The Risk of Rate Cuts

Reimbursement Rules Cast Shadow on Comp

Rate cuts for pain management procedures may have repercussions for workers' comp.
By: | February 16, 2014

“Interventional pain docs may decide non-work comp patients aren’t worth their time, and focus even more on work comp,” wrote Joseph Paduda. “Comp payers should very carefully monitor interventional pain docs and claimants treated by those docs and be alert for practice or treatment plan changes.”

Paduda, principal of Health Strategy Associates, made the comments in his Managed Care Matters blog. They followed the release of rules to cut the reimbursement rates for interventional pain management procedures.

The Centers for Medicare and Medicaid Services recently announced its 2014 final rules for physician payments, hospital outpatient, and ambulatory surgical center payments. They are scheduled to take effect April 1.

A pain management advocacy group says the cuts will hurt physicians and ultimately patients.

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“It is not an exaggeration to say that the cuts are draconian, and it will be devastating,” according to a statement from the American Society of Interventional Pain Physicians. “Unless we act upon the issue, this may be the end of interventional pain management practice for almost 40 percent of the physicians who base [the] majority of the practices [in an] out of office setting.”

The ASIPP has issued a Call to Arms: Participate in the Contribution Project to Save IPM posted on its website. The organization noted that the cuts include reimbursement reductions to physicians of 36 percent for epidural injections and 58 percent for office settings, which it said would reduce access to care among patients.

“This will move them into most expensive setting, namely hospitals which perform these procedures in a small procedure room and reap the major benefits — further empowering hospitals under Affordable (Obama) Care,” the ASIPP said. The result of the cuts, it said, would also “increase Medicare expenses by $187 million per year by moving the patients into most expensive settings.”

The ASIPP says it is encouraging physicians and patients to write to CMS and members of Congress. The group says it has the support of eight congressional members.

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]