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August 2001
Volume 65 |
Number 8
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WASHINGTON REPORT
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HHS Issues Proposed
Regulation Restoring Physician Supervision
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Consistent with Health and Human Services (HHS) Secretary Tommy
Thompson’s May 18 announcement, the Centers for Medicare &
Medicaid Services (CMS, formerly HCFA) issued on July 5 a proposed
regulation under which the traditional Medicare requirement of physician
supervision of nurse anesthetists would be retained. Comments on
the proposed rule are due by September 4.
In early January of this year, the Clinton administration issued
a final regulation eliminating the physician supervision requirement.
Promptly on taking office, President Bush suspended the effectiveness
of the regulation until May 18 in order to permit the new administration
to consider the wisdom of the regulation. In his action of May
18, Secretary Thompson further suspended the effective date of
the Clinton regulation for six months and announced that HHS would
shortly be issuing a proposed rule restoring the physician supervision
requirement.
The July 5 proposed CMS regulation, consistent with Secretary
Thompson’s announced intent, contemplates that the individual
state governors would be permitted to “opt out” of the
reinstated physician supervision rule if they found, after consultation
with their boards of medicine and nursing, that such action was
in the interest of the state’s citizens. Any “opt out”
action, however, would be required to be consistent with existing
state law. This means, for example, that in a state where the
law already required supervision, an “opt out” action
would not be permissible.
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NOW IS THE TIME!
Please Write Letters Supporting New Rule
We need all ASA members, their colleagues, families and
friends to write to Health and Human Services Secretary
(HHS) Tommy Thompson to support the most recent rule
change that reinstates the federal requirement for physician
supervision of anesthesia services for Medicare/Medicaid
patients.
Write personal letters (no faxes or e-mails accepted) supporting
this patient-safety message to:
Health Care Financing Administration
Attention: HCFA-3070-P
P.O. Box 8013
Baltimore, MD 21244-8013
All letters (one original and three copies) must be received
no later than Tuesday, September 4, 2001. NOTE: Monday,
September 3, is Labor Day, and no mail will be delivered
on the holiday.
For additional information and communication points to
include in your letter, check the July 23 issue of the President’s
Update mailed to all members, or go to the ASA Web site:
www.ASAhq.org/hhshalts.htm.
Please do not delay in writing to HHS Secretary Thompson.
The previous proposal for no supervision is unnecessary
and not in the best interest of patients. Make sure that
your voice as the patient’s advocate is heard loud
and clear in Washington!
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The CMS proposed rule also seeks comments on a proposal that the
HHS Agency for Healthcare Research and Quality conduct a prospective
anesthesia outcomes study to examine the results of nurse anesthetist
practice, or in the alternative, to establish some form of voluntary
monitoring system for reporting adverse outcomes.
Because of retention of the long-standing federal physician supervision
requirement, ASA expects in general to comment favorably on the
proposed rule. It plans to offer constructive comments on the
mechanism by which a governor would establish that the “opt
out” requirements have been met and are reported to CMS and
the public. It is also likely that ASA will support the conduct
of an outcomes study — since it has for many years advocated
such a study while opposing the Clinton initiative.
If the new CMS proposed rule is finalized in its present form,
it will mean that the long-standing Medicare rule for hospitals
and ambulatory surgical centers requiring supervision of a nurse
anesthetist by either the operating practitioner or an anesthesiologist
will remain in place, as will the rule requiring that anesthesiologist
assistants be supervised by an anesthesiologist.
Senate Passes Patient
Protection Bill; House Debate to Begin After Recess
On June 29, the Senate adopted by a wide margin strong patient
bill of rights legislation (S. 1052) containing a variety of protections
against managed care abuses and a host of legal remedies not previously
available to beneficiaries. The Senate action represented a political
defeat for President Bush, who promised to veto the measure if
passed by Congress, and for Senate Republicans who either opposed
passage of any patient protection bill or supported a somewhat
more modest bill (S. 889).
Both Senate bills contained the fundamental patient protections
that ASA supported as a member of the Patient Access Coalition.
Most recently, ASA has endorsed S. 889, principally authored by
Senator Bill Frist (R-TN), because President Bush had advised
that, if passed, he would sign such a bill.
With the Senate action, the patient protection scene now shifts
to the House, where debate on the issue is expected to begin in
late July. On June 26, the GOP House leadership bill (H.R. 2315)
was introduced by Representative Ernest Lee Fletcher (R-KY), a
family physician serving on the Committee on Education and the
Workforce. Representatives of the Patient Access Coalition were
extensively consulted on the specific terms of patient protections
contained in this bill, including ASA and a number of physician
specialty groups that have endorsed the bill. The President has
said that he would sign this bill if it came to his desk. On July
11, ASA President Neil Swissman, M.D., attended a White House
meeting along with several other specialty society leaders to
brief the President on specialist access issues.
The House GOP bill contains somewhat stronger legal remedies
for beneficiaries than the Frist bill in the Senate, particularly
in that it permits some lawsuits to be brought in state courts
rather than federal courts. Those remedies still fall short of
the provisions of the Senate-passed bill, and the principal question
is whether the bill can gain sufficient Republican votes for passage.
At least some Republicans and virtually all House Democrats are
expected to favor the competing bill (H.R. 526) introduced by
Congressmen Greg Ganske (R-IA) and John D. Dingell (D-MI) and
recently endorsed by Congressman Charles Norwood (R-GA).
In the end, the question remains whether the two congressional
bodies can agree on the bill that the President will sign. Patient
protection legislation now looms as one of the principal tests
of political will in the 107th Congress. Its chances for passage
appear greater than at any time since the original bills were
introduced six years ago, but the issue of defining appropriate
legal remedies remains the sticking point — just as it did
in the last Congress.
Medicare Parts A and B Spending Up for First Eight Months
of FY 2001
In a likely precursor of disappointing things to come, the Treasury
Department reported in late June that Medicare spending for the
first eight months of FY 2001 has increased by 7.6 percent —
6.6 percent under Part A and 9.1 percent in Part B. This increase
is radically higher than in the past two fiscal years and will
make Congress’ willingness to further “give back”
spending cuts effected by the Balanced Budget Act of 1997 extremely
problematical. For physicians, it could also spell a negative
update for calendar year 2002 under the Medicare Fee Schedule.
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