SVR, SGR and You:
Why You Need the ASAPAC
Warren K. Eng, M.D., Senior
Co-editor
“Residents’ Review”
 VR
versus SGR: Which is more critical to our future in
anesthesiology? As we prepare for the 2006 in-training
examination slated for Saturday, July 9, the systemic
vascular resistance (SVR) equation, the arterial blood
oxygen content equation and other formulae are among
topics we must master in becoming successful practicing
anesthesiologists.
However, one formula residents may not be aware of
looms as a larger challenge to our future as anesthesiologists:
Medicare’s Sustainable Growth Rate (SGR) formula.
The SGR system was meant to control the growth of
Medicare’s payments to physicians — yet
in reality results in a 4-percent to 5-percent annual
reduction in Medicare payments to anesthesiologists
and other physicians, as it does not factor in increasing
costs to provide services.
A complex formula based on gross domestic product,
number of Medicare fee-for-service beneficiaries,
input prices and various laws and regulations, the
SGR has been criticized as flawed by ASA and other
physician societies, the American Medical Association
(AMA) and the Medicare Payment Advisory Commission.
Its first implementation in 2002 resulted in a 5.4-percent
reduction in physician payments.
Anesthesiologists in 2006 will not see their Medicare
payments reduced — ASA and its allies have again
successfully lobbied Congress this year to negate
the cuts. Since 2003, Congress has passed one-year
budget provisions restoring SGR-cut funds; however,
these are temporary fixes that leave the SGR provision
intact. Consequently, ASA, AMA and other physician
groups are left to lobby representatives and senators
on the same issue, every year.
What’s a busy resident to do? Between clinical
duties, reading, the in-training examination and family
life, how do we defend our specialty against external
threats such as the SGR formula and the Medicare Teaching
Rule reimbursement policy (see the October 2005 “Residents’
Review”)?
At a minimum, all residents should be aware of the
ASA Political Action Committee (ASAPAC). ASA’s
voice in Washington, ASAPAC was founded in 1991 as
a bipartisan lobbying body. ASAPAC is one of the top
100 PACs in Washington, D.C., and was instrumental
in orchestrating negation of the SGR fee reductions
for this year.
While one notes with pride that ASAPAC is among the
top 100 PACs in Washington, it also is noteworthy
that other top 100 PACs include the American Association
of Nurse Anesthetists, the Association of Trial Lawyers
of America and the American Hospital Association.
Only 10 percent of ASA members donate to ASAPAC —
while already loud, imagine how much stronger our
voice would be in Washington if that participation
was simply doubled to a measly 20-percent participation
rate (or even higher)!
Membership in ASAPAC should not be a question!
As we strive to become the best anesthesiologists
possible, it is illogical to not sponsor a nonpartisan
organization that ensures the continued viability
of anesthesiology. For further information, go to
the ASA Web site <www.ASAhq.org>
and log in to the “Members Only” section.
The next level of resident participation might be
the ASA Legislative Conference in Washington, D.C.,
from May 1-3. With various symposiums on pertinent
regulatory/legislative issues and keynote speakers,
the conference will culminate in congressional office
visits on Capitol Hill. For more information, contact
your state component or any ASA Resident Governing
Council members at <www.ASAhq.org/asarc/index.html>.
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Warren
K. Eng, M.D, is a CA-2 resident at the University
of North Carolina, Chapel Hill, North Carolina.
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