Advocacy Update
ASA Monitor Today
Up-to-the-minute news on ASA’s advocacy activities, what’s happening at the federal and state level that affects ASA members, thoughts from ASA’s D.C. staff, and more.
July 26 | June | May | April | March | February | January
Broken Medicare System? CMS seeking Reduced Physician Payments in 2024
July 26
On July 13, CMS released its Calendar Year (CY) 2024 Medicare Physician Fee Schedule (PFS) proposed rule, which includes proposals related to Medicare physician payment and the Quality Payment Program (QPP). Within the fee schedule, CMS proposed Medicare payment cuts to the Anesthesia Conversion Factor that will only compound the financial strain that anesthesia groups are already facing. The proposed rule has a 60-day comment period. Final regulations will be issued on or around November 1 and unless otherwise noted, policies will be effective on January 1, 2024.
ASA opposes these additional Medicare payment cuts included in the CY 2024 PFS proposed rule. The proposed rule underscores how the Medicare payment system is broken, especially during a time when anesthesia groups are faced with continued inflation pressures. ASA has already launched an initiative to engage legislative stakeholders and regulatory agencies to minimize and reverse these cuts that negatively impact anesthesiologists.
For in-depth coverage of the impact of the fee schedule provisions, payment rates, pain medicine code updates, quality payment program provisions, and more, visit ASA’s Washington and Federal Alerts website.
June
A new home for CAAs
June 15
Nevada Gov. Joe Lombardo signed into law Assembly Bill 270, which authorizes licensure of certified anesthesiologist assistants to provide anesthesia care in the state. ASA and the Nevada State Society of Anesthesiologists applaud this action, which will make the services of CAAs available to Nevada patients.
“This action allows patients to benefit from the highly trained care CAAs already provide in more than 20 jurisdictions,” said Michael W. Champeau, president of ASA. “CAAs balance and supplement the perioperative anesthesia workforce and actively contribute to better access, increased quality, and improved service line expansion efforts in patient care.”
CAAs are trained extensively in the delivery of quality anesthesia care as well as advanced patient monitoring techniques. They work exclusively under the medical direction of physician anesthesiologists to implement anesthesia care plans within the Anesthesia Care Team model of care where there are up to four non-physician anesthesia providers (i.e., CAAs and nurse anesthetists) per anesthesiologist.
All CAAs possess a pre-medical undergraduate education and complete a comprehensive educational and clinical graduate program at the master’s degree level. CAAs are fully recognized by the Centers for Medicare & Medicaid Services and the U.S. Department of Veterans Affairs system.
“Gov. Lombardo’s action will help Nevada keep pace with the growing demand for anesthesia services, while ensuring optimal patient safety under the ACT model of anesthesia care,” said NSSA President and Director Nariman Rahimzadeh, MD, FASA. “We’d like to express our gratitude to members of the state legislature who worked tirelessly with NSSA to help advance this bill.”
Legislative Conference 2023 – Advocacy in Action
June 14
Thank you to everyone who helped make Legislative Conference 2023 a success. More than 500 attendees (including more than 100 residents) from 43 states and territories spent three days in Washington, D.C. to learn about the top federal issues impacting the specialty, hear from elected officials, and then advocate directly with lawmakers.
Initial reports indicate that meetings were productive and persuasive, as ASA members spoke about physician-led anesthesia care in the Department of Veterans Affairs, Medicare payment reform, implementation of the No Surprises Act, workforce issues, and access to naloxone.
It’s not too late to submit a meeting report! All members are encouraged to download the ASA Advocacy App to learn more about these issues and to send a message to their lawmakers.
Members of the California Society of Anesthesiologists meet with Rep. Julia Brownley, center right (D-CA-26).
The Pennsylvania Society of Anesthesiologists in the office of Rep. John Joyce, left (R-PA-13).
Rep. Val Hoyle, left, meeting with members of the Oregon Society of Anesthesiologists.
May
HALT Act and medical-use fentanyl
May 26
On Thursday, May 25, the U.S. House of Representatives voted on a bipartisan basis to pass H.R. 467, the Halt All Lethal Trafficking of (HALT) Fentanyl Act, legislation that would permanently place fentanyl analogues or fentanyl-related substances (described as “any substance that is structurally related to fentanyl by one or more modifications”) as a Schedule 1 controlled substance. The HALT Act does not target medical-use fentanyl, which is a Schedule II drug.
ASA worked closely with Rep. Guthrie, Chair of the Energy and Commerce Health Subcommittee, and members of House leadership to ensure that the HALT Act does not interrupt the supply of medical fentanyl in ORs. Rep. Guthrie has made statements for the Congressional record to reaffirm Congress’ intent to maintain the supply of medical fentanyl in surgery. Earlier this week, members of the House Doctors’ Caucus, including ASA member Rep. Andy Harris, hosted a press conference on the importance of the legislation and differentiated between the need for medical-use fentanyl and illicit fentanyl.
ASA will monitor the advancement of this legislation as it moves to the Senate.
South Carolina Society recognized for win against independent practice bill
May 12
In 2022, the South Carolina Society of Anesthesiologists (SCSA) was the recipient of the Component Recognition Award in the Medium Component category for their legislative win against the South Carolina Association of Nurse Anesthetists (SCANA). At the beginning of the 2021-2022 South Carolina General Assembly Session, SCANA introduced House Bill 3682, which would have removed all requirements of physician supervision.
The SCSA quickly mobilized to defeat the bill and educate legislators on patient safety and the anesthesia care team.
The SCSA developed a multifaceted action plan that included the development of social media materials, handouts for legislators and staff, and engaging the South Carolina Medical Association (SCMA) and other specialty societies. The handouts for legislators were compelling and illustrated the impact of H.B. 3682 on patient safety in South Carolina, noting that it would completely remove the requirement for physician supervision of anesthesia care. A letter was sent to State Rep. Leon Howard, Chairman of the House Medical, Military, Public and Municipal Affairs Committee, opposing the bill, and was signed by 15 state medical specialty societies, including SCMA, the South Carolina Chapter of the American College of Surgeons, the South Carolina Chapter of the American College of Physicians, and the South Carolina Society of Emergency Medicine Physicians, to name a few.
The society also created a document for its members outlining talking points in opposition to H.B. 3682 and the importance of physician supervision of CRNAs. The SCSA sent over 50 anesthesiologists to the state house lobby during the critical month of debate to speak with legislators and urge them to oppose the bill. Members participated in fundraisers, sent numerous call to action emails, and set up individual meetings with leaders in the General Assembly. In the end, the SCSA was successful, and H.B. 3682 was defeated in March 2022. “Advocating for patient safety is at the core of why the SCSA exists. The SCSA is committed to maintaining physician supervision of all anesthetists,” stated Margarita M. Pate, PhD, Executive Director of the SCSA.
The SCSA is committed to maintaining physician supervision of all anesthetists,” stated Margarita M. Pate, PhD, Executive Director of the SCSA.
The SCSA had approximately 450 active members in 2022. As a recipient of the 2022 Component Recognition Program award, the SCSA was presented with the award at the August 20, 2022, Board of Directors meeting and received a $1,500 prize to continue with their advocacy or other society initiatives.
To learn more about the South Carolina Society of Anesthesiologists’ advocacy efforts, contact Margarita M. Pate at mpscsa@gmail.com. Applications for the 2023 Component Recognition Program are now open.
Visit the Component Recognition Program webpage to learn more, or email Brittney Conway, Component Relations Manager, at b.conway@asahq.org.
Photo caption: ASA CEO Paul Pomerantz, SCSA member Laura L. Roberts, ASA Director for South Carolina Jennifer Root, ASA Immediate Past President Randall M. Clark, and SCSA Executive Director Margarita M. Pate, PhD.
April
WVSA recognized for standout advocacy efforts
April 20
The West Virginia Society of Anesthesiologists (WVSA) is the recipient of the 2022 Component Recognition Program Award in the Small Component category for their advocacy initiatives affecting patient safety. After many years of relative quiet related to advocacy within the state, the WVSA faced three consecutive years of bills that were introduced into the state legislature to remove physician leadership of anesthesia care teams and to allow independent anesthesia practice of nurses in West Virginia.
The promoters of the bills were aggressive, so the WVSA had to innovate and improve its defense of patient safety in the state. The result was that each year, West Virginia anesthesiologists defeated attempts to remove physician leadership of anesthesia care teams.
In addition to the above efforts, the WVSA organized a survey of West Virginia citizens by a polling firm respected by state politicians. The survey revealed the expected overwhelming support for physician anesthesiologists, the results of which were widely publicized. The society also published two op eds in the Charleston Gazette, the newspaper most read by state legislators, in favor of physician anesthesiologist leadership of anesthesia care teams.
The WVSA engaged their membership by assigning local members to communicate directly with each legislative health committee member (except for the two committee members who promoted the nurse bill) about the importance of patient safety. Lastly, the WVSA strengthened their partnership with the state medical association. Their lobbyists and members supported the WVSA’s efforts to defeat the nurse independent practice bills. Two WVSA members, Dr. Johnstone and Pavithra Ellison, MD, FASA, spoke at the annual state medical association meeting, and several members now participate in the state medical PAC leadership.
The WVSA had approximately 140 members in 2022. This was a great example of how a small society, through organization and communication, can make a big impact on anesthesia practice. As a recipient of the 2022 Component Recognition Program Award, the WVSA was recognized at the August 20, 2022, ASA Board of Directors meeting and received a $1,500 prize to continue with their advocacy and other society initiatives.
To learn more about the West Virginia Society of Anesthesiologists’ advocacy efforts, contact Robert E. Johnstone, MD, FASA, at johnstoner1944@gmail.com. Applications for the 2023 Component Recognition Program are now open. Visit the State Component Resources webpage to learn more or email Brittney Conway, Component Relations Manager, at b.conway@asahq.org.
Photo caption: ASA CEO Paul Pomerantz; Ralph Harding, DO; 2022 ASA President Randall Clark, MD, FASA; and Robert Johnstone, MD, WVSA Secretary.
March
Legislative conference 2023
March 28
ASA’s Legislative Conference 2023 will take place May 15-17 at the Hyatt Regency Washington on Capitol Hill, Washington, D.C. This conference is devoted to protecting patient care and advocating for the specialty at the highest level.
Join fellow physician anesthesiologists, residents, certified anesthesiologist assistants, students, anesthesia practice administrators and executives, and state component staff for a unique opportunity to:
- Stay current about federal issues impacting the specialty.
- Learn how to influence legislative and regulatory efforts at the federal level.
- Connect with elected officials to help guide federal health care policy.
- Hear about ASA's legislative, political, grassroots, and regulatory agenda for 2023.
Medical associations call on CMS to resume all disputed No Surprises Act payment determinations
March 17
The American College of Emergency Physicians (ACEP), the American College of Radiology® (ACR®), and the American Society of Anesthesiologists (ASA) are urging the Centers for Medicare and Medicaid Services (CMS) to quickly resume all independent dispute resolution (IDR) payment determinations paused by its order on Feb. 6. While CMS provided some relief Feb. 24, when it instructed certified IDR entities to resume making determinations for payment disputes involving services furnished before Oct. 25, ACR, ACEP, and ASA call on the agency to resume swift determinations for disputes involving items or services furnished on or after Oct. 25 as well.
CMS temporarily halted the IDR process payment determinations — included in the No Surprises Act passed into law in December 2021 — following a U.S. District Court for the Eastern District of Texas decision in the case of Texas Medical Association, et al., v. United States Department of Health and Human Services. The medical associations assert that the government’s pause exacerbates the existing backlog of IDR determinations, causing harm to health care providers who provided those services.
ACR, ACEP, and ASA jointly supported the Texas Medical Association’s lawsuit by filing an amicus brief last October. Two additional lawsuits have been filed by the Texas Medical Association addressing the qualifying payment amount (QPA) calculation methodology, the 600% administrative fee increase for the IDR process announced in December, and overly restrictive batching rules. ACR, ACEP, and ASA filed amicus briefs on the QPA lawsuit in late January and the administrative fee increase and batching lawsuit in February.
Read the latest ASA Monitor article on the No Surprises Act here and follow our continued coverage in ASA Monitor Today and on our social media channels.
February
You know how to organize an anesthesia cart, but do you know how Congress is organized?
February 21
Republicans claimed control in the House of Representatives with a 222-213 majority. In the Senate, Democrats maintained the majority, gaining a one vote margin of 51-49. Considered the more deliberative body (House loyalists will disagree!), the Senate convened on January 3 with no drama, elected its leadership, and has taken a measured approach to committee appointments.
As we saw during the – count them – 15 votes for House Speaker, the Clerk of the House (appointed by the previous Speaker, Nancy Pelosi) presided over the House of Representatives until Rep. Kevin McCarthy (R-CA) was finally elected. Only after the Speaker’s election could the House organize, electing other party and committee leaders and appointing Members of Congress to their committee assignments. Following are the leaders and physicians appointed to the assignments to key committees that ASA engages.
Who do you know?
Please take a look at the committee memberships for the 118th Congress and send us a quick note at grassroots@asahq.org.
Senate Health, Education, Labor and Pensions Committee (“HELP”):
Chair: Bernie Sanders (D-VT)
Ranking Member: Bill Cassidy, MD (R-LA)
Physician Members: Roger Marshall, MD (R-KS), Rand Paul, MD (R-KY)
Senate Finance Committee:
Chair: Ron Wyden (D-OR)
Ranking Member: Mike Crapo (R-ID)
Physician Members: Bill Cassidy, MD (R-LA), John Barrasso, MD (R-WY)
Senate Veterans’ Affairs Committee:
Chair: Jon Tester (D-MT)
Ranking Member: Jerry Moran (R-KS)
House Appropriations Committee:
Chair: Kay Granger (R-TX-12)
Ranking Member: Rosa DeLauro (D-CT-2)
Food and Drug Administration Subcommittee Chair: Andy Harris, MD (R-MD-1)
House Ways and Means Committee:
Chair: Jason Smith (R-MO-8)
Ranking Member: Richie Neal (D-MA-1)
Physician Member: Greg Murphy, MD (R-NC-3)
House Energy and Commerce Committee:
Chair: Cathy McMorris Rogers (R-WA-5)
Ranking Member: Frank Pallone (D-NJ-6)
Physician Members: Michael Burgess, MD (R-TX-26), Larry Bucshon, MD (R-IN-8), Neal Dunn, MD (R-FL-2), John Joyce, MD (R-PA-13), Marianette Miller-Meeks, MD (R-IA-1), Raul Ruiz, MD (D-CA-25), Kim Schrier, MD (D-WA-8)
House Veterans’ Affairs Committee:
Chair: Mike Bost (R-IL-2)
Ranking Member: Mark Takano (D-CA-41)
Health Subcommittee Chair: Marianette Miller-Meeks, MD (R-IA-1)
Ranking Member: Julia Brownley (D-CA-27)
Physician Member: Greg Murphy, MD (R-NC-3)
January
ASA meets with HHS staff on Medicare supervision rule, regulatory relief from NSA implementation
January 25
ASA kicked off the new year with a series of meetings with senior staff from the U.S. Department of Health and Human Services (HHS) as part of campaigns to secure the retention of the Medicare supervision rule and to achieve regulatory relief for anesthesiologists from the flawed implementation of the federal No Surprises Act (NSA).
As a follow-up to meetings in 2022, ASA President Michael Champeau recently met with HHS officials to urge the retention of the Medicare supervision rule – the rule that requires physician oversight over nurse anesthetists. The rule is currently under an enforcement waiver implemented in March 2020 as part of the federal government’s public health emergency (PHE) declaration. With the PHE expected to conclude in the coming months, CMS is undertaking a process to determine which waivers should be made permanent. The supervision rule is among the waivers under CMS review. Dr. Champeau presented ASA’s arguments that the Medicare supervision rule represents an important longstanding patient safety standard that supports the safest, highest-quality care for Medicare beneficiaries and that it should be retained. Dr. Champeau has additional meetings on the subject in the coming months.
Dr. Champeau and other ASA representatives also met with the leadership of the Center for Consumer Information and Insurance Oversight (CCIIO) to seek relief from problems with the implementation of the NSA. Of particular interest to ASA are the current CCIIO rules and guidance related to the batching of anesthesia claims for the independent dispute resolution (IDR) process. Currently, anesthesiologists and their groups are severely restricted in how they can batch their anesthesia disputes. Only claims from the same health plan and the same CPT code may be batched. ASA has argued that with the significant backlog of disputes pending in IDR entities, larger, more robust batches should be permitted so that the entities can resolve the large numbers of anesthesia disputes in a single action. ASA pushed for agency to permit the batching of all anesthesia CPT codes for all beneficiaries covered by the same insurance “issuer.” ASA has also conveyed the urgent need for the agency to resolve problems with unreasonably low qualifying payment amounts (QPA) and delays in IDR consideration of disputed claims.
Join ASA leadership for a special virtual wine tasting
January 24
Please join ASA President Mike Champeau, Ron Harter, Don Arnold, Lois Connolly, Kraig de Lanzac, Jay Mesrobian, Crystal Wright, Patrick Giam, Paul Yost, Julius Hamilton, Jim Kelly, Erin Sullivan, Joseph Koveleskie, Knox Kerr, John Scott, ASA CEO Paul Pomerantz, Chief Advocacy Officer Manuel Bonilla, Director of Congressional and Political Affairs Nora Matus, and members of the Host Committee for a virtual reception on Wednesday, February 15, 2023, at 8 p.m. EDT. Based on the strong feedback received after last year’s reception, we are pleased to announce that we will again be joined by a guest speaker from Pine Ridge Vineyards, who will discuss the signature wines that will be enjoyed during the reception.
If you are among the first 100 ASAPAC donors to make a new contribution of $500 between January 20 and January 31, you will receive an invitation to the reception and receive a special selection of wines from Pine Ridge Vineyards. All contributions will go toward support of the continuous advocacy efforts of the ASAPAC. You can also sign up for the virtual ASAPAC wine tasting with ASA leaders. Hurry, though – space is limited!
Once you make your contribution, please RSVP via email to asapac@asahq.org and include your phone number and your current mailing address where you can receive FedEx shipments. If you do not confirm your mailing address in your RSVP, you will not be included in the final guest count. We hope you join us for this unique experience!
State Legislative Committee Assignments
January 19
ASA congratulates ASA member Tim Melson (R) on his new position as Chair of the Alabama Senate Healthcare Committee. He was recently reelected to represent District 1 in the 2022 election. Dr. Melson was first elected in November 2014 and was the first physician anesthesiologist elected to the Alabama Senate. He is an anesthesiologist at Helen Keller Hospital in Alabama, where he has served as Chief of Anesthesia. He has also served as Chair of the Education Policy Committee and Vice Chair of the Finance and Taxation Education Committee.
Congratulations, Dr. Melson!
On the Road with State Affairs
Last week, I attended the AMA State Advocacy Summit in Marana, Arizona, with Michael Champeau (ASA President), Michael Beck (Chair of ASA’s Task Force on State Advocacy), and Paul Pomerantz (ASA CEO). This conference provides the opportunity for key volunteer physicians and staff from state and specialty medical associations from across the nation to learn about legislative issues of importance to medicine. ASA attends the conference each year.
Presentations included:
- The Current Political and Legislative Landscape: What it Means (Speaker: Charlie Cook)
- Scope of Practice: The Value of Data to Drive Policy (Moderated by anesthesiologist Claude Brunson, with panelists Bryan Batson [CEO, Hattiesburg Clinic] and David C. Chan Jr. [Associate Professor, Stanford University])
- State Departments of Insurance – 2023 Priorities
- Competition and Antitrust Policy: What’s Going On?
- Telehealth: Advancing Policies to Ensure High-Quality Care
- The Nation’s Overdose and Death Epidemic: What Will It Take for Policymakers to Listen to Physicians?
The takeaways were clear – 2023 is going to be a busy year. And now, more than ever, physician leaders need to be engaged in the variety of state advocacy campaigns that can help or hurt their patients.
Advocacy update: State Legislatures are Back in Session
January 18
As of the first week of January, about 39 state legislatures and the District of Columbia were back in session, and more will convene in the coming weeks and months.
With these new legislative sessions, ASA’s State Affairs staff is expecting several states to again consider dangerous and unnecessary legislation that would reduce or fully remove physician involvement from anesthesia care. ASA is working in partnership with about one dozen states to advance certified anesthesiologist assistant (CAA) licensure bills. Additionally, ASA is working with a number of states to introduce legislation that would protect patients from misleading nursing titles, like the deceptive phrase “nurse anesthesiologist.”
As a result of the recent elections, there are new legislatures that will be called upon to consider these complex bills that have far-reaching consequences (or in the case of the CAA initiatives, opportunities) for patient safety. Now, more than ever, it is time to connect with your state component and offer to connect with and ultimately serve as a health policy resource for the lawmakers in your district. For more information about what is happening in a specific state or how to get involved, please contact advocacy@asahq.org
State Advocacy by the numbers – A 2022 snapshot
January 18
ASA’s state components finished a successful advocacy year in 2022 with:
- No new independent practice states (there were 12 states that considered scope of practice legislation)
- Two new states prohibited misleading nursing titles like “nurse anesthesiologist”
- Two new states authorized CAA practice
Twelve state legislatures considered advancing misguided legislation that would have reduced or eliminated physician involvement requirements for nurse anesthetists. State Affairs staff worked very closely with the component societies in these states, achieving strong wins that maintain patient safety. In Florida, such legislation was defeated for the 23rd year in a row. North Carolina also defeated another attempt from nurse anesthetists to expand their scope of practice. In Wisconsin, the component society faced dangerous scope of practice bills. They, along with other medical professionals in the state, voiced their strong concerns throughout the legislative process, and in a significant win for patient safety, the governor made the appropriate decision to veto the measure. The governor’s veto message provides in part that he made this decision because he opposes “altering current licensure standards for APRNs, allowing practices functionally equivalent to those of physicians or potentially omitting physicians from a patient’s care altogether notwithstanding significant differences in required education, training, and experience.”
Misleading nursing titles remain an issue of high concern for ASA, with continued efforts to protect patients from nurse anesthetists seeking to use the deceiving descriptor or title “nurse anesthesiologist.” Such descriptors and titles are inappropriate, as they mislead and confuse patients. In a significant win for patient safety, Indiana enacted medical title misappropriation legislation that prohibits anyone who is not a physician from using medical and medical specialty titles or designations, including “anesthesiologist,” “cardiologist,” “dermatologist,” and many others. The legislation also prohibits health care professionals from using deceptive or misleading advertising that misrepresents or falsely describes their profession, education, or skills. In South Carolina, the Board of Nursing approved a motion preventing use of the term “nurse anesthesiologist” by limiting nurse anesthetists to using only their statutorily defined term – certified registered nurse anesthetist – in professional written and verbal communications.
In Utah, the governor signed into law legislation authorizing CAAs to practice in the state. In Pennsylvania, the Department of State opined that the state’s medical practice act expressly authorizes a physician to delegate medical services. With these actions, CAAs are now authorized to practice in 20 jurisdictions.
2022 was a busy and eventful year with patient safety as the winner. With the 2023 legislative session, state lawmakers will again consider several nurse anesthetist-driven bills that put nursing special interests in the driver’s seat and patient safety in the far back. It is more important than ever for anesthesiologists to connect with governors, state legislators and their staff, and regulatory board members to have a voice in the deliberations that affect both physicians and their patients. For more information about what is happening in a specific state or how to get involved, please contact advocacy@asahq.org.
ASA member advocacy in action
January 10
Last week, we spent some time with ASAPAC Board member Knox Kerr, who is going to be the Key Contact for Rep-elect Aaron Bean of the new Fourth District in Florida. Rep. Bean previously served in the Florida Senate (as president). In the months when Bean was running his campaign, Dr. Kerr became a model Key Contact: he arranged a meeting with Bean to discuss ASA’s federal issues and participated in some of his campaign events. Subsequently, Dr. Kerr was invited by Rep-elect Bean to come to D.C. last week for the first days of the 118th Session of Congress. Dr. Kerr attended a dinner, an evening monument tour, and other activities arranged by Rep-elect Bean. Proof positive that joining our Grassroots Network can pay off in big ways!
