusion and summary at the end of this post.


Health Care Policy and Marketplace Review




smartWill Smart Pills, Cash Boost Drug Compliance?


Innovative technology that can track when a patient ingests a pill is being touted as a way to tackle drug nonadherence. The so-called smart pill joins other new compliance strategies such as financial incentives for patients and game-like applications.


The strategies are the latest methods offered to physicians and others in health care to battle the perennial problem of patients not taking their medicines, which adds billions of dollars to U.S. medical costs annually.


The Food and Drug Administration cleared the smart pill, called the Ingestion Event Marker, for marketing as a medical device on July 10. The ingestible sensor is the size of a grain of sand and can be integrated into an inert pill or an active medication. Fluid in the stomach activates the sensor and sends a signal through body tissue to a small, water-resistant patch worn on the torso. The patch detects when the pill is ingested and wirelessly sends that data to an application accessible by mobile phone or computer.


AMA news



smallSmall Practices may be least able to take new Medicaid patients


Washington A recent federal survey underscores the struggles some primary care and small practices face in taking on new Medicaid patients.


Most doctors - 96% - continue to accept new patients, Sandra L. Decker, PhD, an economist at the National Center for Health Statistics, found in polling more than 4,300 licensed, office-based physicians. But in comparing acceptance rates among various payment sources in 2011, Medicaid trailed behind Medicare and private insurance.


Of the doctors who responded to the survey, 31% expressed an unwillingness to take on new Medicaid patients, compared with 17% who didn't want to accept new Medicare patients and 18% who said they weren't going to accept new privately insured patients. Decker's findings were published in the August Health Affairs. The sample population was drawn from the master files of the American Medical Association and the American Osteopathic Assn.


AMA news




kyKY Shuts Down Doctor Over Pill Dispensing


BOWLING GREEN, KY - A Tennessee-licensed physician working in Kentucky has been ordered to close his practice because the state Board of Medical Licensure found he was dispensing "large quantities of narcotics" to customers from all around the state.

Board investigators went to the Bowling Green office of Dr. James Bridges on Wednesday and delivered paperwork revoking his temporary permit to practice in Kentucky.

Board of Medical Licensure Medical Investigator Doug Wilson told The Daily News that the clinic, Advanced Therapeutics, drew the attention of law enforcement when it began taking customers from as far away Pikeville in eastern Kentucky.

Wilson says Bridges dispensed "large quantities" of the addictive pain reliever oxycodone, as well as Xanax, which, when taken with oxycodone, is "a deadly combination." Bridges has not been charged with a crime.



West Ky Star




lawmakersLawmakers Hear Evidence of Gray Market in Shortage Drugs


Washington An investigation by congressional staff concluded that so-called gray market companies were identifying weak points in the drug distribution system and taking steps to drive up prices for drugs that were determined to be in short supply.


These companies are profiteers that zero in on short-supply drugs and sell them at inflated prices, said Sen. Jay Rockefeller (D, W.Va.), chair of the Senate Committee on Commerce, Science and Transportation. During a July 25 committee hearing, Rockefeller unveiled the findings of a price-gouging investigation in which his office collaborated with the staffs of Sen. Tom Harkin (D, Iowa) and Rep. Elijah Cummings (D, Md.).



AMA news



severeAre Opioids only for Patients with "Severe Pain"?


A group of 37 physicians in July petitioned the Food and Drug Administration to no longer approve the use of opioid analgesics in patients with moderate noncancer pain. The FDA has until the end of the year to respond to the petition, which is the latest entry in the fierce debate about the proper boundaries of opioid prescribing for patients with chronic pain.


The petition, filed by the New York-based Physicians for Responsible Opioid Prescribing and Washington-based Public Citizen, asks the FDA to change the label for instant-release and extended-release opioids by:

  • Striking the term "moderate" from the indication for noncancer pain.
  • Limiting the maximum daily dose to the morphine equivalent of 100 mg for noncancer pain.
  • Limiting daily use for noncancer pain to 90 days.



AMA news



ryanCommentary: Ryan VP nod re-opens spigot of healthcare lies, half-truths


If you were tired of the lies, half-truths and fear-mongering that has pervaded the health reform debate for the past three years, well strap on your hip waders, because it's about to get deep.


A funny thing happened on the way to a presidential campaign that promised to focus on jobs, taxes and the economy: Mitt Romney picked Paul Ryan to be his running mate. In one deft move, Camp Romney brought healthcare and Ryan's 2011 bill to radically alter the structure of Medicare back into focus for the duration of the campaign.


"I think Governor Romney chose Ryan despite his Medicare plan and not because of it," said Robert Blendon, a professor of health policy and political analysis with the Harvard School of Public Health. "Because right away (the Romney campaign) has to spend the first days after the announcement running around Florida and Iowa convincing people he is supportive of Medicare."



Healthcare Finance News



DEAOperation Pill Nation Strikes Again with Phase II Takedown

 Seven Doctors, three Clinic Owners, and another Co-conspirator Busted
 in Florida Pill Mill Operation


AUG 16- (MIAMI)- Seven doctors, three clinic owners and one of their relatives have been charged with racketeering and other criminal violations in South Florida. This morning's operation, which is part of Operation Pill Nation, was announced by Mark R. Trouville, Special Agent in Charge, Drug Enforcement Administration (DEA), Miami Field Division; Pam Bondi, Attorney General of Florida, and Al Lamberti, Sheriff, Broward County Sheriff's Office (BSO). The arrests come following a three year investigation led by the DEA in conjunction with the BSO, and the Attorney General's Office of Statewide Prosecution.


The defendants, Steven August Edson (40, Coral Springs), Bruno Balbi (29, Deerfield Beach), Francisco Carlos Balbi (57, Deerfield Beach), Dr. Thomas Rodenberg (53, Ft. Lauderdale), Dr. Gabriel Sanchez (74, Tamarac), Dr. Mark Cukierman (56, Boca), and Dr. Marcia Sills (59, Ft. Lauderdale) are charged with racketeering and conspiracy to commit racketeering. Additionally, Edson and the Balbi's are charged with trafficking in a controlled substance, conspiracy to traffic in a controlled substance and money laundering. Aline Balbi Leca (31, Deerfield Beach) is charged, along with the three owners, with conspiracy to commit money laundering. Dr. Michael Fronstin (75, Palm Beach Gardens), Dr. Adeline Essian (59, Illinois) and Dr. Khanh Van Kim Duong (33, New York), are charged with illegally prescribing a controlled substance by a practitioner. All defendants, except Leca, have been charged with several counts of delivery of a controlled substance.


"Due to the success of Operation Pill Nation, these defendants will no longer push drugs under the guise of legitimate medical practices," said DEA Special Agent in Charge Mark Trouville. "The DEA will remain focused on working with our state and local law partners until these pill mills and rouge doctors are put out of business."






sendASIPP Members: Send in Your Published Article Information



 A new feature of the ASIPP enews will offer ASIPP members the opportunity to send in and have their recenlty published works listed.  Please email in notification of any published article that was not published in Pain Physician journal and that was published in the current year and we will ist in the weekly enews.



 Send in notification of your published works today to Holly Long (hlong@asipp.org)








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American Society of Interventional Pain Physicians ®
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Phone 270.554.9412, Fax 270.554.5394
E-mail asipp@asipp.org