Recommendations of the medicare payment advisory commission (MEDPAC) on the health care delivery system: The impact on interventional pain management in 2014 and beyond

Pain Physician

Volumn 16, Issue 5, 2013, Pages 419-440

  Manchikanti, Laxmaiah ^a,b   Benyamin, Ramsin M ^c,d   Falco, Frank J E ^e,f   Hirsch, Joshua A ^g  

^a PAIN MANAGEMENT CENTER OF PADUCAH   (United States)

^b UNIVERSITY OF LOUISVILLE   (United States)

^c MILLENNIUM PAIN CENTER   (United States)

^d UNIVERSITY OF ILLINOIS AT URBANA CHAMPAIGN   (United States)

^e Mid Atlantic Spine and Pain Physicians   (United States)

^f TEMPLE UNIVERSITY HOSPITAL   (United States)

^g MASSACHUSETTS GENERAL HOSPITAL   (United States)

Author keywords

Ambulatory surgery centers (ASCs); Health care delivery system; Hospital outpatient departments (HOPDs); Medicare; Medicare payment advisory commission (MedPAC); Physician office practices

Indexed keywords

NARCOTIC ANALGESIC AGENT;

AMBULATORY CARE; AMBULATORY SURGERY; CHRONIC PAIN; COST CONTROL; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE UTILIZATION; HUMAN; LOW BACK PAIN; MEDICAL FEE; MEDICARE; NERVE BLOCK; OUTPATIENT DEPARTMENT; PATIENT SAFETY; PHYSIOTHERAPY; PRIVATE PRACTICE; PROSPECTIVE PAYMENT; REIMBURSEMENT; REVIEW; UNITED STATES;

HEALTH CARE COSTS; HUMANS; MEDICARE; MEDICARE PAYMENT ADVISORY COMMISSION; PAIN MANAGEMENT; PROSPECTIVE PAYMENT SYSTEM; UNITED STATES;

EID: 84884685034     PISSN: 15333159     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (146)

1. Antos JR, Pauly MV, Wilensky GR. Bending the cost curve through marketased incentives. N Engl J Med 2012; 367:954-958.
2. Keehan SP, Cuckler GA, Sisko AM, Madison AJ, Smith SD, Lizonitz JM, Poisal JA, Wolfe CJ. National health expenditure projections: Modest annual growth until coverage expands and economic growth accelerates. Health Aff (Millwood) 2012; 31:1600-1612.
3. Public Law No: 111-148: H.R. 3590. Patient Protection and Affordable Care Act. March 23, 2010.
4. Manchikanti L, Hirsch JA. Obamacare 2012: Prognosis unclear for interventional pain management. Pain Physician 2012; 15:E629-E640.
5. 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, May 31, 2013. www.cms.gov/Research-Statistics-Dataand-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2013.pdf
6. Manchikanti L, Hirsch JA. Regulatory burdens of the Affordable Care Act. Harvard Health Policy Rev 2012; 13:9-12.
7. Congressional Budget Office. Updated estimates for the insurance coverage provisions of the Affordable Care Act. March 2012. www.cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage%20Estimates.pdf
8. Hoffman A, Emanuel EJ. Reengineering US health care. JAMA 2013; 309:661-662.
9. Shortell SM. Bridging the divide between health and health care. JAMA 2013; 309:1121-1122.
10. Medicare Payment Advisory Commission. Report to the Congress. Medicare and the Health Care Delivery System. Washington, DC: MedPAC. June 2013. www.medpac.gov/documents/Jun13_EntireReport.pdf
11. Public Law 112-96. Middle Class Tax Relief and Job Creation Act of 2012. February 22, 2012.
12. Rubin J. Employer mandate delay-pulling on a string. Washington Post, July 3, 2013. www.washingtonpost.com/blogs/rightturn/wp/2013/07/03/employer-mandatedelay-pulling-on-a-string/
13. United States House of Representatives, Energy & Commerce Committee, Chairman Fred Upton. Obamacare oversight: The looming premium rate shock. May 13, 2013. http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/analysis/insurancepremiums/FinalReport.pdf
14. Blankley B. ObamaCare to Increase Health Insurance Premiums by 100-400 Percent, Deficit and Taxes to Skyrocket. CP Opinion, June 10, 2013. www.christianpost.com/news/obamacare-to-increase-health-insurance-premiums-by-100-400-percent-deficit-andtaxes-to-skyrocket-97599/
15. Manchikanti L, Pampati V, Falco FJE, Hirsch JA. Growth of spinal interventional pain management techniques: Analysis of utilization trends and Medicare expenditures 2000 to 2008. Spine (Phila Pa 1976) 2013; 38:157-168.
16. Manchikanti L, Falco FJE, Singh V, Pampati V, Parr AT, Benyamin RM, Fellows B, Hirsch JA. Utilization of interventional techniques in managing chronic pain in the Medicare population: Analysis of growth patterns from 2000 to 2011. Pain Physician 2012; 15:E969-E982.
17. Manchikanti L, Pampati V, Falco FJE, Hirsch JA. Assessment of the growth of epidural injections in the Medicare population from 2000 to 2011. Pain Physician 2013; 16:E349-E364.
18. Manchikanti L, Pampati V, Singh V, Falco FJE. Assessment of the escalating growth of facet joint interventions in the Medicare population in the United States from 2000 to 2011. Pain Physician 2013; 16:E365-E378.
19. Manchikanti L, Hansen H, Pampati V, Falco FJE. Utilization and growth patterns of sacroiliac joint injections from 2000 to 2011 in the Medicare population. Pain Physician 2013; 16:E379-E390.
20. Abbott ZI, Nair KV, Allen RR, Akuthota VR. Utilization characteristics of spinal interventions. Spine J 2012; 1:35-43.
21. Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299:656-664. Erratum in: JAMA 2008; 299:2630.
22. Martin BI, Turner JA, Mirza SK, Lee MJ, Comstock BA, Deyo RA. Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997-2006. Spine (Phila Pa 1976) 2009; 34:2077-2084.
23. Institute of Medicine (IOM). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press, Washington, DC, June 29, 2011. www.iom.edu/~/media/Files/Report%20Files/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-PreventionCare-Education-Research/Pain%20Research%202011%20Report%20Brief.pdf
24. Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain 2012; 13:715-724.
25. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, Castel LD, Kalsbeek WD, Carey TS. The rising prevalence of chronic low back pain. Arch Intern Med 2009; 169:251-258.
26. Manchikanti L, Abdi S, Atluri S, Benyamin RM, Boswell MV, Buenaventura RM, Bryce DA, Burks PA, Caraway DL, Calodney AK, Cash KA, Christo PJ, Cohen SP, Colson J, Conn A, Cordner HJ, Coubarous S, Datta S, Deer TR, Diwan SA, Falco FJE, Fellows B, Geffert SC, Grider JS, Gupta S, Hameed H, Hameed M, Hansen H, Helm II S, Janata JW, Justiz R, Kaye AD, Lee M, Manchikanti KN, McManus CD, Onyewu O, Parr AT, Patel VB, Racz GB, Sehgal N, Sharma M, Simopoulos TT, Singh V, Smith HS, Snook LT, Swicegood J, Vallejo R, Ward SP, Wargo BW, Zhu J, Hirsch JA. An update of comprehensive evidence-based guidelines for interventional techniques of chronic spinal pain: Part II: Guidance and recommendations. Pain Physician 2013; 16:S49-S283.
27. Manchikanti L, Abdi S, Atluri S, Balog CC, Benyamin RM, Boswell MV, Brown KR, Bruel BM, Bryce DA, Burks PA, Burton AW, Calodney AK, Caraway DL, Cash KA, Christo PJ, Damron KS, Datta S, Deer TR, Diwan S, Eriator I, Falco FJE, Fellows B, Geffert S, Gharibo CG, Glaser SE, Grider JS, Hameed H, Hameed M, Hansen H, Harned ME, Hayek SM, Helm II S, Hirsch JA, Janata JW, Kaye AD, Kaye AM, Kloth DS, Koyyalagunta D, Lee M, Malla Y, Manchikanti KN, McManus CD, Pampati V, Parr AT, Pasupuleti R, Patel VB, Sehgal N, Silverman SM, Singh V, Smith HS, Snook LT, Solanki DR, Tracy DH, Vallejo R, Wargo BW. American Society of Interventional Pain Physicians (ASIPP) opioid prescribing in chronic non-cancer pain: Part 2-Guidance. Pain Physician 2012; 15:S67-S116.
28. Erickson W, von Schrader S, Lee C. 2010 Disability Status Report, United States. Cornell University ILR School, January 1, 2012. http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1561&context=gladnetcollect&seiredir=1&referer=http%3A%2F%2Fwww.google.com%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3D2010%2520disability%2520status%2520report%26source%3Dweb%26cd%3D2%26ved%3D0CD0QFjAB%26url%3Dhttp%253A%252F%252Fdigitalcommons.ilr.cornell.edu%252Fcgi%252Fviewcontent.cgi%253Farticle%253D1561%2526context%253Dgladnetcollect%26ei%3Du7LuUZm9E4_M9gTLm4H4Cw%26usg%3DAFQjCNFL5h4gi7FLj7_nY2OCsHX67Elu2w%26bvm%3Dbv.49641647%2Cd.eWU#search=%222010%20disability%20status%20report%22
29. Merlin J. Disability ranks outpace new jobs in Obama recovery. Investor's Business Weekly, July 6, 2012.
30. U.S. Social Security Administration. Annual statistical report on the Social Security Disability Insurance Program, 2011. Release July 2012. www.ssa.gov/policy/docs/statcomps/di_asr/2011/di_asr11.pdf
31. Davis MA, Onega T, Weeks WB, Lurie JD. Where the United States spends its spine dollars: Expenditures on different ambulatory services for the management of back and neck conditions. Spine (Phila Pa 1976) 2012; 37:1693-1701.
32. Dagenais S, Roffey DM, Wai EK, Haldeman S, Caro J. Can cost utility evaluations inform decision making about interventions for low back pain? Spine J 2009; 9:944-957.
33. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008; 8:8-20.
34. Department of Health and Human Services, Health Care Financing Administration. 42 CFR Parts 410, 411, 414, 415, and 485. Medicare Program; Revisions to payment policies under the physician fee schedule for Calendar Year 2000; Final Rule. November 2, 1999.
35. Department of Health and Human Services, Health Care Financing Administration. 42 CFR Parts 410 and 414 Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2001; Final Rule. November 1, 2000.
36. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 405, 410, 411, 414, and 415. Medicare Program; Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 2002; Final Rule. November 1, 2001.
37. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 403, 405, 410, 411, 414, 418, 424, 484, and 486. Medicare Program; Medicare Payment Policies Under the Physician Fee Schedule for Calendar Year 2005; Final Rule. November 15, 2004.
38. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 405, 410, 411, 413, 414, 424, and 426. Medicare Program; Medicare Payment Policies Under the Physician Fee Schedule for Calendar Year 2006 and Certain Provisions Related to the Competitive Acquisition Program of Outpatient Drugs and Biologicals Under Part B; Final Rule. November 21, 2005.
39. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 405, 410, 411, 414, 415, and 424. Medicare Program; Medicare Payment Policies, Five-Year Review of Work Relative Value Units, Changes to the Practice Expense Methodology Under the Physician Fee Schedule, and Other Changes to Payment Under Part B; Revisions to the Payment Policies of Ambulance Services Under the Fee Schedule for Ambulance Services; and Ambulance Inflation Factor Update for CY 2007; Final Rule. December 1, 2006.
40. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 405, 409, 410, 411, 414, 415, 424, 485, and 486. Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2009; E-Prescribing Exemption for Computer-Generated Facsimile Transmissions; and Payment for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); Final Rule. November 19, 2008.
41. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 410, 411, 414. Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010; Final Rule; Medicare Program; Solicitation of Independent Accrediting Organizations To Participate in the Advanced Diagnostic Imaging Supplier Accreditation Program Notice; Final Rule. November 25, 2009.
42. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 405, 409, 410, 411, 413, 414, 415, and 424 Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011; Final Rule. November 29, 2010.
43. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 410, 414, 415, and 495. Medicare Program; Payment Policies Under the Physician Fee Schedule, FiveYear Review of Work Relative Value Units, Clinical Laboratory Fee Schedule: Signature on Requisition, and Other Revisions to Part B for CY 2012; Final Rule. November 28, 2011.
44. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Part 416. Medicare Program; Update of Ambulatory Surgical Center List of Covered Procedures; Proposed Rule. November 26, 2004.
45. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Part 416. Medicare Program; Update of Ambulatory Surgical Center List of Covered Procedures; Interim Final Rule. May 4, 2005.
46. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 410, 416 et al. Medicare Program-Revisions to Hospital Outpatient Prospective Payment System and Calendar Year 2007 Payment Rates; Final Rule. November 24, 2006.
47. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 410, 416, and 419. Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2009 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2009 Payment Rates; Hospital Conditions of Participation: Requirements for Approval and Re-Approval of Transplant Centers To Perform Organ Transplants-Clarification of Provider and Supplier Termination Policy Medicare and Medicaid Programs: Changes to the Ambulatory Surgical Center Conditions for Coverage; Final Rule. November 18, 2008.
48. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 410, 416, and 419 Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2010 Payment Rates; Final Rule. November 20, 2009.
49. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 410, 411, 412, 413, 416, 419, and 489. Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Payments to Hospitals for Graduate Medical Education Costs; Physician Self-Referral Rules and Related Changes to Provider Agreement Regulations; Payment for Certified Registered Nurse Anesthetist Services Furnished in Rural Hospitals and Critical Access Hospitals; Final Rule. November 24, 2010.
50. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 410, 411, 416, 419, 489, and 495. Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical Center Payment; Hospital Value-Based Purchasing Program; Physician Self-Referral; and Provider Agreement Regulations on Patient Notification Requirements. Final Changes to the Hospital Outpatient Prospective Payment System and CY 2012 Payment Rates. November 30, 2011.
51. Manchikanti L, Singh V, Hirsch JA. Saga of payment systems of ambulatory surgery centers for interventional techniques: An update. Pain Physician 2012; 15:109-130.
52. Hirsch JA, Rosman DA, Liu RW, Ding A, Manchikanti L. Sustainable growth rate 2013: Time for definitive intervention. J Neurointerv Surg 2013; 5:382-386.
53. Manchikanti L, Singh V, Caraway DL, Benyamin RM, Falco FJE, Hirsch JA. Proposed physician payment schedule for 2013: Guarded prognosis for interventional pain management. Pain Physician 2012; 15:E615-E627.
54. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 405, 410, 411, 414, 423, and 425. Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule & Other Revisions to Part B for CY 2014; Proposed Rule. June 26, 2013.
55. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 405, 410, 412, 416, 419, 475, 476, 486, and 495. Medicare and Medicaid Programs: Hospital Outptient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organizations; Quality Improvement Organizations; Electronic Health Records (EHR) Incentive Program; Provider Reimbursement Determinations and Appeals; Proposed Rule. June 26, 2013.
56. Medicare Payment Adivsory Commission. Fact Sheet: Report to the Congress. Washington, DC. March 2010. www.medpac.gov/documents/Mar10_FactSheet.pdf
57. Berenson RA, Ginsburg PB, Christianson JB, Yee T. The growing power of some providers to win steep payment increases from insurers suggests policy remedies may be needed. Health Aff (Millwood) 2012; 31:973-981.
58. O'Malley AS, Bond AM, Berenson RA. Rising hospital employment of physicians: Better quality, higher costs? Issue Brief Cent Stud Health Syst Change 2011; 136:1-4.
59. Kocher R, Sahni NR. Hospitals' race to employ physicians--the logic behind a money-losing proposition. N Engl J Med 2011; 364:1790-1793.
60. Testimony of Paul B. Ginsburg, PhD, President, Center for Studying Health System Change. Hearing on "Health care industry consolidation." Before the Subcommittee on Health, Ways and Means Committee, United States House of Representatives. September 9, 2011.
61. Jain M. Doctors in private practices are now joining hospital staffs. Washington Post, March 12, 2012.
62. Dutton A. The cost of doctor buyouts: Charges rise, patient choice suffers, critics say. Idaho Statesman, October 28, 2012.
63. Mathews AW. Same doctor visit, double the cost: Insurers say rates can surge after hospitals buy private physician practices; Medicare spending rises, too. Wall Street Journal, August 27, 2012.
64. Hacker K, Walker DK. Achieving population health in accountable care organizations. Am J Public Health 2013; 103:1163-1167.
65. Hines P, Mercury M. Designing the role of the embedded care manager. Prof Case Manag 2013; 18:182-187.
66. Landon BE, Onnela JP, Keating NL, Barnett ML, Paul S, O'Malley AJ, Keegan T, Christakis NA. Using administrative data to identify naturally occurring networks of physicians. Med Care 2013 Jun 25. [Epub ahead of print].
67. Freeman WD, Vatz KA, Griggs RC, Pedley T. The Workforce Task Force Report: Clinical implications for neurology. Neurology 2013 Jun 19. [Epub ahead of print].
68. Harvey HB, Cohen IG. The looming threat of liability for accountable care organizations and what to do about it. JAMA 2013; 310:141-142.
69. Maust DT, Oslin DW, Marcus SC. Mental health care in the accountable care organization. Psychiatr Serv 2013 Jun 14. [Epub ahead of print].
70. Homer CJ, Patel KK. Accountable care organizations in pediatrics: Irrelevant or a game changer for children? JAMA Pediatr 2013; 167:507-508.
71. Shaz BH, Hillyer CD, Waters JH. Patient blood management: Key for accountable care organizations. JAMA Surg 2013; 148:491-492.
72. Miller DC, Ye Z, Gust C, Birkmeyer JD. Anticipating the effects of accountable care organizations for inpatient surgery. JAMA Surg 2013; 148:549-554.
73. Penson DF. Accountable care organizations in surgery: location, location, location: comment on "will accountable care organizations cut costs and improve quality for inpatient surgery?" JAMA Surg 2013; 148:554.
74. Zusman E, Reagan R. Competitive kaisers: The future of American healthcare is vertically integrated accountable care organizations where patient members pay for health care instead of health insurance. Neurosurgery 2013; 72:N11-N13.
75. Sorrel AL. ACOs, Texas-Style. Tex Med 2013; 109:25-28.
76. Ranola P. Leadership of accountable care organizations. Virtual Mentor 2013; 15:515-517.
77. Kuperman GJ, McGowan JJ. Potential unintended consequences of health information exchange. J Gen Intern Med 2013 May 21. [Epub ahead of print].
78. Rosman DA, Farinhas JM, Ullrich CG, McGinty G. Accountable care organizations: Is the radiologist at risk? J Am Coll Radiol 2013 May 9. [Epub ahead of print].
79. Schultz S, Abercrombie S, Crownover B, Hoekzema G, Krug N, Maxwell L, Mazzone M, Mitchell K, Shaffer T, Tuggy M. Accountable care organizations: An opportunity for synergy. Ann Fam Med 2013; 11:283-284.
80. Taplin SH, Foster MK, Shortell SM. Organizational leadership for building effective health care teams. Ann Fam Med 2013; 11:279-281.
81. King ML. Affordability, accountability, and accessibility in health care reform: Implications for cardiovascular and pulmonary rehabilitation. J Cardiopulm Rehabil Prev 2013; 33:144-152.
82. Thorpe JH. Health system transformation and the role of health information law. Public Health Rep 2013; 128:231-235.
83. Curnow RT Jr, Doers JT. Preparing for accountable care organizations: A physician primer. Chest 2013; 143:1140-1144.
84. Maddux FW, McMurray S, Nissenson AR. Toward population management in an integrated care model. Clin J Am Soc Nephrol 2013; 8:694-700.
85. Ortiz J, Bushy A, Zhou Y, Zhang H. Accountable care organizations: Benefits and barriers as perceived by rural health clinic management. Rural Remote Health 2013; 13:2417.
86. Jaffery J, Golden RN. Accountable Care Organizations: What are they? Where are they coming from? Where will they lead? WMJ 2013; 112:98-99.
87. Noble DJ, Casalino LP. Can accountable care organizations improve population health?: Should they try? JAMA 2013; 309:1119-1120.
88. Stecker EC. The Oregon ACO experiment--bold design, challenging execution. N Engl J Med 2013; 368:982-985.
89. Lewis VA, McClurg AB, Smith J, Fisher ES, Bynum JP. Attributing patients to accountable care organizations: Performance year approach aligns stakeholders'interests. Health Aff (Millwood) 2013; 32:587-595.
90. Robeznieks A. Collaborating on healthcare. Insurers, physicians see value in partnerships. Mod Healthc 2013; 43:12-13.
91. Burling S. Why heart doctors are leaving practice to work for hospitals. Philadelphia Inquirer, January 26, 2012.
92. American College of Cardiology. Changing CV practice landscape: Findings from ACC Cardiovascular Practice Census. Presentation to the ACC Michigan Chapter, September 2012.
93. Schulte F. Hospitals face increased scrutiny for charging facility fees. Washington Post, December 23, 2012.
94. Medicare Payment Advisory Commission. Report to the Congress. Medicare Payment Policy. Washington, DC: Med-PAC. March 2013. www.medpac.gov/documents/Mar13_entirereport.pdf
95. Current Procedural Terminology. CPT 2012. American Medical Association, Chicago, 2011.
96. Current Procedural Terminology. CPT 2013. American Medical Association, Chicago, 2012.
97. Ostrom CM. Why you might pay twice for one visit to doctor. Seattle Times, November 3. 2012.
98. North Carolina Department of Health and Human Services, Division of Health Service Regulation. Declaratory ruling to the Presbyterian Hospital and SameDay Surgery Center at Presbyterian Hospital, LLC. 2008
99. State of Connecticut, Department of Public Health, Office of Health Care Access. Notice of final decision for an application for a certificate of need filed by Hartford Hospital & Constitution Eye Surgery Center, LLC. Change of ownership and control of Constitution Eye Surgery Center, LLC to Hartford Hospital. January 20, 2011.
100. Public Law 112-240. The American Taxpayer Relief Act of 2012 (ATRA). January 2, 2013.
101. Manchikanti L, Burks T. Correct coding policies for physical therapy. In: Manchikanti L (ed). Principles of Documentation, Billing, Coding, and Practice Management for the Interventional Pain Professional. ASIPP Publishing, Paducah, KY, 2004, pp 281-288.
102. Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med 2005; 142:776-785.
103. Michael YL, Whitlock EP, Lin JS, Fu R, O'Connor EA, Gold R; US Preventive Services Task Force. Primary care-relevant interventions to prevent falling in older adults: A systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2010; 153:815-825.
104. Manchikanti L, Falco FJE, Pampati V, Cash KA, Benyamin RM, Hirsch JA. Cost utility analysis of caudal epidural injections in the treatment of lumbar disc herniation, axial or discogenic low back pain, central spinal stenosis, and post lumbar surgery syndrome. Pain Physician 2013; 16:E129-E143.
105. Indrakanti SS, Weber MH, Takemoto SK, Hu SS, Polly D, Berven SH. Value-based care in the management of spinal disorders: A systematic review of cost-utility analysis. Clin Orthop Relat Res 2012; 470:1106-1023.
106. Whynes DK, McCahon RA, Ravenscroft A, Hardman J. Cost effectiveness of epidural steroid injections to manage chronic lower back pain. BMC Anesthesiol 2012; 12:26.
107. Chou R, Huffman L. Guideline for the Evaluation and Management of Low Back Pain: Evidence Review. American Pain Society, Glenview, IL, 2009. www.ameri-canpainsociety.org/uploads/pdfs/LBPEvidRev.pdf
108. Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ, Koes B, Ferreira PH. Epidural corticosteroid injections in the management of sciatica: A systematic review and meta-analysis. Ann Intern Med 2012; 157:865-877.
109. Staal JB, de Bie RA, de Vet HC, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low back pain: An updated Cochrane review. Spine (Phila Pa 1976) 2009; 34:49-59.
110. Tosteson AN, Skinner JS, Tosteson TD, Lurie JD, Andersson GB, Berven S, Grove MR, Hanscom B, Blood EA, Weinstein JN. The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: Evidence from the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 2008; 33:2108-2115.
111. Tosteson AN, Lurie JD, Tosteson TD, Skinner JS, Herkowitz H, Albert T, Boden SD, Bridwell K, Longley M, Andersson GB, Blood EA, Grove MR, Weinstein JN; SPORT Investigators. Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: Cost-effectiveness after 2 years. Ann Intern Med 2008; 149:845-853.
112. Tosteson AN, Tosteson TD, Lurie JD, Abdu W, Herkowitz H, Andersson G, Albert T, Bridwell K, Zhao W, Grove MR, Weinstein MC, Weinstein JN. Comparative effectiveness evidence from the spine patient outcomes research trial: Surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation. Spine (Phila Pa 1976) 2011; 36:2061-2068.
113. Abbott JH, Robertson MC, Chapple C, Pinto D, Wright AA, Leon de la Barra S, Baxter GD, Theis JC, Campbell AJ; MOA Trial team. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: A randomized controlled trial. 1: Clinical effectiveness. Osteoarthritis Cartilage 2013; 21:525-534.
114. Pinto D, Robertson MC, Abbott JH, Hansen P, Campbell AJ; the MOA Trial Team. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee. 2: Economic evaluation alongside a randomized controlled trial. Osteoarthritis Cartilage 2013 Jun 27. [Epub ahead of print].
115. Giné-Garriga M, Martin-Borràs C, Puig-Ribera A, Martín-Cantera C, Solà M, Cuesta-Vargas A; on behalf of the PPAF Group. The effect of a physical activity program on the total number of primary care visits in inactive patients: A 15-month randomized controlled trial. PLoS One 2013; 8:e66392.
116. Jowett S, Crawshaw DP, Helliwell PS, Hensor EM, Hay EM, Conaghan PG. Cost-effectiveness of exercise therapy after corticosteroid injection for moderate to severe shoulder pain due to subacromial impingement syndrome: A trial-based analysis. Rheumatology (Oxford) 2013; 52:1485-1491.
117. Maas ET, Juch JN, Groeneweg JG, Ostelo RW, Koes BW, Verhagen AP, van Raamt M, Wille F, Huygen FJ, van Tulder MW. Cost-effectiveness of minimal interventional procedures for chronic mechanical low back pain: Design of four randomised controlled trials with an economic evaluation. BMC Musculoskelet Disord 2012; 13:260.
118. Standaert CJ, Friedly J, Erwin MW, Lee MJ, Rechtine G, Henrikson NB, Norvell DC. Comparative effectiveness of exercise, acupuncture, and spinal manipulation for low back pain. Spine (Phila Pa 1976) 2011; 36:S120-S130.
119. Tricco AC, Antony J, Soobiah C, Hemmelgarn B, Moher D, Hutton B, Yu CH, Majumdar SR, Straus SE. Safety, effectiveness, and cost of dipeptidyl peptidase-4 inhibitors versus intermediate acting insulin for type 2 diabetes: Protocol for a systematic review and network metaanalysis. Syst Rev 2013; 2:47.
120. Memtsoudis SG, Stundner O, Yoo D, Gonzalez Della Valle A, Boettner F, Bombardieri AM, Jules-Elysee K, Poultsides L, Ma Y, Sculco TP. Does limb preconditioning reduce pain after total knee arthroplasty? A randomized, double-blind study. Clin Orthop Relat Res 2013 Jun 13. [Epub ahead of print].
121. Oosterhuis T, van Tulder M, Peul W, Bosmans J, Vleggeert-Lankamp C, Smakman L, Arts M, Ostelo R. Effectiveness and cost-effectiveness of rehabilitation after lumbar disc surgery (REALISE): Design of a randomised controlled trial. BMC Musculoskelet Disord 2013; 14:124.
122. Liamina NG, Razborova IB, Kotel'nikova EV, Karpova ÉS, Nosenko AN, Lipchanskaia TP. Clinico-economic aspects of physical rehabilitation of patients with coronary heart disease after endovascular interventions. Klin Med (Mosk) 2013; 91:9-13.
123. Delaney CL, Spark JI, Thomas J, Wong YT, Chan LT, Miller MD. A systematic review to evaluate the effectiveness of carnitine supplementation in improving walking performance among individuals with intermittent claudication. Atherosclerosis 2013; 229:1-9.
124. Manchikanti L, Buenaventura RM, Manchikanti KN, Ruan X, Gupta S, Smith HS, Christo PJ, Ward SP. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician 2012; 15:E199-E245.
125. Parr AT, Manchikanti L, Hameed H, Conn A, Manchikanti KN, Benyamin RM, Diwan S, Singh V, Abdi S. Caudal epidural injections in the management of chronic low back pain: A systematic appraisal of the literature. Pain Physician 2012; 15:E159-E198.
126. Benyamin RM, Manchikanti L, Parr AT, Diwan SA, Singh V, Falco FJE, Datta S, Abdi S, Hirsch JA. The effectiveness of lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain. Pain Physician 2012; 15:E363-E404.
127. Falco FJE, Manchikanti L, Datta S, Sehgal N, Geffert S, Onyewu O, Zhu J, Coubarous S, Hameed M, Ward SP, Sharma M, Hameed H, Singh V, Boswell MV. An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician 2012; 15:E909-E953.
128. Falco FJE, Manchikanti L, Datta S, Wargo BW, Geffert S, Bryce DA, Atluri S, Singh V, Benyamin RM, Sehgal N, Ward S, Helm II S, Gupta S, Boswell MV. Systematic review of therapeutic effectiveness of cervical facet joint interventions: An update. Pain Physician 2012; 15:E839-E868.
129. Manchikanti KN, Atluri S, Singh V, Geffert S, Sehgal N, Falco FJE. An update of evaluation of therapeutic thoracic facet joint interventions. Pain Physician 2012; 15:E463-E481.
130. Helm II S, Benyamin RM, Chopra P, Deer TR, Justiz R. Percutaneous adhesiolysis in the management of chronic low back pain in post lumbar surgery syndrome and spinal stenosis: A systematic review. Pain Physician 2012; 15:E435-E462.
131. Balanced Budget Act of 1997. H.R. 2015. P.L. 105-33, August 5, 1997.
132. Centers for Medicare and Medicaid Services. National Coverage Determinations. www.cms.gov/medicare-coverage-da-tabase/indexes/ncd-alphabetical-index.aspx?bc=AgAAAAAAAAAAAA%3d%3d&
133. National Government Services. www.ngsmedicare.com/wps/portal/ngsmedicare/
134. CGS Medicare. www.cgsmedicare.com/medicare.html
135. Wisconsin Physician Services. www.wpsmedicare.com/index.shtml
136. Novitas Solutions.www.novitas-solutions.com/
137. Palmetto GBA Medicare.www.palmettogba.com/palmetto/pal-metto.nsf/SiteHome?ReadForm
138. Noridian Healthcare Solutions.www.noridianmedicare.com/
139. First Coast Service Options, Inc. http://medicare.fcso.com/
140. Cahaba Government Benefit Administrators, LLC. www.cahabagba.com/
141. Maxwell S, Basseggio C, Storeygard M. Part B therapy services under Medicare, 1998-2000: Impact of extending fee schedule payments and coverage limits. Urban Institute, Washington, DC. September 2001.
142. Department of Health and Human Services, Health Care Financial Administration, Medicare and Medicaid Programs; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships; Final Rule. 66 Federal Register 855, Jan. 4, 2001.
143. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 411 and 424. Medicare Program; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships (Phase II); Correction, Federal Register, July 26, 2004.
144. Department of Health and Human Services, Centers for Medicare & Medicaid Services. 42 CFR Parts 411 and 424. Medicare Program; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships (Phase III); Final Rule. Federal Register, Wednesday, September 5, 2007.
145. Schoofs M, Tamman M. Confidentiality cloaks Medicare abuse. Wall Street Journal, December 22, 2010.
146. Office of Inspector General, Department of Health and Human Services. 2010. Questionable billing for Medicare outpatient therapy services. Report # OEI-0409-00540. Washington, DC: OIG.