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                               IMPORTANT NOTICE !!!!
FAPM  annual membership renewal notices have been mailed to our membership list. This year the renewal can be paid online. The renewal fiscal year is January 1-December 31, 2016.
Thanks to each of you for your continued support of the
Florida Academy of Pain Medicine.


December 14, 2015 

Dear FAPM Members and Friends: 

At this busy season of the year, I wanted to take a moment to wish everyone a Happy Holiday Season and a wonderful New Year. As we are all involved in the medical profession, may each of us enter the New Year with renewed confidence in our abilities to treat our patients with the best possible care. 

As we face the issues confronting our medical professions, be assured that your FAPM Board Members will continue to address your concerns and interests in dealing with legislative matters, practice management issues, and medical education programs. 

Our “Executive Committee” is planning an excellent program for the annual FAPM Scientific Meeting to be held on August 12-14, 2016, at the beautiful Waldorf Astoria Hotel in Orlando. I hope you all are planning to attend this event. 

Let us all be proud of the profession we serve and strive for excellence in all that we do for our profession, patients and community. 

Fraternally yours,

Vinod Malik, DO

FAPM President



THE CAPITAL: TALLAHASSEE, October 20, 2015 ...... The Legislature may have inadvertently made it harder for legitimate patients to get critical pain medications when it passed a 2011 law aimed at shutting down rogue clinics that branded the state as the “pill mill capital" of the country. But now, a powerful state senator said he intends to fix the problem. (Read More)

Conference Moved 


The Florida Academy of Pain Medicine is moving the 2016 Scientific Meeting to the beautiful Waldorf-Astoria in Orlando. The dates for this event are August 12-14, 2016. This hotel offers luxurious guest rooms and suites, impeccable service, an exquisite pool, private cabanas, spa and much more.

Surrounded by Walt Disney World theme parks, the hotel provides luxury transportation to and from these parks. The hotel offers a program for kids in the WA Kids Club every day. The Fitness Center features a variety of cardiovascular and weight training machines along with morning yoga classes.

The hotel is home to a wide variety of superior dining locations with celebrity chefs, entertaining family eateries and one-of-a-kind hidden gems including the award winning Bull and Bear Restaurant. This restaurant was named Best Fine Dining by Orlando Home and Leisure, and offers a menu of trend setting fare. It is the only Florida restaurant to exclusively serve certified Angus Beef Prime Grade Cuts.

Now is the time to plan your family vacation at the Florida Academy of Pain Medicine Annual Scientific Meeting at the famous Waldorf-Astoria Hotel on August 12-14, 2016.

2016 Notice Waldorf

FL BdMedicineSealFL Bd Medicine

Pain Management Physicians If you are a physician practicing in a Pain Management Clinic and were registered based on the 6th qualification option in Rule 64B8-9.0131, F.A.C ., please keep in mind that as a part of your 40 hours of Continuing Medical Education (CME) required per biennium, you must complete 15 hours of live lecture format, Category I CME in pain management for every year you practice in pain management. These will need to be reported to CE Broker along with the rest of your CME credits in order for the Board to renew your license. Answers to many questions regarding license renewal can be found at the Board of Medicine's website at flboardofmedicine.gov 

CE Broker
Have you signed up for a CE Broker account?

License renewal is coming up for half of Florida's allopathic physicians in Jan, 2016 and for all of Florida's osteopathic physicians in March, 2016. This is the first year that the online renewal system will be linked to CE Broker, the Florida Department of Health 's online CME tracking system. If you haven't signed up for your CE Broker account and begun reporting, do so by visiting www.cebroker.com. There are three account options: free, professional and concierge. As an FMA member, you can get a discount on CE Broker's concierge service to take over the process of managing, tracking and reporting your CME. Simply send your certificates to CE Broker's trained staff members, and they will handle the rest.

Description: Felix Linetsky, MDCongratulations to
Dr. Felix Linetsky

Dr. Felix Linetsky, FAPM Board Member and nationally recognized medical education leader, has written a chapter in the Second Edition of Pain Medicine and Management – Just the Facts Textbook published by McGraw Hill. Chapter 71 – Regenerative Injection Therapy (aka – Prolotherapy was co-authored by Peter Peter Staats and Mark Wallace, MD. This book can be purchased from Amazon for the amount of $80.90.

FAPM Represented at Florida Board of Pharmacy’s
Controlled Substances Meeting (see below) 

The Florida Board of Pharmacy’s Controlled Substances Standards Committee recently met at Delray Beach, Florida, to discuss issues regarding the availability of certain medications for patients. They have been receiving numerous complaints from patients and physicians across the state regarding this issue. 

Jeffrey Zipper, MD, the Immediate Past President of the Florida Academy of Pain Medicine, attended this meeting representing the Academy. He noted that those attendees at this meeting made several recommendations for the board to consider. The board will review these matters and report back to the committee at the next meeting. 

FAPM will continue to monitor the activities of the Florida Board of Pharmacy, and report any new developments to the members.

2015 Meeting Best

  • FAPM Annual Meeting Hyatt Grand Cypress
  • Florida Academy of Pain Medicine
  • New President Vinod Malik MD presents Past Presidents plaque to Jeffrey Zipper MD
  • Jeffrey Zippper,M.D. presents the Distinguished Service Award to Albert Ray, M.D.
  • Felix Linetsky MD presents the Distinguished Educator Award to Michael Scarpone DO
  • Jeffrey Zipper MD outgoing FAPM President, Alan-Pillersdorf MD, FMA President and Kenneth Webster, EdD, FAPM Executive Director
FAPM Annual Meeting Hyatt Grand Cypress1 Florida Academy of Pain Medicine2 New President Vinod Malik MD presents Past Presidents plaque to Jeffrey Zipper MD3 Jeffrey Zippper,M.D. presents the Distinguished Service Award to Albert Ray, M.D. 4 Felix Linetsky MD presents the Distinguished Educator Award to Michael Scarpone DO5 Jeffrey Zipper MD outgoing FAPM President, Alan-Pillersdorf MD, FMA President and Kenneth Webster, EdD, FAPM Executive Director6




FAPM Welcomes New Board Member

At the FAPM Annual Scientific Meeting on Saturday, June 25, the attendees elected TSE CHUNG LEE, M.D. to the Board of Directors as a Member at Large. Dr. Lee is presently in practice at the PRC Pain Associates in Daytona Beach as an Interventional Physiatrist. He will be representing the FAPM at the FMA House of Delegates in Orlando.

Dr. Lee earned his medical degree at the Medical College of Ohio in Toledo, Ohio. He completed a residency in Physical Medicine and Rehabilitation at New York University, Rusk Institute in New York City. He then completed a Fellowship in EMG/Musculoskeletal/Spinal/Ultrasound in Napa, California under the direction of Marko Bodor, M.D.

He is further a member of the American Academy of Physical Medicine and Rehabilitation, the International Society of Interventional Spine and the American Institute of Ultrasound Medicine. He is a Diplomate of the American Board of Physical Medicine and Rehabilitation and of the American Board of Pain Medicine.

The Florida Academy of Pain Medicine is pleased to welcome Dr. Lee as the newest member of the Board of Directors.


2015-2017 Board of Directors
President - Vinod Malik, MD
President Elect - Stanley Dennison, MD
Vice President - Peter Taraschi, DO

Secretary - Felix Linetsky, MD

Treasurer - Kenneth Botwin, MD

Immediate Past President - Jeffrey Zipper, MD

Member-at-Large - Susanti Chowdhury, MD

Member-at-Large - Tse Lee, MD

Member-at-Large - Raul Monzon, MD

Member-at-Large - Albert Ray, MD

President's Message

As the newly elected President of the Florida Academy of Pain Medicine, I want to thank the Board and Members for the vote of confidence in my ability to lead this Academy.

At our recent FAPM Scientific Meeting in Orlando, we set records of the number of physician attendees and for the number of exhibitors. Our program offering 20 Category 1A CME credits was highly complimented by the attendees, and the exhibitors greatly appreciated the increased attendance and interest in their products and services.

I want to thank our Gold Sponsor, Medtronic and the other special event sponsors -St. Jude Medical and Quest Labs. On our website ­you can find a list of all of our exhibit sponsors and their services. I hope you will support them by using their services whenever possible.

Our membership will reach new heights this year, and I hope everyone reading this message will be sure to join FAPM. Our fiscal year ends on December 31st and you can pay dues on our website. In order for FAPM to remain a viable Academy, we need the support of every pain medicine physician in Florida.  

Speaking at our conference luncheon, FMA President Alan Pillersdorf, MD reminded everyone to support their medical associations so we can present a united front of strength as we face the challenges of our profession.

We are currently in the process of evaluating this year's conference, and planning for the 2016 program. Hopefully, each of you will want to attend that event in Orlando on August 12-14, 2016.

At this conference we will continue to offer a comprehensive program emphasizing pain medicine issues including interventional and integrated techniques. We plan to offer additional workshops and welcome any suggestions from our members on topics of interest to you. Just email your ideas to our executive office at websterk427@gmail.com .

Fraternally, Vinod Malik, MD
FAPM President

From the Immediate Past President:
New Physician Compensation Model Under MACRA

Dear Colleagues,
Below is my assessment of the new law that replaced the SGR legislation! 

 The SGR formula promulgated by congress has threatened physicians with payment cuts for the past decade. Making financial planning and growth of physician practices difficult.

 On April 16th 2015 the SGR formula was repealed and replaced by the Medicare Access and CHIP Reauthorization Act AKA (MACRA).

 The full impact of the new law, which will fundamentally alter the delivery of healthcare, is likely to be unknown for several years, as much is dependent upon regulatory actions of bureaucrats.  

MACRA permanently repeals the current SGR reimbursement formula and provides for a 10-year transition period to a new performance-based payment system with financial incentives for participation in alternative payment models.

First five years: Provides short term stability for physician payments received from MC.

1)    Payment updates to physicians are set to increase 0.5%/year

2)    This is less than the payment updates since 2009 which have averaged 2.4%/year

3)    These small payment updates will likely impact future pay increases from other 3rd party payors.


During the following five years (2019-2024): Payment uncertainty for physicians raises its ugly head again!

1)    Beginning in 2019 there will be no further automatic reimbursement increases for physicians providing MC services. 

2)    Physician compensation will be adjusted annually based on performance under the new law’s Merit-Based Payment Incentive System (MIPS). Which will consist of:

a.     Physician Quality Reporting System (PQRS)

b.     EHR/Meaningful Use Incentive Program

c.      Value-Based Payment Method (VBPM). 

3)    Under the new law MIPS will be based on four categories of annually developed metrics concerning:

a.     Quality measures

b.     Resource use

c.      EHR meaningful use

d.     Clinical practice improvement activities

These metrics will be selected by suggestions from professional entities and stakeholders. 

4)    The MIPS program will provide confidential feedback to providers concerning their performance on a quarterly basis

a.     Doctors with low MIPS scores will have their payments reduced in proportion to their scores.

                                                              i.      Negative payment adjustments will be capped at 4% in 2019, 5% in 2020, 7% in 2021, and 9% in 2022

b.     Physicians with composite scores above the threshold will receive positive payment adjustments capped annually at $500 million from 2019 – 2024 

5)    The Value-Based Payment Method (VBPM) increases begin in 2019

a.     This system is in place today, it is voluntary and is presently only open to groups of 100 or more providers.

b.     Payment increases based on VBPM will likely be difficult to achieve based upon the performance history of groups presently participating

                                                              i.      Of the 1278 groups eligible in the US, only 106 participated

                                                            ii.      Of the 106 groups only 14 were eligible for a payment increase, 11 groups incurred reductions in payments and 81 received no adjustment at all. 

Estimates are that MACRA will cost $214 billion and add $141 billion to federal budget deficits over 10 years. Spending reduction offsets will produce some savings, defraying a portion of the cost of the new law. Other cost savings will be achieved by policy changes aimed at Medicare beneficiaries and providers.

 The government will achieve cost savings through 

1)    Larger premiums for higher income MC beneficiaries starting in 2018 

2)    The minimum income threshold for income-related premiums will be adjusted upwards starting in 2020 and indexed for inflation going forward. 

3)    Post-Acute Care market basket will increase by no more than 1% 

4)    In-patient hospital rates will see a one-time increase of 3.2% phased in from 2018 through 2025 

5)    If you owe the government back taxes the new law gives the treasury department power to levy 100% of provider payments for back taxes rather than the current 30% until paid off.  

This new law and future payment methodology relies heavily upon regulatory rules that will be established by governmental bureaucrats. Make sure your National, State and Local Medical Societies are involved when new rules are promulgated!!!

Jeffrey A. Zipper, MD

4774 Boca Raton Blvd | Suite A3B | Boca Raton, FL. 33431
Cell: 561-441-0707


CMS BLOG http://blog.cms.gov/2015/04/24/open-payments-data-review-and-dispute-underway-for-physicians-log-in-today/
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 available here. While companies that are submitting payment records to CMS attest to the accuracy of the data, 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.
CMS acknowledges
the benefits of collaboration among physicians, teaching hospitals and drug and device manufacturers in the design and delivery of many life-saving drugs and devices. 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 cms.gov/openpayments today. 

Emily Tillman, Operations Analyst
Medical Policy and Procedures
First Coast Service Options, Inc.

"When Experience Counts and Quality Matters"

Phone: 904-791-8465
Fax: 904-361-0331
Email: emily.tillman@fcso.com

Legislative ALERT!

Dear Colleagues,

            Below please find a synopsis of bills that are pertinent to our specialty! Links to the bills are provided below. 

1)      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. 

2)      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. 

3)      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”. 

4)      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.

Cell: 561-441-0707


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 of pain.

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 pain.

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. 

President's Message
Dear Colleagues,

I 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 Medicare reimbursement.

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 unresolved issues:
       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 agenda.

Jeffrey A. Zipper, M.D.
President FAPM

  • 2014ConfAwards

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Political Pulse
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Description: Herald Tribune  Politcs

The battle for Florida
Herald-Tribune 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.

Description: Politico

Crunch time for Jeb Bush
Politico 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.”

  Description: Herald Tribune

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 Herald-Tribune 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 amendment.


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?"  (Read More)

Walgreens’ Good Faith Dispensing Protocol

From: Bob Twillman [mailto:btwillman@aapainmanage.org] 
Sent: Monday, October 07, 2013 1:10 PM
To: Jeffrey Zipper
Subject: Academy 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
Deputy Director
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.
Dr. Zipper
,President FAPM 
Read More

Pill Mill Crackdown Pays Off

The Florida 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. 

Our congratulations to every physician and organization that stepped up to the task that made these changes happen.

[ EDITORIAL-2014 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."
(Read More)

  • Leaders & SpeakersFrom 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
Leaders & Speakers1 2 3 4 5 6 7

FAPM Conference Is Big Success

With excellent 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.

2014 Conference Program


2014 Conference Brochure 

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 month.

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 treatment.

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 premiums.

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.

Read more here: http://www.miamiherald.com/2014/05/21/4129354_insurance-companies-should-not.html#storylink=cpy


Patient Op-Ed: Denying necessary prescriptions to needy patients 

The Florida Academy of Pain Medicine is working diligently to bring attention 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 prescribed drug requests filled. Should you have any similar cases to report of patients not getting their prescribed drugs in a timely manner, please let us know. Together we can help alieviate this problem. (Read OpEd)

Fraternally, Jeffrey Zipper, FAPM President 


Dear Colleagues, 

            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 to brianjburgess@gmail.com. Thank you! 

Jeffrey A. Zipper, M.D.

Peripheral nerve blocks -- revision to the Part B LCD
LCD ID number: L29258 (Florida)
LCD ID number: L29466 (Puerto Rico/U.S. Virgin Islands)

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.
Effective date

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 http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx external link.

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.

Note: To review active, future, and retired LCD for jurisdiction 9, please click here

FAPM has a “Neutral” Position on Medical Marijuana Amendment:
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

Today, 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.

Specifically, 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 specialties
  • 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 provide. However, 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). 

Your Academy 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.
FAPM President


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 https:llcms.hhs.gov/. (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.  


Dear Colleagues,           

            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 these services (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. 
Jeffrey Zipper
President FAPM
Chief Executive Officer

FY 2014 Medicare OBS Reimbursement Rates for SCS Trials

September President's Message

Dear Colleagues,
I hope 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!  (READ MORE)

2014 Sponsor Exhibitor Prospectus

FMA’s Business 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. Howard, M.D.

Contact Information:
Erin VanSickle
(850) 339-3184

Annual Scientific Meeting
Draws Record Attendance

Conference Pictures

Conference Pictures

Conference Pictures

Conference a Great Success

2013 FAPM Awards Recipients
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

Congratulations to Felix Linetsky, MD and Albert Ray, MD for recent publications in a major new textbook on Pain Medicine.

 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.

Dr. 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 interested.

Albert 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 “Neuroplasticity, 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 Ullmann, MS.

Dr. Ray, 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.

The FAPM 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. (Read More)

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

                                                 Membership Benefits
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 regulatory agencies.
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 Specialty Council.

New 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~
(Read More)

NY Times- FDA Won't Require Special Training


Join the Court Fight to Protect Physician Medicare Data

Attorney General Bondi's Weekly Briefing: Prescription Drug Diversion: Combating the Scourge
Congress Approves 10-Month SGR Patch

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.

MAJOR ALERT!! House GOP agrees to doc pay-rate extension

ALERT! CVS tells some Florida doctors it won't fill their prescriptions for narcotics

ALERT! Lyons: Doctors 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

2011 Conference Presentation

MSK Medicine Council Outstanding Service Award

The 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 product development.
Congratulations to 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.