Issue link: https://beckershealthcare.uberflip.com/i/170079
Pain Management istration and dependency on opioids. The floodgates will be opened for these patients to have future dependency and addiction problems. Q: The American Society of Anesthesiologists called the ruling dangerous to patient safety and said it could lead to increased cases of fraud. Do you agree? Are there other risks to this measure? LM: It is not just the American Society of Anesthesiologists. They are accurate in this. The American Society of Interventional Pain Physicians in essence spearheaded this process and the project. The GAO study was requested by ASIPP. This rule will increase fraud and abuse, controlled substance abuse, addiction and overuse, leading to numerous fatalities. The statistics at present show that 60 percent of the deaths secondary to opioids, deaths which have exceeded the number of motor vehicle injuries, are due to prescribed opioids. It is also interesting to note that the United States uses so much opioids that it if we were to give each person in the United States 5 mg of hydrocodone four times a day, it would last 45 days – that is each and every person in the United States. There are also major risks related to these procedures. If nurses start performing these procedures in the thoracic and cervical spine, they will cause spinal cord injury and nerve injury. Q: How do you foresee this measure impacting billing for anesthesia? LM: In the short run, there should not be any change in billing for anesthesia. However, as time passes on nurse anesthetists will be more empowered in conjunction with the hospitals and together they will try to capture higher revenues. This will affect the insurance companies and they will start fighting back and reducing reimbursement for everyone, including anesthesiologists, physiatrists and everyone else. This is, provided there is any insurance other than Medicare in the future. Q: Will any further advocacy efforts be made on behalf of your organization to oppose CMS' decision? LM: We will continue to oppose this rule. As stated, numerous members of Congress are appalled and disappointed at this rule. They continue to oppose it. This will be discussed when the U.S. Department of Health and Human 43 Services' funding comes in front of various committees. Further, the GAO study is on its way. The results will illustrate that these nurses do not have the proper training and we hope the GAO will then make an objective decision. The fact is that there is no training for nurse anesthetists to perform interventional pain management techniques. Their education is only one-third of what a physician's education and training entails. It will be extremely interesting to note if and when GAO says that these nurses are not qualified and yet they continue doing these procedures. This will be taken into notice by various states and they may start reversing their previous opinions of nurse anesthetists performing anesthesia independently. It may also spread to other professions, such as nurse practitioners and physician assistants. There are two types of consequences: one is unlimited practice with increasing fraud and abuse and the second one is more restrictions on these groups. Q: What do you think is at the root of this decision? LM: The final rule is devastating. It is a travesty. The entire issue boils down to the control of medicine. The medical profession is controlled by various organizations which are not coherent and oppose each other. These include Accreditation Council for Graduate Medical Education and American Board of Medical Specialties. The first programs recognized by the ACGME were accredited in 1993. The number of ACGME accredited programs and the number of trainees in accredited programs have grown steadily over the past decade, reaching almost 100 programs that train approximately 300 new pain specialists each year; there was, however a decline to 90 programs since 2006 due to stringent requirements. The ABMS is not controlled by medical groups and established specialty certification. In contrast, the nursing boards are the same as the nursing society and advocacy organizations, and it is mandatory nurses to have membership. Consequently, no one speaks against the boards because they are the boards. Essentially, 50 percent or more of the nurse anesthetists are categorically opposed to such an expansion. Even then, CMS and some active members of the group are pursuing these aspects. CRNAs would like to do many procedures which are difficult for even physicians to perform safely or comfortably unless they have had extensive training in the procedures. Overall, this is very sad news for the United States, in which will ultimately result in decreased quality of care and increased cost of healthcare. More than likely, this will also cause potential access to care issues and could even result in fatalities. n 5 Tips to Enhance Pain Specialist Communication With Primary Care Physicians By Heather Linder C ommunication break downs between primary care physicians and consulting pain management physicians can lead to inadequate and potentially hazardous patient care. Yousuf Sayeed, MD, of the Spine Center at DuPage Medical Group in Naperville, Ill., takes several steps with his patients to ensure open channels of communication with referring physicians. Communication is important for all specialties, he says, but pain specialists often have patients with unique needs requiring extra care. For example, often pain patients require powerful medications and many have underlying physical problems, such as disc pathology or surgical diseases. "A unique set of individuals may require higher levels of communication," he says. "Most primary care physicians don't witness these types of issues on a daily basis. With a pain management patient, heightened communication between pain management and primary care physicians alike can lead to much better collaborative care." The biggest challenge physicians face with pain patients is making sure the appropriate treatments are administered to bring the patient relief. If a pain physician's assessment doesn't reach the primary care physician, a follow-up could be missed or an acute treatment plan may not be properly executed, Dr. Sayeed says. Communication is vital for properly caring for patients. Patients with acute pain are often easier for primary care physicians and pain specialists to treat than patients with chronic pain syndromes, Dr. Say-