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Discussing Migraine With Your Patients

MACRA rule expands exemptions and provides more flexibility for physicians

The Florida Academy of Pain Medicine has researched recent actions of the Centers for Medicare and Medicaid Services including the MACRA rules and MIPS program. See here, and here and registration here "Medicare Speaks 2016" which offers sessions in Tallahassee on November 2-3, 2016. FAPM will continue to keep our members updated on important issues affecting the practice of pain medicine.  

The MACRA Final Rule:
Eight Things Physicians Need to Know

PRESIDENT'S MESSAGE
OCTOBER, 2016 

The Florida Academy of Pain Medicine’s Annual Scientific Meeting this year provided attendees with excellent national and international speakers, three distinct pre-conference workshops, great social events, and a first class hotel venue. We thank all of those who attended this conference, and we hope you will plan to join us again next year. 

I want to remind any members who have not paid their 2016 dues that our fiscal year ends on December 31, 2016, so please send your check in or pay online with your credit card. Within the scope of the Florida Medical Association, the FAPM is one of the smaller specialty affiliates. Dues collection provides only 25% of our budget, yet we maintain an office and staff to serve our members. However, without our members financial support we could not meet our budget needs nor could we provide the services for our members or present our annual conference. I ask every pain medicine physician in Florida to become a member of the society that best represents your interests and that is the Florida Academy of Pain Medicine! 

Our Education Committee is already in the planning stages for our annual scientific meeting to be held on June 16-18, 2017, at the Hyatt Regency Grand Cypress Hotel where we can best meet the interests of our members, exhibitors and sponsors as we did for several previous years. Mark the dates on your calendar and plan to join your pain medicine colleagues at this beautiful hotel in the heart of Disney World. Bring your family members so they can enjoy all of the amenities of this hotel as well as the many attractions in the Orlando area. 

If we can be of any service to you as a member, please do not hesitate to call our office at 727-581-4319. 

Sincerely, 

Vinny Malik, MD, President 

Turn the Tide:
The Fight to End the Opioid Crisis

 Pre-Conference Workshops Provide Special Certification Recognition

Attendees registering for the Florida Academy of Pain Medicine pre-conference workshops will receive a certificate depicting their special training received in these programs. Specialist certificates will be presented for Musculoskeletal Ultrasound and International Pain Therapies, Interdisciplinary Approaches to Pain Medicine, and Physical Medicine and Rehabilitation Treatments and Therapies. (Complete Program)

The "Musculoskeletal Ultrasound and Interventional Pain Therapies" will include ultrasonography of the shoulder, knee and hips as a correlation of physical findings and clinical anatomy. The Interventional Spine Procedures will teach the use of innovative techniques such as facet joint injections, nerve blocks, neuroaugumentation, spinal fusion and implantable drug delivery systems.

The "Interdisciplinary Approach to Pain Medicine Workshop" features nationally known speakers on pain medicine issues on such topics as: pain, stress, mood, cognitive and memory holographic pain treatments, low level inflammation and fascia stimulation and sensitization, opioid crisis concerns, medical laser applications and much more.

The third workshop deals with PM&R treatments and therapies. Featured topics include updates on subacute rehabilitation, medical marijuana update, intrathecal therapies, treatment and management of spinal stenosis, and multimodal approaches to the treatment of low back pain.

Each workshop offers 8 CME hours.

AAPM's 33rd Annual Meeting
March 16-19, 2017 (Preconference Sessions: March 15-16, 2017)
Loews Sapphire Falls Resort
Orlando, Florida

FAPM Board Reviews
CDC Guidelines for
Prescribing Opioids for Chronic Pain 

The FAPM Executive Board met recently to discuss the CDC Guidelines for Prescribing Opioids for Chronic Pain. It was noted that the original draft by CDC was not altered, in spite of over 4,000 testimonies from societies, corporations and individuals.

However, the board recognizes the challenges involved with prescribing opioids for chronic pain, and the necessity for safety precautions and effectiveness when providing pain treatments.

Therefore, we support the efforts and concerns expressed by the American Academy of Pain Medicine in the following letter: (MORE)

Drug industry on edge for Obama action on prices
Peter Sullivan –The Hill
 The pharmaceutical industry is anxiously awaiting a series of regulatory actions from the Obama administration aimed at combating high drug prices. 

Drug prices have been a major issue on the campaign trail, with Hillary Clinton, Bernie Sanders and Donald Trump pounding pharmaceutical companies.

Martin Shkreli, the ex-pharmaceutical company CEO who made headlines for hiking the price of a life-saving drug by 5,000 percent, also has put the issue of drug prices in the spotlight.

Spending on drugs in 2014 grew by a sharp 13 percent, the most in a decade. The spike was driven partly by new high-cost drugs for Hepatitis C, but it seemed to point to a larger issue.

A Kaiser Family Foundation poll in August found that 24 percent of the public had not filled a prescription in the past year because of cost. (More)

President’s Message:
February, 2016

 I am often asked the question, “What is the mission or purpose of the Florida Academy of Pain Medicine?” My answer is simple, We are a unique medical specialty society that represents physicians practicing in the field of pain medicine. As such, we are involved with education training, as provided at our annual conference, legislative issues affecting the practice of medicine in Florida, and research of medical issues confronting our members. (More)                         

IMPORTANT NOTICE !!!!
FAPM  annual membership renewal notices have been mailed to our membership list. This year the renewal can be paid online. The renewal fiscal year is January 1-December 31, 2016.
Thanks to each of you for your continued support of the Florida Academy of Pain Medicine.

    December 14, 2015 

Dear FAPM Members and Friends: 

At this busy season of the year, I wanted to take a moment to wish everyone a Happy Holiday Season and a wonderful New Year. As we are all involved in the medical profession, may each of us enter the New Year with renewed confidence in our abilities to treat our patients with the best possible care. 

As we face the issues confronting our medical professions, be assured that your FAPM Board Members will continue to address your concerns and interests in dealing with legislative matters, practice management issues, and medical education programs. 

Our “Executive Committee” is planning an excellent program for the annual FAPM Scientific Meeting to be held on August 12-14, 2016, at the beautiful Waldorf Astoria Hotel in Orlando. I hope you all are planning to attend this event. 

Let us all be proud of the profession we serve and strive for excellence in all that we do for our profession, patients and community. 

Fraternally yours,

Vinod Malik, DO

FAPM President

SENATE COMMITTEE TO TACKLE PATIENTS' PAIN MED PROBLEMS

THE CAPITAL: TALLAHASSEE, October 20, 2015 ...... The Legislature may have inadvertently made it harder for legitimate patients to get critical pain medications when it passed a 2011 law aimed at shutting down rogue clinics that branded the state as the “pill mill capital" of the country. But now, a powerful state senator said he intends to fix the problem. (Read More)

Pain Management Physicians If you are a physician practicing in a Pain Management Clinic and were registered based on the 6th qualification option in Rule 64B8-9.0131, F.A.C ., please keep in mind that as a part of your 40 hours of Continuing Medical Education (CME) required per biennium, you must complete 15 hours of live lecture format, Category I CME in pain management for every year you practice in pain management. These will need to be reported to CE Broker along with the rest of your CME credits in order for the Board to renew your license. Answers to many questions regarding license renewal can be found at the Board of Medicine's website at flboardofmedicine.gov 

Congratulations to
Dr. Felix Linetsky

Tweet Dr. Felix Linetsky, FAPM Board Member and nationally recognized medical education leader, has written a chapter in the Second Edition of Pain Medicine and Management – Just the Facts Textbook published by McGraw Hill. Chapter 71 – Regenerative Injection Therapy (aka – Prolotherapy was co-authored by Peter Peter Staats and Mark Wallace, MD. This book can be purchased from Amazon for the amount of $80.90.

FAPM Represented at Florida Board of Pharmacy's
Controlled Substances Meeting (see below) 

The Florida Board of Pharmacy’s Controlled Substances Standards Committee recently met at Delray Beach, Florida, to discuss issues regarding the availability of certain medications for patients. They have been receiving numerous complaints from patients and physicians across the state regarding this issue. 

Jeffrey Zipper, MD, the Immediate Past President of the Florida Academy of Pain Medicine, attended this meeting representing the Academy. He noted that those attendees at this meeting made several recommendations for the board to consider. The board will review these matters and report back to the committee at the next meeting. 

FAPM will continue to monitor the activities of the Florida Board of Pharmacy, and report any new developments to the members.

Featured speakers included Alan Harmon, MD, President of the Florida Medical Association and Judy Foreman, author of the bestselling book, “A Nation in Pain". The panel discussions held on the second day featured specialists in various disciplines, a representative on E-FORCE and PDMP issues, and legal and legislative programs. Panel moderators were: Albert Ray, MD, FAPM Past-President, and Jeffrey Zipper, MD, current FAPM President.

Highlights of the annual membership luncheon included FAPM awards. Marla Golden, DO, received the Felix Linetsky, MD, Education Award for her leadership and participation in FAPM educational programs the past few years. The Distinguished Service Award was presented to Jeffrey Zipper, MD, for his leadership in legislative issues affecting the practice of medicine in Florida. Lynne Columbus, DO, from Clearwater, Florida was elected to the FAPM Board of Directors.

Patient Op-Ed: Denying necessary prescriptions to needy patients 

The Florida Academy of Pain Medicine is working diligently to bring attention to our legislature, patients and citizens regarding the problems patients are having getting drug prescriptions filled. The following article was printed in the Tampa Bay Times in support of our concerns over this process of denying necessary prescriptions to needy patients. Please feel free to share this article with you patients, colleagues and staff. We will continue our efforts to help patients across the state to be able to have their physician prescribed drug requests filled. Should you have any similar cases to report of patients not getting their prescribed drugs in a timely manner, please let us know. Together we can help alieviate this problem. (Read OpEd)

Fraternally, Jeffrey Zipper, FAPM President 

ALERT ALERT

Dear Colleagues, 

            The FAPM has hired a public relations firm to help bring media attention to issues of importance and concern to us and our patients. We are presently working on a project to help our patients gain better access to their needed medications from Pharmacies. To that end, if you have any patients experiencing difficulty with getting their prescriptions filled for CS’s please contact Mr. Brian Burgess from Meteoric Media Strategies ASAP at 850-273-2270 or email to brianjburgess@gmail.com. Thank you! 

Regards,
Jeffrey A. Zipper, M.D.
President

Peripheral nerve blocks -- revision to the Part B LCD
LCD ID number: L29258 (Florida)
LCD ID number: L29466 (Puerto Rico/U.S. Virgin Islands)

The local coverage determination (LCD) for peripheral nerve blocks was most recently revised January 1, 2013. Since that time, major revisions were made throughout the entire LCD. The ‘Indications and Limitations of Coverage and/or Medical Necessity’ section of the LCD has been revised to clarify indications versus limitations of coverage. In addition, the ‘CPT®/HCPCS Codes’, ‘ICD-9 Codes that Support Medical Necessity’, ‘Documentation Requirements’, ‘Utilization Guidelines’ and ‘Sources of Information and Basis for Decision’ sections of the LCD were revised.
Effective date
This LCD revision is effective for services rendered on or after March 17, 2014. First Coast Services Options Inc. LCDs are available through the CMS Medicare coverage database at http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx .

Coding guidelines for an LCD (when present) may be found by selecting “LCD Attachments” in the Jump to Section…” drop-down menu at the top of the LCD page.

Note: To review active, future, and retired LCD for jurisdiction 9, please click here

FAPM has a “Neutral” Position on Medical Marijuana Amendment:
Florida is facing a pain medicine crisis, and lawmakers must find a way to deliver pain medicine to legitimate patients while still blocking these controlled substances from those who abuse them. No matter how Floridians vote on medical marijuana amendment this November, the real burden must be on lawmakers to overhaul our pain medicine regulations so that patients with legitimate health issues can get the medications they need to have a high quality of life. They deserve to have this access legally and without undue excessive burden.

Congress Reaches Deal on SGR Repeal

Today, February 6, 2014, Congress reached a bipartisan, bicameral agreement on a bill that would repeal the Medicare Sustainable Growth Rate (SGR) and replace it with a pay-for-performance system that would evaluate and incentivize quality health care. All 3 congressional committees of jurisdiction—the Senate Finance Committee, the House Ways and Means Committee, and the House Energy and Commerce Committee—have agreed on 1 piece of legislation that will now move through the legislative process as a consensus bill.

Specifically, the legislation would:

• Repeal the SGR immediately
• Provide positive annual payment updates of 0.5% for 5 years
• Install a Merit-Based Incentive Payment System (MIPS), which would include prospectively set performance thresholds and offer flexibility in the imposition of performance requirements that are inappropriate for some specialties
• Delay the effective date of the MIPS program 1 year, from 2017 to 2018
• Increase the MIPS funding pool and adjust the phase-in of penalty risks for those who fall in the lowest performance quartile to be capped at a maximum of 9% (as opposed to the previous 12%)
• Sustain a 5% incentive payment for physicians participating in alternative payment models
• Double original funding for technical assistance to small practices of 15 or fewer professionals
• Recognize the development of functional status quality measures as a priority

Many of the provisions of the bill are improvements from previous proposals and current law. AAPM&R advocated strongly to incorporate items that would be beneficial in highlighting the care that physiatrists provide. However, because this legislation is not budget neutral, legislators will now spend several weeks considering budget-cutting options to offset the cost of the repeal. Some options have been leaked, including cuts to postacute care and changes to the in-office ancillary services exceptions to the physician self-referral law (Stark law). 

Your Academy is advocating tirelessly to ensure that the SGR repeal is not achieved on the backs of our physician members. Stay tuned for additional information in the coming weeks. 

 Regards,
Jeffrey A. Zipper, M.D.
FAPM President

ALERT, ALERT, ALERT 

Medicare will deny claims for referring physicians who are not enrolled in PECOS as of January 6, 2014. Physicians must be enrolled to prescribe durable medical equipment. For more information, refer to their website at https:llcms.hhs.gov/. (at the time of this post, this website is down).

Some of our vendors are concerned that prescribing physicians who are not enrolled will not be able to prescribe the durable medical equipment that you have prescribed in the past.  

ALERT ALERT

Dear Colleagues,           

            FSCO the Medicare administrate contractor for jurisdiction J 9 has retracted its previous article titled “Ultrasound Guidance for Needle Placement in the Office Setting”. This retraction was based upon input from your specialty society CAC representatives. Although this article has been retracted there are still some limitations on these services (please see attachment). Please also note, that in the 2014 proposed rule for Revisions to Payment Policies under the Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) proposes a reduction in the relative value units (RVUs) based on equipment inputs and procedure time assumptions for Current Procedural Terminology (CPT®) code 76942. 
Regards,
Jeffrey Zipper
President FAPM
Chief Executive Officer 

ALERT ALERT
FY 2014 Medicare OBS Reimbursement Rates for SCS Trials

September President's Message

Dear Colleagues,
            I hope everyone has enjoyed their summer and all are ready to get back into the swing of things. I would like to start off by thanking Dr Albert Ray our immediate past president for his leadership and tireless efforts in serving our organization over the past two years; as well as, Dr. Felix Linetsky, Dr Kenneth Webster and the entire FAPM board of directors for putting on an excellent educational program at this year’s annual scientific conference. If you were unable to attend this year’s conference you certainly missed out and I hope to see you at the conference next year. In fact, place it on your calendar today! (June 20-22, 2014). The Florida Academy of Pain Medicine largely exists to advocate for and to protect the rights of the chronic pain patients and the physician community that serves them within the State. Your membership in this organization is of paramount importance and without your support we would not have a voice in Tallahassee. I personally value your membership in the Academy and believe that together we are making a difference in your practice and patients’ lives. I hope each of you will see fit to renew your membership this year. If you know of a colleague that is not presently a member of FAPM, please encourage him or her to join today!  (READ MORE)

FMA’s Business of Medicine Survey Reveals Florida Physicians’ Top Concerns 

Pictures from Past Conferences