Fight Crime With Those PDRs!

Wondering what to do with that old Physicians’ Desk Reference when the new one arrives? Drop it off at your local law enforcement agency. A favorite trick of people who possess illegal drugs is to put them in a prescription bottle and claim that they are legitimate medications. The section in the front of the PDR can be used by police and other law enforcement personnel to quickly determine whether the pills in the bottle match those in the PDR.

Susan Dorsch, M.D.
Orange Park, Florida

Medicare’s Anesthesia Underpayments – It Is Time to Act

In response to Karen Bierstein’s article “Medicare Proposes More Cuts in Payments to Specialists” in the September 2006 ASA NEWSLETTER, I am saddened to hear nothing new from ASA about this very serious problem.

Medicare Payment Advisory Commission data demonstrates that the problem is now 14 years old.

I personally believe that we created the problem in 1991 by requesting the retention of actual time. By not becoming a part of the fee schedule like all other physicians, we not only immediately accepted a 29-percent reduction in the anesthesia conversion factor, but now we cannot effectively compare anesthesia work intensity to other physician services. Future revisions to the Resource-Based Relative Value Scale (RBRVS) will only make the problem much worse.

While I agree that the flawed sustainable growth rate (SGR) is a compounding issue, it should not be the advocacy priority of ASA. The American Medical Association will deal with the SGR problem because it affects all physicians.

Only ASA can fix the anesthesiology work relative value problem. It is our fight alone. Now is the time to act.

I believe that in order to develop an effective strategy, we must accept the following two facts. First, the current structure of the Relative Value Update Committee and the statutory limitation of RBRVS fiscal impacts create a zero-sum environment that will always preclude parity for anesthesiology services. We have tried this approach for a decade now, and it has not worked. Second, and more importantly, ASA seems unwilling or unable to develop an effective advocacy strategy to fix this problem. This is a political problem that needs a political solution.

We can win this fight. Many, if not most, state societies have been very successful in lobbying for parity in their Medicaid programs. ASA can do the same.

We can begin by making this the ASA’s number-one advocacy issue. I believe most ASA members would agree.

Rodney L. Trytko, M.D., M.B.A.
Spokane, Washington

Private Practitioners can Help Academic Departments

I read with interest and concern Dr. Bacon’s editorial regarding the financial plight of academic departments resulting from Medicare’s refusal to compensate faculty for supervision of more than one anesthetic procedure (October 2006).

I concur that this is a threat to all anesthesiologists, academic and private practice, and to the future of the specialty. I agree that we should contact our elected representatives to inform them of our concerns.

I would add another perspective by which private practice anesthesiologists can in a very concrete and financial manner assist our academic colleagues and their essential training programs.

After I retired, Ronald D. Miller M.D., chairman of the UCSF Department of Anesthesia was gracious enough to appoint me to his volunteer clinical teaching staff. For the next seven years, I had one of the most exciting professional experiences of my career. Depending upon my schedule and the staffing needs of the UCSF anesthesia department, I would supervise residents four to six times per month in the O.R. setting. The department billed for and collected anesthesia fees for my services, covered all malpractice insurance and provided parking privileges.

The department paid a stipend to some other nonacademic clinical staff, so I also received a stipend. I donated my stipend back to the department chairman’s discretionary fund. During those seven years, approximately $200,000 of my stipend went into that fund. The stipend was not large, certainly less than the billings for my services and hopefully also less than the actual collections for my services. The department should have netted significantly more than my stipend.

Although my contribution over those years was but a small fraction of the budget for a large department, I felt that it must have helped. If five to 10 other individuals did likewise, a greater contribution would result. I cannot but wonder what might happen if academic anesthesiology departments nationwide were to develop a program by which their ex-residents and other anesthesiologists in practice proximal to the department were able to donate professional services one or two days a month. If they did, that would significantly help these financially strapped departments.

For certain, some efforts must be made by the academic departments.

Facilitation of the credentialling of these volunteer faculty, provision for parking and, if from considerable distance from the department, lodging and such would need to be arranged. I think that there is a reservoir of good will that could benefit many academic departments. It remains largely untapped. The creative and problem-solving intellects of academic departments ought be able to resolve the obstacles to establishing such a program and meet the needs of ex-residents and practitioners in their areas willing to participate in a volunteer teaching program.

Obviously this is not a solution preferable to the Medicare program changing its payment policy. It could be a mutually beneficial program to the academic programs and the nonacademic participants that will intellectually and professionally benefit from their close association with faculty and residents.

One need not be retired to participate in such a program. If retired, yes, volunteer more than one to two days a month, but if in practice, try to find one to two days per month to give back to those programs that gave us so much and launched our professional careers.

Clair S. Weenig, M.D.
Walnut Creek, California

The views and opinions expressed in the “Letters to the Editor” are those of the authors and do not necessarily reflect the views of ASA or the NEWSLETTER Editorial Board. Letters submitted for consideration should not exceed 300 words in length. The Editor has the authority to accept or reject any letter submitted for publication. Personal correspondence to the Editor by letter or e-mail must be clearly indicated as “Not for Publication” by the sender. Letters must be signed (although name may be withheld on request) and are subject to editing and abridgment.