Gasline Newsletter July 2008

Volume 10, No. 2

Medicare Improvements for Patients and Providers Act of 2008

As most CSA members are aware, on July 15 the United States Congress voted to override President Bush's veto and enact the Medicare Improvements for Patients and Providers Act of 2008, retroactively reversing the 10.6% SGR-mandated across-the-board reduction in payments for physician services that went into effect on July 1. While it would be disingenuous to characterize the prevention of a 10.6% reduction in an already unacceptably low payment as a victory for anesthesiologists, there are aspects of this legislative battle in which we should take some heart, and some pride.

The legislation contains one outright victory for organized anesthesiology on behalf of our academic brethren: correction of the onerous “anesthesia teaching rule.” Promulgated by CMS in 1996, the rule mandated a 50% reduction in payments from CMS to teaching anesthesiologists supervising residents in two operating rooms if the cases overlapped by even a single minute. This rule applied only to anesthesiologists and did not affect other physicians supervising more than a single trainee.

After years of behind-the-scenes work and hundreds of hours of lobbying by CSA members, in late June language providing the long-sought relief was successfully included in the Medicare bill, ultimately becoming law when Congress overrode the President's veto. Every academic anesthesiologist in California owes a debt of gratitude to the CSA and ASA for their efforts on his or her behalf. Every academic anesthesiologist in the state who is not a member of the CSA and ASA should go online today and submit an application for membership in these organizations.

Congratulations to Rebecca Patchin, M.D.

The California Society of Anesthesiologists congratulates Rebecca Patchin, M.D., on her recent election as Chair-Elect of the Board of Trustees of the American Medical Association. The CSA is honored to have one of our own as a leader of the world's largest, and most influential, professional medical association.

During her years in organized medicine, Dr. Patchin has been an inspiration to her fellow physicians in the CSA. Her service on the CSA Board of Directors, her role as Vice-Chair of the Legislative and Practice Affairs Division, and in particular her tireless efforts as Chair of the California Medical Association's Council on Legislation have all set a high standard for physician involvement in the political process. In addition, her articulate arguments on the importance and value of AMA membership in addition to specialty society membership have influenced many of us to join the American Medical Association. We look forward to her continuing involvement with CSA.

PAC Contributions

An important corollary of the teaching rule victory is the importance of PAC contributions, and frankly, we in California are performing poorly in this regard. The inclusion of the teaching rule relief in the larger Medicare bill would simply not have occurred if not for work of the ASA government relations office and the close relationships between certain anesthesiologists and their legislators. If you've ever wondered how anesthesiologists become well enough acquainted with their legislators to have this sort of influence, the answer is: money.

The ASAPAC is the nation's largest medical specialty PAC, and it supports candidates from either party who, in turn, support anesthesiology. The ASAPAC, and our state society's GASPAC for candidates for state offices, deserve our support. Every CSA member can easily afford to contribute $100 to each of these organizations. Speaking from personal experience, I know the exercise of opening one's wallet can be quite painful the first time around. However, as with all exercise, it becomes less painful with each repetition.

Compared to other states, California's contributions to the ASAPAC are embarrassingly meager. Despite our numbers, we are regularly trounced by such states as Alabama, not just in the percentage of members participating, but even in total dollars contributed! One of my goals for the upcoming year is to increase contributions to the ASAPAC, so let's start thinking about stepping up to the plate. Every person reading this can afford a $100 contribution. Go online today to the Members Only section at and click on the ASAPAC button. The teaching rule victory would not have occurred without the ASA, or the ASAPAC. Please join today.

CSA Dues

Without unity we cannot protect the public from those who endeavor to limit patient access to an anesthesiologist's care or compromise patient safety with cost-cutting measures designed by those who stand to profit most. If you have not renewed your membership, please do so today and stand with all California anesthesiologists to promote patient safety and support CSA legislative efforts to protect your professional interests both in Sacramento and Washington, D.C.

Go to the CSA Web Site at to see what CSA provides by way of professional updates, practice information and legislative support. To renew your membership online, use this link: If you have a colleagues who you think should be a member of CSA, please forward this e-mail and encourage them to become a member and support the profession.

2008 CSA Fall Hawaiian Seminar

Don't forget to sign up for the 2008 CSA Hawaiian Seminar at the Mauna Lani Resort, October 27-31, 2008. This year's featured speakers are Manuel Pardo, Jr., M.D., William Camann, M.D., Michael A. Gropper, M.D., Ph.D., Steven Hall, M.D., and Francis V. Salinas, M.D. The topics for the meeting include:

Transfusion Issues
Mechanical Ventilation
Obstetric Anesthesia
Regional Anesthesia
Pediatric Anesthesia
Trends in Anesthesia Training & Certification
       … and much more!

CSA's First Podcast

CSA's first podcast is now on the CSA Web Site! This podcast is the 2008 Leffingwell Lecture given at the CSA Annual Meeting in May by Jack Lewin, M.D., CEO of the American College of Cardiology and former Executive Vice President of the California Medical Association. At the beginning of the podcast, my predecessor as CSA President, Virgil Airola, M.D., gives some interesting background on Forrest E. Leffingwell, M.D., and then introduces Dr. Lewin. The title of his lecture is “Fixing Healthcare from the Inside Out.”

There are three ways to locate a podcast on the CSA Web Site. First, a new item under Hot Topics on the home page will alert you to the presence of the new podcast. Second, the Podcast page will be located under the Publications button on the left side navigation. Finally, a link in the Welcome to CSA portion of the home page will direct you to the podcasts. Watch for more podcasts as the year progresses!

Michael W. Champeau, MD