By Dr. Sanford Silverman
January 5th, 2014
The federal government took a dangerous step backwards late last month that will not only cost taxpayers more, it will eventually lead to the broader use of narcotics and other pain medications.
Under proposed rules related to the Affordable Care Act, otherwise known as Obamacare, the federal government's Centers for Medicare and Medicaid Services issued proposed guidelines earlier this summer. Those proposed guidelines offered some cuts in payments for interventional pain management practices.
Fair enough. The cuts were tough, they were bad policy, but they were bearable.
But, in an unexpected final release of these rules, CMS made a huge policy shift and suggested draconian cuts to payments for these services, but only when those services are provided outside of a hospital.
What does this mean?
It is vital to explain the types of services in question. These services, known collectively as "interventional pain medicine," are offered to the sickest and most debilitated members of our society who suffer severe and chronic pain. And these services are very, very different from those offered at so-called pill mills that offer generalized pain-killing drugs that treat the whole body.
Interventional pain treatment involves complex procedures that diagnose, treat and cure pain at its source. Physicians who practice this highly specialized medicine often have more than 14 years of intensive medical training.
As patients most-often require repeated treatment, outpatient and office-based (i.e. non-hospital) services are the most accessible and affordable means of providing safe quality care without the hassle, inconvenience or possible exposure to infection of being admitted to a hospital.
During the past decade, more and more surgical procedures have moved to this proven means of serving patients and so too has interventional pain medicine. As a result, the health care delivery of these services has saved billions in health care costs while providing safer, more accessible care for those who suffer from chronic and severe pain.
With these extreme cuts – nearly 60 percent in some cases -- physicians will no longer be able to provide these services in non-hospital settings, as they will cost far more to provide than Medicare will pay.
In a few short weeks, it will cost more to have these procedures, epidural injections, done in a hospital than in the physician's office suite -- over 7 times the cost. As a result, thousands of elderly Floridians will be forced to suffer without the treatment they so desperately need.
The American Society of Interventional Pain Physicians, estimates that 40 percent of these highly specialized physicians will likely close up shop and Medicare expenses will increase by nearly $200 million as a result of increased hospitalizations. These dollar figures of course do not take into account the immeasurable amount of human suffering that will result as well.
With decreased access to point-of-pain treatment centers, highly addictive pain drugs like Oxycontin, hydrocodone or other narcotic pain pills may be the only option for Medicare patients with chronic and severe pain.
During the last decade, Florida lawmakers wisely closed the door on unscrupulous providers who gave out pain medications like they were working in candy dispensaries. Thankfully, today these highly controlled medications are less likely to be abused in Florida.
As a result of the work of dedicated lawmakers and our state's Attorney General, Floridians are safer, dangerous drug sales are down, and our state is saving millions in unnecessary costs.
But with the federal government's unwise proposal to slash payments for highly specialized interventional pain treatment, chronic pain patients will be forced to seek relief from the only available sources they can find.
I shudder to think of the results.
Dr. Sanford Silverman is president of the Florida Society of Interventional Pain Physicians and president-elect of the Broward County Medical Association. He is the medical director and CEO of Comprehensive Pain Medicine in Pompano Beach and is board certified in anesthesiology, pain medicine, and addiction medicine.
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