" The Voice Of Interventional Pain Management "

celebrating our 10th anniversary

Nov. 21, 2012


Update: Multistate Outbreak of Fungal Meningitis and Other Infections Associated with Contaminated Steroid Medication


Summary: The Centers for Disease Control and Prevention (CDC) continues to work closely with state public health departments on a multistate investigation of fungal meningitis and other infections among patients who received a methylprednisolone acetate (MPA) injection prepared by the New England Compounding Center (NECC) in Framingham, Mass. This HAN notice provides updated information on the following:

  • Epidural abscess and other clinical syndromes being diagnosed in exposed patients
  • Diagnostic and treatment recommendations for clinicians

Background: As of November 19, 2012, a total of 490 cases, which includes 34 deaths, have been reported in 19 states (see CDC's website http://www.cdc.gov/hai/outbreaks/meningitis.html

for up-to-date information about case count and distribution by state). Exserohilum rostratum continues to be the predominant fungus identified in patients and confirmed by the CDC laboratory.


Clinical Syndromes Reported to CDC


Currently, more than 7 weeks after the three implicated lots of MPA1 were recalled, CDC continues to receive reports of fungal infection in exposed patients. Previously, the majority of new cases reported to CDC were patients with fungal meningitis following injection.


Although cases of fungal meningitis continue to be reported, CDC has recently observed an increase in the number of patients presenting with evidence of epidural abscess, phlegmon, discitis, vertebral osteomyelitis, or arachnoiditis at or near the site of injection. These complications have occurred in patients with and without evidence of fungal meningitis.


Of the 91 cases reported to CDC since November 4, 2012, a total of 26 (29%) were classified as meningitis, 61 (67%) had spinal or paraspinal epidural abscess or osteomyelitis, 2 (2%) had peripheral joint infection, and 2 (2%) had more than one condition.


To read rest of report click HERE.



cmsCMS Issues Final Rule for 2013 Physician Reimbursement


On November 1, the Centers for Medicare & Medicaid Services (CMS) issued a final rule with a comment period on Medicare's payments for physician fees for 2013.


The final rule also includes a statutorily required 26.5 percent across-the-board reduction to Medicare payment rates for more than 1 million physicians and non-physician practitioners under the Balanced Budget Act of 1997's Sustainable Growth Rate (SGR) methodology. However, Congress has overridden the reduction every year since 2003.


The final rule also expands access to services provided by non-physician practitioners. The rule allows Certified Registered Nurse Anesthetists (CRNAs) to be paid by Medicare for providing all services that they are permitted to furnish under state law. This change will allow Medicare to pay CRNAs for services to the full extent of their state's scope of practice policy. The rule also allows Medicare to pay for portable x-rays ordered by nurse practitioners, physician assistants, and other non-physician practitioners.


The rule will be published on November 16, 2012 with the comment period closing on December 31, 2012.The rule will take effect on January 1, 2013


Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rule

The rates and policies set in the calendar year (CY) 2013 final rule with comment period will increase payment rates for hospital outpatient departments by 1.8 percent. The increase is based on the projected hospital market basket-an inflation rate for goods and services used by hospitals-of 2.6 percent, minus 0.8 percent in statutory reductions, including a 0.7 percent adjustment for economy-wide productivity and a 0.1 percentage point adjustment required by statute.


For CY 2013, ASC payment rates will increase by 0.6 percent-the projected rate of inflation of 1.4 percent minus a 0.8 percent productivity adjustment required by law. Medicare uses changes in the consumer price index for urban consumers (CPI-U) as the measure of inflation for ASCs.


2013 Final Physician Fee Schedule


2013 Final ASC Fee Schedule


2013 Final HOPD Fee Schedule

cutsMedicare Cuts Give Health Providers Jitters


The $716 billion in Medicare "cuts" that got so much attention in the presidential election have already begun sinking their teeth into health care providers.


And there are widespread jitters that any further cuts as part of a year-end deal to stave off sequestration or strike a "grand bargain" for a long-term fiscal deal would deeply gouge some providers, if not put them out of business.

It's similar to the perennial jockeying that goes on whenever Congress looks to cut health spending to pay for some other priority - the so-called doc fix, for instance. But this time around, having already been cut substantially to pay for the federal health care law, providers say the stakes are higher than ever, and some are digging in their heels.



phoenexPhoenix in February: ASIPP Offers Three Different Courses



ASIPP is pleased to announce a new course curriculum for its Comprehensive Review Course and Cadaver Workshop scheduled Feb. 16, 17 in Phoenix, AZ


The course will feature three levels: basic, intermediate and comprehensive IPM exam prep with up to 21 AMA PRA Category 1 Credits.

Book now through Jan. 15 and enjoy ASIPP's special room rates at the Pointe Hilton Tapatio Cliffs Resort .


This 1½-day workshop is designed for interventional pain physicians, for a review, skills improvement, or to assist in preparation for Comprehensive Interventional Pain Management Examination qualifications. ASIPP offers the most in-depth, comprehensive, and individualized programs available in interventional pain management, featuring maximum hands-on training with cadavers in a state-of-the-art facility and maximum ability to interact with other participants. Participants will experience a comprehensive and intense learning opportunity, focusing on interventional pain management techniques.

  • Each cadaver station is limited to a maximum of 7 participants.
  • Participants can choose the level of participation: basic, intermediate, or Comprehensive Interventional Pain Management Examination Preparation Course.
  • C-arms and state-of-the-art equipment are utilized in this course. Participants are requested to dress in casual attire or scrubs. Leaded aprons and thyroid shields will be provided. However, participants are advised to bring their own protective eyewear.
  • Participants will be provided with 7 video lectures relevant to the course material

 Brochure: http://www.asipp.org/documents/0213-cadaver.pdf



Click HERE to Register.



ASIPP is also offering two other courses, Feb. 15-17, 2013 :


These two-day comprehensive review courses are planned as a CME

activity to prepare for competency certification or an in-depth review in

areas of What You Need to Know in Controlled Substance Management

and Essentials in Practice Management in IPM. This review course

is based on the American Board of Interventional Pain Physicians'

specifications for competency certification examinations.


CSM course objectives

  • * Review basic science and core concepts
  • * Discuss pharmacology
  • * Identify clinical use and effectiveness
  • * Identify substance abuse
  • * Discuss topics with documentation, regulatory issues,
  • legal issues, and ethical issues


CCPM course objectives:

  • * Discuss documentation
  • * Review practice management topics
  • * Discuss coding and billing
  • * Examine compliance issues

Click HERE for brochure


Click HERE to register for Essentials in Practice management course


Click HERE to register for Controlled Substance Management Course

deathsPrescription Drug Deaths: Two stories


Pete Jackson attended his brother-in-law's funeral along with his daughter, Emily, six years ago. He never dreamed it would be the last day of his daughter's life.


"It's so tragic, just not something you would never, ever expect," said Pete Jackson.

Instead of going home to the Chicago suburb of Arlington Heights after the funeral, Emily Jackson, 18, spent the night with her cousins.


That night, she made a deadly decision. She took an Oxycontin -- a single prescription pill -- that her cousin offered to her while drinking. She went to sleep that night and never woke up. She died of respiratory depression -- she simply stopped breathing



howHow Back Pain Turned Deadly


RANDALL KINNARD'S legal clients had steroids injected into their backs last summer for a wide range of reasons. Of the 25, one got three shots in a two-month period when pain never totally disappeared. Another got one as a preventive measure because she was going on a trip to Europe and was worried that cobblestones would aggravate an old injury.


Now the 25 - or their survivors - have engaged Mr. Kinnard, one of Nashville's leading lawyers, to sue the New England Compounding Center. Three have died, one is paralyzed, several more are still hospitalized and all suffer blinding headaches - victims of the meningitis that resulted from vials of steroid medicine contaminated by fungus.



New York Times


ppaPPACA Not Out of Danger in Upcoming Negotiations


How does the country's economic future look as we peer over the edge of the "fiscal cliff"? Will Congress take action and avoid the expiration of tax cuts and sequestration? And how will all this impact the Patient Protection and Affordable Care Act? These are questions that every financial leader should be pondering. A legal and a legislative expert offered their thoughts on what may happen next.

Mark E. Lutes, a healthcare attorney with the national law firm Epstein Becker Green and William C. Oldaker, a member of the Washington, DC-based consultancy National Health Advisors, discussed the post-election regulatory agenda in a webcast last week.



Health Leaders Media

whyWhy Healthcare Costs Trillions Less in Canada


As always before a major election, there's the chorus of threats. "If so and so wins, I'm moving to Canada." (Groan.) "This country is broke, and out of control, and we're all going to hell in a hand-basket."

And so it went this year, except that in 2012, many a Twitter tirade blamed the healthcare reform law-aka Obamacare, aka the Patient Protection and Affordable Care Act-now on its way to full implementation, for the urge among the electorate to flee the country.

I paraphrase, but some of the unenlightened comments went like this: "I'm moving to Winnipeg. Don't want the government controlling my life or my healthcare."

Here's the irony: The Maple Leaf nation's government-paid healthcare system, which requires few if any co-payments or deductibles, may provide much higher quality of healthcare services at a fraction of the spending compared with the Medicare program in the United States.


Health Leaders Media


payPhysician Pay a Major Unknown Despite Health Reform Certainty


Washington President Obama's victory in the November election clears up one major element of uncertainty on how the nation will proceed with health system reform. The Democratic Party's continued control of the Senate and the White House means that the Obama administration will move ahead with implementing the Affordable Care Act's payment and coverage reforms in the coming months.


The election "relieves any doubts in people's minds that the Affordable Care Act will be repealed or aspects of it will be repealed - or that payment reform is going away," said Laura Jacobs, executive vice president with the Camden Group, a business advisory consulting firm. For doctors, "the things we've been talking about for the last year-and-a-half in terms of new ways of being paid, quality reporting, concerns about cost, transparency and quality" all remain important, she said.







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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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