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CMS has released a proposed rule for its 2010 Physician Fee Schedule. The 1,128 page rule includes a number of complex regulatory changes. Of particular interest to ASA, the proposed rule includes CMSs proposals for implementing the Medicare Anesthesiology Teaching Rule. Because of its lack of understanding of the medical specialty of anesthesiology, CMS has made proposals that run contrary to Congressional intent, as well as common sense.
Specifically, CMS proposes to narrowly interpret the law and require that only one individual teaching anesthesiologist be present during all of the key or critical portions of the anesthesia procedure. This interpretation would severely limit anesthesia handoffs for anesthesiologists teaching residents, thus impacting O.R. staffing, work flow and payment. Potentially more troubling is that if this regulation is implemented, it may serve as the basis for further regulation of medical direction in non-academic settings (i.e., YOUR hospital).
Every ASA member is encouraged to contact CMS with comments about the proposed rule. It is imperative that we inundate CMS with comment letters correcting its misunderstanding. We must ensure that the 50 percent payment penalty for teaching programs is fully restored, just as Congress intended, without any added burdens for our programs.
Comments must be submitted by August 31.
Follow these steps to submit a letter to CMS electronically:
- Go to http://www.regulations.gov/fdmspublic/component/main?main=DocumentDetail&o=09000064809e75e4
- Click on Add Comment
- Copy the text from the sample letter below
- Paste the letter text into the CMS comment form
- Add your edits to make it personal to you and your practice (sticking as closely to our message as possible).
Tell your colleagues/partners/administrators/practice managers/students that we need their help, too. Please encourage others to take this important action.
And finally
LET ASA KNOW THAT YOUVE DONE YOUR PART! We are committed to generating a large number of comment letters, and we need your help tracking the number of letters sent to CMS.
To report that your comments have been sent, please email Moriah Merkel in the ASA Washington Office at [email protected]
Weve come too far in getting this important legislation passed. Please dont let CMS bureaucrats scuttle our efforts and place arbitrary restrictions on how anesthesiologists practice and get paid. TAKE ACTION NOW!!!
For more information on the proposed rule, visit http://www.asahq.org/news/asanews070209.htm.
Sample comment letter:
I am writing to offer comments on the proposed rule for the 2010 Physician Fee Schedule. As a practicing anesthesiologist, I am particularly concerned about the portion of the proposed rule relating to Section 139: Improvements for Medicare Anesthesia
Teaching Programs.
In 2008, Congress passed, as part of MIPPA, the Medicare Anesthesiology Teaching Funding Restoration Act to restore full Medicare payment to academic anesthesiology programs. Before passage of the bill, Medicare payment to our programs had been cut in half each time an attending oversaw two residents on cases that overlapped. To this end, I am very pleased that the proposed rule appropriately recognizes this statutory change and proposes to pay the full Medicare fee for cases involving a teaching anesthesiologist and one or two residents (that are not concurrent to other cases) or one resident case that is concurrent to another case paid under medical direction payment rules. I strongly believe that CMS made the correct decision for these cases.
I further believe that CMS made the correct decision with respect to payment for anesthesia services furnished by a teaching nurse anesthetist with a student nurse anesthetist, as well as the payment policy for an anesthesiologist, or an anesthesiologist and nurse anesthetist jointly, with a student nurse anesthetist. It is encouraging to see that CMS recognizes the significant differences in experience, education and other qualifications between anesthesia residents and student nurse anesthetists.
However, I am disappointed that after acknowledging We do not have data on the extent to which anesthesia handoffs occur during resident or other cases, or whether quality of anesthesia care is affected CMS chose to narrowly interpret the law and require that only one individual teaching anesthesiologist be present during all of the key or critical portions of the anesthesia procedure.
Anesthesia handoffs are a common and necessary part of running a quality and efficient operating room, especially in academic settings where the cases are often longer and more complex than in smaller, non-teaching settings, and where medical expertise is often needed to teach a particular skill or to staff a particular case at any given time. To arbitrarily raise this issue now directly contradicts anesthesiologys nationally recognized patient safety record, as well as the Congressional intent of providing full funding for overlapping cases as they are currently staffed in every academic program in the country.
Anesthesiology is proud of its reputation for quality and the recognition it has received for such efforts by the Institute of Medicine and other sources. We achieved this reputation with current practice, not despite it. Handoffs are a normal part of anesthesia care. They allow smooth, seamless and safe treatment of patients. Prohibiting anesthesia handoffs would have a ripple effect throughout operating rooms by creating staffing problems in hospitals, which would in turn lead to longer wait times and generally compromise safe and efficient patient care.
In the final rule please implement the option that was articulated, but not proposed, and permit different anesthesiologists in the same anesthesia group practice to be considered the teaching physician for purposes of being present at the key or critical portions of the anesthesia case. This will ensure that anesthesiology residency programs receive full Medicare payment for overlapping cases, just as Congress intended.
