Gasline Newsletter June 2007

Volume 9, No. 1

CSA Annual Meeting and Clinical Anesthesia Update

The CSA Annual Meeting and Clinical Anesthesia Update, held May 31-June 3, was a success with an outstanding educational program and over 275 attendees. The CSA House of Delegates took action on several important issues, including approval of Guidelines for Deep Sedation by Non-Anesthesiologists; a resolution that expresses the CSA's philosophical opposition to Pay for Performance as a means to improve quality and patient safety for anesthesia services and calling on the CSA to work to minimize the negative effects of P4P, and work with other entities to develop alternatives to P4P that support medical professionalism. In another resolution, the CSA Committee on Physician Health and Well Being is charged to research and develop strategies of benefit to individual anesthesiologists for the recognition and management of personal emotional distress that can impair attention to, and safe care of, patients.

Dues are Due

It's time to renew your CSA membership for 2007-2008. Dues assessments were mailed June 18. Members can easily renew via the CSA Web Site. The CSA asks members to provide home addresses, as well as professional corporation names, so members' state and federal legislative districts can be identified. The CSA does not sell or lend member contact information to outside entities and your information is held in the strictest confidence.

2007 CSA Hawaiian Seminar in Kauai

Don't forget to sign up for the 2007 CSA Hawaiian Seminar in Kauai! This is a very popular meeting and will have excellent speakers and lectures this year. Register online.

CSA Web Site Evolves

By the end of this summer, the CSA Web Site will have a more contemporary look and user-friendly feel. You will find navigation easier with the enhanced search function. Check the site regularly as information and new material are added continuously. We are striving to make the CSA Web Site the "Go-to" place for members to get free CME, information on federal and state laws, regulations and policies affecting anesthesiologists, membership information—and more!

District Director Nominations Underway

Nomination materials were sent June 25 to voting CSA members in Districts 1 (San Diego and Imperial counties), 9 (Marin County and northern counties), and 10 (San Luis Obispo, Santa Barbara and Ventura counties) to elect new district directors. Nominations may be submitted by mail or fax until July 25 at 5 p.m. A list of eligible members and a Nomination Form can be obtained through the CSA Web Site. The duties of the District Director can be found in the CSA Bylaws in Section 8.031. Members interested in getting involved in CSA governance who are able to commit to three years of service are encouraged to submit a nomination form. A member can self-nominate and must obtain a seconding signature from a voting member within his or her district.

Federation of Physicians and Dentists (formerly Union of American Physicians and Dentists)

Articles in the Bulletin in the last several years have reported on the Federation's efforts to act as a union, representing physicians in private practice. In 1998, the U. S. Department of Justice challenged the Federation's representation of Delaware orthopedists in negotiations with Blue Cross and Blue Shield. A 2001 consent decree substantially limited the Federation's activities, allowing only a restricted “messenger” role. In 2005, the Department of Justice sued again, alleging that the Federation had illegally fostered collective demands upon health care insurers by Cincinnati area OBs. Now the Federation seems to have reached the end of the road, as to private practice. A new consent order announced on June 19 prohibits the Federation from:

Being involved anywhere in the country in negotiating or contracting with payers for health care services provided by the Federation's private-practice members.
Representing any independent physician with any payer.
Reviewing or analyzing any proposed or actual contract or contract term negotiated between a physician and any payer.
Communicating with any independent physician regarding contracts or terms; and
Training or educating any independent physician about contracting or negotiating with any payer.
It is clear that the agencies that enforce the antitrust laws do not subscribe to the notion that physicians in private practice can lawfully engage in collective bargaining, under the “union” label.

California Health Insurance Reform 2007

It's still anyone's guess on what, if anything, will come out of our state legislature this year to expand health insurance coverage among the uninsured. A few weeks ago both houses of the California Legislature passed reform bill that gave initial approval to similar Democratic proposals to:

Require employers spend 7.5 percent of their Social Security into a state fund that arranges insurance or provide health insurance for employees. Employees might pay a portion of the premiums. Some exemptions are allowed.
Provide state-subsidized insurance for children of families earning less than three times the federal poverty level ($61,950 a year for four). Families above poverty level would pay some portion of their coverage costs, indexed to their income.
Health insurance companies would be mandated to spend at least 85 percent of premiums on medical care and publicly reveal profit ratios. Medical insurance companies would be subject to restrictions on reasons for refusing individual coverage.
Businesses with 51 to 250 workers would have the same medical insurance protections that smaller businesses currently enjoy. Insurers could neither refuse to renew policies nor demand large premium increases.
Serious negotiations with Governor Arnold Schwarzenegger, who has offered his own health reform proposal that differs on several key points, have yet to begin. The bill passed by the State Senate and Assembly did not gain a single Republican vote.

Recently, Assembly Republicans—including GOP leader Mike Villines of Clovis and Dr. Alan Nakanishi of Lodi, ranking Republican on the Assembly Health Committee—asked Assembly Health Committee Chairman Mervyn Dymally, D-Compton, to hold a hearing on whether health initiatives requiring employer mandates fees or health insurance coverage run afoul of the 1974 Employee Retirement Income Security Act, or ERISA. Hawaii is the only state granted an ERISA exemption by Congress for such an employer mandate. Maryland's mandate to provide health insurance coverage for employees of mega-sized employers was recently declared void by the federal court.

In my view, everything nationally and in California is pointing to health insurance reform as a major issue in the 2008 Presidential year elections.

A Call for New Members

Most CSA members know one or more California anesthesiologists who for one reason or another have not joined CSA. Please do me a huge personal favor. Call those non-member friends and ask each of them to favor their fellow anesthesiologists by joining CSA and ASA now! You and I have seen a huge escalation in efforts by legislators, bureaucrats, health insurance plans, and risk-bearing insurance organizations to throw sand into the gears of your practice and somehow interfere with your ability to take care of your patients as you've done for years. Together we are stronger! Together we can speak with one voice! Help make CSA more vibrant! Do me a personal favor. Call your non-member friends and ask them to join CSA today!

Virgil M. Airola, M.D.