Year in Review:
ASA Advocacy and Practice Management — Providing
Valuable Benefits and Representation to Our Members
Ronald Szabat, J.D., L.L.M., Director
Governmental and Legal Affairs
ased
on the momentum and rebuilding of recent years, ASA
is working hard to ensure that our members have a
“seat at the table” on a wide range of
advocacy and practice management issues. With bold
physician leadership and ever-increasing grassroots
involvement, your ASA Washington Office staff presents
the following information as an update and scorecard
of our recent accomplishments and continuing future
challenges.
ASA is aggressively fighting Medicare Sustainable
Growth Rate (SGR) payment reductions. Throughout
2006, ASA has worked again in coalition with the American
Medical Association (AMA) and other physician groups
to avert proposed reductions in Medicare payments
for anesthesiology services. Overall, Medicare SGR
cuts were averted in 2003, 2004, 2005 and 2006. These
efforts have saved anesthesiologists multiple millions
of dollars and will continue unabated until the SGR
is eliminated as unworkable and unfair, especially
to anesthesiology.
ASA continues working to boost payments for
anesthesiology services under Medicare. In
2003, ASA secured a 2.1-percent work value boost to
the anesthesia conversion factor. Seeking additional
increases, in 2004, ASA secured congressional support
for a government-endorsed study of low payments for
anesthesiology services under Medicare to substantiate
well-known problems experienced by practicing anesthesiologists.
The two-year study, currently under way at the Government
Accountability Office (GAO), is expected to be released
in the near future. It is believed that it will show
that the Medicare anesthesia conversion factor is
grossly below the level needed to reflect patient
and practice costs.
ASA is leading efforts to support teaching
anesthesiologists and strengthen and save anesthesiology
residency programs. ASA worked with key lawmakers
of both parties in the U.S. House and Senate on the
drafting of legislation to repeal the onerous Medicare
50-percent payment penalty currently hurting academic
anesthesiology. S. 2990, H.R. 5246 and H.R. 5348,
the “Medicare Teaching Anesthesiology Funding
Restoration Act of 2006,” have received strong
bipartisan support and are currently pending in Congress.
ASA is continuing working to secure this needed legislative
change and to counter the Medicare anesthesiology
teaching rule from being adopted by private sector
payers. In addition to nearly 150 Republican and Democrat
cosponsors, to date, ASA has enlisted the added support
of AMA, the American Osteopathic Association, the
Medical Group Management Association and the Association
of American Medical Colleges in our efforts.
ASA is working to expand anesthesiology research
opportunities through NIH. In the FY 2006
appropriations bill providing funding for the National
Institutes of Health (NIH), ASA convinced key lawmakers
to support and include the first-ever provisions directing
NIH to enhance research in the areas of anesthesiology
and pain medicine.
ASA is helping to maintain patient access
to important pain-related controlled substances.
In response to strong ASA and AMA lobbying, the Drug
Enforcement Administration (DEA) published a rule
in the September 6, 2006,
Federal Register
that would allow physicians to issue multiple “dated”
prescriptions so that patients undergoing long-term
pain management can receive, over time, up to a 90-day
supply of their Schedule II medications. DEA had previously
sought to restrict the practice. ASA’s educational
efforts with DEA will continue building on this renewed
basis of understanding.
ASA is advancing efforts to expand rural access to
the services of anesthesiologists. In ground-breaking
work with Representatives Todd Akin (R-MO) and Henry
Cuellar (D-TX), ASA successfully saw legislation introduced
to expand generous Part A hospital rural pass-through
payments (currently only available for nonphysician
anesthesia providers) to anesthesiologists. H.R. 5955,
the “Medicare Access to Rural Anesthesiology
Act of 2006,” is currently pending before Congress.
ASA is pushing for accurate health care information
for patients to protect them against nonphysician
providers who advance misinformation. ASA
and other physician groups worked with Representative
John Sullivan (R-OK) in the crafting of H.R. 5688,
the “Health Care Truth and Transparency Act
of 2006.” This legislation would strengthen
Federal Trade Commission enforcement against limited-licensed
health care providers such as nurse anesthetists who
engage in deceptive misrepresentations as to their
education, skills and training. The legislation also
would keep nonphysicians from holding themselves out
as medical doctors (M.D.), doctors of osteopathic
medicine (D.O.), doctors of dental surgery (D.D.S.)
or doctors of dental medicine (D.M.D.). This bill
is currently pending before Congress.
On the state level, ASA is working at the request
of its component society members on an array of legislative
and regulatory matters.
ASA provides financial assistance to state
component societies for legislative/regulatory initiatives
and to assist component societies involved in litigation
on such matters as office-based surgery, pain medicine
and scope-of-practice issues. ASA’s
involvement in the Colorado Society of Anesthesiologists’
lawsuit, for example, prevented the governor from
opting out of the Medicare supervision requirements.
In the past, ASA successfully defended office-based
legal challenges in New York, New Jersey and North
Carolina, and this year won a similar victory in Illinois.
ASA actively opposes opt-outs of Medicare’s
physician supervision requirement in order to ensure
greater patient safety. There have been no
state opt-outs in 2006 from Medicare’s physician
supervision requirements. As part of its educational
and lobbying efforts, ASA provides talking points
to our members and state component and medical societies
to educate them on this issue.
ASA represents its members before the National
Conference of State Legislatures (NCSL).
NCSL is a bipartisan organization that serves the
legislators and staffs of the nation’s 50 states,
its commonwealths and territories. ASA’s attendance
at its annual meeting increases the visibility of
anesthesiologists and educates state legislators about
the differences between anesthesiologists and nonphysician
anesthesia providers, while highlighting accomplishments
by anesthesiologists to improve patient safety. ASA
is one of 11 physician groups that exhibit together
each year.
On the practice management front, ASA remains a leader
in assisting its members across a range of important
activities. Illustrative of these member benefits
are activities in the following areas.
ASA is becoming a force on CPT and RUC issues.
ASA is a recognized leader in the Current Procedural
Terminology™ (CPT) process. For the last few
years, virtually all new codes proposed by ASA have
been approved by the CPT Editorial Panel. While challenges
remain with the Relative Value Update Committee (RUC)
as far as valuing anesthesia work in comparison to
other medical services and surgical procedures, ASA
has successfully convinced the RUC to accept our recommended
base unit values for our new and revised codes. ASA
also convinced the RUC to include the value of pre-service
practice expense resources to each and every anesthesia
code.
ASA is positioning the specialty for success
under pay-for-performance programs. ASA has
demanded and obtained a front-row seat in negotiating
with Medicare and payers on performance measures.
As part of this process, ASA has developed five initial
quality “incentives” for anesthesiologists
and is shepherding them through the external approval
process, while discussing future implementation of
such incentives with payers.
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