Chronic Pain and Medicare Coverage

By: Dr. Thomas M. Basch

Dear Patients,

Another short but not-so-sweet blog for you to, I hope, act upon ASAP. Medicare (coverage for the elderly and/or the disabled) in addition to forbidding the use of sedation for patients undergoing injections, is now forbidding the epidural use of Depo-medrol, our longest-lasting corticosteroid. The recommended replacement, Decadron, typically has a shorter duration of action. In other words, if you have Medicare and you have chronic pain, you are now being denied a very standard, tried and true, safe pain management protocol.

When I say “forbidden”, in truth I am allowed to practice how I chose and use the techniques and medications I want to use. No problem. BUT, I won’t be paid. Now, as you may know, Medicare stopped paying us for giving sedations years ago. We continue to do it on our own dime because it is safest (sudden involuntary movements by the patient increase risk of nerve injury), and it is, for patients who find injections distressing and/or painful, the humane thing to do. Patients who have a hard time with the pain of the injections or who are apprehensive about needles can lose hours, days, even weeks to unnecessary fear and anxiety over an upcoming treatment. That is time lost forever and absolutely does not have to be. I shall continue to use sedation for Medicare patients who otherwise cannot remain safely motionless during the procedure; no one can tell me to make a procedure for which I am responsible more dangerous than it has to be. But my point on the sedation ruling stands.

If you feel that these restrictions adversely affect your pain management, will you help us? If you are not affected (yet) but know older or disabled people who ARE likely affected, will you contact your elected state and federal politicians? Will you contact Medicare and ask why the elderly and the disabled are denied important parts of their healthcare? Ask why the elderly and the disabled are required to endure more pain and more anxiety than other patients? Ask why your doctor is being told that he/she cannot use the medications that are most likely to give the longest duration of relief?

I try not to fall prey to conspiracy theory, but I cannot help but feel that interventional pain management is under attack, that someone in power just plain wants this field gone. I don’t know why. Even if money/cost were the major issue, we have proven over the years that patients with chronic pain who see an MPC specialist typically SAVE money compared to patients with chronic pain who don’t. One emergency room visit with the concomitant Xrays and MRI's to evaluate uncontrolled often costs more than a year’s worth of MPC pain management.

Many of you, my patients, have seen me for years. I feel that between the two of us, we can best assess your needs as well as your treatment outcomes. Frankly, I’m proud of you and I’m proud of myself (in a good way!). Be it at my pain practice or be it at my Revive practice, one purpose drives me: I want you to have a BIG LIFE. I want you to live largely, and in this, I think you and I are of one mind. I want to keep going, as do all of my partners, but we need your help.

Thomas M Basch MD

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