Majestic Legislation, Hope and Little Change

  • Yost, Paul, MD
| May 07, 2012

I don’t think it is any secret that politics in Washington DC are polarized. This fact was obvious at the 2012 ASA Legislative Conference. The keynote speaker, Dr. Donald Berwick (CMS Administrator 2010 – 2011 and strong advocate of the Patient Protection and Affordable Care Act, aka: PPACA, Obama Care, etc.), took the podium to discuss “Professional Leadership in Health Care Reform.” He started his talk by saying that after listening to the previous panel of speakers, he wasn’t sure he was getting out of the auditorium alive. The prior panelists, Dr. Andy Harris (the first anesthesiologist elected to congress), Dr. Sam Page, Member of the Missouri House of Representative, and Jeffrey Burton, executive director of the of the Republican Congressional Committee discussed the best ways to repeal and replace PPACA with a system that was affordable, accountable, and allowed Americans to choose their health care providers and health care delivery system. Dr. Berwick went on to describe PPACA as a “Majestic Piece of Legislation” that moves this country closer to declaring medical care a “right of all Americans. He continued  to explain why he believes that we need to have government oversight and direction to improve quality of care and decrease costs. Dr. Berwick did receive a less than warm reception from the audience, and he did not take questions from the floor. I believe the decision to have Dr. Berwick speak was wise. It is critically important for us to understand the reasons and rationale behind the proposed changes to our health care system. Often we speak only within our own group, which serves to reinforce our own ideas and does not foster a good understanding of the opposing position.

One of my favorite parts of this conference each year is the State Issues Forum. This is an opportunity for state societies to present regulatory and political issues of significance. CSA President Kenneth Pauker, MD gave an excellent update on the California Opt-out, as did several other state society presidents. A representative of the Nevada Society Anesthesiologists described an issue familiar to us in California: a hospital requiring anesthesiologists to increase their medical malpractice premiums from 1 million per occurrence 3 million per year to 2 million/6 million coverage. We had just faced this issue in California and by sharing information through our group president’s forum and LPAD Groups, we were able to give Nevada the ammunition they needed to win their battle. This type of sharing of information and resources is truly a member benefit for the ASA and CSA, and one of the reasons to attend the ASA Legislative Conference.

A couple of awards were given to deserving ASA members. California was proud to see the recognition of the wonderful and far reaching contributions of one member or our Delegation, Stanley Stead, MD, MBA. Dr. Stead received the Bertram W. Coffer, MD Excellence in Government Award for “Exemplary Contributions to the medical Specialty of Anesthesiology, its Practitioners and Patients.” Congratulations Dr. Stanley Stead.

The legislative issues identified by our ASA staff to present to our law makers were the same issues as last year. Drug shortages, rural pass through legislation, truth and transparency, and legislation to achieve fair payment for anesthesiologists, including legislation to halt the implementation of the Independent Payment Advisory Board (IPAB). Drug shortages need no explanation to any practicing anesthesiologist, as we have all suffered with this unacceptable situation that threatens patient care. Rural pass through legislation closes a loophole which allows rural hospitals financial support for hiring CRNAs but not anesthesiologists. The legislation would offer the same incentives for rural hospitals to hire anesthesiologists. Truth and transparency legislation requires health care practitioners to clearly identify themselves and their qualifications—a doctor is a medical doctor and doctor of nursing practice is a nurse. Achieving fair payment for anesthesia services also needs no clarification.

The Capitol Hill visits were a little different this year. For the first time, Congress was not in session during the ASA Legislative Conference. While I initially thought this might be a negative, in fact it offered some improved opportunities to advocate for our specialty. Without Congress being in session, the atmosphere was much more relaxed, and it was far easier to get appointments with legislative offices. Although the meetings did not include the legislator, we had better access to senior legislative analysts (LA), who had more time to spend with us discussing the issues. In fact, many of the LAs contribute heavily to the position of the legislator on an issue, so if you can convince the senior LA of your point, you are most of the way toward gaining support from the actual legislator on your issue. Additionally, the analysts seemed more open and honest with their answers. For example, when speaking with the LA of a key Democratic congress person, he told us that his legislator was in complete agreement to remove the IPAB as a non-elected, non-accountable entity that has enormous potential to influence health care access and payments for millions of Americans. He was brutally honest in saying that attaching tort reform to the bill made it impossible to pass. He urged us to put our weight behind a “clean IPAB bill.”

What I liked best about the conference—and what gives me the most hope for the future—was the incredible, infectious enthusiasm of the resident participants. California boasted seven residents at this year’s conference, out of our total delegation of nineteen anesthesiologists. One of our residents is applying for the ASA’s Public Policy Research elective in Washington DC. Seeing so many residents interested in the political process at this stage of their career gives me hope for the future of our specialty. 

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