Gasline Newsletter August 2007

Volume 9, No. 3

GAO Report on Medicare and Private Payments to Anesthesiologists

The U.S. General Accounting Office just released a report on Medicare and Private Payment Differences for Anesthesia. The report and executive summary can be found at Medicare Physician Payments: Medicare and Private Payment Differences for Anesthesia Services. GAO-07-463, July 27.

The report validates other reports of disparities between Medicare and private payments for anesthesia services, showing an average difference of 67 percent for the procedures examined. Ironically, CMS noted that “private payer rates are not a criterion under the law to determine whether Medicare physician payments are reasonable and stated that private payment differences for anesthesia services do not necessarily indicate a deficiency in Medicare payment rates.”

Of note is that the CMS response written by Kathleen King went out to the GAO before the RUC came out with their recommendation to begin to correct the underpayment for anesthesia services by raising anesthesia payment levels by one-third!

Proposed Medicare Increase for Anesthesia Services—RSVP

As probably the best news anesthesiologists have gotten about Medicare payments since 1992, CMS has issued proposed regulations that would increase the anesthesia conversion factor by almost $4 for 2008. As a zero sum game, increased payments will be financed by fractional reductions in payment for other medical services. The ASA is to be congratulated for its quiet work over the past several years to achieve fairer payments for anesthesia services. It is imperative that CMS be inundated with letters of support for this regulation because other specialties will oppose it. If you have not contacted CMS, you have until August 31 to submit your comments. Visit the ASA Web Site at for information and sample letters.

2007 CSA Hawaiian Seminar in Kauai

Don’t forget to sign up for the 2007 CSA Hawaiian Seminar in Kauai, October 29-November 2, 2007. This year’s featured speakers are Richard L. Applegate, II, M.D., Zeev N. Kain, M.D., MBA, MA (Hon), FAAP, Steven N. Konstadt, M.D., Joseph M. Neal, M.D., and Randolph H. Steadman, M.D. To register online, go to The topics for the meeting include:

CAD Risk Reduction for Non-Cardiac Surgery
Assessing Cardiovascular Function in the OR: Invasive, Non-Invasive, or None?
Transfusion Medicine Update: Options, Indications and Complications
Neurologic Complications of Regional Anesthesia and Pain Medicine
Virtual Crisis Management: Head to the Simulator!
Management of Perioperative Anxiety in Pediatric Patients
Mechanisms of MR: From Anatomy to Ischemia
Upper Extremity Regional Anesthesia: Essentials of our Current Understanding
… And more!

Who is Andy Harris?

Andy Harris is an anesthesiologist running for Congress! If elected, he’ll be the first anesthesiologist to serve in the House of Representatives. Dr. Harris has been an obstetric anesthesiologist and associate professor at The Johns Hopkins Hospital for 20 years. He has served in the Maryland State Senate since 1998.

He addressed the ASA leadership at the August ASA Board meeting and outlined his primary campaign battle against a nine-term incumbent who has reportedly alienated his conservative Republican constituency in a “safe” Republican congressional district in Maryland. The incumbent Congressman, Wayne Gilchrest, has also lost the endorsement of the Republican National Committee, the Maryland State GOP, and the White House—something very unusual for an incumbent Congressman. John Fund of The Wall Street Journal declared on June 27th that Mr. Gilchrest “often casts liberal votes that are out of step with his district.”

I asked Dr. Harris to discuss his positions on current issues that he felt were relevant to Californians. His answer was enlightening! Dr. Harris took me back to 8th grade civics class when he reminded me that his biggest current issue is showing that he’s in sync with the conservative Republican voters in his district because the whole election will be decided by the Republican primary. So the key issue is how effectively he can present himself to those Republican voters in his district and that, apparently, comes down to money.

Congressman Gilchrest has never been able to raise significant amounts of money in previous campaigns. From April to the end of June the Congressman raised $52,000 compared to the $176,000 that Dr. Harris raised. But Congressman Gilchrest has $351,000 “cash-on-hand” in his war chest, yet $750,000 is required to run an effective congressional campaign.

More information on Andy Harris is available on his website:

Virgil Airola, MD