A Message from FAPM's President
CMS BLOG NOTICE!
Sponsor/Exhibitor Online Payment
FAPM CONFERENCE PROGRAM
OFFERS SPECIAL WORKSHOPS
Florida Academy of Pain Medicine annual Scientific
Meeting on June 26-28, 2015, is offering a new
format that includes 20 CME credits for all
attendees and four new workshop tracks.
Friday, June 26th there will be four
concurrent tracks from 1:00 - 5:00 P.M. on the
Regenerative Injection Therapy Principles and
Interventional Spinal Procedures
Integrative Approach to Basic Pain Management
FSPM&R Workshop that includes Osteoporosis
Diagnosis and Treatment, Integrative Medicine and
The Physiological Basics of Exercise for Strength
Saturday, June 27th the A, B, and C
sessions from Friday will be repeated. However,
Session D will have two segments. From 1:30 P.M. -
3:30 P.M. the topic will be "Protecting Personal and
Business Assets and Revenue Enhancement
Possibilities" and from 3:30 P.M. - 5:30 P.M. "Legal
Issues with Denying Patients Meds” by Assistant
State Attorney Dave Aronberg.
Sunday, June 28th from 10:15 A.M. - 12:15
P.M. there will be a Panel Discussion on "Concerns
over Patient Access to Controlled Substances".
Register online at fapmmed.net or by
telephone at 727-581-4319.
A Message from FAPM's President
It gives me great pleasure to
invite you to the Florida Academy of Pain Medicine's
Annual Scientific Meeting on June 26-28, 2015, at
Hyatt Regency Grand Cypress Hotel
in Orlando, Florida. As you know, Chronic Pain is an
astounding problem in today's society. By addressing
this issue we can have an impact on how we care for
our patients as we prevent or eliminate pain. We
recognize that pain exists on a continuum from acute
FAPM strives to be a leader with
our focus on pain education, including training and
practice. Our workshops are designed to give
attendees hands-on experiences in interventional
spinal procedures, ultrasound demonstrations and
integrative approaches to basic pain management.
With the ever changing practice
of pain medicine, FAPM prepares for our upcoming
annual meeting by providing each attendee with the
education and resources that place them at the
forefront of pain medicine. This year’s program
offers sessions that cover the wide range of pain
management, assessment, prevention and research.
The annual meeting is designed to
be uplifting, educational and innovative. It will
provide each medical professional with a wide
variety of information, excellent educational
sessions, expert faculty, and opportunities to
network with colleagues. You will receive updates on
legislative issues pertaining to the practice of
pain medicine and other regulatory issues that
affect your practice.
A copy of the
program can be found on our
website where you
can also register online.
I look forward to welcoming you to this event in
Orlando, Florida on June 26-28, 2015.
Jeffrey Zipper, MD
Regency Grand Cypress
the third consecutive year, the Hyatt Regency Grand
Cypress Hotel at Lake Buena Vista in Orlando, will
serve as the host hotel for the Florida Academy of
Pain Medicine’s Annual Scientific Meeting on June
Located in the area adjacent to Disney World and
Downtown Disney, the hotel is set within a 1500 acre
paradise that includes 45 holes of Jack Nicholas
signature designed golf, sailing on a private lake,
world class tennis courts, swimming pool with
waterfalls and waterslides, new spa services, and
special children’s programs.
hotel offers 815 stylish designed guest rooms, 46
luxury suites, three restaurants including the
classic “Hemingways” and many other amenities not
found in area hotels. Bus services are provided
regularly to Disney World and Downtown Disney.
luxury hotel further offers a reduced rate for
attendees at $169.00 per night, an exceptional rate
when compared to area hotels. This is a great family
friendly hotel, so come and enjoy this vacation
hotel with your family while earning your
re-licensing credits for this year.
Posted: April 24, 2015
By Shantanu Agrawal, M.D., CMS deputy administrator
for program integrity
Open Payments: Data review and dispute underway for
physicians – log in today
In its second year, the Open Payments program
continues to promote transparency and accountability
in health care by providing consumers with
information about financial relationships between
drug and medical device manufacturers and physicians
and teaching hospitals. The data posted has been
viewed nearly 6 million times and we’re pleased with
the continuing engagement of stakeholders on this
important transparency initiative.
All data for payments made in 2014 has been
submitted by the drug and medical device
manufacturers who are reporting the information. CMS
is encouraging physicians and representatives of
teaching hospitals to register in Open Payments now.
Instructions and quick tips for registration are
here. While companies that are submitting
payment records to CMS attest to the accuracy of the
continued success of the program relies on voluntary
participation by physicians and teaching hospitals.
This is the only opportunity for doctors and
teaching hospitals to review the data submitted by
manufacturers and group purchasing organizations
(GPOs) before it is included in the public database
on June 30, 2015.
the benefits of collaboration among physicians,
teaching hospitals and drug and device manufacturers
in the design and delivery of many life-saving drugs
Open Payments has given
patients a tool to become more involved and informed
health care consumers by discussing these
relationships with their physicians.
Last year, 26,000 physicians registered in the
system and lodged over 12,500 disputes. In contrast,
we published information about 4.45 million payments
made to at least 366,000 physicians or teaching
hospitals that were valued at $3.7 billion. I expect
that the data reported this year will be on scale
with the number and value of payments reported last
year. For physicians, the only way for each of you
to confirm that the data reported about you is
correct is to register and review your payments
before the review period ends.
To learn more about the program, visit
Emily Tillman, Operations Analyst
Medical Policy and Procedures
First Coast Service Options, Inc.
"When Experience Counts and Quality Matters"
Below please find a synopsis of bills that are
pertinent to our specialty! Links to the bills are
SB 728 with companion HB 1021 – These bills deal
with insurance company requirements for coverage of
opioid analgesics. Language- “A health insurance
policy that provides coverage for opioid analgesic
drug products: a) may impose a prior authorization
requirement for an abuse-deterrent opioid analgesic
drug product only if the policy imposes the
same prior authorization requirement for each opioid
analgesic drug produce without an
abuse-deterrent labeling claim which is covered by
the policy, and b) May not require use of an
opioid analgesic drug product without an
abuse-deterrent labeling claim before
providing coverage for an abuse-deterrent opioid
analgesic drug product.
SB 450 with companion HB4017 – These bills amend
the “pill mill” Statute 458.3265 and 459.0137 by
removing the January 1, 2016 sun-setting provision
presently in the Statute.
SB 532 with companion HB 281 – These bills seek
to allow PA’s and ARNP’s to order controlled
substances in a hospital setting under the
supervision of an attending physician. Language
– “A practioner who supervises a licensed PA or ARNP
may authorize the licensed PA or ARNP to order
controlled substances for administration to a
patient in a facility licensed under chapter 395”.
SB 614 with companion HB 547 – These bills seek
to allow PA’s and ARNP’s to designate themselves as
a controlled substance prescribing practitioners
under FS 456.44. Allowing them to prescribe all
schedules of CS’s in an office setting!
Links to the individual bills:
Jeffrey A. Zipper, M.D.
DEA crackdown causing legitimate pain
patients to suffer
The state of Florida recently endured the "pill mill
crisis," a proliferation of narcotic medication that
resulted in the reported overdose deaths in Florida
of approximately 7 people per day.
This crisis was the result of drug dealers paying
people to pose as patients in pain while presenting
to Florida physicians. Physicians and pharmacies
were either duped or knowingly participated until
2011, when the Florida Legislature dealt with the
crisis by passing legislation to regulate
prescriptions of narcotic medications.
Simultaneous with the Florida legislative action,
the Drug Enforcement Administration (DEA)
investigated, fined and suspended pharmacies that
were dispensing allegedly inappropriate
prescriptions. The DEA investigation resulted in
million-dollar settlements with national
pharmaceutical companies with operations in Florida.
These pharmacies must regulate themselves more
tightly than ever in order to minimize the risk of
further DEA actions. Unfortunately, the pharmacies
have gone too far and patient care is now suffering.
The dispensing policies of national chain pharmacies
have created a shortage of legitimate use pain
medicine in Florida. Fearing the DEA, the non-chain,
private pharmacies have also followed suit. Under
pressure these pharmacies are now observing strict
quotas for the sale of controlled substances.
I'm not referring to the shady guy on the street
corner, but instead about regular, everyday people
who require well regulated pain medication to
function. Under the guidelines established by the
state of Florida, legitimate pain medication clinics
see patients with acute and chronic pain. Some of
these patients have terminal illnesses, some have
debilitating arthritis and/or trauma induced sources
Through multi-modality treatments including
behavioral counseling, physical therapy,
chiropractic treatment, massage, acupuncture and
medications, many of these patients remain
functional members of our society.
Because the DEA has not established clear acceptable
guidelines for pharmacies, many pharmacies have
chosen to tighten their prescription dispensing
policies to the point that patients, without
warning, suddenly are told their prescriptions
cannot be filled. People are suffering.
In response to this situation, the Florida Medical
Association convened a meeting with representatives
from the Florida Board of Pharmacy, the DEA, the
Florida attorney general, the Florida Retail
Association, the Florida Society of Interventional
Pain Physicians, the Florida Academy of Pain
Medicine and the Florida Society of Physical
Medicine and Rehabilitation. The various meeting
participants expressed their positions, but
unfortunately the meeting did not result in any
resolution. The representative for the DEA denied
being the source of the problem, or that there was
in fact a problem to discuss.
Of course, the DEA is not an agency of health care.
Its job is to protect the U.S. citizens from illegal
use of drugs. To that end the DEA has succeeded on
its mission in Florida.
However it was obvious the legitimate needs of
suffering patients was not the concern of the DEA.
I believe the current situation will not change
until the American public demands Congress, which
regulates the DEA, to swing the pendulum back.
Things have gone too far.
Our politicians need to realize that while it is
vitally important to prevent inappropriate ordering
and dispensing of narcotic prescriptions, the pill
mill crisis in Florida is not what it was in 2011.
That period is over. The DEA watchdog is creating a
pain medicine shortage for patients who need these
medications to function.
I urge those of you who are affected or know someone
affected by this situation to contact your members
of Congress and express your desire for patients
with legitimate medical needs to always be able to
receive their necessary medicines for relief of
Jesse A. Lipnick, M.D., is board certified in
physical medicine and rehabilitation with added
qualification in pain medicine. He practices in
Gainesville and in Chiefland with Southeastern
Integrated Medical (SIMED). He serves as vice
president for the Florida Society of Interventional
Pain Physicians and is a board member for the
Alachua County Medical Society.
would like to wish everyone a safe, healthy and
happy holiday season!
I want to highlight this past year’s activities on
behalf of our membership and take a moment to
discuss some upcoming initiatives.
During this year’s legislative session, FAPM was
well represented by our lobbyist. Patient access to
controlled substances, as well as State pre-emption
for the regulation of pain management clinics, were
and remain at the top of our list. Other issues of
concern that were addressed include, insurance
companies denial of payment for many well
established interventional pain procedures based
upon them being deemed “investigational or
experimental” solely by the insurers own set of
criteria, and of course the annual Medicare and
Medicaid reimbursement issues. Next year our Academy
will continue to work closely with the FMA and other
State Medical Societies, in furtherance of causes
important to physicians and the patients we serve.
In FY 2013, Congress enacted a “temporary
doc fix” to the sustainable growth rate (SGR)
formula and have until April 1, 2015, to prevent a
projected 21% across the board cut to physician
Despite bipartisan support for a
comprehensive Medicare physician payment reform bill
in the past; House and Senate members have never
been able to agree on how to fund the measure.
Hopefully, with a Republican majority in both the
House and Senate, agreement on funding will come to
fruition by Q1 2015. On a positive note for those
owning surgical centers, CMS has adopted an ASC PPS
update of 1.4% for FY 2015.
In any event we will all need to make our
voices heard on Medicare physician payment reform
shortly. To that end, a letter writing campaign for
repeal of the SGR formula will be the first thing on
our plate for 2015. I will keep you posted!
This year, FAPM leadership supported FSIPP’s
resolution before the FMA’s legislative committee.
The resolution resolved to address “patient access
to opioid pain medications”. As a result of this
resolution, FMA initiated a teleconference between
all Florida pain related medical societies and
authoritative representatives from the DEA, Pharmacy
Associations, and Florida’s Board of Pharmacy.
I attended the October teleconference on
behalf of our Academy. I found it to be an open
forum where all parties had an opportunity to
clearly state their concerns and positions regarding
the dispensing of controlled substances by
pharmacists. All parties agreed that access to
controlled substances must be made available to
those in need. Furthermore, all parties seemed
interested in working together to resolve the
problems and will meet face to face in Q1 of 2015.
During next year’s legislative session FAPM
leadership will also work with the FMA and other
local pain related societies on the following
1) Preempt to the State all regulation
concerning the licensure, registration and
governance of PMC’s in an effort to void all local
municipalities and county ordinances in excess of
what is required by State law.
2) Legislation to prohibit commercial
insurers from deeming IPM procedures as experimental
or investigative when they are clearly covered
services recognized as reimbursable by a federally
funded government payor.
Lastly our annual three day Scientific
Meeting will be held on June 26-28, 2015. This year
we will be offering a full complement of 20 CME
credit hours on topics relevant to the practice of
pain medicine. Mark the dates on your calendar and
plan to join us at the beautiful Hyatt Regency Grand
Cypress Hotel in Orlando.
I wish all a Merry Christmas, Happy Hanukah
and Healthy New Year! I will keep you posted on
developments as we move forward this year with our
Jeffrey A. Zipper, M.D.
The battle for Florida
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.
Crunch time for Jeb Bush
says former Florida Gov. Jeb Bush is likely
facing his last shot at the White House, and
the pressure is on for him to enter the 2016
fray. His father, former President George W.
Bush, is reportedly eager for him to run.
Insiders are uncertain that a campaign will
come to fruition, and family concerns are
cited as one obstacle. A person who spoke
with Bush recently in Washington said, “He
told me two things: that he knows he has to
decide very soon, and that his wife is not
at all happy with the possibility.”
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
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
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?"
Walgreens’ Good Faith Dispensing Protocol
October 07, 2013 1:10 PM
To: Jeffrey Zipper
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
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.
Pill Mill Crackdown Pays Off
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.
congratulations to every physician and organization that stepped up
to the task that made these changes happen.
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."
- From 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
FAPM Conference Is Big Success
pre-conference programs on basic pain issues, ultrasound treatments
and physical medicine and rehabilitation, the conference provided
special training in multiple modalities. The pre-conference
workshops were followed by offering twelve CME credits in areas
related to pain medicine issues.
Featured speakers included Alan Harmon, MD,
President of the Florida Medical Association and Judy Foreman,
author of the bestselling book, “A Nation in Pain". The panel
discussions held on the second day featured specialists in various
disciplines, a representative on E-FORCE and PDMP issues, and legal
and legislative programs. Panel moderators were: Albert Ray, MD,
FAPM Past-President, and Jeffrey Zipper, MD, current FAPM President.
Highlights of the annual membership luncheon
included FAPM awards. Marla Golden, DO, received the Felix Linetsky,
MD, Education Award for her leadership and participation in FAPM
educational programs the past few years. The Distinguished Service
Award was presented to Jeffrey Zipper, MD, for his leadership in
legislative issues affecting the practice of medicine in Florida.
Lynne Columbus, DO, from Clearwater, Florida was elected to the FAPM
Board of Directors.
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
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
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
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.
Patient Op-Ed: Denying necessary prescriptions to needy patients
The Florida Academy of Pain Medicine is working diligently to bring
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
filled. Should you have any similar cases to report of patients not
their prescribed drugs in a timely manner, please let us know.
Together we can help
alieviate this problem.
Fraternally, Jeffrey Zipper, FAPM President
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
Jeffrey A. Zipper, M.D.
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.
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
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.
To review active, future, and retired LCD for jurisdiction 9, please
FAPM has a “Neutral” Position on Medical Marijuana
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
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.
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
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
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).
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.
ALERT, ALERT, ALERT
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
(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.
December 16, 2013
I would like to take this opportunity to wish everyone a safe
and Happy Holiday season. Once again the house of medicine is coming
under reimbursement pressure from the annual mandated Congressional
SGR formula cuts, budget sequester cuts, the President’s ACA and CMS
spending reductions. Cuts to MC reimbursement for those of us
practicing pain medicine are especially severe this year. The
private practice of medicine appears to be dying a “death by a
Thousand cuts” in the US! While this news is disheartening, it is
incumbent upon medical leadership to make our voices heard to
protect access to care for our patients and preserve our ability to
make a living.
The recent passage of the bi-partisan Congressional budget
deal has revoked 40 billion of the 63 billion automatic budget cuts
due to sequestration. The brunt of the remaining 23 billion in
budget cuts due to sequestration will largely be borne by physicians
and hospitals. Both physicians and hospitals will continue to be
subject to an automatic 2% across the board reduction in MC
reimbursement for our services for the next two years. Congressional
staffers believed that Medicare providers were the” least painful”
CMS recently released the FY-2014 MC Physician Fee schedule.
The schedule takes into account an automatic 24% SGR reduction
unless action is taken by Congress to avert this annual issue.
Presently the House Ways and Means Committee have unanimously
approved a bill to repeal and replace the MC SGR formula. Hopefully
passage by the House and Senate will follow. If the SGR cuts are not
repealed there will be devastating financial consequences for all
healthcare providers! Even if the SGR formula is repealed this year
physicians who provide IPM services for MC beneficiaries will
experience severe reductions in reimbursement for those services.
This is especially so for providers performing office based IPM
procedures. Your Academy will keep you posted as to the outcome of
On another note FAPM is preparing for this year’s legislative
session in Tallahassee. Dr. Stanley Dennison, Chairmen of FAPM’s
legislative committee, will be leading our legislative initiative
this year. We have two major legislative issues for 2014.
will once again seek to preempt to the State all regulation
concerning the licensure, registration and governance of PMC’s in an
effort to void all local municipalities and county ordinances in
excess of what is required by State law.
FAPM will seek legislation to prohibit commercial insurers
from deeming IPM procedures as experimental or investigative when
they are clearly covered services recognized as reimbursable by a
federally funded government payor.
To that end, we
have hired Mr. Chip Case from Jefferson Monroe Consulting to help
with our lobbying efforts and Mr. Brian Hughes from Meteoric Media
to facilitate a PR campaign on our behalf. Dr. Dennison and I will
be working closely with these gentlemen to help achieve our goals
for this year’s legislative session.
Lastly, many of
our member’s patients are experiencing difficulty obtaining
necessary opioid analgesic medications for treatment of their
conditions. This is leading to significant frustration and stress
for healthcare providers and our patients. FAPM will ask our PR
agency for help in designing and implementing a campaign focused on
addressing this situation in multiple media outlets. Hopefully, we
can put some pressure on legislators to address this issue.
I wish all a
Merry Christmas and Happy New Year! I will keep you posted on
developments as we move forward this year with our agenda
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
(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.
Chief Executive Officer
2014 Medicare OBS Reimbursement Rates for SCS Trials
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!
of Medicine Survey Reveals Florida Physicians’ Top Concerns
Florida Medical Association Installs
W. Alan Harmon, M.D.
as 137th FMA President
The Florida Medical Association installed Jacksonville physician W.
Alan Harmon, M.D., FACP, as its 137th President this evening during
the 2013 FMA Annual Meeting in Orlando. Dr. Harmon is known among
his colleagues as a dedicated physician leader who has made many
contributions to organized medicine.
“Dr. Harmon has served the medical profession at the county, state
and national levels, and he is committed to making Florida a better
place for physicians to practice medicine,” said FMA Executive Vice
President Timothy J. Stapleton. “His knowledge of the many complex
issues facing doctors today is a great asset to the FMA.”
Board certified in internal medicine and gastroenterology, Dr.
Harmon practices with the Borland-Groover Clinic in Jacksonville. He
graduated with honors from the University of Florida College of
Medicine in 1976, and he completed his residency in internal
medicine and a fellowship in gastroenterology at the University of
Alabama in Birmingham.
Dr. Harmon has served on numerous FMA committees as well as the FMA
Board of Governors and the FMA PAC Board of Governors. He has been a
delegate from the FMA to the American Medical Association, and he
also served as FMA Treasurer from 2007 to 2011. He is a Past
President of the Duval County Medical Society, the Florida Society
of Internal Medicine and the Florida Gastroenterological Society.
Dr. Harmon is a Fellow of the American College of Physicians and was
elected last year to the AMA Council on Medical Service.
Dr. Harmon succeeds Vincent DeGennaro, M.D., who served as FMA
President from 2012-2013. Other FMA officers for 2013-2014 are:
President-Elect Alan Pillersdorf, M.D.; Vice President Ralph J. Nobo
Jr., M.D.; Secretary John Katopodis, M.D.; Treasurer Ronald Giffler,
M.D.; Speaker David J. Becker, M.D.; and Vice Speaker Corey L.
Draws Record Attendance
Conference a Great Success
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
Felix Linetsky, MD and Albert
Ray, MD for recent publications in a major new textbook on Pain
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.
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
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
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
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.
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.
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
● 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
● 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
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~
NY Times- FDA Won't Require Special Training
the Court Fight to Protect Physician Medicare Data
Bondi's Weekly Briefing: Prescription Drug Diversion: Combating
Congress Approves 10-Month SGR
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.
House GOP agrees
to doc pay-rate extension
tells some Florida doctors it won't fill their prescriptions for
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
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
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.