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March 1998
Volume 62 |
Number 3
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| ASA Responds With
Eye on Patient Safety to HCFA's Proposed Rule |
Literally, within minutes of being informed that the Conditions
of Participation (COP) by the Health Care Financing Administration
(HCFA) were released in the Federal Register, public relations
and public affairs programs were being developed in the ASA Executive
and Washington Offices.
Public Relations
At the December 1997 meeting of the ASA Administrative Council,
officers approved a series of proactive communications initiatives
to reach the media and the public with the message that physician
supervision of nurse anesthetists is vitally important to maintain
quality anesthesia care in the United States.
A news release and position statement outlining ASA's concerns
over the proposed COP were developed, approved by ASA officers
and distributed to more than 400 media outlets nationwide.
In addition to the position statement, a "fact sheet"
was prepared and distributed that included specific citations
and background information about the anesthesiologist's role in
providing safe, comprehensive and cost-effective anesthesia care.
The fact sheet also pointed out why nurse anesthetists are not
qualified to medically assess patients, including the fact that
more than one-third of them do not have a bachelor's degree.
In early discussions, it became apparent that the public needed
to know that removing the supervision of nurses would adversely
impact the quality of anesthesia care that would be provided to
Medicare/Medicaid beneficiaries. These included senior citizens,
disabled persons and poor people. Since senior citizens represent
the largest segment of Medicare patients, it was important to
ASA to know what type of care they wanted and what their personal
opinions were on this issue.
In late January, ASA commissioned a nationwide survey of senior
citizens to determine who senior citizens wanted supervising their
anesthesia care in hospitals and surgical centers. Within a few
days, preliminary data indicated that an overwhelming majority
of Medicare beneficiaries want a physician supervising their anesthesia
care. Final results of the survey were definitive: 81 percent
of seniors 65 years and over indicated that they oppose
eliminating the physician supervision requirement.
ASA staff, with the assistance of outside public relations counsel,
scheduled a national news conference for Thursday, February 5,
in Washington, D.C., to announce the results of the nationwide
survey and to showcase the diverse support that medicine was receiving
in maintaining HCFA's 30-year-old policy of physician supervision
of nurse anesthetists.
The panelists at the news conference included: William D. Owens,
M.D., ASA President; Senator Lauch Faircloth (R-NC); Randolph
A. Smoak, M.D., Vice-Chair, Board of Trustees, American Medical
Association; Jane C.K. Fitch, M.D., and Stephen T. Pyles, M.D.,
who are former nurse anesthetists and now practicing anesthesiologists;
the Rev. David Matthews, Ph.D., President, General Missionary
Baptist State Convention of Mississippi; and Lisa Cashion, Missouri
Association for Community Action.
Several days prior to the news conference, media alerts were
sent to print and broadcast newsrooms throughout the country with
special attention paid to those outlets with offices in Washington,
D.C., and the surrounding area.
In an effort to reach as many media outlets as possible, ASA
also set up a toll-free telephone line that news outlets could
dial into, hear the news conference and then ask questions of
the participants.
On the day of the news conference, a full-page advertisement
was published in the front section of the nationally distributed
newspaper USA Todaywith a circulation of more than 1.6
million daily readers. The ad was designed to alert people to
HCFA's proposal and encourage them to send their opinions to HCFA.
The ad included HCFA's address where readers could send their
comments on the proposed regulatory change. As of press time,
it is not known how many letters have been filed with HCFA on
this issue.
In the days preceding the news conference, Dr. Owens was interviewed
by 20 radio stations in several states, including Pennsylvania,
Texas, Missouri and New York. In addition, two radio news releases
were distributed to radio stations nationwide. The first release
included ASA's position on this issue with comments from Dr. Owens
on the proposed HCFA rule change. The second radio news release
announced the results of the national survey of senior citizens.
Preliminary figures indicate that the interviews and radio news
releases reached an audience of more than 8 million listeners.
Legislative and Public Affairs:
With Administrative Council approval, the ASA Washington Office
organized and implemented a proactive legislative and public affairs
program to inform legislators and special interest groups about
HCFA's
proposal.
A key objective of the public relations, legislative and public
affairs programs was to get as many individuals and groups as
possible to write HCFA by the February 17 deadline (now extended
to April 20)indicating why they opposed removing physician supervision
of nurse anesthetists from Medicare's conditions of participation
for hospitals. Hundreds of state organizations representing senior
citizens, disabled persons and poor people, including state chapters
of the American Association of Retired Persons, have submitted
letters to HCFA in opposition to its proposed rule.
The ASA Web site has become an integral communications vehicle
for getting late-breaking news and information to the membership,
the public and the media.
Immediately following the Washington, D.C. news conference on February
5, Drs. Owens, Fitch and Pyles visited several key legislators on
Capitol Hill in visits that were previously arranged by the Washington
Office. U.S. Senators were presented with results of the senior
citizen survey and materials that outlined the patient safety concerns
of the HCFA proposal.
Panel Speakers:
The national press conference on February 5, 1998, in Washington,
D.C., featured a prestigious panel of seven speakers, representing
the legislature, organized medicine, consumer groups, former nurse
anesthetists and ASA.
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Senator Lauch Faircloth
R-North Carolina
"The practice of anesthesiology is the practice
of medicine, not the practice of nursing. ... There
are reasons why specialized physicians receive such
extensive training, and those reasons are patient
safety and quality of care."
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Randolph D. Smoak, Jr., M.D.,
Vice Chair, Board of Trustees, American Medical Association
"The AMA is deeply concerned ... Decisions made
during surgery, quite literally, can mean the difference
between life and death. It's impossible to exaggerate
the importance of having skilled physician oversight
at this critical time."
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William D. Owens, M.D.
President, American Society of Anesthesiologists
"Nurses play an important role
in the administration of anesthesia, but they do not
have, nor should they have or ever be expected to
have, sufficient knowledge to play the role of a doctor.
... This change that HCFA is proposing is not an issue
of cost. It is purely an issue of patient safety."
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David Matthews, Ph.D.,
President, General Missionary
Baptist State Convention of Mississippi
"It is my fervent prayer that our government
will heed the call of many who feel as I feel - believe
as I believe - and stop this proposal which could
be tragic in the lives of many."
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Lisa M. Cashion,
Missouri Association for Community Action
"Medicare and Medicaid patients deserve the
same level of supervision and care that you, and I,
and our families deserve. We urge HCFA to reconsider
this proposal that is based neither on cost-savings
nor sound medical judgment."
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Jane C.K. Fitch, M.D.,
Assistant Professor of Anesthesiology, Yale University
"I challenge nurse anesthetists who want independent
practice to go for it - but do what I did and go through
the proper medical education process and don't seek
legislative shortcuts."
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Stephen T. Pyles, M.D.,
Director of Anesthesia Care Team, Munroe Regional
Medical
Center, Ocala, FL
"I don't think HCFA should regulate that a nursing
education is equivalent to a medical education."
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