ACGME Pain Fellowship +Boards means nothing now unless ABA

[emd123]

Did anyone catch this?

In the final CMS LCD for Palmetto GBA, you are only considered subspecialty certified in Pain Management if certified by the ABA only (not PMR, psych/neuro), and you are essentially not considered Board Certified in Pain, and cannot do in office stims based on that criteria, unless you have hospital privileges. If you have hospital privileges, you can do them with no training at all.

"Physicians performing SCS trials in the office setting must have like privileges at a local hospital or ASC, or the providers must be subspecialty boarded in Pain Medicine by the Amercian Board of Anesthesiology."

What about the other 3 boards that take the same exact exam?!



In other words, ACGME fellowship, plus ABMS pain boards by ABPMR, or American Board of Psych/Neuro, means NOTHING, even though you took the same damn fellowship and passed the same damn test as the ABA folks.

WTF?

I'm I the only one that caught this. Do other regions have this policy? Now, there is a loophole, that if you have hospital privileges, then you can do in-office stim with no Board certification and no fellowship (and probably even if you are a nurse/crna). But without hospital privileges, you cannot do in office stim, according to CMS in Palmetto, if you are PM&R, Neuro, or "other specialty" with ACGME Pain fellowship and Pain Subspecialty boards.


What if next year, they decide to delete the hospital privileges qualification? Then according to that wording, there will be no way for anyone non-anesthesia, despite an ACGME pain fellowship and despite passing the legit AMBS pain board exam written by the ABA, to do in-office stim. Then soon, private payers will follow. Then this will be extended to ESIs, RFs, TFs, MBBs, Kypho, SIs.

So my and your entire ACMGE fellowship, and Pain Boards, and the dozens of stims I did in fellowship are going to mean nothing?

Aparantly this could happen.

I'm sorry, but the anesthesia folks need to rally around non-anesthesia, ACGME Pain Fellowship trained docs, that passed the same ABA board exam as them, to get this changed before we fall down this very dangerous slippery slope. With all the weekend warrior sheisters out their that never even attempt to do a fellowship, with all the nurses and other people trying to do Pain with ZERO training, ACMGE fellowship + Pain Boards cannot be deleted and made irrelevant....

FOR ANYONE

 

[hyperalgesia]

Many people think the ABA is the one who boards everyone since they administer the exam. Hopefully they meant to say ABMS.

 

[emd123]

Many people think the ABA is the one who boards everyone since they administer the exam. Hopefully they meant to say ABMS.

Whether they meant to say it or not, they sure as hell didn't. I cut and pasted that quote right from the PDF. If they did mean to put "ABMS exam" or "aba pain subspecialty exam" they sure as hell need to fix it. Because if they mean to keep the hospital privileges part in there and just so happen to "oopsie" and happen to leave it out next year, that's going to ensnare a whole hulluva lot of people, that are top notch qualified to do stims, and are doing a lot of stims and will be cut off because of two "oopsies" 2 years in a row.



Loebel, aren't you in Palmetto?

 

[DOctorJay]

can you post the PDF or a link to it?

 

[hyperalgesia]

This was no "oops". I don't buy it. Not for a second.

I think it was an oops. But I totally relate to your frustration. Unfortunately the low levels that you will be able to communicate with will probably be like, "Oh you're not ABA, well let me make a note of that."

I think this was probably initiated to weed out untrained people, ARNPs, etc.

But it really pisses me off too. This is a good job for ASIPP or ISIS to clear up. Or ABPMR...

 

[lobelsteve]

This will be discussed at an AAPMR committee meeting on Friday 2/1/13.

Clarification regarding the ABMS vs administering boards will be addressed.

I believe it is an intentional error, just the same as the deletion of SCS codes for 2 weeks.

SML

 

[emd123]

can you post the PDF or a link to it?

I have the PDF in an email. I was going to post it here but I went to the CMS site to verify it and you have to click on a bunch of legal disclaimers, so due to that, I'm not going to post it publicly.

But I went to verify it and found something very interesting. It is listed under "draft" but on the draft it says it went in to effect 1/25/13.

Then when I went to the line I was quoting, I found something even more amazing.

They deleted this "must be subspecialty boarded in Pain Medicine by the Amercian Board of Anesthesiology" and added this, "Physicians performing SCS trials in the office setting must have like privileges at a local hospital or ASC, or be certified by the American Board of pain management"

So now, according to that update, even ACGME fellowship, +ABMS pain boards and Subspecialty certification by the ABA doesn't even matter, if you don't have hospital privileges. ABPM does.

Here's the link:

http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32548&ContrId=234&ver=15&ContrVer=1&CntrctrSelected=234*1&Cntrctr=234&name=Palmetto+GBA+(11202,+MAC+-+Part+B)&DocStatus=Draft&LCntrctr=234*1&bc=AgACAAIAAAAA&




Now I'm starting to think they are just confused, have no clue and need some help from ASIPP or ABPMR or someone to sort this out.


If you want the copy I have PM me and I'll email it to you.

 

[Ducttape]

they are obviously just confused and dont know about the bizarre multitude certifications we have in our practice. look, she didnt capitalize "pain management", suggesting that she does not know there is an ABPM vs. ABA.

which is why i advocate that there be 1 standard - Board Certification through ABMS, and grandfathering in with criteria for those not fellowship trained.

 

[stim4u]

It is a sad day when a CRNA can do a stim in the midwest, but a practicing PMR physician with fellowship is blacklisted. That is messed up my man. I imagine this will be changed.

 

[Pain Applicant1]

This was meant to help the field, not hinder it. It will be difficult for someone who is not trained in doing stim to gain the privileges at a hospital. It was designed to stop the fly by night trialers. There are some folk out there who will just open a trial kit and not care about anything else. They don't care if the patient gets relief. In fact, they don't even care if the trial lead goes in. Once you open, you can bill.

 

[jettavr6]

Nice... just did three stim trials in office today. I guess ACGME aint worth much these days. Then again, a Medical Degree isn't much either.

 

[emd123]

This was meant to help the field, not hinder it. It will be difficult for someone who is not trained in doing stim to gain the privileges at a hospital. It was designed to stop the fly by night trialers. There are some folk out there who will just open a trial kit and not care about anything else. They don't care if the patient gets relief. In fact, they don't even care if the trial lead goes in. Once you open, you can bill.

ACGME fellowship trained PMR/neuro/other with Pain Boards who did dozens of stim in fellowship are fly by night trialers?

It makes it EASIER for the fly by night trialers. All they have to do is convince some small hospital without an interventional pain program that they can make big bucks if they let someone that took a weekend course do stim trials.


You can get privileges at medium and small size hospitals in "Pain Management" easily with no fellowship, never having down a stim, but that allows you to do in-office stim?

In fact, that wording only says "hospital privileges" it doesn't even specify the privileges have to be in "Pain."



But ACGME Pain trained, ABMS boarded, who did dozens of stim in fellowship isn't enough, even though you did the same fellowship, and took the same ABMS test?

It makes people with no training able to do a highly technical procedure, and limits the people with the most training?

No, that makes the field worse, and is worse for patients.

It's idiotic, that's what it is.

 

[Pain Applicant1]

ACGME fellowship trained PMR/neuro/other with Pain Boards who did dozens of stim in fellowship are fly by night trialers?

It makes it EASIER for the fly by night trialers. All they have to do is convince some small hospital without an interventional pain program that they can make big bucks if they let someone that took a weekend course do stim trials.


You can get privileges at medium and small size hospitals in "Pain Management" easily with no fellowship, never having down a stim, but that allows you to do in-office stim?

In fact, that wording only says "hospital privileges" it doesn't even specify the privileges have to be in "Pain."



But ACGME Pain trained, ABMS boarded, who did dozens of stim in fellowship isn't enough, even though you did the same fellowship, and took the same ABMS test?

It makes people with no training able to do a highly technical procedure, and limits the people with the most training?

No, that makes the field worse, and is worse for patients.

It's idiotic, that's what it is.

Maybe so, but the reasons I mentioned are the reasons the policy changed. This was thought up several months ago. One way or another, something needed to be done specifically for the reasons I mentioned. Theoretically, it shouldn't be that easy to gain privileges as it becomes a liability for the hospital as well. I have privileges from a small hospital and I needed to have a slew of background, fellowship, residency, reference checks, etc. before they were granted. I'm sure the board certified issue will be resolved in the future.

 

[hyperalgesia]

The largest hospital system in my city is requiring ABMS Pain certification for all new docs requesting pain privileges. They are still trying to put that into words with difficulty.

On the OP, in my last 2 months of fellowship one of my anesthesia friends said he thought it was not appropriate how the ABA grants board certification to PMR docs. This is a BC pain fellowship trained anesthesiologist. And then I, as a rehab doc, had just learned otherwise. There is no way that these uneducated people in the insurance world, would know the intricacies and quirks of our boarding process. It's actually rather strange that ABA "administers" our exam.

Anyway my point is, as Mr.M once said, "Never attribute to malice that which can be explained by incompetence", (or something like that).

 

[lobelsteve]

This was no "oops". I don't buy it. Not for a second.


Lobel, aren't you in Palmetto?

Nope, leaving the shire for Bree this afternoon.

 

[Ducttape]

Nope, leaving the shire for Bree this afternoon.

Why O why did I ever leave my hobbit-hole?


emd, since CMS is obviously willing to change the terminology associated with that statement, they obviously are confused as to the specific board certification they are looking for.

you are finding demons where there only lie shadows.

petition the board and tell them the correct terminology - that SCS should be only performed by those individuals who have recieved Pain board certification from ABMS, or are in the queue.


of course, they will counter: "What about APBM certification?" "what about ASIPP/ISIS/whatever certification?" What about members of APF (i know its extinct, thank goodness)?" Thats why our certification needs to be unified and not this hodgepodge.

 

[Mister Mxyzptlk]

The anesthesia plot worked! Muwahahahaha! I told you we just had to pay the right people.