We may not always win, but we always must be heard!
All advocacies are competitive. Every group is fighting hard to have its voice heard by legislators and regulators. We attend the ASA Legislative Conference in order educate ourselves about the issues and effective advocacy for our members.
It was a privilege to attend this year’s legislative conference in Washington, DC with 16 other CSA members, including four CSA resident members. Legislative advocacy is such an essential function of our professional societies (both state and national), and it’s informative to see the regional issues our specialty faces in many states as well as learn what is happening at the federal level. The first day of the conference focused on state issues. Leaders for several state societies discussed issues that affect all of our states, including independent practice of nurse anesthetists, state licensing for anesthesia assistants (AAs), the expanding scope of practice of non-physician providers and nurse anesthetists attempting to expand their role into chronic pain management. Several states are dealing with expansion of practice across many specialty areas, with optometrists seeking to treat eye disease, pharmacists wanting prescriptive authority, and psychologists prescribing psychoactive drugs. To ensure the safety of patients some states are seeking to define chronic pain management and interventional pain procedures as the practice of medicine. While there have been a few successes at the state level on the legislative front, the overall tenor is a bit depressing for those seeking to protect patients from inadequately trained providers seeking to extend their reach into areas where physicians in general and highly trained anesthesiologists in particular, provide excellent, high quality care.
The second day focused on federal issues, which is where the ASA places the main focus of its advocacy efforts. As a result of last year’s advocacy efforts we saw legislative success in dealing with drug shortages; language was included in the FDA Safety and Innovation Act requiring manufacturers to report anticipated shortages to the FDA. While shortages persist, the FDA now has more information to proactively manage the situation.
This year the ASA is advancing legislation with bipartisan authors to require all of providers of care to disclose their training and licensure, with the goal of better informing patients who is providing their care so they can make informed decisions. Repeal of the Independent Payment Advisory Board (IPAB) under PPACA and finding a solution for the Sustainable Growth Rate (SGR) under Medicare are also two key thrusts of the ASA again this year. The good news is that we have wide support from both other medical specialties and from Congress on these issues. Another federal issue is payment for anesthesia care in eligible rural hospitals. Currently, nurse anesthetists can provide care in these facilities and receive compensation through a “pass through” to CMS under Medicare Part A payments. Anesthesiologists are not eligible to receive this higher rate of compensation afforded nurse anesthetists in these hospitals and must bill under Medicare Part B. ASA is advocating for parity in payment for physicians in these rural access hospitals. The briefings from the ASA on these key issues may be accessed here.
Many guest speakers addressed the conference on day two. The Honorable Andy Harris, MD, our only anesthesiologist in Congress, gave a very informative and dynamic presentation. Dr. Harris has been appointed to, and is the only physician to serve on the important congressional Appropriations Committee, which provides funding for HHS, CMS, NIH, FDA and other agencies of the executive branch of government. He feels that the time is right to come up with a permanent SGR fix. According to the Congressional Budget Office, the cost of this fix over 10 years is $139 billion, about half of prior estimates. While that’s still a daunting sum to find other cuts to replace, the solution appears more within reach than in prior years. This is expected to be one of the few initiatives that may move forward in a very divided and dysfunctional Congress.
Turning legislation into regulation is the function of the executive branch of government, and the ASA is equally involved in monitoring proposed rules as they are published for comment in the Federal Register. This may, in fact, be the most important function of the ASA Washington office. While the legislation for PPACA was daunting in length, over 9,000 pages of regulation have accompanied implementation of this legislation. As issues arise in proposed regulation require member comment, you may be contacted by the ASA to assist in providing comments to regulators.
After a short session the third morning, which this year included a presentation on Quality Measurement in Anesthesiology, given by our own Dr. James Moore, most attendees were off to visit offices on Capitol Hill. Unfortunately, Congress was in recess during the week of the conference, but on the positive side, this provided more time to focus lobbying efforts on legislative staff, who brief and advise congressmen on the issues As in past years, our California contingent was very thorough in visiting the offices of our two Senators and representatives from the attendees’ congressional districts.
Any help you can personally give your specialty is critical in this challenging political environment. Visiting the office of your local congressman or state elected official, supporting their election or re-election as appropriate, and contributing to GASPAC and ASAPAC are just a few things you can do to advance all of our interests.
We have to fight hard to be heard. We can’t always win, but we can always effectively represent our positions. If we can’t personally to do the work ourselves, at a minimum, we must support others who are willing.