Concerned Doctors Ask Medicare & Medicaid to Prohibit Untrained Non-Doctors from Prescribing Addictive Painkillers and Performing Out-Patient Surgeries

NEW YORK, Oct. 3, 2012 /PRNewswire/ -- Two national medical associations, the American Society of Interventional Pain Physicians (ASIPP), comprised of over 4,500 members, and the North American Neuromodulation Society (NANS), with approximately 1,000 members, believe that the recent request by Medicare & Medicaid Services (CMS) to the federal government to allow nurse anesthetists to receive coverage for medical treatments of chronic pain, is a dangerous disservice to patients.

"This disregard to the education, board certifications, and training of medical physicians will be detrimental to patients, causing undue hardship and putting an increased financial burden on the healthcare system as poor results proliferate," stated Dr. Laxmaiah Manchikanti, ASIPP Chairman of the Board and CEO.

The CMS proposal would allow advanced nurse practitioners and certified nurse anesthetists (CRNAs) the right, without any formal training, to perform interventional pain treatments, such as out-patient surgeries and the prescribing of highly addictive painkillers. Dr. Manchikanti believes, "Patient access to pain treatments will not improve if CRNAs are given greater responsibility in this area as access to appropriate care is not an issue. A person in chronic pain must be properly assessed, diagnosed and treated by a fully trained medical doctor. This will ensure the patient's best long and short term health." He continued, "CRNAs are demanding to be allowed to perform treatments that they have not received the proper training and education to perform." 

"While the FDA has approached multiple organizations to help draft guidance on epidurals, which is one of the most common procedures interventional pain management, due to severe safety concerns, CMS is in essence saying that it doesn't matter who performs these treatments - 'no training required'" Dr. Manchikanti said.

"Most importantly, CRNAs receive no education in the diagnosis and work up of chronic pain conditions and therefore are not trained to determine what is wrong with the patient. How can they prescribe the appropriate treatment? This will only result in a great deal of expensive and wasted care," stated Dr. David Kloth, president-elect of NANS.

There are significant patient risks when CRNAs perform interventional chronic pain procedures. CRNAs have not received formal training in a myriad of interventional techniques. Their training in blind epidurals and peripheral nerve blocks constitutes at most 10% of their training. They also receive no education in imaging guidance and other interventional pain techniques that are inherently dangerous due to the anatomy and structure of the spine and nerves. They also lack the training to respond to many medical complications. CRNAs do not receive any clinical experience in chronic pain treatments. The Standards for Accreditation for Nurse Anesthesia Education Program cites that no clinical experience with acute or chronic pain management is required. Most importantly they have no training in how to assess patients with chronic pain and therefore are not equipped to make a proper diagnosis.

At this time, CRNAs may provide anesthesia and related services to Medicare patients consistent with the scope of practice in their state, along with their training and clinical privileges. They can also insert arterial lines, draw blood gases, and place peripherally inserted central Venus catheters (PICCs and CVPs) consistent with the guidelines, instruction, and skills assessment provided during their training. 

CRNAs want to be allowed to expand their scope of practice into the practice of medicine which by definition must be performed by an MD with proper qualifications and training.  ASIPP does not believe that CRNAs should be allowed to diagnose complex conditions, order expensive tests or provide treatments of complicated and dangerous procedures for a field of medicine where they have no formal training.

About the American Society of Interventional Pain Physicians

ASIPP promotes the development and practice of safe, high-quality, cost-effective interventional pain management techniques for the diagnosis and treatment of pain and related disorders, and to ensure patient access to these interventions.   For more information, visit or call 270.554.9412. Ext. 215

About the North American Neuromodulation Society

The North American Neuromodulation Society (NANS) is dedicated to being the premier organization representing neuromodulation. NANS promotes multidisciplinary collaboration among clinicians, scientists, engineers, and others to advance neuromodulation through education, research, innovation and advocacy. Through these efforts NANS seeks to promote and advance the highest quality patient care.

SOURCE American Society of Interventional Pain Physicians

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