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.
ASA meets with HHS staff on Medicare supervision rule, regulatory relief from NSA implementation
ASA Chief Advocacy Officer Manuel Bonilla
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
Nora Matus, ASA Director of Congressional and Political Affairs
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 email@example.com 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
Jason Hansen, ASA Director of State Affairs
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.
- 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
Jason Hansen, ASA Director of State Affairs
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 firstname.lastname@example.org
State Advocacy by the numbers – A 2022 snapshot
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 email@example.com.
ASA member advocacy in action
Quintessential D.C.! ASA Key Contact Dr. Knox Kerr and Rep-elect Aaron Bean.
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!
Rep. Aaron Bean, Dr. Kerr, Speaker of the House Kevin McCarthy, and former Speaker of the House Newt Gingrich aboard the USS Orleck in support of Rep. Bean.