Wednesday, November 28, 2012

Medicare and Chronic Pain

The Providence Journal recently published an article on 10/30 about Medicare coverage as it relates to chronic pain treatment.  The original article, written by Janice Izlar, can be viewed by continuing to read below or byclicking this link.

Imagine that you're a 67-year-old farmer living in Wisconsin and suffering from chronic back pain. Seeing a physician who specializes in pain management entails a long, expensive trip. Fortunately, you don't have to make that trip because a local Certified Registered Nurse Anesthetist (CRNA) can administer the pain management that you need to lead a normal life.

But one day, your nurse anesthetist informs you that he or she can't administer your chronic pain treatments anymore because Medicare won't pay for them. With the nearest pain physician hundreds of miles away, you face the grim prospect of unnecessarily living in agony or regularly making the grueling journey to seek treatment.
That's precisely what's happening for countless seniors and other pain patients across America. Unless Medicare officials take action to guarantee patient access to chronic pain management administered by CRNAs, especially in rural and other medically underserved areas of the country, our hypothetical Wisconsinite's experience may become the norm nationwide.
The ins and outs of Medicare's reimbursement practices may seem arcane. But they have real effects on the lives of Medicare beneficiaries, particularly those in rural areas.
Seeing a doctor can pose a significant challenge for rural Americans. Roughly 20 percent of Americans live in rural areas, but only 9 percent of physicians practice there.
For pain patients, the access problem is even more acute. Today, with more than 100 million Americans suffering from chronic pain, our nation lacks sufficient healthcare providers to care for them, according to the Institute of Medicine. One nurse anesthetist in Kansas reports that her patients' lone alternative is a three-hour round trip to the nearest city.
CRNAs play a crucial role in filling the pain-care gap. There are more than 45,000 nurse anesthetists nationwide delivering 33 million anesthetics annually. They've been doing so for many years, and Medicare has long reimbursed them for their work.
That was the case until last year, when two Medicare administrative contractors operating in several western states suddenly cut off access to chronic pain care delivered by CRNAs.
Some nurse anesthetists have continued to provide such therapy without reimbursement, but others simply haven't been able to afford to do so in the wake of the Medicare contractors' decision.
Medicare officials are expected to soon settle the issue by issuing a uniform rule for the entire country. The proposal they're considering would guarantee reimbursement to CRNAs who are legally authorized by the laws of their state to administer chronic pain therapy.
The Institute of Medicine has made statements consistent with this policy, saying, "the constraints of outdated policies, regulations, and cultural barriers, including those related to scope of practice, will have to be lifted, most notably for advanced practice registered nurses" in order to solve the pain-care crisis.
And there's no question that CRNAs are qualified to provide chronic pain-management. They've graduated from accredited nurse anesthesia educational programs. In fact, the Council on Accreditation of Nurse Anesthesia Educational Programs requires nurse anesthetists to receive rigorous graduate education in such disciplines as pathophysiology, pharmacology, anatomy and pain management.
Many nurse anesthetists undergo further training in the form of fellowships, supervised practice, professional education, and weekend courses.
As Brian Bradley, a nurse anesthetist in Montana, recently put it, "If you're saying I can't treat chronic pain, you're telling me I'm a fireman but can only put out fires in the living room and bathroom."
Expanding access to pain care through CRNAs will also obviate patient need for prescription painkillers, which can be prone to abuse.
Medicare's very mission is to ensure that no senior goes without the health care that he or she needs. The agency's leaders must therefore ratify the rule they're considering, and guarantee patient access to Certified Registered Nurse Anesthetists.

Attorney Doug Stoehr is a personal injury lawyer serving western and central Pennsylvania who takes claims involving elder abuse and neglect, as well as motor vehicle accident cases. For more information on his central Pennsylvania practice, pleasevisit his website or call his office at 814-946-4100.

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