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Sunday, May 27, 2018
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How the federal government is harming pain treatment for the elderly

The Center for Medicare and Medicaid Services announced an unwarranted, unilateral, no-public-comment-allowed edict that will decrease payment for the vast majority of interventional pain medicine procedures. Although we expected some reductions due to the overall Affordable Care Act and 4 percent to 7 percent was commonly seen, the greater than 50 percent decreases in cervical, lumbar and caudal epidurals and almost 40 percent decrease in spinal cord stimulation took all by surprise.

Most appalling was that although the ACA touts fiscal responsibility and cost savings, the decreases targeted office-based procedures, the lowest cost center for performance of these procedures. Even worse, increases in payments were provided to hospitals and ambulatory surgery centers, already the more expensive venues. This makes no sense.

Interventional pain medicine (i.e., epidurals, “nerve blocks,” etc.) has demonstrated its efficacy and popularity over the past two to three decades. Aside from providing targeted relief and allowing patients to avoid surgical procedures, they are pivotal in decreasing reliance on powerful and addictive narcotic medications. Although this latter point is part of a national prescription drug epidemic, Florida in particular held the dubious distinction of being the worst offender in this regard, serving as the country’s major source of prescription drugs for abuse and filling our streets and schools.

During the past decade, with the Florida Board of Medicine taking the leadership role in establishing rules regulating office practice, more surgical procedures have moved to this safe and proven venue. Interventional pain medicine is no exception. Performing these services in accredited offices has saved billions in health-care costs while providing safer, more accessible care for those who suffer from chronic and severe pain.

Without immediate action to correct 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. For example, for certain procedures it will cost seven times as much to provide in a hospital as it would for the same procedure in a non-hospital setting. As a result, thousands of elderly Floridians will be forced to suffer without the treatment they so desperately need.

During the past 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 good 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. This very unwise step by the feds to reduce payments to legitimate offices while increasing payments to hospitals will encourage more “pill mills” to prescribe ever-increasing amounts of narcotics, reversing an improving trend in combating prescription drug abuse and trafficking. Finally, this unwarranted and unwise move will not only lead to more expensive hospital visits, with higher co-pays, it will incentivize criminal drug-dealing outfits that focus solely on the distribution of narcotics.

Our elderly and disabled patients in chronic pain deserve better.

Rafael Miguel, M.D., is the secretary of the Florida Society of Interventional Pain Physicians, and a former vice chair of the Florida Board of Medicine. He has an appointment at the professor level at the University of South Florida, where he trains tomorrow’s pain medicine physicians. He has a private practice in Tampa, and is board-certified in anesthesiology with sub-specialty certification in pain medicine.

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