Gasline Newsletter September 2008

Volume 10, No. 4

Update on Billing for Non-Contracted Services

As many CSA members know, the regulatory and legislative battles in Sacramento over attempts to limit billing for non-contracted services (balance billing) continue to drag on.

On August 1, the California Department of Managed Health Care (DMHC) released new regulations restricting the practice of balance billing for care administered to HMO patients in emergency settings. The regulations deemed the practice an “unfair billing pattern” and allowed DMHC enforcement actions against hospitals, hospital-based physicians, and on-call specialists that sought payment from the patients themselves when the HMO refused to pay for their care.

On September 15, the Office of Administrative Law approved the regulations, despite objections by the CSA and the California Medical Association (CMA) that the DMHC lacked the authority to promulgate or enforce them. This regulation will become effective on October 15. CSA has now joined a CMA-led coalition, along with the California Hospital Association, CAL/ACEP (emergency physicians), the California Radiological Society and the California Orthopedic Association, to challenge the regulations in court.

A lawsuit challenging the legality of the DMHC regulation was filed on Friday, September 26. CSA is a plaintiff in the lawsuit and has vowed to protect its members' right to be fairly compensated for the emergency care which, under force of law, they must provide. More information about the hearing date of the lawsuit and suggestions on billing after the 15th will be forthcoming as soon as it is available.

On the legislative side of the same issue, SB 981 (Perata), which would prevent emergency physicians who provide non contracted emergency services from billing HMO patients directly, was vetoed by the governor in the final hours of the bill signing/veto period.

Even if CSA ultimately prevails in the defeat of the DMHC regulations and in spite of the governor's veto of SB 981, the current perception in Sacramento remains that this issue will not simply go away, and that anesthesiologists will be far better served by being seen as part of a solution to the problem rather than as simply opposed to any limitations whatsoever.

CSA Legislative Counsel William Barnaby, Sr., and William Barnaby, Jr., have been working closely with CSA LPAD Chair Kenneth Pauker, M.D., on CSA's plans to introduce its own legislative solution to this problem. Legal Counsel Phillip Goldberg has prepared draft legislation calling for baseball-style arbitration of fees for emergency services to HMO patients between physicians and insurers in return for an agreement not to bill the patients directly. Current plans call for introduction of the legislation early next year. CSA will continue to keep its members abreast of developments with this issue.

2008 Fall Hawaiian Seminar

October 3 is the cutoff date for early registration for the 2008 CSA Fall Hawaiian Seminar at the Mauna Lani Resort, October 27-31, 2008. This year's featured speakers are Manuel Pardo, Jr., M.D., William Camann, M.D., Michael A. Gropper, M.D., Ph.D., Steven Hall, M.D., and Francis V. Salinas, M.D. The topics for the meeting include:

Transfusion Issues
Mechanical Ventilation
Obstetric Anesthesia
Regional Anesthesia
Pediatric Anesthesia
Trends in Anesthesia Training & Certification
      … and much more!

Ultrasound Guided Regional Anesthesia Workshop, December 6, 2008—Register Now!

The CSA will hold its first ever Ultrasound Guided Regional Anesthesia Workshop on December 6, 2008, at the Westin San Francisco Airport. CSA will promote this program statewide starting next week. This Gasline serves as early notice for CSA members to reserve their seats ahead of the general promotion. There will be a limit of 42 students (seven per station), so if you want to be part of this workshop, sign up soon. The price for CSA members is $495.

Problems with Palmetto Medicare Transition

Many members have contacted the CSA reporting a wide range of problems with the new California Medicare Part B Carrier, Palmetto GBA, located in Columbia, South Carolina. Problems include the inability to reach anyone at the carrier, wrong payments, no payments, denials for bundling and downcoding. The CSA is at work advocating for members, along with the CMA. All physicians are experiencing problems and Palmetto is taking steps to reprocess denied and incorrect claims. In addition, three dozen staff were added to respond to calls from physicians and billing services.

The CSA will keep members informed via member alerts as new information is available.

ASA Annual Meeting

The ASA Annual Meeting will begin on Saturday, October 18, in Orlando, Florida. The free registration offered by the ASA to its members remains one of the premier benefits of ASA/CSA membership. The meeting is the world's largest and most influential gathering of anesthesiologists, with extensive educational, research, commercial and governance offerings.

Issues expected to generate interest at this year's meeting of the House of Delegates include the Society for Pediatric Anesthesia's petition for subspecialty certification in Advanced Pediatric Anesthesia, the ambitious (and expensive) plan by the ASA to develop its own quality initiative, ASA President-Elect Roger Moore's Wellness Initiative which would commit extensive funds to assist anesthesiologists in times of extraordinary need, and the ASA's plan to purchase additional property at its Park Ridge headquarters.

Dr. Ron Miller, chair of the UCSF Department of Anesthesia, will receive dual honors this year. He will be awarded the ASA Distinguished Service Award and is the 2008 Rovenstine lecturer.

All CSA attendees to the ASA Annual Meeting are invited to stop by the CSA suite. The room number will be posted on the events board at the Peabody Hotel.

CMA Annual Meeting

The California Medical Association will hold its Annual Meeting in Sacramento from October 2-5. Several CSA leaders will be seated at the CMA House of Delegates, some as representatives of their county medical societies and others as members of the specialty delegation. All CMA members are of course welcome and encouraged to attend. Issues of importance to anesthesiologists that are debated during the session will be reported in future communications.

Michael W. Champeau, M.D.