Nov. 21, 2012
Update: Multistate Outbreak of Fungal Meningitis and Other Infections Associated
with Contaminated Steroid Medication
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
- Epidural abscess and other
clinical syndromes being diagnosed in exposed patients
- Diagnostic and treatment
recommendations for clinicians
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
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
DEPARTMENT OF HEALTH AND
CMS 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
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
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
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
2013 Final ASC Fee
2013 Final HOPD Fee
Medicare 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
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
- Participants will be
provided with 7 video lectures relevant to the course material
Click HERE to
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'
competency certification examinations.
- * Review basic science and
- * Discuss
- * Identify clinical use
- * Identify substance
- * Discuss topics with
documentation, regulatory issues,
- legal issues, and ethical
- * Discuss
- * Review practice
- * Discuss coding and
- * Examine compliance
Click HERE for
Click HERE to register
for Essentials in Practice management course
Click HERE to register for
Controlled Substance Management
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
How Back Pain
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
PPACA 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.
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.
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
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
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.
Physician Pay a
Major Unknown Despite Health Reform Certainty
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
Copyright © 2008
American Society of Interventional Pain Physicians ®
81 Lakeview Drive, Paducah, KY 42001
Phone 270.554.9412, Fax 270.554.5394