As a pain physician, I would like to personally explain to President Barack Obama, Kathleen Sebelius, senior citizens and any disabled American suffering in pain, the devastating effects that will result from the drastic Medicare cuts in chronic pain care that are scheduled to take effect January 1, 2014. These cuts will severely, drastically and unfairly cut access to chronic pain care for senior citizens and other Medicare beneficiaries and at the same time promote the worsening of the prescription drug abuse epidemic. This is the wrong medicine, at the wrong time.
Now a pain specialist, I started my career as an emergency physician, and for years I took care of thousands of patients suffering from pain, as well as countless patients suffering from the ravages of prescription opiate addictions and overdoses. After more than a decade in emergency medicine, I rededicated my career to becoming a pain management specialist, by being one of the first emergency physicians to complete an ACGME accredited pain medicine fellowship, and earn ABMS pain medicine board certification. I did this with the expressed goal of committing my career towards simultaneously easing the suffering of those in chronic pain with keen attention towards non-addictive treatments that would help ease suffering, yet not contribute to the terrible prescription drug overdose epidemic occurring in the United States today.
Tragically, on November 27th, 2013, Medicare published its final payment rule for 2014 that will enact a crushing blow to funding for chronic pain care, particularly non-narcotic, and non-addictive pain procedures and injections provided in doctors’ offices. Such procedures include epidural steroid injections, nerve blocks, joint injections and pain-relieving spinal cord stimulators among others. The judicious use of such procedures is a crucial weapon in the battle against chronic pain many senior citizens and other disabled Medicare beneficiaries face, particularly for those physicians who choose to focus on non-narcotic and non-addictive treatment options.
For such procedures performed in a physician’s office, the cuts are drastic and across the board, including cuts up to 58% for epidural steroid injections, and over 75% for in-office spinal cord stimulator trials. Nearly every other procedure a pain specialist performs will be cut by at least 5 to 25%. Cutting such treatments will necessarily have the unintended effect of increasing the use of the other main option to treat chronic pain: narcotics.
Such drastic cuts will naturally reduce the most highly-trained pain specialists’ ability to provide quality, safe and non-addictive treatment options to their patients. For a physician who just started his own practice just over a year ago, these sudden cuts are devastating. I may not be able to stay in business or provide the quality care my patients need. The startup and ongoing overhead costs for an interventional pain practice including equipment and staff are in the hundreds of thousands of dollars, not to mention student loans from medical training.
Simultaneously, while cutting physician fees provided in a physician’s office, Medicare has opted to increase funding for the same identical procedures provided in hospitals. These procedures provided in a hospital already cost 5-6 times more than when provided in a physician’s office, for the identical procedure. Yet, Medicare has opted to increase such already more expensive payments up to 20% while drastically decreasing funding to physicians providing the same care at already much cheaper fees in their offices.
Such cuts by Medicare will deal a crushing blow to senior citizens and disabled Medicare patients in chronic, severe pain, while at the same time reducing the ability of the most highly-trained pain specialists to provide such care. The result will be to encourage the prescribing of already overprescribed narcotic pain medications that are contributing to the more than 15,000 yearly deaths by prescription pain killers.
Patients will not be able to afford the cost of the best and safest treatments if forced to pay out-of-pocket. I urge those that suffer with chronic pain, and those with a loved one suffering in pain, to please call or write your US Congressman, the United States Secretary of Health and Human Services Kathleen Sebelius, President Barack Obama, and anyone else who cares about the disabled, and those suffering in chronic pain. Tell them to stop these harmful cuts now.
Scott Mayhew is a physician specializing in pain management.
