SA works with many other groups to address a variety of issues related to improving health care in the United States. In keeping with that goal, ASA has chosen to participate in the Pain Care Coalition to improve access to care for those suffering from pain and to advance research into an improved understanding of pain and its treatments.

The Pain Care Coalition was originally formed in 2000 by the American Academy of Pain Medicine, the American Pain Society and the American Headache Society. ASA began informal collaborations with the Pain Care Coalition in 2003 and formally joined in 2004. This Coalition works to provide a unified voice regarding pain medicine causes in the legislative process. While the Coalition is the primary voice in Washington for the three founding societies, for ASA it is simply one facet of the substantial and always evolving government affairs program that the Society has operated through its Washington Office for several decades.

The Coalition is managed by a steering committee of eight individuals with two members appointed to represent each of the four societies. The authors of this article currently serve in that capacity for ASA. The steering committee, under the leadership of a rotating chair, currently Joel R. Saper, M.D., of the American Headache Society, develops policy for the Coalition and meets in Washington at least annually for that purpose. Day-to-day representation of the Coalition at the national level is provided by a Washington law and public affairs firm under contract to the Coalition. That firm works under the general direction of the steering committee and works closely with ASA’s Washington Office on matters of particular interest to ASA and the Committee on Pain Medicine.

The stated mission of the Pain Care Coalition is: “To develop, monitor and advocate for responsible Federal Healthcare Policy on behalf of persons with pain by addressing quality of care and access to care issues through legislative, regulatory, and policy research mechanisms.”

Under that broad framework, the Coalition has worked actively to initiate policy change at the federal level and to react to legislative and regulatory developments on the Hill and in the Executive Branch agencies that impact pain physicians and their patients. In its relatively short life, the Pain Care Coalition has monitored or intervened on a wide range of issues affecting different aspects of pain care practice, education and research.

The Coalition’s work led to the drafting and eventual introduction of the first comprehensive pain care bill at the national level. First reintroduced as H.R. 1863 in the 108th Congress and subsequently reintroduced as H.R. 1020 in the 109th, the “Pain Care Policy Act” is an ambitious agenda for 1) increasing resources and infrastructure for pain and palliative care research at the National Institutes of Health (NIH), 2) establishing professional and patient education and training programs through the Department of Heath and Human Services and 3) ensuring access by patients to diagnosis and treatment for pain in federally supported health care programs, including those of the Department of Defense and the Veterans Administration.

H.R. 1020, championed by Congressman Michael J. Rogers (R-MI), has been an important legislative effort for several reasons. It has attracted support on a bipartisan basis in the House, it has become a focal point for other patient and professional organizations in the pain field, and it has generally increased awareness of pain as a public health problem among legislators and their staff.

There is still a great deal of work that remains to be completed if this bill is to become a serious legislative vehicle in the next Congress. This will likely entail modifications to the bill, particularly as it pertains to NIH, to enhance its prospects for movement in the House and for bringing it to the Senate for consideration.

While H.R. 1020 has been the hallmark activity for the Coalition in recent years, several other initiatives are ongoing, including the following:

1. We have worked with the House Commerce Committee to get some recognition for pain in its efforts to move an NIH re-authorization bill. An NIH bill did, in fact, clear the House in late September, and pain is included as an area for heightened NIH reporting and congressional oversight.

2. We have begun an informal dialogue with the Drug Enforcement Administration (DEA) that shows early signs of promise. A September 6 proposed rule from DEA resolves, in a reasonable and balanced way, previous uncertainty about a physician’s ability to write multiple “do not fill until” prescriptions for Schedule II drugs. The rule would permit that practice for supplies not exceeding 90 days in total.

3. We continue to monitor Medicare payment changes — physician fee schedule, inpatient diagnosis-related group (DRG) rule, outpatient DRG rule, ambulatory surgical center reform and other issues — that impact pain practices, and we will use the resources of the Coalition to support items of interest to ASA as appropriate.

With the congressional elections now behind us, the Pain Care Coalition will be looking for new opportunities to advance its issues with a dramatically changed House and Senate. As ASA’s representatives to the Pain Care Coalition, we look forward to putting anesthesiology’s issues and expertise “front and center” in the pain care debates ahead.
ASA will continue to partner with the Pain Care Coalition as long as the mission and goals remain consistent with the interests of our membership and patients. The long-term goal of this endeavor remains the advancement of appropriate care and improved access to treatment for those in pain, appropriate reimbursement and support for those in practice, and continuing dialogue to enhance pain medicine.

Dr. Deer and Dr. Rosenquist welcome any advice or feedback from the ASA membership on these important issues and the Coalition’s activities.

Timothy R. Deer, M.D., is President and CEO, The Center for Pain Relief, Charleston, West Virginia.

Richard W. Rosenquist, M.D., is Professor of Anesthesia and Director, Pain Medicine Division, University of Iowa, Iowa City, Iowa.