FAPM board met recently to discuss plans for this year as we
prepare for the upcoming legislative sessions, plans to increase
membership and preparations for our 17th Annual
Scientific Meeting on June 16-18, 2017.
2017 State Legislature begins on Monday, March 6th
with a wide range of issues affecting the practice of Medicine
in Florida. Our Legislative Chairman Stanley Dennison, MD, is
working closely with the FMA to identify legislation that we
need to support along with those issues that we feel need to be
defeated. We will keep our members up-to-date on the progress we
are making on these key issues.
most of you know, FAPM is a small specialty society compared to
other specialties in Florida. We strive to maintain our
membership base, with the goal to increase our numbers each
year. Therefore, we need every pain medicine physician in
Florida to pay their annual dues to support our programs. Our
fiscal year begins January 1st each year, so please
take a moment to pay this year’s dues online or by check. Thanks
for continuing to support our efforts to better serve you.
17th Annual FAPM Scientific Meeting will return to
the Hyatt Regency Grand Cypress Hotel with exciting new programs
that are designed to keep us at the forefront of pain medicine
issues. Mark the dates of June 16-18, 2017, and plan a family
vacation in the heart of Disneyland. This great hotel offers you
and your family many exciting activities including several
swimming areas, two golf courses, numerous tennis courts,
boating, horseback riding and special programs each day. The
hotel also provides transportation to Disney adventures. Let’s
make this our best conference as you can earn up to twenty CME
credits by attending the pre-conference and the general
thanks for your continued interest in FAPM programs.
Vinod Malik, MD
recently suspended McKesson Corporation’s sales of
controlled substances from distribution in Florida.
This suspension could impact your patients’ ability
to fill their prescriptions and you may want to
advise them about the potential implications. As a
practitioner, you should be aware of the possibility
of drug shortages and consider alternative treatment
options when prescribing controlled substances. As
always, use your best professional judgment when
caring for your patients.
Please see the link to the news release below:
My Own Harrowing Experience
American Council on Science and Health
DEA Renewal Process
notice on its website, the Drug Enforcement Administration (DEA)
recently announced significant changes to its registration
renewal process. Effective January 1, 2017, the DEA is
eliminating the informal grace period which the agency has
previously allowed for registrants to renew their registrations.
Only one renewal notice will be sent to each registrant’s “mail
to” address approximately 65 days prior to the expiration date;
no other reminders to renew the DEA registration will be
provided. The notice also advises that online capability to
renew a DEA registration after the expiration date will no
longer be available, and that failure to file a renewal
application by midnight EST of the expiration date will result
in the “retirement” of the registrant’s DEA number. The original
DEA registration will not be reinstated. In addition, paper
renewal applications will not be accepted the day after the
expiration date. If DEA has not received the paper renewal
application by the day of the expiration date, mailed in renewal
applications will be returned and the registrant will have to
apply for a new DEA registration.
The AMA has
strongly expressed our concerns to DEA about this change in
policy and the problems it could create for both patients and
their physicians. In letters sent Friday, December 9 to DEA
Acting Administrator Charles Rosenburg and Louis Milione
(Assistant Administrator for Diversion Control), the AMA urged
DEA to reverse the change to the renewal process.
If you have
any questions, feel free to contact Debra Cohn, Senior
Washington Counsel, at
From the President
Dear FAPM Members:
This year is closing fast, so I wanted to take a moment to
wish everyone a very Happy Holiday Season and a prosperous
New Year! Let's all strive to make 2017 the best year we
FARM is in the process of developing new and exciting
programs for our members and associates. Our website
continues to provide informative and timely information. Our
Membership Committee is launching new programs for
recruitment and retention. Our Legislative Committee has
already submitted a resolution on pain issues and will be
involved with FMA/RAC.
We are looking forward to another great conference on June
16-18, 2017, as we return to the Hyatt Regency Grand Cypress
Hotel with exciting new programs. As we strive to stay on
the cutting edge of medicine, this year's program will offer
an in-depth study of nitro medicine along with continued
updates on interventional pain issues, ultrasound techniques
and new basic pain treatments. As we strive to keep pace
with the many issues facing the practice of medicine today,
I want to encourage each of you to become a member this year
so we can continue to provide updated information and a good
CME program. Our fiscal year is January 1 - December 31, so
dues statements will go out in January. Please be looking
for them and you can pay online, by credit card or check. My
thanks for your continued support of this academy.
Vinod Malik, MD
Vinod Malik welcomes FMA President David
Becker to the FAPM conference.
Presidents meet with conference sponsor.
(L-R) Michael Creamer, President of
FSPM&R, Kevin Kline,
Medtronic Regional Manager,and Vinod Malik, President of
Check out more Conference photos on our Facebook page.
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
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
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!
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
If we can be of
any service to you as a member, please do not hesitate to call our
office at 727-581-4319.
Vinny Malik, MD,
Trescot (Ed.) Peripheral Nerve Entrapments Clinical Diagnosis and
▶ This book features over 50 videos of examination and injection
techniques, at least 2 per nerve ▶ Contains "Pain Problems Index" to
navigate by symptom ▶ Includes anatomy, injection technique, and
complications for each nerve
Featured as a single volume, this is a comprehensive guide to
possible nerve entrapment syndromes and their management. Each
chapter covers a single nerve, or group of closely related nerves,
and goes over the clinical presentation, anatomy, physical exam,
differential diagnosis, contributing factors, injection techniques,
neurolytic/surgical techniques, treatments of perpetuating factors,
The Fight to End the Opioid Crisis
Workshops Provide Special Certification Recognition
for the Florida Academy of Pain
Medicine pre-conference workshops will receive a certificate
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.
Ultrasound and Interventional Pain Therapies"
will include ultrasonography of
shoulder, knee and hips as a correlation of physical findings and
clinical anatomy. The Interventional Spine Procedures will teach the
use of innovative techniques
as facet joint
injections, nerve blocks, neuroaugumentation, spinal fusion and
implantable drug delivery
Approach to Pain Medicine Workshop" features nationally known
on pain medicine issues
mood, cognitive and memory holographic pain treatments, low level
inflammation and fascia
opioid crisis concerns,
medical laser applications and much more.
The third workshop
deals with PM&R treatments and therapies.
Featured topics include updates on
rehabilitation, medical marijuana update, intrathecal
therapies, treatment and management of
stenosis, and multimodal approaches
the treatment of low
Each workshop offers 8 CME hours.
“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 Spinal Procedures will teach the use of
innovative techniques such as facet joint injections, nerve
blocks, neuroaugmentation, spinal fusion and implantable drug
“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.
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.
program for these workshops can be
found on the
FAPM website where you can also
Don’t miss out on the latest treatments in these special
33rd Annual Meeting
March 16-19, 2017
(Preconference Sessions: March 15-16, 2017)
Loews Sapphire Falls Resort
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:
Drug industry on edge for Obama action on prices
Peter Sullivan –The
pharmaceutical industry is anxiously awaiting a series of regulatory
actions from the Obama administration aimed at combating high drug
Drug prices have been a major issue on the campaign trail, with Hillary Clinton, Bernie Sanders and Donald Trump pounding
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
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.
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
Our “Executive Committee” is planning an excellent program for the
annual FAPM Scientific Meeting to be held on August 12-14, 2016, at
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
Vinod Malik, DO
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.
Pain Management Physicians
you are a physician practicing in a Pain Management Clinic and were
registered based on the 6th qualification option in Rule
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
License renewal is coming up for half of Florida's allopathic
physicians in Jan,
2016 and for all of Florida's osteopathic physicians in March,
This is the first
year that the online renewal system will be linked to CE Broker,
the Florida Department of Health
online CME tracking system.
If you haven't signed up for your CE Broker account and begun
do so by visiting
There are three account options:
free, professional and concierge. As an FMA member, you can get
a discount on CE Broker's
concierge service to take over the process of managing,
tracking and reporting your CME.
Simply send your certificates to CE Broker's
trained staff members,
and they will handle the rest.
signed up for a CE Broker account?
Dr. Felix Linetsky
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.
at Florida Board of Pharmacy's
Controlled Substances Meeting
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.
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.
continue to monitor the activities of the Florida Board of Pharmacy,
and report any new developments to the members.
FAPM Welcomes New Board
At the FAPM Annual Scientific Meeting on Saturday,
June 25, the attendees elected TSE CHUNG LEE, M.D.
to the Board of Directors as a Member at Large. Dr.
Lee is presently in practice at the PRC Pain
Associates in Daytona Beach as an Interventional
Physiatrist. He will be representing the FAPM at the
FMA House of Delegates in Orlando.
Dr. Lee earned his medical degree at the Medical
College of Ohio in Toledo, Ohio. He completed a
residency in Physical Medicine and Rehabilitation at
New York University, Rusk Institute in New York
City. He then completed a Fellowship in
EMG/Musculoskeletal/Spinal/Ultrasound in Napa,
California under the direction of Marko Bodor, M.D.
He is further a member of the American Academy of
Physical Medicine and Rehabilitation, the
International Society of Interventional Spine and
the American Institute of Ultrasound Medicine. He is
a Diplomate of the American Board of Physical
Medicine and Rehabilitation and of the American
Board of Pain Medicine.
The Florida Academy of Pain Medicine is pleased to
welcome Dr. Lee as the newest member of the Board of
Vinod Malik, MD
President Elect - Stanley Dennison, MD
Vice President - Peter Taraschi, DO
Secretary - Felix
Treasurer - Kenneth
Immediate Past President
- Jeffrey Zipper, MD
Susanti Chowdhury, MD
- Tse Lee, MD
Member-at-Large - Raul Monzon, MD
Albert Ray, MD
As the newly elected President of the Florida
Academy of Pain Medicine, I want to thank the Board
and Members for the vote of confidence in my ability
to lead this Academy.
At our recent FAPM Scientific Meeting in Orlando, we
set records of the number of physician attendees and
for the number of exhibitors. Our program offering
20 Category 1A CME credits was highly complimented
by the attendees, and the exhibitors greatly
appreciated the increased attendance and interest in
their products and services.
I want to thank our Gold Sponsor,
and the other special event sponsors -St.
Jude Medical and
Quest Labs. On
our website you can find a list of all of our
exhibit sponsors and their services. I hope you will
support them by using their services whenever
Our membership will reach new heights this year, and
I hope everyone reading this message will be
sure to join FAPM. Our
fiscal year ends on December 31st and you can
pay dues on our website.
In order for FAPM to remain a viable Academy, we
need the support of every pain medicine physician in
Speaking at our conference luncheon,
FMA President Alan Pillersdorf, MD reminded everyone
to support their medical associations so we can
present a united front of strength as we face the
challenges of our profession.
We are currently in the process of
evaluating this year's conference, and planning for
the 2016 program. Hopefully, each of you will want
to attend that event in Orlando on August 12-14, 2016.
At this conference we will continue to
offer a comprehensive program emphasizing pain
medicine issues including interventional and
integrated techniques. We plan to offer additional
workshops and welcome any suggestions from our
members on topics of interest to you. Just email
your ideas to our executive office at
Fraternally, Vinod Malik, MD
The battle for Florida
Politics provides a visual guide
to the gubernatorial battle for Florida in
geographic terms. Political Editor Jeremy
Wallace examines a number of issues facing
the campaigns as the race reaches its peak.
For example, Duval County, “once a solid
Republican stronghold,” is eroding for the
GOP. However, Gov. Rick Scott is likely to
once again dominate among rural voters as he
did in 2010. On the upside for Charlie
Crist, he has an opportunity to take a bite
out of the margin that carried Gov. Scott in
2010 in Miami-Dade and Broward counties.
Physicians touchy about marijuana
Many physicians are speaking out against a
proposed constitutional amendment to
legalize medical marijuana in Florida,
saying its passage could lead to abuse. The
says the overarching concern is that
“Yesteryear’s ‘pill mill’ doctor will become
tomorrow’s ‘pot doc,’ someone who
rubber-stamps prescriptions for medical
marijuana regardless of concern.” The FMA
has cited the issue of potential drug abuse
as one of its reasons for opposing the
Overstep on painkillers
Prescription painkiller crackdown has gone
'way too far,' some doctors believe
Tampa Bay Times 9/2/2014
Tampa anesthesiologist Dr. Rafael Miguel
helped lead the fight against a surging prescription drug
abuse crisis in Florida.
As vice chair of the state's Board of Medicine,
Miguel called for legislative change to stem the flow of drugs that
led to thousands of overdose deaths each year.
Eventually, people listened.
Laws tightened. Police stepped up enforcement.
And deaths declined by 23 percent from 2010 to 2012.
Miguel now is in a different drug battle — one
for more access to narcotics, not less.
The obstacle, Miguel and other doctors report,
are pharmacies that are increasingly second-guessing them, asking to
see medical records or refusing service.
"They call us sometimes and ask if (a
prescription) is medically necessary," said Miguel, 59, who has a
Brandon clinic and teaches pain medicine at the University of South
Florida. "Well, if I write a prescription and it's got my DEA number
and my signature on it, what do you think, I'm joking around?"
Walgreens’ Good Faith Dispensing Protocol
October 07, 2013 1:10 PM
To: Jeffrey Zipper
update: Walgreen information, request feedback
Last June, your Academy's Policy and Advocacy Department sent all
members a letter summarizing the situation with respect to
Walgreens’ Good Faith Dispensing protocol. That information also
provided members with an easy way to report problems encountered
with patients filling prescriptions for opioid analgesics. After
hearing more concerns expressed by many of you at the Annual
Clinical Meeting held in Orlando, we have decided that we need to
re-send this information.
Attached is the original memo, for your review. If you and your
patients have been having problems getting prescriptions filled, please
provide feedback using this form. The form is also
in the attached document with more information as to what we are
seeking and how the information will be handled.
As always, thank you for your support of the Academy.
Bob Twillman, PhD, FAPM
Director of Policy and Advocacy
Dear Colleagues, as you can see from the missive below it
appears the FAPA’s #1 Legislative priority this year is to obtain
controlled substance prescribing privileges (all hands on deck)!!
Given the fiasco that Florida has recently experienced with the
advent of “pill mills” this would be an unwise turn of events and
must be opposed for the safety of our patients. THE PAIN MANAGEMENT
COMMUNITY MUST FIGHT TO PREVENT THIS LEGISLATIVE INTIATIVE.
Pill Mill Crackdown Pays Off
Academy of Pain Medicine is proud of the role our board and members
have played in the development of effective policies that have
contributed to the decline of "pill mills" in the state of Florida.
Over the past four years our lobbyists, presidents, staff members
and our affiliate medical societies have worked tirelessly to
see these policies implemented to the fullest extent of the law.
congratulations to every physician and organization that stepped up
to the task that made these changes happen.
TheLedger.com -All rights reserved ]
Florida's Effective Policies: Pill Mill Crackdown Pays Off
Florida, once labeled "the pill mill capital of
the country," has shown that it's ready to relinquish that title.
A report last week by the U.S. Centers for
Disease Control and Prevention found that changes in Florida
policies and law enforcement have led to what appears to be "the
first documented substantial decline in drug overdose mortality in
any state during the past 10 years."
From left, Rigoberto Guzman, MD, President FSPMR; Jeffrey Zipper, MD, President FAPM; Alan Harmon, MD, President FMA; Vinod Malik, MD, President-Elect, FAPM
Marla Golden, DO, receiving the Felix Linetsky Education Award
Jeffrey Zipper, MD, President, Florida Academy of Pain Medicine
receiving the FAPM Distinguished Service Award
Alan Harmon, MD, President, Florida Medical Association
Albert Ray, MD, Past President FAPM
Kenneth Webster, Executive Director, FAPM
- Ken Webster's Special Lady
FAPM Conference Is Big Success
pre-conference programs on basic pain issues, ultrasound treatments
and physical medicine and rehabilitation, the conference provided
special training in multiple modalities. The pre-conference
workshops were followed by offering twelve CME credits in areas
related to pain medicine issues.
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.
Insurance companies should not meddle
in patients’ treatment
By Albert Ray
You pay your insurance premiums on time, and you know
exactly what kind of medical and prescription coverage to
expect. But what happens when your insurance company decides
it doesn’t want to provide the same coverage anymore?
That’s exactly what happened to “Mark,” one of my patients
suffering from osteoarthritis and a serious lower-back
injury. Without treatment for the severe, debilitating pain,
Mark simply could not function. As a 60-year-old man living
by himself, Mark has been completely self-reliant. He has no
one in his household to help him deal with the pain, so pain
management has been critical to his quality of life and
ability to function.
For years, Mark underwent physical therapy and a full range
of interdisciplinary treatment to restore his quality of
life. Thankfully, his pain has been consistently managed
with medications. I prescribed a specific dosage of
painkillers that provided adequate pain relief without any
sedation or adverse side effects. Although not perfect,
Mark’s situation was manageable. And as important, he was
paying his insurance premiums on time — to a major Florida
insurance company — until suddenly, he received a notice
that this unscrupulous company planned to arbitrarily limit
the amount of pain medication he could receive in any given
As Mark’s doctor, I had to find a way to provide him with a
new prescription that fell within the limits of this new,
arbitrary insurance-coverage limit. Sadly, it also meant
that I had to reduce his dosage from 90 milligrams per day
to 80 milligrams, which meant that Mark would have less pain
relief and an increase in the level of sedation because of
the insurance company’s interference with my patient’s
Why would an insurance company interfere this way? Was it
just plain greed, a simple case of trying to save a few
bucks so it could pocket more profits?
Unfortunately, Mark’s case is not unique. In 2011, Florida
lawmakers took steps to fight “pill mills” that were
thriving in our state and allowing people to abuse
prescription drugs. Unscrupulous people from around the
country would drive here to buy pain medication and sell it
on the black market.
Since passage of new laws aimed at fighting pill mills,
doctors and pharmacists, working closely with law
enforcement, were able to reduce the number of pill mills
and prescription drug-abuse incidents. But the unfortunate
side effect is that legitimate patients, in desperate need
of pain-management treatment, are getting shafted by
insurance companies who use the new law as an excuse to
alter insurance coverage and boost their profits.
They are playing games with patients, forcing them to jump
through hoops, fill out mountains of paperwork to justify
even the slightest adjustment to a sleeping-pill
prescription or an arthritis treatment. And when they get
called on it, they point to the laws passed in 2011 that
were designed to fight criminals and illegal drug abuse.
No insurance-company executive should have the right to tell
a doctor what to prescribe for a patient, nor should they be
able to impose arbitrary limits that could radically affect
a patient’s well being. Most of all, insurance-company
executives should never be allowed to interfere with
treatments they previously agreed to pay for. Such meddling
can only be ascribed to one motive: greed and profiteering
on the backs of patients who have dutifully paid their
The Legislature was right to combat prescription-drug abuse
in 2011. But now greedy insurance companies are abusing the
law. Until state lawmakers do something, patients will
continue to suffer.
Albert Ray, M.D., is the medical director at The LITE
Center and clinical associate professor at the University of
Miami Miller School of Medicine.
Patient Op-Ed: Denying necessary prescriptions to needy patients
The Florida Academy of Pain Medicine is working diligently to bring
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
filled. Should you have any similar cases to report of patients not
their prescribed drugs in a timely manner, please let us know.
Together we can help
alieviate this problem.
Fraternally, Jeffrey Zipper, FAPM President
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
Jeffrey A. Zipper, M.D.
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.
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
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.
To review active, future, and retired LCD for jurisdiction 9, please
FAPM has a “Neutral” Position on Medical Marijuana
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
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.
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
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
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).
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.
Jeffrey A. Zipper, M.D.
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
(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.
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
(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.
Chief Executive Officer
2014 Medicare OBS Reimbursement Rates for SCS Trials
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!
of Medicine Survey Reveals Florida Physicians’ Top Concerns
Conference a Great Success
Special Award Presented at Conference Luncheon
Left to Right: Rigoberto Puente-Guzman,MD, President of FSPR&R
Ralph Nobo, MD, Vice-President of FMA, Albert Ray, MD, President of
FAPM, Kenneth Webster, Ed D. FAPM Executive Director receiving the
Presidential Achivement Award,
and Jeffrey Zipper, FAPM President-Elect
Two Leadership Members of FAPM
Author Major Works
Felix Linetsky, MD and Albert
Ray, MD for recent publications in a major new textbook on Pain
Felix Linetsky, MD, FAPM
Board member, chairman of the FAPM Education Committee responsible
for our excellent Annual
Educational programs, and President of the American Academy of
Regenerative Orthopedic Medicine, has
coauthored “Treatment of Chronic Painful Musculoskeletal Injuries and Diseases with
Regenerative Injection Therapy (RIT): Regenerative Injection Therapy
Principles and Practice,” along with Hakan Alfredson, MD, PhD,
David Crane, MD, and Christopher Centano, MD. This chapter
was published in the
Comprehensive Treatment of Chronic Pain by Medical, Interventional,
and Integrative Approaches: the American Academy of Pain Medicine
Textbook on Patient Management and released last month. This
chapter offers a comprehensive review of regenerative injection
therapies including treatments related to pathology of connective
tissue, mechanism of action of chemical injectates and biological
injectates; provides a step
by step approach to differential diagnosis and treatment; and offers
future directions for regenerative injection therapies.
Linetsky and his co-authors are all internationally recognized
experts in the field of regenerative injection therapies, and have
combined their knowledge and skills in this excellent chapter.
Dr. Linetsky will be speaking and also teaching an
Ultrasound Guided Treatment
course at our upcoming annual meeting in June 28-30, 2013. The FAPM
has named an award in Dr Linetsky’s honor:
The Annual Felix Linetsky Award for Excellence in Education, to
recognize his lifelong dedication to helping patients receive better
care through education.
Dr. Linetsky will be available for private conversations for those
Ray, MD, current president of FAPM and president of the
Foundation for Pain Medicine, has served as the section editor on
Integrative Approaches for the Comprehensive
Treatment of Chronic Pain by Medical, Interventional, and
Integrative Approaches: the American Academy of Pain Medicine
Textbook on Patient Management.
He has served as the editor for 25 chapters including
such topics as pain perception, neuroplasticity and sensitization,
muscle pain treatment, addictive disorders, mental status exam of
pain patients, psychological assessment s and treatments, hypnosis,
acupuncture, manual therapies, regenerative therapies,
interdisciplinary functional restoration programs, spirituality,
disparate populations, sleep and pain, empowerment for pain
sufferers and their caregivers, geriatric issues in pain, primary
care issues, patient advocacy, neonatal pain, disability assessment,
the Double Effect, and failure to treat issues. Within this book,
Dr. Ray has authored a chapter entitled
Sensitization, and Pain,” and coauthored
“Pain as a Perceptual
Experience” with Ms. Rhonwyn Ullmann, MS, and Michael Francis,
MD; as well as “Manual
Therapies,” with Mr. John Barnes, PT,LMT, NCTMP and Ms. Rhonwyn
has dedicated his medical career to the understanding,
treatment, and teaching of pain in the whole person, and has also
served as the president of the American Academy of Pain Medicine,
the Southern Pain Society, and the National Pain Foundation. He has
been a Director at Large for the American Board of Pain Medicine and
still sits on their Exam Council.
Dr. Ray has also been a pioneer working for the establishment
of Pain Medicine as a primary specialty. Dr. Ray will be leading a
course in Basic Pain Medicine
at our Annual Educational Meeting next month.
will have this brand new textbook available at the exhibit hall
at Booth 306 for anyone interested. Come join this exciting meeting and meet our
authors in person.
FL Doc Arrested for Running Pill Mill, 3rd Offense
A St. Petersburg doctor who was accused
in 2011 of helping operate an illegal pain clinic in Pasco County
was arrested again Thursday on charges that he was doing the same
thing in Citrus County.
From the President:
Dear FAPM Members:
The Florida Academy of Pain Medicine strives to represent our
members on important issues that affect your ability to practice
medicine in the state of Florida. While we have expanded our member
services the past two years, including Executive Offices and
services, we have not increased your annual dues.
However, it is important for the success
of our programs to maintain a strong member base. As we enter the
fourth quarter of our fiscal year we need every member to be sure
their dues are current. We have a current list of dues paying
members for this year posted in our membership section on this
website. Please check to see if your name appears. If your name is
listed, thank you for your support of FAPM programs. If your name is
not listed, please take a moment to pay them “on line”. Your support
is needed now so that FAPM can continue to represent you on issues
that affect your medical practice.
Take time to check our website often to
stay informed of important medical matters. We strive to maintain
up-to-date communication so that our members are properly informed.
Albert Ray, MD, President
● Active website with regular updates,
special alerts and blast emails.
● Educational programs designed to
keep you up-to-date on the latest developments in pain medicine.
Discounted fees for members.
● Information resources to provide
practical insight into dealing with third party payers and
● Annual scientific conference with
nationally known speakers and relevant topics.
● PAC FUND to support legislative
issues pertaining to pain medicine.
● Opportunities for the exchange of
information and experiences with colleagues who have encountered
problems similar to those with which you are dealing.
● PainInfo, the Academy’s periodical
newsletter, which keeps you informed as to upcoming meetings,
Academy activities, and economic, legislative and regulatory
information (both state and national) which affects your practice.
● Representation within Florida’s
recognized organized medicine body, the Florida Medical Association,
both via a seat in the FMA House of Delegates and a seat on the FMA
FDA guidance urges patient outreach regarding important drug
recall related to Aspergillus Meningitis
FLORIDA DEPARTMENT OF HEALTH COLLABORATES WITH HEALTH CARE
PROFESSIONALS IN ONGOING FUNGAL MENINGITIS OUTBREAK INVESTIGATION
~New FDA guidance urges patient outreach~
NY Times- FDA Won't Require Special Training
the Court Fight to Protect Physician Medicare Data
Bondi's Weekly Briefing: Prescription Drug Diversion: Combating
Congress Approves 10-Month SGR
Note!The Electronic - Florida Online Reporting of Controlled
Substances Evaluation program
(E-FORCSE) is Florida's Prescription Drug Monitoring Program
(PDMP). The PDMP was created by the 2009
legislature in an initiative to encourage safer prescribing of
controlled substances and to reduce drug abuse and diversion
within the state of Florida. Remember: Section
893.055, Florida Statutes, requires health
care practitioners to report to the PDMP each time a controlled
substance is dispensed to an individual. This information
is to be reported through the electronic system as soon as
possible but not more than 7 days after dispensing. This
reporting timeframe ensures that health care practitioners have
the most up-to-date information available.
House GOP agrees
to doc pay-rate extension
tells some Florida doctors it won't fill their prescriptions for
on CVS blacklist feeling branded
Pain Management Regulations Affect
More Than Pain Management Specialists
Linda A. Keen
of counsel to The Florida
Healthcare Law Firm
MSK Medicine Council Outstanding Service Award
AAPM&R Outstanding Council Service Award was established this year
to recognize service/volunteerism of Council members who contribute
to the success of the Academy in fulfilling its mission and serving
its membership in ways not limited to research, education, and
Andrew Sherman, MD, MS—the
first MSK Medicine Council recipient of the AAPM&R Outstanding
Council Service Award! Outstanding Council Service Award recipients
will be recognized at the Annual Assembly at our Council business
meeting on Friday, November 5, at 5:45 pm, and will be announced
during the Forty-Second Walter J. Zeiter Lecture and Awards Ceremony
on Saturday, November 6, at 11 am.