" The Voice Of Interventional Pain Management "

celebrating our 10th anniversary

May 30, 2012


  1. Pain Physician Publishes 5 Systematic Reviews on Interventional Techniques
  2. ASIPP Offers Review Courses, Competency Exams in San Francisco
  3. Most Doctors Headed for Penalty over Medicare Quality Reporting
  4. Affordable Care Act to Threaten Quality of Treatment Says Hudson Institute Report
  5. Opioid Painkillers should be Monitored Electronically: N.Y. Grand Jury
  6. The Medicaid money trail?
  7. Pain Meds Linked to Lower Risk for Skin Cancer
  8. Proposed Changes to Psychiatric Manual Could Impact Addiction Diagnosis
  9. AMA, MGMA letters to lawmakers suggest SGR alternatives
  10. Most Individual Health Plans Fall Short of ACA Standards
  11. Chattanooga Doctor Faces 105-Count Federal Indictment 
  12. Challenges to Peer Review Confidentiality Rising
  13. E-prescribing Sign-up Highest Among Small Practices
  14. Many Hospitals, Doctors Offer Cash Discount for Medical Bills
  15. Physician Compensation in U.S. Among Lowest for Western Nations
  16. 14 Charged in Massive Manhattan Illegal Prescription Pill Diversion, Distribution SchemeState Society News
  17. ASIPP Welcomes New Staff
  18. Physicians Wanted

ppjPain Physician Publishes 5 Systematic Reviews on Interventional Techniques


These systematic reviews were developed utilizing very strict criteria prior to the publication of guidelines for managing chronic spinal pain. The results of systematic reviews are as follows:


 Caudal Epidural Injections in the Management of Chronic Low Back Pain: A Systematic Appraisal of the Literature

Allan T. Parr, MD, Laxmaiah Manchikanti, MD, Haroon Hameed, MD, Ann Conn, MD, Kavita N. Manchikanti, MD, Ramsin M. Benyamin, MD, Sudhir Diwan, MD, Vijay Singh, MD, and Salahadin Abdi, MD, PhD


There was good evidence for short- and long-term relief of chronic pain secondary to disc herniation or radiculitis with local anesthetic and steroids and fair relief with local anesthetic only. Further, this systematic review also provided indicated evidence of fair for caudal epidural injections in managing chronic axial or discogenic pain, spinal stenosis, and post surgery syndrome.





Effectiveness of Therapeutic Lumbar Transforaminal Epidural Steroid Injections in Managing Lumbar Spinal Pain

Laxmaiah Manchikanti, MD, Ricardo M. Buenaventura, MD, Kavita N. Manchikanti, MD, Xiulu Ruan, MD,, Sanjeeva Gupta, MD, Howard S. Smith, MD, Paul J. Christo, MD, and Stephan P. Ward, MD


The evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids and fair with local anesthetic only; it is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids; and limited for axial pain and post surgery syndrome using local anesthetic with or without steroids.






Effectiveness of Thermal Annular Procedures in Treating Discogenic Low Back Pain

Standiford Helm, II, MD, Timothy R. Deer, MD, Laxmaiah Manchikanti, MD, Sukdeb Datta, MD, Pradeep Chopra, MD, Vijay Singh, MD, and Joshua A. Hirsch, MD


The evidence is fair for IDET and poor for discTRODE and biacuplasty is being evaluated in 2 ongoing randomized controlled trials.





A Systematic Evaluation of Prevalence and Diagnostic Accuracy of Sacroiliac Joint Interventions

Thomas T. Simopoulos, MD, Laxmaiah Manchikanti, MD, Vijay Singh, MD, Sanjeeva Gupta, MD, Haroon Hameed, MD,

Sudhir Diwan, MD, and Steven P. Cohen, MD


The evidence for the diagnostic accuracy of sacroiliac joint injections is good, the evidence for provocation maneuvers is fair, and evidence for imaging is limited.




A Systematic Evaluation of the Therapeutic Effectiveness of Sacroiliac Joint Interventions

Hans Hansen, MD, Laxmaiah Manchikanti, MD, Thomas T. Simopoulos, MD, Paul J. Christo, MD, Sanjeeva Gupta, MD,

Howard S. Smith, MD, Haroon Hameed, MD, and Steven P. Cohen, MD



The evidence was fair in favor of cooled radiofrequency neurotomy and poor for short-term and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.





boardASIPP Offers Review Courses, Competency Exams in San Francisco


  Attend the Comprehensive Review Course in Controlled Substance Management July 30-31 and take that Competency Exam on Aug. 1



Register HERE



Attend the Comprehensive Review Course in Coding, Compliance and Practice Management Aug. 2-3 and take that competency exam Aug.5.


Register HERE


 Courses will be at the Westin San Francisco Market Street.


Click HEREfor reservations


mostMost Doctors Headed for Penalty over Medicare Quality Reporting


Absent a significant change in the trajectory of Medicare's physician quality reporting system, a large majority of doctors will set themselves up for future rate cuts by failing to report enough quality measures to the federal government in 2013.


A recent trends report from the Centers for Medicare & Medicaid Services shows that fewer than 200,000 physicians, out of the more than 600,000 who were eligible for the incentive program, reported PQRS measures in 2010. More than 125,000 physicians reporting as individuals met enough of the requirements to share a total of nearly $400 million in bonuses, but hundreds of thousands of eligible doctors did not attempt to meet the pay-for-reporting criteria. More than 50,000 tried for the bonuses but did not report enough quality measures to hit the minimum.



AMA news


ACAAffordable Care Act to Threaten Quality of Treatment Says Hudson Institute Report


In The Secretary Shall: How the Implementation of the Affordable Care Act Will Affect Doctors, Hudson Institute Senior Fellow Tevi Troy evaluates the potentially hazardous impact that the Affordable Care Act (ACA) will have on a critical actor in American health care--the physician.


As the political and legal worlds debate the virtues and viability of the ACA and the nation follows along in confusion, America's doctors must prepare for the potentially large and deleterious impact that the new law may have on their careers, incomes, and relationships with their patients. A survey by the Doctors Company indicates that 60 percent of physicians feel that the health care law will have a negative influence on overall patient care and 51 percent feel that the law will negatively impact their relationships with patients. In light of this troubling reality, Tevi Troy, a former Deputy Secretary of the Department of Health and Human Services, examines the 2,700 page law to explain why these concerns may be well-founded.


 Market Watch


opioidOpioid Painkillers should be Monitored Electronically: N.Y. Grand Jury


NEW YORK-A New York grand jury investigating an epidemic of controlled substance abuse has called on pharmaceutical manufacturers to help fund electronic monitoring of opioid pain medication prescribing.


Suffolk County, N.Y., District Attorney Thomas Spota released a 99-page report on Thursday that contains several other recommendations from the Suffolk County Supreme Court Special Grand Jury, which was first empanelled in January.


The report also criticizes drug manufacturers' profit motives and the medical establishment for overprescribing addictive pain medications.


The grand jury's many recommendations include mandating electronic prescribing for controlled substances or else mandating that all pharmacy dispensers enter controlled substance prescription data into a central registry.

Such efforts could inhibit doctor shopping by patients while helping hold prescribers accountable when discipline is warranted, the report states.


The grand jury also called for pharmaceutical manufacturers to subsidize the proposed monitoring of controlled substance prescriptions.


"Manufacturers provide the supply of controlled substances, pay to market them and reap enormous profits," the report states. "It is therefore reasonable to require that, as a cost of doing business in New York, manufacturers subsidize the implementation and operation of the (registry) here. There is precedent for this in Florida. Manufacturers must also contribute to a research fund for addiction evaluation and treatment."


Business Insurance

medicaidThe Medicaid money trail?



Doctors are shunning Medicaid patients because of low fees, a trend that is likely to become a crisis in less than two years, when the ranks of patients are expected to swell.


Budget talks in Springfield last week to reduce a $2.7 billion annual deficit in the health care program for the poor won't help ease the chronic shortage of doctors willing to treat patients at rates that are among the lowest in the nation. Fees are one reason many Chicago-area specialists don't make appointments with Medicaid patients, two studies have found.


Roughly 16 percent of the state's 47,000 doctors aren't signed up for the program. Even among those who are, the overwhelming majority infrequently see patients, leaving the care concentrated in the hands of a few, according to a Crain's analysis of payment records.


About 25 percent of Medicaid doctors account for just 0.4 percent of the $2.8 billion paid from 2009 through 2011 and make less than $1,400 a year in the program, Crain'sfinds. At the other end, the top 10 percent of Medicaid earners received more than 55 percent of the total payments, making at least $70,000 a year, the analysis shows.


Crain's Chicago Business



skinPain Meds Linked to Lower Risk for Skin Cancer


People who used common nonsteroidal anti-inflammatory drugs (NSAIDs) had a significantly lower risk of melanoma and squamous-cell skin cancer (SCC), and the benefit increased with duration and drug dose, according to a large Danish cohort study.


Any NSAID use was associated with a 15% reduction in the relative risk of SCC and a 13% lower risk of melanoma. NSAID use had no overall effect on basal-cell skin cancer (BCC), but was associated with a statistically reduced risk of BCC at sites other than the head and neck.


MedPage Today

proposedProposed Changes to Psychiatric Manual Could Impact Addiction Diagnosis


What's in a name? That's a question that experts are wrestling with as they prepare to revise the diagnostic manual that spells out the criteria for addiction and other substance-use problems.


The catalyst for this discussion is a set of proposed changes to the Diagnostic and Statistical Manual of Mental Disorders, the reference guide upon which clinicians, researchers, insurers and others rely to identify and classify psychiatric disorders. The revised guide, called DSM-5, will incorporate changes to more than a dozen categories of disorders, including those related to mood, eating and personality, as well as substance use and addiction.

Developed under the auspices of the American Psychiatric Association, the revised manual is scheduled for release in May 2013.



Kaiser Health News


amaAMA, MGMA letters to lawmakers suggest SGR alternatives


WASHINGTON - Letters sent last Friday to House Ways and Means Committee chairs Dave Camp (R-Mich.) and Wally Herger (R-Calif.) from the American Medical Association (AMA) and Medical Group Management Association (MGMA) suggest a number of different payment approaches aimed at a long-term solution to the current Medicare sustainable growth rate (SGR).


Both letters were submitted in response to a request from the committee seeking ideas on how to create new payment models.


"There is widespread agreement among experts and stakeholders that the existing physician payment system under the Medicare program is inadequate," wrote Susan Turney, MD, president and CEO of MGMA. "Although Congress has repeatedly intervened to prevent rate cuts, it has never eradicated the formula that dictates these cuts."


Healthcare Finance News



shortMost Individual Health Plans Fall Short of ACA Standards


More than half of the people who have health insurance coverage through an individual insurance plan are enrolled in plans that won't meet minimum coverage requirements for plans sold in 2014 as defined by the Affordable Care Act, according to research supported by The Commonwealth Fund.


The study, published in the May issue of Health Affairs sought to quantify the number of individual health plans sold today that fail to an actuarial value of 60 percent, the bare minimum for plans that will be sold at the "bronze" level on the health insurance exchanges starting in 2014.


According to the findings the average actuarial value for all health plans sold on the individual market was 60 percent and among that group 51 percent of the plans provided an actuarial value below 60 percent. These so-called "tin" plans see the insurance companies responsible for less than 60 percent of total healthcare costs, and the individual members responsible for more than 40 percent due to deductibles, co-payments and other out-of-pocket expenses



Healthcare Finance News



chattaChattanooga Doctor Faces 105-Count Federal Indictment


A Chattanooga doctor is facing a 105-count federal indictment.

Dr. Ishaan Al Amin, 61, was brought into a federal courtroom in handcuffs on Tuesday afternoon as the indictment was unsealed.


It charges that the operator of O'Neil Medical Clinic in Brainerd has been illegally dispensing controlled substances. He is also charged with money laundering and possession of a weapon in furtherance of a federal offense. Authorities said he was found with two firearms.


The Chattanoogan

challengesChallenges to Peer Review Confidentiality Rising


Physicians historically have enjoyed state protections when discussing a colleague's behavior or analyzing an adverse event in peer review committees. At least 45 states prevent disclosure of what is said during such meetings to facilitate open communication and foster better health care.


But a recent rise in legal challenges against peer review protections is putting doctors' confidentiality - and the process itself - at risk, legal experts and physicians say.



AMA news


e-prescribeE-prescribing Sign-up Highest Among Small Practices


Government incentives aimed at e-prescribing and electronic health record use had the intended effect, as they are considered the primary reasons for the great interest in e-prescribing among small practices.


The 2011 "National Progress Report on e-Prescribing and Interoperable Health Care" by Surescripts, the largest e-prescribing network, found that 58% of office-based physicians are using e-prescribing systems and the highest use - and largest growth - has been among small practices. Solo practices saw the most significant growth from 2010 to 2011.



AMA news


cashMany Hospitals, Doctors Offer Cash Discount for Medical Bills


Unknown to most consumers, many hospitals and physicians offer steep discounts for cash-paying patients regardless of income. But there's a catch: Typically you can get the lowest price only if you don't use your health insurance, says the Los Angeles Times.

That disparity in pricing is coming under fire from people like Jo Ann Snyder, whose share of a $6,707 CT scan amounted to $2,336 after her Blue Shield of California negotiated price. The cash price? $1,054. 

National Center for Policy Analysis

compensationPhysician Compensation in U.S. Among Lowest for Western Nations


ALPHARETTA, GA - A recent study by Alpharetta, Ga.-based staffing company Jackson Healthcare found that U.S. physician compensation is among the lowest of western nations.


Researchers obtained salary data from the Organisation for Economic Co-Operation and Development and the Medical Group Management Association to determine compensation percentages for nations with modern healthcare systems.


Total U.S. physicians' salaries comprised 8.6 percent of the nation's total healthcare costs. Of the western nations with modern healthcare systems, only Sweden devoted less money to physician salaries than the U.S, at a portion of 8.5 percent.



Healthcare Finance News


charged14 Charged in Massive Manhattan Illegal Prescription Pill Diversion, Distribution Scheme
 --More than 10,000 Prescription Pills Distributed Weekly--


May 23 - (New York) - Wilbert L. Plummer, the Acting Special Agent in Charge of the New York Field Office of the Drug Enforcement Administration, Preet Bharara, the United States Attorney for the Southern District of New York, and Raymond Kelly of the New York City Police Department (NYPD), today announced charges against: Julio Cesar Guerrero Brito, Hector Luis Vargas-Paredes, Jonathan Cruz, Virgilio Antonio Diaz Garciano, Ruben Alexander Santiago Guillermo, Plino Ramos, Eward Delrosario, Agustin Cabrea-German, and Arturo Lara for conspiring to distribute oxycodone and oxymorphone.


In a second complaint, Jenny Gomez, Felix Abreu, and Joanna Fuertes are charged with conspiring to distribute oxycodone and oxymorphone. In a third complaint, Walid Zeyad Asmar and Hector Jiminez are charged with conspiring to distribute oxycodone.


The defendants allegedly participated in the distribution of illegally diverted prescription pills through open-air, hand-to-hand, and car sales on certain blocks in Upper Manhattan. Multiple defendants also allegedly assisted in transporting these drugs to New England, where they command higher prices on the illegal market. The oxycodone was distributed in various forms, including what is commonly known as "Percocet," and the oxymorphone was distributed in a form commonly known as "Opana."




newASIPP Welcomes New Staff


Summer Moffitt comes to ASIPP as an administrative assistant. Her role as an administrative assistant include, typing correspondence reports and other documents, making phone calls, organizing documents, and giving assistance to other staff members. She has earned her Associates of Science in Health Information Technology at Daymar College, Clinton.


She will be handling the CME certificates as well. For any questions regarding your CME certificates, please contact Summer at summer@asipp.org or call 270-554-9412.






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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