Pain Medicine
ASA considers pain medicine a top priority of the organization and advocates for its members on issues related to pain medicine out of the Office of Governmental and Legal Affairs in Washington, D.C. The resources on this page are designed to inform you about federal legislative and regulatory activities that may impact the practice of pain medicine.
Learn about state activities on pain medicine.
Contents
Scope of Practice
Patient Protection and Affordable Care Act (PPACA)
Essential Health Benefits
Institute of Medicine (IOM) Report on Pain
Prescription Drug Abuse
E-Prescribing (eRx) Incentive Program
ASA Nomination Letters
Payment Issues
Scope of Practice
Interventional Pain Management is the Practice of Medicine
Patient Protection and Affordable Care Act (PPACA)
ASA commends the inclusion of key elements of the National Pain Care Policy Act in section 4305 of PPACA. First, PPACA required the Secretary of Health and Human Services (HHS) to enter into an agreement with the Institute of Medicine (IOM) to convene a Conference on Pain. Accordingly, in June 2011 IOM released a report in which it summarized its findings and recommendations, entitled, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. Second, PPACA created the Interagency Pain Research Coordinating Committee (IPRCC) to coordinate all efforts related to pain research within HHS and other federal agencies. Third, PPACA permits the HHS Secretary to make grants for programs that provide training and education to health care professionals in pain care. Congress has not yet appropriated funds for these grants.
View the text of section 4305.
Essential Health Benefits
In December 2011, the Centers for Medicare and Medicaid Services (CMS) released an Essential Health Benefits Bulletin (Bulletin), which set forth CMS’s proposed approach to defining an Essential Health Benefits (EHB) package under PPACA. Non-grandfathered plans in the individual and small group markets both inside and outside of the Exchanges, as well as Medicaid benchmark plans, must cover EHB beginning in 2014. According to the Bulletin, CMS intends to propose that each state pick a benchmark plan among certain plans currently offered in the state, and the benefits and services included in the benchmark plan would be the EHB package. EHB must include coverage of ten mandated benefit categories identified in PPACA (ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness screenings and chronic disease management, and pediatric services). The benchmark plan will serve as a reference plan, and health insurance issuers in the state must offer benefits “substantially equal” to the benefit package offered by the benchmark plan.
In response to the Bulletin, the Pain Care Coalition, which includes the American Society of Anesthesiologists, submitted a comment letter urging CMS to include the assessment, diagnosis, treatment and management of a patient’s acute or chronic pain in the EHB package.
Institute of Medicine (IOM) Report on Pain
In June 2011, IOM released a report, entitled, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The report assessed the current state of the science of pain research, care, and education, and made numerous recommendations that the authors believe would advance the field of pain medicine. These recommendations focused on data collection, patient care, education, and research.
The report found that at least 116 million U.S. adults suffer from common chronic pain, and the annual cost of chronic pain in the United States is estimated to be a staggering $560-635 billion in direct medical treatment costs and lost productivity. The report claimed that there is not enough consistent data to determine the incidence and prevalence of pain, and recommends that federal and state agencies and private organizations collect data on pain through surveys and electronic health records. The report also recommends that patients receive the majority of care and management through self-management and primary care, while specialists focus on more complex cases. In addition, the federal government and relevant stakeholders should develop education programs for patients, the public, and health care providers to address gaps in knowledge about pain. Finally, the report advocates for one of the existing NIH institutes to be the lead institute for pain. NIH should also broaden the scope of the NIH Pain Consortium and increase its financial resources and staffing support. The report also calls for improvement of the process for developing new agents for controlling pain, as well as increased support for interdisciplinary and longitudinal research in pain and training of pain researchers.
Read the full report
10/11/11 - ASA Urges Senate Committee to Hold Hearing on IOM Pain Report
E-Prescribing (eRx) Incentive Program
Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized the Secretary of Health and Human Services (HHS) to establish an Electronic Prescribing (eRx) Incentive Program. The eRx Incentive Program, implemented in 2009, offers financial incentives to eligible professionals who are successful electronic prescribers. In 2012, CMS will apply a penalty to those eligible professionals who do not either (1) meet the 2011 e-Prescribing Incentive Program reporting requirements during the 6-month reporting period of January 1-June 30, 2011, or (2) qualify for a significant hardship exemption. The deadline to apply for the hardship exemption is November 1, 2011.
Learn more about the eRx Incentive Program and how to apply for a hardship exemption.
09/06/11: CMS Final Rule on Changes to the Electronic Prescribing Incentive Program
08/30/11: ASA Urges for Exemptions in Comment Letter on Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2012
ASA Nomination Letters
ASA Nomination of Dr. James Rathmell to IOM Committee on Pain
ASA Nomination of Dr. Richard Rosenquist to the Interagency Pain Research Coordinating Committee
Payment Issues
HHS Office of Inspector General (OIG) Work Plans
OIG Reports
Please note that CPT codes and reporting instructions have been revised since OIG issued the reports below. To ensure correct and compliant coding, always use the codes and guidance in effect on the date services are provided.
Transforaminal Epidural injection Services (August 2010)
Facet Joint Injection Services (September 2008)
Medicare Coverage Database: The Medicare Coverage Database contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). The database also contains local articles, proposed NCDs and other national coverage policy-related documents.