Physicians are pushing back against a proposed Medicare policy that would deny coverage for peripheral nerve blocks, warning that the move could harm patients, drive up costs and accelerate the erosion of independent practice.
The procedures — minimally invasive, relatively inexpensive and widely used to treat chronic conditions including headaches, knee pain and complex regional pain syndrome — also serve a diagnostic function, helping physicians pinpoint the source of a patient’s pain before recommending more aggressive treatment.
John Cianca, MD, president of the American Academy of Physical Medicine and Rehabilitation, joined Becker’s to discuss how CMS is increasingly scrutinizing pain procedures.
Question: CMS is increasingly scrutinizing interventional pain procedures. From your perspective, what does this proposed nerve block coverage denial signal about where Medicare policy is heading more broadly?
Dr. John Cianca: Historically, this type of scrutiny is not unprecedented. Medicare has previously used payment policy to limit the utilization of ultrasound examinations and electromyography. In this case, it is about a low-cost, minimally invasive procedure that could prevent surgeries that have a greater risk of complications or outright failure. This type of denial of care narrows the options for treatment and can even reduce the effectiveness of remaining treatments. Physical therapy, which is traditionally used as an initial treatment option, is often difficult to tolerate until pain relief is obtained. So by eliminating access to this type of treatment, the effectiveness, and perhaps even the tolerance of a more conservative option such as physical therapy is also negatively impacted. It also exposes patients to the potential for opioid use and abuse.
Q: How does reimbursement uncertainty affect independent physicians differently than large employed groups, and what best practices have you seen help mitigate that risk?
JC: This is a long-standing issue, particularly with Medicare. For years now, reimbursement rates have not kept up with the rate of inflation. In fact, it has been shown that reimbursement is actually less over time. Additionally, there have been more and more administrative obstacles placed on getting reimbursed in a timely fashion. This is particularly difficult for physicians in small practices as it demands administrative infrastructure to deal with the increased burden of preapprovals and post treatment justification. With reduced reimbursement, this infrastructure is difficult to support. As a result, independent and small practice providers are getting squeezed from both ends. AAPM&R has tried to provide resources to physicians to enable them to address new models of care and reimbursement with greater efficiencies. Working with physician members is a prime example of how AAPM&R is trying to meet the needs of its members.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
