Gasline Newsletter November 2009

Volume 11, No. 7

CSA Committee Appointments

Active and resident members who are interested in becoming more involved in the CSA and would like to start by serving on a committee need to contact Narendra Trivedi, M.D., President-Elect, at or the CSA office at 800-345-3691 or by February 1, 2010, indicating interest in the following divisions and committees. For more information about the committees and the two divisions, call the CSA office or refer to the CSA Bylaws at

Educational Programs Division
Legislative and Practice Affairs Division

Standing Committees:
Committee on Bylaws
Committee on Finance and Administration
Committee on Peer Review
Committee on Public and Professional Communications

Special Committees:
Committee on Physicians Health and Well Being

California Opt-Out Update

At the recent meeting of the AMA House of Delegates, a resolution was adopted asking that the AMA urge the federal government to repeal the CMS regulations allowing states to opt out of physician supervision of CRNAs. This resolution was brought forward by the CMA delegation, received input from, and was strongly supported by the ASA delegation to the AMA. The text of the final resolution is below:

RESOLVED, That our American Medical Association urge the federal government to repeal the opt-out provision of the Medicare Conditions of Participation that eliminated the long-standing requirement that certified registered nurse anesthetists practice under physician supervision.

At the October 30 meeting of the Medical Board of California (MBC), CSA lobbyists Bill Barnaby Sr. and Jr. successfully urged the MBC to inquire into the Governor’s opt-out action and the implications for physicians and patients of unsupervised administration of anesthesia by CRNAs. They pointed out that the action was intentionally concealed from interested parties by the Governor’s office, was contrary to the advice of the MBC, and was not consistent with state law as recently confirmed by the Legislative Counsel, the office responsible for writing state statutes. CMA representatives strongly backed the CSA request. The opt-out will be a formal MBC agenda item at its next meeting in late January.

Public Record Act demands have produced thousands of documents that are undergoing review and analysis by CMA and CSA attorneys. This has proved to be time consuming but necessary work, largely done by the Barnabys, to prepare the best legal and political strategy. The legal team will be meeting with CSA leadership in early December to map out next steps in going forward with the proposed litigation.

National Health Care Reform

The following information is from the ASA Web Site:

November 19, 2009

U.S. House of Representatives passes SGR fix

The U.S. House of Representatives on Thursday passed H.R. 3961, the “Medicare Physician Payment Reform Act of 2009” by a vote of 243-183.

The legislation would permanently repeal the unworkable Sustainable Growth Rate formula (SGR) and create a path for future positive updates. Without SGR reform this year, anesthesiologists and all other physicians face a 21 percent Medicare payment cut beginning Jan. 1, 2010, with additional cuts projected in future years. H.R. 3961 would eliminate such SGR reductions to Medicare physician payments.

Instead, the bill would create a new physician payment formula with two buckets that would:

Allow the volume of most services to grow at the rate of GDP plus 1 percentage point per year
Allow the volume of primary and preventive care services to grow at GDP plus 2 percent per year
H.R. 3961 would also remove drugs and laboratory services not paid directly to practitioners from spending targets. For the bill to continue moving through the legislative process, it must receive consideration by the U.S. Senate.

November 23, 2009

U.S. Senate votes to proceed with health reform bill

The U.S. Senate on Saturday voted to invoke cloture on “The Patient Protection and Affordable Care Act,” the health care reform bill Senator Reid released last week. The cloture vote means that the Senate will now proceed with formal debate on the legislation.

All Democrats and Independents voted aye, with all Republicans voting nay.

The Senate is expected to resume debate following the Thanksgiving holiday. Please check for updates.

Additional information about “The Patient Protection and Affordable Care Act” is available at

In addition the ASA Administrative Council has considered a set of resolutions which will serve as guiding principles for the ASA’s positions on health care reform going forward. ASA leadership is cognizant that there is a wide range of opinions and concerns regarding the bills currently working their ways through Congress, and that these concerns are not limited to the narrow issues that ASA has focused on to date. These principles will be considered by the full ASA Board of Directors in a teleconference in early December and, if ratified, should be available to the general membership shortly thereafter.

Do You Want to Serve on an ASA Committee?

Mark Singleton, M.D., the new ASA Director for California, has invited CSA members to nominate themselves for ASA committees on which they would like to serve. As he stated in his November 4 letter to CSA members:

Many members on ASA Committees are adjunct (a one year appointment), which requires reappointment annually. In order to be considered for reappointment, you need to self-nominate each year. The nomination process is supposed to open on November 15th this year and will be available on the “Members Only” section of the website. There is a relatively short timeframe for nominations, so please make a note to self-nominate in November if you are interested in serving on an ASA committee, or in continuing to serve on a committee to which you are currently appointed. I have included below a link to the ASA website with more information on the process (it is on the Members Only section and will require you to log in) as well as some of the more important answers from the FAQs on this process. Please let me know if you have any questions or concerns. (Self Nomination Required)

Answers to most of your questions can be found on the Web page listed above.

CSA Winter Hawaiian Seminar

Beat the winter blahs! Attend the CSA’s Winter Hawaiian Seminar, January 19-23, 2009, at the beautiful Hyatt Maui Resort & Spa. Visit the CSA Web Site to learn more​.

Intraoperative Blood Pressure Management: Is the Standard of Care, Ideal Care?
Anesthetic Considerations for Spine Surgery
Perioperative Management of the Patient with Coronary Artery Disease
Analgesia for Routine Labor: What’s Old, What’s New, What Works
Concepts in Regional Anesthesia—Ultrasound and Nerve Stimulation
Our Evolving Practice: Oxygen, Vasopressors, Pre-Eclampsia and More
Book your sleeping room as soon as possible on the Hyatt’s online CSA registration site at

Linda B. Hertzberg, M.D.

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