Clyde pain clinic to close; medical spa services will continue

Sept. 28--CLYDE -- After a decade of practice, Dr. Allan Zacher will cease providing a non-narcotic and nonsurgical option to dealing with pain. He plans to continue his Mountain Radiance medical spa and cosmetic services offered in the same location.

Pending changes in the Medicare reimbursement system left the founder of Interventional Pain Services of Western North Carolina, PLLC, with a stark choice.

"Medicare reduced the reimbursement by over 50 percent," said Zacher, "and that's a reduction of over 50 percent of our gross receipts. That's not enough to pay rent, staff and recurring expenses."

Because insurance companies base compensation on the government-set rates for Medicare and Medicaid, Zacher said for him to continue providing cortisone injections at the source of the pain is all but impossible.

"The bottom line, running a high-quality, ethical practice in pain medicine is no longer economically viable for a solo practitioner in a semi-rural setting. This is America and I can opt out of Medicare, but I but don't think we'll get enough people to pay out of pocket for a $400 to $500 treatment."

Zacher's website used to include testimonials from patients who raved about the results they received from injections that kept spinal or arthritic pain in check, or even eliminated it. Through the years he racked up numerous patient-satisfaction awards, including the coveted Top 10 Doctor award from the physician rating site Vitals.com.

"There are certain types of pain, mostly spine pain, that can be addressed with various interventional procedures that are minimally invasive," he explained. "I've treated patients with varying degrees of success by putting cortisone near the pain source using a high degree of precision with live X-ray equipment."

In some cases, such as a herniated disc in a younger person, one or two shots did the trick. In other cases, a series of injections was needed to address the pain, and in still others, the cortisone wasn't the answer.

"I've written letters, worked with our national specialty group, attempted to work with Congress to prevent these cutbacks, and it all boiled down to if you do a lot more procedures, you could still make a living," he said.

While others in the region who still will be doing injections, most will be hospital-based procedures, and that will make them four to five times more expensive because they will include hospital charges as well, he said.

Option to drugs, surgery

Long ago, Zacher realized the addictiveness of narcotic drugs, and would not prescribe them. Until just last year, the position of the North Carolina Board of Medicine was to prescribe painkillers to those who said they were in pain, but the alarming rate of 75 to 100 prescription-based drug overdoses a day in America led to new guidelines. Now physicians in the state need to test patients to make sure they are actually taking the pain killers, not selling them.

Despite the societal costs to prescription drugs and the high cost of surgery, those setting rates that ultimately decide winners and losers in the medical field placed a lower value on procedures such as cortisone shots.

"Who knows why Medicare rates are set where they are?" Zacher asked. "People sit around in conference room and determine what they will pay for a service. The rates of pay for an office-based practice doing what I have been doing were dialed down to point we just couldn't continue."

Even more significant than the reduced rates is Oct. 1 deadline revising the International Classification of Disease (ICD-9) system that's been used for decades.

Under the current system, there's a basic category for a disease and a treatment code that's used to claim government or insurance reimbursement for the service. The upgraded system (ICD-10) has expanded the number of specific disease codes by 20-fold or more, Zacher said.

A medical provider must use the exact code corresponding to the treatment to be paid, he said, and the Government Accounting Office has estimated the average small practice will lose $200,000 annually in lost or delayed payments because of confusion over the new diagnostic codes.

"We don't make $200,000, and we can't afford to go through the transition," Zacher said. "That's the reason I'll stop seeing patients on Oct. 1. That was the straw that broke the camel's back."

Interventional Pain Services patients can request a copy of their records in person or by calling 627-9998 during regular business hours of Monday through Friday. Zacher is providing patients with a list of others in the region providing similar services.

Mountain Radiance Medical Spa, also located 24 Falcon Crest Lane, Clyde, will continue to offer cosmetic services such as skin care consultation, age reversal techniques and medical weight loss services.

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