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American Society of Interventional Pain Physicians News  | May 6, 2015


    1. ASIPP Relief Fund Accepting Donations for Nepal
    2. Vicodin Top Medicare Drug in 2013
    3.  Registration Now Open for July Board Review Course in Chicago 
    4. ASIPP To Offer Controlled Substance Management, Coding, Compliance and Practice Management Courses in Chicago
    5. CMS Touts Pioneer ACO Results 
    6. Ketamine's Troubled Past, Promising Future 
    7. Bill Clinton gave 542 speeches between 2001 and 2013. He made $104.9 million 
    8. Docs Need Better Training to Treat Opioid Addiction, Congress Told 
    9. Electronic Health Records: First, Do No Harm?  
    10. Chronic Pain Follows Adverse Life Events 
    11. FDA Wants Data to Support Antiseptic Claims 
    12. Emergency department opioid prescribing 
    13. State Society News 
    14. Physician Wanted 

ASIPP Relief Fund Accepting Donations for Nepal


To date, ASIPP has given $25,000 toward the Nepal earthquake relief fund.


On Saturday, April 25, a powerful 7.9 earthquake, the country's worst in 80 years, rocked mountainous Nepal. A day later Nepal was struck by a major 6.7 aftershock. Now more than 5,000 people are dead. More than 9,000 injured. The death toll and injury rate continues to rise as the rescue and relief efforts continue. Millions across Nepal urgently need our help.


Dr. Yogesh Malla, who is Dr. Laxmaiah Manchikanti's partner in two pain management centers and a member of ASIPP, has family directly affected by the Nepal Earthquake. He and his wife were born in Nepal and most of their family is still living there. After hours of making phone calls, trying to reach friends and families, they were finally able to find out that everyone survived - but were very shaken by the amount of chaos and damage done to their country. Read Dr. Malla's story in the Paducah Sun HERE


It's not too late to join with ASIPP and make a donation to the ASIPP® Relief Fund, Inc. to  assist with the recovery efforts mobilizing around the world to help earthquake victims. Dr. Manchikanti has personally given $2,000 to support relief efforts.


Click HERE to access the donation form.



Vicodin Top Medicare Drug in 2013


CMS has published Medicare Part D data on the utilization of various drugs. The Wall Street Journal picked up on hydrocodone prescribing to cover in an article entitled "Generic Vicodin was a Top Medicare Drug in 2013" which they described as the generic Vicodin and a top Medicare drug in 2013.


Even though hydrocodone was the most widely prescribed drug to Medicare beneficiaries in 2013, it shows that the majority of the drugs were provided by family practice physicians (9.98 million) and internal medicine (8.11 million) together 18.09 million claims representing 52% of total claims, nurse practitioners (2.04 million) and Physician assistant (1.61 million) together 3.65 million representing 10.5% of the total claims. Physical medicine and rehabilitation (0.83 million), anesthesiology (0.70 million) and interventional pain management (0.69 million) together provided 2.22 million representing 6.4%. This illustrates that nurse practitioners and physician assistants prescribe more Vicodin than pain physicians.   Hydrocodone is ranked the No. 1 prescribed drug based on number of Medicare beneficiaries, ranked 4 for number of claims, and ranked 32 for cost for Medicare beneficiaries.


There is additional news on hydrocodone which was the number one drug in 2012 and 2013. In 2014, it dropped to be a number 2 drug with an 8% decrease from 2013 in 2014. While it is a comforting trend to be decreasing in number, this needs to be evaluated more closely.  This may be in part due to a change in scheduling from  schedule 3 agent to  schedule 2 drug which is associated with more stringent monitoring.  Physicians may feel that since this drug is more scrutinized today than in years past they are switching to other agents such as tramadol, or other controlled substances.  Also note that these numbers represent only the number of prescriptions, they do not have any correlation to the number of tablets or their strength per day, month, or per year.




Claims (million)



per Provider

Family practice & Internal Medicine

18.09 (52%)

124,064 (18%)



3.65 (10.5%)

 53,524 (7.7%)


PM&R, IPM & Anesthesia

2.22 (6.4%)

8,724 (1.3%)









Since patients with chronic pain frequently end up in a pain physician's office, it should not be surprising to find that pain physicians prescribe opioids, it is somewhat surprising that given the complexity of these patients and severity of the population only 1.3% of hydrocodone is prescribed by pain physicians


This may in part be due to the balance that pain physicians demonstrate when caring for complex patients, knowing when to prescribe a variety of medications ( including opiates) , refer for counseling, offer alternative therapies, physical modalities and offer minimally invasive interventions .  This balance is what constitutes a well trained physician and may help to maintain pain control and minimize abuse and diversion.  


Click HERE to read entire Wall Street Journal article



Registration Now Open for July Board Review Course in Chicago


Make plans today to attend the 2015 Board Review Course set for July 21-24 at the Palmer House in Chicago, IL.


This intensive and comprehensive high-quality review will prepare physicians appearing for the American Board of Medical Specialties (ABMS)-Subspecialty Pain Medicine examination and for the American Board of Interventional Pain Physicians (ABIPP)-Part 1 examination.


- A five-day review covering anatomy, physiology, pharmacology, psychology, ethics, interventional techniques, non-interventional techniques, controlled substances and practice management

- Unique lectures by experts in the field

- Extensive educational materials




ASIPP To Offer Controlled Substance Management, Coding, Compliance and Practice Management Courses in Chicago


The ASIPP Comprehensive Review Courses and Exams in Controlled Substance Management and Coding, Compliance, and Practice Management will be held in Chicago, Illinois, on July 22-24, 2015.


The Coding, Compliance and Practice Management is so beneficial to practices, both office-based and ASCs, that many physicians send their staff early to keep them current on the cutting edge aspects of practice management. These intensive review courses are designed to present interventional pain management specialists and other health care providers an in-depth review of multiple areas of interventional pain management-the areas we were never taught, yet are crucial for our survival.


 The course features many nationally recognized experts in pain management billing and coding and practice management as well as controlled substance management. In today's environment of regulations and litigations, you can't afford not to broaden your knowledge and refresh your skills in these areas.


Educational Objectives for Coding, Compliance, and Practice Management in IPM:

- Discuss documentation

- Review practice management topics

- Discuss coding and billing

- Examine compliance issues


CLICK HERE to register for Coding, Compliance and Practice Management Course 


Educational Objectives for Controlled Substance Management:

- Review basic science and core concepts

- Discuss pharmacology

- Identify clinical use and effectiveness

- Identify substance abuse

- Discuss topics with documentation, regulatory issues, legal issues, and ethical issues


CLICK HERE to register for Controlled Substance Management Course 


In addition to the review course, the American Board of Interventional Pain Physicians (for physicians) and the American Association of Allied Pain Management Professionals (for non-physicians) offers the opportunity for examination in order for physicians to obtain competency certification to and non-physicians to obtain associate certificates in Controlled Substance Management and Coding, Compliance, and Practice Management.


Click HERE for Reservations at The Palmer House Hotel  

17 East Monroe Street, Chicago, IL 60603 | Phone: 312-726-7500


CMS Touts Pioneer ACO Results


WASHINGTON -- The "Pioneer Model" of an accountable care organization (ACO) saved Medicare about $385 million in its first 2 years, according to the Centers for Medicare and Medicaid Services (CMS).


Compared with 12-to-13 million beneficiaries studied who were enrolled in traditional Medicare in 2012 and 2013, the 676,000-to-806,000 beneficiaries aligned with ACOs had aggregate reductions in spending increases of about $280 million in 2012 and $105 million in 2013, according to a CMS study online in the Journal of the American Medical Association.


"Results from this study and previously reported data on Pioneer ACOs' performance on clinical quality measures suggest it is possible to reduce expenditure growth while maintaining or improving quality in a FFS [fee-for-service] payment environment," wrote Rahul Rajkumar, MD, JD, acting deputy director of the Center for Medicare and Medicaid Innovation in Baltimore, and colleagues.



MedPage Today




Pioneer Model Saved Medicare Nearly $400 Million in Two Years
Centers for Medicare and Medicaid Services publish latest findings by independent actuaries


A key pilot program in the federal health law saved Medicare nearly $400 million over two years and is the first alternative-payment model certified to cut costs while improving health-care quality, the Centers for Medicare and Medicaid Services said.


Wall Street Journal




Ketamine's Troubled Past, Promising Future


It is difficult to discuss clinical uses of ketamine without stirring up references to its use as an equine anesthetic or its notoriety as a drug of abuse. One participant in our low dose ketamine clinical trial left me a box of "Special K" as a parting gift.


However, the worst of ketamine's baggage as a therapeutic agent probably comes from its reputation for causing emergence phenomena in adults. Shortly after its FDA approval in 1970, ketamine was noted to occasionally cause severe hallucinations, agitation and delirium in adults; more recent literature has noted that this occurs in approximately 10 - 20% of adults receiving anesthetic doses of ketamine (≥1 mg/kg IV or ≥2 mg/kg IM). This is not to mention the tachycardia, hypertension, and emesis...



MedPage Today


Bill Clinton gave 542 speeches between 2001 and 2013. He made $104.9 million


There's new attention being paid to the speaking fees Bill Clinton commanded since he left office, thanks to questions raised by NBC's Cynthia McFadden in an interview with the former president.


Back in June 2014, the Post did a deep dive into Clinton's speaking fees and reported the following:

Bill Clinton has been paid $104.9 million for 542 speeches around the world between January 2001, when he left the White House, and January 2013, when Hillary stepped down as secretary of state, according to a Washington Post review of the family's federal financial disclosures.



Washington Post



Docs Need Better Training to Treat Opioid Addiction, Congress Told


WASHINGTON -- Physicians need better training in how to manage pain as well as how to treat addiction to opioids, several experts told a congressional committee.


"[We need] to develop better strategies for the management of chronic pain," saidNora Volkow, MD, director of the National Institute on Drug Abuse, in Bethesda, Md., while testifying Friday at a House Energy & Commerce Oversight and Investigations Subcommittee hearing on government efforts to combat the opioid abuse epidemic. "Physicians are forced -- their patients are suffering, they don't know what to do and give an opioid, even though the evidence does not really show us they're effective for chronic pain, but there are not very many alternatives."



MedPage Today


Electronic Health Records: First, Do No Harm?

EHRs are commonly promoted as boosting patient safety, but are we all being fooled? InformationWeek Radio investigates.


One of the top stated goals of the federal Meaningful Use program encouraging adoption of electronic health records (EHR) technology is to improve patient safety. But is there really a cause-and-effect relationship between digitizing health records and reducing medical errors? Poorly implemented health information technology can also introduce new errors, whether from scrambled data or confusing user interfaces, sometimes causing harm to flesh-and-blood patients.


This is the issue we will tackle in our InformationWeek Radio show, Is Digitizing Healthcare Making It Less Safe?, Tuesday, July 1, at 2 p.m. EST. My guest for the show will be Scot M. Silverstein, M.D., a consultant and professor in the Drexel University informatics program who researches the shortcomings of EHR software. He also tracks the literature on EHR risks and offers his interpretations on the Health Care Renewal blog, where he posts as InformaticsMD. Silverstein serves as an expert witness in cases involving malfunctioning EHRs or malpractice cases involving the reliability of evidence recorded in EHR systems.


Information Week

Chronic Pain Follows Adverse Life Events 
But biological stress markers don't show relation to chronic pain risk.


Adverse life events, although not biological stress systems, independently predict the onset of chronic multisite musculoskeletal pain over 6 years of follow-up, new research indicated.


In a cohort of 2,039 subjects involved in the Netherlands Study of Depression and Anxiety who were free from chronic pain at baseline, 11% developed chronic multisite musculoskeletal pain over 2 years, 17% developed it over 4 years, and 21% had chronic multisite musculoskeletal pain by the end of the 6-year follow-up.



MedPage Today


FDA Wants Data to Support Antiseptic Claims


WASHINGTON -- Following up on a promise made last year, the FDA is proposing new rules governing topical healthcare antiseptics that will require manufacturers to submit hard data on their safety and effectiveness.


Under current rules, any product can be marketed as antiseptic if it contains ingredients listed in a 1994 FDA monograph on such products, which included a number of agents generally recognized both as effective in killing pathogens and as safe for topical use. These ranged from various alcohols and iodine tinctures to triclosan and hexylresorcinol.


MedPage Today


edEmergency department opioid prescribing 
Brigham and Women's Hospital, 05/05/15


The Emergency Department (ED) is at the convergence of the opioid epidemic as emergency physicians (EPs) routinely care for patients with adverse effects from opioids, including overdoses and those battling addiction, as well as treating patients that benefit from opioid use. Increasingly, EPs are required to distinguish between patients who are suffering from a condition that warrants opioids to relieve pain, and those who may be attempting to obtain these medications for other purposes, such as abuse or diversion. Overall, opioid pain reliever prescribing in the ED setting has increased over the past decade, but until now, the question of how ED prescribing is contributing to opioid use had not been clearly defined. In new research published online by the Annals of Emergency Medicine, researchers from Brigham and Women's Hospital (BWH) found that the majority of opioid prescriptions in the ED setting had a low pill count and almost exclusively were immediate-release formulations, not the long-acting medications such as methadone, Oxycontin and MS-Contin, which are more strongly associated with overdoes. "Our data show that opioid prescribing in the ED is done with caution and aligned with short-term use goals. The median number of pills per prescription was 15, and only 1.5 percent of prescriptions were for more than 30 pills, suggesting that emergency physicians (EPs) generally follow guideline recommendations to limit opiod prescriptions to only 3-5 days, and avoid long-acting opiods," said Scott G. Weiner, MD, MPH, corresponding author of the study and emergency physician at BWH.





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State Society News



WVSIPP Meeting Set for  Aug 13-16, 2015

The West Virginia Society of Interventional Pain Physicians will hold its annual meeting at the Eden Roc Miami Beach, Miami Beach, FL Aug. 13-16, 2015. For more information, go to www.painconfreg.info     

Save The Date! CASIPP Meeting set for October 2015
The 2015 Annual Meeting of the California chapter of the American Society of Interventional Pain Physicians will be Oct. 16-18, 2015.  The event will take place at the Monterey Plaza Hotel in Monterey, California.  Registration will open early next year.  


NY and NJ Societies to hold Pain Symposium Nov. 5-8

The New York and New Jersey Societies of Interventional Pain Physicians will host a Pain Symposium titled Evolving Pain Therapies on November 5-8, 2015 at the Hyatt Regency, Jersey City, NJ. Click HERE for Schedule and more information.


SAVE the DATE: FSIPP Meeting May 20-22, 2016

The Florida Society of Interventional Pain Physicians will hold its annual meeting in 2016 on May 20-22. The meeting will be held at the Orlando World Center Marriott in Orlando.

Watch FSIPP.org for more details.





Please send your State Society meetings and news to: Holly Long at hlong@asipp.org



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