2014 billing update

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Do you think King O, Sebelius or anyone in this administration care about you, us or our complains?

No but they care if senior citizens, which is a huge voting block, get panicked over lost access to care, which this will cause. That should be the focus for persuasion.

Also, you

MUST

MUST

MUST

send your letter to as many news outlets as possible. Unless it blows up in the Press, it will go nowhere.

Focus on THE PATIENT and their lost access to care, as a result of these massive cuts.

That argument will get much, much, more traction than any of our collections or billing worries.

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No but they care if senior citizens, which is a huge voting block, get panicked over lost access to care, which this will cause. That should be the focus for persuasion.

Also, you

MUST

MUST

MUST

send your letter to as many news outlets as possible. Unless it blows up in the Press, it will go nowhere.

Focus on THE PATIENT and their lost access to care, as a result of these massive cuts.

That argument will get much, much, more traction than any of our collections or billing worries.

These kind of stuff has been said million times before by the Republicans. But I don't fault you to try. But bringing attention to the press and public is a good idea. Is it going anywhere, I doubted.
 
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Is there a legal process to appeal this decision????
CMS slashed cardiology reimbursement a few years back... Lots of noise was made... But nothing actually happened...

Only if the ASIPP, ISIS, ASA, AAPMR come together and strongly oppose this, or hint at stopping to see Medicare will we see any changes ... Otherwise get ready to take a paycut ... If we all come together, maybe we have a chance.. our strength is going to be our number...or this could be the beginning of the end for IPM. ..

Looks like Pill management the new pain management... ...
 
http://communities.washingtontimes....us-grim-reaper-obamas-hhs-head-controls-medi/

Under Obamacare, the decision on what Medicare will, and won’t, pay for rests with the Head of Health and Human Services, and note it is ‘Health and Human‘ not ‘Health and Humane‘ Services. As head of HHS, she can, without oversight, make what ever decision she wants over your health care benefits. What will and won’t be paid for. And how much they will pay the doctors and hosptials.

The plan, as articulated in the article If America blames Obama, Obamacare dies is for Obamacare to put the private insurance companies out of business leaving only Medicare, or a Medicare-esque service, for all Americans. Also, many hospitals and doctors receive a good amount of their income from Medicare and Medicaid patients. When IPAB stops paying for certain services and drugs, many hospitals and doctors will not be able to perform those services at all, as income from private insurance companies may not cover the overhead for certain procedures and drugs.

This is how IPAB will control the availability and price of services and drugs for those with private insurance as well.



Read more: http://communities.washingtontimes....-obamas-hhs-head-controls-medi/#ixzz2n98KN0yq
Follow us: @wtcommunities on Twitter
 
Is there a legal process to appeal this decision????
CMS slashed cardiology reimbursement a few years back... Lots of noise was made... But nothing actually happened...

Only if the ASIPP, ISIS, ASA, AAPMR come together and strongly oppose this, or hint at stopping to see Medicare will we see any changes ... Otherwise get ready to take a paycut ... If we all come together, maybe we have a chance.. our strength is going to be our number...or this could be the beginning of the end for IPM. ..

Looks like Pill management the new pain management... ...

The whole point is to discourage procedures. The less you do, the better. Pain management is a relatively small field and an easy target. It will happen to other specialties, I think Ortho is next. Take home point, Obamacare is destroying the economy. Even though our economy is already destroyed under this regime.
 
The whole point is to discourage procedures. The less you do, the better. Pain management is a relatively small field and an easy target. It will happen to other specialties, I think Ortho is next. Take home point, Obamacare is destroying the economy. Even though our economy is already destroyed under this regime.

Obama ... What a conniving little *unt... There I said it.. And I actually liked the guy a little bit... All these politicians and their ****ing agendas...
 
okay, i looked at the 3 proposed fee schedules, and it seems like what is being nerfed is the physician portion of procedures. of course, this kills office based proceduralists who are garnering global fees.

if you look at the ASC and the HOPD schedules, there is actually an increase in payment for them. for example, 64483 (lumbar/sacral transforaminal epidural injection)

physician payment non-facility down 7.9% (232.38 down to $214)
physician payment facility down 3.8% ($115 down to $110.57)

ASC up 16.6% ($317.46 up to $370.07).
HOPD up 18.4% ($669.9 up from $565.8)

they did get rid of add on levels for ASC and HOPD. it also looks like they tried to equalize all the injections for ASC/HOPD - ie $354 for almost all the peripheral nerve blocks.

office based procedures is trouble...

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fyi stim4u, the topic is the draconian cuts enacted by CMS. not pinning the blame on "progressives" or liberals.

got something meaningful to add?


didnt think so.
Ducttape you are dumb as nails....And it is losers like you that have ruined and supported this dectruction of our health system.

The CMS director is a socialist that wants to emulate the British system. He wants a single payer system with NO coverage of interventional pain management. A 15 member advisory committee has nothing to do with this, which was clearly set up by ACA???
Look up NASPER, dumb ass.... Read a little. Or even better, suffer from these cuts, and go bankrupt bother, you deserve it.

I suggest that the forum members have all their family members have this letter signed as well, and get up to 10 people to support our cause. Complaining on this site will do little. Get the work out....

Because idiots like ductappe and socdoc/lonel are beyond help, and will not help practicing doctors with this lunacy.
 
Ducttape you are dumb as nails....And it is losers like you that have ruined and supported this dectruction of our health system.

The CMS director is a socialist that wants to emulate the British system. He wants a single payer system with NO coverage of interventional pain management. A 15 member advisory committee has nothing to do with this, which was clearly set up by ACA???
Look up NASPER, dumb ass.... Read a little. Or even better, suffer from these cuts, and go bankrupt bother, you deserve it.

I suggest that the forum members have all their family members have this letter signed as well, and get up to 10 people to support our cause. Complaining on this site will do little. Get the work out....

Because idiots like ductappe and socdoc/lonel are beyond help, and will not help practicing doctors with this lunacy.

This is rather counterproductive. The left leaning posters on this board are pain physicians just like the rest if us who hold different world views. Some of them I agree with, and some of them I do not. Regardless, I respect their views and opinions.

We all knew this day was going to come. We ALL knew that Medicare/Medicaid is a Ponzi scheme just waiting to collapse. We all knew that it was going to get worse before it gets better. What surprises most of us is that it is collapsing this quickly.

Medicare/Medicaid/third party insurance paying for every penny of patients health care is unsustainable. Eventually, we will have a two tier system, where all of the entitled can get their free Obama/Hillary care. There will also be a cash pay tier where those who want quality and timely care can go and pay reasonable prices.

Until this mess of a system crashes, we will not have a great opportunity to get back to practicing medicine the way it was done pre Medicare. Up until that point, I plan to adapt and survive. Everything done at ASC, no CESI, 20+ f/u in the am clinic, etc. And when Hillary comes in to finish the job in 2016, hopefully the well respected, quality physicians can take the opportunity to create this second tier. Just think about it. No EMR, no pre auths, no meaningful use, no billing company, etc. Just you an your patients.

This is the silver lining that I am holding on to. I pray that I see it in the next decade. And for those fighting "socialized medicine," what the f**k do you think we have right now? We just have the worst of both worlds. So give the masses their single payer and let all the NPs do the injections for $10 while the rest of us escape out from under the government/insurance company bull****.

I do not blame anyone who voted for Obama. This was going to come no matter who was in office. Instead, I blame the a$$holes doing 90 pseudo ESI per day. To them, I would like to send out a massive F**K you!!!
 
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So yesterday, I called Congressman Bill Cassidy and Congressman Charles Boustany. As both these men are physicians and republicans in a bright red state, I figured they might be sympathetic. Neither have returned my calls to date.

I called Lee Snook, the AMA rep for ASIPP. He directed me to speak with Lax, who has not called me back, and Margaret Klys, the ISIS Director of Advocacy. As ISIS has a seat on the RUC, Ms. Klys was incredibly helpful.

1) ESI's are the only procedure that haven't been bundled with Fluoro. As a result, when you make $103 on the L/S ESI, and $86 on the fluoro, you are generating $189. When you consider that a L/S TF-ESI generates $214, INCLUDING the fluoro, that is not unreasonable.

2) Remember those surveys they always ask us to fill out? When the dinguses among us suggest that it takes them 5-10 minutes to do an ESI, CMS takes that seriously. The last time the ESI codes were evaluated, procedures were still being done in the hospital with those fluoro units on sleds. Clearly, that took significantly more time.

3) Despite the above, the AMA RUC actually only recommended a cut of between 5-10%, like all the other procedures we do (other than stim). However, CMS decided this was not appropriate, and instead implemented the draconian cuts we are all pissed about.

4) The good news: These cuts ARE NOT FINAL.

A) The CMS commenting period is still ongoing. Ms. Klys said ISIS, in coordination with ASA, is working to put together comments appropriate to counter the CMS rationale.

B) When appropriate, she will provide us with appropriate talking points we need to focus on. However, venting and political BS is not helpful, and will be a waste or time and effort. Points need to address CMS's rationale for why they felt the cuts were appropriate.
5) The bad news: even if we some how are able to get the cuts reduced or reversed, increases in payment will not go into effect until 2015.

6) Ms. Klys said she would never discourage you from having a conversation with your elected representatives, but at this point, it is in the hands of CMS, NOT the Congress.
 
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Ducttape you are dumb as nails....And it is losers like you that have ruined and supported this dectruction of our health system.

The CMS director is a socialist that wants to emulate the British system. He wants a single payer system with NO coverage of interventional pain management. A 15 member advisory committee has nothing to do with this, which was clearly set up by ACA???
Look up NASPER, dumb ass.... Read a little. Or even better, suffer from these cuts, and go bankrupt bother, you deserve it.

I suggest that the forum members have all their family members have this letter signed as well, and get up to 10 people to support our cause. Complaining on this site will do little. Get the work out....

Because idiots like ductappe and socdoc/lonel are beyond help, and will not help practicing doctors with this lunacy.

again, resorting to namecalling and defamation. nice one stim. woo hoo.:rolleyes:


if you want to get into a political discourse, please just answer the following questions: what was the alternative that was postulated by the conservative that ran for office? or did he kowtow to the tea party republicans and not put out a definitive proposal that was an viable alternative to the disaster economically that has been health care?

by what marker has the US health care system demonstrated it is doing well? not financially, for sure, as it has been outstripping all other financial markers. we spend more on health care as a portion of GDP than any other nation in the world. not healthwise, as the average life expectancy of americans as a nation is somewhere ranked 35-40th in the world, depending on who you read. not based on the amount of opioids used, as we americans consume over 80% of the worlds opioid supply.

something was going to be done. its unfortunate that the conservative tea party sabotaged the republican candidate, and obama got reelected (and yes, i did vote for him, because the other guy had no plans, nothing at all).

who should suffer for the crisis are those greedy insurance company execs, hospital admin, and pharmacy directors. they are getting off scot free.
and maybe the guys abusing the system, including some pain docs billing millions for bilat multilevel TF q2week.

ill tell you - if Romney had a definitive plan that targetted these greedy bastards, i would have voted for him.

ill say it again - i completely disagree with the views and decisions of CMS and the Health and Human Services director.

(ps i sent my Capwitz in already. and i am hospital outpatient based, and employed by a hospital system, cause i was rightfully thought 4 years ago that this would occur).
 
I love being punished for being able to do something faster. When I was doing gas Medicaid decided to pay by time spent in contact with the pt, so if you popped in the labor epidural in 5 mins you got paid less than the klutz who tried 3 times.
 
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again, resorting to namecalling and defamation. nice one stim. woo hoo.:rolleyes:


if you want to get into a political discourse, please just answer the following questions: what was the alternative that was postulated by the conservative that ran for office? or did he kowtow to the tea party republicans and not put out a definitive proposal that was an viable alternative to the disaster economically that has been health care?

by what marker has the US health care system demonstrated it is doing well? not financially, for sure, as it has been outstripping all other financial markers. we spend more on health care as a portion of GDP than any other nation in the world. not healthwise, as the average life expectancy of americans as a nation is somewhere ranked 35-40th in the world, depending on who you read. not based on the amount of opioids used, as we americans consume over 80% of the worlds opioid supply.

something was going to be done. its unfortunate that the conservative tea party sabotaged the republican candidate, and obama got reelected (and yes, i did vote for him, because the other guy had no plans, nothing at all).

who should suffer for the crisis are those greedy insurance company execs, hospital admin, and pharmacy directors. they are getting off scot free.
and maybe the guys abusing the system, including some pain docs billing millions for bilat multilevel TF q2week.

ill tell you - if Romney had a definitive plan that targetted these greedy bastards, i would have voted for him.

ill say it again - i completely disagree with the views and decisions of CMS and the Health and Human Services director.

(ps i sent my Capwitz in already. and i am hospital outpatient based, and employed by a hospital system, cause i was rightfully thought 4 years ago that this would occur).

I guess I am clueless. Not sure how this is NOT political. If republicans, or even an independents were in control, our issues would be addressed more immediately (as discussed above). My office and friends have sent 20 Capwitz letters to democratic representatives today. What will that do? And as amph confirmed, this is a function of CMS and a socialist progressive director (placed by democrats) that is shifting this system in to a NASPER model. Even Congress cannot do anything, only public opinion can help us. If people don't think this is political, you are living in la-la land.

Sorry for the harsh works ductappe, but the reality is that a GOOD ECONOMY is the answer that fixes most evils. Sorry if this is in direct conflict with your 'anti-capitalism redistribution model' but be very clear, this is a democratic single-payer system play. If you don't believe it good luck in the next few years. I will opt out of medicare later this year, what are you going to do?....take care.
 
something was going to be done. its unfortunate that the conservative tea party sabotaged the republican candidate, and obama got reelected (and yes, i did vote for him, because the other guy had no plans, nothing at all).

Yes, Romney and the Republicans had a plan and even if they don't, Obamacare is a radical reform that's based on ideology. The government is incapable of running healthcare ,Period.

who should suffer for the crisis are those greedy insurance company execs, hospital admin, and pharmacy directors. they are getting off scot free.
and maybe the guys abusing the system, including some pain docs billing millions for bilat multilevel TF q2week.

You kept blaming the crooks and criminals of the system. There will always be criminals in the society. The majority of the physicians are only trying to make a living and do the right thing.

ill tell you - if Romney had a definitive plan that targetted these greedy bastards, i would have voted for him.

Nice try. Really nice try.

ill say it again - i completely disagree with the views and decisions of CMS and the Health and Human Services director.
Hello? CMS is under Obama's watch.

(ps i sent my Capwitz in already. and i am hospital outpatient based, and employed by a hospital system, cause i was rightfully thought 4 years ago that this would occur).

Congratulation. What's your crystal ball for the lottery #s? Since you are doing so well, I would love to see you donate half your next year's salary to our national debt.
 
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I guess I am clueless. Not sure how this is NOT political. If republicans, or even an independents were in control, our issues would be addressed more immediately (as discussed above). My office and friends have sent 20 Capwitz letters to democratic representatives today. What will that do? And as amph confirmed, this is a function of CMS and a socialist progressive director (placed by democrats) that is shifting this system in to a NASPER model. Even Congress cannot do anything, only public opinion can help us. If people don't think this is political, you are living in la-la land.

Sorry for the harsh works ductappe, but the reality is that a GOOD ECONOMY is the answer that fixes most evils. Sorry if this is in direct conflict with your 'anti-capitalism redistribution model' but be very clear, this is a democratic single-payer system play. If you don't believe it good luck in the next few years. I will opt out of medicare later this year, what are you going to do?....take care.

So you are saying you want Bill Clinton in office again?
 
the point - focus more on trying to affect changes, less with pointing fingers and berating each other for political standpoint. these changes are announced. do we stand on top of the sinking ship and say "i told you so" "no I told YOU so", or do we try to find a liferaft, vest, send SOS.....

you sent letters. i sent letters. im telling patients and other pain docs that arent up to speed, and hopefully some of them will send letters.


i am going to stay HOPD employed physician, and yes, that is playing into the hands of the enemy. but i have lots of debt from 2 residencies and a fellowship and 3 kids.

ironically, these draconian cuts actually might improve my clinic's revenue and financial status. that being said, i am still going to put out my voice in support of all practitioners of board certified IPM, including office based.

Congratulation. What's your crystal ball for the lottery #s?
lucky guess... or listening to some of you guys too much...
 
To try and reiterate, letters may help you feel better, but despite what Lax says, they will have no impact in this process. When our RVS Update Committee (RUC) representatives give the green light, making intelligent comments during the public comment period that address thee specific reasons why the value of the codes were lowered may have some effect.
 
I lived with a congressional aide in DC years ago. She's the one who read the letters. They are all over the map with requests for sympathy, predictions of disaster, and everything in between. I agree with ampaphb, the most effective method is an organized process. Not that the individual letters now can't help, just that they are probably low yield.
 
So you are saying you want Bill Clinton in office again?
sure, I voted for Clinton. Maybe we need Obama to accept BJ's in the back room, while the republicans run the country.
As for what we can do; 1. drop medicare en-mass, 2. take it to the media, 3. strike, 4. repeal ACA with a new health model (ie. Paul Ryan's plan).
good luck all. Did not think this was going to happen before 2016, when the PRQS incentive are disappear...
 
So does anyone have a $ estimate for ultrasound guidance?

We ran our numbers today for a worst case scenario and it's about a 30% hit for us (whole practice). We ran our numbers for HOPD and get basically 3x office numbers. Very strong incentive to sell our and merge.
 
From ASIPP:


December 11, 2013

Dear Ligament:



We sent you a letter yesterday along with a fact sheet which can be found at the top of this letter and on the ASIPP homepage, however, today we wanted to talk to you about how to successfully lobby on this issue.



ASIPP has a Capwiz account for our members because it is the most efficient and effective way to send the letters.



Please don't stop at sending your own letter, or even 2 or 3 other letters. Each physician should make a conscious effort and send minimum of 500 and as many as 2,000 per physician. Obviously this will mean if there are 10 people in your group minimum will be 5,000, and may be able to send as many as 20,000 or so. It is extremely important that we send as many letters as possible. Here is the process:



Computerized Signatures:

The traditional way is to divide the patients into the state and congressional district in which they live. Following this you put one letter for each congressional district and state. This letter will be addressed to CMS, congressman, and both the senators.



If you have patients from 4 states, you need to have 4 different types of letters based on their congressional offices. If your patients come from 10 congressional offices, you will have 10 different letters. Click here for an example for the KY 1st District letter.



Show the patient this letter and if they are willing to sign make sure they provide their address, phone number, e-mail, etc. as we have shown in the example letter above.



Preferably that same day one of your staff members will enter all the names along with the addresses using the patient letter Capwiz link. This will produce a customized letter to CMS, the member of the congress, and to both senators as one letter. If you have personnel onsite to do this, this is the best approach. You can ask the patients, their attendants, staff, and each and every one to sign on to the computer itself.



You should keep the addresses, etc. of the person who is signing the letter and after making a copy to keep, mail one to each addressee. Again, this may not reach the authorities on time and no action may be taken. However, if this is the only way you can do this. As the saying goes, doing something is better than doing nothing. We will always be ahead of the one who is doing nothing at all.



Let us get to work. We will be monitoring the number of letters going. All the letters going through ASIPP website will be known to us; however, if you send them outside we will not know about them. You may want to send us a copy of those letters.




Capwiz Link for Pysician Letters

Word Version for Physician Letters



Capwiz Link for Patient Letters

Word Version for Patient Letters



Fact Sheet



Fee Schedules



Save IPM Fund



If you have any questions, please feel free to contact Melinda Martin, [email protected], 270-554-9412, ext. 215 or Summer Moffitt, [email protected], 270-554-9412, ext. 204.



Thank you,





Hans C. Hansen, MD

President, ASIPP

Medical Director

The Pain Relief Centers, LLC

224 Commerce St

Conover, NC 28613

Phone: (828) 261-0467

Fax: (828) 261-7293

[email protected]


Laxmaiah Manchikanti, MD

Chairman of the Board and Chief Executive Officer, ASIPP

Medical Director, Pain Management Center of Paducah

Clinical Professor, Anesthesiology and Perioperative Medicine

University of Louisville, Kentucky

2831 Lone Oak Road

Paducah, KY 42003

Phone: 270-554-8373 ext. 101

Fax: 270-554-8987

[email protected]
 
Aren't ESI bundled with fluoroscopy already?
 
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Answering my own question here, the number I received from my biller is $70.


So does anyone have a $ estimate for ultrasound guidance?

We ran our numbers today for a worst case scenario and it's about a 30% hit for us (whole practice). We ran our numbers for HOPD and get basically 3x office numbers. Very strong incentive to sell our and merge.
 
FYI: I have confirmed that my letter below will be running nationally on KevinMD.com in the next 1-3 weeks, which gets hundreds of thousand of readers, monthly. I think it's crucial we not only take this to Congress and CMS, but take it public, to the American people, to let them know how drastically these cuts will effect their access to healthcare. It is the voters after all, that politicians are more likely to listen to, rather than a bunch of doctors seen to be complaining. Please send your letters to every newspaper, blog, news station, family member and media outlet. I'll post a link when it runs on the website. See below.

As a Pain Physician, I would like to personally explain to President Barack Obama, Kathleen Sebelius, senior citizens and any disabled American suffering in pain, the devastating effects that will result from the drastic Medicare cuts in chronic pain care that are scheduled to take effect January 1, 2014. These cuts will severely, drastically and unfairly cut access to chronic pain care for senior citizens and other Medicare beneficiaries and at the same time promote the worsening of the prescription drug abuse epidemic. This is the wrong medicine, at the wrong time.

Now a Pain Specialist, I started my career as an Emergency Physician, and for years I took care of thousands of patients suffering from pain, as well as countless patients suffering from the ravages of prescription opiate addictions and overdoses. After more than a decade in Emergency Medicine, I re-dedicated my career to becoming a Pain Management specialist, by being one of the first Emergency Physicians to complete an ACGME accredited Pain Medicine fellowship, and earn ABMS Pain Medicine board certification. I did this with the expressed goal of committing my career towards simultaneously easing the suffering of those in chronic pain with keen attention towards non-addictive treatments that would help ease suffering, yet not contribute to the terrible prescription drug overdose epidemic occurring in the United States today.

Tragically, on November 27th, 2013, Medicare published its final payment rule for 2014 that will enact a crushing blow to funding for chronic pain care, particularly non-narcotic, and non-addictive pain procedures and injections provided in doctors’ offices. Such procedures include epidural steroid injections, nerve blocks, joint injections and pain-relieving spinal cord stimulators amongst others. The judicious use of such procedures is a crucial weapon in the battle against chronic pain many senior citizens and other disabled Medicare beneficiaries face, particularly for those physicians who choose to focus on non-narcotic and non-addictive treatment options. For such procedures performed in a physician’s office, the cuts are drastic and across the board, including cuts up to 58% for epidural steroid injections, and over 75% for in-office spinal cord stimulator trials. Nearly every other procedure a Pain specialist performs will be cut by at least 5-25%. Cutting such treatments will necessarily have the unintended effect of increasing the use of the other main option to treat chronic pain: narcotics.

Such drastic cuts will naturally reduce the most highly-trained Pain Specialists’ ability to provide quality, safe and non-addictive treatment options to their patients. For a physician who just started his own practice just over a year ago, these sudden cuts are devastating. I may not be able to stay in business or provide the quality care my patients need. The startup and ongoing overhead costs for an Interventional Pain practice including equipment and staff are in the hundreds of thousands of dollars, not to mention student loans from medical training.

Simultaneously, while cutting physician fees provided in a physician’s office, Medicare has opted to increase funding for the same identical procedures provided in hospitals. These procedures provided in a hospital already cost 5-6 times more than when provided in a physician’s office, for the identical procedure. Yet, Medicare has opted to increase such already more expensive payments up to 20% while drastically decreasing funding to physicians providing the same care at already much cheaper fees in their offices.

In summary, such cuts by Medicare will deal a crushing blow to senior citizens and disabled Medicare patients in chronic, severe pain, while at the same time reducing the ability of the most highly-trained Pain specialists to provide such care. The result will be to encourage the prescribing of already overprescribed narcotic pain medications that are contributing to the >15,000 yearly deaths by prescription pain killers. Patients will not be able to afford the cost of the best and safest treatments if forced to pay out-of-pocket. I urge those that suffer with chronic pain, and those with a loved one suffering in pain, to please call or write your US Congressman, the United States Secretary of Health and Human Services Kathleen Sebelius, President Barack Obama, and anyone else who cares about the disabled, and those suffering in chronic pain. Tell them to stop these harmful cuts now.
 
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Answering my own question here, the number I received from my biller is $70.

So US guidance code now pays less than fluoro guidance code? That's just great.

I was really close to buying an ultrasound machine, but decided to wait a couple months because I was worried about this happening.

Guess I'll be doing the hips and shoulders with fluoro.
 
Do you think King O, Sebelius or anyone in this administration care about you, us or our complains? Majority of Americans don't want Obamacare and we are force to take it in the chin. Hey folks, suck it up or go home. The only glimmer of hope is to repeal Obamacare and you know the only way to make it happen is to vote out these Dems and liberals.


We have tended to be somewhat myopic here. Yes, interventional pain management is in the middle of the battle but every other specialist is getting "shot" as well. Oncology and cardiology are getting it even worse than us. Our best strategy may be to unite across the board as all specialists. Divide and conquer has been a tactic that has worked well by insurance companies and now the government. The government has declared war on all specialists. For us to make any traction it is going to take the combined effort of all specialists.

It is clear to see the strategy:

1) Cut pay across the board to all specialists effectively eliminating them or forcing them into the hospitals.
2) Give the hospitals an ever increasing set of rules. Hospitals will then pressure docs to not do certain procedures and will have the leverage to do so.
3) From this point it is hard to predict the next moves but it will undoubtedly lead to rationed care and possible elimination of private insurance/movement to a single payer system.


They are running a playbook. It is evil and meticulous. It will take the combined effort and a near revolution to overthrow it. We must combine with other specialists if we have a prayer. Otherwise we will all go to private pay. That strategy will not work very long either as they will make acceptance of insurance/government patients a condition of licensure.
 
4) The good news: These cuts ARE NOT FINAL.

A) The CMS commenting period is still ongoing. Ms. Klys said ISIS, in coordination with ASA, is working to put together comments appropriate to counter the CMS rationale.

B) When appropriate, she will provide us with appropriate talking points we need to focus on. However, venting and political BS is not helpful, and will be a waste or time and effort. Points need to address CMS's rationale for why they felt the cuts were appropriate.
5) The bad news: even if we some how are able to get the cuts reduced or reversed, increases in payment will not go into effect until 2015.

6) Ms. Klys advised that she would never advise that you not have a conversation with your elected representatives, but at this point, it is in the hands of CMS, NOT the Congress.

I'm going to start planning as if the cuts are final.

We tried this with the EMG cuts (going through the CMS refinement panel process). No dice.
 
Answering my own question here, the number I received from my biller is $70.
So US guidance code now pays less than fluoro guidance code? That's just great.

I was really close to buying an ultrasound machine, but decided to wait a couple months because I was worried about this happening.

Guess I'll be doing the hips and shoulders with fluoro.

Does anyone have the actual link to show the updated ultrasound guidance code?
 
Does anyone have the actual link to show the updated ultrasound guidance code?

I would like to see the break down between office and hosp/ASC as well if anyone has specifics.
 
We have tended to be somewhat myopic here. Yes, interventional pain management is in the middle of the battle but every other specialist is getting "shot" as well. Oncology and cardiology are getting it even worse than us. Our best strategy may be to unite across the board as all specialists. Divide and conquer has been a tactic that has worked well by insurance companies and now the government. The government has declared war on all specialists. For us to make any traction it is going to take the combined effort of all specialists.

It is clear to see the strategy:

1) Cut pay across the board to all specialists effectively eliminating them or forcing them into the hospitals.
2) Give the hospitals an ever increasing set of rules. Hospitals will then pressure docs to not do certain procedures and will have the leverage to do so.
3) From this point it is hard to predict the next moves but it will undoubtedly lead to rationed care and possible elimination of private insurance/movement to a single payer system.


They are running a playbook. It is evil and meticulous. It will take the combined effort and a near revolution to overthrow it. We must combine with other specialists if we have a prayer. Otherwise we will all go to private pay. That strategy will not work very long either as they will make acceptance of insurance/government patients a condition of licensure.


What we really need is:
1. an election
AND
2. an alternative plan

we need a Reagan (not a younger Bush or Romney...)


we can yell all we like, and group together all we like. im all for it. but i doubt those in power will listen to any of that.

what Congress and the White House will listen to is the possibility they will lose an election and be voted out of power.

unfortunately, the republican party is so fractured and beholden to its own superconservative factions that repulse the average American that this may not happen by the next election.
 
Maybe we can sell guns to the Contras to help pay for Medicare
 
Maybe we can sell guns to the Contras to help pay for Medicare

Really? I know you are one of the smartest and this is one of your jokes. Have you ever heard of higher taxes and income redistribution?
 
Here is the reply that I received after sending the capwiz letter yesterday ...



Thank you for contacting me regarding the cuts to Medicare and Medicaid Services. I appreciate hearing from you and welcome the opportunity to respond.
As you may know, Social Security, Medicare and Medicaid make up 40% of our federal budget. This cost and number is growing rapidly and is projected to consume the federal government’s entire tax revenue within 10-15 years or so. This looming crisis must be addressed as part of any serious proposal to return spending to sustainable levels.
While I do not have all the answers, first and foremost, I believe promises made to our seniors should be completely honored. People who are receiving Social Security and Medicare benefits should continue to receive 100% of those benefits and never be cut.
With the foregoing in mind, please know that, should legislation specifically concerning Medicare and Medicaid reform or more broadly reforming our entitlement program come before the House of Representatives, I will keep your views in mind.
Please feel free to contact me again in the future. You may wish to visit my website at http://brooks.house.gov/ for additional information about issues and legislation before Congress.
Sincerely,
Mo Brooks
Member of Congress
 
What we really need is:
1. an election
AND
2. an alternative plan

we need a Reagan (not a younger Bush or Romney...)

Don't act like you suddenly come to senses and will vote for the right candidate. You are a liberal and Obama/Dem supporter that I can see you from a mile away. Did we experience these kind of radical reforms under Bush? Alternative plan? There was one. But you only want to hear what you like to hear, so anything not Obamacare are noise to you.

we can yell all we like, and group together all we like. im all for it. but i doubt those in power will listen to any of that.

what Congress and the White House will listen to is the possibility they will lose an election and be voted out of power.
You certainly don't belong to the group that wants to work hard and get rewarded for their effort. Obamacare and the King have probably done irreversible damage to us. The only hope is not to make it worse. The middle class are being stepped on. I sure hope it is going to be a bloodbath next November for the democrats.

unfortunately, the republican party is so fractured and beholden to its own superconservative factions that repulse the average American that this may not happen by the next election.

Sure, Nancy Pelosi and Harry Reid are your idols? Both parties have their rotten eggs.

PS I don't want to make it too much off topic anymore. So, you have the last word.
 
Here is the reply that I received after sending the capwiz letter yesterday ...



Thank you for contacting me regarding the cuts to Medicare and Medicaid Services. I appreciate hearing from you and welcome the opportunity to respond.
As you may know, Social Security, Medicare and Medicaid make up 40% of our federal budget. This cost and number is growing rapidly and is projected to consume the federal government’s entire tax revenue within 10-15 years or so. This looming crisis must be addressed as part of any serious proposal to return spending to sustainable levels.
While I do not have all the answers, first and foremost, I believe promises made to our seniors should be completely honored. People who are receiving Social Security and Medicare benefits should continue to receive 100% of those benefits and never be cut.
With the foregoing in mind, please know that, should legislation specifically concerning Medicare and Medicaid reform or more broadly reforming our entitlement program come before the House of Representatives, I will keep your views in mind.
Please feel free to contact me again in the future. You may wish to visit my website at http://brooks.house.gov/ for additional information about issues and legislation before Congress.
Sincerely,
Mo Brooks
Member of Congress
This is why a CapWiz letter writing campaign for this issue is ridiculous. There are no bills currently before Congress that we are advocating for. Call your Congressperson's office, and ask to speak with his or her legislative aide who handles healthcare.

Specifically, the members who sit on Ways and Means, as well as Energy in the House, as well as Finance in the Senate, have jurisdiction over CMS
 
Has anyone found the CMS link to "comment" yet ("Final rule with comment period")?

Is there one?

I know we are all writing Sebelius and our Congressmen, but if CMS has a specific "comment" process we need to saturate that too. In the past, they've taken comments online.

Where is it?
 

Thanks but that's not where you comment...


Found it!


To officially comment to CMS on this, here is the link:

http://www.regulations.gov/#!documentDetail;D=CMS-2013-0155-10181

We all must, MUST, MUST, comment here too, directly to CMS to be heard. Let 'EM have it with you best argument. Outrageous cuts to CESI 58%, and how much skill, time and risk is involved in this procedure. Also, outrageous cuts to LESI 51%. Draconian across the board cuts to all IPM procedures of 5-10%. Also, a crushing cut to spinal cord stim with 100% reduction of L8680 and outrageously inadequate increase in 63650.

Explain how this will threaten your ability to provide these procedures to senior citizens and the disabled, threaten to force you to shut your practice down and leave the specialty, promote increased opiate prescribing, and hurt patient care. Also will drive care to the five fold more expensive hospital setting with it's very large facility fees.

If you don't comment here, the people who REALLY can change it won't even know you're upset.

Let's throw a Hail Mary, and maybe, just maybe they'll realize, "Wow, maybe we went a little too far here."

Let them know how highly trained you are and how you are NOT abusing these procedures AND YOUR PATIENTS SHOULD NOT BE FORCED TO SUFFER.
 
Please don't do that. It will be completely ignored. Those kind of impassioned arguments may well sway politicians and public opinion, but they will have no impact on the CMS petty bureaucrats.

Instead, please wait for the societies to come up with appropriate talking points. They understand what the CMS rationale was for the reductions, and only cogent, well reasoned, counter arguments based on data will win the day.

The final arbiters here are 27 subspecialty societies whose members sit on a committee. We all know the cuts are insane, but feeding them a line of crap like "patient access will suffer" or "I'll have to close my doors" is ineffective at best, and frankly, an outright lie.

If we have any chance at all of winning this argument, it has to be done with facts, not bull.
 
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Please don't do that. ...
Instead, please wait for the societies to come up with appropriate talking points. ...We all know the cuts are bullcrap, but feeling like them a lot of crap like patient access will suffer or I'll have to close my doors is simply ineffective at best, and frankly, an outright lie.

Uh...what?

"Patient access will suffer" is a lie?

Closing our doors a lie?

Wait for our societies to say different?

From ASIPP's home page:

"This may put 40% of pain physicians out of practice.
Reduce access to patient care
Increase Medicare expenses by $187 million."

ASIPP.org

Sit back and wait?

Are you kidding me?

On nov 29th I leaked the devastating stim cuts before anyone and no one believed it. Everyone sat on their hands and waited for our societies.

On Dec 5th I posted the final fee rule to the penny and sat around and waited....and waited...and waited....hoping our societies would tell me I had it all wrong.

Some sat around and waited, when I placed it in plain daylight to see.

Some people came on this site and doubted it, said it was "alarmist" and it's just the "SGR which will be fixed."

I'm not sitting around and waiting anymore.

You can sit around and wait to be cooked but I'm going to at least do my part to fight to save a specialty that when practiced properly has great power to do good, and the once great profession of Medicine, no matter how unlikely.

At best we'll pull off a long shot victory, and at worst, at least I'll go down while fighting.

Feel free to go down while "waiting."
 
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Don't act like you suddenly come to senses and will vote for the right candidate. You are a liberal and Obama/Dem supporter that I can see you from a mile away. Did we experience these kind of radical reforms under Bush? Alternative plan? There was one. But you only want to hear what you like to hear, so anything not Obamacare are noise to you.


You certainly don't belong to the group that wants to work hard and get rewarded for their effort. Obamacare and the King have probably done irreversible damage to us. The only hope is not to make it worse. The middle class are being stepped on. I sure hope it is going to be a bloodbath next November for the democrats.



Sure, Nancy Pelosi and Harry Reid are your idols? Both parties have their rotten eggs.

PS I don't want to make it too much off topic anymore. So, you have the last word.


no, i wouldnt vote republican (i have left ballots empty rarely).

a viable alternative would have made Democrats less willing to push through their reforms, more tentative, not empowered them by thinking the people wanted this. our government works best when it is balanced. there was no alternative plan. Romney never specified one.


and i take offense to the statement that i dont belong to a group that wants to work hard and get rewarded for my effort. is that just because i dont do PP? how do you know how hard ive worked and how hard i work?

EDIT: i was going to post a long winded commentary about how hard ive worked. its pointless, but if you want to get in a pee-ing contest, i can guarantee a tight contest.
 
The MGMA average pain doc makes ~$450k, so yes, is is bull to say you will be closing your doors.

What are you gonna do? Shut down if Medicare pays you less? Are you NOT going to do the right thing, because they cut your fee by $100? You know you would already gone to a concierge model if you could, so, given that you are still taking Medicare, you will earn a bit less. BFD.

So EMD, go right ahead, and rant like the ***** you sound like you are. You will be wasting your breath, but if it makes you feel better, that, of course, is all that matters.
 
The MGMA average pain doc makes ~$450k, so yes, is is bull to say you will be closing your doors.

What are you gonna do? Shut down if Medicare pays you less? Are you NOT going to do the right thing, because they cut your fee by $100? You know you would already gone to a concierge model if you could, so, given that you are still taking Medicare, you will earn a bit less. BFD.

So EMD, go right ahead, and rant like the ***** you sound like you are. You will be wasting your breath, but if it makes you feel better, that, of course, is all that matters.

ampaphb, What are we going to do?
I will:
1. Cut staff cost, and help the 16% under-employment rate
2. Order less supplies, consolidate my operations. Spend less.
3. Accept less desirable patients.
4. Opt out of crappy commercial contracts tied to medicare
5. charge ridiculously high fees to insurances, and write off 1/2 of out-of-network deductibles. which will still be cheaper for patients than their 10K current deductibles.
5. Move all crappy medicare cases to ACS, and buy more shares to offset losses. this can generate another 80K from lost CESI/LESI fees.
6. move away from governmental insurances.

What are you going to do? wait for ASIPP to write more letters? The majority of the forum members are clueless and clearly don't own businesses. If you actually ran a business, you realize there are many things that can be done, but in the end it hurts patients, and the country. TO date only fox news supports our cause. Show me a democrat that gives a **** about physicians.
 
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