I am trying to understand the rationale behind the recent elimination of reimbursement for sedation during interventional pain procedures lasting less than 10 minutes. I’m hearing that MCR does not feel it’s necessary. I have also heard that MCR feels these procedures should be accomplished in a few minutes.
This is flawed on multiple levels.
1) Anxiety and other psychiatric conditions that make it difficult to relax and cope with pain are comorbid in a majority of chronic pain patients. If you ask a majority of my patients I’m certain they would have a different view of whether or not sedation is “indicated” compared to a large organization like MCR that is seemingly removed from the realities of day-to-day pain management.
2) Many patients require interventions in multiple regions of the body. This requires more than a few minutes to safely and effectively perform these procedures. Yet this is greatly appreciated by patients who can receive treatment for multiple painful areas at a single appointment.
3) Training in the management of sedation and the airway is required by the ACGME. This training is a requirement, among many others, for a physician to be recognized as a board certified pain physician trusted to administer sedation. I find it inconsistent on the part of MCR to not reimburse for sedation yet comply with the requirements of training in sedation in order to verify that a physician has completed specialty training.
4) The arbitrary amount of 10 minutes makes it seem as though MCR sees the need for sedation by reimbursing for it after ten minutes yet will only reluctantly pay for it. I can tell you from years of experience that there is nothing special about the 10 minute mark that makes it a better indication for sedation. Instead the more valuable marker is the instant the patient enters the procedure room and may need sedation. It is at THIS moment and not at 10 minutes that the pain physician must be able to use sedation and be fairly reimbursed for this service and the years of training behind it. When the patient enters the procedure room it is then that the patient exhibits a deep level of trust that the pain physician will reduce their pain and improve their function through a procedure that can be uncomfortable and stressful in unique ways for each patient. Thus sedation must be available in this moment as a service provided by the physician with fair reimbursement – NOT at an arbitrary time of 10 minutes that ignores the struggles faced by many pain patients and devalues the services provided by the physician and the years sacrifice and training required to provide those services.
I submit these concerns with respect but also with concern for ever farther reaching regulations that impede patient care.
Josh Suderman, MD