A message from the GSIPP President
Dear GSIPP Members,
It is my pleasure to have been elected as your president for the Georgia Society of Interventional Pain Physicians (GSIPP)
at our meeting in the spring of 2015. My predecessor Dr. David Gale has left some big shoes to fill. We have consistently
put on some great didactic programs and our program in 2015 was the best since I have been a member of GSIPP. In the
session this year I learned that the size of a Radiofrequency Lesion is dependent not only on the size of the needle
and its active tip but also on the duration of lesion. This means that if I wanted to make a bigger lesion, I just
had to increase the time of lesion and not necessarily use a larger needle. I learned that the latest medical evidence
indicates that we may not need to take patients off anti-coagulation for all procedures. I also learned that epidurals
may be performed with anesthetic alone in patients whose blood sugar is elevated. These are important pieces of
information that I have been able to put into practice since the conference. This is what GSIPP is about. Now what
else are we going to do going forward?
Dr. Shevin Pollydore,
In short, we are going to fight for you, or better put, together we will take on the challenges that are facing Pain
Medicine in the current Insurance, Regulatory, and legal environment. GSIPP has fought to get a Prescription Drug
Monitoring Program (PDMP) passed, and has helped to shape numerous other pieces of legislation but there are many
other battles ahead. Every day there are payers who try to get rid of procedures by using what ASIPP Founder Dr.
Laxmaiah Manchikanti calls "Guideline Warfare" or by "any means necessary". Every day there are unqualified people
trying to do Pain Management procedures who will shed a negative light on us as we are often lumped in with them. We
will help these and other battles on the local level, and we will work with ASIPP on the national level.
The challenges ahead as I see them are:
#1. Regulatory: local and national regulatory entities pass rules or laws that impact us. Recently regulators
have raised questions about the efficacy and safety of steroids used in the epidural space. Most of us have done
thousands of epidurals without a seizure, stroke or death, yet these policies or proposed rules or laws will
impact us if we are passive. Almost every procedure we perform has come under attack. From Facet procedures
to Vertebroplasty, from SI Joint Injections to IDET, we have faced challenges on all fronts. These policies
restrict patient access to safe and effective Interventional Pain Procedures and drive up our cost of doing business. In
politics there is a saying that “If you are not at the table, then you are on the menu!” GSIPP will continue to be at the
table to shape these policies before they impact all of us negatively. Dr. David Gale is the Executive Director of GSIPP
and the Carrier Advisory Committee (CAC) Rep for Cahaba, the Medicare administrator for Georgia, Tennessee and Alabama. So
GSIPP is there fighting to preserve your ability to provide Pain Management services for your patients.
We have a representative, Chandler Haydon, who is on the floor of the Georgia legislature when it is session and is fighting
daily on behalf of GSIPP members. We typically review dozens of bills during the legislative session and help to shape
them. We will continue to be there informing and educating our legislators about Pain Management.
#2. Insurance Company Rules/Policies: Insurance Companies can at a moment’s notice put language on their website stating
that they are not covering thoracic epidurals or any other procedure they decide. These arbitrary policy changes can
overnight decrease our patient’s access to Pain Management Procedure. There is “no rhyme nor reason” and no obvious
medical rationale to these decisions (other than cost-savings). One Company can allow 2 facet blocks per year and
another 2 facet blocks per lifetime and one may not cover facet procedures at all. GSIPP will be stepping up its
efforts to challenge unfair policies when they arise.
#3. Unfunded Mandates: Pain management physicians are continually being asked to provide services that are
uncompensated. Some of these are laws, some are rules, and some are established as case law in malpractice cases. We
are asked to track down records on new patients who show up in our clinics. If we give narcotics to a patient who
has been discharged from 5 Pain Clinics for diversion, we can be held liable, but no one pays us for tracking down
those records. Regulators mandate Urine Drug Screens (UDS), but don’t mandate that any Insurance Company pays for
drug screens. GSIPP is already seeing Insurance Companies not wanting to cover drug screens. Malpractice cases are
setting precedents by “requiring” Thoracic MRI’s before Spinal Cord Stimulator lead placement, but no concomitant
mandate that any Insurance Company pay for said MRI scans, particularly if the patient has no thoracic pathology. GSIPP
has heard you and we will take on these and many other similar challenges on your and the patient’s behalf. If there
is a mandate that a Pain Management physician should “do X”, then there should be a concomitant mandate that the Insurance
Company should “pay for X”.
#4. Untrained or under-qualified professionals attempting to practice Pain Management: Some of you may remember the
problems in the past with facet blocks. There were companies offering weekend courses to do “blind” facet procedures. Anyone
who has performed a facet procedure under fluoroscopy knows that it is extremely unlikely that even a well-trained
physician would be able to get into a facet joint blindly or do a facet nerve block blindly. The nationwide spike in
these procedures led to numerous rules, reimbursement cuts and the like and we have had to fight vigorously just to be
able to preserve this vital Pain Management procedure. Further threats are on the horizon. Many other practitioners,
including Non-MD’s (and Non-DO’S) are trying to get the ability to do Interventional Pain Management procedures without
the appropriate Residency or Fellowship training. We are there to look out for you. We will fight the regulatory and
legislative battles on your behalf.
In summary, GSIPP is the organization which has been at your side providing didactics/education and looking out for you. We
are facing unprecedented challenges on all fronts and we need to step up our efforts. As president I can’t “fight the good fight”
by myself, the GSIPP Board can’t do it by itself, but together we have to do it!
This is a call to action. We need your help. We need active involvement in the organization. We may need you to meet with
your local legislators. We may need your (and your patient’s) involvement in a letter writing campaign at a moment’s notice. We
need donations to the Political Action Committee (GSIPP PAC). If you don’t have time, donate money, if you don’t have money,
donate time, but the season for excuses has long passed. If you do nothing you will be sitting by the fireplace decades from
now telling your grandchildren about this once great specialty called Pain Management that has gone the way of the dinosaur.
Shevin Pollydore M.D.
DEA to Publish Final Rule Rescheduling Hydrocodone Combination Products
AUG 21 (WASHINGTON)–On Friday the U. S. Drug Enforcement Administration (DEA) will publish in the Federal Register the Final Rule moving
hydrocodone combination products (HCPs) from Schedule III to the more-restrictive Schedule II, as recommended by the Assistant Secretary for Health of the
U.S. Department of Health and Human Services (HHS) and as supported by the DEA’s own evaluation of relevant data. The Federal Register has made the Final
Rule available for preview on its website today at go.usa.gov/mc8d.
This Final Rule imposes the regulatory controls and sanctions applicable to Schedule II substances on those who handle or propose to handle HCPs. It goes
into effect in 45 days.
Georgia gets an A grade for Pain Policies
We have recently received great news from The Pain and Policy Studies Group at The University of Wisconsin as they have given
Georgia a grade of A with respect to our Great State's Pain Policies. This has been a steady decade of improvement as in 2006
and 2007, Georgia graded in at a D+. GSIPP has led the path to making those improvements by advocating and fighting for our
Prescription Drug Monitoring Program; promoting legislation and increased requirements of our specialty in order to weed out
pill mills in our state and by being a resource to influence policymakers while making the practice of Interventional Pain
This is not a time for patting ourselves on the back but a sign that GSIPP has and IS making a difference in Georgia.
Please take this opportunity to share this news with your colleagues and friends.
The GSIPP-PAC needs your contributions to keep fighting on behalf of our specialty and all of our patients. Please give generously
as our future depends on it. CLICK HERE to donate to the PAC.
You can find the article here: http://www.acscan.org/content/wp-content/uploads/2014/07/PRC-2013.pdf
Carlos Giron, M.D.
GSIPP Founder and Executive Director
Georgia Prescription Drug Monitoring Program (PDMP) begins allowing access to Rx data
On July 26th, the switch was finally flipped to turn on access to allow practitioners to register and have access to the
Georgia Prescription Drug Marketing Program (PDMP). This means that all practitioners licensed by the Georgia Composite Medical Board
and the Georgia Board of Dentistry who have authority to prescribe or order controlled substances can now register for access the GA PDMP.
For more information for practitioners licensed by the Georgia Composite Medical Board click here
For more information for practitioners licensed by the Georgia Board of Dentistry click here