You Are Going Where Together?

On May 10 and 11, 2004, in Washington, D.C., the leaders of ASA and the American Association of Nurse Anesthetists (AANA) held their fourth meeting. The May meeting was unique because several additional members of each society were included to help in the discussion of issues of common interest related to the Medicare payment system. At this meeting, a number of misunderstandings and misconceptions regarding the Medicare payment rules arose. Through candid and respectful discussion, each society’s position on these critical issues was better understood, and common issues were identified.

We agreed to meet with the Centers for Medicare & Medicaid Services (CMS) to discuss possible approaches to resolve an issue commonly described as “split medical direction,” i.e., a case where part of the care is administered by a medically directed nurse anesthetist and the remainder of the care is personally administered by an anesthesiologist. Currently there is no mechanism for nurse anesthetists or anesthesiologists to bill Medicare for this service. ASA and AANA representatives will be meeting with CMS in June to discuss the possibility of addressing this issue. Coming to a peaceful understanding of this one issue alone has prevented what could have been a costly skirmish between our two organizations; these resources can be applied to more productive and mutually beneficial efforts.

In the longer term, we initiated a preliminary process to develop recommendations for a new Medicare anesthesia payment system for consideration by each organization. The goal would be to have an updated payment system that would allow practice to drive payment policy and reflect the reality of current anesthesiology practice. A subcommittee will be meeting in June to start this process, and its work will be reviewed at the July joint leadership meeting. Any policy issues or possible solutions will be brought to the policy-setting bodies of ASA and AANA as required by the respective organizations.

Work was continued on the substantive issues for a draft procedural agreement between ASA and AANA that will be the basis for an ongoing, mutually respectful professional relationship. Both professional organizations will be provided an opportunity to review and approve this document.

The leadership team scheduled two additional meetings. The July meeting will include new leaders from both ASA and AANA. In August the 11-member AANA Board of Directors will meet with the 12-member ASA Administrative Council for an introduction to the process that has been essential to the progress we have made so far. We also have started discussions on how we can engage more of our members and staff in this process in the future, including the involvement of state leaders.

In closing on this monthly update, we would like to thank the members of both organizations for allowing us to begin this dialogue. Heaven knows we could all find more than one reason to not be involved in this process of effective communication. Without your support, we would not be together at the table. There is hope in the foundation of trust that we are building, even if it is one small brick at a time. We have attempted to keep our respective members informed of all the issues and details involved in this important process, but we may have failed to answer questions or address issues that are important to you. We invite you to submit your questions to us so that we can keep this process as open and transparent as possible. We will try to respond to your questions as directly and as often as possible. Please send your questions to either the AANA or ASA headquarters by letter or e-mail. We look forward to an open discourse about those aspects of this process that are most important to you.

Roger W. Litwiller, M.D.,
ASA President
<mail@ASAhq.org>

Tom L. McKibban, CRNA, M.S.,
AANA President
<info@aana.com>