This month marks the fourth year that we have been publishing the CSA Online First blog, on a nearly weekly basis. The first blog post was written following the ASA Legislative Conference in Washington DC in May 2011. That meeting started the day after Osama bin Laden was killed, and the entire experience of the meeting was colored by that event. Four years later I am still grateful that Osama bin Laden is gone, but I am not certain that anything has really changed. The forces of evil, intolerance, and injustice still exist in our world. Only the geography has changed.
|Drs. Paul Yost, Michael Champeau, Mark Zakowski, Amir Shbeeb, Narendra Trivedi, James Moore, and CSA Lobbyist Bryce Docherty
This time at least the backdrop of the events of the ASA Legislative Conference was more political than international. Much of the buzz had to with the repeal of the Sustainable Growth Rate (SGR) Medicare payment formula. The Chair of the ASA Committee on Economics, Mark L. Leib, MD, JD, gave an outstanding talk on “Payment System Changes” outlining the implications of the SGR repeal for anesthesiologists. He summarized these changes as follows:
The flawed SGR mechanism is permanently repealed, averting a 21 percent SGR-induced cut. Professionals will receive an annual update of 0.5 percent in each of the years 2015 through 2019. From 2019-2025 the rates in 2019 will be unchanged, while providing professionals with the opportunity to receive additional payment adjustments through Merit-Based Incentive Payment System (MIPS). In 2026 and subsequent years, professionals participating in alternative payment models (APMs) that meet certain criteria would receive annual updates of 0.75 percent, while all other professionals would receive annual updates of 0.25 percent. However there is a strong potential for negative payment adjustments for physicians if MIPS or APM criteria are not met. The ASA website contains a more detailed discussion of the MIPS and APM requirements.
Since we were no longer lobbying to prevent negative SGR updates, the conference attendees were focused on the proposed changes to the Veterans Health Administration (VHA) Nursing Handbook, discussed in earlier CSAOF blog posts. This new policy document has been in process since the end of 2013 and would abandon the VA’s proven model of team-based physician-led anesthesia care. The proposed policy mandates that nurses provide surgical anesthesia without physician involvement, diminishing the standard of care for Veterans. The leading experts on surgical anesthesia care in the VA, the Chiefs of Anesthesiology, have informed VA leadership that the new policy “would directly compromise patient safety and limit our ability to provide quality care to Veterans.” The VA leadership has ignored their concerns.
Of particular concern was a video shown early in the conference which had highlights of the AANA rally on Capitol Hill several weeks earlier. If you don’t believe that preventing changes to the VHA Nursing Handbook is a critical issue for the ASA I suggest you watch the video now. ASA members are strongly encourage to visit the ASAPAC website to stay informed on this and other important issues.
Armed with the information (requires ASA login) provided by the ASA we went to Congressional and Senate offices to ask that our Congressional Representatives and Senators work both in the regulatory and legislative arenas to preserve physician-led anesthesia care in the VA system.
Linda Mason, MD; James Moore, MD; Daniel Cole, MD; R. Lawrence Sullivan, Jr., MD; Neal Cohen, MD; Michael Champeau, MD; Paul Yost, MD; Bryce Docherty; Mark Zakowski, MD; Peter Sybert, MD; Stan Stead, MD, MBA; Jeffrey Poage, MD; Linda Hertzberg, MD; Earl Strum, MD; Julie Freeman.
The California delegation to the Legislative Conference consisted of Drs. Michael Champeau, Neal Cohen, Daniel Cole, James Moore, Linda Mason, Nassim Moradi, Jeffrey Poage, Johnathan Pregler, Cody Reeves, Stan Stead, Earl Strum, Larry Sullivan, Peter Sybert, Narendra Trivedi, Paul Yost, and Mark Zakowski, resident physicians Anuj Aggarwal, Tracy Burns, Shara Cohn, and Amir Shbeeb, CSA Legislative Advocate and lobbyist Bryce Docherty and CSA Executive Director Julie Freeman. We were very successful in our efforts to meet with Congressional staffers with over twenty appointments and meetings scheduled.
When the time comes it is of paramount importance that you respond to requests from the ASA to send in your comments regarding the proposed changes to the VHA Nursing Handbook. Only through continued member engagement and involvement will we succeed on this and other critical issues.