Gasline Newsletter June 2005

Volume 7, No 1.

ASA Legislative Meeting

A delegation of 15 CSA representatives participated in the annual ASA Legislative Conference in Washington, D.C., from May 1-4. Seeking a fix to the Medicare Sustainable Growth Rate (SGR) formula was emphasized in visits to congressional representatives. The SGR is used by the Centers for Medicare and Medicaid Services (CMS) to calculate annual changes in payments to physicians for Medicare services. Without a change, physician reimbursement would decrease around 5% each of the next six years beginning January 1, 2006. Two bills, HR 2356 and S 1081, have been introduced in the House of Representatives and Senate, respectively, to correct the formula. Please contact your Congressional Representative and Senators Boxer and Feinstein to urge them to cosponsor the respective bills. You can locate your Congressional Representative at: The full text of the bills is available at the following website:

The upcoming April-June 2005 Bulletin includes an article by Barbara Baldwin that provides more detail on problems with the SGR and needed changes.

Update on Recent Balance Billing Issues

Balanced billing of patients by non-contracted physicians continues to be a volatile issue in the legislature, with several bills introduced to greatly limit or prohibit balance billing by hospital-based physicians. The 2005 CSA House of Delegates (HOD) adopted a statement on billing practices to provide some balance to the many threats to receiving reasonable and fair compensation for the care that we provide our patients. A detailed article as to the rationale for developing this policy will appear in the next edition of the CSA Bulletin. The statement reads:

RESOLVED, that bills to patients should not exceed usual, customary or reasonable fees, as defined by the California Court of Appeal in Gould v W.C.A.B. (1992) 4 Cal. App. 4th 1059, taking into account the physician's usual fees and other factors, which particularly include the fees usually charged in the geographic area in which the services were rendered; and

RESOLVED, that fees negotiated by anesthesiologists with health plans cannot be the sole measure by which fees paid by noncontracted plans are determined. Other measures that can be used to determine reasonable fees include the extent that the noncontracted plan provides similar ease of billing, certainty of collection, a comparable volume of referrals, ease of appeal, and meets other reasonable criteria for comparison; and

RESOLVED, that anesthesiologists, when billing noncontracted health plan patients directly, whether initially or for balances unpaid by the health plan, should provide an explanation to patients why this process is required, and assist patients in securing payment to the physician by their responsible health plan, seeking patient responsibility only as a last resort when health plans refuse or fail to make timely payment of reasonable fees for services rendered.

Two bills were introduced in the legislature this year and language may be amended into other bills this year. AB 1321 (Yee) Health Care Coverage, the more onerous bill, is currently in the Assembly Appropriations suspense file, making it a two-year bill. SB 417 (Ortiz) Payment of Provider Claims would require the Department of Managed Health Care to review complaints by providers concerning the payment practices of a health plan, to determine if the practice constitutes an unfair payment practice. This bill passed the Senate on June 1 and has been sent to the Assembly Health Committee. The CSA is working with the CMA to develop language acceptable to both physicians and the legislature.

Task Forces on the Annual Meeting and the House of Delegates

Two new task forces were approved at the House of Delegates, and our President is currently looking for volunteers to participate. The Task Force on the Annual Meeting will evaluate the educational portion of the Annual Meeting. This task force will examine all aspects of the meeting, including number of days and CME credits offered, workshops, overlap with the House of Delegates and other factors, and make recommendations for possible changes by the 2006 HOD.

The Task Force on the House of Delegates will evaluate its current governance process (the HOD itself) and will review the reference committee and HOD structure, the materials provided to delegates and alternates, and make recommendations for possible changes by the next HOD. Contact Dr. Canada via e-mail at or via telephone at 858-565-9666 or via facsimile at 858-777-3657.

Medi-Cal Labor Epidural Billing

An ongoing issue still not resolved is Medi-Cal labor epidural billing. Acceptable methods of billing for professional charges according to the ASA Relative Value Guide (RVG) are:

Basic units plus patient contact time (insertion, management of adverse events, delivery, removal) plus one unit hourly.
Basic units plus time units (insertion through delivery), subject to a reasonable cap.
Single fee.
Incremental fees (e.g., 0-2 hrs, 2-6 hrs, >6hrs).
The CSA Board discussed the concerns raised by some members regarding compliance with documenting patient contact time. An alternative is billing a single fee for labor epidural analgesia vs. having to worry about the proper documentation of patient contact time. In 2000, the HOD adopted policy which states "that the California Society of Anesthesiologists pursue negotiations with the DHS to establish acceptable reimbursement using a global or flat fee methodology for obstetrical anesthesia services for Medi-Cal patients." In 2004, the House adopted a related policy, that "the CSA actively pursue with Medi-Cal, alternatives to the current requirements for documentation for labor epidurals, such as recognizing anesthesia records as adequate documentation for billing one unit per hour, or establishing a global fee for reimbursement."

What are your thoughts on this issue? Please let your District Director, any CSA Officer, or the central office know your thoughts on this important issue.

ASA Centennial Celebration

This year the ASA celebrates its 100th year and will include events to raise money for its foundations. A gala celebration that includes a dinner and separate dessert reception will take place Monday, October 24, with the proceeds donated to FAER, the Anesthesia Patient Safety Foundation, the Wood Library-Museum of Anesthesiology and the Anesthesia Foundation. See the ASA web site at (link no longer active) for more information. The CSA will have at least two tables and anyone who wants to sit with the CSA group should indicate so on the form.