June 6, 2012
Multiple Regulations in Tennessee
Pain Bill Passes
TMA member physicians
and supporters won a big victory with the passage of the Interventional Pain Management Bill (SB1935/HB1896).
Tennessee State Senate Bill
1935, a bill that establishes requirements for the supervision of nurses and
physician assistants by qualified physicians when engaged in interventional pain
management, has passed in the General Welfare, Health and Human Resource
Committee. The bill, sponsored by Sen. Randy McNally, specifies
that an advanced practice nurse and a physician assistant can only perform
invasive procedures involving any portion of the spine, spinal cord, sympathetic
nerves or block of major peripheral nerves under the supervision of a licensed
physician who has been certified in certain medical specialties, including
anesthesiology, neurological surgery, orthopedic surgery, or physical medicine
The measure was approved
in the State Senate by a vote of 20-10 (three not voting);The House of
Representatives vote was 68-16 (four not voting). The measure was sponsored by
Sen. McNally and Rep. Joey Hensley, MD.
"The TMA is delighted that our
state legislature continues doing the right thing by ensuring the citizens of
our state receive quality medical care," said TMA President Wiley Robinson, MD,
New Tennessee Law Requires Physicians
to Use Drug Monitoring Database
A new Tennessee law aims to
lessen drug overdoses in the state by requiring physicians to use a statewide
drug monitoring database to check patient information prior to prescribing,
according to a Times Free Press report.
As part of a law that takes effect in April 2013, Tennessee
physicians must consult the state database every time they begin a new episode
of treatment for a patient requiring an opioid prescription and at least once
per year thereafter. The database has been up and running since 2007, but only
about a third of physicians are registered to use it, and even fewer regularly
check patient information.
Injured workers in
Tennessee now face new requirements when receiving pain management services in
their Workers' Compensation case. SB 3315/HB 3372, sponsored by Senator Jack
Johnson and Representative Mark White was intended to "ensure the availability
of quality medical care services for injured and disabled employees and to
manage medical costs" by "eradicating prescription drug abuse through
utilization review." The effective date of the bill is July 1, 2012 and applies
to pain management prescribed on or after that date.
Missouri Pain Bill
Still Awaiting Governor's Signature
SB 682 remains on Missouri
Governor Jay Nixon's desk awaiting signature. The bill passed Missouri
legislature in May.
The bill requires
fluoroscopic guided injections of the spine for chronic pain to be performed by
licensed physicians. Lumbar inter-laminar injections may be performed by other
health care providers.
The momentum for the bill was provided by two
tragic cases of patient injury following cervical spine injections by a CRNA
with no formal interventional pain training. One patient suffered a recurrent
laryngeal nerve injury following cervical facet FR ablation. The other patient
developed a spinal cord injury following cervical spinal cord injection of local
anesthetic during a cervical facet injection.
The bill's passage means
that Certified Nurse Anesthetists (CRNAs) in Missouri no longer may practice
chronic and interventional pain management
We need all Missouri
ASIPP members to call Missouri Governor Jay Nixon and ask him to sign the bill.
His number is 573-751-3222
Congressional Budget Negotiations Could Impact Surgery
The Budget Control Act that
Congress passed in late August capped reductions in Medicare spending at no more
than 2 percent each year, which could produce total savings of $123 billion over
10 years, according to an ASC Association report.
addition, the Medicare cuts could not be to benefits or services provided by the
program, and some payments would be exempt, including Part D subsidies for
low-income beneficiaries and catastrophic coverage. Because of the difficulty in
agreeing on major policy issues during a presidential election year, Congress
will handle many decisions on payment reductions, tax policy and unemployment
insurance after the election.
Mandatory reductions in federal spending
are due to go into effect on Dec. 31, 2012, due to Congress' failure to reach a
comprehensive agreement to reduce the federal deficit. The process, known as
sequestration, mandates across-the-board cuts beginning in 2013 that are
sufficient to reduce the deficit by a total of $1.2 trillion over the next 12
Boards Get More Tools to Investigate Physicians
Political pressure and more
attention to the growing problem of prescription drug abuse have contributed to
increased scrutiny of medical boards in recent years. That has led some states
to pass legislation or make policy changes to bolster how the boards regulate
and discipline physicians.
States such as Delaware,
Florida and Texas have enacted laws to prevent the operation of so-called pill
mills by targeting physicians who abuse their prescribing rights, said Lisa
Robin, chief advocacy officer at the Federation of State Medical Boards. Other
states have increased their medical board staffs or expanded their boards'
abilities to investigate and discipline doctors.
Medicaid Fraud Is Costing Taxpayers Billions
Medicare and Medicaid fraud
have become an extraordinarily lucrative business. Though estimates vary widely
on the exact figures, the opportunities to scam taxpayers are so substantial as
to entice everyone from Nigerian mobs to New York crime families to participate.
This is likely due to the sheer vastness of the sums at stake, says Merrill
Matthews, a resident scholar at the Institute for Policy Innovation.
authorities announced on May 2 they had arrested 107 health care providers in
several cities and charged them with cheating Medicare out of $452
federal officials charged 94 people in 2010 with making $251 million in phony
- When the
Medicare Fraud Strike Force visited nearly 1,600 Miami businesses in 2007 that
had billed Medicare for durable equipment, it found nearly a third of the
businesses, 481, didn't even exist, yet they had billed Medicare for $237
Online Tool for Healthcare Job Seekers
The U.S. Department of Labor (DOL) recently launched a new online tool that will
allow current and prospective healthcare workers to explore more than 80
occupations, identify local education and training programs and tap into current
Through the Virtual Career
Network (VCN) users also can learn how previous experience such as military or
on-the-job training can be applied toward a healthcare career, take free online
courses and find sources for financial aid.
"Healthcare continues to be
one of the bright lights in our improving economy," said Secretary of Labor
Hilda L. Solis, in a press release. "In order to sustain this positive momentum,
we must do everything we can to ensure that our workforce is equipped with the
skills and experience that meet the needs of this growing industry. This
exciting new platform will help connect people with the knowledge and training
they need to qualify for available health care jobs."
How CPT Code
Modifiers Impact Physician Cash Compensation
The use, or misuse, of
Current Procedural Terminology code modifiers in physician compensation plans
could lead to unintended cash compensation figures, according to an article from Integrated Healthcare Strategies.
CPT code modifiers
are the two-digit codes attached to the five-digit CPT code, and they give more
detail to a medical service. For example, 80 is the CPT code modifier that
explains a surgical assistant and/or physician assistant offered services, and
payment is usually far less than the full amount.
Mark Ryberg, senior
consultant of physician services at Integrated Healthcare Strategies, wrote that
CPT code modifiers could affect both reimbursement and work relative value unit
productivity. "To the extent organizations rely upon wRVUs in a physician cash
compensation model, there is the potential for overpayment," he said.
U.S. Drug Recalls
Common, Not Well Publicized, Study Finds
The U.S. Food and Drug
Administration (FDA) recalls potentially harmful drugs about once every month,
but they could be doing a better job of letting doctors and patients know about
them, says a new study.
Over an eight-year span,
researchers found that the FDA failed to send notifications for one in five of
the most serious recalls through its two electronic systems used to alert
doctors and the public.
The so called Class I
recalls, according to the FDA, are issued for drugs that, if taken, have the
potential to cause "serious adverse health consequences or death."
Small Businesses Aren't Using the Health Insurance Tax
The White House estimates
that only a small minority of companies thought to be eligible for the Small
Business Health Care Tax Credit made use of it in fiscal 2011, according to a
report released by the Small Business Majority and Families USA. The immediate
question then becomes, why would these businesses voluntarily forgo a tax
provision meant to help them, asks Scott Shane, the A. Malachi Mixon III
Professor of Entrepreneurial Studies at Case Western Reserve
John Arensmeyer, founder
and CEO of the Small Business Majority, argues that there is a lack of
participation due to a lack of awareness -- that is, small business owners
simply don't know about the credit. However, surveys of relevant parties suggest
that this isn't the case.
Call for Halt to Marketing of Opioids for Long-Term Pain
Md.- Doctors, patients and advocacy groups are urging
federal officials to make it illegal for drug companies to market prescription
opioids to treat chronic, long-term pain.
Such a move would help curb
the rapid increase of overdoses and addiction that has been fueled by the
powerful narcotics, said Andrew Kolodny, president of Physicians for Responsible
Others countered at a
two-day meeting such a change would mean people who desperately need the drugs
would not have access to them.
The Journal Sentinel reported this week that the drugs increasingly have been
prescribed for chronic pain, an area where their safety and effectiveness are
unproven, especially for older patients.
Since 2007, top-selling
opioids dispensed to people 60 years and older have increased 32%, double the
rate for those in the 40-to-59 age group.
|Iowa Health Closes
Pain Clinic Without Explanation
Iowa Health-Des Moines
announced last week that it will shutter its pain clinic near Iowa Lutheran
hospital, leaving hundreds of chronic pain patients seeking treatment from new
physicians, according to a Des Moines Register report.
An Iowa Health
letter sent to approximately 1,800 patients said the clinic will close June 29
but did not provide further details. "While the pain clinic is closed, we will
be evaluating community need and the best approach for meeting it," the letter
said. "We are exploring options for reopening the Pain Clinic, but cannot say if
or when that might occur. The management of chronic pain is challenging for
patients and healthcare professionals alike because the therapies are very
individualized and the course of treatment often requires readjustment. That
complexity and evolving standards of care in pain management are causing us to
carefully assess the best approach for this challenging field of
Pills Add Cost and Delays to Job Injuries
Workplace insurers are
accustomed to making billions of dollars in payments each year, with the biggest
sums going to employees hurt in major accidents, like those mangled by machines
or crushed in building collapses.
Now they are dealing with
another big and fast-growing cost - payouts to workers with routine injuries who
have been treated with strong painkillers, including many who do not return to
work for months, if ever.
Workplace insurers spend an
estimated $1.4 billion annually on narcotic painkillers, or opioids. But they
are also finding that the medications, if used too early in treatment, too
frequently or for too long, can drive up associated disability payouts and
medical expenses by delaying an employee's return to work.
New York Times
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American Society of Interventional Pain Physicians ®
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Phone 270.554.9412, Fax 270.554.5394