AAN Guideline: TENS Not Effective for Chronic Low-Back Pain

A new guideline issued by the AAN finds that transcutaneous electric nerve stimulation (TENS), a widely used pain therapy involving a portable device, is not recommended to treat chronic low-back pain pain that has persisted for 3 months or longer because research shows it is not effective. The guideline is published in the December 30 online issue of Neurology®.

The guideline also determined that TENS can be effective in treating diabetic nerve pain, also called diabetic neuropathy, but more and better research is needed to compare TENS to other treatments for this type of pain.

Senate Passes Health Reform Bill

In a 60-39 party line vote, the Senate passed the Patient Protection and Affordable Care Act in the morning on December 24.

Prior to the Senate vote, AMA President-elect Cecil B. Wilson, MD, announced the Association's backing during a Dec. 21 Capitol Hill appearance with Senate Majority Leader Harry Reid (D, Nev.) and other top Democrats. Dr. Wilson noted that the leaders had amended the bill to eliminate some earlier provisions that had prompted AMA concerns, such as a one-year Medicare pay patch that would have led to a projected 23% cut in 2011, an elective cosmetic surgery tax and a proposed Medicare enrollment fee.

But the AMA will continue to push for additional changes to the legislation during the conference negotiations. The Association, for instance, said it will not support a final House-Senate bill unless lawmakers make key revisions to: a proposed independent Medicare advisory board that could impose pay cuts on physicians, a plan to release Medicare data in the form of physician performance reports, and a requirement that doctors participate in Medicare quality reporting or face penalties.

In order to preserve AMA backing for the health system reform bill, the Association said Congress must also demonstrate that it is on track to approve separate legislation permanently repealing the Medicare physician payment formula before the current rate freeze expires at the end of February.

CMS Holds Claims and Extends Provider Enrollment

Last week Congress temporarily averted the 21.2% Medicare physician payment cut. On December 19, President Obama signed the bill which will stop the cuts until March 1, 2010. Other changes reflected in the 2010 Medicare Physician Fee Schedule final rule will still take effect on January 1, 2010 and may have a slight impact on the conversion factor used for the first two months of 2010. Similar to other years, since Congress acted so late in the year to avert the cut, CMS will hold claims for the first 10 business days of January (January 1 through January 15) for 2010 dates of service to allow its contractors time to update their systems and pay claims based on the updated rates CMS does not anticipate any cash flow problems for physicians since by law no claims are paid prior to 14 days after receipt anyway.

In addition, CMS has extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010. Physicians still have time to consider their participation options with the Medicare program. Additional information can be found on the AMA's web site. The effective date for any participation status change during this extension remains January 1, 2010, and will be in force for the entire year. Medicare contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are received or post-marked on or before March 17, 2010.

AMA Supports Senate Health Reform Bill

After carefully evaluating the changes contained in the manager's amendment filed by Senate Majority Leader Harry Reid (D-Nev.), the AMA Board of Trustees voted to support passage of H.R. 3590. In a letter of support to Sen. Reid, the AMA noted the need for additional changes in the final conference committee agreement that reconciles the differences between the House and Senate bills.

The AMA Board's decision to support passage of the amended version of H.R. 3590 is consistent with the recommendation from the AMA Council on Legislation that the AMA support H.R. 3590 while seeking additional changes in the House-Senate conference committee agreement. Check the AMA website for more detailed analysis.

SGR Cut Temporarily Prevented

Yesterday the President has signed, a measure that extends the current Medicare physician payment rate for the next two months, thus blocking a 21.2 percent reduction that was scheduled to go into effect on Jan. 1 under the SGR formula.

The two-month payment patch, which was passed as part of a massive defense appropriations bill, gives lawmakers more time to replace the SGR payment formula.

House Votes to Delay SGR Cuts

This afternoon, the House passed a 2-month extension of expiring appropriations for the Department of Defense that included a 2-month extension of the sustainable growth rate (SGR). In other words, the legislation would stop the 21.2% Medicare pay cut scheduled take effect on January 1 for a period that will end March 1, 2010. The legislation does not affect any of the other payment policies included in the final 2010 fee schedule rule; those will take effect on schedule.

A cloture motion on the DoD extension bill was filed in the Senate today. Votes on cloture and passage should be completed this weekend.

AMA Morning Rounds: Early data for ALS drug candidate shows improved muscle function

The AP (12/10) reports, "Sangamo Biosciences Inc. said Wednesday that early data from a clinical trial shows its Lou Gehrig's disease drug candidate," SB-509, "improved patients' muscle function." Patients injected with the drug "were about twice as likely to have improved muscular function," according to Sangamo. Specifically, "32 percent of patients who received SB-509 had improved muscle function, compared to 17 percent of patients who took standard treatments." The company "is also testing SB-509 as a treatment for diabetic neuropathy."

HIPAA 5010 Resources for January 2012

Are you preparing for the compliance deadlines for the Health Insurance Portability and Accountability Act (HIPAA) 5010 standard transactions, the next version of HIPAA? Beginning Jan. 1, 2012, physicians will be required to use only the 5010 standard transactions when conducting them electronically. The AMA has prepared several educational resources to assist physicians with implementing the 5010 standard transactions.

AMA Morning Rounds: Findings shed light on essential tremor

In the New York Times (12/8, D7) Personal Health column, Jane Brody writes, "Recent studies have begun to unravel the mysteries of essential tremor," a condition characterized by "uncontrollable shaking...that is not due to some other condition." According to Dr. Elan D. Louis, of Columbia University, the progress is marked by "discoveries in three areas -- the brain, clinical findings, and genetics and environment." Researchers have "analyzed and compared...the brains of normal individuals" to those of patients with essential tremor, finding that "this is probably a family of diseases." Abnormal findings include "degenerative changes in the cerebellum," and "a messy arrangement of neurofilaments." Meanwhile, "two environmental toxins have been found to be elevated in tremor patients: lead and a dietary chemical called harmane that occurs naturally in plants and animals."

AMA Morning Rounds: FDA lifts clinical hold on CytRx Lou Gehrig's treatment

The AP (12/2) reported that the FDA "lifted a nearly two-year suspension on development of" CytRx Corp.'s "arimoclomol as a treatment for Lou Gehrig's disease." The agency "halted arimoclomol studies" in January 2008, "citing the need for additional analysis from previously completed animal studies with arimoclomol."

Reuters (12/2) reported that the FDA accepted CytRx's revised trial protocol to review the safety and efficacy of the experimental drug at four times the dose previously studied. The FDA has granted the drug a fast-track review and orphan drug status to treat Lou Gehrig's disease.

Texas Judge Rules EMG, MUA are Beyond Scope of Chiropractors

In a November 24th ruling, Austin State District Judge Stephen Yelenosky said state law prevents chiropractors from performing clinical needle electromyography (EMG) or spinal manipulation under anesthesia (MUA). Yelenosky granted a Texas Medical Association and Texas Medical Board request for a partial summary judgment against the Texas Board of Chiropractic Examiners and the Texas Chiropractic Association.

"Judge Yelenosky ruled that chiropractors cannot perform needle EMGs or manipulation under anesthesia because both of those procedures are beyond the chiropractors' lawful scope of practice," said Austin attorney David F. Bragg, one of the lawyers for TMA. The chiropractors are expected to appeal the ruling, he said.

TMA sued in 2006 to block the chiropractic board's rules that would permit chiropractors to perform clinical needle EMG and MUA, because both procedures constitute the clinical and legal practice of medicine. View the full press release at the TMA website.