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May 2000
Volume 64 |
Number 5
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WASHINGTON REPORT
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| 320 ASA Members
Attend Legislative Conference, Lobby Hill on Nurse Anesthetist
Supervision Issue |
Michael Scott, Director
Governmental and Legal Affairs
Fortuitously moved up two years ago to avoid conflict with the
congressional calendar, the 2000 Legislative Conference was held
in Washington, D.C., March 20-22, hard on the heels of the surprise
March 8 announcement by the Health Care Financing Administration
(HCFA) of its intention to finalize its 1997 proposal to eliminate
the Medicare supervision requirement for nurse anesthetists by
June.
Needless to say, ASA's response to this announcement dominated
the conference agenda and the message conveyed by participants
to senators and representatives during visits to Capitol Hill.
Members of both bodies were asked to contact HCFA to express their
concern in light of Congress' November 1999 recommendation, acknowledged
but not followed by the agency, that HCFA base any action on scientifically
based outcomes data.
House Members were asked to sign on to a "Dear Colleague" letter
from Representatives David Weldon, M.D., (R-FL) and Gene
Green (D-TX) to the leadership of the Ways and Means Committee,
asking them to move legislation to require HCFA to conduct an
outcomes study before finally acting. As of this writing, about
90 representatives had signed the letter. The number of House
sponsors of the Weldon-Green bill (H.R. 632) and of H.R. 2002,
authored by Congressman Fortney "Pete" Stark (D-CA), had
risen to about 95. [By the end of the conference, the number of
sponsors of S. 818, the Senate companion bill introduced by Senators
Mike DeWine (R-OH) and Harry Reid (D-NV), had risen
to 11.]
At the end of November 1999, ASA was advised by a high-ranking
HCFA official that the agency was awaiting the publication of
the University of Pennsylvania study (which showed markedly higher
mortality rates when a nonanesthesiologist supervised the anesthesia
care), before deciding what it would do. As noted in his March
31 President's Update, ASA President Ronald A. MacKenzie,
D.O., met during the conference with HCFA Administrator Nancy-Ann
Min DeParle. Ms. DeParle offered no explanation for HCFA's
precipitous action other than that the agency has been pressed
to act by Senator Arlen Specter (R-PA), Chairman of the
Senate Appropriations Subcommittee on Labor, Health and Human
Services, and Education.
ASA's leadership has authorized an all-out effort to block finalization
of the proposed rule prior to consideration of current anesthesia
outcomes data. This has included a radical augmentation of ASA's
legislative representation in both Houses of Congress and a major
grassroots campaign involving ASA's members, the nation's seniors
and other supporters of anesthesia patient safety. By the time
this column is published, the details of this effort will have
become known to ASA members via the Web site and e-mails to ASA
members who have an e-mail address on file.
IOM's Shine Keynotes Conference
Before HCFA's March 8 announcement, organizers of the Legislative
Conference had intended that it would focus on the December 1999
"To Err Is Human" report of the Institute of Medicine (IOM), which
detailed the incidence of apparent medical errors in the treatment
of patients. Keynote speaker for the conference was IOM President
Kenneth I. Shine, M.D., who outlined the findings and recommendations
of the report and congratulated the specialty of anesthesiology
on its exemplary record of reducing medical errors. The disconnection
between this patient safety record (which of course includes supervision
of nonphysicians) and the contemporaneous HCFA announcement that
it intends no longer to require supervision was not lost on conference
participants.
The first day of the conference also featured a panel on federal
and state antitrust reform. Among those participating was Lori
Kinder, a legislative assistant to Representative Tom Campbell
(R-CA), author of the Quality Health Care Coalition Act of 1999
(H.R. 1304). This bill, which would allow physicians to come together
to negotiate contract terms with health plans, was favorably (26-2)
reported out of the House Judiciary Committee on March 30, 2000,
and is expected to reach the House floor after Easter.
Several federal legislators appeared before the conference on
its second and third days, including Senators DeWine and Jon
L. Kyl (R-AZ), the author and a cosponsor of S. 818, respectively;
and Representatives John D. Dingell (D-MI), Charles
B. Rangel (D-NY), Steny H. Hoyer (D-MD), Paul D.
Ryan (R-WI), Shelley Berkley (D-NV) and Sherrod
Brown (D-OH).
Appearing for the GOP and Democratic congressional campaign
committees were their respective chairmen, Thomas M. Davis
III (R-VA) and Patrick J. Kennedy (D-RI). Addressing
the conference on the second day, Larry J. Sabato, Ph.D.,
a professor and nationally known election analyst from the University
of Virginia, reviewed the upcoming presidential and congressional
races for participants. Receptions were also held honoring Dr.
Shine and Senator DeWine during the conference.
Two ASA members, Burton S. Epstein, M.D., and L. Charles
Novak, M.D., also appeared on the second day of the conference
to discuss office-based anesthesia issues and developments with
respect to the Medicare Fee Schedule. Dr. Novak's comments were
complemented by a presentation from Thomas A. Marciniak, M.D.,
from HCFA's Center for Health Plans and Providers.
Conference participants received extensive briefings by ASA's
legislative staff and consultants not only on the HCFA physician
supervision issue, but also on the status of the antitrust, patient
protection and pain relief promotion bills pending before the
Congress. These briefings were supplemented by a presentation
from Sharon McIlrath, Assistant Director, Federal Affairs,
of the American Medical Association.
The final conference speaker was David Weldon, M.D.,
author of H.R. 632 and a committed opponent of the apparent federal
trend to "dumb down" the quality of health care delivered to our
nation's Medicare and Medicaid beneficiaries. Continuing his fight
to require HCFA to base its nurse anesthetist supervision decision
on sound scientific data, Dr. Weldon coauthored with Representative
Green a vigorously critical letter to HCFA Administrator DeParle,
distributed by participants to the various congressional offices
at the end of the conference.
A copy of the Weldon-Green letter to Ms. DeParle is available
on the ASA
Web site.
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