" The Voice Of Interventional Pain Management "

celebrating our 10th anniversary

August 29, 2012


  1. Please Take Part in ASIPP Use of Antithrombotics in IPM Survey
  2. Less than a Week Left to Add Your Comments on Payment Schedules
  3. Comment Period Ends Tuesday on CMS Proposes IPM Privileges for CRNAs
  4. Spots Still Remain for ASIPP's Vertebroplasty Course and the Comprehensive Review Course and Cadaver Workshop
  5.  More Infusion Pump Problems for CareFusion
  6. Medicare Pay: Budget Sequester Adds to Annual Payment Rate Woes
  7. Drug Abuse by Elders Often a Hidden Problem
  8. ASCs, Physicians Face Potential Payment Cuts in January 2013
  9. The American Society of Interventional Pain Physicians Announces Guidelines for Responsible Prescribing of Pain-Killers for Chronic Non-Cancer Pain
  10. Worry Creates Tension Over Law
  11. Same Doctor Visit, Double the Cost
  12. Doctors Discuss Drug Abuse Prevention
  13. Can Markets Work in Medicine?
  14. ASIPP Members: Send in Your Published Article Information
  15. Massachusetts Statistics Show Drug Abuse a Growing Epidemic
  16. Kimberly-Clark's Cooled Radiofrequency Treatment for Chronic Low Back Pain Now Health-Insurance-Reimbursed by New Jersey Insurer
  17. State Society News
  18. Physicians Wanted

surveyPlease Take Part in ASIPP Use of Antithrombotics in IPM Survey


The American Society of Interventional Pain Physicians (ASIPP) is conducting a survey on bleeding complications, specifically epidural hematomas. The goal of this survey is to gain a better understanding of current and future trends in managing patients on antithrombotics undergoing spinal and other interventional techniques. The results will eventually be utilized in the ASIPP guidelines.


All information will remain confidential, and only aggregate not individual responses will be published. As a participant, you will receive a copy of the survey results. This data will be extremely helpful for the future of our speciality. The survey should only take about 5 to 10 minutes to complete.


If you are willing to participate, click on the following link to download the survey form. Please complete the survey and email your completed form back to us at drm@asipp.org or fax to 270-554-5394.

Click here to download paper survey


We also offer the option to take the survey online. Click the link below to take survey:


commentLess than a Week Left to Add Your Comments on Payment Schedules


We are providing links to the 2013 proposed physician, ASC, and HOPD payment schedules which have been published by CMS. Please look over the schedules carefully. If you have any questions or comments, you should write to them as soon as possible.


ASIPP will be sending a letter to CMS with our comments soon however, it is extremely important for individuals to express their opinions as well. Below you will find all of the information you need to send in your comments for each fee schedule, including the comment period deadline, addresses, and submission links.



The 2013 Conversion Factor will be published by November 1, 2012 as part of the CY 2013 PFS final rule. The present rates are based on the 2012 Conversion factors and if Congress does not act on this, the cut for 2013 will be over 30%. Additionally, there were significant cuts for non-facility payments for Transforaminal, Intercostal & Radiofrequency neurotomy procedures.


For IPM codes: http://www.asipp.org/documents/2013Pro_Physicians.pdf


Proposed Rule: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1590-P.html 

Comment date: No later than 5:00 p.m. on September 4, 2012.


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


By USPS 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



There are not been significant changes to this fee schedule. There are small increases for almost all codes; however there was a 6%-7% decrease for kyphoplasty and percutaneous adhesiolysis. The increases were 3% for most commonly used codes (with higher increases for implantables), to as much as 18% for neuroreceiver revision or removal. Again, there is no payment for discography in ASC settings. ASIPP is working with CMS and Congress to change this.


For IPM codes: www.asipp.org/documents/2013Pro_ASC.pdf


Proposed Rule: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices-Items/CMS-1589-P.html 

Comment date: No later than 5:00 p.m. on September 4, 2012.


Electronically: You may submit electronic comments on these regulations at http://www.regulations.gov/#!submitComment;D=CMS-2012-0084-0002 


By USPS mail: You may mail written comments to the following address ONLY:

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS-1589-P

P.O. Box 8013

Baltimore, MD 21244-8013



In general, there are significant increases, much better than the physician and ASC rates. However, there are some decreases for kyphoplasty and adhesiolysis. As with previous years, they continue to make the mistake paying much higher rates for epidural catheterization while paying lesser amounts for cervical radiofrequency neurotomy.


For IPM Codes: http://www.asipp.org/documents/2013Pro_HOPD.pdf


Proposed Rule: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1589-P.html


Comment date: No later than 5:00 p.m. on September 4, 2012.


Electronically: You may submit electronic comments on these regulations at http://www.regulations.gov/#!submitComment;D=CMS-2012-0084-0002


By USPS mail: You may mail written comments to the following address ONLY:

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS-1589-P

P.O. Box 8013

Baltimore, MD 21244-8013

crnaComment Period Ends Tuesday on CMS Proposes IPM Privileges for CRNAs


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.


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.



infusionMore Infusion Pump Problems for CareFusion


WASHINGTON -- The FDA has raised the recall of an infusion pump module to class I because of a defect that may stop drug delivery, potentially resulting in death.


The door keypad overlay of CareFusion 303's, Alaris Pump Module, Model 8100 may become loose, peel away, or separate from the door assembly, which can cause fluid to leak into the module. This can cause a keypad malfunction, stopping the infusion "with alarm. When infusion stops, it could result in serious injury or death," according to the FDA.


The recall affects products manufactured from October 2011 to February 2012 and includes all devices with lot numbers listed on the recall website.



MedPage Today

payMedicare Pay: Budget Sequester Adds to Annual Payment Rate Woes


Much like the Medicare sustainable growth rate formula, the budget sequester that also threatens the program in 2013 is cryptically named and arbitrary in nature.


The sequester, a governmentwide spending reduction plan for the next decade, is not based on health policy, analysts say. Lower funding won't offer health professionals incentives to improve patient care, and it won't discourage fraud. The metaphor that critics of the plan often cite is the budgeting mechanism functioning not as a surgical scalpel, but as a meat ax or a buzz saw - eviscerating federal agency budgets over a period of nine years.


Though Medicaid and Social Security are exempt from the reckoning, all other areas of the government will share in the budgetary pain.


AMA news


eldersDrug Abuse by Elders Often a Hidden Problem


SCITUATE - At the Catherine McGowan Senior Center, Florence Choate, director of Scituate's Council on Aging, offers a variety of programs for seniors, but she rarely talks with them about addiction to prescription narcotics.

"If we held a discussion on seniors with addiction issues around prescription pills, most of them would not come," Choate said. "It is a hidden addiction. . . . There are very few seniors who will get help for alcohol or opiate addiction."


In an effort to address opiate abuse in communities south of Boston, the council last week cohosted a regional forum called "Opiate 101" at the Scituate Harbor Community Building.


The event Monday attracted about 100 people, half of them seniors, and focused on ways that seniors can safely discard prescription medicine, particularly to prevent young people from gaining access to opiate painkillers.



The Boston Globe


cutASCs, Physicians Face Potential Payment Cuts in January 2013


This week, the Congressional Budget Office issued a report predicting a recession in the first half of 2013 if Congress fails to avoid the fiscal cliff the government faces at the end of 2012. Because Congress has not agreed on solutions for many tax and spending issues in 2012, more than $500 billion in tax increases and spending cuts are scheduled to take effect on Jan. 1, 2013.

The following changes would have a direct impact on ASCs:

* A scheduled 27 percent cut in physician payment, triggered by the SGR, the method CMS uses to update physician payments. The SGR was enacted by Congress in 1997 to control Medicare spending physician services. Since its inception, SGR has caused 11 potential reductions in physician payment, but Congress has delayed the cuts each year except 2002. Every time the cuts are delayed, the cost of "fixing" the SGR increases. If the scheduled reduction is not delayed this year, the physician rate cut will affect the 2013 ASC facility payment rate for procedures paid at the physician-office payment rate.

* A scheduled 2 percent cut to all Medicare providers. The cuts, beginning in 2013, should reduce the deficit by a total of $1.2 trillion over the next 10 years. If Congress does not delay the 2 percent cut and CMS makes no changes to the proposed 2013 ASC payment rule, which would enact a 1.3 percent increase in ASC payments, the combined effect would result in a 0.7 percent ASC payment reduction starting Jan. 1, 2013.


Beckers ASC Review


guidesThe American Society of Interventional Pain Physicians Announces Guidelines for Responsible Prescribing of Pain-Killers for Chronic Non-Cancer Pain


The American Society of Interventional Pain Physicians (ASIPP), a national medical society of over 4,000 members, has released its "Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain." A multidisciplinary panel of 55 medical experts drafted this comprehensive two-part guideline to improve patient care, curtail the abuse of opioids without jeopardizing non-cancer pain management treatments, and improve understanding among law enforcement agencies, lawmakers, insurance providers and regulatory agencies.


Dr. Laxmaiah Manchikanti, founder and CEO of ASIPP stated, "Opioid abuse has increased at an alarming rate since the 1990's and physicians must be proactive and take all necessary steps to ensure that their patients are properly assessed, diagnosed and monitored while receiving opioid treatment. This report provides clear and concise guidelines to improve patient access and avoid diversion and abuse."


In 2005, ASIPP published the first guidelines for prescribing opioids and the 2012 revised version was published in the July issue of Pain Physician, a high impact (IF 10.7) peer reviewed journal. Part 1 of the 2012 Guidelines reviews various aspects of opioid use, misuse, abuse, overuse and resulting fatalities. It presents statements of best practice based on a thorough evaluation of evidence from published studies on treatments outcomes. Part 2 provides recommendations for initiation and maintaining of appropriate chronic opioid therapy for 90 days or longer.

The 2012 guidelines illustrate a 10-step process with comprehensive assessment and documentation process, establishing medical necessity and treatment goals, recommendations for responsible opioid therapy with dose limitations, and necessity for a comprehensive and robust patient agreement.


It also discusses adherence monitoring, evaluation of side effects and discontinuation or maintenance of opioid therapy on a long-term basis additionally the report covers the means and ways to initiate opioid therapy, specific guidelines for methadone use, and reduction in prescription drug dose.


Wall Street Journal

 Content from Subscription-Only Site

worryWorry Creates Tension Over Law



While debate continues to flare over the month-old state law that tightens regulations on doctors prescribing controlled substances, a local pain physician contends a lack of understanding on the issue paints a wrong picture of the legislation.


One of the goals of House Bill 1 - which took effect July 20 - is to curb prescription pain pill abuse while ensuring patients who need the drugs can maintain their access through their physicians.


But a growing contingent of health care professionals across the state worry the new regulations create needless hoops to jump through just to treat patients.


Dr. Laxmaiah Manchikanti, American Society of Interventional Pain Physicians CEO and board chairman, and Paducah's Pain Management Center medical director, said dissent over the law stems from misconceptions of certain regulations and a general misunderstanding of the issue.


Click HERE to read entire article


Paducah Sun

Content from Subscription-Only site

doubleSame Doctor Visit, Double the Cost


After David Hubbard underwent a routine echocardiogram at his cardiologist's office last year, he was surprised to learn that the heart scan cost his insurer $1,605. That was more than four times the $373 it paid when the 61-year-old optometrist from Reno, Nev., had the same procedure at the same office just six months earlier.


"Nothing had changed, it was the same equipment, the same room," said Dr. Hubbard, who has a high-deductible health plan and had to pay about $1,000 of the larger bill out of his own pocket. "I was very upset."

But something had changed: his cardiologist's practice had been bought by Renown Health, a local hospital system. Dr. Hubbard was caught up in a structural shift that is sweeping through health care in the U.S.-hospitals are increasingly acquiring private physician practices.


Hospitals say the acquisitions will make health care more efficient. But the phenomenon, in some cases, also is having another effect: higher prices.


As physicians are subsumed into hospital systems, they can get paid for services at the systems' rates, which are typically more generous than what insurers pay independent doctors. What's more, some services that physicians previously performed at independent facilities, such as imaging scans, may start to be billed as hospital outpatient procedures, sometimes more than doubling the cost.


The result is that the same service, even sometimes provided in the same location, can cost more once a practice signs on with a hospital.


Major health insurers say a growing number of rate increases are tied to physician-practice acquisitions. The elevated prices also affect employers, many of which pay for their workers' coverage. A federal watchdog agency said doctor tie-ups are likely resulting in higher Medicare spending as well, because the program pays more for some services performed in a hospital facility.


Renown said in a statement that cardiologists moving into hospital employment helps "eliminate duplication, improve coordination, and reduce hospitalizations," and with "more proactive management of patients with heart disease, we are working to improve the health and well being of our patients."


This year, nearly one-quarter of all specialty physicians who see patients at hospitals are actually employed by the hospitals, according to an estimate from the Advisory Board Co. That is more than four times as many as the 5% in 2000. The equivalent share of primary-care physicians has doubled to about 40% in the same time frame. Traditionally, most doctors who see patients at hospitals are in independent practice.


The structural shift is being driven partly by declining reimbursements for physicians, particularly in certain specialties like cardiology. Doctors are also being pressed to make new investments, such as introducing electronic medical records, and some are attracted to the idea of more regular hours with fewer administrative headaches.


Wall Street Journal


Content from Subscription-Only Site


discussDoctors Discuss Drug Abuse Prevention


PADUCAH - Emergency room doctors are seeing an increase in patients who are using, and often abusing, prescription drugs.


"We have more deaths in Kentucky than any other states around," said Dr. Laxmaiah Manchikanti.

He's the director of Paducah's Pain Management Center said what begins with a doctor's initial prescription often turns into a patient's dependency and over use of meds.


"Doctors have been used to just satisfy the patient. Whatever the reason they come to a doctor's office, they leave for a prescription with pain medicine. That practice has to change," he said.


Dr. Manchikanti is spearheading a workshop to address Kentucky's new drug monitoring system. This weekend he's talking with doctors on how to decrease the number of over prescribed pills, and more directly, ways patients don't become hooked.


"We need to look at each and every patients and we have to evaluate, establish the medical necessity that they do need this treatment then give it," said Dr. Manchikanti.


And he warns, it isn't just the doctor's responsibility. Patients looking to pop pills could be charged with serious drug offenses. While the number of drug related deaths nationally may be down, locally, Dr. Manchikanti said western Kentucky is on the map for all the wrong reasons.


"There was one death for every 19 minutes in 2007. But in 2009, there was only one death for every 30 minutes. So things are working - so it can get better," he said.






marketCan Markets Work in Medicine?



There exists a sharp divide in the realm of health care over whether the market can fairly and accurately provide health care to consumers. Those in favor of government regulation are often cited as saying that leaving health care to be provided by powerful vested interests will result in increased prices and complexity for the average consumer, says Christopher J. Conover, a research scholar in the Center for Health Policy & Inequalities Research at Duke University.


However, just as with other complex issues such as cellphone or automobile shopping, the consumer benefits from a market that lowers prices and improves quality of services, despite not being very knowledgeable about the products. The facts suggest the same result would occur in a health care services market.


A 1974 RAND study tested the efficacy of the market in health care.

  •  7,000 individuals were randomly assigned different health policies: ones with free care, ones with a $200 deductible and 25 percent cost sharing, and finally those with high deductible policies.
  • The cost-sharing policies had an upper limit on how much the consumer spent. Once a family had spent 10 percent of its income on health spending the insurance policy would cover the rest.
  •   Those with free health care had 32 percent higher average spending than those that had to pay some, and 93 percent of that spending was from waste.
  • Finally, there was no difference in the health of the average patient between those groups.




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.


Sent in by:

Dr. med. Stephan Klessinger


Radicular pain in post lumbar surgery syndrome. The significance of transforaminal injection of steroids.

S. Klessinger

Pain Med. 2012 Aug 8. doi: 10.1111/j.1526-4637.2012.01463.x. [Epub ahead of print]


Sent in by:

Laxmaiah Manchikanti, MD


1. Management of chronic pain of cervical disc herniation and radiculitis with fluoroscopic cervical interlaminar epidural injections.

Manchikanti L, Cash KA, Pampati V, Wargo BW, Malla Y.

Int J Med Sci. 2012;9(6):424-34. Epub 2012 Jul 23.


2. The role of thoracic medial branch blocks in managing chronic mid and upper back pain: a randomized, double-blind, active-control trial with a 2-year followup.
Manchikanti L, Singh V, Falco FJ, Cash KA, Pampati V, Fellows B.
Anesthesiol Res Pract. 2012;2012:585806. Epub 2012 Jul 19.

3. Growth of Spinal Interventional Pain Management Techniques: Analysis of Utilization Trends and Medicare Expenditures 2000 to 2008.

Manchikanti L, Pampati V, Falco FJ, Hirsch JA.

Spine (Phila Pa 1976). 2012 Jul 11. [Epub ahead of print]


4. Analysis of utilization patterns of vertebroplasty and kyphoplasty in the Medicare population.

Manchikanti L, Pampati V, Hirsch JA.

J Neurointerv Surg. 2012 Jul 7. [Epub ahead of print]


5. Physician payment outlook for 2012.
Manchikanti L, Hirsch JA, Barr RM, Donovan WD, Nicola GN.
J Neurointerv Surg. 2012 Jul 4. [Epub ahead of print]


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


statsMassachusetts Statistics Show Drug Abuse a Growing Epidemic


A worsening epidemic

June 30, 2010 to July 1, 2011

►43,265 people admitted to substance abuse treatment

services in Massachusetts reported using heroin the year prior to admission; of those, 266 were under age 18, and 31,549 were between ages 21 and 39, with a median age of 31.5.

►Of the 43,265 people referenced above who reported heroin use, officials say 85 percent reported heroin as their primary substance of use.

In 2010

►140,000people age 12 or older in the United States used heroin for the first time within the previous 12 months.

►4.9 million drug-related emergency department visits were made nationwide; 2.3 million were for misuse or abuse.

►Heroin was thirdafter cocaine and marijuana as the most common illegal drug responsible for emergency department visits among users 21 and older.

Between 2004 and 2010

►Emergency department visits involving misuse or abuse of pharmaceuticals increased 115 percent, from 626,472 to 1.3 million. About half of those visits involved pain relievers, the majority of which were narcotics, such as oxycodone and hydrocodone.

In 2011

►The US Drug Enforcement Administration seized 1,065 kilograms (2,347 pounds) of heroin domestically, up from 721 kgs. in 2010.

SOURCES: Massachusetts Department of Public Health, Bureau of Substance Abuse Services; National Survey on Drug Use and Health, 2010; Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Drug Abuse Warning Network report, July 2, 2012





RFKimberly-Clark's Cooled Radiofrequency Treatment for Chronic Low Back Pain Now Health-Insurance-Reimbursed by New Jersey Insurer


Kimberly-Clark announced today that its SInergy Cooled Radiofrequency (RF) System, has become eligible for reimbursement under a new sacroiliac joint denervation policy* adopted by Horizon Healthcare Services, Inc., New Jersey's oldest and largest health insurer. The policy, which provides coverage for sacroiliac joint denervation for those patients diagnosed with chronic sacroiliac joint (SIJ) pain, temporarily destroys the nerve endings to the sacroiliac joint. The new policy went into effect on July 28, 2012.


The SInergy procedure is a minimally-invasive treatment intended to target and treat the pain-generating nerves in the lower back and buttock region that may be responsible for SIJ pain. The treatment can significantly reduce low back pain.






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American Society of Interventional Pain Physicians ®
81 Lakeview Drive, Paducah, KY 42001
Phone 270.554.9412, Fax 270.554.5394
E-mail asipp@asipp.org