Congress and the Administration
Turning Up the Heat — Important Issues Starting
to Simmer
Ronald Szabat, J.D., LL.M., Director
Governmental and Legal Affairs
s is typical, new sessions of Congress start out slow.
Issues are floated for consideration. There is much
hoopla connected to swearing-in ceremonies. Then the
president gives his State of the Union address, followed
by a month or two of moderate legislative activity,
largely focused on budget deliberations, punctuated
by a lengthy early spring “recess.” Nice
work for our legislators, but a busy time for lobbyists
and policymakers seeking to advance important issues
and be positioned when things really get cooking.
ASA is in this legislative mix, just as we continue
to stir the pot productively on other important regulatory
issues! For some really good news on two important
anesthesiology issues from the Centers for Medicare
& Medicaid Services (CMS), see the
“Practice Management”
column by Karin Bierstein, J.D.,
on page 28 of this
NEWSLETTER concerning
ASA’s significant progress in bringing the realities
of medical practice to bear on securing medications
in the operating room suite (the “locked cart”
issue) and for completion of the postanesthesia evaluation
report
(March
NEWSLETTER, page 22).
Medicare SGR, Update and Pay-for-Performance
Already this year, the House Ways and Means Health
Subcommittee has held two high-profile hearings on
Medicare physician payment issues. Members of Congress
on both sides of the aisle remain extremely concerned
about what may happen to access to medical care for
seniors if scheduled cuts averaging 5 percent per
year begin January 1, 2006. At the same time, the
price tag for a needed sustainable growth rate (SGR)
fix remains extremely high, with no readily apparent
place to get funds for it.
In differing federal budget resolution bills recently
passed by the House and Senate, the path for resolving
the SGR dilemma is by no means clear. The Senate has
pointedly taken major Medicaid and many entitlement
spending cuts off of the table, while the House has
said that programs within the jurisdiction of the
Ways and Means Committee, including Medicare, must
produce savings for the fiscal year of some $18 billion.
Exactly how these two bills are made one, if that
is possible, could guide much of the future debate
on Medicare, particularly the financing of physician
services, which need
increased dollars. The
political stakes for the governing GOP will be extremely
high as this process unfolds. Failure to reach agreement
on the president’s goal for deficit reduction
will greatly embolden Democrats hoping to improve
their mid-term fortunes next year.
On the related issue of Medicare pay-for-performance
(P4P) standards, primary House and Senate authorizing
committees continue to speak with interested specialties
of all stripes on ideas about how this concept might
be advanced and possibly linked to an SGR fix. No
real consensus exists yet on whether or not, or how,
the extensive details of such a concept can be extended
to all Medicare physician-delivered services. The
unique nature of anesthesiology services, in particular,
is creating wonderful opportunities for ASA to educate
Members of Congress about the specialty and tell our
story of greatly enhancing patient safety in recent
decades.
More mechanical issues relating to data transmission,
be it through electronic medical records or claims
submissions, remain wide open for development and
debate, even as critics are beginning to link the
fledgling P4P efforts of private payers less to quality
and more to their profit-taking. The new Medicare
Advantage plans, coming into being for 2006, will
need to be heavily scrutinized by CMS, physicians
and beneficiaries to be certain that funding for needed
medical care will not be denied in the name of phony
quality measures. Stay tuned as this issue unfolds
before Congress and the public this year.
Emerging DEA and Pain Issues
As will be further detailed in next month’s
NEWSLETTER, Congress and the Administration
are continuing to focus more and more attention on
various issues relating to pain prescribing. Along
these lines, ASA and the American Medical Association
(AMA) recently joined forces in submitting detailed
comments to the Drug Enforcement Administration (DEA),
responding to a public call for input into such matters
as sequential prescriptions for controlled substances.
ASA also recently weighed in with the Food and Drug
Administration (FDA), supporting an effort to keep
Congress from extending an appropriations rider that
would allow the DEA to wield a veto over the marketing
of new controlled substances — a matter previously
in the sole purview of the FDA. Also ASA, AMA and
other interested medical specialties continue to work
with House and Senate sponsors of drug monitoring
bills that would provide federal grants to effective
state programs designed to keep patients from filling
multiple prescriptions for the same controlled substance
from different physicians.
Medicare Teaching Rule for Anesthesiology Residents
As is widely known, the current CMS Medicare teaching
rule allows anesthesiologists who train anesthesiology
residents to be reimbursed under Part B at only half
the rate of their surgical colleagues. The rule allows
full reimbursement only for a single case involving
a single resident, with absolutely no time overlap
permitted. In short, every academic anesthesiology
program, every day, is losing half the revenues that
should be flowing to it from treating Medicare patients.
Resolution of this issue remains a top ASA priority
for 2005, and ASA is continuing to press CMS, through
high-level meetings and other political contacts,
to resolve this matter favorably.
Academic anesthesiology program directors who have
not yet responded to ASA’s latest request for
simple survey data are directed to the “Members
Only” section of our ASA Web site. Your responses
will give ASA the best chance yet to right the wrong
in the current anesthesia teaching rule as we continue
working closely with the Society of Academic Anesthesiology
Chairs and the Association of Anesthesiology Program
Directors on this issue.
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