" The Voice Of Interventional Pain Management "

celebrating our 10th anniversary

January 22, 2014


  1. Comment Period of Draconian Cuts is Ending: Only a Few More Days- Act Now or Never
  2. When Pain Therapies Fail
  3. CMS to Release Physician Payment Data
  4. Easier Way for Doctors to Identify Substance Abuse?
  5. Is Marijuana More Dangerous than Alcohol?
  6. MedPAC Recommends No ASC Pay Increase for 2015; 3.25-5.25% Increase for HOPDs
  7. Radiation Exposure to Spine Surgeons: Fluoroscopic Transforaminal vs. Caudal Lumbosacral ESI
  8. Will Physicians Be Dropped From Managed Care Networks?
  9. Why Aren't Doctors More Tech-Savvy?

dracoComment Period of Draconian Cuts is Ending: Only a Few More Days- Act Now or Never



The fight to reverse the draconian cuts continues.

While we are making progress, we must continue to act. We have until Monday, January 27th to comment and be heard. Because of this, there is no longer time for mailing the letters. They should now only be sent electronically through the ASIPP Capwiz links.Many of the offices are saying that they have not heard from doctors in their district. It is extremely important that they hear from you. All politics are local, all lobbying is local.


It is an understatement to say that the cuts are draconian and it will be devastating. Unless we act upon the issue this may be the end of interventional pain management practice for almost 40% of the physicians who base majority of their practices out of office setting, reduce access to patient care, and increase Medicare expenses by $187 million.


If we think it is devastating that they are paying a doctor for doing a cervical epidural $42 without the SGR cut (which includes a 0.5% increase), consider what the reimbursement will after March 31. With an SGR cut, if HHS has its way, it will drop to $30. Imagine all the new Affordable Care and Medicaid contracts, with some paying only 80% of $30, that will be $24 for doing a cervical epidural injection in post laminectomy syndrome.


ASIPP has set up Capwiz letters for physicians and patients. You should customize and describe your own situation in physician letters. Make sure each and every physician writes a letter and all of your patients sign a letter.


How to Implement a Letter-Writing Campaign in Your Office


As of today, January 22, 2014, there have been 10,442 letters sent to CMS and 52,749 total letters to multiple members of the Congress through the ASIPP Capwiz website.


We now have 11 letters of support from members of Congress:

Senators John Boozman, Mark Pryor, Rand Paul, Richard Blumenthal, Christopher Murphy, Mary Landrieu, and Minority Leader Mitch McConnell.


Representatives Ed Whitfield, Pete Olson, Renee Ellmers, and Brett Guthrie


We expect several others this week including a Doctor Caucus letter and an additional group letter lead by Rep. Ed Whitfield.


Save IPM Fund


whenWhen Pain Therapies Fail


Like many people suffering from chronic and debilitating pain, 28-year-old Cassie Winters has tried it all: physical therapy, powerful pain killers, massage, energy healing and meditation. She was even told that finding a new hobby or thinking happy thoughts would get her mind off the pain.

"Nothing worked," she said.


But Winters refused to give up. Though traditional therapies failed, she found a interventional pain specialist, a doctor who can diagnose and treat acute and chronic pain using targeted injections and minimally invasive therapies, often in conjunction with other modalities. Today she says she's finding some relief with a spinal cord stimulator, an implanted device that sends electrical signals to the brain to help mask the pain.


Chicago Tribune


CMSCMS to Release Physician Payment Data



The Centers for Medicare and Medicaid Services announced Tuesday that it will start to evaluate requests for individual physician payment information on a case-by-case basis.

The driving force to replace the previous policy was the more than 130 comments from over 300 organizations and individuals. "Numerous of these comments identified ample benefits to releasing Medicare physician payment data," Jonathan Blum, principal deputy administrator of CMS, wrote in a blog post about the announcement.




easierEasier Way for Doctors to Identify Substance Abuse?

Study supports asking a simple question, rather than giving lengthy questionnaire


A single question may help doctors determine whether a patient has a drug or alcohol problem and the level of abuse, a new study suggests.

Keep it simple is the message from the study of nearly 300 people recruited from the Boston Medical Center primary care clinic.


"We found that single questions may be useful in both screening and preliminary assessment" of substance-use severity, lead author Dr. Richard Saitz, chair and professor of community health sciences at Boston University School of Public Health, said in a university news release.



Health Day

marijuanaIs Marijuana More Dangerous than Alcohol?


Physicians and drug policy groups are sharply at odds over President Obama's statement to a magazine that marijuana is no more dangerous than alcohol "in terms of its impact on the individual consumer."


Obama's interview with The New Yorker magazine will appear Jan. 27. In it he said that while he considers marijuana "a bad habit and a vice," a waste of time and not very healthy, he doesn't think it's more dangerous than alcohol.


The issue is in the news as two states, Colorado and Washington, begin experiments with the legal sale of recreational marijuana this year. Both passed laws legalizing its recreational use on Nov. 6, 2012.



USA Today

medpacMedPAC Recommends No ASC Pay Increase for 2015; 3.25-5.25% Increase for HOPDs


On Friday, the Medicare Payment Advisory Commission approved a final recommendation for Medicare pay rates in 2015, recommending that ambulatory surgery centers get 0 percent pay raise, according to an AHA News report.

At the same time, MedPAC recommended increasing hospital inpatient and outpatient prospective payment systems by 3.25 percent in the absence of sequestration cuts and 5.25 percent if spending cuts continue. The sequestration that begun last April enacted automatic 2 percent Medicare payment cuts for the next 10 years.

However, MedPAC did suggest reducing or eliminating pay differences between hospital outpatient departments and physician offices for some procedures, as currently hospital outpatient departments are paid significantly more.


Becker's ASC


radiationRadiation Exposure to Spine Surgeons: Fluoroscopic Transforaminal vs. Caudal Lumbosacral ESI


A report in the February edition of the Journal of Spinal Disorders and Techniques evaluates radiation exposure during fluoroscopy-guided transforaminal and caudal approaches of lumbosacral epidural steroid injections.

The study included 228 patients who received lumbosacral ESI; 181 patients received transforaminal ESI and 47 received caudal ESI. Fluoroscopy time was 11 to 161 seconds for transforaminal ESI and four to 78 second for caudal ESI.


The researchers found that kerma-area product and fluoroscopy time were positively correlated for both transforaminal and caudal ESI, and after correction for fluoroscopy time KAP was less in transforaminal ESI than caudal ESI.


Becker's Spine Review


willWill Physicians Be Dropped From Managed Care Networks?


Insurers are dropping thousands of physicians from their managed care networks in response to growing pressures from the Affordable Care Act (ACA), leaving many doctors to wonder what plans they will still participate in for 2014 and beyond. But that's not all. If the insurer lets you stay, reimbursement rates may be cut so much that you will wonder whether being dropped was the better outcome.


UnitedHealth Group confirmed recently that it sent discontinuation letters to thousands of physicians in 10 states that cited "significant changes and pressures in the healthcare environment" as the cause. The company issued a statement saying that it expected its Medicare Advantage network, which covers about 27% of people on Medicare, to remain at about 85% of its 2013 size through the rest of 2014. The insurer currently has more than 350,000 providers in the Advantage network. (See the sidebar on p. 3 for UnitedHealth's explanation of why the cuts were necessary.)



HealthLeaders Media

whyWhy Aren't Doctors More Tech-Savvy?



Whenever I feel like taking a trip back in time, I save myself the trouble of building a time machine and instead just head over to a doctor's office. For a Millennial, or really anyone who lives a modern lifestyle, getting medical care is a rare departure from an otherwise technology-fueled existence.


First comes making the appointment, which usually requires a phone call. My gynecologist's office, for example, doesn't use online booking, so scheduling a visit means calling them from my "open plan" office and describing what, if any, "the issue is." Layered on top of this indignity, my last name is basically impossible to spell or pronounce. "Yes, once again that's K-H-A-Z-as-in-zebra-A-N."


Filling out forms in triplicate in the waiting room is, for me, relatively painless. By now, I've perfected my ability write my address, insurance ID number, and the words "allergies to most plants and animals" in about 15 seconds or less.



The Atlantic





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