Gasline Newsletter December 2009

Volume 11, No. 8

CSA President’s Page

This quarter’s Bulletin article by Dr. Hertzberg examines the strategic issues facing the CSA and some thoughts about the future as the CSA moves forward. The article is posted on the CSA Web Site prior to print publication.

Opt-Out Information and Update

Recently a letter was sent to the entire membership containing information regarding legal activity and the state legislative counsel opinion regarding physician supervision of CRNAs. The letter and opinion are posted in the “members only” section of the Web site and may be viewed here. In addition, our legal team is in the process of drafting the documents to be filed in the upcoming legal challenge to the Governor’s opt-out.

Medicare Interpretive Guidelines

CMS recently released revised interpretive guidelines concerning the provision of anesthesia services in a hospital, which are effective immediately. The revisions have substantive changes that will impact anesthesia practices in hospitals. The most striking “clarification” is that labor epidurals are specifically defined as analgesia and CRNAs may administer them without physician supervision, even in states that have not opted out of the Medicare supervision requirement. Other additions clarify when the pre anesthesia and post anesthesia times begin for purposes of providing the pre and post anesthesia evaluations within 48 hours of the procedure. The revised guidelines can be viewed at

A detailed analysis by the ASA of the effects on anesthesiologists will be posted on the CSA Web Site when it is available.

Medicare Physician Payment Cuts Delayed to March 1

On December 21, Congress approved a measure that would maintain Medicare physician payments at their 2009 levels, delaying the 21.2 % decrease scheduled for January 1. The delay was approved as part of a $636 billion defense appropriations bill, and would postpone the effective date of the physician payment cut until March 2010. In the meantime, longer-term or permanent fixes for the flawed SGR formula are being sought. The president is expected to sign the bill in the next few days.

National Health Care Reform Update

The ASA has posted the series of resolutions on health care reform that was recently considered by its Executive Committee and Board of Directors on its Web site. These are intended to guide the ASA and its leadership in formulating policy regarding developments with health care reform legislation going forward. To view the resolutions, click on the following link:

Senate Moves Toward Passage of Health Reform Legislation – ASA Urges “No” Vote

The U.S. Senate is moving forward with a series of procedural votes on H.R. 3590, the “Patient Protection and Affordable Care Act,” the chamber’s version of health reform legislation. It is expected that the final vote on passage will take place on Thursday, Dec. 24. At this point, it appears that Senate Majority Leader Harry Reid has sufficient support to pass the bill. Because the legislation includes a number of provisions that would harm anesthesiologists and the patients who receive their care, ASA urges a “no” vote on final passage of the Senate health reform bill. ASA President Alex Hannenberg, M.D., previously reached out to Sen. Reid to outline ASA’s concerns with the legislation. Regrettably, many of the harmful provisions remain. Therefore, Dr. Hannenberg on Tuesday sent another letter to Sen. Reid reiterating ASA’s opposition to the legislation. Dr. Hannenberg’s 12-22-09 letter to Sen. Reid.

CSA Survey on “Smartphones”

Your Public and Professional Communications Committee is reviewing recommendations from an outside consultant on potential changes to our Web site. In order to properly design these changes, CSA needs information from you on your use of “Smartphones” like the iPhone and Blackberry, and how you would ideally like to access the CSA Web Site from your Smartphone. CSA has set up a quick survey about this issue. Please complete this survey by January 3, 2010, so the information can be presented to the CSA Board of Directors at their meeting on January 9. Here is the link:

CSA Winter Hawaiian Seminar

Beat the winter blahs! Attend the CSA’s Winter Hawaiian Seminar, January 19-23, 2010, at the beautiful Hyatt Maui Resort & Spa. Visit the CSA Web Site to learn more.

Intraoperative Blood Pressure Management: Is the Standard of Care, Ideal Care?
Anesthetic Considerations for Spine Surgery
Perioperative Management of the Patient with Coronary Artery Disease
Analgesia for Routine Labor: What’s Old, What’s New, What Works
Concepts in Regional Anesthesia—Ultrasound and Nerve Stimulation
Our Evolving Practice: Oxygen, Vasopressors, Pre-Eclampsia and More
Book your sleeping room as soon as possible on the Hyatt’s online CSA registration site at The Hyatt Maui has extended the cut off for CSA’s Golf/Mountain and Deluxe Ocean View rates to December 30, 2009.

CSA Committee Appointments

Active and resident members who are interested in becoming more involved in the CSA and would like to start by serving on a committee need to contact Narendra Trivedi, M.D., President-Elect, at or the CSA office at 800-345-3691 or by February 1, 2010, indicating interest in the following divisions and committees. For more information about the committees and the two divisions, call the CSA office.

Educational Programs Division
Legislative and Practice Affairs Division

Standing Committees:
Committee on Bylaws
Committee on Finance and Administration
Committee on Peer Review
Committee on Public and Professional Communications

Special Committees:
Committee on Physicians Health and Well Being

District 7 Half-Day Symposium

Dr. Uday Jain, Director of District 7, is inviting all CSA members to a half-day symposium on Saturday, January 23, 2010, from 8 a.m. to noon. Breakfast will be served at 7 a.m., and the lectures will begin at 8 a.m. The symposium will be held at the Waterfront Hotel at Jack London Square, 10 Washington Street, Oakland. For more information, see the invitation appended to this Gasline.

CSA Annual Meeting and Clinical Anesthesia Update

Don’t miss the CSA’s 2010 Annual Meeting May 14-16 in Costa Mesa/Newport Beach. The program is being finalized now, and it is shaping up to be an exciting line up. Program Chair Zeev Kain, M.D., will kick off the program on Friday, introducing a series of lectures on The New World of Medicine as Related to Anesthesiology, a peek into the year 2030, predicting clinical, political and business changes we can expect. Communications expert, Cheri Kerr, will lead a highly interactive communications session, with an eye toward improving communication in the OR. Other topics to be covered include How to Choose and Implement an AIMS in 6 Months or Less, pain management, and crisis resource management. For the second year in a row, the Annual Meeting will feature an optional hands-on Ultrasound for Regional Anesthesia Workshop. Brochures will be mailed in early 2010, but the best place to find up-to-the-minute information is at

Scheduled CSA Web Site Maintenance

The CSA Web Site will not be available on Monday, December 28, from the hours of 5 a.m. to 7 a.m. due to scheduled maintenance. If you need to access the site early that morning, be sure to do it before or after the maintenance period. CSA apologizes for any inconvenience. If you have any specific questions, please contact the CSA office.

Best Wishes for the Holidays and 2010

As we move through the Holidays and New Year, I would like to extend to all CSA members and readers of Gasline my thanks for their interest in and support of the CSA. Best wishes to all for a safe, happy and healthy holiday season.

Linda B. Hertzberg, M.D.

The CSA Gasline, a monthly newsletter, is sent as a member service to CSA members who have e-mail addresses.
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California Society of Anesthesiologists
Uday Jain, MD, PhD, Director
Cordially Invites all Anesthesia Providers to
Perioperative Pain Management
Two lectures by Girish Joshi, MD
University of Texas Southwestern Medical School, Dallas
Ultrasound Guided Regional Anesthesia
Two lectures by Gligor Gucev, MD
University of Southern California, Los Angeles
Saturday, 01/23/2010, 8 AM-12 Noon
Full hot breakfast from 7 AM, Refreshment break 10:00-10:30 AM
Waterfront Hotel at Jack London Square 
10 Washington Street, Oakland, CA 94607; 510-836-3800 
Parking off-street or adjacent public garages
Supported by Baxter Healthcare, Garrett Lee 
No registration fee or CME credits. Space is limited. 
Please reserve ASAP: 650-346-8926 or