ASA November 2007 Newsletter

Rockefeller Introduces Senate Teaching Rule Reform Bill, Congress Continues Work on Broader Medicare Package

Ronald Szabat, J.D., LL.M.
Executive Vice-President – External Affairs and General Counsel

t the behest of ASA, and with strong, coordinated encouragement by leaders in the West Virginia component society, Sen. John D. “Jay” Rockefeller IV (D-WV) has introduced S. 2056, the “Medicare Anesthesiology Teaching Funding Restoration Act of 2007.” Sen. Rockefeller serves as Chairman of the Health Subcommittee of the powerful Senate Finance Committee and has been at the forefront of valiant efforts to ensure reauthorization of the Children’s Health Insurance Program (CHIP).

The bipartisan bill, introduced jointly by Sen. Jon Kyl (R-AZ), third ranking member of the Senate Republicans, and a strong group of 13 other senators, many from the Senate Finance Committee, would restore full Medicare payment to academic anesthesiology programs, all of which have been uniquely short-changed 50 percent by the infamous Medicare anesthesiology teaching rule. The current teaching rule as it applies to teaching anesthesiologists is costing an average of more than $400,000 per program nationally and has led to the closure of 28 programs since its inception. All of this has occurred as student nurse anesthesia programs continue opening at a rapid pace.

In his Congressional Record remarks upon introduction, Sen. Rockefeller stated that “no other medical specialty or nonphysician providers were affected by this policy change. In fact, payments to nonanesthesiology teaching physicians continue to be paid using the conventional Medicare Physician Fee Schedule. All teaching physicians, except anesthesiologists, can collect the full Medicare fee for working with one resident and also collect an additional full Medicare fee for working with a second resident on an overlapping case as long as the teaching physician is present during the ‘critical and key’ portions of each procedure and is immediately available to return to a case when not physically present.”

Sen. Rockefeller also stressed that in his home state, where there is only one academic anesthesiology program, at West Virginia University in Morgantown, “this program is losing nearly $700,000 per year because of this unfair Medicare payment policy.” Sen. Rockefeller added that “when you take into account the fact that many private insurance companies follow Medicare’s lead on reimbursement, the final dollar impact is even greater.” Accordingly, “other departments within the medical school are being called upon to subsidize these losses instead of using their resources to advance important research initiatives or recruit highly qualified faculty,” Sen. Rockefeller observed.

In his rationale for a national legislative solution to the problem facing academic anesthesiology, Sen. Rockefeller summarized the threat to the Medicare program. “This is not just a West Virginia problem,” he warned. “This is a national problem with severe implications in every community. Academic anesthesiology programs treat the sickest of the sick, patients with multiple diagnoses, unusual conditions and/or in need of highly complex and sophisticated surgeries.” The Senate Finance Health Subcommittee Chairman further warned that “the arbitrary Medicare payment reductions for teaching anesthesiologists could mean that patients of all ages and in all communities could see increased anesthesiology shortages in operating rooms, pain clinics, the military, critical care units, labor and delivery rooms, and emergency rooms,” without action to reverse the Medicare anesthesiology teaching rule.

In equally strong remarks upon introduction, Sen. Kyl, after noting the severe health care shortages facing Arizona, stated emphatically that, “under this bill [S.2056], the clear winners are patients. Restoring funding helps preserve patient access to safe, quality health care and alleviate growing health professional shortages.”

Currently ASA has launched a major grassroots initiative to add Senate support for the measure. The bill mirrors H.R. 2053, the Medicare anesthesiology teaching payment reform legislation introduced in the House by Rep. Xavier Becerra (D-CA), who sits on the House Ways and Means Committee. The House bill currently has almost 100 cosponsors.

As was the case in 2006, the fate of the Medicare anesthesiology teaching rule reform bills likely will rise or fall this year with broader efforts to reverse Medicare sustainable growth rate (SGR) cuts in 2008 and beyond as part of an omnibus health package. ASA continues to work effectively with a broad range of medical specialty organizations and the American Medical Association to advance multiyear, positive updates for all of Medicare that are fully offset from a federal budgetary standpoint. Efforts to extend CHIP, which sunseted on October 1, 2007, and was recently extended on a stop-gap basis, are associated with these efforts.

With so much at stake affecting the health care of both children and seniors in 2007 and beyond, ASA has continued to call on Congress to fairly fund all such programs. In addition, our battle to reform the Medicare anesthesiology teaching rule continues as we seek to ensure a supply of anesthesiologists into the future.

For up-to-the-date information on how you can help take ASA’s message to Congress, please visit www.ASAhq.org/government.htm#alerts.