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August 2002
Volume 66 |
Number 8
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WASHINGTON REPORT
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| ASA Members
Get Their Money's Worth in AMA Research and Advocacy Services |
Michael Scott, J.D., Director
Governmental and Legal Affairs
This month's column will be a bit different in that I will not
be reporting on current legislative or regulatory developments.
Barry M. Glazer, M.D., has taken care of that very nicely in the
reimbursement advisory that appears on page 4.
Instead, I want to draw the attention of the membership to the
enormous volume of research and advocacy services provided to
the Society each year by that organizational behemoth we love
to hate, or at least criticize, the American Medical Association
(AMA). Based on my nine years' experience as ASA's Director of
Governmental and Legal Affairs, I am convinced that if AMA continues
its current membership "death spiral," the country's
physicians will need to create, out of its ashes, a medicine-wide
organization very much like it.
Few ASA members are aware of the contributions made by AMA, and
especially its Washington office, in representing our mutual interests
in this city. I have often estimated that these contributions
are worth annually about a half-million dollars to the Society
and its members. That's just a guess, measured in terms of the
cost to ASA of qualified researchers and lobbyists if AMA did
not exist, but if anything, it is a conservative guess.
Let me explain.
I begin with the handbooks produced for delegates to the AMA
semiannual meetings. These handbooks contain a plethora of reports
from the AMA Board of Trustees and its various councils on subjects
of interest and importance to the physician community and the
staffs, like ours, who are working to advance the views of organized
medicine. The most recent handbook is a representative example.
It contains reports on such diverse matters as Medicare reimbursement,
clinical practice guidelines, Internet prescribing, conscious
sedation, office-based surgical standards, vaccine and drug shortages,
peer review immunity, resident physician working conditions, professional
liability insurance, pain management standards, safe disposal
of used needles, and hospital emergency services diversion –
to name just a handful of those topics with a more than passing
interest to anesthesiologists.
Each of these reports is comprehensive, the product of extensive
research by the AMA staff. They provide a valuable resource for
the 18-member ASA Section Council, which includes the ASA principal
officers, in keeping abreast of developments in and debate on
the vast array of subjects of current interest to organized medicine.
More importantly to the six-person ASA Washington Office staff,
they collectively provide an instant and regularly updated research
library that can be accessed when the need arises.
Also important from the Washington Office's perspective are the
services available through the AMA staff in this city. There is
rarely, if ever, a federal legislative or regulatory development
upon which AMA, often in coordination with specialty offices such
as ours, does not advocate on behalf of organized medicine. Most
often, this comes in the form of written communications to Congress
or regulatory agencies such as the Centers for Medicare & Medicaid
Services; but as to more important subjects, positions are developed
and advocacy undertaken hands-on in collaboration with the specialties.
An ASA representative at any one time will be serving on a half-dozen
AMA legislative task forces, and ASA staff members frequently
work collaboratively with AMA in-house lobbying staff in supporting
or opposing various legislative proposals. The bills on professional
liability reform, regulatory relief and antitrust reform currently
pending in Congress are all a product of this process. Less visibly
but equally important, AMA represents the physicians' principal
watchdog on regulatory issues under the jurisdiction of the Department
of Health and Human Services, and ASA regularly joins in briefings
and written advocacy – all principally organized by AMA –
on these issues.
What the AMA's coordinating role means is that for most of the
time, ASA legislative and regulatory advocates are able to focus
their efforts on issues of unique interest to anesthesiologists.
In the recent past, these have included the extended battle with
nurse anesthetists over scope-of-practice issues, anesthesia reimbursement
issues under the Medicare program and a host of state issues such
as office-based surgery standards and licensure of anesthesiologist
assistants. Even on these anesthesia-specific issues, ASA is often
able to call upon AMA and its state associations for valuable
support.
It is not always the case that ASA, or any specialty, will view
federal or tate issues in the same way as AMA. In the last analysis,
the AMA Washington office advocates in style and substance as
directed by the AMA Board of Trustees, and in circumstances when
we do not agree, we are of course free to pursue our own path.
The most recent example is the schism that developed within organized
medicine over the proper advocacy approach to patient protection
legislation last year. This led to the formation last January
by ASA and 13 other specialties of the Coalition for Fair Medicare
Payment to work with Congress on the Medicare update issue. Even
here, however, AMA was smart enough to offer the coalition three
seats on its update workgroup in an effort to assure that all
medicine's advocates would sing with harmonious voices to the
extent possible.
AMA's annual advocacy budget is about $19 million, and a large
portion of this budget is represented by the policy staff, lobbyists
and lawyers employed in Washington. Given this commitment and
AMA's problem with declining membership, it is little wonder that
AMA seeks to take the lion's share of the credit for everything
positive for medicine that happens here in Washington. In my personal
judgment, AMA does deserve much of the credit most of the time,
but in fact, the successes enjoyed here are normally the result
of the current symbiotic working relationship between AMA and
specialty societies. Also a fact is that AMA's vast advocacy resources
permit specialties such as ours to be effective at a far more
modest cost than if we had to go it alone, without our big, mostly
benevolent brother.
Again, speaking personally and not on behalf of ASA, I believe
the AMA House of Delegates made a wise decision last June in plotting
the course for a restructured AMA. Restructuring of a time-honored
institution is always highly controversial because restructuring
means disturbing personal and organizational fiefdoms, large and
small. These parochial interests, however, should not be permitted
to stand in the way of a re-energized AMA; the services AMA provides
to the specialties and their physicians are too important to be
placed at risk.
ASA Washington Office • 1101 Vermont Ave.,
N.W., Suite 606
Washington, DC 20005 • (202) 289-2222 • mail@ASAwash.org
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2003 MEDICARE REIMBURSEMENT ADVISORY
July 1, 2002
Dear ASA Colleague:
Many of you have read that the House
of Representatives last week passed the GOP-sponsored
Medicare prescription drug benefit bill, H.R. 4954.
Of special interest to physicians, that bill contains
a statutory 2-percent update in Medicare fees for
2003 and makes certain interim adjustments in the
Medicare update formula that are expected to produce
further 2-percent positive adjustments in 2004 and
2005. The issue now moves to the Senate, where a more
permanent revision in the update formula is under
active consideration. We do not expect, however, that
the issue will be finally resolved until the fall.
In this context, you should take with
a grain of salt the announcement by the Centers for
Medicare & Medicaid Services (CMS) – in its June
28 proposed rule on the 2003 Medicare Fee Schedule
– that anesthesia fees will drop by approximately
5 percent from current levels next year. Almost all
of that negative adjustment is attributable to CMS'
projection of application of the current Medicare
update statutory formula. That projection does not
take into account likely passage by year-end of legislation,
such as that passed last week by the House, modifying
the formula at least on an interim basis.
You should also be aware that ASA representatives
met with CMS staff early last week to discuss the
outstanding issue of an increase in anesthesia work
values – entirely apart from what happens with
respect to the Fee Schedule update formula. Based
on increased values for eight common anesthesia codes
reported favorably to CMS by the American Medical
Association/Specialty Society Relative Value Update
Committee (RUC), extrapolation to the entire family
of anesthesia codes by CMS could result in an approximate
10-percent increase in the Medicare anesthesia conversion
factor. During their meeting with CMS, the ASA representatives
presented compelling statistical evidence that extrapolation
was appropriate and produced results consistent with
the numerous studies previously presented to the RUC
by ASA. Again, it is likely that we will not know
CMS' decision on this issue until the fall; we do
know, however, that CMS included a "placeholder"
in its June 28 proposed rule that would permit the
agency to place new anesthesia work values into effect
next January 1.
We will keep you advised on these matters
through the ASA NEWSLETTER, and if need be,
through further e-mails or President's Update mailings
to the membership.
Cordially,
Barry M. Glazer, M.D., President
American Society of Anesthesiologists
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