Issue link: https://beckershealthcare.uberflip.com/i/170079
Pain Management 42 Should CRNAs Treat Chronic Pain? Q&A With ASIPP Chairman Dr. Laxmaiah Manchikanti By Heather Linder L axmaiah Manchikanti, MD, is the chairman of the board and chief executive officer of the American Society of Interventional Pain Physicians and Society of Interventional Pain Management Surgery Centers. He is also a clinical professor of anesthesiology and perioperative medicine at the University of Louisville (Ky.), and he practices anesthesiology and pain management at several surgery centers. ASIPP opposes the final rule from The Centers for Medicare and Medicaid Services to allow Medicare funds to pay for certified registered nurse anesthetists to diagnose and treat chronic pain. The organization has gathered support of approximately 30 members of Congress, who have written CMS asking them to withdraw the regulation, Dr. Manchikanti says. Two senators and one representative also requested a U.S. Government Accountability Office study to evaluate if nurse anesthetists are qualified to perform these procedures or not. Dr. Manchikanti weighs in on the CMS ruling and its potential effects on anesthesia and pain management. Q: What was ASIPP's reaction to the final rule by CMS to allow CRNAs to practice chronic pain management? Dr. Laxmaiah Manchikanti: We at ASIPP call it evidence by proclamation with a poor prognosis and certification by politics. We Dr. Laxmaiah Manchikanti were disappointed, but even more stunned and appalled. This may be the first time in the history of the United States that CMS will take a position when a certain group of providers are not educated, not experienced and not trained to provide medical care. Several members of Congress overwhelmingly oppose the CMS decision; the General Accountability Office is looking into whether nurse anesthetists are qualified to perform interventional pain management procedures. It is the opinion of many that this rule definitely will not hold up because of the impending GAO study. Q: What were the main considerations for the rule? ANTICIPATE CHANGE. WE DO. The ASC Revenue Cycle. It's all we do. It's all we think about. And it shows. Named one of the world's best outsourcing service providers – Fortune Magazine 2012 LM: The main considerations are political, rather than focusing on the issue of access. As of now, nurse anesthetists perform only 1 percent of interventional pain management techniques. They also consider all interventional pain management techniques to be blind epidural injections. There is overwhelming evidence that blind epidural injections do not work and further, they can cause serious problems. Epidurals are less than 50 percent of interventional pain management. Access is a nonissue as there are qualified, well trained pain physicians within a 40 to 50 mile radius of every city and county in the United States, with the possible exception of some rural areas, which have longer distances to travel, for any type of care. CMS has ignored taking into consideration these nurses' lack of training. They have only used as the basis of their decision that student nurse anesthetists' curriculum in the future will include chronic pain management. Interventional pain management is a medical discipline with defined interventional techniques that should only be performed by physicians who are well trained and qualified. Q: What will be the results of this rule for the practice of anesthesia and pain management? LM: The results of this rule could be devastating. Hospitals are supporting this so that they can have better leverage on well-trained physicians. Some physician groups may be supporting this because of their own special interests as they can start these clinics in their offices and provide everyone with a certain number of epidural injections. 2012 ® 636.273.6711 | www.nationalASCbilling.com The problem will be that these patients will be started on opioids and will not be followed by these physicians. Further, they will exhaust their number of interventional techniques to be performed. No one will approve any further treatment. Patients will suffer afterwards. The only thing these patients will have are side effects from these inaccurately performed treatments including weight gain, osteoporosis and other issues related to excessive steroid admin-