Gasline Newsletter January 2003

Volume 4, No. 3


Don't be misled by statements made by the California Board of Registered Nursing (BRN) and published in the CHA (California Healthcare Association) News. CRNAs in California must be supervised by a physician. While some CRNAs dispute opinions by California's Attorney General, saying that California law requires supervision, it is undeniable that the Medicare Conditions of Participation, which cover all facilities that receive Medicare and Medicaid dollars, mandate supervision, unless the Governor has "opted out" after consulting with the State nursing and medical boards, and provided this opt out is consistent with State law. In California, nurses (including CRNAs) may administer medications only if "ordered by and within the scope of practice of a physician, dentist, podiatrist, or clinical psychologist..." Contact Barbara Baldwin, or 1-800-345-3691, if you have questions or if it is an issue in your practice.


Medicare has cut physician and other Part B provider payments (non-anesthesia) by 4.4%—not as bad as the 5.1% originally anticipated, but still a significant blow. The cut is 3.3% for the anesthesia conversion factor. The following are the anesthesia conversion factors for 2003 (effective March 1, 2003) for participating providers. Do not use them for services provided before March, or you will be paid at the lower rate.

  26 Anaheim/Santa Ana, CA 16.86
  18 Los Angeles, CA 17.00
  03 Marin/Napa/Solano, CA 16.41
  07 Oakland/Berkeley, CA 16.71
  05 San Francisco, CA 17.54
  06 San Mateo, CA 17.23
  09 Santa Clara, CA 17.25
  17 Ventura, CA 16.41
  99 Rest of California 15.91

Submit your January and February Medicare claims ASAP or you will be paid even less than you are due. Any claim, processed after February 28, 2003, will be paid at the lower 2003 rate.


On January 7, House Ways and Means Chairman Bill Thomas (R-CA) introduced legislation, House Joint Resolution 3, by which CMS' Medicare Fee Schedule Update rule would be disapproved and become of no effect. Passage of this resolution would mean that 2002 Medicare reimbursement rates would remain in effect until 2004 (unless changed by further legislation during 2003), thus voiding the 3.43 per cent cut for anesthesiologists scheduled to take effect March 1. In the interim, CSA/ASA members are encouraged to continue sending messages to Congress. (The link is no longer available as of 10/04/05)


With the delay in publishing the Medicare fee schedule, providers have until February 28 to decide whether to participate or not participate in Medicare. This date is different from that in the printed material sent by Medicare. For more info on participation vs. nonparticipation, go to


Last month Governor Davis proposed an across-the-board 10 percent Medi-Cal provider reimbursement rate reduction as one step to deal with an estimated $21 billion "budget shortfall." Since then, the estimated shortfall has mushroomed to $34.6 billion. The 2003-04 State Budget proposed January 10 seeks an additional 5 percent rate cut for a total of 15%.

The California Medical Association (CMA) is putting together a coalition of Medi-Cal providers large and small. The search is on for a revenue source as an alternative to Medi-Cal cuts that will further imperil patient access.


By now every voting member of the CSA should have received a notice of open director and delegate/alternate delegate positions and a list of members eligible to serve from that district. Nominations are due in the Central Office by FEBRUARY 3. Contact Linda Herren if you haven't received materials.

Nominations for the 2004 Distinguished Service Award (DSA) must be submitted to your district director at least 90 days before the CSA House of Delegates. The due date for DSA nominations is MARCH 3. If no nominations are received, the DSA Committee can make a nomination, which will be voted on at the 2003 House of Delegates on June 7 at the Disneyland® Hotel.

The CSA/CMA Legislative Day is Wednesday, APRIL 30, in Sacramento. It will begin with a march on the Capital to rally support for saving the emergency care system. The morning session will feature speakers and an update on the CMA's legislative priorities for 2003. Following lunch, the afternoon is free so attendees can meet with their elected representatives. Appointments should be made in advance. CSA members are urged to attend, and those representing the CSA (not a county medical society) will have their 14-day advance airfare or mileage costs reimbursed.


President-elect Doug Roberts, MD, is preparing committee appointments for 2003-2004. These include appointments to the Educational Programs Division, the Legislative and Practice Affairs Division and Committees on Disaster Preparedness, JCAHO Surveys, Pain, Communications, and Finance and Administration. A complete committee roster may be found at Contact Dr. Roberts at if you are interested in serving on a committee.


See the CSA web site for details and online registration.

March 8-9, 2003 
CSA Pain Management Workshop (Using Cadavers), Sheraton Gateway Hotel, San Francisco International Airport.

June 5- 8, 2003 
CSA/UCSD Annual Meeting and Anesthesiology Review Course. Disneyland® Hotel, Anaheim, California. Includes TEE, Difficult Airway, and Practice Management Workshops. The House of Delegates will meet on Saturday, June 7; any member can submit a resolution proposing that the CSA engage in some activity or adopt a policy. Contact Barbara Baldwin at if you wish to submit a resolution.

October 20-24, 2003 
CSA Hawaiian Seminar, Hyatt Regency Hotel, Poipu, Kauai.

Patricia A. Dailey, M.D.