Senate Fails to Prevent SGR Cuts

Yesterday, the House passed HR 4691, legislation that extends a number of expiring programs for 30 days, including current Medicare physician payment rates, which would once again postpone the 21% cut that was scheduled to take effect this year. The Senate attempted unsuccessfully on several occasions last night and this morning to pass the same bill by unanimous consent, but objections were raised by Senator Jim Bunning (R-KY), on the basis that $10 billion cost of the program extensions was not offset. The Senate has now adjourned for the weekend, so the 21% Medicare physician payment cut will be effective on Monday, March 1.


The Centers for Medicare and Medicaid Services (CMS) informed the AMA that they are notifying their contractors to hold Medicare physician claims for 10 business days, effective Monday. The agency will also be sending out a similar message on its various list serves this afternoon to physicians, and contractors will be instructed to disseminate this information as well.

Express your outrage to Congress about its terrible mismanagement of the Medicare and TRICARE programs, which are so important to the health and well-being of Americans who have served our nation so long and so well. Tell them:

• Congress had more than a year to repeal the Medicare payment formula and ensure the security and stability of the program. Instead, it has abandoned patients who rely on Medicare and TRICARE for their health care.
• Parliamentary procedures offer no excuse for the harm they are causing these programs.
• Stop playing games with patients and the physicians; repeal the sustainable growth rate (SGR) formula once and for all.

Use the AMA's toll-free grassroots hotline at (800) 833-6354 or write them an e-mail.

Needle Electromyography Through a Tattoo

This morning I found an interesting question in my email: "Is needle EMG through a tattoo contraindicated?" The physician who inquired was concerned about both an increased risk of infection and possible damage to the tattoo.

The AANEM does not address this issue in any of its documents, although Risks in Electrodiagnostic Medicine says, "Insertion of needle electrodes through infected skin or sores is contraindicated." A search in Muscle & Nerve produced no articles that mention tattoos in any context. I located a statement from the American Association of Nurse Anesthetists that discusses the risk of piercing a tattoo for an epidural. Similar information was available at mayoclinic.com. An increased risk of infection has not been documented, although needle insertion of a fresh tattoo is not advised. When possible, it is desireable to avoid piercing any tattoo should a small scar disfigure the image.

If you have experience with EMG through a tattoo or a similar "preexisting condition," please share it using the comments feature.

AMA Morning Rounds: H1N1 Hits Children with Neuromuscular Disorders

USA Today (2/18, Sternberg) reports that "thousands of children and adolescents with neuromuscular disorders, asthma and other conditions...are suffering consequences of H1N1 that will linger long after the 2009/2010 swine flu pandemic ends." Although "no one knows exactly why flu has such a devastating effect on" these children, "the evidence has been mounting since late 2005. Researchers at Children's Hospital of Philadelphia "reported that, even in typical flu years, children with these ailments were six times more likely than other children to develop severe complications from flu."

Access 2007 Re-Run and 2008 PQRI Feedback Reports

Physicians may now access their 2007 re-run and 2008 Physician Quality Reporting Initiative (PQRI) data through a new tool. CMS has created the “Verify Report Portal” which is available on the PQRI Qualitynet Portal. In addition to PQRI information, these reports will provide individual physicians with information on their Medicare Part B Physician Fee Schedule allowed charges for the 2007 or 2008 PQRI reporting period, upon which an incentive payment is based.

The tool is available at https://www.qualitynet.org/portal/server.pt.

Paraspinal Mapping Superior to Imaging for Diagnosing Stenosis

A recent JAMA commentary by AANEM member Dr. Andy Haig, notes that while most surgeons use imaging to diagnose stenosis and make surgical recommendations, recent studies have shed doubt on the ability of imaging to confirm a diagnosis of stenosis. In contrast, new data has shown that paraspinal mapping can reliably identify patients with clinical stenosis. Haig says there are three key steps that need to be taken:“Find and treat what is not stenosis, define and treat the effects of stenosis, and treat presumed stenosis without a definitive diagnosis. Failing all of these steps, a positive diagnosis is an important consideration before surgery,” said Haig.

“I hope this commentary can begin a shift in the way some of these topics are considered and researched. Patients don’t present with stenosis; they present with back pain. As physicians, our guidelines should reflect that we diagnose and treat patients who have symptoms that help us make a diagnosis and treatment plan,” Haig concluded.

The commentary written was published in the January 6, 2010, issue of JAMA. The article was co-author by Christy Tomkins, PhD.

SGR Delay Expires March 1

The clock is ticking—tell your senators to repeal the SGR. With a 21 percent cut in Medicare physician payments scheduled to take effect in just 20 days, the time to persuade lawmakers to pass a permanent repeal of Medicare's sustainable growth rate (SGR) formula is ticking away. Contact your U.S. senators and insist that they pass legislation to repeal the SGR formula to avert the cuts, which are slated to take effect March 1. Use the AMA's toll-free grassroots hotline at (800) 833-6354 or write them an e-mail.