FAPM Welcomes New Board
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
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
Florida Academy of Pain Medicine is pleased to
welcome Dr. Lee as the newest member of the Board of
Vinod Malik, MD
President Elect - Stanley Dennison, MD
Vice President - Peter Taraschi, DO
Secretary - Felix
Treasurer - Kenneth
Immediate Past President
- Jeffrey Zipper, MD
Susanti Chowdhury, MD
- Tse Lee, MD
Member-at-Large - Raul Monzon, MD
Albert Ray, MD
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,
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
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
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
Fraternally, Vinod Malik, MD
From the Immediate Past President:
New Physician Compensation Model Under MACRA
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
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
First five years: Provides short term stability for physician payments received from
Payment updates to physicians are set to increase
This is less than the payment updates since 2009
which have averaged 2.4%/year
These small payment updates will likely impact
future pay increases from other 3rd party
During the following five years (2019-2024): Payment
uncertainty for physicians raises its ugly head
Beginning in 2019 there will be no further automatic
reimbursement increases for physicians providing MC
Physician compensation will be adjusted annually
based on performance under the new law’s Merit-Based
Payment Incentive System (MIPS). Which will consist
Physician Quality Reporting System (PQRS)
EHR/Meaningful Use Incentive Program
Value-Based Payment Method (VBPM).
Under the new law MIPS will be based on four
categories of annually developed metrics concerning:
EHR meaningful use
Clinical practice improvement activities
These metrics will be selected by suggestions from professional
entities and stakeholders.
The MIPS program will provide confidential feedback
to providers concerning their performance on a
Doctors with low MIPS scores will have their
payments reduced in proportion to their scores.
Negative payment adjustments will be capped at 4% in 2019, 5% in
2020, 7% in 2021, and 9% in 2022
Physicians with composite scores above the threshold
will receive positive payment adjustments capped
annually at $500 million from 2019 – 2024
The Value-Based Payment Method (VBPM) increases
begin in 2019
This system is in place today, it is voluntary and
is presently only open to groups of 100 or more
Payment increases based on VBPM will likely be
difficult to achieve based upon the performance
history of groups presently participating
Of the 1278 groups eligible in the US, only 106 participated
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
government will achieve cost savings through
Larger premiums for higher income MC beneficiaries
starting in 2018
The minimum income threshold for income-related
premiums will be adjusted upwards starting in 2020
and indexed for inflation going forward.
Post-Acute Care market basket will increase by no
more than 1%
In-patient hospital rates will see a one-time
increase of 3.2% phased in from 2018 through 2025
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.
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