April 2000
Volume 64 |
Number 4
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WASHINGTON REPORT
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| Society Requests
Work Value Re-evaluation in Connection With MFS Five-Year
Review |
Michael Scott, Director
Governmental and Legal Affairs
On February 28, 2000, ASA filed a request with the Health Care
Financing Administration (HCFA) that the physician work values
included in all anesthesia codes under the Medicare Fee Schedule
(MFS) be re-evaluated as part of the upcoming five-year review
mandated by federal law. ASA also renewed its request, most recently
made last January 3, 2000, that increased work values for several
pain management and critical care codes be immediately accepted
by HCFA or, if not, be re-evaluated as part of the five-year review.
Under the review procedures, new approved values would take effect
January 1, 2002.
As a result of the first HCFA five-year review that took effect
January 1, 1997, ASA succeeded in gaining a 22.76-percent increase
in physician work values, which translated into a 15.95-percent
increase in the anesthesia Medicare conversion factor. This increase
was smaller than that requested by ASA, based both on a survey
of double-boarded anesthesiologists and on a "building block"
valuation of anesthesia work by a multispecialty physician panel.
The increase nonetheless represented a significant step in recouping
a part of the major downward adjustment in the anesthesia conversion
factor that occurred at the inception of the MFS in 1992.
ASA's current request is again principally based upon a "building
block" approach, this time by equating physician work in the preoperative,
intraoperative and postoperative portions of an anesthesia procedure
to work relative value units for four evaluation and management
(E&M) codes: outpatient visit; new patient, level two; prolonged
physician service with direct patient contact (two time-based
codes); and subsequent hospital visit, level one.
On a weighted average basis, this approach suggests that anesthesia
work is currently undervalued by over 30 percent -- without taking
into account the several non-E&M procedures (e.g., intubation)
commonly performed in connection with anesthesia procedures. ASA
will be surveying some of its members in the next several weeks
as to the frequency and duration of the non-E&M procedures.
ASA has estimated to HCFA that when they are taken into account,
the current undervaluation will look more like 40 percent.
ASA anticipates that, as was the case five years ago, HCFA will
refer ASA's request to the American Medical Association/Specialty
Society Relative Value Update Committee (RUC) for a recommendation.
The RUC consists of representatives from 26 medical specialty
groups, including ASA, and because adjustments in relative values
must be budget neutral, the group tends as a practical matter
to require a high standard of persuasion before it will recommend
an increased value. ASA expects to present both its member survey
and additional data in support of its request to the RUC in September.
The RUC will formulate its recommendations on all work value adjustments
by the end of the year.
Congress Returns From Recess,
Confronts Major Health Issues
Following a two-week Presidents' Day recess, the House and Senate
were both back in session at the end of February. Principal speculation
in the health care field centered around the conference on patient
protection legislation. The two bodies last year passed widely
divergent bills, and doubt exists whether the conferees can agree
on a bill that will pass both houses, let alone be signed by the
president. At press time, the conferees had reached agreement
on three rather noncontroversial issues but were still far apart
on others.
The most visible issues separating the two bills are whether
managed care enrollees will have the right to sue over coverage
issues following exhaustion of internal remedies, and whether
the bill will cover all managed care enrollees or only the 44
million enrollees of plans currently protected under the federal
Employee Retirement Income and Security Act. The bills also differ
in numerous more subtle but important details; in general, the
bipartisan House bill affords more effective enrollee protection
and is supported by organized medicine, including ASA, in most
particulars.
Seldom in recent years has a piece of health legislation enjoyed
greater political significance. If the Republican-controlled Congress
is unable to produce a bill or to produce one that the president
will not sign, the Democrats are certain to seek political advantage
in the upcoming elections, especially with reference to the House,
where majority control hangs in the balance.
Complicating this picture is the congressional response to the
Institute of Medicine study on medical errors, discussed in an
article by Neil Swissman, M.D., in the March
NEWSLETTER. Several committees have already held hearings
on the report, and a number of bills have been introduced or are
being drafted to implement some of the report's recommendations.
Clearly, the most controversial recommendation would require providers
to report medical errors resulting in death or serious injury
to a national agency. AMA and virtually all broad-based provider
organizations have already expressed opposition or skepticism
to mandatory reporting.
ASA members attending the March 20-22 Legislative Conference
were urged to highlight the Society's successful two-decade patient
safety program during their visits on Capitol Hill. ASA has urged
Congress to consider alternatives to mandatory reporting such
as the closed claim study initiated by ASA in the mid-1980s, which
was unquestionably a major source for identifying the causes of
anesthesia mishaps and providing the basis for development of
appropriate practice parameters.
A number of senators and representatives have suggested that
legislation responding to the Institute of Medicine study might
appropriately be added to the patient protection legislation now
being discussed in conference. Such a move would undoubtedly complicate
the politics surrounding the patient protection debate, but such
a possibility cannot be discounted in a session shortened by party
conventions and the upcoming elections.
Looming in the health care wings for Congress are several proposals
for restructuring the Medicare program and for adding a drug benefit
for Medicare enrollees. Most observers doubt that these proposals
can be converted into legislation in the politically polarized
atmosphere that currently exists on Capitol Hill, especially in
the House. At the same time, however, extensive hearings will
almost certainly take place, teeing up these issues for the 107th
Congress and a new president next year.
TELL
CONGRESS THAT HCFA'S DECISION IS WRONG DEAD WRONG!
The nurse anesthetists have told the Health Care Financing
Administration (HCFA) that they can do what we do. We know that
as nonphysicians, they cannot provide the safest care--and
we have the facts to prove it.
YOU NEED TO CONVINCE CONGRESS THAT THE NURSES AND
HCFA ARE WRONG and that seniors covered by the Medicare program
are the ones who will suffer from this arrogant political stance.
Not only will seniors be put at risk due to a patchwork
of varying state regulations regarding anesthesia care, but there
is the real possibility that other health care plans attempt to
follow suit. This could ultimately affect everyone!
THIS IS ABSOLUTELY UNACCEPTABLE AND MUST BE STOPPED!
ASA President Ronald A. MacKenzie, D.O., is organizing a massive
effort to block HCFA action with congressional intervention. A
massive effort by all 35,000 ASA members to contact
Congress is needed immediately .
All component societies have received information on this
critical issue and have been asked to organize telephone calling
campaigns to all ASA members encouraging them to contact Congress.
YOU DON'T HAVE TO WAIT FOR THE TELEPHONE CALL
HERE IS WHAT YOU MUST DO: Telephone calls, letters and personal
visits to your legislators' home offices are urgently
needed. The U.S. Capitol switchboard number is (202) 224-3121.
Correspondence to your senators can be sent to the U.S. Senate,
Washington, D.C. 20510 and to members of the U.S. House of Representatives,
Washington, D.C. 20515.
Please ask your legislators to:
- Ask HCFA why it is rushing to make this change without
any evidence to ensure patients' safety.
- Become a co-sponsor of the Safe Seniors Assurance Study
Act of 1999 (S. 818/H.R. 632)
- In the House, sign on to the Dave Weldon/Gene Green "Dear
Colleague" letter asking for action by the Ways and Means Committee.
Please include some of your personal experiences as a physician
who is involved in the medical assessment and care of patients
each and every day.
DO THIS TODAY!
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