Dear Patients:

As 2020 comes to a close and 2021 approaches, quite a few of you have asked me what the new year will hold in terms of insurance coverage for chronic pain treatment. Until just a few years ago, this question almost never came up. However, beginning about 6 years ago, a new set of economic realities entered into our sub-specialty. Most of you have experienced changes in your own care in terms of what insurance will authorize at any given visit, how often you can receive particular treatments, and so forth. As pain specialists, we’ve had to deal with annual reductions in our reimbursement, but then, all of our colleagues in other interventional fields like orthopedics and neurosurgery have dealt with this as well.

No doubt, in 2021, both doctors and patients will have to contend with the same process. Medicare typically initiates the reductions in reimbursement and the restriction in treatment, and then most of the other insurances follow. Some private insurances always end up being even more restrictive than Medicare.

As I frequently remind my patients, they’ll always get the truth from me and will know what I am thinking, because I feel that pain management is best practiced in an environment of mutual trust. When it comes to the economic realities of medicine, my personal policy is no different. I share with you what’s on my mind. I’ve seen so many of you for so many years now that I feel comfortable with this approach, and it just feels right. In this vein, as soon as I hear what is being proposed in terms of reductions in pain care, I’ll tell you.

So far, I know that facet injections are coming under scrutiny. A number of insurances already won’t cover facet injections, but will cover diagnostic medical branch blocks followed by radiofrequency ablation, aka rhizotomy/nerve burning/RF, so my hope is that in a worst case scenario, Medicare (and hence the other insurances) will take this approach if indeed there are plans to restrict facet treatment. I’ve also heard that a number of the insurances plan to require patients to come back after each injection for a follow up visit to confirm the effectiveness of the injection before authorizing another one. We are trying to see if a telemedicine visit would suffice for this follow up. I have also heard that some insurances are going to “count” a bilateral nerve block as two injections even it only one appointment is used. Hence, if you are allowed 5 nerve blocks per year, and you choose to have both left and right sides injected at you appointment, you’ve used up two of the five for that year. I know, I know. I don’t think it is fair either.

I’m sure there are going to be more restrictions proposed. What they’ll be I cannot say. As soon as I hear anything, I will share what I know with you. As for doing something about it, unfortunately, as doctors, we are limited. We have had our interventional pain management society voice our concern and frustration, but frankly, I am not holding my breathe. I’ve spoken with a couple physician business men in the federal legislative loop, and they have confirmed what I’ve suspected for a few years now: when it comes to the economics of medicine, doctors have lost their ability to influence decision making. We have spent neither the money nor the time needed to have a seat at the table, money being the biggest stumbling block. Speaking for myself, I’ll confess that I saw myself as being above spending money to influence how federal Medicare money gets spent. Looking back, I guess I wish that as physicians, we had been more willing to participate in the pay-to-play system. So now, we do not have the power that insurance companies, hospitals, and pharmaceutical companies have.

As patients, you may actually have more power than we as doctors have when it comes to influencing how much gets spent on pain management. However, you do need to make yourselves heard. I searched “making patient voices heard” and a dozen or more sites popped up. I’d suggest you start there. Most importantly, commit to taking the best possible care of yourself. As what I can do for you becomes more restricted, what you can do for yourself becomes all the more important.