Five pain management physicians discuss the treatments for which they're having the most difficulty receiving pre-approval from payors.
Laxmaiah Manchikanti, MD, Pain Management Center of Paducah (Paducah, Ky.): Traditionally we had problems with disc decompression, stimulators, adhesiolysis procedures, etc. Now many insurers, including Aetna and Cigna, are considering facet joint nerve blocks as experimental. Quite a few insurers are also considering sacroiliac joint injections as experimental. Recently Blue Cross Blue Shield of Kentucky, also known as Anthem, has ruled to reduce reimbursement by 60 percent of what Medicare pays for facet joint nerve blocks performed in surgery centers. Obviously this has become a major issue.
Standiford Helm II, MD, medical director, Pacific Coast Pain Management Center (Laguna Hills, Calif.): The list is long, and [ASIPP's] recent activities at a national level have been directed towards bringing forth the evidence supporting the efficacy of the procedures we do. Intradiscal work has been gone for several years, essentially since CMS's non coverage determination. We have been able to maintain facets procedures and SI joint injections. SI joint radiofrequency ablations are problematic. The number of indications we can get coverage for spinal cord stimulation is decreasing in some sectors. Interestingly, some payors continue to view peripheral nerve stimulation as experimental. We need to document the benefits to the payors of decreased visits so that they can see the type of benefit they believe in.
Frank J. E. Falco, MD, Mid Atlantic Spine (Bear, Del.): IV Ketamine.
Gennady Gekht, MD, Coastal Pain and Rehabilitation (Bradenton, Fla.): Epidural steroid injections. The big problem is that the same competitive pressures that are applied across all industry in the U.S. are also applied to the medical industry, specifically the private insurers. As such, a large number of procedures get denied based on the fact that private insurers need to control costs. There's some truth in saying that we do not have great outcomes data to support some of these procedures, like some of the injections. However, we feel that insurance companies use data to control their expenditures and not so much to help the patient.
Marc E. Lynch, DO, medical director, Casa Colina Surgery Center (Chino, Calif.): Workers' compensation in California. We have a difficult time getting most procedures approved because they have guidelines that aren't based 100 percent on the literature but rather the literature they want.
This is an ongoing series which will feature five pain management physicians' responses to questions about the specialty.
Next week's question is: What is the biggest factor contributing to your pain management practice's profitability?
Submit responses to abby@beckershealthcare.com before Feb. 7.
Related Articles on Pain Management:
Study: Targeted Steroid Injections Relieve Pain, Reduce Inflammation in Rheumatoid Arthritis
Pain Management Physician on the Move: Dr. Robert W. Giering Joins Southwestern Vermont Medical Center
8 Statistics on ASC Pain Management Case Revenue Based on Net Revenue
Laxmaiah Manchikanti, MD, Pain Management Center of Paducah (Paducah, Ky.): Traditionally we had problems with disc decompression, stimulators, adhesiolysis procedures, etc. Now many insurers, including Aetna and Cigna, are considering facet joint nerve blocks as experimental. Quite a few insurers are also considering sacroiliac joint injections as experimental. Recently Blue Cross Blue Shield of Kentucky, also known as Anthem, has ruled to reduce reimbursement by 60 percent of what Medicare pays for facet joint nerve blocks performed in surgery centers. Obviously this has become a major issue.
Standiford Helm II, MD, medical director, Pacific Coast Pain Management Center (Laguna Hills, Calif.): The list is long, and [ASIPP's] recent activities at a national level have been directed towards bringing forth the evidence supporting the efficacy of the procedures we do. Intradiscal work has been gone for several years, essentially since CMS's non coverage determination. We have been able to maintain facets procedures and SI joint injections. SI joint radiofrequency ablations are problematic. The number of indications we can get coverage for spinal cord stimulation is decreasing in some sectors. Interestingly, some payors continue to view peripheral nerve stimulation as experimental. We need to document the benefits to the payors of decreased visits so that they can see the type of benefit they believe in.
Frank J. E. Falco, MD, Mid Atlantic Spine (Bear, Del.): IV Ketamine.
Gennady Gekht, MD, Coastal Pain and Rehabilitation (Bradenton, Fla.): Epidural steroid injections. The big problem is that the same competitive pressures that are applied across all industry in the U.S. are also applied to the medical industry, specifically the private insurers. As such, a large number of procedures get denied based on the fact that private insurers need to control costs. There's some truth in saying that we do not have great outcomes data to support some of these procedures, like some of the injections. However, we feel that insurance companies use data to control their expenditures and not so much to help the patient.
Marc E. Lynch, DO, medical director, Casa Colina Surgery Center (Chino, Calif.): Workers' compensation in California. We have a difficult time getting most procedures approved because they have guidelines that aren't based 100 percent on the literature but rather the literature they want.
This is an ongoing series which will feature five pain management physicians' responses to questions about the specialty.
Next week's question is: What is the biggest factor contributing to your pain management practice's profitability?
Submit responses to abby@beckershealthcare.com before Feb. 7.
Related Articles on Pain Management:
Study: Targeted Steroid Injections Relieve Pain, Reduce Inflammation in Rheumatoid Arthritis
Pain Management Physician on the Move: Dr. Robert W. Giering Joins Southwestern Vermont Medical Center
8 Statistics on ASC Pain Management Case Revenue Based on Net Revenue