Promoting changes in laws, regulations, and other government actions to advance the mission of ASIPP®.
In its relatively short history, ASIPP has accumulated an impressive list of major achievements from its work in our nation’s capital and 50 states. These achievements have fostered patient access to pain-relieving techniques and services, while strengthening the specialty of interventional pain management.
CMS Publishes 2023 Physician Fee Schedule
It is over! Last night (July 7), CMS published the 2023 Physician Fee Schedule. As suspected, the conversion factor is going down. It will be reduced from $34.61 to $33.08, a decrease of $1.53. This will be added to the 2% sequester cut from ACA and 4%statutory PAYGO from the American Rescue Plan Act. Unless Congress acts, the total expected cuts are 9% from 2022, and 9.75% form 2021, starting January 2023.
We encourage every ASIPP member to join us in the effort to contact every member of Congress. You can start by contacting the senators and representative of your district. It is essential that we act soon and participate in meetings with members of our Congress, as well as starting a letter campaign involving physicians, providers, nurses, staff and most importantly, the patients.
COVID-19 Pandemic, Current Medicare Payment System, Impending Cuts of 9%, and Fraud and Abuse Investigations: A Perfect Storm is Brewing
ASIPP is deeply concerned about multiple issues facing interventional pain physicians. Please see the enclosed fact sheet (FACT SHEET) and sample letters (SAMPLE PHYSICIAN LETTER) (SAMPLE PATIENT LETTER).
In January 2023, physician practices face the following Medicare financial hits:
● Potential 9% cuts in physician payments, 6% cut in facility payments, extensive fraud and abuse investigations with refund requests and increasing work related to documentation for Merit-Based Incentive Payment System (MIPS).
To avert these disasters, we want to start this campaign as early as possible as the fee schedule publication season is coming. Initially, we would like for you to prepare your own letters explaining the issues at a personal level and write to all your members of the Congress and Senate, which is only 3 letters. Everyone in interventional practice should do that. Following this, we can get patients involved. We will open a website to sign on to this in an easy manner. It is crucial that you personally reach out to everyone in the next 2 weeks or so before we proceed with a massive campaign.
On behalf of the membership, ASIPP is proposing the following to reverse these trends:
1. Adding a 3.75% increase and making it permanent instead of the 3% from last year in the Medicare physician fee schedule (PFS) conversion factor to avoid payment cuts associated with budget neutrality adjustment tied to PFS policy changes.
2. Elimination of the 2% sequester completely without budget gimmicks and extending potentially through 2050. This policy was scheduled to sunset in 2021. Consequently, it is high time for the policy to be removed without gimmicks.
3. Wave the 4% statutory PAYGO sequester permanently. This sequester was a result of the passage of the American Rescue Plan Act. Further, Congress should enact legislation so that Medicare will never be included so that elderly and providers will never be punished for government spending activities.
4. Remove facility cuts by eliminating the 4% statutory PAYGO sequester resulting from passage of the Budget Control Act of 2011 and under the American Rescue Plan Act of 2021 and eliminating the 2% cut from sequester, which was set to sunset in 2021.
5. Provide financial stability.
It is crucial that Congress provide financial stability to providers with or without systematic reform to Medicare so that the system works better for patients and providers through a baseline positive annual update reflecting inflation and practice costs. Furthermore, Congress should eliminate, replace, or revise budget-neutrality requirements to allow for appropriate changes in spending growth.
It is hard for any person to understand why providers are the only ones being affected when all other sectors of Medicare continue to increase several-fold compared to physician payments.
6. Reform fraud and abuse investigations policies.
At present, the Office of Inspector General (OIG) and multiple private contractors have their own policies of investigation with any regard for established local coverage determinations (LCDs) and medical policies.
· These audits and investigations, specifically from private contractors, are also defying precertification rules and regulations and demanding refunds on each and every patient even though a precertification has been obtained.
· The demands of these investigations are costing physicians hundreds of thousands of dollars financially and creating unnecessary mental stress. These also increase future costs by increasing provider time and require the investment of substantial resources just to meet everchanging computerized program criteria developed by the same people who developed electronic medical records (EMRs) and established these EMRs for so-called rapid documentation, which is now considered to be copying/pasting, cloning, cloned verbatim, pre-populated, highly redundant, and auto filled, beyond obligations from MIPS, LCDs and medical policies.
It is essential that we act soon and participate in meetings with members of our Congress, as well as starting a letter campaign involving physicians, providers, nurses, staff and most importantly, the patients.
ASIPP, IPM, and Patient Response to the Proposed CDC Guidelines
The 2016 CDC opioid guidelines were aimed at primary care providers, but many state boards mandated them by law, resulting in tremendous needless suffering and exacerbating the illicit opioid epidemic with causation of needless deaths. These guidelines not only restrict opioid prescriptions, but also have restricted almost all interventional techniques to reduce access and sending patients to the streets for illicit opioids. With the new guidelines, these unintended consequences, including overdoses, deaths, and access limitations will continue.
The guidelines should call for a multidisciplinary approach to chronic pain that includes multiple modalities incorporating the role of interventional pain management for diagnosis and treatment.
1. Interventional pain management techniques are safe, and have extensive clinical and cost-effectiveness data.
2. With extended mandate and mission creep, the CDC guidelines are becoming mandatory for standard of care even though they have not reviewed appropriately all other therapies.
3. A transparent assessment without inclusion of conflicted studies, but with real-world evidence, which have a dominant role in the preparation of these guidelines, will show the appropriate real-world evidence for interventional techniques including epidural and facet joint interventions, spinal cord stimulation, intrathecal infusion systems, interspinous prosthesis, and multiple other techniques will show an abundance of evidence.
The CDC must strongly advocate for multidisciplinary care, personalized for each individual patient. This includes behavioral therapy, restorative therapy, complementary medicine pharmacologic therapies, and Interventional Pain Management (IPM) strategies.
Please contact Congress requesting that they ask the CDC to adopt the 2019 HHS Best Practices report, specifically Section 2.4 dealing with IPM.
ASIPP has submitted the following ASIPP/SIPMS Comment Letter to the CDC and we encourage you to submit your own letter as well. You can send your letter by the April 11 by customizing this letter or creating your own.
You may also send a letter to your senators and representative or through Voter Voice by using the following link: https://www.votervoice.net/ASIPP/campaigns/93501/respond
For more information read the article Fourth Wave of Opioid (Illicit Drug) Overdose Deaths and Diminishing Access to Prescription Opioids and Interventional Techniques: Cause and Effect and Context and Background of CDC Proposed Guidelines Issues
Merry Christmas and Good News from Congress Reducing the Payment Cuts from 9.75% to 2.5%!
ASIPP has advocated on three (3) policies. Last night the House of Representatives passed the legislation which included most of the aspects of what we have been working for this year to prevent the cuts. The Senate is expected to pass this soon.
1. Waive PAYGO – Providers would be subject to a 4% payment reduction if Congress did not waive the PAYGO requirements in the end of year package.
Great news! The last night the House passed a year-end package with this provision removed in its entirety.
2. Congressman Ami Bera (D-CA) and Congressman Larry Bucshon (R-IN) introduced legislation to extend the 3.75% Medicare payment increase, rather than decrease for physicians. This is in response to the CMS conversion factor that needed to be addressed.
Good News! Last night this was passed by Congress to avoid the cut and instead provide a 3% increase. This leaves still a cut of 0.75%.
3. Finally, the extension of the moratorium on Medicare Sequestration cuts of 2%.
Bad News! Last night The House passed to extend the reprieve from 2% cut of sequestration through March 31, 2022; however, after this date, the cuts resume. Further, this may have significant consequences later on. We will have to work on it next year. For now, we are faced with 2% cut from April 1, 2022, rather than January 1, 2022.
Overall, this is good news. Instead of a total 9.75% cut, we will be facing, approximately, a 2.5% cut.
ASIPP and SIPMS thanks all the members of the Congress from both aisles, the Administration, Board of Directors, the entire membership, and all those who supported the measures.
CALL TO ACTION!
September 28, 2021
Extension of Telephone Only Services and Elimination of Impending Cuts to Providers – Please Act Now!
In January 2022, physician practices face the following Medicare financial hits:
1. Physician Payment Cuts
• The expiration of the congressionally enacted 3.75% temporary increase to the Medicare physician fee schedule conversion factor, which was set into place to avoid payment cuts associated with budget neutrality adjustment tied to PFS policy changes.
• The expiration of the current reprieve from the repeatedly extended 2% sequester stemming from the Budget Control Act of 2011. It appears that while Congress originally scheduled this policy to sunset in 2021, it will now continue into 2030.
• The Imposition of a 4% statutory PAYGO sequester resulting from passage of the American Rescue Plan Act, presumably extending for at least another 10 years.
2. Facility Payment Cuts
• Under the present status, it appears that ambulatory surgery centers and other facilities will be suffering with 2% cut from sequester extension and a 4% reduction with imposition of a 4% statutory PAYGO sequester resulting from passage of the Budget Control Act of 2011
3. Telephone Only Services
• CMS has eliminated coverage for telephone only services (CPT 99441-99443), effective December 20, 2021.
All the financial uncertainty comes at a time when physician practices and facilities are still suffering from the financial impact of the COVID-19 public health emergency, including continued infection control protocols, that while necessary, have increased costs of provider care. In addition to this, the Delta insurgence has created numerous new problems with a reduced patient load and increased practice costs. We continue to face 20% to 25% reductions in patient revenue, while costs have escalated by 20% to 25%, with a net result of 40% reductions. No practice can sustain this. This will stretch physician practices to their limits finically, clinically, and emotionally. The reality is, as the pandemic persists and continues, it is unknown what other variants will continue attacking us. Overall, Medicare physician payments actually declined 22% from 2001 to 2020, or by 1.3% per year on average.
Please act now by contacting Members of Congress asking them to act! We need all our members, their staff, and patients to send a letter to the Members of Congress through VoterVoice. If you prefer to send your letter my mail, here is the link to the sample letter. Physician and Staff Sample Letter for customizing and mailing.
For patient letters:
• Click on the link to the Word version of the Patient Letter
• Print it off daily changing the date and ask your patients to sign it as they check in.
• Each day, assign a member of your staff to enter the patient letters using the VoterVoice link for Patient Letters
See ASIPP Letter to Speaker Pelosi Majority Leader Schumer Leader McConnell and Leader McCarthy
Link to submit patient letters through VoterVoice: https://www.votervoice.net/ASIPP/campaigns/88591/respond
Link to submit physicians and staff letters through VoterVoice: https://www.votervoice.net/ASIPP/campaigns/88596/respond
ASIPP VOTER VOICE
August 30, 2021
A proposed LCD on Epidural Procedures for Pain Management services was announced on June 10, 2021. This nationwide policy contains many onerous changes that will detrimentally affect patient access to care. ASIPP has written comment letters with detailed explanations of the issues and needed changes to each Medicare Contractor. Click to read more.
Sample Letters Proposed LCDs on Epidural Procedures for Pain Management for Physicians, Staff, and Patients:
At no other time in the history of the American Society of Interventional Pain Physicians has it been more important to get involved in advocacy efforts. We are finally seeing the potential for change. After struggli..
A Delegation of ASIPP representatives met with Congressional leaders to discuss issues which are of concern for Interventional Pain Physicians. ASIPP members discussed ‘Inappropriate Reimbursement Patterns of Medicar..
Through the American Society of Interventional Pain Physicians-PAC, the organization is able to offer significant presence and influence in Washington. ASIPP members who wish to contribute, can click this link to log into our PAC Action Center to make a donation.