The National Pain Care Policy Act has passed the House and now is in a Senate subcommittee. It will likely sit there unresolved until the bigger health care reform debate is resolved. Providers and patients alike need to acquaint themselves with this legislation and voice their support to the legislators.
Additional attention needs to be paid to achieve funding for NASPER. This is the National All Schedules Prescription Electronic Reporting that became law in the past, but was never funded. The current version leaves it up to each state to implement this. Unfortunately, the lack of interstate communication defeats the purpose in many locations. Fully implemented, this system allows providers that prescribe controlled substances to access a database to determine if and when a patient under their care receives a controlled substance from another provider. Knowledge of this will lead to the safer practice of medicine, and will decrease diversion and inappropriate use of controlled substances for non-medical use. Concerns about the confidentiality of this information is valid, but should not rule the day. With the rapid increase in pharmaceutical medication abuse, especially by the youth of America, we need more tools to help with appropriate prescribing. Without this, proper pain care will be suppressed.
The FDA has been mandated by Congress to address prescription abuse, misuse, and diversion. Though I support more effort in this area, I also am concerned that actions in this area could create more barriers to access. Many physician colleagues in Oregon bristled at the legislature required mandate for continuing education in pain treatment. The FDA has already stated that documentation of additional training for opiate prescribing will likely be included in their new efforts. Some physicians will likely give up the privilege to prescribe these medications rather than submit to more training. Many of my primary care colleagues already refuse to prescribe opiate medications for non-cancer pain.
Noridian, one of the carriers overseeing Medicare reimbursement for many states in the West, has proposed to stop coverage for lumbar facet injections, lumbar medial branch blocks, and lumbar medial branch block radio-frequency neurolysis. This likely sounds like gibberish to most of you, but these treatments are a core tool for my specialty to treat one of the most common causes of back pain. They are effective when applied in the right circumstances. Noridian claims there is inadequate evidence for the effectiveness of these techniques. If you have experienced the benefit from these, or are a practitioner who utilizes these techniques in your practice, now is the time to speak out. You need to contact CMS prior to the end of the month to voice your opinion, preferably supported by medical literature. Several entites have contact information and sample letters on their websites. These include the American Academy of Pain Medicine, http://www.painmed.org; International Spine Injection Society, http://www.spinalinjection.com/; American Society of Anesthesiologists, http://www.asahq.org/; and American Society of Interventional Pain Physicians, http://www.asipp.org/index.html.
Thank you for assisting in this effort.
Ed McCluskey, MD
