Gasline Newsletter July 2007

Volume 9, No. 2

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. Register online. 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!
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 for information and sample letters.

Blue Cross Fee Schedule Changes—Check Your Rates!

Blue Cross has published a new Prudent Buyer fee schedule that will take effect August 30. Many anesthesia groups report no changes in their rates, while others anticipate reductions. Be sure to check the rates for your geographic area so you can decide whether to continue or terminate your contract with Blue Cross. The fee schedule can be found here.

Medicare Reviewers Needed

Medicare is seeking anesthesiologists to serve as impartial experts for the Office of Medicare Hearing and Appeals on an as-needed basis. The services involve providing both expert review and expert witness testimony in pending Medicare appeals on claims determination appeals for Parts A, B, C and D of Medicare.

As an expert for the Office of Medicare Hearings and Appeals, you will be provided with relevant information pertaining to a denied claim and asked to review the records and provide written responses to questions posed by an Administrative Law Judge. You will be well compensated on an hourly basis that is agreed upon prior to accepting a case and the compensation is commensurate with your specialty, expertise and experience. Signing up does not require you to ever accept a case. Signing up will let us know that you "may" be available to help when a relevant case exists, if you have the time.

The questionnaire will take one minute to complete and a CV is needed. The process is simple to begin. Please contact Mark Makary to receive a questionnaire (Mark Makary, STG International Inc., 866-500-6642, #267, Completed questionnaires and CVs may be e-mailed.

Please consider this opportunity to give back to the local community and help us ensure our Medicare system is working.

Health Reform Outlook

Time is growing short for health reform legislation. When the Legislature reconvenes on August 20th, less that four weeks will remain for the 2007 session. A vast number of details need to be worked out if there is to be a significant expansion of healthcare coverage. The only specific bill on the table is AB 8 (Nunez-Perata). It combines two separate bills authored by the leaders of the two houses, which passed their houses of origin without a single Republican vote.

As currently written, AB 8 proposes a "play or pay" approach to health insurance. Employers would be obligated to pay 7.5 percent of Social Security wages for healthcare expenditures or pay an equivalent amount into a state purchasing pool. It would cover an estimated 3.4 million Californians or about two-thirds of the uninsured. The 7.5 percent employer obligation has been termed a "fee" because a tax increase would require approval by two-thirds votes in both houses of the Legislature. The bill may be altered further before final passage out of the legislature in an attempt to address concerns the Governor may raise and the ERISA concerns raised by the Assembly Republicans.

If somehow all the pieces fall into place and AB 8, or some other vehicle, is approved and signed into law while being financed largely by "fees," it could face several challenges.

The courts could invalidate the plan if the "fees" are determined to be taxes that require a two-thirds legislative vote.
The business community could force a referendum to repeal the legislation at the ballot box next year. This happened to a "play or pay" measure, SB 2 (Burton), passed in 2002.
The plan could be invalidated by a claim virtually certain to be brought by business interests that ERISA has pre-empted this type of statewide healthcare coverage. The federal Employment Retirement Income Security Act has blocked such plans in other states, most recently Maryland. The comprehensive health coverage plan enacted in Hawaii some years ago was granted an exemption from ERISA by the U.S. Congress.
Governor Schwarzenegger insists that he loves to take on big challenges. This one is big, perhaps even bigger than he can master. Future developments promise to be fascinating if not fantastic!

Medical Board to Terminate Diversion Program

The Medical Board of California voted Thursday, July 26, to abolish its drug and alcohol diversion program for doctors, which several audits have faulted for being poorly administered and imperiling patients. By this time next year, physicians could face immediate suspension of their medical licenses if they are determined to have a substance abuse problem. And the onus will likely be on them to complete a treatment program and prove they won't jeopardize patient care if they want to get their licenses back. The Medical Board stated it will hold a summit to discuss options. The California Medical Association, a longtime supporter of the program, will gather stakeholders to develop a strategy.

One option is to engage a private vendor, Maximus, to take over the program. If anyone has information about Maximus, please contact Barbara Baldwin.

Virgil Airola, MD