Gasline Newsletter November 2006

Volume 8, No. 6

Disastrous Cuts in Medicare Rates Scheduled for 2007

Anesthesia conversion factors effective January 1, 2007 were published on the NHIC (California Part B carrier) November 20. The new rates reflect an almost 14 percent reduction in all of California's geographic areas, bringing Medicare rates perilously close to Medi-Cal rates. The 2006 and 2007 conversion factors can be found here and show the percentage reduction for each geographic area.

click here It still is not too late to pressure Congress to avert the reductions before adjournment on December. See the ASA web site at (link no longer active) to contact your congressional representatives. For California specific talking points, letter.

Final CMS Rule on Locked Carts Released

Final Medicare rules for locked cart security proposed in March 2005 were adopted November 27, 2006. The regulation modified a restrictive rule so that anesthesia carts no longer must be locked as long as they are "kept in a secure area, and locked when appropriate." Five years ago, the CSA successfully worked with the DHS to clarify the interpretation of the security rule to largely reflect the adopted federal regulation. Despite the change, several CSA members reported that some JCAHO surveyors interpreted the Medicare condition of participation rules narrowly and cited some hospitals for non compliance. Anesthesiologists can now refer to the final regulation that does not require that carts be locked while in a secure area. See the final regulation here. The regulatory language is on pages 24 and 25; comments regarding anesthesia issues begin on page 18.

CSA Stipend and Payment Survey

In January the CSA will conduct a survey similar to the reimbursement and stipend survey completed three years ago. The previous survey results proved to be very valuable and were used by many members in contract negotiations and benchmarking.

The new survey questions have been refined to enable respondents to provide information without significant time expenditures. The survey will be conducted by a third-party consultant who has conducted surveys for the ASA and other organizations. Most of the information will be supplied by billing services and practice managers, but groups must give permission to submit responses. All CSA members are encouraged to participate by approving submission of non-identifying data. We are hoping to have a much higher rate of response to the upcoming survey; the higher the response rate, the more useful the results.

Don't Forget! Requirement for Pain Management and End-of-Life Care CME

The due date to complete the AB 487 CME requirement for Pain Management and End-of-Life Care is December 31, 2006. Modules 1-11 are available now and Module 12 will be online this week. These CME offerings are free to CSA members. 

CSA Hawaiian Seminar

Sign up now for one of our most popular meetings! The brochure and online registration are now available on the CSA Web Site for the Hawaiian Seminar, January 22-26, at the Hyatt Regency Maui Resort and Spa on Maui.

CSA/UCSD Annual Meeting and Clinical Anesthesia Update

Don't forget to register for the CSA/UCSD meeting this year in San Diego! The meeting will have a slightly different format with more time for you to enjoy San Diego in the afternoons. The scientific sessions will be updates this year rather than reviews and there will be a great faculty. 

Election Results

From Team Barnaby: Governor Arnold Schwarzenegger won re-election in a landslide but his popularity failed to help "down ticket" Republicans. The only other GOP winner for statewide office was Steve Poizner who reportedly spent $13 million of his own money to gain the post of Insurance Commissioner. Poizner has become well liked and respected by Peninsula-area physicians, including several CSA members who have gotten to know him over the past few years.

Not a single state legislative seat changed parties so the Democrats retain their statehouse majorities of 25 to 15 in the Senate and 48 to 32 in the Assembly. Of 53 U.S. House of Representatives districts, one incumbent lost. Congressman Richard Pombo (R-Tracy) was targeted by national environmental groups and lost to Democrat Jerry McNerney. Of 154 state and federal legislative seats up for election in California, one changed.

The most prominent healthcare issue on the ballot, Proposition 86, went down to defeat. It proposed a sharp increase in tobacco taxes to fund emergency and trauma care as well as a host of other pet programs of the organizations that paid for the pro-Prop. 86 campaign. Opposition from several county and specialty medical societies resulted from a provision in the lengthy and complex measure that would have given added clout to hospital administrators in negotiating payment rates for on-call services. A much bigger factor was the many millions spent to defeat the measure by tobacco interests.

With finance reports as yet incomplete, more than $650 million was spent on California campaigns during the general election cycle. With re-election safely tucked under his Mr. Olympia belt, Gov. Schwarzenegger has designated 2007 as his "Year of Health Care." More heavy lifting ahead, it seems.

People to People Announces Fall 2007 Anesthesiology Program in Vietnam and Cambodia

People to People Ambassador Programs is coordinating a delegation of professionals specializing in anesthesiology who will travel to Vietnam and Cambodia from November 6 - November 16, 2007. In order to establish a conceptual framework for understanding and evaluating healthcare practices for the populations they serve, delegates will participate in a comparative analysis of U.S. and Chinese based healthcare systems. Topics will be: access and delivery of primary healthcare; burden of communicable disease, including the HIV epidemic, and the impact on surgical and anesthetic delivery; and the demand versus available resources of trained physicians, nurses, and allied health care personnel to staff hospitals in cities and rural areas.

The Anesthesiology Delegation is being led by Edgar D. Canada, M.D., Immediate Past President of the CSA, who is looking forward to sharing this opportunity for professional and personal growth with colleagues from the United States, Vietnam and Cambodia.

"I encourage anesthesiologists to pursue this rare and exciting opportunity to share their expertise with others," he said. "Delegates can play a role in defining the themes for discussion, and will be able to both share and gain insights through the exchange. This is an opportunity to discuss healthcare issues that will be vital not only for Vietnam and Cambodia, but also for the rest of Asia, for the United States, and for the world at large."

Delegates will visit three primary areas—Ho Chi Minh City, Siem Reap and Phnom Penh. Program details and a registration form are available by e-mailing or by calling 1-877-787-2000, ext. 8100. For more information on People to People Ambassador Programs, go to

Mark A. Singleton, M.D.