IN THIS ISSUE 

1. FDA Meeting on Epidural Steroid Use and How You Can Get Involved
2. Pain Physician journal receives Impact Factor of 4.766 
3. Companies Try to Escape Health Law's Penalties 
4. A recent poll shows that most doctors give Obamacare low grades - but should this influence voters evaluation of the program?
5. New doctors site rates for experience, quality  
6. Blog: Figures Don't Lie But Liars Figure--Will There Be Some Obamacare Rate Shock in 2015?  
7. Ebola: CDC Tightens Protection Rules 
8. Dr. Devi Asked to Speak on Ebola  Issue with Various Media Outlets 
9. FDA approves labeling with abuse-deterrent features for third extended-release opioid analgesic 
10. ASIPP Resident/Fellow Governing Counseling Seeking Officer Nominations 
11. Register Today for ICD-10 Preparation Webinar Set for Nov. 4 
12. The Promise and Peril of ACOs 
13. Data quality killed my analytics program 
14. CMS extends ACO fraud and abuse waivers 
15. CCI 4th Quarter Updates Now Available 
16. Call for Abstracts! Make Plans Today to Participate in 17th Annual Meeting Abstract Session 
17. State Society News 
18. Physician Wanted 

FDA Meeting on Epidural Steroid Use and How You Can Get Involved

On November 24-25, 2014 the FDA Anesthetic and Analgesic Drug Products Advisory Committee Meeting will hold a meeting to discuss the risk of serious neurologic adverse reactions associated with epidural steroid injections (ESI) administered to reduce inflammation for pain management. The committee will also consider the efficacy of ESI and the overall risk benefit balance of injecting steroids in the epidural space to treat pain. The outcome of this meeting will determine future regulatory options, including but not limited to changes to the product labeling. This FDA hearing could be the greatest threat to IPM than anything we have faced in the past.

You can get involved in two ways:

• The most critical is support from patients with letters by Nov. 7, 2014.
• Attend the FDA meeting on November 24

ASIPP is attempting to secure time to present our views; however, we will not know the time allocated to us until October 31st. If you would like to submit your own request to speak, you may do so by October 30th. Request may be submitted via e-mail to:    

Stephanie L. Begansky, PharmD

Center for Drug Evaluation and Research

Food and Drug Administration

10903 New Hampshire Avenue

WO31-2417

Silver Spring, MD 20993-0002

E-mail: AADPAC@fda.hhs.gov

It is our understanding that several pain organizations and other societies such as ASA, PMR, etc., will also be presenting both pro and con views. In addition and most importantly, there are many patient groups such as the Arachnoiditis Association, which may be presenting in opposition to epidural injections.

Because of this, it is crucial to obtain as many patient letters and send them to the FDA via our Capwiz link.

Time is of the essence. The comments must be sent by November 7th so you should start today and continue sending through November 7.

How to Get Patients Letters Signed and Submitted 

The following information has been published thus far on epidural injections, FDA warning of epidural injections and other developments:

ASIPP's FDA Citizen Petition requesting the Commissioner to withdraw the present Safety Warning.

Pain Physician Journal Health Policy Opinion: Epidural Steroid Injections Safety Recommendations by the Multi-Society Pain Workgroup (MPW): More Regulations Without Evidence or Clarification

Pain Physician Journal Health Policy Review: Epidural Steroid Warning Controversy Still Dogging FDA:

Work group passes epidural steroid injection consensus in response to FDA warning. Healio Spine Surgery, August 1, 2014

Recommendations for safe use of epidural steroid injections presented at the ASA 2013 annual meeting as part of FDA's Safe Use Initiative

American Society of Anesthesiologists. ASA Formally responding to FDA warning on injection of corticosteroids into epidural space, July 14, 2014.

The open public portion of the meeting will take place on Monday, November 24 from 8:00 a.m. to 5:00 p.m. If you would like to attend you would need to arrive on Sunday and could leave Monday afternoon and there are numerous hotels available in the area. The meeting location is:

FDA White Oak Campus

Building 31

The Great Room (Rm. 1503)

White Oak Conference Center

10903 New Hampshire Avenue

Silver Spring, Maryland

It is crucial that we have good representation at the meeting. If you are planning to attend please let us know.

The American Society of Interventional Pain Physicians'  Pain Physician journal has received an Impact Factor of 4.766 in the 2014 release of the  Thomson Reuters Journal Citation Reports.

Below you will find a list of Impact Factors for journals in the same field of interest as Pain Physician journal.

Journal Title                                        Impact Factor

Pain Physician                                       4.76

Pain Practice                                            2.183

Pain Medicine                                          2.243

Spine                                                        2.447

Pain                                                          5.836

J of Neurointerventional Surgery             2.495

Spine journal                                            2.8

Journal of Pain                                         2.737

Clinical J of Pain                                      2.703

Regional Anesthesia & Pain Medicine     2.12

J. of Pain & Symptom Management        2.737

J of Spine Disorders & Tech                    1.888

Anesthesiology                                        6.168

Anesthesia & Analgesia                          3.422

Pain                                                         5.836

Current Pain and Headache Reports      2.256

Pain Research and Management            1.39

Journal of Headache and Pain                3.281

As you can see, this is a great accomplishment for our journal and it is in part because of you and the hard work you do serving on the editorial board, as section editors, as reviewers, as authors and even as promotors of journal articles.

With companies set to face fines next year for not complying with the new mandate to offer health insurance, some are pursuing strategies like enrolling employees in Medicaid to avoid penalties and hold down costs.

The health law's penalties, which can amount to about $2,000 per employee, were supposed to start this year, but the Obama administration delayed them until 2015, when they take effect for firms that employ at least 100 people.

Now, as employers race to find ways to cover their full-time workers while holding a lid on costs, insurance brokers and benefits administrators are pitching a variety of options, sometimes exploiting wrinkles in the law.

Wall Street Journal

Access to this article may be limited.

A recent survey of doctors by the Physicians Foundation finds that most give low grades to Obamacare. Some 46% of the doctors polled gave Obamacare a grade of "D" or "F" and 29% gave it a "C." Only 25 percent give it an "A" or a "B," including just 4% who gave it the highest grade. It's possible that some of the doctors who chose C really meant to say that it was at least reasonably good. But in modern America, thanks to grade inflation, a C is generally considered a very bad grade. Thus, it seems likely that a large majority of doctors have strongly negative view of the program.

The first comprehensive physician rating and comparison database launches Monday in time for open enrollment on federal and state health exchanges, as well as for many employer-provided plans.

The new version of the website Healthgrades.com uses about 500 million claims from federal and private sources and patient reviews to rate and rank doctors based on their experience, complication rates at the hospitals where they practice and patient satisfaction.

The new way to find the best doctor comes at a time when many health insurance plans offer fewer choices of doctors and hospitals. Users can sort and compare physicians based on where they live and their insurance plans.

USA Today

Hanging around actuaries as long as I have one of the old sayings I picked up was, "Figures don't lie, but liars figure."

I have read one story after another this summer and fall about the modest Obamacare rates increases--or decreases--for 2015.

On this blog you have also seen me write about the complex way the 2015 Obamacare rates will hit people particularly because of the impact the changes in the so called second lowest cost Silver plan will have on so many people's final subsidy. You have also seen me write about the fact that we really won't know what Obamacare costs people until the now unlimited Obamacare reinsurance program stops subsidizing insurance rates in 2017.

Ebola: CDC Tightens Protection Rules

Faced with dismay over the Ebola infection of two nurses, the CDC has tightened its guidance for personal protective equipment.

The new guidelines "provide an increased margin of safety" for healthcare workers treating Ebola patients, according to CDC Director Tom Frieden, MD.

As first reported by MedPage Today, healthcare professionals had found the former guidance inadequate and incomplete, and many were angry that the CDC appeared to blame the two infected nurses for errors in using their equipment.

MedPage Today

Dr. Devi Asked to Speak on Ebola  Issue with Various Media Outlets

Below you will find just a sampling of interviews that Dr. Devi Nampiaparampil has done on the Ebola Issue. For a complete list of Dr. Devi's interviews, go to: http://doctordevi.com/

October 7: Ebola vs. Flu: What Should You Be Concerned About

Fox News

"The Real Story with Gretchen Carlson"

http://video.foxnews.com/v/3825895537001/ebola-vs-flu-what-should-you-be-concerned-about/#sp=show-clips

October 14: WHO-- Nearly 9000 Ebola Cases in W. Africa

NOW With Alex Wagner

MSNBC

http://www.msnbc.com/now/watch/who--nearly-9-000-ebola-cases-in-w.-africa-342508611660

October 16: CDC Grilled About Ebola

CNN Newsroom with Brooke Baldwin

CNN

https://www.youtube.com/watch?v=iRIQiZpAKGI&feature=youtu.be

October 16: Congressional Hearing on Ebola

NOW with Alex Wagner

MSNBC

http://youtu.be/GT4NUn-4Fpg

October 17: WHO Admits Botched Response to Ebola

The Daily Rundown with Craig Melvin

MSNBC

http://www.msnbc.com/daily-rundown/watch/who-admits-botched-response-to-ebola-344075331637

October 17: Here's How Ebola Spreads Among Health Workers

Politics Nation with Rev. Al Sharpton

MSNBC

http://www.msnbc.com/politicsnation/watch/heres-how-ebola-spreads-among-health-workers-344372291787

October 17: An Ebola Czar Is Appointed

CNN Tonight with Don Lemon

CNN

https://www.youtube.com/watch?v=0EMLIWVqNL0

October 19: Ebola in America 

A Fox News Special

Fox News Channel

https://www.youtube.com/watch?v=YSs948nmMxc&feature=youtu.be

The U.S. Food and Drug Administration today approved new labeling for Embeda (morphine sulfate and naltrexone hydrochloride) extended-release (ER) capsules, an opioid analgesic to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. Embeda is the third ER opioid analgesic to be approved with labeling describing the product's abuse-deterrent properties consistent with the FDA's 2013 draft guidance, Abuse-Deterrent Opioids - Evaluation and Labeling. The new labeling includes a claim indicating that Embeda has properties that are expected to reduce oral abuse when the product is crushed.

FDA

ASIPP Resident/Fellow Governing Counseling Seeking Officer Nominations

Interested in pursuing a career in pain management? Want to advocate on behalf of your profession and patients? Trying to distinguish yourself from other fellowship applicants? Enjoy networking with prominent members of your profession? Want to learn about prominent issues in pain medicine?

If you answered "yes" to any of these, consider joining the American Society of Interventional Pain Physicians (ASIPP) and serving as a member of the Residents and Fellows (RFS) Governing Council. The Governing Council will be tasked with creating content recommendations for this year's annual conference and improving resident and fellow membership in ASIPP.

We are soliciting nominations for the following positions (one year term):

Chair- directs the section and implements the agenda as outlined by the board

Vice Chair- assists the chair and lead membership recruitment

Secretary - responsible for accurate record keeping of the section activities

Member At-large - responsible for arranging RFS activities at the annual meeting

Treasure - responsible for accurate financial management of funding designated to the section

Please submit your CV and a 250 word maximum statement of interest to sunnyjha@gmail.com by October 31st. You can express interest in any and all positions. 

Governing Council members must be members of ASIPP, members of an accredited residency and/or fellowship program but must commit to attending the ASIPP Annual Meeting April 9-11 in Orlando, FL. ASIPP offers drastically reduced registration fees for the meeting to residents, fellows, and medical students. Governing Council members receive complimentary registration. 

Joining ASIPP as a resident and fellow is free and is easy, simply go to www.asipp.org and follow the links.

Register Today for ICD-10 Preparation Webinar Set for Nov. 4

WEBINAR HIGHLIGHTS 

• Background on ICD-10
• Technology readiness to make sure the products are ready
• The new 'Road to 10' tool to create a custojmized action plan for ICD-10
• Key steps to ensure a successful transition
• Resources to help with a smooth implementation
• Discover the top ICD-10 areas likely requiring documentation updates for pain management providers
• Technology readiness to make sure the products are ready
• What are the testing procedures needed with payers
• Practice determining the correct ICD-10 diagnosis codes in common pain management conditions

WEBINAR FEE:   $175     

WEBINAR DATE: November 4, 2014  

TIME:   11:00am-12:30am CST

CREDIT HOURS: 1.5 CEUs

LENGTH: 90 Minutes

SPEAKER:

Marvel J Hammer, RN, BS, CPC, CCS-P,  ACS-PM, CPCO   

Click HERE to register:

A sleeping dragon awakes.

At our weekly health policy colloquium yesterday, the presenter described plans for our organization to form its own accountable care organization, or ACO.

The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then "attribute" their healthcare and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and cost-efficient healthcare.

MedPage Today

Improving the health of at-risk, vulnerable and chronically sick populations remains a massive challenge for healthcare organizations' financial administrators. Social, cultural, hereditary, economic and geographical issues not only stand in the way of traditional approaches to care, but also complicate efforts at controlling medical costs.

In order to properly manage complex populations, comprehensive and reliable data on patient health and demographics are required. However, many players in the healthcare ecosystem have only a limited or imprecise understanding of the populations in their care.

Healthcare Finance News

Last week the Department of Health and Human Services Office of Inspector General and the Centers for Medicare & Medicaid Services published a joint notice continuing the effectiveness of fraud and abuse law waivers granted in 2011 in connection with the Medicare Shared Savings Program, which is intended to encourage physicians, hospitals, and certain other types of providers and suppliers to form accountable care organizations (ACOs).

By way of background, in a November 2, 2011, joint OIG-CMS interim final rule with comment period, the agencies established waivers of the application of the federal physician self-referral law, the federal anti-kickback statute, and certain civil monetary penalties law provisions to specified arrangements involving ACOs participating in the Shared Savings Program (the Waiver IFC).

Healthcare Finance News

CCI 4th Quarter Updates Now Available

These new edits have been effective since 10/1/2014 and will be effective through 12/31/2014.

As a member benefit, we are providing you with the 4th quarter updates for IPM codes.

For detailed analysis of NCCI for most commonly used interventional techniques, please follow the following link