BREAKING NEWS MARCH 29, 2018
CMS proposes to force patients off effective opioid doses without their physician's approval
Centers for Medicare and Medicaid Services (CMS) is proposing a limit on the amount of opioids a physician can prescribe to a patient. This limitation, that may take effect on Jan.1, 2019, would be unrelated to the patient's past experience or need. It would render pharmacists unable to fill prescriptions that CMS has defined as “high” or long-term dosages unless an appeal is approved. CMS defines long-term opioid therapy as opioid use for more than 90 consecutive days and high-dose usage as at least 90 mg morphine equivalent dosage (MED) per day. However, this definition has never received substantial scientific support. The history of dose investigation shows that opinions about what constitutes the appropriate amount of opioids have changed through the years. To begin, a paper published 15 years ago in the New England Journal of Medicine suggested most people do not benefit from opioids administered above 180 mg per day. This article ignited a heated debate. However, it focused on efficacy, not the risk of overdose or addiction at higher doses.
BREAKING NEWS - NOVEMBER 3, 2015
CMS Publishes Final Payment Rules
The Centers for Medicare & Medicaid Services (CMS) has issued a final rule updating payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2016. CMS finalized a number of new policies, including several that are a result of recently enacted legislation.
CMS released the final rules on Physician Payment Rates, Hospital Outpatient Departments (HOPD) payments, and Ambulatory Surgery Center (ASC) payments.
In reference to Ambulatory Surgery Center payments, there have been significant modifications including increasing facet joint interventions rates and reducing epidurals. One item of good news is that CMS has increased payment for one-day percutaneous adhesiolysis, for which we have been struggling for a long period of time.
Following are the fee schedules for interventional pain management physicians, and for HOPDs and ASCs performing interventional pain management procedures.
Click below for schedules:
October 27, 2015
It is important for our FSIPP members to stay up to date on important policy guidelines that affect our patients and practice. Please note this important policy change with respect to urine drug testing for our Medicare Patients.
Here is an excerpt from the policy:
Coverage Indications, Limitations, and/or Medical Necessity
Urine drug testing (UDT) provides objective information to assist clinicians in identifying the presences or absence of drugs or drug classes in the body and assist in making treatment decisions.
This policy details:
To review the entire update from CMS click here.
(you need to click on "Accept" at the bottom).
October 7, 2015
On October 5, 2015, the Center for Drug Evaluation and Research, the U.S. Food and Drug Administration (FDA), the Department of Health and Human Services, notified the American Society of Interventional Pain Physicians (ASIPP) of the status of citizen's petition o f the non-adaptation of the 17 recommendations developed by Multisociety Pain Workgroup (MPW). SEE LETTER
In response to the FDA citizens petition on behalf of ASIPP and letter written to the FDA by 1,040 practicing pain physicians to amend the April 23, 2014, Drug Safety Communication regarding epidural corticosteroid injections for pain and not adapt 17 recommendations developed by MPW. The FDA has determined that that will not amend the drug safety communication; however, they will not adapt 17 recommendations by the MPW.
A letter signed by 1,040 interventional pain physicians was sent on June 26, 2014, and ASIPP filed a citizen petition on September 3, 2014. The FDA held hearings on November 24-25, 2014 2014, on drug safety of epidural steroid injections. On March 4, 2015, the FDA informed ASIPP that they were unable to reach a decision on our petition because it raised complex issues requiring extensive review and analysis by agency officials.
Finally, FDA has reached an agreement providing a major victory for practicing interventional pain physicians avoiding micromanagement and additional bureaucracy created by MPW.
If you recall, on April 23, 2014, the FDA issued Drug Safety Communication warning of "rare but serious neurologic problems after epidural corticosteroid injections for pain" and "injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death." The FDA has not accepted our request to amend this.
There were also 17 recommendations provided by MPW which were not based on scientific evidence or even consensus among interventional pain physicians. They were developed in closed door meetings by societies that, as a majority, were not practicing interventional pain management. These standards were published in Anesthesiology (2015; 122:974-984) and JAMA (2015; 313:1713-1714), essentially they read that even for cervical and lumbar interlaminar epidural injections the following:
September 1, 2015
TALLAHASSEE—The clash over health care spending that ripped apart the Republican-controlled Florida Legislature isn't likely to end anytime soon.
With a firm line of succession in place for the next five years in the Florida House, top Republicans in that chamber say they are committed to taking aim at what they consider the underlying causes of rising health care costs.
That’s the promise being made by Rep. Jose Oliva, who has put in charge of the new House Select Committee on Affordable Healthcare Access that has been created by House Speaker Steve Crisafulli.
Oliva, a Miami Lakes Republican in line to become House speaker after the 2018 elections, pointed out that there are now three consecutive House speakers in favor of pushing reforms.
“To the degree we are in the House, and we have influence in the House, we will lend a tremendous amount of that influence to improving a health care system that is unsustainable,” Oliva told POLITICO Florida in an interview last week.
While the select committee is new, many of the ideas that it plans to discuss aren’t.
March 11, 2013
Sanford M. Silverman, MD
President Florida Society of Interventional Pain Physicians
5200 NW 43rd Street Suite 102-321
Gainesville, Florida 32606
Dear Dr. Silverman:
Thank you for your January 28 letter, including your position statement regarding the use and practice of epidural steroid injections. Insight from Florida's experienced pain physicians is of great value to the Department. I will be certain to share your statement with the Board of Medicine.
Your effort to promote safety with epidural steroid injections is appreciated. Again, thank you for your work to that end.
John H. Armstrong, MD ,FACS
Surgeon General & Secretary
January 16, 2012
By RAY REYES | The Tampa Tribune
Published: January 16, 2012
TAMPA --Patients seeking painkillers are subject to a rigorous screening process at Deborah Tracy's office.
Tracy, a pain management physician in Spring Hill, now has an even better chance of making sure she's not prescribing narcotic-grade pills to addicts. She checks each patient's history against an online database that, since its launch in October, has grown to track about 21 million prescription records.
"It helps me as a tool, to use more due diligence," said Tracy, the president of the Florida Society of Interventional Pain Physicians. "It helps me tremendously."
Using the prescription drug monitoring system, Tracy said, she was able to identify several people who appeared to be doctor-shopping, visiting different doctors in a short period to obtain prescriptions for opiate-based pills such as oxycodone and hydrocodone.
Without the tracking system, she said, she would've never known they were addicts or drug dealers.
"Some of them lie pretty well," Tracy said. "I query all new patients. And you can do it within seconds."
The database, known as the Electronic Florida Online Reporting of Controlled Substances Evaluation, or E-FORCSE, has been in the works for about three years.
Gov. Rick Scott initially opposed the tracking system last year, but Attorney General Pam Bondi and several GOP legislators pushed for it to be included in a bill that toughened laws regulating pharmacies and pain clinics.
Under the new law, pharmacists and other health professionals who prescribe narcotic-grade medication have seven days after the painkillers are dispensed to patients to report the information to the database. Only doctors, pharmacists and law enforcement officers working active investigations can access the database.
The system launched Oct. 17. The state Department of Health released a report last month that detailed how the database has performed since it went online.
So far, 5,787 medical professionals have registered to use it, according to the report.Within two months of the database's launch, those health professionals checked the prescription histories of 106,414 patients.
"Right off the bat, these figures are encouraging," said Greg Giordano, chief legislative aide for state Sen. Mike Fasano, R-New Port Richey.
Fasano sponsored the Senate version of the bill last year calling for the creation of the database as well as strengthening regulations governing the ownership and operation of pain management clinics.
This year, Fasano plans to file legislation to eliminate the seven-day grace period for doctors to enter prescriptions in the database, Giordano said. Fasano wants the system updated as soon as a doctor files a prescription or a pharmacist dispenses it.
Bondi also was pleased that the system has run smoothly.
"I'm encouraged that, although this database has only been running for a short time, doctors and pharmacists have been reporting prescriptions and viewing patient-specific information," Bondi said. "We are well on our way to protecting Floridians from prescription drug abuse."
Thirty-seven states have prescription drug databases up and running. Lawmakers in 13 other states are seeking to create their own online systems.
The lack of a statewide database in years past and Florida's once-lax laws contributed to an increase in the number of so-called "pill mills," storefront clinics that dispense massive amounts of painkillers, law enforcement officials said.
State and local officials consider the Tampa Bay area and parts of South Florida as epicenters for pill mills and prescription drug abuse.
August 29, 2011
Florida Tribune Staff, 08/29/2011 - 03:26 PM
Just days before a new drug database is set to start operation, the state of Florida announced that it was lifting the statewide public health emergency it declared due to Florida's prescription drug crisis. State officials first declared the emergency back in early July and then swept through clinics across the state for inspections that yielded in the seizure of hundreds of thousands of prescription drugs. “While the statewide public health declaration may no longer be in effect, the efforts of the Florida Department of Health, law enforcement partners and other state agencies remain strong,” said Gov. Rick Scott in a statement.
Scott had set up a task force to go after pain clinics back in March. Scott initially was opposed to keeping intact the proposed drug database - which is meant to track prescriptions issued by doctors for drugs such as OxyContin, Valium and Xanax. But Scott, lawmakers and Attorney General Pam Bondi reached a compromise that kept the database which is scheduled to become operational this Thursday. A bill passed this past session also requires physicians to submit their prescription informationwithin seven days.
Dr. Frank Farmer, the Department of Health secretary, also announced along with lifting the state of emergency he was also lifting a moratorium on a part of HB 7095 that had been put on hold.
Two months ago Farmer put on hold a requirement that as many as 50,000 Florida-licensed physicians use counterfeit-resistant prescription pads. The move was taken in the wake of phone calls from patients and doctors saying that pharmacies around the state had begun to refuse to fill prescriptions for controlled substances because the prescriptions were not written on the approved pads. “Allowing the practitioners who are approved to prescribe controlled substances more time to order the prescription pads was necessary to ensure public safety over the long term,” Farmer said. “Now is the time to start using them.”
August 15, 2011
ASAM RELEASES NEW DEFINITION OF ADDICTION
Addiction Is a Chronic Brain Disease, Not Just Bad Behaviors or Bad Choices
CHEVY CHASE, MD, August 15, 2011 – The American Society of Addiction Medicine (ASAM) has released a new definition of addiction highlighting that addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling or sex. This the first time ASAM has taken an official position that addiction is not solely related to problematic substance use. When people see compulsive and damaging behaviors in friends or family members—or public figures such as celebrities or politicians—they often focus only on the substance use or behaviors as the problem. However, these outward behaviors are actually manifestations of an underlying disease that involves various areas of the brain, according to the new definition by ASAM, the nation’s largest professional society of physicians dedicated to treating and preventing addiction.
“At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”
The new definition resulted from an intensive, four‐year process with more than 80 experts actively working on it, including top addiction authorities, addiction medicine clinicians and leading neuroscience researchers from across the country. The full governing board of ASAM and chapter presidents from many states took part, and there was extensive dialogue with research and policy colleagues in both the private and public sectors.
The new definition also describes addiction as a primary disease, meaning that it’s not the result of other causes such as emotional or psychiatric problems. Addiction is also recognized as a chronic 2 disease, like cardiovascular disease or diabetes, so it must be treated, managed and monitored over a life‐time.
Two decades of advancements in neurosciences convinced ASAM that addiction needed to be
redefined by what’s going on in the brain. Research shows that the disease of addiction affects
neurotransmission and interactions within reward circuitry of the brain, leading to addictive behaviors
that supplant healthy behaviors, while memories of previous experiences with food, sex, alcohol and
other drugs trigger craving and renewal of addictive behaviors. Meanwhile, brain circuitry that governs
impulse control and judgment is also altered in this disease, resulting in the dysfunctional pursuit of
rewards such as alcohol and other drugs. This area of the brain is still developing during teen‐age years,
which may be why early exposure to alcohol and drugs is related to greater likelihood of addiction later
There is longstanding controversy over whether people with addiction have choice over antisocial and dangerous behaviors, said Dr. Raju Hajela, past president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on the new definition. He stated that “the disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”
“Choice still plays an important role in getting help. While the neurobiology of choice may not be fully understood, a person with addiction must make choices for a healthier life in order to enter treatment and recovery. Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.
“Many chronic diseases require behavioral choices, such as people with heart disease choosing to eat healthier or begin exercising, in addition to medical or surgical interventions,” said Dr. Miller. “So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment.”
To read the full Definition of Addiction, visit: http://www.asam.org/DefinitionofAddiction-LongVersion.html Dr. Miller is past president of ASAM. Dr. Hajela is past president of the Canadian Society of Addiction Medicine and is a board member of ASAM. The American Society for Addiction Medicine is a professional society representing close to 3,000 physicians dedicated to increasing access and improving quality of addiction treatment, educating physicians and the public, supporting research and prevention, and promoting the appropriate role of physicians in the care of patients with addictions.
American Society of Addiction Medicine
4601 North Parke Avenue, Upper Arcade, Suite 101 Chevy Chase, MD 20815‐4520
Phone (301) 656‐3920 ● Fax 301‐656‐3815 ● Web www.asam.org