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Senator Thomas R. Carper, Senator Chris Coons, Representative John Carney: Devastating Cuts for Interventional Pain Management

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The Honorable Thomas R. Carper
United States Senate
513 Hart Senate Office Building
Washington, DC 20510

The Honorable Chris Coons
United States Senate
127A Russell Senate Office Building
Washington, DC 20510

The Honorable John Carney
House of Representatives
1406 Longworth House Office Building
Washington, DC 20515

 

Re: Devastating Cuts for Interventional Pain Management

Dear Senator Carper, Senator Coons and Representative Carney:

We write to you today out of great concern. On November 27, 2013, Centers for Medicare and Medicaid Services (CMS) posted the 2014 final rules for physician payments as well as hospital outpatient and ambulatory surgical center payments with the new rates to go into effect on January 1, 2014.

These cuts are draconian and will devastate our specialty. Unless we act upon the issue this may be the end of interventional pain management practices for almost 40% of the physicians who practice in an office setting.

The cuts for physician payment for epidural injections are 36% and 58% for office settings. This does not include the 20% SGR cuts. Spinal cord stimulation has also been deeply cut. We are also facing cuts for transforaminal epidural injections as well as facet joint interventions. Across the board cuts such as these will force office based physicians to either close or move into the more expensive hospital setting. Either outcome will have a devastating effect on patient access to care.

All the while, hospitals payments are being increased by almost 20% for the same procedures, whereas in‑office procedures are facing almost 60% cut, with same operational expenses. There were many reckless flaws in determining process:

• Medicare did not take into consideration Medicare Economic Index (MEI) which has been increasing substantially. Now the gap with SGR cuts will be 90% and without SGR cuts will be 70% between expenses and the revenue.
• The RUC process did not involve all of the physicians and even then, the AMA has recommended continuing the same payment schedule.
• The data was available in 2012, yet the proposed schedule in July did not include the proposed cuts. The required comment period was not provided.
• Medicare has not taken into consideration MedPAC recommendation of widening gap between hospitals and physician payments.

 

As the Delaware epidemic of prescription drug abuse crisis worsens, we cannot stop offering patients better alternatives to addictive substances for intractable pain conditions. This will lead to explosion of pill mills in Delaware.

We respectfully ask that you contact CMS to ask them to postpone the implementation of these cuts until further investigation is done. Without your help millions of chronic pain patients will be left with nowhere to turn.

 

Sincerely,

Delaware Society of Interventional Pain Physicians

Alan Gonzalez-Cota, M.D., President

Obi Onyewu, M.D., Executive Director

Selina Xing, M.D., Secretary

Emmanuel DeVotta, M.D., Treasurer

 

 



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