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September/October 2005
Volume 1, Issue 3
In this Issue:
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Click on the icon to view the newsletter as a pdf. |
We Must Act NOW to Preserve
Medical Access for Our Medicare Patients!!!
An Original Contribution by Frank J. E. Falco, M.D.
America's seniors and disabled deserve a first-class Medicare program. But, access to care for our elderly and disabled is in jeopardy.
Medicare payment rates have already failed to keep up with increases in medical practice costs. Payments are not tied to the actual costs of providing care or to the health needs of our seniors and disabled.
Severe payment cuts, escalating practice costs, and increases in medical liability premiums are forcing physicians to make difficult decisions. Future Medicare physician reimbursement will be cut by 26% over the next six years down to 1/3 of what physician payments were in 1991. Practice expenses are also expected to higher by 15% over that same time period.
According to an AMA survey, greater than 1/3 of physicians will lower the number of new Medicare patients they accept, greater than 1/2 will defer technology purchases that could improve medical care, 1/3 will limit or discontinue nursing home visits and 1/4 will close satellite offices if payment cuts takes place in 2006.
Physicians and patients must act now to preserve Medicare by urging their senators and representatives to support S 1081, HR 2356 and HR 3617 congressional bills. Physicians can call the AMA at 800-833-6354 and patients can phone the AMA at 888-434-6200 to contact members of Congress.
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Click here to view the senate list. |
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Click here to view a sample senator letter. |
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Click here to view the house of representatives list. |
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Click here to view a sample representative letter. |
NASPER Signed into Law by President Bush!!!
An Original Contribution by Frank J. E. Falco, M.D.
The National All Schedules Prescription Electronic Reporting Act (NASPER) was signed into law by President George Bush on Thursday, August 23rd 2005. The bipartisan sponsored bill introduced on behalf of the American Society of Interventional Pain Physicians (ASIPP) for the third straight year finally passed through both the House and Senate and later signed into law by the President. Countless hours of lobbying efforts over the past 3 years by members of ASIPP led by Lax Manchicanti, the founder and president, ultimately led to victory for this very important law. There are 20 states that presently monitor prescription narcotics within state boarders that have had a significant impact on reducing drug diversion in those states. This law will now allow for monitoring of prescription narcotics within all 50 states as well as across all state lines that should have an even greater impact on drug diversion.
Pharmacies and physicians across the country will be linked into the same computer system in order to monitor opioid prescriptions. This will allow pharmacies and physicians to identify and prevent those individuals who try to fill several prescriptions from multiple providers at different pharmacies within a particular state or boarding state(s). This will be a giant step towards limiting prescription drug abuse.
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Click here to view or download a copy of NASPER. |
Discogenic Low Back Pain Under Appreciated and Misunderstood
An Original Contribution by Frank J. E. Falco, M.D.
Discogenic low back pain (DLBP) is a common cause for chronic axial back pain that is often unrecognized and misdiagnosed. This occurs because of the lack of objective findings, a low index of suspicion and limitations of imaging studies. DLBP results from a fissure or tear of the outer annulus that surrounds the disc nucleus.
The fissures or tears can result from trauma such as a slip and fall, MVA, or a lifting, twisting or bending event. The injury leads to intense back pain that can radiate into the buttocks, posterior thigh or sometimes into the groin. The pain is typically higher with sitting, driving, standing, bending or lifting and lower in a recumbent position.
There are few findings on exam such as muscle spasms, painful range of motion and pain with palpation. The neurological exam is normal. Imaging studies are often unremarkable. A "high intensity" finding in the annulus can be present on MRI that has a 90% positive predictive value for DLBP but this finding is present in less than 20% of patients with DLBP.
Discography is the only reliable means of diagnosing DLBP. Contrast is injected into the disc in an attempt to recreate the pain and to detect any annular tears. The contrast injections are followed by a CT scan for a more detailed evaluation.
Primary treatment for DLBP is aggressive PT supplemented with pain medications. Discography is considered in those who fail six months of conservative treatment. Depending on the results, interventional treatment options include an IDET procedure or spine surgery. |
