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President’s Message: What Have We Done, and Where Are We Going?

Feb 8, 2024, 07:30 AM by David Provenzano, MD

Cite as: Provenzano D. President’s message: what have we done, and where are we going?. ASRA Pain Medicine News 2024;49. https://doi.org/10.52211/asra020124.001.

Dr. David ProvenzanoIt has been a busy 10 months since becoming President of ASRA Pain Medicine. At the start of the new year, I thought I would reflect and provide members with an update on some important initiatives.

Education Delivered Through First Class Meetings

First, I would like to thank Alexios Carayannopoulos, DO, MPH, the program committee, and faculty for all their efforts with the 22nd Annual Pain Medicine Meeting. The meeting was an enormous success with over a 1,000 attendees and 449 abstracts submitted. The meeting was dynamic, informative, and engaging. I was genuinely excited to see so many individuals interested in science. The meeting covered a wide range of topics from virtual reality and advanced interventional techniques to health and wellness. It was also a great honor to have David Julius, PhD, a Nobel Prize laureate, receive the 2023 John J. Bonica Award. Furthermore, it was a privilege to present Andrea Chadwick, MD, MSc, with the Presidential Scholar Award. The Presidential Scholar Award recognizes outstanding scientific and sustained contributions to regional anesthesia, acute or chronic pain medicine, over the preceding 10 years. Dr. Chadwick has done so much for the field of pain medicine and the mission of ASRA Pain Medicine. We are grateful for all her efforts.

ASRA Pain Medicine Board of Directors and 2023 Fall Meeting Program Chair with John J. Bonica awardee Dr. David Julius (fifth from right) and Presidential Scholar awardee Dr. Andrea Chadwick (seventh from right).

We also invited Patrick Giam, MD, the first vice president of the American Society of Anesthesiologists (ASA). He gave a great speech on the advocacy work that ASA is doing for the field of pain medicine. Some examples of this work includes (1) the Surgical Care Coalition, addressing decreasing Medicare payments to physicians, (2) the G2211 Coalition, opposing the G2211 code(3) holding big insurance accountable through efforts to address the flawed implementation of the No Surprises Act and United Health Care’s anti-competitive conduct and (4) pro-anesthesiology campaigns from fighting to save VA care to defeating an Oklahoma bill to expand CRNA practice in interventional pain. We are grateful for our partnership with ASA and all its advocacy efforts for the field of pain medicine. We will continue to work together with ASA on important issues relevant to both societies.

In addition, the Advanced Interventional Pain Management Course and Workshop for Fellows, cohosted with the Association of Pain Program Directors and the Medical Education Master Class, led by Trent Emerick, MD, MBA, both held the Thursday prior to the annual meeting, were great initiatives that provided additional education to select populations. The feedback from the fellows course, which covered many interventional techniques including neuromodulation and kyphoplasty, was outstanding. Below are some of the fellow comments we received in the review process.

“I had an incredible experience at the Fellows Course. Getting to learn from so many leaders in the field of pain medicine was awesome. There are very few instances where I would have gotten real hands-on cadaver experience with this many procedures in one afternoon anywhere else, and I learned a ton.”

“I am deeply grateful for this enriching experience and for the opportunity to expand my knowledge under the guidance of such esteemed professionals. The knowledge gained from this course will undoubtedly shape my future practice in pain medicine and is something I can take back to my attendings and co-fellows at my institution.”

Faculty and participants of the Advanced Interventional Pain Management Course and Workshop for Fellows. Faculty includes Drs. Magdalena Anitescu, Ryan D’Souza, Yashar Eshraghi, Vincent Galan, Michael Hanes, Chong Kim, Lynn Kohan, Leena Mathew, Ehren Nelson, David Provenzano, Cynthia Shum, and Sayed Wahezi.

We are grateful to the sponsors, faculty, and the leadership of Sayed Wahezi, MD, for investing in the next generation of pain physicians. Evidence-based education for fellows is critical to the future of pain care, and ASRA Pain Medicine will continue to support these events. Christine Hunt, DO, is busy planning for the 23rd Annual Pain Medicine Meeting, which will be held November 21-23 in Las Vegas, Nevada. Dr. Hunt will offer a program with emphasis on practical applications for improving the delivery of pain care, combining innovation with clear implementation strategies. Click here to be notified when the abstract submission site opens.

The Perioperative and Outpatient Management of Patients with Substance Use Disorder Symposium led by the Opioid Safety and Substance Use Disorder Special Interest Group was well attended and allowed members to meet their requirements for the Medication Access and Training Expansion (MATE) Act. We are grateful to the scientific planning committee consisting of Ariana Nelson, MD, Sudheer Potru, DO, and Mercy Udoji, MD.

The meeting will provide content on state-of-the-art regional anesthesia and acute pain medicine methods and tools to manage the current health care economic landscape.

Currently, we are planning for the 49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, March 21-23, in San Diego, California, which is fast approaching. Ki Jinn Chin, MBBS, MMed, and the program committee have developed an awesome program that will focus on precise, practical, personalized, and patient-centered pain care. In addition, the meeting will provide content on state-of-the-art regional anesthesia and acute pain medicine methods and tools to manage the current health care economic landscape. The full program can be viewed here.

Along with topnotch education, we also want to provide an opportunity for personal connection, networking, and fun. From the Welcome Networking Reception to the Morning Fun Run/Walk, there will certainly be plenty of opportunities to reconnect with old friends and make new ones. The meeting will cap off with the not to be missed Annual Meeting Celebration, featuring what’s uniquely San Diego while enjoying our last evening together. We hope to see you there.

Morning Fun Run/Walk at the 47th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in 2022.
Resident/Fellow and Fellowship Directors Meet and Greet at the 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in 2023.
Location of the 49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, the Hilton Bayfront San Diego.

Guidelines

Our Guidelines and Regulatory Advocacy Committee, under the leadership of Carlos Pino, MD, and Eric Schwenk, MD, continues to review and approve high-quality, evidence-based guidelines and practice advisories for the regional anesthesia, acute pain, and chronic pain community. Two new guidelines, the Evidence-Based Clinical Practice Guidelines on Postdural Puncture Headache: A Consensus Report From a Multisociety International Working Group and the Standardizing Nomenclature In Regional Anesthesia: An ASRA-ESRA Delphi Consensus Study of Upper and Lower Limb Nerve Blocks, have been published in just the last several months. 2024 will be another year for highly anticipated guidelines to be published.

Sister Societies—Continued Partnership

Our work with our four sister societies (ESRA, LASRA, AFSRA, and AOSRA-PM) as well as our Canadian colleagues, the Canadian Anesthesiologists’ Society—Regional Anesthesia Section, continues. Our first collaborative ASRA Pain Medicine newsletter piece with ESRA is published in this edition , so read on. ASRA Pain Medicine participated in the 1st World Day of Regional Anesthesia and Pain Medicine on Saturday, January 27, 2024. The event involved over 100 cities across all continents. The educational program included a common scientific program with journal clubs and hands-on clinical workshops and live demonstrations. We are thankful for ESRA’s leadership in initiating this event. In the United States, Stuart Grant, MBChB, MMCI, led a site at the University of North Carolina Chapel Hill. This was a wonderful way to share knowledge between all the societies. We look forward to participating again next year.

The Newsletter Committee, under the leadership of Vivian Ip, MBChB, has developed an extraordinary collaboration to disperse knowledge among all the sister societies, so acute, chronic, and transitional pain topics can be shared and discussed from different areas of the world. Each sister society has a representative, who will serve a 2-year term.

  • ESRA – Kris Vermeylen, MD, PhD
  • LASRA – Carlos Eduardo, MD
  • AOSRA-PM - J Balavenkat, MD
  • AFSRA – Francois Retief, MBchB, MMed

In addition to the sister societies, the Canadian Anesthesiologists’ Society will be represented by Garret Barry, MD.

Knowledge will be shared through multiple article types, including How I Do It and Problem-Based Learning Discussions. We will also have translated articles. I am looking forward to learning from our colleagues on pertinent topics in the field of pain medicine.

The upcoming 2024 Spring Meeting will also feature several speakers from our sister societies, including a joint ASRA Pain Medicine-ESRA session on creating pharmacological recipes in regional anesthesia and acute pain. This session will feature ESRA President, leni Moka, MD, PhD, MSc, and ESRA members, Alan Macfarlane, MBChB, MRCP, and Margaretha Breebaart, MD, PhD. LASRA President, Juan Carlos de la Cuadra, MD, will discuss regional anesthesia in under-resourced/developing nations as part of the “Beyond Our Borders: Lessons in Pain Management from Outside the OR Environment” session. Justin Ko, MD, PhD from AOSRA-PM will provide an international perspective on the practice-changing research in regional anesthesia and pain management. I look forward to welcoming these individuals to our meeting and continuing to build on these collaborations.

ASRA Pain Medicine’s Growth in the American Medical Association (AMA)

Richard Chou, MD, represented ASRA Pain Medicine at the 2023 Interim Meeting of the AMA House of Delegates, held in National Harbor, Maryland. Prior to the meeting, the Practice Management Committee led by Kevin Vorenkamp, MD, reviewed all the resolutions relevant to ASRA Pain Medicine. Important topics were covered at this meeting, including addressing Medicare reimbursement challenges, improving access to post-acute medical care for patients with substance abuse disorders, recognizing specialty certification positions, examining physician burnout, physician shortages, cannabis product safety, clinical trials, buprenorphine dose limits, and the use of social media for product promotion and compensation by physicians. Based on the committee’s recommendations and the ASRA Pain Medicine Board’s approval, Dr. Chou was able to vote on the resolutions addressing these crucial issues.

Dr. Richard Chou, AMA Alternate Delegate

ASRA Pain Medicine is also involved in the CPT Editorial Panel and RUC process. We participated with numerous other specialties in a survey of a set of new Telemedicine Office Visit Codes. These codes will be effective January 1, 2025. Thank you to all the members who participated in the survey process. The Centers for Medicare & Medicaid Services (CMS) has largely maintained flexibility around telehealth services established during the COVID-19 pandemic through CY 2024. Telehealth payment and coverage policies in 2025 are uncertain at this time, but there is significant advocacy being conducted at the Congressional level and with CMS. ASRA Pain Medicine is actively engaged in these efforts.

In addition, ASRA Pain Medicine and the ASA submitted a Fascial Plane Block Code application to establish six new codes to allow for more specific reporting. While these codes were accepted, nothing is official until the 2025 codes are released in August/September of 2024.

With our continued involvement in the AMA, we want to make sure we’re communicating and providing the resources and information you need. At the end of January, CMS released the Interoperability and Prior Authorization Final Rule (CMS-0057-F) to expand access to health information and improve the prior authorization process. Beginning primarily in 2026, the key provisions finalized include payers sending prior authorization decisions within 72 hours for expedited (ie, urgent) requests and seven calendar days for standard (ie, non-urgent); payers including a specific reason for denying a prior authorization request; and payers being required to report prior authorization metrics publicly. For additional information, please click here.

We also recently released the highly anticipated 2024 Fee Schedule for commonly performed regional anesthesia, acute, and chronic pain medicine procedures. This table replaces the information previously housed within the ASRA Coder App and is available to all ASRA Pain Medicine members. While generally anticipated, stakeholders were disappointed that the CY 2024 Medicare Physician Conversion Factor (CF) was reduced to $32.74, a 3.4% reduction from the 2023 CF of $33.89. While Congress has addressed physician payment cuts in year-end legislation in years past, this year, Congress passed a temporary funding patch which has delayed addressing the payment cuts. While action by Congress is not guaranteed, if they do act, the chart will be updated accordingly.

Recognizing the Importance of Other Specialties in the Field of Pain Medicine

Although ASRA Pain Medicine has predominantly been a society of anesthesiologists, we continue to recognize and invite other specialties into the ASRA Pain Medicine family. The field of pain medicine involves many specialties, including physiatry, neurology, psychiatry, and emergency medicine. The practice of pain medicine continues to evolve, and this can be seen in practice and the growth of other specialties in pain medicine fellowships. ASRA Pain Medicine recognizes this evolving landscape and has developed workgroups to enhance our relationship with other subspecialties in addition to anesthesiologists. Our physiatry working group includes Drs. Alexios Carayannopoulos, Christine Hunt, Lynn Kohan, Karson Mostert, Ameet Nagpal, Anish Parkash, and Sayed Wahezi. We also had a physical medicine and rehabilitation think tank at the Fall Meeting, and I genuinely enjoyed listening and learning from other specialties. It is clear that we all have unique skill sets, and collaboration is critical. Recognition of the importance of other specialties can clearly be seen in the leadership of our last pain meeting, Dr. Alexios Carayannopoulos, and our future pain meeting, Dr. Christine Hunt. Both are physiatrists. It will be critical that ASRA Pain Medicine has an open-door policy to all specialties involved in the care of pain patients. I look forward to seeing growth in our membership in these other areas while maintaining our anesthesiology strengths.

In conclusion, in a short 10 months, an extensive number of great strides have been made in advancing ASRA Pain Medicine’s mission. I am truly thankful for all the volunteers’, home office team’s, and board of directors’ time and efforts.

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