Message from ASA President Alex Hannenberg: ASA opposes current Senate bill

[veetz]

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Below is message from ASA President Alex Hannenberg regarding the proposed current Senate Health Care Reform Bill. I didn't see anyone else post it, so I thought I would to see if anyone here has some thoughts regarding this issue.


"Dear Colleagues:

ASA continues its proactive involvement in the current health reform debate. We remain committed to supporting legislation that expands access to health insurance coverage for all Americans while ensuring that anesthesiology remains a strong and vital physician specialty.

To that end, we have recently communicated our views to the U.S. Senate leadership about legislation currently under consideration. We believe that the “Patient Protection and Affordable Care Act,” H.R. 3590, the Senate’s version of health reform legislation, contains a number of meaningful health insurance market reforms that represent an important step forward in expanding insurance coverage. Like H.R. 3962, passed by the House of Representatives several weeks ago, this bill contains a public health plan with voluntary participation and negotiated fees. Regrettably, however, the bill includes other provisions that pose a grave threat to our specialty. Accordingly, ASA must oppose the legislation as currently written.
On Nov. 4, ASA joined a coalition of surgical societies to communicate our concerns with proposals under consideration. At that time, a formal bill had not yet been introduced. In the letter, we and the surgical community outlined a number of concerns that we sought to have addressed. The letter can be found on the ASA website.

The Senate leadership has backed away from provisions penalizing physicians deemed high resource utilizers. However, the Senate did not address our other serious concerns, and most of the flawed provisions remain in the Patient Protection and Affordable Care Act as introduced in the Senate, as H.R. 3590.

Consequently, just yesterday the surgical community, joined by ASA, sent a second letter to the U.S. Senate leadership restating its concerns and expressing its opposition to the bill as currently written.

The specific concerns outlined by the coalition include:

Establishment and proposed implementation of an Independent Medicare Advisory Board empowered to make across-the-board cuts to physician payments
Mandatory participation in a seriously flawed Physician Quality Reporting Initiative (PQRI) program with payment penalties for non-participation
Reductions in payments to anesthesiologists and other physicians to fund bonus payments to primary care physicians and rural general surgeons
Creation of a budget-neutral value-based payment modifier which CMS does not have the capability to implement and places the provision on an unrealistic and unachievable timeline
Requirement that physicians pay an application fee to cover a background check for participation in Medicare, despite already being obligated to meet considerable requirements of training, licensure, and board certification
The so-called “non-discrimination in health care” provision that would create patient confusion over greatly differing levels of education, skills and training among health care professionals while inappropriately interjecting civil rights concepts into state scope of practice laws
The absence of a permanent fix to Medicare’s broken physician payment system and any meaningful proven medical liability reforms
At this time, ASA continues to look for opportunities to modify the bill as the Senate moves forward with the amendment process. In addition, we will continue working to ensure that any new health insurance options not be based on Medicare rates but instead allow for fair negotiated payment levels, and have the fewest possible government interventions.

Weeks of work lie ahead before the Senate bill reaches its final form. ASA will continue working with key Senators to address our concerns with the legislation. Please stay informed about latest developments by checking the ASA website, joining the ASA Grassroots Network, and following us on Facebook and Twitter. We need your help as the legislative process moves forward.

I ask that you reach out to your Senators to voice your concerns about H.R. 3590. Please use the ASA CapWiz Action Center to email your Senators.

Please feel free to contact staff in the ASA Washington office if you have questions. Also, you may use the following links for additional information:

ASA CapWiz Action Center
The “Patient Protection and Affordable Care Act” – Bill language
CBO analysis
ASA/Surgical Coalition letter to Senate Majority Leader Harry Reid (Dec. 1)
ASA/Surgical Coalition letter to Senate Majority Leader Harry Reid (Nov. 4)"

 

[foxtrot]

Below is message from ASA President Alex Hannenberg regarding the proposed current Senate Health Care Reform Bill. I didn't see anyone else post it, so I thought I would to see if anyone here has some thoughts regarding this issue.


"Dear Colleagues:

ASA continues its proactive involvement in the current health reform debate. We remain committed to supporting legislation that expands access to health insurance coverage for all Americans while ensuring that anesthesiology remains a strong and vital physician specialty.

To that end, we have recently communicated our views to the U.S. Senate leadership about legislation currently under consideration. We believe that the “Patient Protection and Affordable Care Act,” H.R. 3590, the Senate’s version of health reform legislation, contains a number of meaningful health insurance market reforms that represent an important step forward in expanding insurance coverage. Like H.R. 3962, passed by the House of Representatives several weeks ago, this bill contains a public health plan with voluntary participation and negotiated fees. Regrettably, however, the bill includes other provisions that pose a grave threat to our specialty. Accordingly, ASA must oppose the legislation as currently written.
On Nov. 4, ASA joined a coalition of surgical societies to communicate our concerns with proposals under consideration. At that time, a formal bill had not yet been introduced. In the letter, we and the surgical community outlined a number of concerns that we sought to have addressed. The letter can be found on the ASA website.

The Senate leadership has backed away from provisions penalizing physicians deemed high resource utilizers. However, the Senate did not address our other serious concerns, and most of the flawed provisions remain in the Patient Protection and Affordable Care Act as introduced in the Senate, as H.R. 3590.

Consequently, just yesterday the surgical community, joined by ASA, sent a second letter to the U.S. Senate leadership restating its concerns and expressing its opposition to the bill as currently written.

The specific concerns outlined by the coalition include:

Establishment and proposed implementation of an Independent Medicare Advisory Board empowered to make across-the-board cuts to physician payments
Mandatory participation in a seriously flawed Physician Quality Reporting Initiative (PQRI) program with payment penalties for non-participation
Reductions in payments to anesthesiologists and other physicians to fund bonus payments to primary care physicians and rural general surgeons
Creation of a budget-neutral value-based payment modifier which CMS does not have the capability to implement and places the provision on an unrealistic and unachievable timeline
Requirement that physicians pay an application fee to cover a background check for participation in Medicare, despite already being obligated to meet considerable requirements of training, licensure, and board certification
The so-called “non-discrimination in health care” provision that would create patient confusion over greatly differing levels of education, skills and training among health care professionals while inappropriately interjecting civil rights concepts into state scope of practice laws
The absence of a permanent fix to Medicare’s broken physician payment system and any meaningful proven medical liability reforms
At this time, ASA continues to look for opportunities to modify the bill as the Senate moves forward with the amendment process. In addition, we will continue working to ensure that any new health insurance options not be based on Medicare rates but instead allow for fair negotiated payment levels, and have the fewest possible government interventions.

Weeks of work lie ahead before the Senate bill reaches its final form. ASA will continue working with key Senators to address our concerns with the legislation. Please stay informed about latest developments by checking the ASA website, joining the ASA Grassroots Network, and following us on Facebook and Twitter. We need your help as the legislative process moves forward.

I ask that you reach out to your Senators to voice your concerns about H.R. 3590. Please use the ASA CapWiz Action Center to email your Senators.

Please feel free to contact staff in the ASA Washington office if you have questions. Also, you may use the following links for additional information:

ASA CapWiz Action Center
The “Patient Protection and Affordable Care Act” – Bill language
CBO analysis
ASA/Surgical Coalition letter to Senate Majority Leader Harry Reid (Dec. 1)
ASA/Surgical Coalition letter to Senate Majority Leader Harry Reid (Nov. 4)"

1. A background check for docs? That is ridiculous, most states already have this requirement when you apply for a license. Just another way to get money out of physicians. Do they want doctors to stop taking medicare/medicaid patients?
2. What does this whole non discrimination in healthcare provision mean? This is the first I have heard of this?

 

[SleepIsGood]

1. A background check for docs? That is ridiculous, most states already have this requirement when you apply for a license. Just another way to get money out of physicians. Do they want doctors to stop taking medicare/medicaid patients?
2. What does this whole non discrimination in healthcare provision mean? This is the first I have heard of this?

i'm assuming the hospital not discriminating whether someone is a nurse (nurse practioner with a PhD or DNP) vs a physician. Atleast that's what it sounds like.

BS....I wrote a letter to the senators of my state...i hope you guys did too.

 

[lushmd]

This is the first I'm hearing of this as well. Judging from this letter (written/signed by representatives of various non-physician groups, including the AANA), it sounds like an attempt to allow non-physicians to be paid the same as physicians. I'm really having a tough time believing that people are using a term as polarizing as discrimination in this way. How insidious... I mean, how dare insurance companies base reimbursement on professional qualification/licensure... I encourage you all to contact your legislators to express your opposition to such a provision.

 

[foxtrot]

This "discrimination" clause is really scary. I read the letter you posted and they have the audacity to state that
"The above federal protection is needed because in today’s delivery system, health plans
routinely discriminate against whole classes of healthcare providers based solely on their
licensure or certification."
This is unbelievable. We have always classified people based on their education, licensure and certification, otherwise what would be the point of going to medical school or getting an advanced degree. This type of language is really scary and could be detrimental to our specialty. I urge everyone on this board to go on the ASA's website and send a letter to your state senators. Interestingly enough the AANA is more than happy to endorse this kind of language.

 

[2win]

This "discrimination" clause is really scary. I read the letter you posted and they have the audacity to state that
"The above federal protection is needed because in today’s delivery system, health plans
routinely discriminate against whole classes of healthcare providers based solely on their
licensure or certification."
This is unbelievable. We have always classified people based on their education, licensure and certification, otherwise what would be the point of going to medical school or getting an advanced degree. This type of language is really scary and could be detrimental to our specialty. I urge everyone on this board to go on the ASA's website and send a letter to your state senators. Interestingly enough the AANA is more than happy to endorse this kind of language.

The language of Marx. And Engels. And the other one.
Mediocrity is THE KING - call your senator. I did it.

 

[leaverus]

Un-real. It's now discrimination against them simply because they want to do what they are NOT trained/educated to do?? I'm just left speechless and shaking my head after reading that letter...

 

[CristaGalli]

I already emailed my senator, and I plan to do so weekly (it's really easy people, you dont even have to draft the email).
Call me simple (I'm a novice to the crna-physician debate), but why not just set up a situation where, if the crna's want to practice independently and get payed equally, they should also be required to pass step 3, the akt's, in-training exams, written board, and oral board. Instead of all the fighting and bickering, lets just simplify things. If they try to fight that plan also, then their arguments have no basis...if they feel confident enough to practice independently, they should have no problem passing all the licensing exams.

 

[furfur]

Trying to impart logic into the imbeciles running our country is akin hammering a nail to solid stone=aint gonna happen. We're ****ed in this country(independent of the imminent problems facing our speciality). However, we have a highly specialized skill that is required throughout the world so we do have other options if(and when) it comes to that. I would have no problem to picking up and moving to another country.

 

[Arch Guillotti]

Call me simple (I'm a novice to the crna-physician debate), but why not just set up a situation where, if the crna's want to practice independently and get payed equally, they should also be required to pass step 3, the akt's, in-training exams, written board, and oral board. Instead of all the fighting and bickering, lets just simplify things. If they try to fight that plan also, then their arguments have no basis...if they feel confident enough to practice independently, they should have no problem passing all the licensing exams.

No way. I think that is just dumbing down our specialty. Although 99%+ of the CRNA's could not become board certified by the ABA via the traditional route there are almost always extreme outliers. I certainly don't want to give them any reason to challenge us any more. If you give an inch, then next thing you know you have given a mile. I think that to have the privilege of taking all these exams you must successfully pass through medical school, without exception.

 

[Arch Guillotti]

their arguments have no basis

Unfortunately baseless arguments are propagated everywhere and can be spun any which way that one chooses and also may bear no semblance to reality.

 

[IN2B8R]

Going through the motions to "pass exams" does not/should not qualify anyone for equivalency. There are reasons why residency training and internship take years in the making: throughout your training, the aim is to mold you into a physician/consultant in the field anesthesiology/peri-op medicine. This is vastly different from simply learning the manual work of what we do day in and day out--intubating, floating PA caths, a-lines, etc.... Eventually, you do not even need a college degree to perform the above procedures, but you do need college/medical school and a residency to become a physician consultant.

I already emailed my senator, and I plan to do so weekly (it's really easy people, you dont even have to draft the email).
Call me simple (I'm a novice to the crna-physician debate), but why not just set up a situation where, if the crna's want to practice independently and get payed equally, they should also be required to pass step 3, the akt's, in-training exams, written board, and oral board. Instead of all the fighting and bickering, lets just simplify things. If they try to fight that plan also, then their arguments have no basis...if they feel confident enough to practice independently, they should have no problem passing all the licensing exams.

 

[militarymd]

No way. I think that is just dumbing down our specialty. Although 99%+ of the CRNA's could not become board certified by the ABA via the traditional route there are almost always extreme outliers. I certainly don't want to give them any reason to challenge us any more. If you give an inch, then next thing you know you have given a mile. I think that to have the privilege of taking all these exams you must successfully pass through medical school, without exception.

Well...actually you didn't go to medical school.....you went to osteopathic school....

We gave an inch....and let osteopaths take our boards....and look...and now you guys have taken a mile....and started calling your schools a "medical school"

It's not like REAL medical students can take DO boards...and learn how to do eye exams.

 

[Arch Guillotti]

Well...actually you didn't go to medical school.....you went to osteopathic school....

We gave an inch....and let osteopaths take our boards....and look...and now you guys have taken a mile....and started calling your schools a "medical school"

It's not like REAL medical students can take DO boards...and learn how to do eye exams.

2 things:

I hope that you feel better inside after making these statements.

I hope that that everyone else reading your comments can see through them.

And I have no idea what the comment about eye exams means.

 

[militarymd]

2 things:

I hope that you feel better inside after making these statements.

I hope that that everyone else reading your comments can see through them.

And I have no idea what the comment about eye exams means.

I tried to ignore you, but the board won't let me....

Don't D.O. give eye exams...isn't that what you guys do before you bullied your way into practicing medicine...

the same way the CRNA's are doing ....start with anesthesia...then bully their way into medicine.

 

[militarymd]

2 things:

I hope that you feel better inside after making these statements.

I hope that that everyone else reading your comments can see through them.

And I have no idea what the comment about eye exams means.

If you're hoping...then deep down...you know the truth.

 

[Planktonmd]

Didn't you know that MMD now is a political activist defending the specialty?
He donates money to the ASAPAC (although he feels the urge to tell the whole world how much he gave)
And He challenges poor residents to give in the "4 digits".
And he goes to defend the specialty on the nurses forum by telling them that they are equal to us which really strengthens our message.
And if you disagree with him then it is obviously Censorship!
We need more MMDs in this specialty and thank god we are witnessing the growth of mini mmd (Nancy) who has the potential to become a fully grown MMD one day.

2 things:

I hope that you feel better inside after making these statements.

I hope that that everyone else reading your comments can see through them.

And I have no idea what the comment about eye exams means.

 

[racerx]

Don't D.O. give eye exams...isn't that what you guys do before you bullied your way into practicing medicine...

Uh, that's an O.D. that does eye exams.

 

[militarymd]

Uh, that's an O.D. that does eye exams.

my bad.

 

[Eta Carinae]

I already emailed my senator, and I plan to do so weekly (it's really easy people, you dont even have to draft the email).
Call me simple (I'm a novice to the crna-physician debate), but why not just set up a situation where, if the crna's want to practice independently and get payed equally, they should also be required to pass step 3, the akt's, in-training exams, written board, and oral board. Instead of all the fighting and bickering, lets just simplify things. If they try to fight that plan also, then their arguments have no basis...if they feel confident enough to practice independently, they should have no problem passing all the licensing exams.

That's being way too lenient.
why don't we start at the very beginning- they should be required to pass the MCAT

 

[porsche518]

I tried to ignore you, but the board won't let me....

Don't D.O. give eye exams...isn't that what you guys do before you bullied your way into practicing medicine...

the same way the CRNA's are doing ....start with anesthesia...then bully their way into medicine.

This has to be one the most ******ed things I have read on these boards How can you be practicing in the United States and not know what a D.O. is, or did you fall of your bike one day?

 

[militarymd]

This has to be one the most ******ed things I have read on these boards How can you be practicing in the United States and not know what a D.O. is, or did you fall of your bike one day?

I guess sarcasm is something that is lost on you........

I know what a D.O. is...it'a MD wannabe.....sort of like how so many people here say that CRNA's are anesthesiologist wannabe's.

 

[SleepIsGood]

All Jokes aside...please CALL your senator: These are the speaking points:

Talking
Points:
1) As an anesthesiologist and your constituent, I am calling with serious concerns about H.R. 3590, the “Patient Protection and Affordable Care Act.” This bill would severely harm the medical specialty of anesthesiology.
2) Most critically for my specialty, the bill must NOT extend Medicare payment rates, whether through a Medicare “buy-in” or public plan. Medicare pays anesthesiologists 33 percent of what private insurers pay, and this low rate does not cover the costs of providing care to my patients. Any new plan should allow for voluntary provider participation, fair negotiated payment levels, and have the fewest possible government interventions.
3) I am also very concerned about the creation of an “Independent Medicare Advisory Board,” or “IMAB” that could make across-the-board cuts to physician payments with limited accountability
4) Further compounding Medicare payment problems, the bill lacks meaningful SGR reform. It is essential that the legislation permanently fix this unworkable payment mechanism.
5) Other troubling language in the bill includes a so-called “Non-discrimination” provision that could confuse patients about providers’ education, skills and training. This inappropriate language should be removed from the bill.
6) For the sake of my specialty, my practice and my patients, please take immediate action to address these critical issues.


Dont know the number of your senator: http://www.capwiz.com/asa/callalert...content_dir=&external_id=&alert_active_taf=1&

Please do this. I've done it twice already. we can sit around and talk...but calling your senator makes a HUGE difference.

 

[doctalaughs]

All Jokes aside...please CALL your senator: .
2) Most critically for my specialty, the bill must NOT extend Medicare payment rates, whether through a Medicare “buy-in” or public plan. Medicare pays anesthesiologists 33 percent of what private insurers pay, and this low rate does not cover the costs of providing care to my patients. Any new plan should allow for voluntary provider participation, fair negotiated payment levels, and have the fewest possible government interventions.
.

I'm kind of curious about this medicare paying 33% of private insurance to anesthesia. I've heard this before... but what does it mean? Do you guys actually lose money on medicare patients? If so, why does anyone agree to do anes. for elective procedures on medicare patients? If you are still making a thin profit on medicare patients does that mean you are making a HUGE profit on privately insured patients?

Just curious- cause it seems kind of an anomaly; usually private insurance is in the same ballpark - ie 110% of medicare not 300%. Thanks for the info.

 

[pd4emergence]

I'm kind of curious about this medicare paying 33% of private insurance to anesthesia. I've heard this before... but what does it mean? Do you guys actually lose money on medicare patients? If so, why does anyone agree to do anes. for elective procedures on medicare patients? If you are still making a thin profit on medicare patients does that mean you are making a HUGE profit on privately insured patients?

Just curious- cause it seems kind of an anomaly; usually private insurance is in the same ballpark - ie 110% of medicare not 300%. Thanks for the info.

We get paid on a per "unit" basis. We get certain number of units per case. Each unit is paid x amout of dollars depending on who pays it. If a private insurer is paying it in my state the number is x. If medicare is paying it in my state the number is about .34x. We are a hospital based specialty. We do the cases in the hospital or surgery center that are scheduled. That is usually how it goes. We just can't say that we are not going to do that pt because they have medicare. There is a huge disparity in the % of reimbursement for anesthesia when compared to other specialties when you look at medicare and private insurers. In my state medicare reimburses a surgeon about 80% on average of what the major private insurer would. That 33% number is real in regards to anesthesiology.

 

[SleepIsGood]

We get paid on a per "unit" basis. We get certain number of units per case. Each unit is paid x amout of dollars depending on who pays it. If a private insurer is paying it in my state the number is x. If medicare is paying it in my state the number is about .34x. We are a hospital based specialty. We do the cases in the hospital or surgery center that are scheduled. That is usually how it goes. We just can't say that we are not going to do that pt because they have medicare. There is a huge disparity in the % of reimbursement for anesthesia when compared to other specialties when you look at medicare and private insurers. In my state medicare reimburses a surgeon about 80% on average of what the major private insurer would. That 33% number is real in regards to anesthesiology.

That's interesting. THen it does beg the question the previous poster asked. Wouldnt medicare 'change' if we refused to do ELECTIVE cases on their pts? Obviously emergent/urgent cases are a different story.

I feel as though this would be perceived to make anesthesiologists look like greedy people. If surgeons are making 80% of the rate and we are onlymaking 33%, we should be paid comparably per unit.

 

[militarymd]

That's interesting. THen it does beg the question the previous poster asked. Wouldnt medicare 'change' if we refused to do ELECTIVE cases on their pts? Obviously emergent/urgent cases are a different story.

I feel as though this would be perceived to make anesthesiologists look like greedy people. If surgeons are making 80% of the rate and we are onlymaking 33%, we should be paid comparably per unit.

"refused to do ELECTIVE cases on their pts?"

if it were only that simple.

There are multiple factors that dictate what type of cases you can or cannot "refuse" to do:

- if you are employed (and it's going in that direction) your employer will decide whether you can "refuse" or not...and the answer will be no especially if your employer is the hospital

- medical staff bylaws also has some say in what cases you will or will not do...and in general the medical staff bylaws will say that you can NOT just refuse a case scheduled in the middle of the day just because of the type of insurance the patient carries.

- if YOU or your GROUP holds an exclusive contract (something many groups seek) with a subsidy (most groups), there will be a clause that says you can NOT refuse to do a case.



Or you could just be you, and refuse to do Medicare...and the CRNAs will step right up to the plate and do it.

You are in a LOSE, LOSE, and LOSE situation if you decide that you are mighty enough to refuse Medicare.

 

[ProRealDoc]

i'm assuming the hospital not discriminating whether someone is a nurse (nurse practioner with a PhD or DNP) vs a physician. Atleast that's what it sounds like.

BS....I wrote a letter to the senators of my state...i hope you guys did too.

I believe it also addresses the 'discrimination' that insurances companies commit against nurse practitioners and other allied health professionals when they are denied reimbursements equal to physicians when performing similar services.

 

[ProRealDoc]

"refused to do ELECTIVE cases on their pts?"

if it were only that simple.

There are multiple factors that dictate what type of cases you can or cannot "refuse" to do:

- if you are employed (and it's going in that direction) your employer will decide whether you can "refuse" or not...and the answer will be no especially if your employer is the hospital

- medical staff bylaws also has some say in what cases you will or will not do...and in general the medical staff bylaws will say that you can NOT just refuse a case scheduled in the middle of the day just because of the type of insurance the patient carries.

- if YOU or your GROUP holds an exclusive contract (something many groups seek) with a subsidy (most groups), there will be a clause that says you can NOT refuse to do a case.



Or you could just be you, and refuse to do Medicare...and the CRNAs will step right up to the plate and do it.

You are in a LOSE, LOSE, and LOSE situation if you decide that you are mighty enough to refuse Medicare.

Totally true.

 

[SleepIsGood]

"refused to do ELECTIVE cases on their pts?"

if it were only that simple.

There are multiple factors that dictate what type of cases you can or cannot "refuse" to do:

- if you are employed (and it's going in that direction) your employer will decide whether you can "refuse" or not...and the answer will be no especially if your employer is the hospital

- medical staff bylaws also has some say in what cases you will or will not do...and in general the medical staff bylaws will say that you can NOT just refuse a case scheduled in the middle of the day just because of the type of insurance the patient carries.

- if YOU or your GROUP holds an exclusive contract (something many groups seek) with a subsidy (most groups), there will be a clause that says you can NOT refuse to do a case.



Or you could just be you, and refuse to do Medicare...and the CRNAs will step right up to the plate and do it.

You are in a LOSE, LOSE, and LOSE situation if you decide that you are mighty enough to refuse Medicare.

http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html

http://www.heraldnet.com/article/20...l.cuts.senior.care.nonpartisan.agency.reports

finally check this out:
http://www.beckersasc.com/news-anal...-about-anesthesia-and-anesthesia-in-ascs.html

the last link talks about how anesthesiologists at ASC that accept Medicare are getting subsidized.

 

[SleepIsGood]

From your last link. Point 2:

"ASCs that do not employ or have anesthesiologists as investors will likely have to compete with other facilities,..."


All this means is that we are a commodity in short supply. When supply meets demand- Look out. I agree that some other specialties have more ability to say "NO" to medicare. But our ability to do so is almost nonexistent.

I agree. Unless the hospital/surgeon says "no", our ability to say it is somewhat non existent.

 

[militarymd]

"refused to do ELECTIVE cases on their pts?"

if it were only that simple.

There are multiple factors that dictate what type of cases you can or cannot "refuse" to do:

- if you are employed (and it's going in that direction) your employer will decide whether you can "refuse" or not...and the answer will be no especially if your employer is the hospital

- medical staff bylaws also has some say in what cases you will or will not do...and in general the medical staff bylaws will say that you can NOT just refuse a case scheduled in the middle of the day just because of the type of insurance the patient carries.

- if YOU or your GROUP holds an exclusive contract (something many groups seek) with a subsidy (most groups), there will be a clause that says you can NOT refuse to do a case.



Or you could just be you, and refuse to do Medicare...and the CRNAs will step right up to the plate and do it.

You are in a LOSE, LOSE, and LOSE situation if you decide that you are mighty enough to refuse Medicare.

http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html

http://www.heraldnet.com/article/20...l.cuts.senior.care.nonpartisan.agency.reports

finally check this out:
http://www.beckersasc.com/news-anal...-about-anesthesia-and-anesthesia-in-ascs.html

the last link talks about how anesthesiologists at ASC that accept Medicare are getting subsidized.

As I've always suspected...You are ******ED, and you can't read...and don't understand the nuances of the practice of medicine as it applies to customers/clients (surgeons/proceduralists) and those who service them (us).

Go right ahead and refuse to take Medicare....I hope you can pay off your loans...

 

[militarymd]

I agree. Unless the hospital/surgeon says "no", our ability to say it is somewhat non existent.

and they won't because their rates are similar to commercial rates....

Have you EVER looked at the facility fees.......the schedules ABSOLUTELY screws us.

 

[SleepIsGood]

As I've always suspected...You are ******ED, and you can't read...and don't understand the nuances of the practice of medicine QUOTE]

coming from you, I'll take that as a compliment

Re-READ my post. I didnt say we could refuse Medicare. I just mentioned it in reference to the previous poster's comment. If strictly doing anesthesia, it's certainly a very difficult task.

 

[militarymd]

coming from you, I'll take that as a compliment

Re-READ my post. I didnt say we could refuse Medicare. I just mentioned it in reference to the previous poster's comment. If strictly doing anesthesia, it's certainly a very difficult task.

On the other hand, if 75% of anesthesia providers just dropped dead in the next year from Halogenated Hydrocarbon Exposure & Asphyxia Toxicity Syndrome (otherwise known as HHEAT Syndrome in the literature)

....you bet you can refuse Medicare...and actually ask the hospital for a percentage of the facility fee.

So, it's actually a shame that HHEAT Syndrome has a very low overall mortality.

 

[Eta Carinae]

so now that Reid has been able to buy Nelson's (D, NE) vote, it seems the senate is ready to go ahead with a filibuster-proof passage of the Health Bill.

I wonder if they found ignoble photos of Nelson rumping with a fee-for-service date?

TEA party anyone?

 

[slunk]

As I've always suspected...You are ******ED, and you can't read...and don't understand the nuances of the practice of medicine as it applies to customers/clients (surgeons/proceduralists) and those who service them (us).

Go right ahead and refuse to take Medicare....I hope you can pay off your loans...

Selling out your own specialty and propping up surgeons seems to go hand in hand for a lot of private practice anesthesiologists. Wonder why.

My main concern is to take care of the patient, not "service" the surgeon.

Its sad that a lot of the talented, highly qualified anesthesiologists just finishing residency/ fellowship the past few years may not have as bright a future as the foolioz who sold out the specialty long ago.