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Sponsors/Exhibitors Registration

FAPM Offers COVID-19 Symposium

On Saturday, October 24, 2020, during the annual FAPM Scientific Meeting, a twohour
symposium on COVID-19 will be offered. This special program will offer response efforts to the pandemic, updates on state and national rules and regulations, treatment modalities, and healthcare provider resources available regarding patient care.

This course will further offer attendees a comprehensive overview ofthe status of
COVID-19 and is designed to assist physicians in making evidence-based decisions
regarding the diagnosis of both inpatient and outpatient management of patients
infected with this virus.

Physicians in Florida are on the frontline of the fight against COVID-19 and this
COVID-19 has created conditions never previously encountered in this nation and
it has pushed the health system to the brink of dealing with the issue. Many
physicians are being called upon to work outside their specialty area to save lives
and stop the spread of the virus.

You can register for the annual FAPM Scientific Meeting at http://fapmmed.net/2020ConferenceRegistration.html  or by calling the FAPM office at 727-581-4319.

Summary of Surgeon General Emergency Order 20-002

DOH Emergency Order was issued (DOH EO 20-011) that again extends Emergency Order 20-002 until the expiration of Executive Order 20-52 (State of Emergency). On Tuesday, Governor Ron DeSantis issued Executive Order 20-166, which extends Florida's State of Emergency for 60 days.

 • MDs, DOs, PAs and APRNs who are designated as a controlled substance prescribing practitioner may issue a renewal of a controlled substance without having to conduct a physical examination of the patient, but only for an existing patient for the purpose of treating chronic nonmalignant pain. Telehealth may only be substituted for the physical examination.

 • Physicians qualified to certify patients for medical marijuana may issue a certification only for an existing qualified patient with an existing certification that was issued by that qualified physician without the need for an in-person physician examination.

• Any health care professionals, advanced life support professionals, and basic life support professionals, holding a valid license in another state, territory or district may provide such services in Florida. Such health care practitioners may not represent or hold themselves out as licensed to practice in Florida. There is no requirement that such practitioners practice in an underserved area, or free of charge.

 • Healthcare professionals not licensed in Florida, to prepare for, respond to and mitigate the effects of COVID-19, may provide telehealth services to patients in Florida for without having to register as a telehealth provider. This exemption applies only to MDs, DOs, physician assistants, and advanced practice registered nurses not currently involved in a disciplinary proceeding. All other requirements of the telehealth statute remain in effect, including the requirement that health care professionals’ practice within their applicable scope of practice.


The Florida Academy of Pain Medicine has hired Shawn Foster as their new Executive Director.
He replaces Kenneth Webster, Ed.D. who has retired after ten years with the Academy.
Shawn has assisted several state associations in the past 10 years. He served as Executive
Assistant to the Florida Academy of Pain Medicine during one of their Annual Meetings and was
the exhibit coordinator. Shawn FosterShawn has also been a consultant for the Florida Blueberry Growers
Association, Florida Blueberry Festival Association, Florida Association of Local Housing Finance Authorities, Florida Solar Energy Industries Association, the Florida Schools Boards Association, and the Florida Bail Agents Association. (Read More)

President's Message

The Florida Academy of Pain Medicine continues to move our programs forward during these difficult times. Our Board Members are focusing on maintaining our status as the premier pain medicine association in the state of Florida.
During our recent board meeting it was decided to move forward with the Annual Conference to be held on October 23-25, 2020 at the beautiful Hyatt Regency Grand Cypress Hotel in Orlando.
This annual event will consist of three pre-conference workshops that provide certificates of achievement and a two-day conference that will present timely and relative sessions.

The pre-conference workshops will include the following topics:

     A. Interventional minimally invasive techniques including peripheral        nerve blocks with nerve stimulation and diagnostic knee arthroscopy ..
    B. Regenerative injection therapy and ultrasound MSK workshop with guided interventional procedures.
    C. The future of pain care by getting at the root causes of pain.

The Scientific Meeting sessions will be offered on Saturday, October 24th and Sunday, October 25th presenting twenty CME credits. These sessions will include a "Symposium of COVID-19 issues and updates, interventional therapies for pain treatments, pharmacologist treatment of pain, innovations in neuromodulation" and so much more.

Register for this conference before July 1, 2020 and receive a discounted registration fee. We need the support of every Pain Medicine Physician to help FAPM to continue presenting programs ·to help you in your daily practice of medicine.
Chung Lee, MD

Annual Meeting Survey
Please download, complete and email or fax

From the President Chung Lee, MD

The Florida Academy of Pain Medicine has gathered several documents  related to the COVID-19 Coronavirus, and we wanted to make sure our members received this information that is attached to this email. We will also be posting this information on our website at www.fapmmed.net.

Included in these documents is information on "Additional Resources" from the Centers for Disease Control and Prevention and from the American Medical Association that has published a Physician's Guide to COVID-19 that includes how to prepare your practice, and protect yourself from infection and diagnosing patients.

Also, attached is a "Clinical Screening Tool" for identifying persons under investigation for the Coronavirus Disease that includes a chart to follow plus where to obtain additional guidance.

Finally, we should note the following recommendations:

As of March 16th, CDC guidance directs the health system to "reschedule non-urgent outpatient visits as necessary." Therefore, physicians should carefully consider when to cancel non-urgent procedures or prioritize their more urgent patients in order to reduce potential exposure and to ensure judicious use of potentially limited supplies of personal protective equipment (PPE). We recommend that physicians check the CDC website for updates to this recommendation given the evolving nature of this situation.
As with other systemic infections, when considering a procedure for a patient with known COVID-19 infection, suspected COVID-19 infection, or a patient who has had close contact with an infected individual, non-urgent interventional pain procedures should be postponed until the patient is no longer infectious or it is determined that they do not have COVID-19. (See CDC materials above relative to identifying at-risk patients and guidance on potential exposure.)

·         When considering a procedure for patients with co-morbidities that may place them at increased risk of immunosuppression, we urge physicians to carefully consider and explain to each individual patient the risks/benefits of the procedure and unique concerns during this time. 

The Florida Academy of Pain Medicine will continue to follow this situation, and keep you informed of any new information. 

Chung Lee, MD,

The thoracolumbar fascia: anatomy, function and
clinical considerations

Subject: Florida House devalues our medical degrees – let’s fight back

Call to Action for Florida Physicians
Don't let Lawmakers Devalue Your Medical Degree
For the third week in a row, I have been in Tallahassee fighting on behalf of our beloved profession. The Florida House of Representatives, led by Speaker Jose Oliva, has made passing legislation that would allow nurse practitioners and physician assistants to practice independently, without any supervision by licensed physicians, its number-one priority this year. Speaker Oliva has repeatedly stated publicly that, in his opinion, there is no difference between the care delivered by nurse practitioners and physicians. Make no mistake: He is saying that the many years of advanced education and training that a physician receives compared to a nurse’s training has no value.
Last week, a parade of special interests joined Speaker Oliva in calling for passage of this legislation. Lobbyists for the Florida Chamber, the Florida Hospital Association, Florida Blue, WellCare and the Florida Association of Health Plans stood with nurse practitioners wearing white coats, declaring that Florida is somehow behind the times because current state law requires physician supervision of mid-level practitioners. Clearly, this isn’t about what is best for Florida’s patients.
It is also clear that physicians must stand in solidarity against this governmental intrusion into the practice of medicine — now, before it is too late. Once again, I am asking you to help the FMA continue defending our profession by becoming a member today.
Renew your membership
This is not just a fight for primary care physicians. Every physician who went to medical school and completed a residency (and in some cases, a fellowship) should be alarmed. If the government decides that a physician’s training is equal to that of a nurse or a PA who receives an online degree with no clinical training, it is certain that the quality of patient care in Florida will suffer.
We also know that nurses will not only provide primary care. If allowed to practice without any physician supervision, they will move into specialty care such as dermatology and cardiology. They will show up in Tallahassee and demand the authority to perform surgery.
Once the Legislature decides medical education and training are no longer necessary and that mid-level practitioners can practice independently, it won’t be a stretch for those practitioners to decide they should expand their scope into every area of medicine.
Don’t sit on the sidelines while the integrity of your profession is under attack.
Ronald F. Giffler, MD, JD, MBA, FMA President
1430 Piedmont Drive East | Tallahassee, FL 32308 | Phone: (800) 762-0233

Meet the New President

At the recent FAPM Annual Meeting at the Hyatt Regency Grand Cypress Hotel in Orlando, Tse Chung Lee, MD, was elected President for the next two years. Dr. Lee currently practices as an Interventional Pain Management Physician in Daytona Beach, Florida. Lee1

Dr. Lee earned his medical degree at the Medical College of Ohio in the city of Toledo. He completed an internship at St. Vincent’s Medical Center, Columbia University in Bridgeport, Connecticut. He then completed his residency at the New York University, Rusk Institute in New York City. This was followed by a Fellowship in EMG Musculoskeletal/Spine/and Ultrasound in Napa, California. 

Active in the Florida Academy of Pain Medicine for the past few years, he is a member of the Florida Medical Association’s CME Committee and of the American Academy of Physical Medicine and Rehabilitation. His hospital affiliations are with the Advent Health Hospitals in Daytona, Palm Coast and Deland. 

Dr. Lee has several articles in publication on such topics as: Effects of Elastin Damage on the Mechanics of the Aortic Valve in the Journal of Biomechanics, the Journal of Heart Valve Disease, and the American Journal of Physiology. 

FAPM is pleased to have Dr. Lee serve as President as he leads this Academy to new and dynamic accomplishments over the next two years.

Survey Results 2019 Conference

2019 Conference Awards


Special Guest FMA President Dr. Ronald Giffler, M.D., J.D.addresses FAPM Annual Meeting Luncheon Attendees


Incoming President Tse Lee, MD presents Stanley R. Dennison, Jr., MD, MBA with a plaque thanking him for his term as FAPM President.

Ray-Lee AwardAlbert Ray, MD, presenting Carol Davis, , DPT, EdD, MS, FAPTA with the 2019" Felix Linetsky, MD Educational Award"at the Annual Meeting luncheon. 


Ken Botwin, MD received the FAPM Distinguished Service Award.

Upcoming Scientific Meeting
October 23-25, 2020
   Hyatt Regency Grand Cypress Hotel in Orlando

 Image result for hyatt regency grand cypress


Requirement for license renewal deadline for Controlled Substance Prescribing Course









A person wearing a suit and tie smiling at the cameraSpecial message from FMA President, Corey L. Howard, M.D.

Dear Colleagues, I challenge each of you to talk to four physicians and let them know the importance of your FMA, what it means to you and what it could mean to them:

·       Let them know that your FMA is dedicated to making Florida a great place to practice medicine by helping to get rid of regulations and other barriers that come between you and your patients.

·       Let them know that your FMA is working to improve the economic viability of all types of medical practices in Florida.

·       Let them know that your FMA is dedicated to promoting public policies that reinforce your role as THE leader of the healthcare team and preserve your ability to be independent advocates for your patients.


·       Let them know that to be that powerful voice of change, we need to come together as physicians, as leaders, as moms and dads, as teachers and as people so that we can all deliver the highest quality healthcare found anywhere in the United States.

I need all of you to be the champions of the FMA and help us grow, help us become better, help us fight the fights worth fighting and, most of all, help us help you practice medicine.

Thank you.

Corey L. Howard, M.D.
President, Florida Medical Association


FAPM Tradition of Excellence Continues

The Florida Academy of Pain Medicine Annual Scientific Meeting & Alliance Medical Summit speaker line up continues a tradition of excellence. This year’s program features another impressive group of 16 nationally known pain leaders sharing the latest pain medicine therapies that includes the impact of opioids, marijuana, and other up-to-date topics in pain research and pain management. You won’t want to miss this chance for an in-person session with these multidisciplinary leaders!

The entire schedule

Offered at Annual Conference

                     Disney Bargains - Annual Meeting 2018 - July 27-29



  • Dr. Albert Ray (left) with Kevin Kline (Medtronic representative)
  • Dr. Matt Hyzy giving a presentation at the annual meeting
  • Dr. Stan Dennison (FAPM newly elected President (left) with newly elected board member - Dr. Abraham Rivera (right)
  • Dr. Stan Dennison (right) (FAPM Incoming President) presents Dr. Vinny Malik (left) with a plaque thanking him for his service as President for the past two years
  • Dr. Steve Wheeler receiving the   Dr. Felix Linetsky  Excellence in Education Award
  • Executive Director Ken Webster with Shawn Foster (right)
  • FAPM President Dr. Vinny Malik (right) with FMA President - Dr. David Becker (left)
  • FMA President Dr. David Becker addresses the annual luncheon attendees
  • Hyatt Grand Cypress Orlando
  • Meeting Hall
  • New board member - Dr. Abraham Rivera
  • Disney Attractions Orlando
  • Dr. Stanley Dennison, new President of Florida Academy of Pain Medicine

FAPM President 

Stanley Dennison, MD

Dr. Stanley Dennison, Jr. is the newly elected President of the Florida Academy of Pain Medicine. He was elected at the 17th annual FAPM scientific meeting in OrlandoDennison.

Dr. Dennison graduated from the University Central Del Este, San Pedro De Macoris, Dominican Republic.

He is a Diplomate of the American Academy of Pain Management. He served his internship at Wayne State University in Detroit and completed his residency in Anesthesiology at the Medical College of Ohio Hospital in Toledo.

Dr. Dennison completed a Fellowship in Pain Management at the University of Kentucky in Lexington. He is a past Director at the Pain Clinic at Shands at the University of Florida, and a member of the American Society of Anesthesiologists, Hillsborough County Medical Association and Florida Academy of Pain Medicine.

He has 30 years’ experience in pain medicine and anesthesiology where he practices in Tampa.

His hospital affiliations include: Brandon Regional Hospital, St. Joseph’s Hospital, Town & Country Hospital and Memorial Hospital.

Dr. Dennison treats advanced pain care patients. He notes that, “over 80% of Americans suffer from back pain, and the majority of these people can gain relief without surgery. Whether the pain is in chronic form or more recent there are many medications, injections and therapies that can be used to treat back pain”.


Florida HealthHeadsUp

The DEA 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:

Opioid Denial
 My Own Harrowing Experience

American Council on Science and Health


Refer to: http://nypost.com/2016/12/19/how-the-feds-are-fueling-americas-opioid-disaster/  


Changes to DEA Renewal Process

Through a 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 debra.cohn@ama-assn.org or (202)789-7423.

Conference Pics


(Left) President 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 FAPM.

Conference Pics1

Check out more Conference photos on our Facebook page.

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

A.M. Trescot (Ed.) Peripheral Nerve Entrapments Clinical Diagnosis and Management
Trescott 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, and complications. 
(Read More)


Turn the Tide:
The Fight to End the Opioid Crisis



Congratulations to
Dr. Felix Linetsky

Felix Linetsky, MDDr. 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.

FAPM Welcomes New Board Member

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 replica watches uk 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 Directors.


Political Pulse
Description: http://fapmmed.net/pulse.png

Description: Herald Tribune  Politcs

The battle for Florida
Herald-Tribune 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.

  Description: Herald Tribune

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 Herald-Tribune 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 amendment.


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?"  (Read More)

Walgreens’ Good Faith Dispensing Protocol

From: Bob Twillman [mailto:btwillman@aapainmanage.org] 
Sent: Monday, October 07, 2013 1:10 PM
To: Jeffrey Zipper
Subject: Academy 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
Deputy Director
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.
Dr. Zipper
,President FAPM 
Read More

Pill Mill Crackdown Pays Off

The Florida 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. 

Our congratulations to every physician and organization that stepped up to the task that made these changes happen.

[ EDITORIAL-2014 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."
(Read More)

  • Leaders & SpeakersFrom 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

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 month.

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 treatment.

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 premiums.

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.

Read more here: http://www.miamiherald.com/2014/05/21/4129354_insurance-companies-should-not.html#storylink=cpy


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 


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! 

Jeffrey A. Zipper, M.D.

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 external link.

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. 

Jeffrey A. Zipper, M.D.
FAPM President


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.  


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. 
Jeffrey Zipper
President FAPM
Chief Executive Officer

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

Conference Pictures

Conference Pictures

Conference Pictures

Conference a Great Success

2013 FAPM Awards Recipients
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

Congratulations to Felix Linetsky, MD and Albert Ray, MD for recent publications in a major new textbook on Pain Medicine.

 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.

Dr. 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 interested.

Albert 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 “Neuroplasticity, 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 Ullmann, MS.

Dr. Ray, 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.

The FAPM 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. (Read More)

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

                                                 Membership Benefits
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 regulatory agencies.
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 Specialty Council.

New 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~
(Read More)

NY Times- FDA Won't Require Special Training


Join the Court Fight to Protect Physician Medicare Data

Attorney General Bondi's Weekly Briefing: Prescription Drug Diversion: Combating the Scourge
Congress Approves 10-Month SGR Patch

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.

MAJOR ALERT!! House GOP agrees to doc pay-rate extension

ALERT! CVS tells some Florida doctors it won't fill their prescriptions for narcotics

ALERT! Lyons: Doctors 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

The 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 product development.
Congratulations to 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.