On May 10 and 11, the
leaders of the ASA and the AANA held their 4 th meeting
in Washington, DC. The May meeting was unique because
several additional members of each society were included
to help in the discussion of issues of common interest
related to the Medicare payment system. At this meeting,
a number of misunderstandings and misconceptions regarding
the Medicare payment rules arose. Through candid and
respectful discussion, each society’s position
on these critical issues was better understood and common
issues were identified.
We agreed to meet with CMS to
discuss possible approaches to resolve an issue commonly
described as “split
medical direction,” i.e., a case where part of
the care is administered by a medically directed certified
registered nurse anesthetist and the remainder of the
care is personally administered by an anesthesiologist.
Currently, there is no mechanism for CRNAs or the Anesthesiologists
to bill Medicare for this service. ASA and AANA representatives
will be meeting with CMS in June to discuss the possibility
of addressing this issue. Coming to a peaceful understanding
of this one issue alone has prevented what could have
been a costly skirmish between our two organizations;
these resources can be applied to more productive and
mutually beneficial efforts.
In the longer term, we initiated
a preliminary process to develop recommendations for
a new Medicare anesthesia payment system for consideration
by each organization. The goal would be to have an updated
payment system that would allow practice to drive payment
policy and reflect the reality of current anesthesia
practice. A subcommittee will be meeting in June to
start this process and its work will be reviewed at
the July joint leadership meeting. Any policy issues
or possible solutions will be brought to the policy
setting bodies of the ASA and AANA as required by the
respective organizations.
Work was continued on the substantive
issues for a draft procedural agreement between the ASA
and AANA that will be the basis for an ongoing mutually
respectful professional relationship. Both professional
organizations will be provided an opportunity to review
and approve this document.
The leadership team scheduled
two additional meetings. The July meeting will include
new leaders from both the ASA and AANA. In August, the
11-member AANA Board of Directors will meet with the
12-member ASA Administrative Council for an introduction
to the process that has been essential to the progress
that we have made so far. We have also started discussions
on how we can engage more of our members and staff
in this process in the future, including the involvement
of state leaders.
In closing on this monthly update, we would
like to thank the members of both organizations for
allowing us to begin this dialogue. Heaven knows we
could all find more than one reason to not be involved
in this process of effective communication. Without
your support we would not be together at the table.
There is hope in the foundation of trust that we are
building, even if it is one small brick at a time.
We have attempted to keep our respective members informed
of all the issues and details involved in this important
process, but we may have failed to answer questions
or address issues that are important to you. We invite
you to submit your questions to us so that we can keep
this process as open and transparent as possible. We
will try to respond to your questions as directly and
as often as possible. Please send your questions to
either the AANA or ASA headquarters by letter or email.
We look forward to an open discourse about those aspects
of this process that are most important to you.
Roger W. Litwiller, MD
ASA President
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Tom L. McKibban, CRNA, MS
AANA President |
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American Society of
Anesthesiologists
520 N. Northwest Highway
Park Ridge, IL 60068-2573
Ph: (847) 825-5586 Fax (847) 825-1692
www.asahq.org www.anesthesiasafety.info |
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American Association
of Nurse Anesthetists
222 South Prospect Avenue
Park Ridge, IL 60068-4001
Ph: (847) 692-7050 Fax: (847) 692-6968
www.aana.com www.anesthesiapatientsafety.com |