| |
June 2000
Volume 64 |
Number 6
|
| |
WASHINGTON REPORT
|
| ASA Steps Up Legislative
Efforts in Response to HCFA Announcement |
Michael Scott, Director
Governmental and Legal Affairs
Responding vigorously to the Health Care Financing Administration's
(HCFA's) March 8 announcement of its intention to finalize its
proposal to eliminate required physician supervision of nurse
anesthetists, ASA's leadership has authorized radically increased
legislative and public affairs initiatives to persuade the Congress
to require the agency to conduct an outcomes study. As of this
writing, immediately before the Memorial Day recess, it is fair
to say that substantial progress has already been made toward
this objective.
Many ASA members, legitimately outraged by HCFA's seeming disinterest
in determining whether patient safety would be endangered by its
precipitous action, have contacted the ASA Washington Office to
determine the extent of our progress in this effort and to offer
suggestions for various strategies. In candor, we have been less
than forthcoming in detailing to members the courses that we are
pursuing, primarily because this information could be used by
our opponents to counter our efforts.
However, nothing could be further from the truth. In consultation
with ASA's augmented legislative team and public affairs team,
your leadership has directed an intense, multi-faceted response
from the outset. At the same time, your leadership is informed,
virtually daily, of the progress of the various strategies we
are pursuing, and they regularly provide us with feedback. It
is simply not in the interest of ASA and its members to detail
these strategies outside the leadership group, nor to discuss
them in a publicly available publication such as the NEWSLETTER.
We can say that the outpouring of support from ASA members,
other medical associations and senior and civic groups for passage
of the Safe Seniors Assurance Study Act of 1999 (H.R. 632/S. 818),
or the Anesthesia Outcomes Study Act of 1999 (H.R. 2002) has been
and will continue to be enormously valuable. With the addition
of each new name to the sponsorship list, our task becomes a little
less daunting -- not just among those Senators and Representatives
who may be willing to declare their support for the bill, but
among those who are unwilling publicly to choose sides but who
nonetheless are willing to support us if the matter comes to a
vote.
There is absolutely no doubt that the physician community --
including the American Medical Association, primary care physicians,
surgeons, other hospital-based groups and state medical associations
-- are solidly behind ASA in this effort and that is due in no
small part to your hard work with your colleagues in medicine.
The volume of mail from ASA members to Congress is unprecedented,
and the number of "hits" on our single-issue action Web
site has been most gratifying (try it, you'll like it!).
By the time this column appears, HCFA's projected date for publishing
its final rule in the Federal Register will have arrived.
For a variety of reasons, however, we have grounds for expecting
that there will be slippage in HCFA's timetable, which means that
the opportunity for gaining passage of the ASA-supported study
bill, or otherwise impeding the finalization of the new regulation,
will have increased. I thus urge you, as ASA President Ronald
A. MacKenzie, D.O., has done several times before, to keep your
communications to Congress coming. In May, an update was mailed
to all ASA members that set forth the current status of sponsorships
on all the bills relevant to this issue, and the content of your
communications should be dictated by where your Senators and Representative
stand. Please remember that a "thank you" to our supporters is
always appreciated.
One final word on this subject: We have received numerous inquiries
from members as to the legal and practical impact of a decision
by HCFA to finalize its proposed rule, and I think it is appropriate
that I respond to those questions for the benefit of all readers
of this column. First, the impact would be initially measured
by the precise language of the final rule. Second, finalization
of the rule would mean that the issue of nurse anesthetist supervision
will be decided under the laws and regulations of the individual
states. According to the analysis by ASA's outside law firm, updated
again this past spring, the practice codes of about half the states
require physician supervision of nurse anesthetists and about
18 more require collaboration with a physician. In addition, many
health facility codes and state regulations relating to the dispensing
of controlled substances require the involvement of a physician.
The result is that very, very few states at present (we can identify
only New Hampshire) permit independent nurse anesthetist practice.
In sum, therefore, it would be wrong to conclude that elimination
of the federal supervision requirement will result in immediate
widespread independent practice by nurse anesthetists as a matter
of state law. It is also true, moreover, that hospitals and other
health facilities are free to, and do, establish supervision standards
that significantly exceed requirements of the law, whether federal
or state. These standards are most often driven by patient safety
concerns, and it is not reasonable to expect that they would measurably
change in the near term.
What would be true, however, is that the principal current supervision
debate will shift from the federal to the state level. That debate
at the state level has been going on for many years and would
without doubt intensify. Your leadership has anticipated this
possibility for more than a year, and the level of ASA support
for state component legislative efforts, both defensive and proactive,
has been commensurately increased.
| One of many anesthesiologists who attended
the Society for Ambulatory Anesthesia Annual Meeting in Washington,
D.C., on May 4 - 7 is assisted by ASA Public Relations Manager
Philip S. Weintraub, right, while completing online e-mail
to Congress, urging opposition to removing physician supervision
of nurse anesthetists. |
GOP Proposes Drug Benefit, Judiciary Reports Pain Bill
Just before the Easter recess, House Republican leaders released
the outline of their own proposal for the addition of a drug benefit
package to the Medicare program. The Administration had earlier
released its own plan, and there is no doubt that there is considerable
steam behind the concept in this election year. It remains to
be seen, however, whether the two parties can come together in
a single proposal that the president will sign; the general view
is that too little time remains for this kind of consensus to
emerge.
On April 27, the Senate Judiciary Committee approved S. 1272,
a bill that would deny the use of controlled substances in connection
with assisted suicide but, at the same time, is designed to lessen
concerns of practitioners engaged in the aggressive treatment
of pain in terminally ill patients. ASA has supported the measure
since its introduction, and by the time the bill reached the Judiciary
Committee, it had been sufficiently clarified to gain support
of AMA and several other medical organizations. A very similar
bill passed the House last year. Because passage of the bill would
effectively negate Oregon's assisted suicide law, Senator Ron
Wyden (D-OR) has promised a filibuster when the bill comes to
the floor, and some doubt exists whether there are sufficient
votes to invoke closure.
At this writing, the conferees on patient protection legislation
are reported to have made significant progress on a number of
issues, but real questions exist as to whether the conferees can
craft a bill that can pass both the Senate and the House and not
be vetoed by the president. As a member of the Patient Access
Coalition, ASA supported the more aggressive version of the bill
passed by the House.
return to top
|