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Rafael Miguel: Pain-treatment policy worsens prescription-drug abuse

The Center for Medicare and Medicaid Services (CMS) announced an unwarranted, unilateral, no-public-comment-allowed edict that will decrease payments for many interventional pain-medicine procedures. 

We expected some reductions due to the Affordable Care Act (ACA). A 4 to 7 percent cut was anticipated, but the greater than 50 percent decrease in reimbursement for cervical, lumbar and caudal epidurals and almost 40 percent decrease in spinal cord stimulation took all by surprise.

Most appalling was that while the ACA touts cost savings, the decreases targeted office-based procedures, which are the least expensive.  Even worse, increases in payments were provided to hospitals and ambulatory surgery centers, which are more expensive.   This makes no sense.

Interventional pain medicine (i.e., epidurals, “nerve blocks”, etc) has demonstrated its efficacy and popularity over the last two to three decades.  Aside from providing targeted relief and allowing patients to avoid surgical procedures, they are pivotal in decreasing reliance on addictive narcotic medications.

Prescription-drug addiction is a national epidemic. And Florida holds the dubious distinction of serving as the country’s major source of prescription drugs for abuse and filling our streets and schools.

During the past decade, with the Florida Board of Medicine taking the leadership role in establishing rules regulating office practice, more surgical procedures have moved to this safe and proven venue.  Interventional Pain Medicine is no exception.

Performing these services in accredited offices has saved billions of dollars in healthcare costs while providing safer, more accessible care for those who suffer from chronic and severe pain.

Without immediate action to correct these extreme cuts in reimbursement, physicians will no longer be able to provide these services in a non-hospital setting because they will cost far more to provide than Medicare will pay.

As a result, thousands of elderly Floridians will be forced to suffer without the treatment they so desperately need.

During the last decade, Florida lawmakers wisely closed the door on unscrupulous providers who gave out pain medications like they were working in candy dispensaries.

Today these highly controlled medications are less likely to be abused in Florida.  As a result of the good work of lawmakers and our attorney general, Floridians are safer, dangerous drug sales are down, and the state is saving millions in unnecessary costs.

The federal government’s unwise step to reduce payments to legitimate offices while increasing payments to hospitals will encourage more “pill mills” to prescribe ever increasing amounts of narcotics.

Finally, this unwarranted move will not only lead to more expensive hospital visits, with higher co-pays, it will encourage criminal drug-dealing outfits that focus solely on the distribution of narcotics.

Our elderly and disabled patients in chronic pain deserve better.

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