October 3, 2012
Street Journal Publishes Article on CRNAs in IPM: Nurses Seek Expanded
in the Wall Street Journal article about the expanded role of nurse anesthetists
by Tim Martin, is Jackie Rowles of Indiana, former president of AANA, performing
some type of injection in the low back with minimal or no prep with Depo-Medrol
under fluoroscopy, and without a mask (which would be in violation of CDC guidelines). According
to the AANA Web site, Indiana is
not an opt-out state for CRNAs to work without the supervision of a physician.
It also appears that they are not entitled to use fluoroscopy or interpret
a very interesting article which includes comments from Laxmaiah Manchikanti,
MD, ASIPP Chairman of the Board. The article provides some of the pros and cons,
however, the author misses the GAO request filed to evaluate the qualifications
of CRNAs to perform interventional techniques.
Click here to read
This is an opportunity for
parties to express thier opinions. If you would like to post comments to the
article's blog on the Wall Street Journal's Web site, click here (Please note,
this is a Wall Street Journal Professional Sucription article). We encourage
members to write letters and post to the article's blog on the WSJ Web
Here is addtional
informaton on the CRNA saga. Based on ASIPP's request for a GAO study,
Congressman Ed Whitfield sent a formal request to the GAO asking them to provide
answers to a number of questions:
Do CRNAs have the
appropriate education and training to perform chronic pain management
What impact would this
proposed rule have on access to care for patients seeking chronic pain
Whitfield Letter to
Additionally, 13 doctors
from the House of Representatives have signed and sent a letter to the Acting
Administrator of CMS, Marilyn Tavenner, on this issue: Congressional Letter to
While this is encouraging
news, we have discovered some very disturbing news regarding this scope of
practice issue. ASIPP has learned that the American Association of Nurse
Anesthetists (AANA) has taken on a very
aggressive and misleading advertising campaign at a national level. On September
21, 2012, they placed a two-page spread feature story advertisement in the
national insert USA Today featuring. Distribution markets for the print version
of the insert include the New York, Chicago, Los Angeles, and Philadelphia
editions of USA Today. According to the AANA Web site, this ad reached a print
circulation exceeding 460,000. To view the advertisement, click here: http://doc.mediaplanet.com/all_projects/11025.pdf
We have done very well so
far and ASIPP continues to work on gathering more letters of support..
Based on our own numbers from ASIPP Web site we have sent nearly 2,000
letters to CMS and over 10,000 letters to members of the congress, this in
addition to the numerous phone calls, personal meetings, and the many other
letters sent from other organizations, including the American Society of
Anesthesiologists, who are collaborating with us on this issue. ISIS also sent a
letter to CMS.
In the coming weeks we have
crucial work on this issue to survive into the future. For more information on
the CRNA issue please look at the following manuscript:
Proposed physician payment
schedule for 2013: guarded prognosis for interventional pain
Multi-State Outbreak of Meningitis Following Epidural Injections
information is surfacing regarding the outbreak of meningitis following epidural
steroid injections. We have learned that the CDC is contacting offices who may
have received contaminated product.
new cases of meningitis have been confirmed in the past 24 hours in Tennessee,
while new cases have been confirmed in North Carolina, Virginia, Maryland and
Florida - and the outbreak could potentially spread to even more states.
John Dreyzehner, the commissioner of health for the Tennessee Department of
Health (TDH) said the total number of cases now stands at 18 - with patients
ranging in age from 49 to 89 years old. Dreyzehner said two people have died
since the cases were initially discovered, and several others are listed in
serious condition and could die from the rare form of Aspergillus
most of the cases have occurred in Tennessee, North Carolina has identified
Monday at least one case that was linked to the meningitis outbreak. According
to the Centers for Disease Control and Prevention, other cases have been
reported in Virginia, Maryland and Florida. Both Virginia and Maryland have
reported one death each.
TDH said 737 patients could have potentially been exposed by receiving
methylprednisolone, a steroid that is usually injected into the spine to relieve
back pain. Pain management clinics in Nashville, Crossville and Oak Ridge are
confirmed to have received the tainted injections dating back to July 30, 2012.
The Oak Ridge clinic confirmed it had received 2,000 injections; however, it is
not known how many the Nashville and Crossville clinics received.
The Food and Drug Administration
said that they are working with several state health departments and the
Massachusetts Board of Pharmacy. They were still investigating the scope and
cause of the outbreak.
Officials said they have
identified the compounding center where the drugs were mixed, a facility called
the New England Compounding Center. The NECC has conducted a voluntary recall of
3 lots of Methylprednisolone epidural injection that was produced at the
Please report cases of
clinical meningitis, other neurologic infection (i.e. epidural abscess, spinal
osteomyelitis, etc.) or cerebrovascular accident with symptom onset within 1
month of epidural injection since July 1, 2012 to Rachel Smith at the Centers
for Disease Control and Prevention (CDC) at firstname.lastname@example.org /
CCI 4th Quarter
Updates Now Available
The National Correct Coding
Initiative (NCCI, or more commonly, CCI) is an automated edit system to control
specific Current Procedural Terminology (CPT) code pairs that can be reported on
the same day. It was developed by the Centers for Medicare and Medicaid Services
(CMS) for use in all Medicare Part B and, more recently, Medicaid claims. The
goal of CCI is to eliminate "mutually exclusive" code pairings and codes
considered to be components of more comprehensive services or otherwise
inappropriate to be delivered to the same patient on the same day. The CCI is
As a member benefit, we are
providing you with the 4th quarter updates for IPM codes.
CCI Updates for IPM
New and Revised
Content for November ASIPP meetings: Cut-off Date Extended to Oct. 11
is hosting three concurrent sessions November 2-4 in Denver, Co. A comprehensive
reivew course and cadaver workshop, a controlled substance mangement course and
the coding, comliance and practice management review.
courses are designed to present interventional pain management
and other health care providers in-depth reviews of multiple areas of
pain management-the areas we were never taught, yet are crucial
our survival. The course features many nationally recognized experts in pain
billing and coding and practice management as well as controlled
management. In today's environment of regulations and litigations, you
afford not to broaden your knowledge and refresh your skills in these areas.
You Need to Know in Controlled Substance Management.
Review basic science and core concepts
Identify clinical use and effectiveness
Identify substance abuse
Discuss topics with documentation, regulatory issues,
issues, and ethical issues
Click here for brochure
Click here to register
in Practice Management in IPM
Review practice management topics
Discuss coding and billing
Examine compliance issues
Click here for brochure
Click here to register
for this course, we have added:
and Physiology, and Psychology of Chronic Pain
an Infection Control in IPM.
the 2½-day Comprehensive Review Course and Cadaver Workshop, you
improve existing skills and/or learn new techniques. Whether you have
interventional pain management for many years or are new to the field
skills, we are confident you will find this course and workshop to be
as it is essential that we continue learning and exploring new procedures
in our specialty.
Click here for brochure
Click here to
Three course will be held at Renaissance Denver Hotel, 3801 Quebec Street,
Denver, CO 80207 | Tel. 303-399-7500 Click here to book your room
under the ASIPP room block (good until COB Oct. 11, 2012).
Workshop Location: Science Care, 19301 East 23rd Avenue Aurora, CO
Special room rates and registration discounts are good through COB October 11,
Board Review Videos Available
This Review Course in IPM is
designed to prepare physicians seeking board certification, re-certification, or
an in-depth review of the specialty of interventional pain medicine.
This review course will be based on the specifications of subspecialty
in pain medicine examination of The American Board of Anesthesiology, Physical
Medicine and Rehabilitation, and Neurology and Psychiatry. This review course
will also meet 90% curriculum of ABIPP Part 1.
This comprehensive Review
Course is intended as an overview of the anatomy, physiology, diagnosis, and
treatment of a wide range of painful disorders, in order for participants to
pass certification or re-certification and obtain in-depth review; and therefore
be able to provide improved interventional management, controlled substance
management, and practice management.
Order the online videos and receive 5 days of course video via the
Internet. You can watch them on your computer or any computer with Internet
access. You will be given a password to access the high quality streaming video
of each day.
|Join the AMA or
Renew Your Membership Today!
American Medical Association (AMA) requires all societies to requalify for
membership in the AMA House of Delegates (HOD) every five years which is 2013
for ASIPP. In order for ASIPP to retain our seat, the AMA requires that 35% of
our physician members also be members of the AMA .
encourage you to join or renew their membership in the AMA. Joining the AMA will
further strengthen our specialty's representation at the national level through
the AMA House of Delegates, the AMA's policymaking body, and strengthen our
ability to meet the challenges in health care today with thoughtful,
As a member
of the AMA, you become part of the organization that unites physicians
nationwide to tackle the major issues we all face: 47 million uninsured
Americans, looming Medicare payment cuts, the need for medical liability reform.
Membership also gives you access to a broad range of practice management
resources and award-winning publications such as the Journal of the American
Medical Association, AMNews, AMA Morning Rounds and the Archives
this opportunity to support the critical activities of ASIPP by joining the AMA
today. To join or renew the AMA, we encourage you to visit www.ama-assn.org or call
Many States Not
Prepared for Health Care Law
More than three dozen states could be
unprepared or unwilling to set up the insurance marketplaces called for under
the 2010 health-care law, leaving at least part of the task up to the federal
government, according to a new report.Thirteen states and the District of
Columbia have formally expressed their intention to set up the marketplaces,
which are known under the law as health insurance exchanges. But many of the rest of the states
are behind in their planning or have decided not to operate exchanges on their
own, according to a report from the Health Research Institute, the research arm
of PricewaterhouseCoopers's health-care consulting business. Even some of the 13 that plan to set
up the exchanges might not be ready for enrollment by October 2013, the report
said. If a state does not set up an exchange, the federal government will either
partner with the state or be the sole operator in that state.
Auditor Targets E&M Services for Review
A Medicare auditor tasked
with reviewing past claims for physician and hospital services in 15 states will
start scrutinizing the billing of office visits, claims that previously had been
off-limits to recovery audit contractors.
The RAC revealed its plans
to conduct limited reviews in southeast and mid-Atlantic states using a
statistical sampling to project how many physician claims that used the
high-level, established patient evaluation and management code 99215 were paid
incorrectly. The contractor, Atlanta-based Connolly Inc., will scour claims
filed by doctors and hospitals with dates of service as far back as Oct. 1,
ObamaCare's Tax Raid on Medical Devices
The Supreme Court decision
in June upholding the Affordable Care Act leaves in place a tax on medical
devices that threatens thousands of American jobs and our global
competitiveness. It will also stifle critical medical innovation in the industry
that gave us defibrillators, pacemakers, artificial joints, stents, chemotherapy
delivery systems and almost every device we depend on to save lives.
The 2.3% tax will be
charged to manufacturers on each sale and takes effect in January. Many U.S.
device companies, in response, have already announced layoffs, canceled plans
for domestic expansion and slashed research-and-development budgets. This month,
Welch Allyn-a maker of stethoscopes and blood-pressure cuffs-announced that it
will lay off 10% of its global workforce over the next three years, but all of
the jobs being cut are in the U.S.
The Wall Street
Lack Knowledge of Health Care Overhaul
The 2010 Affordable Care Act affects
almost every aspect of the U.S. healthcare system, but many future doctors who
will be operating under its policies admit they don't know that much about the
In a survey of about 850 medical
students in Minnesota, less than half said they understood the healthcare law's
basic components, and more than 40 percent said they had no opinion on the
Copyright © 2008
American Society of Interventional Pain Physicians ®
81 Lakeview Drive, Paducah, KY 42001
Phone 270.554.9412, Fax 270.554.5394