Eastern Florida Society of Interventional Pain Physicians
Florida Society of Interventional Pain Physicians
Florida Society of Interventional Pain Physicians

FSIPP ALERTS

May 8, 2017

PRESS RELEASE: Letter to Governor Rick Scott

Dear Governor Scott,

The Florida Society of Interventional Pain Physicians (FSIPP) would like to thank you for rising to the challenge of combatting the substance abuse and the opioid crisis in the State of Florida. Your unrelenting support of this problem has been much appreciated by the pain management physicians in our State. The task of controlling or eliminating this killer epidemic will not be easy, but we believe you can succeed. Thank you from the families, community, physicians, and others who have been impacted by this crisis.

Read the Entire Letter


May 2, 2017

REGARDING: CMS Webinar Series on the opioid epidemic, first of its kind. FSIPP suspects the perspective of CMS should be interesting and maybe even challenging. Click the link below to register for the Webinar.

Join us for the Learning Series Webinar
May 11, 2017
1:00 - 2:30 pm EDT


The Center for Program Integrity will discuss CMS’ approach to combating the opioid epidemic, including priority areas which aim to:

  • Implement more effective strategies to reduce the risk of opioid use disorders, overdoses, inappropriate prescribing, and drug diversion
  • Expand the use and distribution of naloxone
  • Expand screening, diagnosis, and treatment of opioid use disorders
  • Increase the use of evidence-based practices for acute and chronic pain management

 

To join the webinar, visit https://goto.webcasts.com/starthere.jsp?ei=1129992.


February 15, 2017

ALERT: Designee Access to E-FORCSE

Summary:      
On February 14, 2017, a designee of a prescriber or dispenser may have direct access to the controlled substance dispensing information in the E-FORCSE® database by registering on the E-FORCSE® secure web portal.

E-FORCSE staff will be hosting two webinars regarding the implementation of designee access, as outlined below.

  1. Designee Registration and Linking (Tuesday, February 14, 3:00-4:00 PM EST; Wednesday, February 15, 9:00-10:00 AM ET; Thursday, February 16, 10:00-11:00 AM ET; and Friday, February 17, 10:00-11:00 AM) - The purpose of this webinar is to outline laws and rules regarding designee access to E-FORCSE, provide an overview of the responsibility of the supervising prescriber or dispenser, and demonstrate the process for designee registration and linking accounts.  The target audience for this webinar are supervising prescribers and dispensers and designees. To register go to: https://attendee.gotowebinar.com/register/5411319424475647234
  2. E-FORCSE 101 for Designees (Wednesday, February 15, 3:00-4:00 EST; Thursday, February 16, 2:00-3:00 PM ET; and Friday, February 17, 12:00-1:00 PM ET) – The purpose of this webinar is to introduce designees to the E-FORCSE web portal and demonstrate  how to use the E-FORCSE database to access controlled substance dispensing information on behalf of their supervising prescriber or dispenser. To register go to: https://attendee.gotowebinar.com/register/2922780463679161346.

 

How It Affects Me:   

As a prescriber or dispenser, you may designate another individual to have direct access to controlled substance dispensing information in the E-FORCSE® database on your behalf.  As the designating prescriber or dispenser, you must affirmatively accept responsibility for the designee's actions within the database and ensure that the required training is completed.

Background:

The 2016 Florida Legislature passed Senate Bill 964 authorizing direct access to controlled substance dispensing information within the E-FORCSE® database to a designee of a prescriber or dispenser.  Florida Administrative Code rule 64K-1.003(3) sets forth the requirements for access, and requires the prescriber or dispenser to certify that the designee has reviewed the "Training Guide for Florida Practitioners and Pharmacists” and the "Information Security and Privacy Course for Designees.”

Action Steps Needed:

Designee

  1. Review the Training Guide for Florida Practitioners and Pharmacists and the Information Security and Privacy Course for Designees and provide certification of completion to the designating prescriber or dispenser.
  2. Register for access on the E-FORCSE® secure web portal at https://flpdmp-phreg.hidinc.com  using the temporary user name "newacct” and temporary password "welcome.”  (NOTE: The designee will receive a user name and password, however the designee will NOT have direct access to information until the prescriber or dispenser has accepted responsibility for the designee and linked the account.)
  3. Inform the designating prescriber or dispenser that registration has been completed and that the designee is available for linking.


Designating Prescriber/Dispenser

  1. Review the Training Guide for Practitioners and Pharmacists  and Florida Administrative Code rule 64K-1.003, for updates regarding designee access to E-FORCSE® and the designating prescriber or dispensers' responsibilities.
  2. Confirm that the designee has reviewed the Training Guide for Florida Practitioners and Pharmacists and the Information Security and Privacy Training Course for Designees and receive certifications of completion, to be stored on file.
  3. Follow the instructions in the Quick Reference Guide to Link a Designee to complete the designee linking process.  NOTE: The designating prescriber or dispenser must accept responsibility for the designee's activities in the E-FORCSE® database.

 

For technical assistance, contact the help desk at flpdmp-info@hidesigns.com.

E-FORCSE Florida Prescription Drug Monitoring Program
4052 Bald Cypress Way, Bin C-16, Tallahassee, FL 32399 l Phone: 850-245-4797 l Fax: 850-617-6430 l Email: e-forcse@flhealth.gov l www.e-forcse.com

 


January 20, 2017

Level II Office Based Florida DOH Certification And Inspection

FSIPP Members,

If you are Level II Office Surgery Certified by the Florida DOH there will be new changes in the inspection process. Please see below communication from Cheryl White, Florida Risk Manager regarding the opportunity for mock inspections, given the new format for certification. Additionally, see attachment.

Dear Office Surgery Administrator,

We would like to offer a Pre-Inspection Consultation prior to your next Office-Based Surgery Inspection. Big Changes have occurred! We are no longer state inspectors. The State of Florida has changed the Office Based Surgery program inspectors. The new inspectors will be from the Investigative Services Unit.

Please see the attached document that shows what we can do to help your office get ready.

Regards,

Cheryl E. White, RN, BS, MSHL, LNCC, LHRM, MSCC, DFSHRMPS
727-480-5911

Sheree M. Saroff, RN, BSN, MBA, LHRM, CLC, MSCC
727-418-7313

Archives

  • 2016 Archives

    December 2, 2016

    No More Interventional Techniques in Oregon - Soon It Could Be Your State


    Just 6 days to show you stand against the sweeping recommendation to eliminate coverage for spinal interventional techniques in Oregon.

    The Oregon Health Evidence Review Commission, without fanfare and without even looking at the literature appropriately, is eliminating coverage for what appears to be ALL spinal interventional techniques, now or in the next few months. They have issued draft coverage guidance strongly recommending against coverage for epidural, facet joint, medial branch, and sacroiliac joint injections for low back pain, regardless of etiology.

    It is time to mobilize our forces across the nation. As you all know, this is based on the inappropriate evidence synthesis that was performed with intellectual bias by Chou et al from an organization which is facing extinction in its own - the Agency for Healthcare Research and Quality (AHRQ).

    Please see the letter we have drafted for presentation to the Oregon Health Authority. Please send in your name. title, and address, as well as the name, title, and address of any other providers in your practice who will sign on. We will also be enclosing an extensive citations list apart from this letter.

    The comment period ends on December 9, 2016. We encourage you to submit your name, title, city and state, as soon as possible, no later than December 6, to Savannah Gold at sgold@asipp.org.

    Please remember you need to send in your name, title, city, and state - not just your name. It is crucial! You can submit your office address. It doesn't have to be your home address, but an address is required.

    Thank you,

    Laxmaiah Manchikanti, MD
    Chairman of the Board and Chief Executive Officer, ASIPP
    Medical Director, Pain Management Center of Paducah
    Clinical Professor, Anesthesiology and Perioperative Medicine
    University of Louisville, Kentucky
    2831 Lone Oak Road
    Paducah, KY 42003
    Phone: 270-554-8373 ext. 101
    drm@asipp.org


    Aaron K. Calodney, MD
    President, ASIPP
    Director of Clinical Research
    Precision Spine Care
    Texas Spine and Joint Hospital
    PO Box 130459
    Tyler TX 75713-0459
    Phone: 903-531-2500
    aaroncalodney@me.com


    August 29, 2016

    Dear FSIPP Members,

    The purpose of this information is to help your hospital administrators and leading clinicians submit comments to CMS about its proposed reimbursement reduction for vertebral augmentation in CY17. Based upon Medicare's own data, Vertebral Augmentation should be reassigned to a Level 5 procedure. The suggested comment below needs to be submitted to CMS before September 6, 2016 @ 5pm (est). It is very easy to submit an online comment via this link:

    https://www.federalregister.gov/articles/2016/07/14/2016-16098/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment#open-comment

    Dear CMS Administrator:

    The proposed assignment of VERTEBRAL AUGMENTATION (CPTs 22513-22515) should be reconsidered. In the CY17 HOPPS proposed rule, CMS proposes to significantly reduce facility reimbursement from $7,064 to $5,199. Please reconsider the costs as shown in Medicare's own cost files. Based on the geometric mean cost = $7,048.17 shown in Addendum J and the Geometric Mean Cost shown in another file = $6,671.97, Vertebral Augmentation should be moved to APC #5125: Level 5 Musculoskeletal Procedures.

    Thank you for your consideration and correction.


    March 23, 2016

    FDA Drug Safety Communication: FDA warns about several safety issues with opioid pain medicines; requires label changes

    Safety Announcement

    The U.S. Food and Drug Administration (FDA) is warning about several safety issues with the entire class of opioid pain medicines. These safety risks are potentially harmful interactions with numerous other medications, problems with the adrenal glands, and decreased sex hormone levels. We are requiring changes to the labels of all opioid drugs to warn about these risks.

    · Opioids can interact with antidepressants and migraine medicines to cause a serious central nervous system reaction called serotonin syndrome, in which high levels of the chemical serotonin build up in the brain and cause toxicity (see List of Serotonergic Medicines).

    · Taking opioids may lead to a rare, but serious condition in which the adrenal glands do not produce adequate amounts of the hormone cortisol. Cortisol helps the body respond to stress.

    · Long-term use of opioids may be associated with decreased sex hormone levels and symptoms such as reduced interest in sex, impotence, or infertility.

    Opioids are a class of powerful narcotic pain medicines that are used to treat moderate to severe pain that may not respond well to other pain medicines (see List of Opioids). They can help manage pain when other treatments and medicines are not able to provide enough pain relief, but they also have serious risks including misuse and abuse, addiction, overdose, and death.

    Recommendations and information for patients and health care professionals...

    Read the Entire Alert Here


    February 25, 2016

    REGARDING: MEANINGFUL USE ATTESTATION

    MGMA is recommending that all physicians, healthcare facility groups and hospitals apply for the meaningful use hardship exception. The reason being, is that even if you have already attested, we have no idea how CMS will handle these attestations, as they were so late in clarifying the measures. Additionally, some of you are counting on your EHR or registry to successfully submit your data, which may not happen. This will not prevent you from a bonus if your attestation is successful and you are in a bonus category. But if anything goes wrong it will prevent you from a 3% cut on all Medicare claims in 2019. The deadline for submitting the hardship extension is March 15, 2016.

    SELECT 2.2d AS THE REASON FOR THE HARDSHIP APPLICATION.

    Click Here for the application.

  • 2015 Archives

    December 21, 2015

    New Pharmacy Regulations Regarding Controlled Substances
    Effective 12/24/2015

    FSIPP Membership

    Below please find the new Pharmacy regulations regarding controlled substances that go into effect December 24, 2015. The Leadership of FSIPP has worked diligently to ensure patients have access to controlled substances. FSIPP President Harold Dalton, DO, Vice President Jesse Lipnick, MD, and member Mark Rubenstein, MD all served on the Florida Board of Pharmacy's Controlled Substance Standards Committee as well as the subcommittee charged with rewriting the rules which pharmacist's follow in dispensing controlled substances. FSIPP Past President's Harold Cordner, MD, Sanford Silverman, MD and Board Member Miguel de la Garza, MD provided testimony to the committee.

    (You may click here to download the information below as a pdf.)

    64B16-27.831 Standards of Practice for the Filling of Controlled Substance Prescriptions; Electronic Prescribing; Mandatory Continuing Education.

    The Board of Pharmacy recognizes that it is important for the patients of the State of Florida to be able to fill valid prescriptions for controlled substances. In filling these prescriptions, the Board does not expect pharmacists to take any specific action beyond exercising sound professional judgment. Pharmacists should not fear disciplinary action from the Board or other regulatory or enforcement agencies for dispensing controlled substances for a legitimate medical purpose in the usual course of professional practice. Every patient’s situation is unique and prescriptions for controlled substances shall be reviewed with each patient’s unique situation in mind. Pharmacists shall attempt to work with the patient and the prescriber to assist in determining the validity of the prescription.

    (1) Definitions: For purposes of this rule the following definitions shall apply:
    (a) Valid Prescription. A prescription is valid when it is based on a practitioner-patient relationship and when it has been issued for a legitimate medical purpose.
    (b) Invalid Prescription. A prescription is invalid if the pharmacist knows or has reason to know that the prescription was not issued for a legitimate medical purpose.
    (c) Validating a Prescription. Validating a prescription means the process implemented by the pharmacist to determine that the prescription was issued for a legitimate medical purpose.

    (2) General Standards for Validating a Prescription: Each prescription may require a different validation process and no singular process can fit each situation that may be presented to the pharmacist. There are circumstances that may cause a pharmacist to question the validity of a prescription for a controlled substance; however, a concern with the validity of a prescription does not mean the prescription shall not be filled. Rather, when a pharmacist is presented with a prescription for a controlled substance, the pharmacist shall attempt to determine the validity of the prescription and shall attempt to resolve any concerns about the validity of the prescription by exercising his or her independent professional judgment.
    (a) When validating a prescription, neither a person nor a licensee shall interfere with the exercise of the pharmacist’s independent professional judgment.
    (b) When validating a prescription, the pharmacist shall ensure that all communication with the patient is not overheard by others.
    (c) When validating a prescription, if at any time the pharmacist determines that in his or her professional judgment, concerns with the validity of the prescription cannot be resolved, the pharmacist shall refuse to fill or dispense the prescription.

    (3) Minimum Standards Before Refusing to Fill a Prescription.
    (a) Before a pharmacist can refuse to fill a prescription based solely upon a concern with the validity of the prescription, the pharmacist shall attempt to resolve those concerns and shall attempt to validate the prescription by performing the following:
    1. Initiate communication with the patient or the patient’s representative to acquire information relevant to the concern with the validity of the prescription;
    2. Initiate communication with the prescriber or the prescriber’s agent to acquire information relevant to the pharmacist’s concern with the validity of the prescription.
    (b) In lieu of either subparagraph 1. or 2., but not both, the pharmacist may elect to access the Prescription Drug Monitoring Program’s Database to acquire information relevant to the pharmacist’s concern with the validity of the prescription.
    (c) In the event that a pharmacist is unable to comply with paragraph (a) due to a refusal to cooperate with the pharmacist, the minimum standards for refusing to fill a prescription shall not be required.

    (4) Duty to Report: If a pharmacist has reason to believe that a prescriber is involved in the diversion of controlled substances, the pharmacist shall report such prescriber to the Department of Health.

    (5) Electronic Prescriptions: All controlled substances listed in Schedule II through V may be electronically prescribed pursuant to the provisions of Section 456.42(2), F.S. (2015), and pursuant to applicable federal law. For more information related to the federal requirements, access http://www.deadiversion.usdoj.gov/ecomm/index.html.

    (6) Mandatory Continuing Education: All pharmacists shall complete a Board-approved 2-hour continuing education course on the Validation of Prescriptions for Controlled Substances. The course content shall include the following:
    (a) Ensuring access to controlled substances for all patients with a valid prescription;
    (b) Use of the Prescription Drug Monitoring Program’s Database;
    (c) Assessment of prescriptions for appropriate therapeutic value;
    (d) Detection of prescriptions not based on a legitimate medical purpose; and,
    (e) The laws and rules related to the prescribing and dispensing of controlled substances. All licensed pharmacists shall complete the required course during the biennium ending on September 30, 2017. A 2-hour course shall be taken every biennium thereafter. The course shall count towards the mandatory 30 hours of CE required for licensure renewal. All newly licensed pharmacists must complete the required course before the end of the first biennial renewal period.

    (7) Summary Record: Every pharmacy permit holder shall maintain a computerized record of controlled substance prescriptions dispensed. A hard copy printout summary of such record, covering the previous 60 day period, shall be made available within 72 hours following a request for it by any law enforcement personnel entitled to request such summary under authority of Section 893.07(4), F.S. Such summary shall include information from which it is possible to determine the volume and identity of controlled substances being dispensed under the prescription of a specific prescriber, and the volume and identity of controlled substances being dispensed to a specific patient.

    Rulemaking Authority 456.013, 465.005, 465.0155, 465.009, 465.022(12) FS. Law Implemented 456.013, 456.42, 456.43, 465.0155, 465.003, 465.009, 465.016(1)(i), (s), 465.017, 465.022(12), 893.04 FS. History–New 8-29-02, Amended 2-24-03, 11-18-07, 12-24-15.

     


    October 29, 2015

    The following Alert was sent to the Society regarding problems or inquiries with ICD 10 coding for Medicare, FCSO.

    Local Coverage Determinations (LCDs) and Relevant ICD-10-CM Codes

    Updated LCDs to include ICD-10 diagnosis codes were posted to the Medicare Coverage Database (MCD) in April 2014. Since the October 1, 2015, ICD-10 transition date, First Coast has received comments from physicians and allied providers suggesting changes and/or additions to the current ICD-10 LCD code sets. First Coast appreciates input from the provider community and evaluates comments as they are received. If the evaluation results in a determination that additional ICD-10 diagnosis code(s) should be included in the applicable LCD, the LCD and associated editing will be updated and an article will be published.

    First Coast is addressing all inquiries related to ICD-10 LCD codes as a priority. Please include the following information with your comments and submit to: medical.policy@fcso.com

    • The name of the LCD and corresponding L number
    • The specific indication as stated in the LCD and relevant ICD-10 diagnosis codes recommended for addition in support of the indication
    • If deletion of codes are recommended, please provide the rationale

     

    As always, diagnosis codes are only a surrogate for the stated indications/limitations in the LCD and must be supported in the medical record. Requests for new indications should be addressed per the normal LCD reconsideration process. For more information regarding this process, see: http://medicare.fcso.com/Coverage_resources/138575.asp

    Note: If an LCD prior to the ICD-10 implementation date of October 1, 2015, did not include ICD-9 codes then the LCD after this date will not include diagnosis codes.


    October 12, 2015

    NEW from ASIPP

    Survival Strategies for the Tsunami of ICD-10-CM for Interventionalists: Pursue or Perish

    ASIPP has published the survival strategies as an e article in the current issue of the online Pain Physician. Since ICD-10-CM will be effective October 1, 2015, each and every physician has to be prepared. Consequently, we are providing you with the tables to assist you with the conversion.

    Many of you have electronic medical records which you are hoping will convert automatically. As you see in this manuscript and also the codes converted, this will not be the case.

    It is crucial that each condition be re-coded for accuracy and to avoid denials and subsequent cash crunch.

    A single comprehensive table shows the conversion of commonly used spinal codes summarized into 2 pages. This can be carried on and put in the chart, even along with the other tables with modifications. You may not need to continue to use ICD-9 codes, however they are provided for your reference.

    We have created 3 tables showing cervical, thoracic, and lumbosacral coding subsequently there are multiple tables with conversion of RSD, causalgia, and neuropathy, headache and facial neuralgia, upper extremity joint coding, lower extremity joint coding, psychological coding, and drug abuse coding.

    The following is a link to the ASIPP website for a listing of tables and documents for your convenience.
    http://www.asipp.org/


    August 26, 2015

    Pain Management Physicians - RE: Category I CME

    If you are a physician practicing in a Pain Management Clinic and were registered based on the 6th qualification option in Rule 64B8-9.0131, F.A.C., please keep in mind that as a part of your 40 hours of Continuing Medical Education (CME) required per biennium, you must complete 15 hours of live lecture format, Category I CME in pain management for every year you practice in pain management. These will need to be reported to CE Broker along with the rest of your CME credits in order for the Board to renew your license. Answers to many questions regarding license renewal can be found at the Board of Medicine's website at flboardofmedicine.gov .


    August 11, 2015

    Medicare Changes to Requirement and Documentation of Home Health Care Orders

    Medicare has requested that FSIPP advise our membership of the following changes (see attached letter):

    Medicare has changed the physician documentation requirements for certification of home health care for dates of service effective January 1, 2015.


    July 14, 2015

    CMS Releases Proposed CY 2016 Medicare Physician Payment Rule

    On July 8, 2015, CMS released its calendar year (CY) 2016 proposed Medicare physician payment rule in prepublication form; the rule will be formally published in the July 15 Federal Register. Comments on the proposed rule are due on September 8, 2015.

    Below you will find payments of specific interest to ASIPP Members:

    2016 PROPOSED - Physician Payment Rates

    2016 ASC PROPOSED Payment Rates

    HOPD 2016 PROPOSED Payment Rates


    June 22, 2015

    Dear FSIPP Membership:

    As you may know FSIPP holds a position on the Medicare Contractor Advisory Committee, allowing us to provide input and insight into the development of Local Coverage Determinations (LCDs) for our specialty with input from other Society Representatives on the CAC. We meet three times per year. I have attached the following from the meeting June 20, 2015 this past Saturday:

    1. The Proposed LCDS, which were reviewed
    2. Handouts provided for ICD-10 transition
    3. The SPOT program
    4. Schedule for Internet Based PECOS classes

    Deborah H. Tracy MD, MBA


    January 8, 2015

    REGARDING: VOTE FOR DR. HAROLD CORDNER AND DR. SANDY SILVERMAN FOR THE ASIPP BOARD OF DIRECTORS

    Dear FSIPP Membership:

    Two members of FSIPP, Dr. Cordner and Dr. Silverman, have been nominated to the ASIPP Board of Directors, our parent organization. We consider it a great honor and advantage to have leadership from FSIPP participate in the ASIPP Board. Please take the time to prepare to vote by paper ballot or electronic ballot as indicated below and in the letter below from ASIPP with instructions regarding how to vote. Dr. Cordner and Dr. Silverman are Past Presidents of FSIPP and have been very active in all issues regarding patient access to pain management healthcare and preservation of our profession.

    Paper Ballot
    http://www.asipp.org/documents/2015ASIPPBoardPaperBallot.pdf

    Electronic Ballot
    http://survey.constantcontact.com/survey/a07eacyn33pi4fq0ut1/start

     

     

  • 2014 Archives

    October 23, 2014

    DRAFT, LCD, Spinal Cord Stimulation for Chronic Pain and Controlled Substance Monitoring and Drugs of Abuse Testing

    Below are links for the proposed DRAFT Local Coverage Determinations (LCD) from First Coast Service Options (FCSO) for the above services. FSIPP has representatives on the Medicare Advisory Committee and provided significant input for recommended changes. You may review these DRAFTS and provide further input during the open public comment period. To submit a comment email or write to:

    Medical Policy and Procedures
    P.O. Box 2078
    Jacksonville, FL 32231-0048
    Email: medical.policy@fcso.com

    Spinal Chord Stimulation for Chronic Pain

    Controlled Substance Monitoring and Drugs of Abuse Testing


    September 11, 2014

    DEA Classifies Tramadol a Controlled Substance

    Under a final rule published in the Federal Register, the pain reliever tramadol is classified as a Schedule IV controlled substance (CS) starting August 18, 2014. Drug Enforcement Administration (DEA) will require manufacturers to print the “C-IV” designation on all labels that contain tramadol, including its salts, isomers, and salts of isomers. See Florida BOM website.


    September 9, 2014

    DEA RESCHEDULES HYDROCODONE PRODUCTS

    On Friday, August 22nd, the U. S. Drug Enforcement Administration (DEA) published a Final Rule moving hydrocodone combination products (HCPs) from Schedule III to the more-restrictive Schedule II. This Final Rule imposes the regulatory controls and sanctions applicable to Schedule II substances on those who handle or propose to handle HCPs. The rule goes into effect 45 days from its publish date. The entire rule text may be found here.

     


    July 31, 2014

    REGARDING: MEDICARE CHANGE IN LCD FOR CEMENT AUGMENTATION

    FSIPP Membership:

    We are receiving increasing inquiries regarding denials for Vertebroplasty and Kyphoplasty. The LCD for these procedures changed in March of 2014. The new LCD requires that a second ICD 9 code be submitted to establish the etiology of the vertebral fracture or it will be denied. The LCD is attached and the language is as follows:

    *Medicare is establishing the following limited coverage for ICD-9 Code 733.13”
    Claims submitted with ICD-9-CM code 733.13 as an indication for percutaneous vertebroplasty and percutaneous vertebral augmentation must include both the ICD-9-CM diagnosis code 733.13 (Pathologic fracture of vertebrae) and an additional ICD-9-CM diagnosis code indicating the etiology of the pathological fracture. Additional ICD-9-CM codes accepted for claims submitted with 733.13 (Pathologic fracture of vertebrae) are as follows: 733.00, 733.01, 733.02, 733.03, and 733.09.


    June 2, 2014

    SIGN ASIPP PETITION LETTER NOW! - FDA's warning epidural steroid injections pose serious risk:

    In addition to our existing burden of the draconian cuts to epidurals, we now have another problem - namely, the FDA's warning that all epidural steroid injections pose a serious risk for neurological injury, paralysis and death.

    Now is the time to get involved. We request that each and every ASIPP/FSIPP member sign onto ASIPP's letter to the FDA immediately. Please reply to this e-mail to confirm your desire to sign onto the letter by Friday, June 6th, 2014. We need at least 1000 physician signatures by this Friday. ASIPP membership is not a requirement to sign onto the letter. Members and non-members alike are welcome to sign. If you have colleagues who are not ASIPP members, please forward this e-mail to them and encourage them to join us in this effort. Click here to read the letter to the FDA.

    This FDA warning is beyond the scope of the FDA (though the FDA may argue that it is not so). Beyond this epidural steroid warning, because of detrimental efforts by some societies and individuals, more assault on IPM is coming. There is an effort to control the practice of IPM by imposing ISIS standards for each and every procedure. The ASA has apparently recruited ISIS to lead this implementation of standards, but the ASIPP board feels that these standards will have very negative effects on IPM, so we do not have any choice but to vigorously oppose this. It is imperative that we understand the goals of these organizations. Instead of modifying the technique of transforaminal epidural injections, they are trying to impose additional regulations which will not have any effect. This is the perfect example of sophistry and making the fox in charge of the hen house. We have already sent multiple letters to FDA on this issue. We have enclosed one of our previous letters, but this is not the letter we are asking that you sign onto.

    The only good news so far is that the epidural cuts may be reversed for 2015. We are vigorously working with the majority leader, multiple committee chairmen, and congressional offices to reverse the cuts back to pre-January, 2014 rates. However, so far, we have not been successful in achieving this.

    It is extremely important that we all participate to let FDA know our opinions. Either raise your voice now, or our voice could be silenced forever.

    Thank you,


    Laxmaiah Manchikanti, MD
    Chairman of the Board and Chief Executive Officer, ASIPP and SIPMS
    Medical Director, Pain Management Center of Paducah
    Clinical Professor
    Anesthesiology and Perioperative Medicine
    University of Louisville, Kentucky
    2831 Lone Oak Road
    Paducah, KY 42003
    Phone: 270-554-8373 ext. 101
    Fax: 270-554-8987
    E-mail: drm@asipp.org


    Ramsin M. Benyamin, MD
    President, ASIPP
    Medical Director, Millennium Pain Center
    Clinical Associate Professor, Dept. of Surgery
    University of Illinois College of Medicine
    Urbana/Champaign, IL
    1015 South Mercer
    Bloomington, IL 61701
    Phone: 309-662-4321
    Fax: 309-661-4532
    ramsinbenyamin@yahoo.com


    February 20, 2014

    VERTEBRAL AUGMENTATION LCD REVISION, FCSO, MEDICARE

    This link provides the newly revised Medicare Local Coverage Determination (LCD) from our jurisdiction for Vertebral Augmentation:

    1. Documentation of Medical Necessity is key.
    2. Must be supported by imaging (MRI, or CT Scan, Bone Scan).
    3. Absolute contraindication for Vertebral Augmentation (with cavity creation) includes a fracture greater than 1 year old that does not enhance with appropriate imaging.
    4. Please review ‘Limitations of Coverage’ and ‘Indications.’


    January 12, 2014

    PERIPHERAL NERVE BLOCKS LCD REVISION, FCSO MEDICARE

    Please see attached, the newly revised Local Coverage Determination (LCD) from our jurisdiction for Peripheral Nerve blocks.

    NOTE:
    No more than 3 injections at a specific anatomic site in 6 months
    No more than 2 anatomic sites per session


    Our Society will provide input at the next Carrier Advisory Committee Meeting regarding the provision of multiple nerve blocks for CRPS.

    In the meantime, you will have to submit documentation of medical necessity, if requested, when more than 3 blocks are required in a 6 month period.


    January 10, 2014

    CMS Cuts to Interventional Pain Procedures

    As we start the New Year, we face new unprecedented challenges. The gauntlet has been thrown down on Interventional Pain Medicine. CMS has used its rulemaking authority, in an unfair, cowardly fashion to reduce the reimbursement for office based epidural injections while paying almost seven times more for them to be done in a hospital outpatient department. Yes, the hospital lobby is strong. They see the future of medicine through the skewed lenses of Obamacare. First, destroy private indemnity insurance. Second, destroy private practice and herd doctors into large holding pens (ACO’s and Hospitals) so they can be controlled. Third, eliminate and capitate healthcare so costs become consistent and predictable.

    How do we respond? In the past, before I became politically involved in medicine, I just assumed “others would take care of the problem.” Well guess what,you are the others. There is no one else who will fight the fight to preserve our practices. Money and influence are necessary to get what we want, it is that simple.

    ASIPP and FSIPP are deeply involved in trying to reverse these cuts. FSIPP has retained a PR firm to reach out to news media and we have already been successful in publishing at least 2 op ed pieces. There are more to come. We have dedicated Lobbyists and meet with legislators and officials to make our voices heard. Every patient you treat should be given the link to capwiz and a copy of your letter to legislators. Make them understand that this makes no sense, and they will be the ultimate losers.

    Some have advocated “if they pick up a knife, you pick up a gun” by suggesting a boycott of all elective surgeries by anesthesiologists. This is not only illegal by violating antitrust laws, but is desperate and would never succeed. It would focus more negative attention on doctors, and the Obama machine would spin that against us. If we all boycott interventional procedures, insurers and CMS will be thrilled, as they see little value in our services. The most effective weapon I know is legislative lobbying. In addition, we need to fight CMS with their own weapon; proving their analysis of the relative values for interventional procedure is flawed. This is already being undertaken by ASIPP and the ASA. With congressional support, this could work.

    Some of you think that you can shift your practice to different procedures. After all, some interventional procedures were not cut, and very few were even increased. But the gauntlet that has been thrown down is just the beginning. We need to stop this now, because the next round will be fatal. One of our long standing FSIPP members notified us today that she is closing her practice.

    I urge all of you to support ASIPP and FSIPP in this fight. Please contribute to the ASIPP PAC and FSIPP PAC. You are the only ones that can make the difference, not a few board members. There is strength in numbers. Remember, there is no “someone else,” it is you!

    Sincerely,
    Sanford Silverman MD
    FSIPP, President

  • 2013 Archives

    December 16, 2013

    Devastating Cuts for Interventional Pain Management - Act Now or Never!

    I urge every IPM physician to act on this NOW.  These cuts could truly mean the end of IPM.  Quite frankly, we have no choice BUT to act. Below is the message (or write one similar) to put into ASIPP’s Capwiz.  Please follow the Capwiz prompts in the ASIPP letter attached here.

    I write to you today out of great concern. On November 27, 2013, Centers for Medicare and Medicaid Services (CMS) posted the 2014 final rules for physician payments as well as hospital outpatient and ambulatory surgical center payments with the new rates to go into effect on January 1, 2014.

    These cuts are draconian and will devastate our specialty. Unless we act upon the issue this may be the end of interventional pain management practices for almost 40% of the physicians who practice in an office setting.

    Interventional Pain Medicine is defined as the discipline of medicine devoted to the diagnosis and treatment of pain related disorders principally with the application of interventional techniques in managing sub acute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment

    The cuts for physician payment for epidural injections are 36% and 58% for office settings. This does not include the 20% SGR cuts. Spinal cord stimulation has also been deeply cut. We are also facing cuts for transforaminal epidural injections as well as facet joint interventions. Across the board cuts such as these will force office based physicians to either close or move into the more expensive hospital setting. Either outcome will have a devastating effect on patient access to care.

    All the while, hospitals payments are being increased by almost 20% for the same procedures, whereas in-office procedures are facing almost 60% cut, with same operational expenses. There were many reckless flaws in determining process:

    • Medicare did not take into consideration Medicare Economic Index (MEI) which has been increasing substantially. Now the gap with SGR cuts will be 90% and without SGR cuts will be 70% between expenses and the revenue.
     • The RUC process did not involve all of the physicians and even then, the AMA has recommended continuing the same payment schedule.
     • The data was available in 2012, yet the proposed schedule in July did not include the proposed cuts. The required comment period was not provided.
     • Medicare has not taken into consideration MedPAC recommendation of widening gap between hospitals and physician payments.

    As a Florida physician who fought hard to protect our patients against the onslaught of prescription drug abuse and the "pill mill" crisis, I am deeply saddened because these draconian cuts will drive MORE patients into pill mills and the use of narcotic pain killers will skyrocket.  Unless we can preserve Interventional Pain Medicine, as an alternative to narcotic pain killers, our citizens will continue to suffer pain and become more dependent on narcotics .

    I respectfully ask that you contact CMS to ask them to postpone the implementation of these cuts until further investigation is done. Without your help millions of chronic pain patients will be left with no where to turn.

    Sincerely,
    Sanford M. Silverman, MD
    Comprehensive Pain Medicine
    President, Florida Society of Interventional Pain Physicians (FSIPP)



    November 25, 2013

    CIGNA Proposal of Non-coverage for Interventional Pain Procedures
    SEE ATTACHED LETTER


    FSIPP Membership:

    Our parent organization ASIPP is involved in a desperate fight to preserve patient access to care, and coverage through CIGNA. Cigna LCD Policy

    The policy will have severe restrictions in providing interventional pain management in almost all sectors with epidural injections, facet joint interventions, percutaneous adhesiolysis, and sacroiliac joint injections.

    A brief summary of the restrictions is as follows:

    1. Interventional pain management procedures can be provided only for a maximum of one year.
      - Cigna considers any treatments for therapeutic purposes beyond an initial treatment period of one year maintenance which Cigna states there is no evidence to support and so Cigna will not cover these procedures.
    2. Epidurals cannot be performed in patients without radiculitis and those who are suffering with spinal stenosis, post surgery syndrome, and axial or discogenic pain after eliminating facet joint and sacroiliac joint as causative factors.
    3. Percutaneous adhesiolysis is considered as an investigational procedure.
    4. The policy also does not cover therapeutic facet joint nerve blocks or joint injections.

    Overall, with this policy, we can only perform diagnostic blocks and at best, 2 radiofrequency neurotomies (for all regions combined) in a patient’s lifetime and a maximum of 4 or 5 epidural injections for all regions combined.

    *TO SIGN ONTO THE CIGNA COMMENT LETTER YOU MUST CLICK ON THE FOLLOWING LINK*
    http://survey.constantcontact.com/survey/a07e8kcd0ighoa44axi/start

    Remember, we need as many signatures as possible if we are to be successful in this effort to preserve interventional pain management. Thank you again for all your help.

    FSIPP, Board of Directors &
    Laxmaiah Manchikanti, MD
    Chairman of the Board and Chief Executive Officer, ASIPP and SIPMS
    E-mail: drm@asipp.org


    October 30, 2013

    Medicare, First Coast Service Options

    FSIPP Membership:

    Please see the below message from Medicare, First Coast Service Options regarding fraud and abuse.

    Hello CAC members,
    Please see the below information related to efforts to prevent and detect fraud in the Marketplace. This is an interagency effort led by HHS, DOJ, and FTC. Medical policy has been asked to share this information with you by the CMS Regional Office. Please feel free to share with society members as you feel is appropriate.

    And here are the links:
    · The Protect Yourself from Fraud in the Health Insurance Marketplace fact sheet is live here.
    · The Tips for Assisters to Help Consumers Navigate the Marketplace fact sheet is live here.
    · And the Securing the Health Insurance Marketplace fact sheet is live here.
    · Today’s AP story can be found here.
    · The press release is now live here.

    Regards,
    Emily Tillman – CAC Coordinator


    October 28, 2013

    AAPMedicine Bylaws Vote Crucial!

    FSIPP is posting this for those who may also be AAPMedicine members.

    It appears the AAPM Board of Directors wants to make the BOD the decision-making body without the input of the membership.

    Please review attached and vote if you are a member of the AAPM.

    Thank you.


    October 21, 2013

    Public Comment Period for Cement Augmentation and Peripheral Nerve Blocks

    Medicare, FCSO has opened a public comment period for Cement Augmentation and Peripheral Nerve Blocks. We encourage all members to comment, in their own words, directly to FCSO. The deadline for comment is November 23, 2013.

    The link for public comments is: http://medicare.fcso.com/Draft_LCDs/138427.asp

    See the following attachments:
    Vertebroplasty Draft Part B
    Vertebroplasty Coding Guidelines Final (10-04-13) Part B
    Peripheral Nerve Blocks Part B


    August 22, 2013

    REIMBURSEMENT TO OFFICE KYPHOPLASTY

    CMS is proposing a 49.6% cut to Office Kyphoplasty. Please see the FSIPP Position Statement here. We encourage all members to comment, in their own words, directly to CMS to avert this cut. The deadline for comment is September 6, 2013. Click Here to leave a comment.

    ADDRESS TO:
    Ms. Marilyn Tavenner
    Administrator
    Centers for Medicare & Medicaid Services
    Department of Health and Human Services
    Attention: CMS-1600-P
    Mail Stop C4-26-05
    7500 Security Boulevard
    Baltimore, MD 21244-1850


    July 3, 2013

    UPDATED ALERT!! ULTRASOUND GUIDED INJECTIONS,
    Republication by FCSO - clarifications of non-coverage

    Medicare FCSO just published an article entitled, “Ultrasound guidance for needle placement in the office setting,” which severely limits the use of ultrasonic guidance injections.

    See the entire article.


    June 24, 2013

    ALERT!! ULTRASOUND GUIDED INJECTIONS

    Medicare FCSO just published an article entitled,”Minimum Criteria for Reimbursement of Diagnostic Ultrasound Test,” which severely limits the use of ultrasonic guidance for joint injections. See the entire article.


    March 12, 2013

    FSIPP Legislative Alert

    Your FSIPP Board has been actively following legislation in Tallahassee that will affect not only us, but all of medicine. Through our lobbying efforts, we are meeting with legislators and working toward protecting pain medicine and our patients. Here is a synopsis of current legislation and our positions:

    1. Controlled substances Bill(s) HB 831 and SB 1192. These bills will:
    a. Limit requirements for CS prescribers
    b. Require physicians (or designate an agent) to consult PDMP prior writing for controlled substance for NEW PATIENTS
    c. Authorize the Board of Medicine to adopt penalty for failure of above
    d. Exempt nursing home residents and certain physicians from CS requirements
    e. Require owners of Pain Clinics to be licensed physicians
    f. Preempt local ordinances with state law**
    g. Allow funding of PDMP by state and pharmaceutical funds

    The bills’ sponsors are Representative Fasano in the House and Senator Grimsley in the Senate. The bills are identical except with respect to

    2. Preemption of local ordinances. SB 1192 completely preempts local ordinances with state law (which we support) and 831 requires a model ordinance to be created through multiple stakeholders after June 30, 2014 (we do not support). FSIPP is working towards the goal of abolishing ALL local ordinances that supercede state law, which discriminate against pain practices .

    3. Certified Registered Nurse Anesthetists (CRNAs) HB 305 and SB 1450. These bills have been submitted through the CRNA interests by Rep. Erik Fresen, and which change “supervision” of CRNAs by anesthesiologists to “collaboration” with for any anesthetic. It defers the plan to be decided by “medical staff” in the facility, further disenfranchising the anesthesia care team. This lays the ground work for independent practice for CRNAs.

    FSIPP is adamantly opposed to these bills and is working closely with the Florida Society of Anesthesiologists (FSA) and the FMA to defeat them. We believe another goal of the CRNAs is to gain the ability to independently practice pain medicine, in particular interventional pain medicine, which they can now bill Medicare for independently in states where this is allowed. Currently, in Florida, any advanced nurse practitioner must be under the supervision of a physician and cannot practice or bill independently. FSIPP continues to be vigilant with regard to the pain medicine issues and CRNAs. For the FSA position, go to http://www.fsahq.org/notice-of-hb-305/.

    4. The “Doctor of Nursing” bill, SB 612: This year, Senator Bill Galvano and Representative Heather Fitzenhagen have filed legislation on behalf of the FMA that will require nurses who call themselves “Doctor” when treating patients to clarify to patients they are not a medical doctor or an osteopathic physician. The House bill has not yet been assigned a number but we expect it to be released very soon.

    The sole purpose of SB 612 is patient protection. An increasing number of nurses are obtaining advanced degrees, including “Doctor of Nursing Practice” degrees. In some instances, these doctoral nurses are introducing themselves to patients as “doctor.” Without further clarification by the nurse, a patient is lead to believe the nurse is a medical doctor or an osteopathic physician.

    FSIPP along with the FMA strongly supports this bill. This bill would simply clarify that they are doctors of nursing, and not doctors of medicine or osteopathy (MD or DO).

    5. Medical Malpractice Reform Bills SB 886 (Thrasher) and HB 827 (Gaetz). FSIPP and the FMA strongly support these bills. See the synopsis below:

    Ensure a Physician’s Constitutional Right to Counsel

    A recent Florida Supreme Court decision has the effect of limiting and even prohibiting non-defendant physicians from speaking to their attorney about non-privileged information. The bills ensure that a health care practitioner has the right to consult with an attorney for the purposes of obtaining legal services, either directly hired or provided by the practitioner’s insurance carrier, regardless of whether or not such consultation is due to a potential or ongoing medical malpractice suit.

    Give Parties Equal Access to Medical Fact Witnesses

    Florida law prohibits a nonparty physician from disclosing a malpractice plaintiff’s medical history and condition to a defendant in a medical malpractice case without the plaintiff’s consent. The bills address this unfairness by permitting prospective defendants or their counsel, after receiving a claimant’s notice of intent to initiate a medical malpractice lawsuit, to interview the claimant’s treating health care providers without the presence of the claimant or the claimant’s attorney.

    Affirm that Physicians and Patients May Enter Binding Arbitration Agreements

    Some physicians and their patients are currently entering into and relying on arbitration agreements that fix potential liability for noneconomic damages at a set amount. The authority to enter these agreements, and to include within them a limit on damages, is under legal challenge. The bills would clarify to the courts that the Florida Legislature finds such agreements should be upheld as a matter of public policy.

    Require Fairness in the Use of Medical Experts

    Florida law does not require that an expert witness be of a same or similar specialty of a defendant physician. The bills correct this problem by restricting the categories of experts who are qualified to testify against health care provider specialists by permitting only those providers in the same specialty as the provider against whom the testimony is offered.

    Help Lower Costs of Defensive Medicine

    Unnecessary diagnostic tests spurred by the constant threat of lawsuits are a major cost driver in health care. The bills raise the standard of proof that a claimant shoulders from a preponderance of the evidence to a higher clear and convincing evidence standard in order to demonstrate that a health care provider breached the standard of care in failing to order, perform, or administer a supplemental diagnostic test.

    Ensure the Proper Provider is Held Responsible

    It has become increasingly common for hospitals to be held liable for the actions of non-employed health care providers that they do not control. The bills provide there shall be no liability for hospitals for the negligence of a physician or other health care provider based upon a theory of non-delegable duty.

    The legislative session is upon us and rapidly progressing. It is a process that is often fluid; changing day to day. FSIPP will continue to monitor the status of these bills and others.

    Sincerely,
    Sanford M. Silverman, MD
    President, Florida Society of Interventional Pain Physicians


    March 6, 2013

    Invitation to Participate in a University of South Florida Research Study:
    Opinions of Medical Clinicians Regarding Prescription Monitoring Programs (PDMP)

    This is a study on prescriber's opinions of the Florida Prescription Monitoring Program
    (E-FORCSE). The study consists of a short survey that can be found at
    https://www.research.net/s/8LZHZQ5

    Following is information on the study:

    • Purpose & Procedures of the Research Study: To obtain the opinions of medical
      clinicians regarding the use of prescription drug monitoring programs. The study
      will take approximately 10-15 minutes to complete, will utilize an online survey tool,
      all responses remain anonymous and participants can withdraw at any time by
      simply leaving the survey website.
    • Eligibility Criteria: Clinicians within the US who manage, or have the potential of
      managing patients on opioid/scheduled drug therapy
    • Compensation: Participants will be given the opportunity, at no charge, to obtain
      6.5 hours of CME/CEU credit by viewing an online prescription drug abuse seminar.

      This study is being conducted by the University of South Florida, IRB # 9509.
      Please contact Study Coordinator, Catherine Jackson at cjackso3@health.usf.edu
      727-385-0682, with questions.

     

    Thank you for your time!
    Catherine Jackson

     


    February 22, 2013

    NEW HIPAA RULES and REGULATIONS, MUST be IMPLEMENTED

    If you have questions or want assistance with any aspect of the new HIPAA rules, we recommend contacting one of the Attorneys below. Attorney Vaughn has prepared a compliance plan and forms that comply with the new rules for $1500. Attorney Meadows-Keefe will evaluate your practice needs. Attorney Contreras makes presentations on the subject matter monthly.

    David Vaughn, Esq., CPC
    Vaughn & Associates, LLC
    8480 Bluebonnet Blvd., Ste. B
    Baton Rouge, LA 70810
    Phone: 225.769.1320
    Fax: 224.769.1115
    david@lalawfirm.net

    Julie Meadows-Keefe, Esq.
    Grossman, Furlow & Bayó, LLC
    2022-2 Raymond Diehl Road
    Tallahassee, FL 32308
    (850)385-1314
    (850)385-4240 (fax)
    j.meadows-keefe@gfblawfirm.com.
    www.gfblawfirm.com

    Darrell Contreras, Esq., CHPC
    JD Healthcare Partners LLC
    1644 Skinner St
    Lakeland FL 33801
    Phone: (863) 797-9917
    Darrell@jdhealthcarepartners.com
    www.jdhealthcarepartners.com

    Your practice must, review, and revise HIPAA policies and procedures, forms, training and response to HHS investigations or inquiries and report by February 28, 2013 all data breaches you may have had within your practice during 2012 that impacted fewer than 500 individuals. Failure to report breaches to HHS can result in investigations and possible fines.

    The Privacy Rule, the Security Rule, and the Enforcement Rule under the Health Insurance Portability and Accountability Act (HIPAA) and the Breach Notification for Unsecured Protected Health Information Rule (Breach Notification Rule) under the Health Information Technology for Economic and Clinical Health Act (HITECH Act), The Final Rule, represents the most significant development in healthcare privacy law since the issuance of the final Privacy Rule and Security Rule a decade ago.


    February 19, 2013

    FSIPP Annual Meeting Will Report Your CMEs Directly to CE Broker, DOH

    CME Reporting Requirements - Florida Department of Health

    The Florida Department of Health (DOH) reports that last year only 8% of physicians fulfilled their requirements through CE Broker. All future licensure renewal requirements by the DOH will use CE Broker as their official tracking system to verify CME credits. You can sign up for CE Broker through the FMA or directly through CE Broker (cebroker.com).

    For a reasonable yearly fee they will:
    Report CMEs to the DOH
    Monitor your requirements
    Alert you of additional hours
    Provide assistance

    Most CME providers, but not all, will report your CME credits to CE Broker. Your requirements to complete 40 hours of credits for each licensure period of two years have not changed. Specific requirements, for example, Medical Errors, Domestic Violence and HIV have not changed. However, physicians practicing in registered pain management clinics must complete CMEs pursuant to rule 64B8-9.0131 of the Florida Administrative Code.


    February 18, 2013

    Medicare Contract Administrator Committee

    Dear FSIPP Membership.

    The FSIPP Society maintains an appointed member on the Medicare Contract Administrator Committee (CAC), First Coast Service Options, for Florida. This committee meets 3 times per year to discuss Local Coverage Determinations (LDCs), address Contractor issues and Society issues. The last meeting was held Saturday, February 16, 2013. Attached (scroll thru) are the handouts provided by the MAC for your review:

    1. Revalidation Enrollment
    2. Medical Director Presentation, Dr. Corcoran
    3. ‘The Spot’ access to Medicare data
    4. Medifest 2013

    Deborah H. Tracy MD, MBA
    CAC, Representative

     

  • 2012 Archives

    December 10, 2012

    CRITICAL FSIPP ALERT – CMS IS CONSIDERING PLACING EPIDURALS, FACET INJECTIONS AND STIMULATORS ON THE NON-COVERED CODE LIST. PLEASE READ THE LETTER BELOW FROM ASIPP. MAKE CONTRIBUTIONS AS SOON AS POSSIBLE.

     

    Dear FSIPP Member:

    …CMS delivering a major blow with the publication of the potential National Coverage Decision (NCD) topics.

    It is now left up to us to fight among ourselves or to work together and form a united front. It is finally time to put arrogance, ignorance, and greed aside and preserve interventional pain management.

    This is how it happened - CMS invited the public's input concerning any items and services that may be inappropriately used (i.e., underused, overused, or misused) or provide minimal benefit in hospitals, clinics, emergency departments, doctor's offices, or in other health care settings. CMS asked the public to be specific about items and services including surgical procedures, diagnostic tests or procedures, imaging or radiology services, lab tests, or durable medical equipment; treatment for diseases such as cancer, heart disease, kidney disease, or gastrointestinal disease; or procedures such as orthopedic or eye procedures. Based on the request from America's health insurance plans and multiple other insurers, CMS, among various other topics, has included facet joint blocks, epidural injections, and neurostimulators.

    CMS obviously states that they reviewed and evaluated all of the submissions and believe that many of the suggested topics may be suitable candidates for further review. CMS also admits that there are LCDs for these subjects in almost every state. Here is the link for the list of NCD topics: http://www.cms.gov/medicare-coverage-database/details/medicare-coverage-document-details.aspx?MCDId=19

    If the NCD arrives with a negative or non-coverage decision, it will be devastating to our specialty. Believe me when I say that this is exactly what insurers want to happen. Remember the fate of IDET. The day after the decision, the entire interventional pain management will be shut down. This will not only affect Medicare/Medicaid, but all insurers. I always thought this would come from PCORI. Consequently, we were working on PCORI, to prevent this from happening. Now it turns out they are doing this administratively rather than through PCORI. There is a very slim chance of getting a positive decision, and also a slim chance of getting a neutral decision, but there is a significant probability that the decision could be negative. A negative decision is what we have to worry about.

    Our defense of interventional pain management have surpassed getting paid for each nerve, fluoroscopy for each nerve or each joint, payment differentials in one setting than other setting, working on 50% relief or 80% relief or no diagnostic blocks; payment for multiple transforaminal with interlaminar, MAC anesthesia, now we are be fighting for our specialty. It can be eliminated in its entirety.

    We beg you not to react hastily. We have a plan. We are working with the administration and Congress to resolve this issue. However, there is a good probability that we may not be able to resolve it until it goes to a hearing. Even then we need a well-orchestrated approach to succeed.

    At this time we are requesting everyone who can afford to contribute as much as possible to ASIPP for the survival of interventional pain management and subsequently ASIPP. We are committed to doing whatever is necessary financially and otherwise.Vijay has contributed over $10,000. We also have received commitments from Ramsin and his partner, each $5,000; John Swicegood, $5,000; Jim Wilson, $5,000; David Bryce, $3,000; Sairam Atluri, $2,000; Kendall Hansen, $5,000; Aaron Calodney, $2,500; and Xiulu Ruan has contributed $3,000.

    We are requesting a year-end tax deductible contribution of at least $1,000 from each member. We are providing a link to a form which will allow you to not only make this contribution but also to pay your 2013 dues in advance if you have not already done so. (Contribution and Dues Form) We believe many of the board members and membership can actually contribute at a much higher rate. As you all know, both of us have contributed substantially, especially Lax.

    Let us work together to preserve the interventional pain management. I've always used this statement in reference to our future, but now the meaning has changed. We now have to preserve it for the present in order to have a future. As JFK once said, "Success has many fathers, but failure is an orphan."


    Thank you,
    Lax and Frank

    Laxmaiah Manchikanti, MD
    Chairman of the Board and Chief Executive Officer, ASIPP and SIPMS
    Medical Director, Pain Management Center of Paducah
    2831 Lone Oak Road
    Paducah, KY 42003
    Clinical Professor
    Anesthesiology and Perioperative Medicine
    University of Louisville, Kentucky
    Phone: (270) 554-9412
    Fax: (270) 554-5394
    E-mail: drm@asipp.org

    Frank J.E. Falco, MD
    President, ASIPP
    Medical Director, Midatlantic Spine
    139 East Chestnut Hill Road
    Newark, DE 19713
    Clinical Assistant Professor
    Temple University Medical School
    Philadelphia, PA
    Phone: (302) 369-1700
    Fax: (302) 369-1717
    cssm01@aol.com


    November 7, 2012

    FUNGAL MENINGITIS OUTBREAK CRITICAL - INFORMATION FROM ISIS

    Clinicians Consultation Network

    Beginning on November 6, CDC is establishing a volunteer Clinicians Consultation Network of experts in fungal disease treatment and management to assist physicians who are directly involved in the treatment of patients associated with the current outbreak of fungal meningitis and other infections. Through this service, doctors who are treating patients will be able to consult by telephone or email with one of a group of participating infectious disease medical experts. To access the service, physicians should call 1-800-CDC-INFO (1-800-232-4636) and then select the appropriate prompts (e.g., "1” for English, "1” for Clinician). A CDC-INFO call agent will verify each physician’s role in direct patient management. After this verification, the calling physician will be referred to the Clinicians Consultation Network. The Network consultants have entered into volunteer agreements with CDC to provide this consultation service to treating physicians. There is no charge for the consultation. The consultants will report their findings to CDC, which may provide valuable information for the response to the outbreak. Operating hours for the service are the same as those for CDC-INFO: 8:00 am to 8:00 pm Monday through Friday (Eastern Time), except federal holidays

    If you have questions about the Clinicians Consultation Network, please contact CDC-INFO (1-800-232-4636).


    October 17, 2012

    FSIPP Submits Position Statement Regarding the Use of Ultrasound Guidance

    Medicare Contractor Advisory Committee met this weekend. Looks like the traffic for the U/S code has increased dramatically and they have determined there is significant abuse. They also think the code was originally weighted by the RUC to be done in a radiology suite with a U/S tech and, that >$200 is much too much for office use. Medicare may publish an ARTICLE that this code is not to be expected to be used for straight forward joint or nerve injections. We shall see. Position statement attached.

    Dr. Marc Hirsch was there and gave a very excellent presentation on the limitations of landmark injections and had his U/S machine there for demonstration. We all chimed in and did a good job of trying to get the ARTICLE softened. Ortho, PMR, FMA, FSIPP provided significant literature and arguments to support the use of office based U/S. So we shall see what happens. In the meantime, your notes need to state why you are electing to use U/S guidance, with a report of what you saw on U/S with supporting images. It is not expected that U/S guidance is reasonable and necessary for every injection.

    Sandy Silverman, MD
    FSIPP President

    Read the Full Position Statement Here


    October 8, 2012

    Stop Using Products from New England Compounding Center (NECC)

    Based on the latest information from the Centers for Disease Control and Food and Drug Administration, the Department of Health and the Department of Business and Professional Regulation strongly advise all Florida health care facilities and practitioners to stop using any products from the New England Compounding Center (NECC). These products should be pulled from shelves immediately and not used unless the CDC and the FDA make determinations that the products are safe.

    This recommendation is in addition to the recall of three lots of NECC Methylprednisolone Acetate received in Lot Nos. 05212012@68, 06292012@26 and 08102012@51 which should be returned in accordance with FDA recall procedures. These three lots have been associated with Aspergillus meningitis following epidural back injections. These medications are not used for epidural analgesia in labor and delivery.

    Any patients known or suspected to have received back injections with NECC Methylprednisolone Acetate from the suspected lots should be evaluated immediately by their health care professional and monitored or treated as necessary.

    We are asking your help in sharing this information with your membership immediately.

    The departments have notified all eight Florida facilities who received contaminated Methylprednisolone Acetate, and all suspected lots have been removed. The departments continue to communicate jointly to all other facilities that may have any products from the NECC. Facilities and practitioners should immediately stop using any NECC products until the CDC and the FDA make determinations that the products are safe.

    We will continue to update our websites at http://newsroom.doh.state.fl.us/ or www.myfloridalicense.com and have set up a toll-free hotline at 1-866-523-7339 for those who may have additional questions.

    Symptoms to look for:

    Infected patients have presented approximately one to four weeks following their injections with a variety of symptoms including but not limited to: fever, new or worsening headache, neck pain, nausea and/or new symptoms consistent with a stroke (including weakness on one side of the body and slurred speech). Some of these symptoms may be mild, yet should still be reported to a health care professional immediately.

    More info from DOH:

    Department of Business and Professional Regulation Q&A for Facilities

    Q: I have product in my facility from the New England Compounding Center. What do I do with it?

    A: Step One: Identify all product received from the New England Compounding Center.

    Step Two: Physically remove the product into a separated area in your facility. Maintain proper storage conditions for each product according to the product label.

    Step Three: Verify your inventory using patient records and invoices to ensure that all product received from the New England Compounding Center has been accounted for and separated.

    Step Four: Monitor FDA recall information and if necessary, follow all applicable FDA product recall procedures.

    Step Five: Maintain product separation until the CDC and the FDA can make determinations indicating that the products are safe for use.

    Q: If I choose to do so, how do I dispose of the product?

    A: Follow FDA product recall procedures or visit www.myforidalicense.com and click on “Our Businesses and Professions.” Select “Drugs, Devices and Cosmetics.” The list of Restricted Prescription Drug Distributor-Destruction establishments is posted on the Drugs, Devices and Cosmetics homepage at http://www.myfloridalicense.com/dbpr/ddc/index.html.

    The mission of the Department of Health is to protect promote and improve the health of all people in Florida through integrated state , county and community efforts. MQA's purpose is to protect the public through health care licensure, enforcement and information and its focus is to be the nation's leader in quality health care regulation. There have been changes to the license renewal process. Please visit www.CEAtRenewal.com to learn more.


    September 24, 2012

    FSIPP Submits Comment to CMS on Proposed CRNA Regulations

    A public comment letter to the Centers for Medicare and Medicaid Services (CMS) strongly opposing CRNAs scope of practice for interventional pain procedures under the Medicare Physician Fee Schedule: if state regulations permit was sent to CMS. See attachment.

    Sandy Silverman, MD
    FSIPP President


    August 27, 2012

    HB 787 Summary

    Dear County Medical Society and Specialty Society Executive Directors,

    We wanted to share with you some information put forth by the Agency for Health Care Administration related to legislation that passed during the 2012 session, HB 787, which requires the Agency for Health Care Administration (AHCA) to post on a website updates to the Preferred Drug List (PDL); step-edit/prior authorization criteria; and prior authorization forms. Below please find the summary from AHCA along with the pertinent website for more information.

    Overview of Florida Medicaid Requirement to Post Prior Authorization Forms

    Effective July 1, 2012, the Agency for Health Care Administration, which runs the Florida Medicaid program, was required to publicly post on their website information about prior
    authorization and step-edit criteria and protocols. Specifically, the Agency must post the list of products subject to prior authorization and step-edit requirements within 21 days of the Agency
    approving any changes made to the criteria and protocols.

    In meeting this requirement Florida has now publicly posted the Medicaid Preferred Drug List (PDL) along with the prior authorization forms which contain the authorization criteria that is
    required of prescribers to utilize when seeking approval for a prior authorization request.

    The Medicaid PDL and prior authorization forms are available at the following website:
    http://ahca.myflorida.com/Medicaid/Prescribed_Drug/preferred_drug.shtml

    Once you have accessed the website there are links available for the PDL and prior authorization forms.


    Sincerely,
    Michelle E. Jacquis
    Director of Legislative Advocacy


    August 13, 2012

    CMS Proposes IPM Privileges for CRNAs: Now is the Time to Act

    Dear FSIPP Member:

    The CMS proposed Rule 42 CFR 410.69(b) regarding the ability of CRNAs to independently bill for interventional pain management services is both wrong and dangerous. The training of a CRNA is limited to the administration of anesthesia in a supervised setting.

    The practice of pain medicine is complex involving extensive knowledge of diagnoses, pharmacology, anatomy, physiology, etc., none of which a CRNA is trained to do, and certainly not to the extent of a practicing pain medicine physician.

    I urge you to contact your senators and congressman through CapWiz, the link supplied below. We must take action on this IMMEDIATELY, otherwise this proposed rule will become law. This could be devastating to pain medicine and your practice.

    (Click Here to view a copy of FSIPP's CMS letter)

    Sincerely,

    Sanford M. Silverman, MD
    President, FSIPP


    August 10, 2012

    The Centers for Medicare and Medicaid Services (CMS) is now accepting public comments on a proposed rule establishing national policy for CRNA pain management services. We NEED your voice now to protect patient safety. Following the comment period (Sept. 4, 2012 deadline), the final rule as it is written, would allow CRNAs to perform IPM techniques. This has sweeping ramifications, from compromised patient safety to an increase in fraud and abuse. I implore you to let CMS know that this proposed rule is unacceptable and dangerous.

    It is essential that you submit your comments and opinions on this issue. Medicare officials read and evaluate each INDIVIDUAL comment submitted on the issue. We expect the opposition to submit a substantial number of comments, so your action today is very important. You may submit your comments in a variety of ways.

    1. Electronically
    You may submit electronic comments on this regulation to: http://www.regulations.gov/#!submitComment;D=CMS-2012-0083-0075

    2. By regular mail
    You may mail written comments to the following address ONLY:
    Centers for Medicare & Medicaid Services
    Department of Health and Human Services
    Attention: CMS-1590-P,
    P.O. Box 8013
    Baltimore, MD 21244-8013
    Please allow sufficient time for mailed comments to be received before the close of the comment period.

    3. By express or overnight mail
    You may send written comments to the following address ONLY:
    Centers for Medicare & Medicaid Services
    Department of Health and Human Services
    Attention: CMS-1590-P
    Mail Stop C4-26-05
    7500 Security Boulevard
    Baltimore, MD 21244-1850

    4. Capwiz
    Use the following link to send your Capwiz letter to CMS, your senators, and representative. Sample text is provided but you are encouraged to edit and personalize your letter. http://capwiz.com/asipp/issues/alert/?alertid=61589631

    It is simple to get your patients involved by customizing the following letter to your state senators and representatives, have your patients sign it before they leave the office, then have your staff enter it in Capwiz for the patient. Sample Patient Letter

    ASIPP's Letter to CMS (you may use as a sample for your own)

    Our goal is to send approximately 20,000 letters but this cannot happen without your help. Please act immediately on this important issue.

    Sincerely,

    Laxmaiah Manchikanti, MD
    Chairman of the Board and Chief Executive Officer, ASIPP and SIPMS
    Medical Director, Pain Management Center of Paducah
    Clinical Professor
    Anesthesiology and Perioperative Medicine
    University of Louisville, Kentucky
    2831 Lone Oak Road
    Paducah, KY 42003
    Phone: 270-554-8373 ext. 101
    Fax: 270-554-8987
    E-mail: drm@asipp.org

    To view some of Dr. Manchikanti's publications go to:
    http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&term=manchikanti


    July 27, 2012

    BCBS New Contracts@ 66% of Medicare

    Attention FSIPP Membership:

    Blue Cross/Blue Shield of Florida began distributing new contracts to pain physicians a month ago. Based on our information, it appears that they are requiring a reimbursement rate of 66% of the current Medicare Fee Schedule. This is across the board for ALL PAIN PHYSICIANS IN FLORIDA.

    Please review your contract carefully for the revised fee schedule prior to renewal. Please do not assume you will be paid at a different rate than stated above unless specifically outlined in your contract.

    Sincerely,

    Sanford M. Silverman , MD
    President, FSIPP


    June 7, 2012

    FSIPP Conference Follow-Up: PT, INR

    FSIPP 2012 Conference Attendees:

    Many of you have been inquiring regarding the PT, INR monitoring system and strips, used prior to interventional injections. This was referenced at the FSIPP annual meeting. You can purchase these through:

    INRatio Prothrombin Time Monitoring System
    HemoSense
    651 River Oaks Parkway
    San Jose, CA 95134
    1-408-719-1393

    They now cost around $49 + $4 per test. For reimbursement, these should be used with billing CPT code 85610, using the ICD-9 code 296.9 with a QW modifier.

    You must also register to be a CLIA-waived laboratory.

    Deborah H. Tracy MD, MBA
    FSIPP Immediate Past President

    Additionally, Kenneth Candido MD (Evidence Based Interventional Spinal Injections)
    has sent the document with the attached 250 citations. Click Here to retrieve it.


    April 25, 2012

    FSIPP Exempt Physicians Must Register as Pain Clinics in Orange Co!

    The Orange County Ordinance (click here for details) is especially onerous for FSIPP members. There will be an Orange County Commission Meeting as below. If you live in and around Orange County you should attend, as this ordinance will supersede the State law and place registration and further regulation on your practice.

    1. Exempt physicians must register as Pain Clinics
    2. The I-4 zoning requirements set forth in the ordinance are punitive in nature.

    The next public hearing will be scheduled for May 22nd at 5:01 p.m. on the PMC Zoning recommendations. The public hearing will be held in the Board of County Commissioner Chambers located at 201 S. Rosalind Avenue, Orlando, Florida 32801 (1st floor). If you would like to speak at the meeting, there will be staff at the front desk to hand out speaker cards for the public hearing. Please let me know if you have any questions.

    Thank you.
    Carol Burkett
    Director Orange County Drug Free Office,
    407-836-7319, 407-836-5391 (FAX)

     

  • 2011 Archives

    October 24, 2011

    Millennium Invitation to FREE one-day CME conference

    Millennium Research Institute invites you to attend one of three, FREE one-day CME conferences in Florida on chronic pain management, risk management, and the new Florida regulations,

    Expanding the Conversations Encompassing Pain Management.

    This conference, offers an opportunity to dialogue around the clinical and regulatory issues facing practicing physicians. Joining the dialogue is Dave Aronberg, the “Florida Drug Czar”, Howard Heit, MD and Doug Gourlay, MD, who will lead clinical case studies and other great speakers who will focus on the regulatory changes related to pain care and walk participants through a practice self-audit.

    Seating is limited for each of these events so register now if you wish to attend. Attached is a PDF of the conference information and you can register at www.millenniumresearchinstitute.org/florida .


    October 20, 2011

    TV - 60 Minutes - Feature on Prescription Epidemic in Florida
    FSIPP Membership:

    This past Sunday, CBS ran an 8 minute feature on the prescription drug epidemic in Florida and across the country. The youtube link to this report is below. The report features law enforcement in Palm Beach and Pinellas Counties.
    Nation's Overdose by Tracy Smith 10-16-11 CBS Sunday Morning
    http://www.youtube.com/watch?v=3QUPmD5Sa8U


    October 19, 2011

    CPT Coding Changes for 2012 for Interventional Pain
    FSIPP Membership:

    The new AMA 2012 CPT® code books are now available. The CPT® code changes that will impact interventional pain physicians (IPM) are provided in this link. Please look over these carefully and consult your billing department to inform them of these changes. Please read each description carefully as descriptions have been revised and the text in red represents new text.
    New codes for radiofrequency have been assigned with fluoroscopy bundled.
    For disc decompression, discography, epidural and fluoroscopy is bundled.
    Fluoroscopy is bundled for SI joints
    Only the pertinent changes for interventional pain management are described in the following information. Click here for the 2012 IPM coding changes.


    October 17, 2011

    Reminder: The Deadline to request a Medicare eRx incentive program hardship exemption for the 2012 eRx payment adjustment is November 1, 2011.

    FSIPP Membership;

    The Centers for Medicare & Medicaid Services (CMS) would like to remind eligible professionals and group practices participating in the Medicare electronic prescribing (eRx) incentive program that the deadline to request a hardship exemption for the 2012 eRx payment adjustment is November 1, 2011.

    Eligible professionals and group practices should determine if they are subject to the 2012 eRx payment adjustment by reviewing the MLN Article SE1107 , “2011 Electronic Prescribing Incentive Program Update – Future Payment Adjustments.” If you believe that you may be subject to the 2012 eRx payment adjustment, you should determine if you meet any of the hardship exemption categories specified by CMS in the 2011 Medicare electronic prescribing (eRx) incentive program final rule.

    Avoiding the 2012 eRx Payment Adjustment:
    An eligible professional can avoid the 2012 eRx Payment Adjustment if he or she:
    Is not a physician (MD, DO, or podiatrist), Nurse Practitioner, or Physician Assistant as of June 30, 2011, based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES);
    Does not have prescribing privileges and reports G-code G8644 (defined as not having prescribing privileges) at least one time on an eligible claim prior to June 30, 2011;
    Does not have at least 100 cases containing an encounter code in the measure’s denominator;
    Becomes a successful electronic prescriber (submits required number of electronic prescriptions (10 for individual) via claims and reports this to CMS before June 30, 2011



    October 12, 2011

    OIG 2012 Work-Plan

    FSIPP Membership;

    Attached is the OIG 2012 Work-Plan. We have extracted below a few key areas of focus. We recommend you scan this document.

    Physicians and Suppliers: Compliance With Assignment Rules
    We will review the extent to which providers comply with assignment rules and determine to what extent beneficiaries are inappropriately billed in excess of amounts allowed by Medicare. We will also assess beneficiaries’ awareness of their rights and responsibilities regarding potential billing violations and Medicare coverage guidelines. Physicians participating in Medicare agree to accept payment on an “assignment” for all items and services furnished to individuals enrolled in Medicare. (Social Security Act, § 1842(h)(1).) CMS defines “assignment” as a written agreement between beneficiaries, their physicians or other suppliers, and Medicare. The beneficiary agrees to allow the physician or other supplier to request direct payment from Medicare for covered Part B services, equipment, and supplies by assigning the claim to the physician or supplier. The physician or other supplier in return agrees to accept the Medicare-allowed amount indicated by the carrier as the full charge for the items or services provided. (OEI; 00-00-00000; expected issue date: FY 2013; new start)

    Physicians and Other Suppliers: High Cumulative Part B Payments (New)
    We will review payment systems controls that identify high cumulative Medicare Part B payments to physicians and suppliers. We will determine whether payment system controls are in place to identify such payments and assess the effectiveness of those controls. Medicare Part B services must be reasonable and necessary (Social Security Act, § 1862(a)(1)(A)), adequately documented (§ 1833(e)), and provided consistent with Federal regulations (42 CFR, § 410). A high cumulative payment is an unusually high payment made to an individual physician or supplier, or on behalf of an individual beneficiary, over a specified period. Prior OIG work has shown that unusually high Medicare payments may indicate incorrect billing or fraud and abuse. (OAS; W-00-12-35605; various reviews; expected issue date: FY 2012; new start)

    Physician-Owned Distributors of Spinal Implants (New)
    We will determine the extent to which physician-owned distributors (POD) provide spinal implants purchased by hospitals. We will also analyze Medicare claims data to determine whether PODs we identify in our review are associated with high use of spinal implants. PODs are business arrangements involving physician ownership of medical device companies and distributorships. PODs are focused primarily in the surgical arena and are currently primarily involve orthopedic implants such as spine and total joints. However, PODs appear to be quickly growing into other areas such as cardiac implants. (HHS OIG Work Plan | FY 2012 Part I: Medicare Part A and Part B Page I-18) Congress has expressed concern that PODs could create conflicts of interest and safety concerns for patients. (OEI; 01-11-00660; expected issue date: FY 2012; work in progress)

    Physicians: Place-of-Service Errors
    We will review physicians’ coding on Medicare Part B claims for services performed in ambulatory surgical centers and hospital outpatient departments to determine whether they properly coded the places of service. Federal regulations provide for different levels of payments to physicians depending on where services are performed. (42 CFR § 414.32.) Medicare pays a physician a higher amount when a service is performed in a nonfacility setting, such as a physician’s office, than it does when the service is performed in a hospital outpatient department or, with certain exceptions, in an ambulatory surgical center. (OAS; W-00-10-35113; W-00-11-35113; various reviews; expected issue date: FY 2012; work in progress)

    Physicians: Incident-To Services (New)
    We will review physician billing for “incident-to” services to determine whether payment for such services had a higher error rate than that for non-incident-to services. We will also assess CMS’s ability to monitor services billed as “incident-to.” Medicare Part B pays for certain services billed by physicians that are performed by nonphysicians incident to a physician office visit. A 2009 OIG review found that when Medicare allowed physicians’ billings for more than 24 hours of services in a day, half of the services were not performed by a physician. We also found that unqualified nonphysicians performed 21 percent of the services that physicians did not perform personally. Incident-to services represent a program vulnerability in that they do not appear in claims data and can be identified only by reviewing the medical record. They may also be vulnerable to overutilization and expose Medicare beneficiaries to care that does not meet professional standards of quality. Medicare’s Part B coverage of services and supplies that are performed incident to the professional services of a physician is in the Social Security Act, § 1861(s)(2)(A). Medicare requires providers to furnish such information as may be necessary to determine the amounts due to receive payment. (Social Security Act, § 1833(e).) (OEI; 00-00-00000; expected issue date: FY 2013; new start)

    Physicians: Impact of Opting Out of Medicare (New)
    We will review the extent to which physicians are opting out of Medicare and determine whether physicians who have opted out of Medicare are submitting claims to Medicare. We will also examine whether specific areas of the country have seen higher numbers of physicians opting out and its potential impact on beneficiaries. Physicians are permitted to enter into private contracts with Medicare beneficiaries. (Social Security Act, § 1802(b).) As a result of entering into private contracts, physicians must commit that they will not submit a claim to Medicare for any Medicare beneficiary.
    (OEI; 07-11-00340; expected issue date: FY 2012; work in progress)


    October 5, 2011

    Practitioner Profile Registration for Prescribing Controlled Substances for Chronic Pain

    FSIPP Membership;
    Effective January 1, 2012 in accordance with s. 456.44(2), Florida Statutes, an allopathic physician licensed under chapter 458, an osteopathic physician licensed under chapter 459, a podiatric physician licensed under chapter 461 or a dentist licensed under chapter 466 who prescribes any controlled substance as defined in s. 893.03, for the treatment of chronic nonmalignant pain, must designate himself or herself as a controlled substance prescribing practitioner on the practitioner profile.
    You must register as a prescriber even if you are exempt:
    To Register Go To: http://www.doh.state.fl.us/mqa/ControlledSubstance_RxReg.html


    October 5, 2011

    Attorney Allen Grossman Update on Department of Health Activities Regarding Pain Clinic Laws

    FSIPP Membership:

    Please see below the recent update from Attorney Grossman regarding the BOM, BOOM and DOH activities in interpreting and enforcing the new prescribing and pain clinic laws.

    I attended the Board of Medicine meetings this past weekend, including the Rules and Legislative Committee. I am providing this report addressing the various aspects of the pain management law and rule as they were relevant during the meeting.

    As has previously been discussed, §458.3265(1)(a)1.b., Florida Statutes*, defines the term “pain management clinic” as any publicly or privately owned facility that advertises in any medium for any type of pain-management services; or where in any month a majority of patients are prescribed opioids, benzodiazipines, barbiturates, or carisoprodol for the treatment of chronic nonmalignant pain. Section 458.3265(1)(a)2., Florida Statutes, requires such clinics to register with the Department of Health unless such clinic meets one of the eight identified exceptions to the registration requirement. (Some of you have determined that you meet one or more of those specific exceptions and therefore have not registered with the Department of Health even though your activities meet the definition of a pain management clinic.

    Section 458.3265(2)(a), Florida Statutes, prohibits a physician from practicing in a pain management clinic that is required to be registered unless it is actually registered. Furthermore, any physician who qualifies to practice medicine in a pain-management clinic pursuant to rules adopted by the Board of Medicine as of July 1, 2012, may continue to practice medicine in a pain-management clinic as long as the physician continues to meet the qualifications set forth in the board rules.

    The Board of Medicine adopted its rule on the qualifications of physicians to practice in pain management clinics with an effective date of May 17, 2011. (The Board of Osteopathic Medicine adopted a very similar rule [64B15-14.0051, Florida Administrative Code] with an effective date of March 16, 2011.) The Board of Medicine’s rule, 64B8-9.0131, Florida Administrative Code, requires that any physician prescribing or dispensing controlled substance medications in registered pain management clinics must meet one or more of the following qualifications:

    (1) Board certification by a specialty board recognized by the American Board of Medical Specialties (ABMS) and holds a sub-specialty certification in pain medicine;

    (2) Board certification in pain medicine by the American Board of Pain Management (ABPM);

    (3) Successful completion of a pain medicine fellowship or residency accredited by the ACGME;

    (4) Successful completion of a residency program in physical medicine and rehabilitation, anesthesiology, neurology, neurosurgery, family practice, internal medicine, orthopedics or psychiatry approved by the ACGME or hold a sub-specialty certification in hospice and palliative medicine or geriatric medicine recognized by the ABMS;

    (5) Hold current staff privileges at a Florida-licensed hospital to practice pain medicine or perform pain medicine procedures; or

    (6) Have 3 years of documented full-time practice, which is defined as an average of 20 hours per week each year, in pain-management and within six months of the effective date of this rule, attendance and successful completion of 40 hours of in-person, live-participatory AMA Category I CME courses in pain management that address all the following subject areas:

    (a) The goals of treating both short term and ongoing pain treatment;

    (b) Controlled substance prescribing rules, including controlled substances agreements;

    (c) Drug screening or testing, including usefulness and limitations;

    (d) The use of controlled substances in treating short-term and ongoing pain syndromes, including usefulness and limitations;

    (e) Evidenced-based non-controlled pharmacological pain treatments;

    (f) Evidenced-based non-pharmacological pain treatments;

    (g) A complete pain medicine history and a physical examination;

    (h) Appropriate progress note keeping;

    (i) Comorbidities with pain disorders, including psychiatric and addictive disorders;

    (j) Drug abuse and diversion, and prevention of same;

    (k) Risk management; and

    (l) Medical ethics.

    In addition, if a physician utilizes option (6) he or she must also document hospital privileges at a Florida-licensed hospital; practice under the direct supervision of a physician who is qualified under options (1)-(4); or have the practice reviewed by a Florida-licensed risk manager and document compliance with all recommendations of the risk management review.

    In spite of its acknowledgement that there do not appear to be any specific courses that provided the requirements, at its meeting last weekend, the Florida Board of Medicine decided once again not to amend its rule regarding the date by which a physician qualifying pursuant to option (6) must complete the 40 hour CME requirement. As of right now, in spite of the fact that he statute provides for compliance by July 1, 2012, the Board of Medicine’s rule requires that the 40 hours of CME be completed by November 17, 2011. The biggest problem in meeting that deadline is that no such single course has been identified. The only course provider who has requested approval of a course, Dannemiller, was told that they had not provided enough information for the Board to grant approval. For now, licensees are required to piece together 40 hours of individual courses that might reasonably be considered to include all of the required elements set forth in the rule. It should be noted that nothing in the rule sets up a time-frame in which the CME hours could have been completed prior to the date set forth in the rule. It might be possible to select various courses from a physician’s completed CME hours in prior years. Most importantly, if any of your members are or employ physicians who will want to qualify to work in a registered pain management clinic on or after July 1, 2012, they need to make sure that the 40 hour CME requirement is fulfilled by the time set forth in the Boards’ rules. It is likely that the Board will have to do some rulemaking because the current rule references dispensing of controlled substances, which is no longer permitted as a matter of law. If such rulemaking is initiated, there may be another opportunity to ask the Board to address the issue of when the coursework must be completed for option 6.

    *Each of the herein referenced statutory provisions has an identical provision in the Osteopathic Medicine Practice Act (Ch. 459, Florida Statutes.)

    It appears that he Department of Health has activated the section in the on-line practitioner profiles for physicians to add their self-designation as a prescriber of controlled substances. Section 456.44(2), Florida Statutes requires that before January 1, 2012, physicians who prescribe controlled substances for the treatment of chronic nonmalignant pain register as a controlled substance prescribing physician on their practitioner profile maintained by the Department of Health. During the Board of Medicine meeting this past weekend, the Board finalized its Declaratory Statement to the Hospice physicians that asked the Board to confirm that they are not prescribing controlled substances for the “treatment of chronic nonmalignant pain” when they prescribe controlled substance pain medications for hospice patients who will need pain medication until they die. (Draft copy attached) However, a similar question asked by a group of physicians who primarily perform interventional pain and other surgical procedures did not receive a response from the Board of Medicine. The physicians provided a specific list of diseases and conditions that routinely require extended use of controlled substances for pain relief and asked whether because the pain was the result of an injury or disease that was within its reasonably expected duration (sometimes lifelong) their prescribing would be considered as being for the treatment of chronic nonmalignant pain, which is defined as being pain that persists beyond the usual course of disease or injury causing the pain. Although the Board of Medicine ultimately declined to answer the question, during the course of their discussion, it was repeatedly acknowledged that the law clearly defines chronic nonmalignant pain as being outside the usual course of a disease or injury. Logically then, a physician prescribing a controlled substance for pain that is existing during the reasonably defined “usual course” of the disease or injury causing the pain would not be prescribing controlled substances for the treatment of chronic nonmalignant pain. We can expect to see more issues in this regard as the Department of Health and State Attorneys’ offices attempt to prosecute physicians.

    The Department of Health has taken the position in regard to the quarterly reporting of patient data by registered pain management clinics that follow-up patient visits should only be reported once each quarter. Therefore, a continuing patient who returns to a clinic for prescriptions throughout the quarter should only be included once in the returning patient data, even if that patient had multiple follow-up visits during the quarter. The Department only wants the number of patients not the actual number of visits at which prescriptions for controlled substances were provided. This may be a bit confusing to anyone who read the reporting requirement and recommended reporting form to require identification of each returning patient encounter.

    There was a rally against the Board of Medicine that was held during the Friday morning portion of the Board of Medicine’s meeting in Tampa. The rally group was reportedly comprised of family members who had lost young adults to drug overdoses. They remained outside the hotel for the most part and did not disrupt the meeting in any way. Their position appeared to be that the Board is not being hard enough on physicians who prescribe pain medications and that all production of Oxycontin should be halted.

    For those of you who may be interested, I have attached a copy of the Department of Health’s recent Declaratory Statement on the issue of registering a pain management clinic. In the reported case, the physician was operating a clinic with the word pain in the name of the clinic and wishes to advertise the clinic on the internet. However, the physician held board certification by the American Board of Anesthesiology and the American Board of Pain Medicine (and others) and the physicians at the clinic did not prescribe controlled substances for the treatment of chronic nonmalignant pain for the majority of its patients. Based on the owner physician’s specialty certification and the fact that less than 50% of the clinic’s patients received controlled substance prescriptions for the treatment of chronic nonmalignant pain, the Department of Health opined that the clinic is not required to be registered.

    Allen R. Grossman


    September 7, 2011

    REGARDING; TRAINING REQUIRMENTS FOR PRACTICING IN A PAIN CLINIC, CMEs

    NOTE: If you have given up your pain management clinic registration or have not been required to have your clinic registered, the following message is not necessarily applicable to you. However, this information and the regulatory “glitch” created by the rule may be significant enough for you to at least be aware of it, even if you do not currently hold a pain management clinic registration.

    The Board of Medicine adopted rule 64B8-9.0131, Florida Administrative Code which became effective on May 17, 2011. This rule sets forth the training requirements that every physician who is prescribing or dispensing controlled substance medications in a registered pain management clinic must meet as of July 1, 2012. We previously provided you with the attached copy of the Board’s notice of this rule on May 6, 2011.

    Although there are five other options:

    1. ABMS specialty board certification with a sub-specialty certification in pain medicine;

    2. American Board of Pain Medicine (ABPM) specialty certification;

    3. Successful completion of an ACGME accredited fellowship or residency in pain medicine;

    4. Successful completion of an ACGME accredited residency in physical medicine and rehabilitation, anesthesiology, neurology, neurosurgery, family practice, internal medicine, orthopedics or psychiatry or hold sub-specialty certification from an ABMS specialty board in hospice and palliative medicine or geriatric medicine;

    5. Hold current staff privileges at a Florida licensed hospital to practice pain medicine or perform pain medicine procedures.

    If any physician practicing in a registered pain management clinic does not meet one of these requirements by July 1, 2012 then that physician must be able to document 3 years of full time practice (average of 20 hours per week for each year) in pain management AND, within six months of the effective date of the rule (no later than November 17, 2011) have attended and successfully completed 40 hours of in-person, live, participatory AMA Category I CME in pain management that address the 12 specific areas set forth in the rule. In addition, physicians meeting the 40-hour CME option must also document either hospital privileges, or practice under the direct supervision (on premises) of a physician who qualifies through one of the first 4 options in the rule, or have the practice reviewed by a Florida licensed risk manager and document compliance with all recommendations. In addition, any physician qualifying by this final option must also document annual completion of 15 hours of live lecture format AMA Category I CME in pain management every year that the physician is practicing pain management.

    Although these requirements do not become effective until July 1, 2012, on that date each physician will need to show that the requirements were met by November 17, 2011. (The Board of Osteopathic Medicine’s rule on training requirements, although very similar, became effective on November 8, 2010 and therefore, the date for completion of CME for the 6th option in their rule was May 8, 2011.) If the 40 hours of CME were not completed within the appropriate 6 month period, then technically the physician will not be in compliance with the July 1, 2012 requirements.

    Should you have a physician working in your registered pain management clinic that needs to meet the 6th option, but is going to have a problem with the completion date, unless the Board’s choose to amend their rules before July 1, 2012, it may be necessary to seek a Waiver or Variance of the appropriate Board’s administrative rule either to seek an extension of time or to seek approval of CME completed outside of the required time frame.

    Allen R. Grossman


    September 16, 2011

    Important Information about Your Rights to Practice Pain

    Dear ABPM Diplomate,

    As a Diplomate of the American Board of Pain Medicine (ABPM), I would like to share some important information regarding recent developments in Florida law, and request that you pass this information along to your colleagues.

    Since 1999 the Florida Board of Medicine (FBM) has recognized the American Board of Pain Medicine (ABPM) as a legitimate non-ABMS Board recognized as equivalent for advertising purposes. This has not changed.

    During the past several years Florida has seen a crisis involving the sale, administration, dispensing and prescribing of controlled substances. The State reacted to this illegal and abusive practice by passing a series of statutes and regulations attempting to curtail such practice. The laws, being amended and modified on numerous occasions have led to marked confusion among the medical profession.

    Current laws, HB 7059, enacting legislation effective July 1, 2011, and 64B8-9.0131, FBM regulations effective July 1, 2011, are the only binding laws that address this issue. The Florida Medical Practice Act is being revised to bring it in conformity.

    Accordingly, most physicians prescribing controlled substances for chronic non-malignant pain and practicing in a registered pain clinic must have completed at least 12 months of an ACGME Accredited fellowship training program in pain medicine. There are a number of qualifications and exceptions.

    Any physicians certified as Diplomates by the ABPM as of July 1, 2012, are exempt from the training requirements. This exemption is in perpetuity under a grandfather clause, as long as the physician holds a valid ABPM Diplomate certificate.

    This advice is based on legal opinions coming from highly regarded attorneys practicing in Florida. In as much as the enabling laws are ambiguous and complex, it is prudent and advisable, as always, to seek the legal opinion of your own attorney.

    Those Diplomates who are scheduled to recertify in the next few years should keep this change in mind, and also consider the right to retake a failed exam prior to the expiration of certification when deciding whether or not to test early in 2012.

    I also ask that you forward this email along to fellow Pain Medicine physicians in Florida that you feel may be qualified to take the 2012 Examination. Don't let them miss the opportunity to retain their rights as pain specialists. Please do encourage your colleagues to view the 2012 Certification requirements to determine if they meet current eligibility criteria.

    There is still time to apply. The deadline for submitting an application to the American Board of Pain Medicine is September 30, 2011. The 2012 Certification examination and American Board of Pain Medicine MOC® examination will both be administered during the 3-week window of Saturday, April 7, 2011 through Saturday, April 28, 2011 at ACT testing centers nationwide.

    For more information and to obtain the 2012 Bulletin of Information and all application materials, please visit www.abpm.org, or contact the ABPM office to request a copy of the Examination packet at (847)375-4726 or info@abpm.org.

    ABPM believes that an ongoing commitment to the specialty of Pain Medicine is critical. I hope you will choose to encourage qualified individuals to apply for the 2012 Certification Examination.

    Sincerely,
    Michel Y. Dubois, MD
    President, American Board of Pain Medicine


    September 7, 2011

    REGARDING; TRAINING REQUIRMENTS FOR PRACTICING IN A PAIN CLINIC, CMEs

    NOTE: If you have given up your pain management clinic registration or have not been required to have your clinic registered, the following message is not necessarily applicable to you. However, this information and the regulatory “glitch” created by the rule may be significant enough for you to at least be aware of it, even if you do not currently hold a pain management clinic registration.

    The Board of Medicine adopted rule 64B8-9.0131, Florida Administrative Code which became effective on May 17, 2011. This rule sets forth the training requirements that every physician who is prescribing or dispensing controlled substance medications in a registered pain management clinic must meet as of July 1, 2012. We previously provided you with the attached copy of the Board’s notice of this rule on May 6, 2011.

    Although there are five other options:

    1. ABMS specialty board certification with a sub-specialty certification in pain medicine;

    2. American Board of Pain Medicine (ABPM) specialty certification;

    3. Successful completion of an ACGME accredited fellowship or residency in pain medicine;

    4. Successful completion of an ACGME accredited residency in physical medicine and rehabilitation, anesthesiology, neurology, neurosurgery, family practice, internal medicine, orthopedics or psychiatry or hold sub-specialty certification from an ABMS specialty board in hospice and palliative medicine or geriatric medicine;

    5. Hold current staff privileges at a Florida licensed hospital to practice pain medicine or perform pain medicine procedures.

    If any physician practicing in a registered pain management clinic does not meet one of these requirements by July 1, 2012 then that physician must be able to document 3 years of full time practice (average of 20 hours per week for each year) in pain management AND, within six months of the effective date of the rule (no later than November 17, 2011) have attended and successfully completed 40 hours of in-person, live, participatory AMA Category I CME in pain management that address the 12 specific areas set forth in the rule. In addition, physicians meeting the 40-hour CME option must also document either hospital privileges, or practice under the direct supervision (on premises) of a physician who qualifies through one of the first 4 options in the rule, or have the practice reviewed by a Florida licensed risk manager and document compliance with all recommendations. In addition, any physician qualifying by this final option must also document annual completion of 15 hours of live lecture format AMA Category I CME in pain management every year that the physician is practicing pain management.

    Although these requirements do not become effective until July 1, 2012, on that date each physician will need to show that the requirements were met by November 17, 2011. (The Board of Osteopathic Medicine’s rule on training requirements, although very similar, became effective on November 8, 2010 and therefore, the date for completion of CME for the 6th option in their rule was May 8, 2011.) If the 40 hours of CME were not completed within the appropriate 6 month period, then technically the physician will not be in compliance with the July 1, 2012 requirements.

    Should you have a physician working in your registered pain management clinic that needs to meet the 6th option, but is going to have a problem with the completion date, unless the Board’s choose to amend their rules before July 1, 2012, it may be necessary to seek a Waiver or Variance of the appropriate Board’s administrative rule either to seek an extension of time or to seek approval of CME completed outside of the required time frame.

    Allen R. Grossman


    August 30, 2011

    REMINDER: The Use of Mandatory Counterfeit-Proof Prescriptions Effective Aug 30

    The new law requiring the use of counterfeit-proof prescription pads or printer paper when prescribing controlled substance(s) will be enforced effective Tuesday, August 30. You may recall the original effective date of July 1 was delayed by the State Surgeon General, Dr. Frank Farmer, for 60 days. The appropriate pads or printer paper must be purchased from a vendor approved by the Department of Health (DOH). The state approved vendor list includes 360 vendors from around the state and a list of frequently asked questions and answers. Both the vendor list and the frequently asked questions can be found at: http://doh.state.fl.us/mqa/counterfeit-proof.html.

    Key Dates for Implementation of Prescription Drug Monitoring Program:

    Currently - Physicians licensed as dispensing practitioners must register to input mandatory reporting requirements
    August 30 - Physicians and other Health Care Providers must use counterfeit resistant prescription pads or paper for prescriptions associated with controlled substances
    September 1*- Reporting by dispensing practitioners to begin, required every 7 days thereafter
    September 8*- First report by dispensing practitioners must be filed
    October 1*- Registration to access voluntary prescription drug database querying privileges begins
    October 17*- Physicians may begin to voluntarily query the database
    *Indicates projected date as released by the Department of Health and dates are subject to change.


    August 15, 2011

    Dear FSIPP Membership;

    Please see below Attorney Grossman’s summary.

    The Board of Medicine at its meeting last week discussed matters that may have some relevance to your practice in and operation of a pain management clinic.

    The Board decided to leave its current rule on the training requirements for physicians practicing in pain management clinics as it currently reads. The rule, 64B8-9.0131, Florida Administrative Code, which became effective May 17, 2011, provides the CME requirements that must be met by any physician who does not qualify through the other options set forth in the rule. (Three years of documented full-time practice in pain management and completion of 40 hours of in-person CME in specific topics set forth in the rule.) I provided a copy and some discussion of the rule back in early May before it became effective. Last week I tried to convince the Board that their language requiring that the CME course be completed within 6-months of the effective date of the rule will probably end up being problematic, but they declined to amend the language. Therefore, in order to practice in a registered pain management clinic after July 1, 2012, every physician must meet one of the qualifications listed in the rule:

    ABMS board certification and a subspecialty certification in pain medicine or

    Certification by the American Board of Pain Medicine (ABPM) or

    Successful completion of a pain medicine fellowship or residency accredited by the ACGME or

    Successful completion of an ACGME accredited residency in (1) physical medicine and rehabilitation, (2) anesthesiology, (3) neurology, (4) neurosurgery, (5) family practice, (6) internal medicine, (7) orthopedics, or (8) psychiatry or

    Subspecialty certification recognized by the ABMS in hospice and palliative medicine or geriatric medicine or

    Hold current staff privileges at a Florida licensed hospital to practice pain medicine or perform pain medicine procedures or

    Complete the required CME by October 17, 2011 (as discussed above).

    In response to a request by a CME provider for approval of a proposed course intended to provide the specific CME required for physicians practicing in pain management clinics after July 1, 2012, the Board appointed a board member to review the course and determine if it qualifies. The Board’s attorney announced a presumption that appropriate courses are out there, but the Board does not appear to have any knowledge of specific courses.

    The director of the PDMP (Prescription Drug Monitoring Program) spoke to the Board and advised that they were going to be initiating rulemaking workshops to address issues for the PDMP. Under the new law, prescribing physicians are not required to query the program or enter information in the data bank. However, you should be aware that some local governments are including such requirements in local ordinances. (This goes hand in hand with those counties that are also requiring registration with DOH even if a pain management clinic is exempt from registration under the state law.) Please be sure that you have reviewed local city and county ordinances as they may apply to your practice. Some of them are specifically overriding the various exemptions from registration and compliance in the state law.

    Throughout the meeting there were comments made by the Surgeon General, representatives of the Department of Health, and Board members, indicating their intention to be aggressive in matters related to pain management and protecting the public from the dangers of pain pill mills. The Surgeon General specifically announced his aggressive use of Emergency Suspension Orders that have and will continue to result from joint enforcement efforts between DOH and local law enforcement, federal agencies, and other state agencies. It appears that the DOH intends to shoot first and ask questions later.

    Allen R. Grossman
    Grossman, Furlow & Bayó, L.L.C.


    July 21, 2011

    CMS Specialty Medical Review Transforaminal Epidurals

    FSIPP Membership:

    CMS has initiated an interventional pain “Specialty Medical Review” of transforaminal epidurals. They have contracted with Strategic Health Solutions, LLC, the auditing entity. The reason for these audits is that a number of transforaminal epidurals do not meet the LCD requirements of Medicare contractors. Responses to audit requests should contain: H&P and/or progress note documenting the medical necessity, rationale for initiating TF injections and follow-up notes showing the efficacy of the injection.


    July 11, 2011

    Pain Clinic Exemptions

    FSIPP Membership;

    I have received inquiries from a few of your FSIPP board members asking about the exemptions from clinic registration provided in §458.3265(1)(a)2.g. and h., Florida Statutes and §459.0137(1)(a)2.g. and h., Florida Statutes. Both of these exemptions require that the clinic be wholly owned by the specified specialists. For purposes of subparagraph g., that would mean all of the owners are either anesthesiologists, physiatrists or neurologists. For purposes of subparagraph h., that would mean that all of the owners are board certified physicians who have completed accredited fellowships in pain medicine OR who are board certified in pain medicine by an ABMS or AOA and perform interventional pain procedures of the type routinely billed using surgical codes. Although , I believe that it would be okay for all of the owners to meet any of the three options, all of the owners must fall into at least one of the identified groups or the exemptions cannot apply to the practice.

    I am providing this statement to you because of the general applicability to your board and membership. If any of them are unsure of the application of this general statement to their specific practice or believe that there may be another exemption for which their practice might qualify and they care to retain my firm to review their specific circumstances, they are welcome to contact me about establishing a separate engagement agreement for our legal services.

    Allen R. Grossman
    Grossman, Furlow & Bayó, L.L.C.
    2022-2 Raymond Diehl Road
    Tallahassee, FL 32308
    (850)385-1314
    (850)385-4240 (fax)
    www.gfblawfirm.com

    July 8, 2011

    E-FORCSE website, PDMP use

    FSIPP Membership:

    The link below is available to the E-FORCSE website. The information at this link has been put together by the Department of Health to address issues likely to be of interest to physicians in regard to the new PDMP and its use.

    http://www.eforcse.com/docs/Fact_Sheet_Health_Care_Practitioners.pdf


    July 7, 2011

    DOH Order Suspends Required Counterfeit-Proof Rx Pads

    FOR IMMEDIATE RELEASE

    July 7, 2011

    Contact: DOH Office of Communications
    Nancy Blum, (850) 245-4111

    STATE SURGEON GENERAL ISSUES A SUPPLEMENTAL ORDER TO PUBLIC HEALTH EMERGENCY DECLARATION

    - Supplemental language suspends requirement for practitioners to use counterfeit proof prescription pads for 60 days -

    TALLAHASSEE – In order to minimize unintended consequences of House Bill 7095, State Health Officer and Surgeon General, Dr. Frank Farmer today issued a supplemental order to his previously issued statewide public health emergency declaration. The supplemental order suspends the requirement for health care practitioners to use the Florida Department of Health (DOH) approved counterfeit proof prescription pads for any controlled substance as defined in Chapter 893 of the Florida Statutes, to run concurrent with the July 1, 2011 declaration.

    Over the last several days, DOH has received phone calls from practitioners and patients stating that pharmacies have refused to fill otherwise-legitimate prescriptions for controlled substances because the prescriptions were not written on the approved counterfeit proof prescription pads. Currently, as many as 50,000 Florida-licensed physicians prescribe controlled substances to treat their patients’ medical needs.

    “Once we began learning of the unintended consequences to law-abiding doctors and patients with legitimate health care needs, we knew we needed to take action to prevent substantial injury or harm to patients,” said Dr. Frank Farmer. “Issuing the supplemental order, provides practitioners the time needed to order the necessary prescription pads to ensure public safety over the long term.”

    On June 15, 2011, DOH’s Division of Medical Quality Assurance published, on its website, a list of approved vendors from which practitioners can purchase the prescription pads. As of today, there are 91 DOH approved vendors on the website. The Division is actively working with the printing industry to increase the vendor list, to make certain each region of the state has an adequate number of participating printers. Any printer interested in becoming an approved vendor can download the application on DOH’s website.

    “As a licensed practitioner myself, I understand the complexities of running a medical practice,” Dr. Farmer added. “But in the interest of public health and safety to stop the abuse of prescription drugs, I urge all of Florida’s licensed health care practitioners to visit DOH’s website and order the counterfeit proof prescription pads.”

    Visit DOH’s website at http://www.doh.state.fl.us/mqa/counterfeit-proof.html for a listing of approved vendors, instructions on becoming a vendor, and answers to frequently asked questions regarding counterfeit-proof prescription pads. View the supplemental order. Practitioners with additional questions can call DOH’s Division of Medical Quality Assurance Customer Contact Center at (850) 488-0595 or email MQAOperations@doh.state.fl.us.


    July 6, 2011

    PDMP Information

    From FSIPP Counsel:HB7095 left the Prescription Drug Monitoring Program in place, but pushed back its starting point to later this year. Although physicians are not required under the new law to report to or inquire of the controlled substance prescription data base (PDMP or E-FORCSE [interesting name]) unless they are still dispensing controlled substances for one of the limited reasons permitted by statute, others such as pharmacies and wholesalers are required to fully participate. Physicians are however, permitted to obtain advisories from the databank or inquire of the databank if they desire.

    For your information, attached is an update on the Department of Health’s progress in regard to the development and operation of the new databank. The link on the update provides additional information.

    Allen R. Grossman


    July 1, 2011

    BOM Pain Clinic Regulation July 1 Effective Date!

    Good afternoon:

    It has been brought to our attention that many of you have not received a letter our office sent out dated June 14, 2011 regarding important legislation going into effect as a result of the recent legislative session. A link to an electronic copy of this letter is included in the June Edition of the Message from the Chair, which we sent out yesterday. However, due to the potential impact of this on your medical practice as soon as July 1st, we thought it prudent to provide this information to you directly.

    A copy of the letter is available on our website here: ftp://ftppub.doh.state.fl.us/pub/medicine/Special/Letter-JuneMessage.pdf. Depending on your computer and Internet settings, you may find that saving the file directly to your computer (right-click on the link and choose "Save As," tell it where to save the file, then double-click the file on your computer to open) works better than simply clicking the link above.

    Thank you for the good work that you do. Feel free to contact our office with any questions or concerns.

    ____________________________

    The Florida Board of Medicine
    E-mail: mqa_medicine@doh.state.fl.us
    Phone: 850-245-4131

    HB 7095 Changes in Effect Today

    FSIPP Membership:

    Our legal Counsel has advised us of the changes that will take place today as a result of HB 7095. Please see the attachment.

    Deborah H. Tracy MD, MBA
    FSIPP President


    June 23, 2011

    Deregister as a Pain Clinic

    Dear FSIPP Membership:

    We expect that most of the FSIPP membership will be exempt from Florida DOH Pain Clinic Registration, when the new law contained in HB 7095 goes into effect on July 1, 2011. If you are exempt by the new law you must deregister as a pain clinic with the DOH or you will still be subject to the Department requirements as a pain clinic. Write a letter to the DOH including your contact information and registration number to deregister.

    If you need help with this task please contact Lorry Davis, director@flsipp.org, and
    she will provide you with the names of Attorneys to assist you.

    EXEMPTIONS
    • Licensed as Chapter 395
    • Majority of physicians provide surgical services
    • Publicly owned and assets per quarter > $50 million
    • Affiliated with Medical School (TO BE DEFINED)
    • No CS prescribed
    • Non-profit, 501 (c) 3
    • Owned and operated by one or more
    - Board-certified Anesthesiologist, Physiatrist, Neurologist
    - Board-certified Medical Specialists
    • Fellowship in pain medicine (ACGME approved)
    • Board Certified in Pain Medicine (ABMS) and perform procedures routinely billed
    as surgical codes.

    June 21, 2011

    Medicare 5010 Conversion

    Dear Membership:

    FCSO, Medicare has advised the Society that it remains very concerned about the implementation of the 5010 version to HIPPA electronic transactions standards. Of the 600 clearing houses for electronic transmittal only about 30 are in active testing. The deadline for conversion is January 1, 2012. Please see the attachment for steps you can take to protect your practice against an interruption in cash flow. Those who have not converted to 5010 in January will NOT get paid.


    May 31, 2011

    FSIPP CORRECTION! Undispensed CS II & III Public Health Emergency

    Dear FSIPP Membership:

    As you know HB7095 will take effect July 1, 2011 (not 2012 as we stated in error in our previous eblast - very sorry).
    Within 10 days of the effective date dispensing physicians (DEA) must return all undispensed CS II & III to distributor from which it was purchased in accordance with contract, or to law enforcement.
    The DOH declares this as a Public Health Emergency. Please find attached the Declaration of Public Health Emergency.