Gasline Newsletter September 2006

Volume 8, No. 4


As part of the Deficit Reduction Act, The Centers for Medicare and Medicaid Services has ordered a hold to be placed on Medicare payments for all claims for the last nine days of the Federal fiscal year, September 22 - 30, 2006. No interest will be accrued or paid, and no late penalty will be paid to an entity or individual for any delay in a payment by reason of this one-time hold on payments. All claims held as a result of this one-time policy will be paid on October 2, 2006.


Unless Congress acts before the end of the year, Medicare payments for anesthesia and all other physician services will plummet in 2007. The proposed adjustment, published in the Federal Register August 22, calls for a 5.1% negative update (read: reduction) in all physician payments to comply with the Sustained Growth Rate adjustments formula.

The proposed rule has some good news for anesthesiologists. In the proposed regulations, CMS accepted an ASA-led recommendation from the Practice Expense Review Committee (PERC) to assign eight minutes to each existing anesthesia code for the scheduling and assignment of anesthesia cases. ASA estimates this change to be worth approximately $30 million for anesthesiologists each year.

Additionally, CMS published draft rules in the June 29 Federal Register which include a new practice expense methodology and changes in work values stemming from the recently-conducted Five Year Review. Federal law requires that these changes be "budget neutral," meaning that more payments to some specialties have to be offset by cuts to everyone else. The government estimates 6% cuts in total payments to anesthesiologists due to the Five Year Review and an additional 1% cut every year through 2010 due to the practice expense changes. Aside from cuts scheduled under the SGR formula, this would amount to a 10% cut in Medicare payments to anesthesiologists over the next four years.


The first of three public hearings on the Department of Managed Health Care's proposed regulations on a balance billing prohibition coupled with a dispute resolution process and modifications to the method of determining reasonable and customary value of services provided by non contracting physicians took place Wednesday, September 13, in Burbank. Many physicians presented testimony on the disastrous effects of adoption of the regulations.

The regulations apply to claims for emergency services provided by non contracting physicians to patients covered by Knox-Keene regulated plans, including HMOs, Blue Shield PPO and some Blue Cross PPO plans.

CSA members are urged to submit comments to DMHC, which will be accepted until close of business October 4. Go to the CSA home page at and click on the links under Hot Topics to access the DMHC Web Site and sample letters for anesthesiologists.


The CSA leadership wishes to extend their thanks to all members who answered our recent Annual Meeting Survey. The survey was targeted to members who have not attended the CSA Annual Meeting. Our goal was to find out why some members attend and others do not—and to make the changes necessary so more members will want to include the CSA Annual Meeting in their yearly CME schedule.

Respondents of the survey want more time to enjoy the meeting location. In 2007, attendees will have Saturday afternoon free to enjoy the host city of San Diego, or simply relax with associates and family.

We also heard that time away from work and family is a factor when considering the CSA Annual Meeting. As a result, in 2008, the Educational Programs Division will shorten the length of the Annual Meeting by one day (starting on Friday rather than Thursday). Beginning in 2007, the EPD will also extend greater member discounts to make the meetings more cost-effective, especially for those who attend the entire educational program.

We hope that as you experience the positive effect your participation has on our planning, you will continue to give us your thoughts and ideas. Members do make the difference, and we are very grateful for your feedback!

In addition, CSA's Educational Programs Division recently completed a review of the CME opportunities offered by CSA and developed a plan for expanding the type and number of continuing education opportunities for members. Based on the information received from members, a plan was developed for increasing the online and Bulletin CME and offering at least one meeting in California in addition to the Annual Meeting.


Register now ( for the October 2006 Hawaiian Seminar at the Mauna Lani Bay Hotel, October 30-November 3, on the Kohala Coast, Hawaii.

The brochure and online registration are now available on the CSA Web Site for the January 2007 Hawaiian Seminar, January 22-26, at the Hyatt Regency Maui Resort and Spa on Maui.