March 2001
Volume 65 |
Number 3
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WASHINGTON REPORT
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| ASA
Increases Efforts to Overturn Clinton Midnight Supervision
Rule |
Michael Scott, Director Governmental and Legal Affairs
Acting upon the opportunity provided by
President Bush's sweeping suspension of the effectiveness of end-of-term
regulations published by the Clinton Administration, ASA has called
on its members, senior citizens and other concerned parties to
express to new Health and Human Services (HHS) Secretary Tommy
Thompson their opposition to the rule published January 18, eliminating
physician supervision of nurse anesthetists for Medicare patients.
The Bush order extended the effective
date of the rule until mid-May to give Secretary Thompson adequate
time to consider the appropriate course of action. Even prior
to his confirmation by the Senate, ASA sent a strongly worded
letter to the new Secretary, criticizing the insensitivity of
the prior Administration to legitimate patient safety concerns
and urging him to overturn the rule.
In early February, the American Medical
Association, the Association of American Medical Colleges, all
50 state medical associations and over 35 national medical specialty
societies wrote Secretary Thompson, urging him to rescind the
rule. The text of the joint letter appears in a box on page 4.
At last count in mid-February, over 5,000 e-mails had been sent
to the Secretary by ASA members, senior citizens and other rule
opponents; several Senators and Representatives have also weighed
in with the Secretary on behalf of anesthesia safety.
Also in early February, sponsors in the
106th Congress of the Safe Seniors Assurance Study Act of 1999
introduced a new version of the bill (H.R.716/S.332), calling
for an anesthesia outcomes study of various anesthesia delivery
modes prior to any action to eliminate the federal rule. ASA President
Neil Swissman, M.D., will have sent an update to the membership
on the new bill by the time this column appears. It will also
serve as one of the focal points for ASA's Legislative Conference
to be held in Washington D.C., April 29-May 2.
Opening Guns Sounded on Patients’ Rights
Bill
Seemingly taking up right where it left
off last year, the Congress has already begun to focus on the
terms of revised compromise legislation granting protections to
managed care subscribers from abusive practices. The new player
on the scene, however, is of course President George W. Bush,
whose views on the issue vary significantly from those of his
predecessor. Although he campaigned last fall on the basis of
his pro-patients’ rights record in Texas, the fact is that as
Governor, he vetoed one such bill in Texas. The bill that ultimately
was passed became law without his signature.
In early February, the Administration announced
that it was preparing its own patients’ rights legislation and,
at the same time, expressed concern about any bill that would
unreasonably open the door to litigation against managed care
organizations and employers. The liability issue is of course
the very same issue upon which this legislation foundered in the
Senate last year, and very few attitudes appear to have changed
in the past several months. It is doubtful much progress can be
made until the Administration's position becomes clearer.
Bush Proposes Stop-Gap Indigent Drug
Benefit Plan
At the end of January, President Bush fulfilled
a campaign promise and proposed a plan to provide block grants
to states to make drug coverage available to about 9.5 million
Medicare beneficiaries at or near the poverty level. The plan
would last for four years or would end sooner if a more comprehensive
drug benefit plan was enacted. The cost is estimated at about
$48 billion over four years.
In offering the proposal, the President
endorsed more sweeping Medicare reforms, including drug benefit
premium support, as proposed by a bipartisan commission last year.
Democrats oppose this approach, believing that a drug benefit
for beneficiaries should be developed as an integral part of the
Medicare program.
HHS Under Clinton Sets Privacy Rules
As noted briefly in last month’s column,
the Clinton Administration prior to its departure issued sweeping
final regulations designed to protect the privacy of patients’
medical records. Development of the new rules was mandated by
the 1996 Health Insurance Portability and Accountability Act (HIPAA)
in the event Congress was unable to reach consensus on privacy
standards.
The new regulations take effect in 2003,
and regulations required by statute are not affected by President
Bush's regulatory suspension order issued January 20. They represent
the second in a series of required administrative simplifications
contemplated by HIPAA. The first of the required regulations,
dealing with electronic exchange of health care data, was published
in October 2000. Both sets of regulations will be reviewed by
speakers at ASA's annual Legislative Conference, this year to
be held April 30-May 2 at the J.W. Marriott Hotel in Washington,
D.C.
The new privacy regulations require patient
consent for the routine release by providers of any information
from medical records and special consent for the nonroutine release
of information such as for marketing and fund-raising. Covered
providers include health care providers who transmit health care
data electronically, health plans and health care clearing houses
as well has health care Web sites and online pharmacies.
Covered providers are required to contract
with their business associates, e.g., independent billing agencies,
to extend the privacy protections to those entities. Providers
are not, however, required to monitor the activities of their
business associates, as had been provided in the proposed regulations
issued earlier. Covered providers may, however, transmit only
the minimum information required for billing purposes, but they
enjoy full discretion when sending information to other providers
for consultative treatment purposes.
The new regulations are expected to create
something of an administrative nightmare for provider groups in
that they do not override stricter state requirements already
in existence. The Administration has estimated that the new regulations
will cost an added 19 cents per visit; provider groups believe
this figure is much too low.
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HHS Secretary Thompson Receives Letter With Renewed
Support From Doctors
On February 1, a letter was sent to HHS Secretary Tommy
Thompson that was signed by more than 80 physician organizations.
Similar to the letter sent to his predecessor last year,
the organizations call for Secretary Thompson to take the
action necessary to rescind the rule published in the Federal
Register on January 19.
Medical societies from all 50 states, Puerto Rico and the
District of Columbia as well as the major surgical societies
signed the following letter:
Dear Secretary Thompson:
The undersigned surgical and medical associations are writing
to express our profound concern over issuance by the Clinton
Administration on January 18 of a final rule eliminating
physician supervision of nurse anesthetists from the Medicare/Medicaid
Conditions of Participation for hospitals and ambulatory
surgical centers. We urge you to take the action necessary
to rescind that final rule.
We support the position of the American Society of Anesthesiologists
and Anesthesia Patient Safety Foundation that revision of
the pre-existing physician supervision requirement should
be considered only after development and review of current
scientific outcomes data. We are deeply troubled by the
position of the Clinton Administration, set forth in the
preamble to the final rule, that the elimination of physician
supervision can be presumed to be safe without scientific
proof in light of the overall improvement of anesthesia
safety over the past several years during which physician
supervision has been required. We believe Medicare and Medicaid
beneficiaries deserve better than a mere presumption of
safety that has no basis in the scientific literature.
We applaud President Bush's order suspending the effectiveness
of this final rule for 60 days, and hope you will use the
added time to construct a new rule that is more sensitive
to the legitimate needs of Medicare and Medicaid patients.
[For complete list of signatories, see www.ASAhq.org/HCFA/SpecialtySocLtr.htm,
or the February 15 President's Update.]
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