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13 Articles in Volume 18, Issue #3
Anger Expression & Chronic Pain
Ask the Expert: Should reliance on gabapentin/pregabalin be limited?
Chronic Pain in Children
Considering Comorbidities When Selecting Medications for Chronic Pain Management
Dousing the Physician Burnout Epidemic: An AMA Perspective
Harnessing the Power of Words
Inside ASRA with David Provenzano, MD
Management of Intrathecal Therapies by Interprofessional Teams
Nurse Burnout in Pediatric Pain Management: A Model and Pilot Intervention
Physician Burnout: An Oldtimer’s View
Reporting Metrics, Media Coverage...Letters from the Minds of Peers and Patients
The Case for Slow-Release Anesthetics
The Impact of Pain Practice

Inside ASRA with David Provenzano, MD

ASRA Board Member David Provenzano, MD, spoke to Practical Pain Management about the society’s goals for the remainder of 2018

With David Provenzano, MD

The American Society of Regional Anesthesia and Pain Medicine (ASRA) will host the World Congress on Regional Anesthesia and Pain Medicine this month in New York City in connection with its annual acute pain meeting. Sessions on chronic pain will address advanced imaging and interventions, regenerative therapies, neuromodulation, and more. ASRA Board Member David Provenzano, MD, spoke to Practical Pain Management about the society’s goals for the remainder of 2018, including its new focus on advocacy and the expected impact of its recently released quality measures on pain practice.

Since 1975, ASRA has focused its work across the country on research and education by providing pain practitioners and anesthesiologists with advisories, best practice guidelines, grant and continuing education programs, and more. Given the evolving landscape of the healthcare industry and the rise of new challenges, however, the organization revisited its mission last year. With education and research still at its core, and the ultimate goal of providing patients with the best outcomes, the society moved to revise its goals to incorporate advocacy in June 2017.1

Advocating for Pain Practitioners & Patients

“In today’s environment in medicine, we are facing challenges in regulatory advocacy that affect the way we provide care. We see decisions made by insurance companies and government policies that affect the type of care that can be provided to patients. As a result, we have stepped into the advocacy arena so that we can comment and speak on issues that affect patient care and patient access in order to maintain and improve quality of care,” explained Dr. Provenzano, who also serves as ASRA’s Practice Management Committee Chair.

He noted, as an example, how some chronic pain patients may benefit from neuromodulation, radiofrequency, or other advanced technologies that offer alternative, nonopioid forms of pain control. “Sometimes there are barriers to providing these solutions to patients; we want to educate patients and insurers about their benefits.”

Additional challenges facing regional anesthesia programs are tied to research and growing regulatory expectations. “Scientists and clinicians have to show that what we do improves outcomes, and this challenge is growing across all aspects of the medical community,” said Dr. Provenzano. ASRA is trying to get ahead of this dynamic through a series of grant programs, including a $200,000 biennial chronic pain medicine research grant aimed at guiding clinical practice for pain physicians. Launched in 2011, the most recent project focused on the effectiveness of Onabotulinumtoxin A (Botox) in pediatric patients experiencing migraines. The society also established Young Investigator and Graduate Student awards to help bridge the gap between acute and chronic pain research.

“We are often focused on pain levels,” said Dr. Provenzano. “But it is important to also look at function and other aspects important to the patient’s quality of life. In addition, there is pressure to examine opioid sparing and whether we can reduce the amount of opioids that patients use through regional anesthesia, interventions, and other treatments in multimodal pain care programs. All of these areas need further exploration,” he said.

In addition to developing research that addresses functional outcomes and quality of life measures, today’s scientists and physicians are tasked with the economics of pain management. “Even when we have limited healthcare resources, we have to still provide the best healthcare in the most efficient manners,” said Dr. Provenzano.

New Quality Measures Connected to Daily Pain Practice

ASRA took a step in this direction by collaborating with the American Society of Anesthesiologists in 2017 to develop four new quality pain measures.2 Approved by the US Centers for Medicare and Medicaid Services (CMS) in January 2018, the measures now fall under the Qualified Registry and Qualified Clinical Data Registry (QCDR) and may be used in merit-based incentive payment system (MIPS) reporting. The measures are:

  • AQI56: Use of Neuraxial Techniques and/or Peripheral Nerve Blocks for Total Knee Arthroplasty
  • AQI57: Safe Opioid Prescribing Practices
  • AQI58: Infection Control Practices for Open Interventional Pain Procedures
  • AQI59: Multimodal Pain Management.

“We recognized the need for measures that are more applicable to our specialty,” said Dr. Provenzano. “The measures developed meet this requirement and will assist in improving clinical practice and outcomes.” When meeting with CMS regarding MIPS and alternative payment models (APMs) in 2016—in anticipation of developing the quality pain measures—ASRA and other organizations called for increased representation from pain physicians. The goal was to help CMS leaders to better understand the unique practice of and inherent challenges involved in acute and chronic pain management.

For example, many of the measures used in reporting did not relate to our daily clinical practice (eg, assessing fall risk), explained Dr. Provenzano. The new measures are better related to activities performed by pain practitioners. The infection control practices relate to open interventional pain procedures, such as neuromodulation-based interventions such as intrathecal pumps and spinal cord stimulators. Quality measures, and metrics, need to connect back to best practices, he explained.

“Overall, these measures need to affect what we do,” said Dr. Provenzano. “They allow us to be adequately judged based on data capture that is more pertinent to what we do every day. By taking the right steps, we will also improve patient outcomes. It took a lot of effort and coordination at the society level, but we are happy with the work.”

About ASRA

Headquartered in Pittsburgh, Pennsylvania, the American Society of Regional Anesthesia and Pain Medicine (ASRA) boasts nearly 5,000 members in 60 counties across six continents. Focused on acute and chronic pain management, the society takes pride in being well versed at helping the whole field of pain management, including the growing continuum of perioperative care. Key pillars of the organization’s mission include education and research and, more recently, advocacy. www.asra.com.

ASRA Board Member David Provenzano, MD, is president of Pain Diagnostics and Interventional Care in Pittsburgh, PA. He is a member of the society’s Practice Management and Industry Relations committees. Dr. Provenzano received his medical degree from the University of Rochester School of Medicine and Dentistry. He completed a surgical internship at Thomas Jefferson University Hospital in Philadelphia and a residency in anesthesiology at The Western Pennsylvania Hospital. He completed a pain management fellowship at the Dartmouth-Hitchcock Medical Center in Lebanon, NH.

Last updated on: May 2, 2018
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