" The Voice Of Interventional Pain Management "

celebrating our 10th anniversary

Dec. 5, 2012



  1. National Coverage Decision: A Real Cliff for IPM
  2. Update: Additional Contamination Identified in Medical Products from New England Compounding Center
  3. Insurers Must Guide Individual Market in 2014
  4. Illinois Expands Prescription Monitoring Program to Help Combat Prescription Drug Abuse
  5. The Feds Will Administer the Insurance Exchanges for Twice What it Costs to Administer Medicare
  6. The Affordable Care Act: Ten Months to Launch "Obamacare"--Get Ready for Some Startling Rate Increases
  7. Painkiller Addiction: The Plague that is Sweeping the US
  8. Medicare Is Faulted on Shift to Electronic Records
  9. Cardio Notes: Stroke Tied to Drug Abuse
  10. Two Dartmouth Studies Report Unnecessary Testing
  11. State Society News
  12. Physician Wanted  

ncd National Coverage Decision: A Real Cliff for IPM

Just a few weeks ago we were worried about the election results and had just been dealt a huge blow with the CRNA issue but now, it seems that IPM has a major issue worse than fiscal cliff - ours is a real cliff. Essentially we have been thrown off the cliff with CMS delivering a major blow with the publication of the potential National Coverage Decision (NCD) topics.


It is now left up to us to either fight among ourselves or to work together and form a united front. It is finally time to put arrogance, ignorance, and greed aside and preserve interventional pain management.


To prepare the recently released NCD list, CMS invited the public's input concerning any items and services that may be inappropriately used (i.e., underused, overused, or misused) or provide minimal benefit in hospitals, clinics, emergency departments, doctor's offices, or in other health care settings. CMS asked the public to be specific about items and services including surgical procedures, diagnostic tests or procedures, imaging or radiology services, lab tests, or durable medical equipment; treatment for diseases such as cancer, heart disease, kidney disease, or gastrointestinal disease; or procedures such as orthopedic or eye procedures. Based on the request from America's health insurance plans and multiple other insurers, CMS, among various other topics, has included facet joint blocks, epidural injections, and neurostimulators. Here is the link for the list of NCD topics:


CMS obviously states that they reviewed and evaluated all of the submissions and believe that many of the suggested topics may be suitable candidates for further review. CMS also admits that there are LCDs for these subjects in almost every state.  If the NCD arrives with a negative or non-coverage decision, it will be devastating to our specialty.This is exactly what insurers want to happen. Remember the fate of IDET. The day after the decision, interventional pain management, in its entirety, will be shut down. This will not only affect Medicare/Medicaid, but also all insurers. We always thought this would come from PCORI. Consequently, we were working on PCORI, to prevent this from happening. Now it turns out they are doing this administratively rather than through PCORI. There is a very slim chance of getting a positive decision, and also a slim chance of getting a neutral decision, but there is a significant probability that the decision could be negative. A negative decision is what we have to worry about.


Our defenses of interventional pain management have surpassed getting paid for each nerve, fluoroscopy for each nerve or each joint, payment differentials in one setting than other setting, working on 50% relief or 80% relief or no diagnostic blocks; payment for multiple transforaminal with interlaminar, MAC anesthesia--now we are be fighting for our specialty, which could be eliminated in its entirety.


We beg you not to react hastily. We have a plan. We are working with the administration and Congress to resolve this issue. However, there is a good probability that we may not be able to resolve it until it goes to a hearing. Even then we need a well-orchestrated approach to succeed.


As we all know, we have achieved many, many, many things since 1998. Since this time ASIPP has given identity, representation, and evidence to IPM. Considering the ever-increasing practice expense and numerous coverage decisions, ASIPP has saved each physician practice at least $100,000 per year and for some, as much as $500,000 per year for the past 13 years with coverage decisions and a 200% increase in practice expense. For ASCs the savings are likely between $250,000 and $2.5 million per year. In addition, we have created evidence-based guidelines and a well-respected, high-impact journal, and forged key government relations, among many other things. Essentially we have saved the specialty. Interventional pain management, and for that matter pain medicine, would not be what it is today without ASIPP. Hopefully we will be able to provide a reprieve on the SDV's soon, which will save your practice a significant amount of money. We will continue to work until this happens.


However, we are saddened to say that our current financial situation is not good. At this time we are requesting that all our members make a tax deductible, year-end contribution to ASIPP for the survival of interventional pain management and subsequently ASIPP. You may use personal and business funds for this contribution.There is no such thing as a donation too large or too small. Donations of any size will make a difference in ASIPP's financial future and actually, its survival. ASIPP  board members have already been asked to step up and help and many have responded generously.


We are providing a link to a form which will allow you to not only make this contribution but also to pay your 2013 dues in advance if you have not already done so.(Contribution and Dues Form)  


We are committed to doing whatever is necessary financially and otherwise. Let us do this together and preserve the interventional pain management. I've


We now have to preserve it for the present in order to have a future. As JFK once said, "Success has many fathers, but failure is an orphan."



updateUpdate: Additional Contamination Identified in Medical Products from New England Compounding Center


Summary: As part of the ongoing investigation of the multistate outbreak of fungal meningitis and other infections, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to test medical products from the New England Compounding Center (NECC) in Framingham, Mass. CDC and FDA are reporting today additional microbial contamination identified in NECC products, which updates the November 1, 2012 Health Alert Network advisory. This update includes the following key points:


  • CDC and FDA have identified additional microbial contamination in unopened vials of betamethasone, cardioplegia, and triamcinolone solutions distributed and recalled from NECC.



insurersInsurers Must Guide Individual Market in 2014


A new survey shows consumers willing to participate in the new individual insurance market in 2014, yet unwilling to take some personal responsibility to drive down healthcare costs. How can consumers be made to connect the dots? Part of the answer lies in how insurers approach them.

This past June, the consulting firm Accenture surveyed three consumer groups expected to make up the largest chunk of the individual market that will participate in the health insurance exchanges: adults under 65 who are uninsured, individually insured, or insured through an employer with less than 100 workers. The survey found that 72% cited affordability as their main concern when it comes to health insurance.


Health Leaders Media

illinoisIllinois Expands Prescription Monitoring Program to Help Combat Prescription Drug Abuse


SPRINGFIELD, Illinois--(ENEWSPF)--December 3, 2012. The Illinois Department of Human Services (IDHS) Prescription Monitoring Program (PMP) has joined a national data-sharing network that will provide for greater identification and prevention of prescription drug abuse.


"This expansion of our Prescription Monitoring Program is an important step in our efforts to better monitor prescriptions for controlled substances," said IDHS Secretary Michelle R.B. Saddler. "Our enhanced program will give us a vital tool in helping to prevent prescription drug abuse."


Enews Park Forest


fedsThe Feds Will Administer the Insurance Exchanges for Twice What it Costs to Administer Medicare


The Obama administration just released another set of regulations, the "Draft Notice of Benefit and Payment Parameters for 2014."

Among many other things in the 373 pages, they have announced their proposed assessments to cover the cost of running the federal exchange.

In order for the feds to administer the new insurance exchanges, they have proposed a fee of 3.5% of premium on each insurance policy sold in the exchanges (page 224).


Health Policy and Market


acaThe Affordable Care Act: Ten Months to Launch "Obamacare"--Get Ready for Some Startling Rate Increases


What will health insurance cost in 2014?

Will the new health insurance exchanges be ready on time or will the law have to be delayed?

There Will Be Sticker Shock!
First, get ready for some startling rate increases in the individual and small group health insurance marketplace due to the changes the law dictates.

In a November 2009 report, the CBO estimated that premiums in the individual market would increase 10% to 13% on account of the health insurance requirements in the ACA. In the under 50 employee small group market, the CBO estimated that premiums would increase by 1% to a decrease of just 2% compared to what they would have been without the ACA. All of these differences in premium would be before income based federal subsidies are applied to anyone's premiums.


Health Policy and Market

painkillerPainkiller Addiction: The Plague that is Sweeping the US


The US is leading the way in eradicating pain, but in doing so has created an unwanted byproduct: painkiller addiction. Prescription pill overdoses are killing 15,000 Americans a year, and the toll is growing


For almost two decades Geni Swartzwelder has played an elaborate game of hide-and-seek with her daughter Heather. Every day, Geni, 52, takes a bottle of little white pills and sneaks it away to a secret location. Every day, 32-year-old Heather then goes on a hunt for the bottle. Many days she succeeds in finding it. Geni knows because when she counts the pills at the end of the day, she often finds their numbers depleted.

The game began when Heather was 14. Geni noticed, haltingly at first but with growing alarm, that her husband's opioid painkillers, prescribed after he was injured in a motorbike accident, were coming up short: "Heather tried to convince us that we'd lost them, but there was no other way, and in the end we concluded she had to be taking them. So I started hiding them, every day, some place different."


The Guardian

medicareMedicare Is Faulted on Shift to Electronic Records


The conversion to electronic medical records - a critical piece of the Obama administration's plan for health care reform - is "vulnerable" to fraud and abuse because of the failure of Medicare officials to developappropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.


The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through bettercoordination of medical services, and the Obama administration is spending billions of dollars to encouragedoctors and hospitals to switch to electronic records to track patient care.


But the report says Medicare, which is charged with managing the incentive program that encourages theadoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.


New York Times

cardioCardio Notes: Stroke Tied to Drug Abuse


Cocaine, tobacco, and alcohol seem to be associated with stroke in those less than 55-years-old. Also, smartphones get intelligent about pulse-ox screening.

Drug Abuse Linked to Stroke in Young


An increase in stroke in the young parallels an increase in substance abuse, particularly cocaine and marijuana, according to a study of records from the Greater Cincinnati and Northern Kentucky area.


The number of strokes in those ages 18 to 54 increased from 297 in 1994 to 501 in 2005, mirroring a similar trend in the overall use of tobacco, alcohol, and illegal drugs (45% versus 62%), reported Brett Kissela, MD, of the University of Cincinnati in Ohio, and colleagues.



MedPage Today


twoTwo Dartmouth Studies Report Unnecessary Testing


Two reports issued last week by the Dartmouth Institute for Health Policy and Clinical Practice raise new questions about whether physicians order far too many tests, and whether some tests might be motivated more by economic rather than diagnostic or therapeutic reasons, whether subconsciously or not.

The first report, published in the Online First edition of Archives of Internal Medicine, points to a wide regional variation in the rate by which Medicare beneficiaries receive certain repeat tests, often with far more frequency than existing guidelines suggest they should be conducted.


Health Leaders Media






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American Society of Interventional Pain Physicians ®
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