January 4, 2006

Prescription Changes in Effect

The program, which is expected to enroll nearly 30 million, relies on private insurance companies to deliver prescription benefits. In the Jan. 1, Herald Leader, Dan Mendelson, president of Avalere Health LLC, a Washington consulting company, was quoted as saying, “What Congress did was completely unprecedented – they created new markets and new products.”

Enrollment for the new benefit began on Nov. 15. Although 17 million were automatically enrolled, many Medicare recipients were required to enroll. Of the 10 to 12 million with little or no coverage, approximately 1 million had signed up prior to the Jan. 1, enactment date. Those eligible have until May 15 to sign up without penalty.

To find out more about the new program go to the Medicare web site

New Opioid Guidelines in Pain Physician Journal

New guidelines for the use of opioids in the treatment of non-cancer pain have been revised and are ready for publication in the January 2006 issue of Pain Physician journal. These guidelines are the result of a major effort by 20 co-authors working over the course of several months. The group, under the direction of the ASIPP Board of Directors was headed by Andrea Trescot, MD, and Mark Boswell, MD, PhD, has created a practical body of work that updates the previous guidelines which were published in January of 2003.

The updated guidelines contain more than 100 additional references and 14 additional authors than the previous version. Both practicing clinicians and academicians were participators or contributors, helping to create a more thorough set of guidelines. The opioid guideline update is a requirement set forth by ASIPP.

Propofol Use for Colonoscopies on the Rise; Anesthesiologists’ Assistance is Challenged

 The Wall Street Journal Online recently reported on the increased use of propofol, a potent and fast-acting anesthetic, for colonoscopy procedures. propofol sedates more deeply and allows patients to recover more quickly than traditional methods of sedation but must be administered by an anesthesiologist rather than by the physician who is performing the procedure.

While the use of propofol is reportedly doubling every two years, some insurance companies are challenging payment of the required anesthesiologist assistance. WellPoint Inc., the country’s largest health insurer, has recently issued guidelines stating anesthesiologist assistance in routine colonoscopies is not a medical necessity. Some health plan providers are no longer paying for the services in average-risk exams.

In an attempt to bring down the cost of using propofol, some doctors are pushing to train nurses to administer the drug under supervision. The American College of Gastroenterology filed a petition to the FDA last year to modify propofol’s warning label to allow trained non-anesthesiologists to administer the medication. Currently nursing boards in 38 states don’t explicitly restrict trained nurses from doing so. Many doctors, among them both anesthesiologists and gastroenterologists, contend the drug is too complex to be administered by medical personnel without extensive anesthetic training and that changing propofol’s warning label is not warranted.

The real issue here is the patient. According to the American Cancer Society, colon cancer is the second-leading cause of cancer death in the U.S. The use of propofol in the life saving colonoscopy procedure eliminates most of the discomfort from the endoscope procedure. Physicians believe that with less discomfort, more people will have the procedure performed. If insurance companies restrict reimbursement for anesthesiologist, propofol use could go down and consequently, colonoscopies could decrease as well.

Subscribers can read the story on Wall Street Journal Online

Reimbursement for IDET and Spinal Endoscopy Increase in Hospital Outpatient Settings

The new Hospital Outpatient Department schedule for Medicare payments to hospitals for percutaneous intradiscal annuloplasty procedures (0062T) and spinal endoscopic adhesiolysis (0027T) has increased significantly, effective January 1, 2006.

The reimbursement for IDET (CPT 0062T) has increased from $622.43 in 2005 to $1424.50 for 2006. For spinal endoscopy (0027T), the reimbursement rate for 2004 and 2005 was $850; for 2006 it will be $1030.75 – a significant increase.

Read FAQs on ABIPP Examination

To answer your questions regarding ABIPP Diplomate exam and certification, visit the ASIPP web site for newly updated FAQs.  http://www.asipp.org/faqsabippdiplomate.htm.

Financial Trouble Predicted for Medicare

The Jan. 2, 2006 issue of the American Medical News reported congressional action to clamp down on program spending could be triggered within two years. This is the prediction of Federal Reserve Board Chair Alan Greenspan, who is retiring from the position at the end of the month.

Greenspan singled out cutting-edge advances in medicines as a major concern in a recent speech to a forum at the Federal Reserve Bank in Philadelphia. If the added expense of physician-prescribed services significantly outweigh the savings from reducing the need for more extensive treatments, the Medicare program will have a difficult time maintaining its funding over time, he stressed.

Subscribers can read the full story along with the following American Medical News stories at...http://www.ama-assn.org/amednews/

Other Stories in the Jan. 2 issue…

Florida doctors wary of Medicaid overhaul – Some say the state plan of shifting more patients into managed care is a bad idea but others see opportunity.

Forward thinking: The future of practice trends – Changes in health care delivery are no longer floating on the horizon. They’re here. One of which is Pay-for-performance. It will be taking center stage and is believed to be here to stay.

Dollars for disaster readiness, bioterrorism tricky to spend – OIG audits find unspent money and trigger calls for more oversight. States respond that problems result from growing pains.

Dec. 26 in American Medical News…

Noise is a rising risk – A Johns Hopkins study has found hospital noise levels have been increasing since 1960, creating more stress for physicians and patients. The study contends that too much noise means slower healing, hearing loss for surgeons and more medication for surgical patients.

Higher coding spurs insurer to “blend” pay rates – As electronic medical records systems improve physicians’ ability to code, Ohio’s WellPoint responds by paying CPT levels three and four at the same rate.

Most large companies will keep retiree drug benefits for now – A government subsidy will help many large employers maintain such plans in 2006, but fewer firms are sure about their plans for future years.

U.S. physicians create medical campus in India – Now in its third year, the school is in its final phase of construction. The six-year medical school has a student body of 400, with 150 students in the firs-year class.