" The Voice Of Interventional Pain Management "

celebrating our 10th anniversary

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 and rehabilitation.

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, of Memphis.





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.


Becker's Spine





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.


 Bill Summary

missouriMissouri 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

congressHow Congressional Budget Negotiations Could Impact Surgery Centers


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.

In 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 years.


Becker's ASC Review


toolsMedical 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.



AMA news


billionsMedicare and 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.


  •  Federal authorities announced on May 2 they had arrested 107 health care providers in several cities and charged them with cheating Medicare out of $452 million.
  •  Similarly, federal officials charged 94 people in 2010 with making $251 million in phony claims.
  •  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 million.



DOLDOL Launches Online Tool for Healthcare Job Seekers


WASHINGTON - 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 job listings.


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."



Healthcare Finance News

CPTHow 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.


Becker's Hospital review


recallU.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."


Fox news

smallWhy Small Businesses Aren't Using the Health Insurance Tax Credit


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 University.


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.




groupsGroups Call for Halt to Marketing of Opioids for Long-Term Pain


Bethesda, 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 Opioid Prescribing.

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.





iowaIowa 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 medicine."



Becker's Spine Review

pillsPain 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
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