14 th. ASIPP Educational and Advocacy Services

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1 ASIPP Educational and Advocacy Services Excellence in Advancing Interventional Pain Physicians 14 th ASIPP ANNUAL MEETING th Annual Meeting, Legislative Session & Capitol Hill Visits IPM: Future Strategies and Emerging Technologies Up to 18.5 AMA PRA Category 1 Credits The 14th ASIPP Annual Meeting is being held in Washington, DC at the Crystal Gateway Marriott and Capitol Hill. The meeting will include ASIPP and SIPMS meetings, Legislative Session, Capitol Hill visits, Practice Management courses, Abstract Poster presentations, Interventional Techniques, Resident/Fellow Sessions. World Class speakers, and much more. June 9-13, 2012 WASHINGTON DC Hotel and MEETING Location: Crystal Gateway Marriott, 1700 Jefferson Davis Hwy, Arlington, VA 22202, (703) Specials: $100 each for Interventional Techniques in Chronic Spinal Pain and Chronic Non-Spinal Pain at Meeting for Attendees 10% off New Books: Foundations, Clinical Aspects, and/or Board Review Self-Assessment (available in hard copy and DVD) Free Registration for Fellows & Residents Special Early Bird room rates follow us on Twitter (@asipp) or Facebook (@AsippMember) American Society of Interventional Pain Physicians The Voice of Interventional Pain Management since 1998

2 Annual Meeting, Legislative Session & Capitol Hill Visits From The ASIPP Board It is our distinct pleasure and honor to invite you to the American Society of Interventional Pain Physicians (ASIPP) 14th Annual Meeting, in Washington, DC on Saturday, June 9 through Wednesday, June 13 at the Crystal Gateway Marriott in Arlington, VA. ASIPP began the tradition of meeting in Washington on a yearly basis in This year in an effort to meet the needs of interventional pain physicians and other providers as well, we have created an educational program of the highest caliber with a focus on many important topics for physicians, staff, and other healthcare providers all under the primary theme IPM: future strategies and emerging technologies. Because of today s environment of regulatory and competitive issues, we must be completely informed in order to assure the emerging specialty of interventional pain management does not become extinct. The preservation of interventional pain management is in our hands. This year s program should prove to be one of the most exciting, enriching, and memorable of any meeting we have ever held. The 14th Annual Meeting will be one of your best opportunities to hear from some of the greatest minds in IPM address current, cutting-edge, and relevant subjects that affect your specialty, practice, and patients. We also offer an extensive practice management session featuring comprehensive coding and compliance lectures. This session is ideal for physicians but is invaluable for their staff. You could consider sending your staff to this meeting as an investment. They will walk away armed with the information they need to better understand the billing and coding issues they face on a daily basis. Our annual legislative session will kick-off on Monday, June 11. We are pleased to announce that the North American Neuromodulation Society (NANS) is once again cosponsoring this event. You won t want to miss this historical meeting. With NANS and ASIPP as cosponsors, this year promises to be the best and most productive legislative session to date. Because ASIPP recognizes the significance of this legislative tradition, we encourage you to stay through Tuesday and Wednesday, when we take the meeting to Capitol Hill, to hear several representatives and senators address us on the issues that affect you and your practice. The faculty is made up of experts in the field of IPM, practice management, and governmental affairs. Invited speakers include Joseph T. Rannazzisi, DEA Deputy Assistant Administrator for the Office of Diversion Control; former Deputy Secretary for HHS, The Honorable Tevi Troy; Dr. Marc Huntoon; Dr. Nagy Mekhail; and many notable others. Laxmaiah Manchikanti, MD Chairman of the Board and CEO, ASIPP Standiford Helm II,MD ASIPP President Frank J. E. Falco, MD President-Elect, ASIPP Whether you have been a member of ASIPP since its inception, are a new member, or have yet to become a member, we are confident that this event will provide the much needed information to help you in the evolving specialty of interventional pain management. We hope you are as excited to attend the in Washington, DC, as we are to present it. On behalf of the Board of Directors of ASIPP, we welcome you to join us for one of the most distinguished and beneficial meetings you will attend all year. American Society of Interventional Pain Physicians The Voice of Interventional Pain Management since Lakeview Drive, Paducah, KY Phone: Fax: asipp@asipp.org Web Site: Chairman of the Board And CHIEF EXECUTIVE OFFICER Laxmaiah Manchikanti, MD Paducah, KY PRESIDENT Standiford Helm II, MD Laguna Hills, CA IMMEDIATE PAST PRESIDENT Allan T. Parr, MD Covington, LA PRESIDENT-ELECT Frank J.E. Falco, MD Newark, DE EXECUTIVE VICE PRESIDENT Ramsin M. Benyamin, MD Bloomington, IL First EXECUTIVE VICE PRESIDENT Hans C. Hansen, MD Conover, NC VICE PRESIDENT STRATEGIC PLANNING David L. Caraway, MD, PhD Huntington, WV SECRETARY Sukdeb Datta, MD Summit, NJ TREASURER Aaron K. Calodney, MD Tyler, TX LIFETIME DIRECTORS Cyrus E. Bakhit, MD Roanoke, VA Laxmaiah Manchikanti, MD Paducah, KY Bentley A. Ogoke, MD Mount Vernon, NY Vijay Singh, MD Niagara, WI DIRECTORS AT LARGE Mark V. Boswell, MD, PhD Louisville, KY David Bryce, MD Middleton, WI Scott E. Glaser, MD Burr Ridge, IL Rodney L. Jones, MD Wichita, KS Haroon Hameed, MD Baltimore, MD David S. Kloth, MD Danbury, CT Gabor B. Racz, MD Lubbock, TX Francis Reigler, MD Malibu, CA Xiulu Ruan, MD Mobile, AL David M. Schultz, MD Minneapolis, MN Peter S. Staats, MD Shrewsbury, NJ John R. Swicegood, MD Fort Smith, AR DIRECTORS EMERITUS W. Stephen Minore, MD Love Park, IL Joshua A Hirsch, MD Boston, MA PAIN PHYSICIAN EDITOR-IN-CHIEF Howard S. Smith, MD Albany, NY AMA DELEGATES Lee T. Snook, MD Sacramento, CA Haroon I. Hameed, MD Baltimore, MD STAFF Melinda Martin, Director of Operations Ray Lane, Director of Public Relations Holly Long, Coordinator of Editorial Services Vidyasagar Pampati, Statistician and Programmer Paula Reynolds Spear, Meeting Coordinator Tom Prigge, Multimedia Specialist Cindy Rogers, Administrative Assistant Government Affairs Counsel Senator Tim Hutchinson & Randi Hutchinson, Esq., Dickstein Shapiro, LLP, 1825 Eye Street NW Washington, DC hutchinsont@dicksteinshapiro.com Legislative Counsel Jeff Mortier, Legislative Partner Ryan, Mackinnon, Vasapoli and Berzok, LLP 1634 Eye Street NW, Suite 1200 Washington, DC General Counsel Erin Brisbay McMahon JD, Wyatt, Tarrant & Combs, LLP, 250 West Main Street, Suite 1600 Lexington, KY emcmahon@wyattfirm.com 2 American Society of Interventional Pain Physicians

3 Annual Meeting,, Legislative Session & Capitol Hill Visits General Information Accreditation Statement This CME activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education thru the Joint Sponsorship of the Institute for Medical Studies (IMS) and the American Society of Interventional Pain Physicians. The Institute for Medical Studies is accredited by the ACCME to provide continuing medical education for physicians. Category I Credit The Institute for Medical Studies designates this educational activity for a maximum of 18 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. RN, NP and PA Credit Nurses may claim credit for activities approved for AMA PRA Category 1 Credits in most states, for up to 50% of the nursing requirement for recertification. This activity is designated for up to 18 AMA PRA Category 1 Credits Nurse Practitioners: The American Academy of Nurse Practitioners (AANP) accepts AMA PRA Category 1 Credits TM from organizations accredited by the ACCME. IMS is accredited to provide continuing medical education for physicians and will provide nurse practitioners who successfully complete each activity with a certificate of participation indicating that the activity was designated for 18 AMA PRA Category 1 Credits TM. The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credits from organizations accredited by the ACCME. The provider of this program, the Institute for Medical Studies, is accredited by the ACCME and designates this educational activity for a maximum of 18 AMA PRA Category 1 Credits TM. Physician assistants should only claim credit commensurate with the extent of their participation in the activity. Agenda Didactics Three days of lectures designed to educate interventional pain physicians, mid-level providers, administration, and support personnel. The faculty will thoroughly explore the topics and provide insight into many important issues facing interventional pain physicians and ambulatory surgery centers. Audience/Objectives Audience Physicians, nurses, and other health care professionals practicing within field of interventional pain management as well as office administrators. Objective: Identify and discuss the evolution and future of interventional pain management Consider the issues related to controlled substance management, its use, as well as abuse Consider and discuss various emerging technology in interventional pain management Discuss the uses for MRI and CT in IPM Identify the principles, technology, and appropriate utilization of ultrasound for non-spinal injections Identify, consider, discuss the various aspects of guidelines for IPM Consider and discuss in-depth coding and billing for IPM Identify compliance issues in IPM, such as employment, HIPAA and medical records and documentation. Outcome The American Society of Interventional Pain Physicians will provide you with an opportunity to improve knowledge and skills regarding multiple aspects of interventional pain management so that you can better diagnose, manage and treat patients using the latest interventional pain technology and information for improved patient outcomes. Identify multiple issues facing interventional pain management. CODING Credit ASIPP has applied for approval of the American Academy of Professional Coders for 7.75 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content or any sponsors. Accommodations Crystal Gateway Marriott Inform the agent that you are booking for American Society of Interventional Pain Physicians. We have secured a group rate of $209. Register early, as all unbooked rooms will be released on May 15, Americans With Disabilities Act Organizers fully comply with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact the organizers at (270) at least 10 days prior to the conference. There is no commercial support for this activity. No duplication or distribution of materials, or recording of lectures associated with this conference is permitted without express written consent of the American Society of Interventional Pain Physicians. All rights reserved. American Society of Interventional Pain Physicians 3

4 Annual Meeting, Legislative Session & Capitol Hill Visits Course Directors Laxmaiah Manchikanti, MD Chairman of the Board and CEO, ASIPP Medical Director, Pain Management Center of Paducah, KY Clinical Professor of Anesthesiology and Perioperative Medicine University of Louisville Louisville, KY Standiford Helm, II, MD President, ASIPP Pacific Coast Pain Management Center Laguna Hills, CA Faculty Frank J. E. Falco, MD President-Elect, ASIPP Medical Director, Midatlantic Spine, Newark, DE Clinical Assistant Professor Temple University Medical School Philadelphia, PA Ramsin M. Benyamin, MD Executive Vice President, ASIPP President, ILSIPP President, Millennium Pain Center, Bloomington, IL Clinical Associate Professor, Department of Surgery University of Illinois College of Medicine, Urbana-Champaign, IL Salahadin Abdi, MD, PhD Vice-Chair and Chief Pain Medicine, BIDMC, Department of Anesthesia, Critical Care and Pain Medicine Associate Professor, Harvard Medical School Boston, MA Marco Araujo, MD Medical Director Advanced Pain Management Pain Centers of Wisconsin - Green Bay Green Bay, WI Jenniferl Bolin, JD The J. Bolen Group Knoxville, TN Michael Brown, BSBA President, Health Care Economics Fishers, IN David Caraway, MD, PhD ASIPP VP-Strategic Planning St. Mary s Pain Relief Center Huntington, WV Steve Cohen MD Associate Professor and Director Resident Education Program, Chronic Pain Clinic Johns Hopkins Baltimore, MD Timothy Deer, MD Center for Pain Relief Charleston, WV Sudhir Diwan, MD Executive Director The Spine and Pain Institute of New York Staten Island, NY Michael A. Erdek, MD Assistant Professor, Anesthesiology, Critical Care Medicine and Oncology Program Director, Division of Pain Medicine Johns Hopkins University School of Medicine Baltimore, MD Debbie Farmer, CPC ACE Compliance Auditor Leawood, KS Joseph C. Gagen Legislative Grassroots Trainer Austin, TX 4 Bassem Georgy, MD Assistant Clinical Professor of Radiology University of California San Diego, CA Haroon Hameed, MD ASIPP, Resident Board Member Johns Hopkins Medicine Baltimore, MD Mariam Hameed, MD Johns Hopkins Medicine Baltimore, MD Marvel Hammer, RN, CPC MJH Consulting Denver, CO Mitchell A. Hardenbrook, MD The Boston Spine Group Newton, MA Salim Hayek, MD Division of Pain Medicine University Hospitals of Cleveland Cleveland, OH Joshua Hirsch, MD Director-at-Large, ASIPP Massachusetts General Hospital Boston, MA Judith Holmes, JD Judith Holmes & Associates, LLC Golden, CO Marc Alan Huntoon, MD Professor and Chief, Division of Pain Medicine Vanderbilt University Hospital Nashville, TN Gabriele Jasper, MD Medical Director Center for Pain Control Brick, NJ A. Jay Khanna, MD Associate Professor, Orthopaedic Surgery and Biomedical Engineering Johns Hopkins University School of Medicine Baltimore, MD David S. Kloth, MD Director-at-Large, ASIPP Medical Director, Connecticut Pain Care Danbury, CT Nagy Mekail, MD, PhD Professor of Anesthesiology Cleveland Clinic Cleveland, OH David Merritt Health Care Executive and Policy Expert Senior Advisor, Leavitt Partners Washington, DC Vicki Myckowiak, JD Myckowiak Associates Detroit, MI David Provenzano, MD Executive Director Institute for Pain Diagnostics and Care Pittsburgh, PA Joseph T. Rannazzisi Deputy Assistant Administrator, Office of Diversion Control, DEA Baltimore, MD David Schultz, MD Director-at-Large, ASIPP Medical Advanced Pain Specialists Minneapolis, MN Sanford Silverman, MD Comprehensive Pain Medicine Pompano Beach, FL Dana Simon, MD Mercy Center for Pain Medicine Des Moines, IA Peter S. Staats, MD Director-at-Large, ASIPP Premier Pain Centers, LLC Shrewsbury, NJ Marsha Thiel, RN, MA Medical Advanced Pain Specialists Minneapolis, MN Andrea M. Trescot, MD Algone Pain Center Wasilla, AK The Honorable Tevi Troy, PhD Former Deputy Secretary Dept. of Health and Human Services Maryland, VA Ricardo Vallejo, MD, PhD Millennium Pain Center Bloomington, IL Faculty is subject to change

5 Annual Meeting,, Legislative Session & Capitol Hill Visits Saturday June 9, :00am 8:00am Registration And Breakfast General Session 8:00am-8:30am Introduction to Annual Meeting Standiford Helm II, MD 8:30am-10:00am Manchikanti Distinguished Lecture Introduction to Distinguished Lecture and David Merritt Ramsin Benyamin, MD The Health Reform Law: What s Happened, What s Next, What You Need to Know David Merritt 10:00am 10:30am Break 10:30am-12:00pm Controlled Substance Use & Abuse: Past, Present, and Future Trials and Tribulations of Controlled Substances in the U.S. Joseph T. Rannazzisi 12:00pm-1:30pm Lunch Symposium Boston Scientific (no CME Credits) Breakout Sessions On Following Pages > > > No duplication or distribution of materials, or recording of lectures associated with this conference is permitted without express written consent of the American Society of Interventional Pain Physicians. All rights reserved. 5

6 Annual Meeting, Legislative Session & Capitol Hill Visits Saturday June 9, 2012 Session 1 Session 2 Session 3 Session 4 Emerging Technology Imaging of The Spine Resident/Fellow Section Billing and Coding 1:30pm - 3:15pm Emerging Technology in IPM Peter Staats, MD 1:30 1:40 Introduction Peter Staats, MD 1:40 2:15 MILD for Lumbar Decompression Timothy Deer, MD 2:15-2:50 Review of Latest Data on MILD Nagy Mekhail, MD, PhD 2:50 3:15 Imaging of the Spine for IPM Frank Falco, MD 1:30 1:40 Introduction Frank Falco, MD 1:40 2:15 Imaging for Vertebral Augmentation; Preoperative Planning and Complications Bassem Georgy, MD 2:15 2:50 The Use of MRI in Interventional Pain Management Frank Falco, MD 2:50 3:15 Resident/Fellow Section Mariam Hameed, MD 1:45-2:45 Evidence-based Procedures in Interventional Pain Management Steven Cohen, MD 2:45-3:15 Introduction to Advocacy David Kloth, MD Billing and Coding for IPM Debbie Farmer, CPC 1:30 1:40 Introduction Debbie Farmer, CPC 1:40-2:25 Coding for Interventional Pain Management Procedures Marvel Hammer, RN, CPC 2:25 3:05 Documentation for interventional Pain Management Procedures Marvel Hammer, RN, CPC 3:05 3:15 3:15pm-3:45pm BREAK (Exhibit Hall) 3:45pm-6:00pm Emerging Technology Ultrasound For Non-Spinal Injections Resident/Fellow Section Billing and Coding Emerging Technology Ramsin Benyamin, MD Topic David Caraway, MD, PhD Resident/Fellow Section Mariam Hameed, MD Billing and Coding for IPM Marvel Hammer, RN, CPC 3:45 3:55 Introduction: Ramsin Benyamin, MD 3:55 4:30 Endoscopic Discectomy Gabe Jasper, MD 4:30 5:00 Minimally Invasive Treatment Options for Vertebral Compression Fractures Bassem Georgy, MD 5:00 5:40 Biacuplasty for Discogenic Pain Nagy Mekhail, MD, PhD 3:45 3:55 Introduction David Caraway, MD, PhD 3:55 4:35 Ultrasound Principles and Technology David Provenzano, MD 4:35 5:15 The Appropriate Utilization and Introduction of Ultrasound into Interventional Pain Medicine David Provenzano, MD 5:15 5:30 3:45-4: 45 Principles of Intrathecal Therapy for Chronic Pain Salim Hayek, MD 4:45-5:45 MILD for Lumbar Decompression Timothy Deer, MD 3:45 4:45 National Correct Coding initiative (NCCI) and Medically Unlikely Edit (MUE): What You Need to Know Debbie Farmer, CPC 4:45-5:30 Understanding Unlisted and Category III Codes Debbie Farmer, CPC 5:30 6:00 5:40-6:00 6

7 Annual Meeting,, Legislative Session & Capitol Hill Visits Sunday June 10, :00am 8:00am Registration And Breakfast 8:00am-12:00pm GUIDELINE WARFARE IN INTERVENTIONAL PAIN MANAGEMENT FACT, FICTION, AND REALITY Moderator Joshua Hirsch Introduction: Joshua Hirsch, MD 8:15am-8:45am Can Trustworthy Guidelines be Prepared? Laxmaiah Manchikanti, MD 8:45am-9:15am What Do ASA/ASRA Guidelines Tell Us? Dana Simon, MD 9:15am-9:45am What Do ASIPP Guidelines Tell Us? Laxmaiah Manchikanti, MD 9:45am-10:15am Critical Analysis of Guidelines in IPM Marc Huntoon, MD 10:15am 10:45am Break (Exhibit Hall) 10:45am-12:00pm Discussion Laxmaiah Manchikanti, MD, Sudir Diwan, MD, Marc Huntoon, MD, Peter Staats, MD, Dana Simon, MD 12:00pm-1:30pm Lunch Symposium Medtronic (no CME Credits) Breakout Sessions On Following Pages > > > No duplication or distribution of materials, or recording of lectures associated with this conference is permitted without express written consent of the American Society of Interventional Pain Physicians. All rights reserved. 7

8 Annual Meeting, Legislative Session & Capitol Hill Visits Sunday June 10, 2012 Session 1 Session 2 Session 3 Session 4 EMERGING TECHNOLOGIES in IPM Emerging Technologies in Intrathecal Therapies Frank Falco, MD 1:30 1:40 Introduction Frank Falco, MD 1:40 2:15 Advancements in Neuromodulation David Caraway, MD, PhD 2:15 2:50 Emerging Technology in Intrathecal Therapies: New Devices and Drugs Salim Hayek, MD, PhD 2:50 3:15 Practice Management Practice Management for IPM Vicki Myckowiak, JD 1:30 1:40 Introduction Vicki Myckowiak, JD 1:40-2:25 Practice Management: Employment Law Compliance Issues Judith Holmes, JD 2:25 3:10 HIPAA Privacy and Security Audits and Enforcement: What s it All About and What Happens if a Violation is Found? Vicki Myckowiak, JD 3:10 3:15 1:30pm 3:15pm RESIDENT/FELLOW SECTION Resident/Fellow Section Haroon Hameed, MD 1:30-2:30 pm Understanding Anti-Coagulants and Implications in Interventional Pain Management Marco Araujo, MD 2:30-3:15 Treatment of Cancer Pain Michael Erdek, MD Controlled Substance Management Controlled Substance Management in IPM Sanford Silverman, MD 1:30-2:00 Buprenorphine in Pain and Chemical Dependency Sanford Silverman, MD 2:00 2:30 Opioid Therapy Side Effects and Treatment Andrea Trescot, MD 2:30 3:00 Case Discussions Andrea Trescot, MD and Sanford Silverman, MD 3:00 3:30 Legal Aspects of Prescribing Jennifer Bolen, JD 3:15pm-3:45pm BREAK (Exhibit Hall) 3:45pm-6:00pm EMERGING TECHNOLOGIES in IPM Practice Management RESIDENT/FELLOW SECTION Abstract Presentations Emerging Technology Setting-up a Practice for Success Resident/Fellow Section Abstract Presentations Standiford Helm, II, MD 3:45 3:55 Introduction: Standiford Helm, II, MD David Schultz, MD 3:45 3:55 Introduction: David Schultz, MD Mariam Hameed, MD 3:45 4:45 MRI of the Spine AJ Khanna, MD Salahadin Abdi, MD. PhD 3:45 3:55 Introduction: Salahadin Abdi, MD, PhD 3:55 4:35 HydroCision Percutaneous Lumbar Discectomy Mitchell Hardenbrook, MD 4:35 5:15 High Frequency Spinal Cord Stimulation Ricardo Vallejo, MD, PhD 5:15-5:30 3:55 4:35 Financial Management: Best Practices for Turbulent Times Michael Brown, BSA 4:35 5:15 Changes to Medical Records: How to Manage Changes and Meet Regulatory Requirements David Schultz, MD & Marsha Thiel, RN 5:15-5:30 4:45 5:30 Endoscopic Spine Surgery Business Frank Falco, MD 5:30-6:00 RFS Business Meeting Close/Summary 3:55 5:30 Presentations and Judging of the Top Five Abstracts Judging Panel: Sudhir A. Diwan, MD Salim Hayek, MD, PhD Joshua A. Hirsch, MD Marc A. Huntoon, MD Nagy Mekhail, MD, PhD 7:00pm-11:00pm ASIPP Presidential Dinner Business MEETING Awards Presentation Dinner and Dance 8

9 Neuromodulation American Society North Annual Meeting,, Legislative Session & Capitol Hill Visits Sunday June 10, 2012 ASIPP Presidential Dinner Events State Of ASIPP Laxmaiah Manchikanti, MD Dinner & Dance President - Standiford Helm, II, md Presentation of Annual Awards Presentation of ABstract awards President-Elect - Frank Falco, MD Monday June 11, :30am 8:00am 8:00am-9:00am 9:00am - 10:00am 10:00am 10:30am Registration And Breakfast Health Care Issues for Capitol Hill Laxmaiah Manchikanti, MD The Health Care Conundrum and the Evolution of Government Policy: Can We Affect and Afford Real Reform? The Honorable Tevi Troy, PhD Break 10:30am 12:30am Legislative Preparation Lecture - Joe Gagen 12:30pm-1:30pm Legislative Lunch, Patient Advocacy Awards, and PAC Recognition Laxmaiah Manchikanti, MD and The Honorable Sen. Tim Hutchinson 1:30pm-4:00pm Legislative Preparation Sessions Legislative Conference Sponsored by the North American Neuromodulation Society and the American Society of Interventional Pain Physicians No duplication or distribution of materials, or recording of lectures associated with this conference is permitted without express written consent of the American Society of Interventional Pain Physicians. All rights reserved. 9

10 Neuromodulation American Society North Annual Meeting, Legislative Session & Capitol Hill Visits Tuesday June 12, :00am 8:00am Registration And Breakfast - CAPITOL HILL 8:00am-12:00pm Congressional Speakers Senate and House Members Speak on topics Pertinent to ASIPP, their Committees, and Healthcare Location HC-5 - Capitol Hill Building 8:00am 8:40am 9:00am 9:30am 9:45am 10:00am 10:30am 10:50am 11:00am 11:20am 11:45am 12:00pm Rep. Ed Whitfield (R-KY) Sen. John Boozman (R-AR) Rep. Dutch Ruppersberger (D-MD) Sen. Sherrod Brown (D-OH) Sen. Bob Casey (D-PA) Rep. Joe Pitts (R-PA) Sen. Mark Pryor (D-AK) Senator Rand Paul (R-KY) Rep. Andy Harris (R-MD) Rep. Ben Chandler (D-KY) Sen. David Vitter (R-LA) Sen. Jeff Sessions (R-AL) HC-5 - Capitol Hill Building 12:00pm-1:00pm Lunch on your own 1:00pm-5:00pm Capitol Hill Visits Capitol Plaza (House & Senate Offices) Congressional Speakers are subject to change Wednesday June 13, :00am-12:00pm LEGISLATIVE Visits No duplication or distribution of materials, or recording of lectures associated with this conference is permitted without express written consent of the American Society of Interventional Pain Physicians. All rights reserved. Legislative Conference Sponsored by the North American Neuromodulation Society and the American Society of Interventional Pain Physicians 10

11 Annual Meeting,, Legislative Session & Capitol Hill Visits Registration Form Please print exactly as you wish your name to appear: Payment Method First NAME last NAME Middle Initial TitlE organization Credit Card Number Address Cardholder Name City State Zip COUNTRY Card/Check Number Phone CEll Fax Expiration Registration fee includes all sessions, breakfasts, and coffee breaks. Also includes handouts for conference and legislative visits. Registration will be accepted on a first come first serve basis. ASIPP reserves the right to alter the schedule based on number of attendees. Capitol Hill Visit I will be participating in the capitol hill visits m Yes m No Your CELL Phone Number Name and Address of Additional Attendees ASIPP will make every effort to coordinate visits with your representative. Please list the representatives you wish to visit. To increase your chances of seeing the representative of your choice, early registration is encouraged Representative Representative Capitol Hill Special: ASIPP will reimburse the hotel expense for registrants who attend the Congressional Speakers session on Tuesday and the Capitol Hill visits on Tuesday and Wednesday. * Room and tax only for Monday and Tuesday nights only. Registration Fees Business and Dinner Meeting m I will be attending the Business and Dinner Meeting Capitol Hill Special: ASIPP will reimburse the hotel expense for registrants who attend the Congressional Speakers session on Monday and the Capitol Hill visits on Tuesday and Wednesday. * Room and tax only for Monday and Tuesday nights only Annual Meeting Check all fees that apply: m I will attending Business Dinner Meeting m ASIPP and/or SIPMS Member: $650 m Associate Member: $350 m Non-Member, Physician: $750 m Non-Member, Non-Physician: $450 m Fellow/Resident - FREE m Medical Student - FREE If registering as a fellow, resident or medical student, please list name of fellowship program, university or hospital. Name of school or hospital Registration Discount: m If registering on or before May 26, 2012: $100 Discount Registration Fee: $ Discount Registration: $ TOTAL: $ Or register online at Security Code Mail completed form to: ASIPP 81 Lakeview Drive Paducah, KY Fax completed form to: (270) CANCELLATION POLICY: The American Society of Interventional Pain Physicians requires a 30-day notice of cancellation. Cancellations must be submitted in writing and received by May 10, 2012; however, an administrative fee of $100 will be assessed. Cancellations after May 10, 2012, will forfeit 50% of their registration fee. No cancellations accepted after May 26, Refunds will be sent after the conclusion of the meeting. Organizers reserve the right to cancel this meeting and will assume no financial obligation to the registrants for cancellation. Although registration fees will be refunded, costs incurred by the registrant (i.e., airline fees, hotel fees, or penalties) are the responsibility of registrant. For your convenience and faster registration, register online at American Society of Interventional Pain Physicians 81 Lakeview Drive. Paducah, KY P: F: Web: asipp@asipp.org 11

12 American Society of Interventional Pain Physicians 81 Lakeview Drive, Paducah, KY The Voice of Interventional Pain Management since th Annual Meeting, Legislative Session & Capitol Hill Visits IPM: Future Strategies and Emerging Technologies Up to 18.5 AMA PRA Category 1 Credits June 9-13, 2012 WASHINGTON DC Hotel, Review Courses, and Examinations Location: Crystal Gateway Marriott, 1700 Jefferson Davis Hwy, Arlington, VA 22202, (703) Specials: $100 each for Interventional Techniques in Chronic Spinal Pain and Chronic Non-Spinal Pain at Meeting for Attendees 10% off Foundations, Clinical Aspects, and/or Board Review Self-Assessment (available in hard copy and DVD) Free Registration for Fellows & Residents Special Early Bird room rates PRSRT STD U.S. Postage Paid Paducah, KY Permit #44