ASA June 2007 Newsletter

A Call for Support

Ronald Szabat, J.D., LL.M.
Chief Operations Officer – External Affairs and General Counsel

he legislative and regulatory high-season is upon us. Congress continues an unprecedented number of committee hearings on health issues as it sets the stage for legislative action. And down the street at the agencies, the Centers for Medicare & Medicaid Services (CMS) is putting the final touches on its proposed physician payment rule for 2008.

Against this backdrop, ASA is continuing to work tirelessly across a range of issues important to anesthesiology and the wider physician community. Working in coalition with the American Medical Association and other large national medical specialty societies, ASA has lent its full support to carefully detailed legislative specifications for a bill that would advance positive Medicare updates over multiple years and work toward ending the ruinous sustainable growth rate (SGR) formula that punishes all Medicare physicians, especially hospital-based specialists such as anesthesiologists, who have no control over Medicare patient volume.

This emerging coalition bill would also require a stringent look at so-called pay-for-performance schemes and not allow this artifice to be extended as a substitute for needed annual positive Medicare updates. Further details will be available soon on this important measure, while at the same time, ASA works through the Relative Value Update Committee to push its case to CMS for a significant positive, upward adjustment in the Medicare anesthesia conversion factor. As anesthesiologists were reminded last year, it’s not just Congress and the SGR formula that can bring devastation to Medicare payment. The regulatory side of Medicare payment also allows harsh adjustments that need to be countered. As ASA progresses to try to reverse the 8.9-percent regulatory cut in our anesthesia conversion factor for 2007, each and every ASA member may be called to act with comment letters to CMS. Please be prepared to act upon receipt of an action alert on this important matter.

On an immediate basis, all ASA members should be contacting their U.S. Representative now to urge that he or she sign on to one of several ASA-supported bills. For example, in late April, House Ways and Means Committee member Representative Xavier Becerra (D-CA) introduced legislation, H.R. 2053, that would restore full payment to anesthesiology teaching programs. Please ask your Representative to co-sponsor this important legislation. The bill mirrors H.R. 5246/H.R. 5348, the Medicare anesthesiology teaching payment reform legislation from the 109th Congress that was nearly enacted in the final days of the last session. With such momentum, prospects for positive action are great this year if ASA members let their voices be heard loud and strong on the Hill.

As academic anesthesiology knows all too well, CMS slashes in half the payment to teaching anesthesiologists who work with two residents on cases that overlap — even for one minute. This misguided policy, in place since 1994, costs programs hundreds of thousands of dollars every year, hindering efforts to recruit and retain high-caliber teaching anesthesiologists and ultimately weakening programs. Support for H.R. 2053 would ensure that the anesthesiology workforce continues, as opposed to withering away as programs close nationally. In short, H.R. 2053 would reinstate full payment to ensure the viability of anesthesiology teaching programs throughout the country.

Among other important bills being advanced by ASA, anesthesiologists again this year have the opportunity to support legislation that could increase patients’ access to anesthesiology medical care in rural areas. Representatives Henry Cuellar (D-TX) and Todd Akin (R-MO) have reintroduced the “Medicare Access to Rural Anesthesiology Act,” which would extend “pass-through” payments to anesthesiologists. Under current Medicare law, some rural hospitals are permitted to use more generous Part A pass-through funds to employ or contract with anesthesiologist assistants or nurse anesthetists only. Surprisingly, Medicare does not allow hospitals to use the funds for anesthesiologists. H.R. 1866 would broaden this policy and allow rural hospitals to use pass-through funds to pay for the services of anesthesiologists as well.

Medicare normally pays for the services of anesthesia providers under the Part B Physician Fee Schedule. By allowing hospitals to use Part A pass-through payments for anesthesiologists, H.R. 1866 would provide additional resources for facilities to offer expert anesthesiology medical care to patients throughout rural America. As with the Medicare anesthesiology teaching rule reform bill, please ask your representative to help expand patient access to anesthesiology medical care by cosponsoring both bills. You may contact your member of Congress through the ASA CapWiz site or the Capitol Switchboard at (202) 225-3121.

With so much at stake and the promise of action high, please bring your voice to bear. ASA has worked hard and will continue working to set the stage and advance the script — but you, the member, must also act. Thank you in advance for heeding these calls to action.