Important News About ASC Reimbursement Cuts
As ASIPP members, we think you should know about a grave
consequence of draconian cuts of 16.3% for epidurals, 25% for facet
joint injections, 25% for adhesiolysis, and 16% for sacroiliac joint
injections at ambulatory surgery centers starting January 1, 2017.
Many of the ASIPP members are also the owners of surgery
centers or are involved in surgery center practices. Please let us know
if you own a surgery center, or are significantly involved, because this
will affect you financially. Please send your information or
the information of any others you are aware of with ownership in surgery
centers to Savannah Gold at firstname.lastname@example.org. Be sure to include the name of the contact person, name of the surgery center, and any other contact information
We should consider this as a departing gift from the Obama
Administration to interventional pain physicians. However, with a new
Administration now taking office, we have a possibility of reversing
these cuts retroactively and the probability of reinstating the previous
reimbursement or improving the reimbursement for 2018.
ASIPP will be assisting in this endeavor; however, the main
impetus will be from the Society of Interventional Pain Management
Surgery Centers (SIPMS). ASIPP will provide some revenues, as well as
personnel support, but not all the revenues. This has to be raised from
surgery center society members.
Please let us know your interest in pursuing such an action.
Because of the required extensive and prolonged advocacy efforts at the
highest levels of Congress and the Administration, our efforts will
involve raising significant amounts of revenue.
If you are interested in participating in any activity,
please let us know. If you are a surgery center owner, or have
significant interest, please complete the enclosed membership dues form
. and also ASIPP-PAC form
as we do not have a separate PAC for SIPMS.
Please respond as soon as you can.
If you have any questions, please feel free to contact us
National Interventional Pain Management Qualified Clinical Data Registry
Based on the numbers this NIPMQCDR will be beneficial:
- 470,000 providers were penalized for PQRS noncompliance
- 209,000 doctors were hit with meaningful use penalty
- Those who do not meet compliance criteria for PQRS will lose 1.5% and those who do not meet criteria for meaningful use will lose 2% of their Medicare reimbursement
This data is very sobering considering each and every one has their plans to combat negative payments. ASIPP® is helping you to not only avoid the negative payments, but make substantial bonuses in future years with the National IPM Qualified Clinical Data Registry. A few Big Leaguers have gotten bonuses, but the majority of pain physicians were left out. Now is the time to join the Big Leagues with our National IPM-Qualified Clinical Data Registry (NIPM-QCDR).
ASIPP® is well on the way to applying for CMS approval for the NIPM-QCDR in collaboration with ArborMetrix. We have had very healthy sign ups and are on track to gather the required amount of participants' quality data to meet CMS requirements by the end of the year.
To help participants prepare for the coming year, we plan to share many of the proposed measures in early January. If you want to begin collecting your data in your systems based on these preliminary measures, that will help you do so. However, CMS does not confirm measures for new QCDRs until later in the first quarter so we will be able to share final measures then and will begin formal data collection by April 1. We do urge you to begin the process of enrollment now, while ASIPP® completes the approval process with CMS.
If you are interested in signing up for the National IPM QCDR, you can send an email to ASIPPQCDR@arbormetrix.com. We will then send you registration forms to complete. There is no commitment or cost to you until we are approved for the QCDR for 2017 reporting.
If you have already signed up, please pass along this information to anyone else who could benefit from this opportunity.
As you are well aware, CMS has issued the final rule on its value-based care entitled, "Merit-Based Incentive Payment System Combining Quality Measures, Meaningful Use or Advancing Care Information, Clinical Improvement Activities and Costs." Because of our efforts, CMS has made substantial changes to enable us to avoid penalties. The QCDR reporting mechanism and specifically the NIPM-QCDR will complete the collection and submission of MIPS requirements.
This unique registry developed only for interventional pain physicians by ASIPP® will:
- Offer as many as 30 new non-MIPS QCDR measures specially designed by ASIPP® for interventional pain management in addition
- Manage submission of both MIPS and non-MIPS QCDR measures
- Support both individual physicians and physician group practices in meeting MIPS requirements.
- Provide documentation and assistance with compiling the needed data for quality improvement
- Provide easily accessible reports and performance updates to registry participants on an ongoing basis as new data is available from your practice
- Allow physicians to review and select measures to report prior to submission
If you have any further questions, we can arrange for you to talk to one of the representatives from ArborMetrix with whose collaboration we are preparing the registry, or you can also attend one of the webinars we will be starting soon.
Please send an email to ASIPPQCDR@arbormetrix.com to sign up for QCDR participation.
ASIPP has submitted the application for a national QCDR and also interventional pain management 18 specific outcomes assessments.
Group Purchasing Organization – Join
ASIPP has formed a partnership with Henry Schein and PedsPal, a
national GPO that has a successful history of negotiating better prices on
medical supplies and creating value added services for the independent
physician. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you
experience today. While the cost of contrast media has skyrocketed due to the
single dose vial issue, because we have partnered with Henry Schein, this could
enable you to purchase Omnipaque 240mg/50 ml for slightly above
It will be easy for ASIPP members in good standing to enroll today and begin to realize the
savings this partnership can bring. Members can join or see sample prices by
going to http://pedspal.org/asipp/default.html
Click on “view our discounted supplier prices” ( Username:ASIPPmember and Password: Save
) or click on the words "join for free now" and begin saving today!
CMS Publishes Final Rule for Hospital Outpatient Department and ASC Final
As you see below, the news is not good for interventional pain
management. Overall both ASCs and hospital outpatient departments are facing
significant cuts as high as 11.5% for most commonly performed interventional
techniques compared to the proposed rule and 2017 payment rates.
Most importantly it is disheartening to see that they plan to
reimburse same amount for surgery centers or HOPDs for epidural injections with
or without imaging guidance. There is a significant difference between hospital
rates. Hospitals are reimbursed more than 85% higher than ASCs. Please click here
to see analysis of interventional pain management for
ASCs. Please click here
for HOPD. To see the entire group please click here
GREAT NEWS! ASIPP SCORES A MAJOR VICTORY AND CONCESSIONS FOR MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) WITH 90-DAY REPORTING
The Medicare Access and CHIP Reauthorization Act (MACRA) /Merit-based Incentive Payment System (MIPS) final rule
has been released unexpectedly this morning.
Now we can call it meaningful changes instead of meaningless use.
The Centers for Medicare and Medicaid
Services (CMS) has made substantial changes. We are extremely pleased
that they have accepted at least part of our recommendation in reference
to a 90-day period reporting rather than full year.
However, the 90-day period was ASIPP's idea. It really helped us to go to Washington and advocate for our positions.
Here is the summary of MIPS as we read it. We are very optimistic, but again, we are cautiously optimistic.
More good news is in the works for interventional pain physicians on MIPS registries, etc. We will keep you posted.
CMS will create a 90-day reporting
period for clinicians reporting in MIPS, the final rule states. The
agency is reducing the number of measures to be reported from 11 to
five. Providers will have the option of reporting all the dropped
Reporting to public health or clinical
data registries will result in a bonus. CMS is also exploring whether to
count managing referrals and consults as part of the MIPS reporting.
The final rule also outlines CMS's
"pick-your-pace" route to MIPS reporting. Given the wide diversity of
clinical practices, the initial development period of the Quality
Payment Program implementation would allow physicians to pick their pace
of participation for the first performance period that begins January
(1) Clinicians can choose to report to
MIPS for a full 90-day period or, ideally, the full year, and maximize
the MIPS eligible clinician's chances to qualify for a positive
adjustment. In addition, MIPS eligible clinicians who are exceptional
performers in MIPS, as shown by the practice information that they
submit, are eligible for an additional positive adjustment for each year
of the first 6 years of the program.
(2) Clinicians can choose to report to
MIPS for a period of time less than the full year performance period
2017 but for a full 90-day period at a minimum and report more than one
quality measure, more than one improvement activity, or more than the
required measures in the advancing care information performance category
in order to avoid a negative MIPS payment adjustment and to possibly
receive a positive MIPS payment adjustment.
(3) Clinicians can choose to report one
measure in the quality performance category; one activity in the
improvement activities performance category; or report the required
measures of the advancing care information performance category and
avoid a negative MIPS payment adjustment. Alternatively, if MIPS
eligible clinicians choose to not report even one measure or activity,
they will receive the full negative 4 percent adjustment.
(4) MIPS eligible clinicians can participate in Advanced Alternative Payment Models ( APMs), and if they receive a sufficient
portion of their Medicare payments or see a sufficient portion of their
Medicare patients through the Advanced APM, they will qualify for a 5
percent bonus incentive payment in 2019.
(5) Other provisions:
- Financial and technical assistance (100 million) to small and rural practices
- Teases that more advanced APMs will be available by January 2017
- Finalizes most of the APM portions of the proposed rule
- New estimate is 200 million distributed under MIPS, down from 833 million
ASIPP Has Great Legislative Session in Washington, DC
Approximately 50 members of ASIPP attended a great
legislative session in Washington, DC. Members and staff had great visits with many
senators and members of the House, including multiple committee chairs.
It appears that we are making substantial progress in making changes
for MIPS. Following is the proposed language for MIPS. We also have
other language for Medicare Advantage Plans. MIPS language is as
- Delay the implementation of merit-based incentive payment
system (MIPS) by one-year, to January 1, 2018, reporting year,
retaining 2019 as penalty/bonus year (performance year), and change
participation of MIPS for 3 months per year, with 2017 serving as a
training year to meet criteria for meaningful use, physician quality
reporting system, and value-based payment.
CMS and Medicare to provide appropriate local coverage determinations
(LCDs), based on the integrity manual, utilizing proper evidence.
- LCDs must be issued in addition to validated
wide-spread problem identified for potentially high dollar or high
volume services and requested by providers for coverage issues to be
added, to assure beneficiary access to care, or when frequent denials
are issued or anticipated.
- LCDs must be prepared with input from specific
specialty Carrier Advisory Committee (CAC) membership and other CAC
- Noncoverage policies must be only issued by CMS with
appropriate review process and evidence synthesis with public comment
for procedures usually performed with available evidence.
- Medicare Advantage Plans must offer a "benefit
package" that is at least equal to Medicare's and coverage everything
Medicare covers, with or without LCDs.
At the same time ASIPP was in the halls of the Congress, CMS
announced that they will be providing multiple options for
implementation of MIPS including an option of delay; however, this does
not include all our issues. Consequently, we continue to fight on this
Here are links to the statement from CMS and the Congressional letter:
Another Big Development:
CMS has issued its revised decision on coverage of Percutaneous Image-guided Lumbar Decompression (PILD) procedure
which does not remove all the restrictions; however, it expands the
coverage. They are asking to perform another cohort CMS approved study.
This is some progress, success, and good news, but not the greatest
news in the world. Obviously the struggle continues for coverage of
(left) Dr. Manchikanti presents the Lifetime
Achievement Award to Ed Whitfield in his last hours of congressional
membership in a heartfelt and almost tearful setting. (right) ASIPP hosted a fundraiser for New Jersey Chairman Rodney Frelinghuysen.
ASIPP Announces Patient Education Program
The American Society of Interventional Pain Physicians (ASIPP), a not-for-profit national organization representing interventional pain physicians, and Medical Media, Inc., dedicated to medical marketing, announced today they have entered into a collaborati on agreement to form Interventional Pain Management Network, a new patient education program. Dr. Laxmaiah Manchikanti, ASIPP Chairman of the Board, said,
“Interventional Pain Management Network consists of interactive videos for waiting rooms as an innovative way to provide awareness and understanding of evidence-based and clinically relevant information to the
patient at a time when the patient is in need and receptive to health issues.
Read complete media release >>>
Final Voyage of FDA and MPW Epidural Saga: Victory for Practicing Interventional Pain Physicians
The FDA has now determined that they will not amend the drug safety communication; however, they will not adopt the 17 recommendations made by the MPW (See Letter). This ruling by the FDA is a major victory for practicing interventional pain physicians that avoids micromanagement (FDA citizen’s petition) and the additional bureaucracy created by the MPW. The FDA also published an article in the New England Journal of Medicine which essentially alludes to the same facts as described, and in no uncertain terms, they emphasize the fact that they are not withdrawing the issued warning, but they also were not endorsing the standards from MPW, even though they facilitated the discussion.
Consequently, the epidural saga continues even though this may be the final chapter.
Who is your IPM CAC Representative?
In March 2005, the Centers for Medicare and Medicaid mandated that Interventional Pain Management become the 34th medical specialty represented on state Carrier Advisory Committees (CAC), which make local decisions about Medicare coverage. It spite of the great efforts it took to secure this position, many states are still without representation.
It is critical that IPM have representation in every state. Do you know who your representative is? More Information on CACs.
Change Your Specialty Designation
Use the CMS Form to Change your Specialty Designation to 09 - Interventional Pain Management
We are faced with the need to increase our 09 Interventional Pain Management specialty designation. Currently CMS claims there are too few IPM physicians, which negatively affects our reimbursement. Interventional Pain Physicians can now change their specialty code designation to 09 utilizing the CMS form CMS855I - see page 8, section D.
Find Your Elected Officials
Stay on top of the issues affecting interventional pain management, know your elected and appointed officials and contact the media in your area. You can make a difference by getting involved! Find out who represents you on Capitol Hill, go to Capwiz: http://www.asipp.org/Alert.htm
ASIPP Launches ASIPP®/PainPhysician Job Board
The ASIPP/Pain Physician Job Board is where talented and qualified interventional pain management physicians connect with great organizations and some of the best jobs available.
Candidates can browse current vacancies, post an anonymous resume and create new job alerts. Employers can post a job or browse the resume bank to find the right candidate.
Click here to access the Job Board...
ASIPP Marketing Services has produced a series of informative and illustrative brochures and are making them
available to you.
View the brochures before ordering.
brochures include descriptions of pain conditions
and procedures, along with accompanying illustrations. The
brochures are designed specifically for the
interventional pain physician. They can be used to communicate with
patients and referral sources in personal settings or via direct mail.
The brochures are supplied in a pdf format. All you
have to do is have your printer place your logo and practice information
in the designated area. It is a quick and easy way to have the
brochures you need in develop patient and referral relations.