Gasline Newsletter July 2009

Volume 11, No. 3

National Health Care Reform

A number of you have asked what the CSA and ASA are doing about what is happening in Washington, D.C., and more specifically about H.R. 3200, the bill on health care reform currently being heard in committee in the House of Representatives.

As many of you are aware, the AMA has endorsed this bill. On behalf of the ASA, President Roger Moore has opposed this move by the AMA, as have a number of other specialty societies. The ASA is not currently working with any specialty society consortium that may be forming, since the issues specific to anesthesiologists may otherwise not be pushed as aggressively as we might like. This could change in the future. In the meantime, the ASA is urgently requesting that we contact our Congressional Representatives and let them know what we think. The link to the ASA with talking points and instructions for doing this is:

Click on the “CALL NOW” zip code link. Once you have made your calls, please fill out the form on that page so the ASA knows you have made contact.

On the CSA level, we are mobilizing members in key congressional districts to make contact with the so-called “Blue Dog Democrats.” If any of you have a relationship with these individuals, please contact them as well. They are:

Joe Baca (D – 43rd) 202-225-6161 Health LA: Brenda D. Villanueva
Dennis Cardoza (D – 18th) 202-225-6131 Health LA: Nora Todd
Jim Costa (D – 20th) 202-225-3341 Health LA: Jacqlyn Schneider
Jane Harman (D – 36th) 202-225-8220 Health LA: Linda Shim
Loretta Sanchez (D – 47th) 202-225-2965 Health LA: Jessica Fernandez
Adam Schiff (D – 29th) 202-225-4176 Health LA: Aaron Baird
Mike Thompson (D – 1st) 202-225-3311 Health LA: Travis Robey
In addition as President of the CSA, I have sent a letter to each and every congressional representative from California. A copy of the letter is pasted at the end of this Gasline and appears on the CSA Web Site at the end of the Gasline. You should use the information on the ASA Web Site and in this letter as your talking points when you call or e-mail your representatives.

In addition I urge you to make contributions to the ASAPAC or GASPAC, the political action arms of the ASA and CSA respectively.

Please contact me if you have any questions or comments.

Chiro MUA Regulation Withdrawn

The proposed Manipulation Under Anesthesia (MUA) regulation was withdrawn from the Office of Administrative Law (OAL) on July 13, 2009. The next regular meeting of the Board of Chiropractic Examiners (BCE) is scheduled for July 30, and a discussion of the MUA proposed regulation is on the agenda. At the moment, neither the OAL nor the BCE is disclosing the reasons for the withdrawal. Perhaps the discussion at the BCE meeting of July 30 will explain.

Under the applicable statute, the proposed regulation must be approved within one year of its date of original notice which in this case was January 9, 2009. If the reason OAL would not approve relates to MUA seen as beyond the chiropractic lawful scope of practice, then it is unlikely to be remedied by January 9, 2010. If the reason is something else, that's a different issue.

Developments will be reported as warranted.

CSA Fall Hawaiian Seminar

Don't miss the CSA's Fall Hawaiian Seminar, October 26-30, 2009, on the Garden Isle of Kauai. CSA is offering a world-class scientific program in one of the most gorgeous locations on earth. Bring the family and earn CME in the morning, and play in paradise in the afternoon. Topics will include:

What We Can Learn From Closed Claims in Obstetric Anesthesia
Echocardiography for the Non-Cardiac Anesthesiologist
Sugammadex: Do We Need It: Will We Get It?
Depth of Anesthesia and Awareness
Prevention and Management of Pediatric Cardiac Arrest
New Options to Optimize Labor and Cesarean Delivery Analgesia
How to Avoid a Lawsuit
Book your sleeping room as soon as possible on the Hyatt’s online CSA registration site at The Mountain View rooms are going fast!

CSA Sends Second Dues Statement

Dues reminders were mailed last week. While summer can be a busy time, please consider that CSA works on your behalf throughout the year. This is especially true as changes in health care have a direct impact on patient safety and your livelihood. We hope your support will continue as the CSA carries on its work to help California anesthesiologists with legal and legislative advocacy, practice management aids and information, and continuing medical education. As you consider your dues for the fiscal year, remember the profession depends on your support!

If you have any questions simply call the CSA office or simply renew online ( Many group practices have set up a “Group Billing Account” for their members. In this way, one check is written for everyone, saving time, administrative hassle and mailing expense. If your practice does not already have a Group Billing account, ask your Group Administrator to contact Tom-Philip Baclagan at 650-345-3020 for more information.

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. If you wish to be removed from the mailing list, please send an e-mail to with the message “unsubscribe.”
CSA Gasline archives are available online at under Publications.


CSA Congressional Letter
Dear Congressman _________________

I am writing this letter requesting that you vote against H.R. 3200, “America's Affordable Health Choices Act,” as currently written, and more particularly the provision that creates a new government-sponsored insurance option tied to Medicare payment rates. As you may well be aware, Medicare pays anesthesiologists only 33% of the average amounts paid by commercial insurance carriers. This contrasts sharply from the 78% of commercial rates Medicare pays the rest of medicine. Such low reimbursements are not sustainable as they do not reflect the true cost of providing care. If a bill such as this becomes law, it will create a critical shortage of anesthesia providers, which will restrict access to safe anesthesia, care for surgery, pain management, and other anesthesia services.

Anesthesiologists, as well as other hospital based physicians, are almost always required by the hospital where they work to treat all patients who present for care regardless of the type of insurance. This differs markedly from other physicians who decide which insurances to accept and may opt out of the Medicare program entirely or simply refuse to admit new Medicare patients to their practice. This requirement to “treat all patients” has been exploited by Medicare to reduce payment to hospital based physicians below the level that would otherwise be required to retain sufficient providers to treat Medicare patients. The insufficient Medicare funding has not created a critical shortage of anesthesiologists due to the fact that commercial payers make up the reimbursement shortfall. Extending Medicare rates to the public plan will eliminate this additional funding, and drive qualified anesthesiologists out of the profession. In addition it may severely reduce the number of new graduates who choose anesthesiology as a profession.

The insufficient reimbursement by Medicare is not a new issue. In 1992, a separate conversion factor for anesthesia services was implemented and anesthesia payments were decreased 29%. Although Medicare has reviewed rates several times since 1992, this historical underpayment for anesthesia services has continued. In a 2002 survey of health plans sponsored by the Medicare Payment Advisory Commission, researchers estimated that Medicare payments for anesthesia services were about 61% lower than private insurance payments. In July 2007, the Government Accountability Office (GAO) issued a report that found Medicare payments to anesthesiologists had declined to a level 67% lower than average private insurance payments (GAO-07-463). In its July 27, 2007 letter to Pete Stark, the GAO stated: “… [T]he difference between Medicare and private payments for anesthesia services is larger than the difference in payments for other physician services, raising the concern that Medicare payment levels could affect where anesthesia practitioners locate and more generally whether interest in anesthesiology as a profession is also affected. [Emphasis added.]”

The California Society of Anesthesiologists (CSA) and the American Society of Anesthesiologists (ASA) firmly believe that payments for anesthesia services under the public plan option must be unlinked from Medicare payment rates. We request that anesthesia rates under the “public health insurance plan” be fair and commensurate with those rates of other physicians relative to commercial rates, detailed above. Accordingly, given Medicare's historical underpayment for anesthesia services, I respectfully request that you work to amend or vote against H.R. 3200 and any other bill that ties payment for anesthesia services to Medicare rates.

The future of the medical specialty of anesthesiology depends on the outcome of this important issue.

Thank you for your efforts and attention.

Respectfully Yours,

Linda B. Hertzberg, M.D.
President, California Society of Anesthesiologists