November 2001
Volume 65 |
Number 11
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Alphabet Soup:
ASIPP, ASRA and ASA
Do We Need Them All? Who Best Takes Care of the Pain Management
Anesthesiologist? |
Ann C. Still, M.D.
Committee on Pain Medicine
With the continued barrage of controversial issues in the area
of pain medicine, many pain physicians question what organization
they should look to regarding state-of-the-art techniques, new
medicines, research outcomes, ever-changing billing and coding
issues and the latest legislative policies. State and national
agencies hear varying testimony as to what pain medicine is, who
should practice it, what procedures are appropriate for safe and
cost-effective patient care and how physicians should be reimbursed.
To whom should these agencies listen as the organization that
speaks for the pain physician? Two such organizations, in addition
to ASA, have taken the lead in pain medicine educational and legislative
issues.
ASIPP
The American Society of Interventional Pain Physicians (ASIPP)
was begun in November 1998 as the Association of Pain Management
Anesthesiologists to represent interventional pain physicians
dedicated to improving the delivery of interventional pain management
services across the country. It was their contention that ASA
was not looking out for pain physicians who spent little or no
time practicing operating room anesthesia. Due to the diverse
backgrounds of pain physicians, their name was changed to the
American Society of Interventional Pain Physicians so not to exclude
other specialists who practiced interventional pain management.
The mission of this organization is “to promote the development
and practice of safe, high-quality, cost-effective interventional
pain medicine techniques for the diagnosis and treatment of pain
and related disorders and to ensure patient access to these interventions.”
1
Having grown to more than 1,000 members in just three years,
ASIPP has become very visible on both state and national levels
in the promotion of the practice of interventional pain medicine.
A few of their achievements include:
1. Passage of the Med PAC Study Bill, which examines barriers
to coverage and payments for outpatient interventional pain
procedures, including ambulatory surgical centers (ASCs), hospital
outpatient and physician offices;
2. Inclusion of nine new or replacement codes in the ASC-approved
list;
3. Level III Current Procedural Terminology™ code for spinal
endoscopy; and
4. Approval of a new classification for interventional techniques,
with higher reimbursement in hospital outpatient settings, including
intrathecal pumps.
Through the formation of the ASIPP-Political Action Committee,
its presence in Washington has been heard. Tireless lobbying efforts
for interventional pain medicine and support of congressional
leaders have not gone unnoticed. It is through this means that
the Centers for Medicare & Medicaid Services now recognizes
pain management as a separate specialty designation.
In addition to its legislative activities, a goal of this organization
is the pursuit of excellence in interventional pain education.
ASIPP held its Third Annual Meeting, a combined educational and
legislative meeting, in Washington, D.C., on September 15-17,
2001. This year’s reception honored Congressmen Edward Whitfield
(R-KY) and Ernest Lee Fletcher (R-KY) along with invited guest
Tommy Thompson, Secretary of Health and Human Services.
ASRA
The American Society of Regional Anesthesia and Pain Medicine
(ASRA) has long been recognized as the premier leader in promoting
the education and research of regional anesthesia and pain. Its
mission is “to associate and affiliate into one organization
all anesthesiologists and other physicians and scientists who
are engaged in or interested in the techniques of regional anesthesia
for surgery, obstetrics and pain control; to encourage specialization
and research in these areas; to promote and sponsor courses and
workshops to disseminate information on regional anesthetic procedures;
to encourage the teaching of regional anesthetic procedure in
all anesthesiology training programs; to edit and publish articles
in these and related subjects; and in all ways to develop and
further the knowledge of safe techniques for providing surgical
and obstetrical anesthesia with local anesthetic agents and for
producing diagnostic and therapeutical blocks with local and lytic
agents for the management of pain.” 2
ASRA has recently undergone a total realignment in order to more
closely meet the educational needs of its pain medicine physicians.
The Society’s annual meeting previously contained equal offerings
of regional anesthesia and pain medicine. Beginning in April 2002,
the Chicago meeting will contain a modicum of pain medicine. The
major emphasis of this meeting will be on regional anesthesia
for obstetrics, pediatrics and the operating room. A new pain
meeting will be held at The Pointe Hilton Squaw Peak, Phoenix,
Arizona, on November 7-10, 2002. This three-and-one-half-day meeting
will be devoted entirely to pain medicine. Abstracts will be accepted
for this meeting, and poster presentations and poster discussions
will be held. The John J. Bonica Lecture, an endowed lecture by
an expert in the field of pain medicine, will be moved from the
annual spring meeting to the fall pain meeting. Lectures on interventional
techniques and outcomes will be held. It is anticipated that this
new format will strengthen the Society by having two strong components:
pain medicine and regional anesthesia.
Five of the 11 active members of the Board of Directors of ASRA
are pain medicine specialists, and the journal Regional Anesthesia
and Pain Medicine is accepting more pain articles for publication
than ever before. All of these moves are meant to show our pain
medicine physicians that this educational society is totally in
support of this new and evolving field of medicine.
As there are now three specialties recognized by the American
Board of Medical Specialties with recognized subspecialty certification
in pain, should there be more than one organization involved in
issues of pain medicine practice? Is the field advancing and changing
at such a rapid pace that it necessitates having more than one
watchdog keeping an eye on the ranch? Clearly, ASRA has demonstrated
its excellence as the leader for the educational and scientific
advancement of regional anesthesia and pain medicine. We look
forward to the changes they have instituted with a concentrated
focus on pain medicine. ASIPP, during its short existence, has
excelled at educating our congressional leaders and influencing
changes in coding and reimbursement issues and legislative policy.
It appears as if both organizations are helping pain physicians
in all specialties.
ASA
Where does ASA fit into the equation, with its eye having been
so focused on the operating room practice of anesthesiology? First
and foremost, we must not forget we are anesthesiologists by training.
ASA is the national organization that represents all anesthesiologists
and deserves our support.
The ASA Committee on Pain Medicine has published three practice
parameters dealing with pain medicine: “Practice Guidelines
for Acute Pain Management in the Perioperative Setting,”
“Practice Guidelines for Cancer Pain Management” and
“Practice Guidelines for Chronic Pain Mangagement.”
3-5
For those critical of what ASA has or has not done for pain physicians,
I challenge you to come and join us in the trenches and help anesthesiology
be the leader advancing the specialty of pain medicine.
So who will win the title of “leader and voice” for
pain medicine anesthesiologists? Whether you pick ASA, ASIPP or
ASRA as your leader, one thing is for sure: All pain physicians
need to work and support one another in the quest for quality,
safety and the delivery of cost-effective pain care. We will all
lose, including our patients who desperately need us, if we cannot
come together and work for the benefit of all pain physicians,
no matter what form of pain medicine we practice.
References:
1. American Society of Interventional Pain Physicians.
Available at: <www.asipp.org>. Accessed on October 8, 2001.
2. American Society of Regional Anesthesia and
Pain Medicine: Available at: <www.asra.com>.
Accessed on October 8, 2001.
3. Practice Guidelines for Acute Pain Management
in the Perioperative Setting. Anesthesiology. 1995; 2:1071-1081.
4. Practice Guidelines for Cancer Pain Management.
Anesthesiology. 1996; 84:1243-1257.
5. Practice Guidelines for Chronic Pain Management.
Anesthesiology. 1997; 86:995-1004.
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Ann C. Still,
M.D., is Assistant Professor, Department of Anesthesiology
and Medical Director, Pain Treatment Center, University of
Alabama at Birmingham. |
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