Gasline Newsletter April 2005

Volume 6, No. 1

2005 CSA/UCSD ANNUAL MEETING AND REVIEW COURSE

The 2005 CSA/UCSD Annual Meeting and Review Course takes place May 12 - 15 at the Hyatt Regency Embarcadero in San Francisco. This year's program offers up to 28.25 CME credits including the UCSD review course plus difficult airway and practice management workshops. The cutoff date for hotel reservations at the CSA rate is April 18. The cutoff date for early registration is April 15. Single day registration is available. Go to www.csahq.org and click on the Annual Meeting link to register on line, or call the CSA office at 800-345-3691.

RESOLUTIONS TO THE CSA HOUSE OF DELEGATES

Resolutions to the CSA House of Delegates are due at the CSA office by April 29. Any member may submit resolutions which recommend new policy or activities for the CSA to undertake. For information, call or send an email to the CSA office and ask for the handout "Writing and Submitting Resolutions."

MEDICARE LOCKED CART REGULATIONS

Regulations on locked carts, pre-op histories and physicals, post-op anesthesia notes were published for a 45-day comment period on March 25. The Centers for Medicare and Medicaid revised Medicare conditions of participation on locked carts in response to concerns first brought to the ASA by the CSA in 2003. The proposed rule deems operating rooms secure areas so carts do not have to be locked between cases. See the ASA web site at http://www.asahq.org/news/05-5916.pdf for the text of the regulations.

Adoption of the regulations in the published form is not guaranteed. Manufacturers of locked carts have lodged strong opposition to the locked cart rule, and members are urged to send letters of support to CMS by May 24. Decision makers give great consideration to real-life examples that support rule changes, so members are encouraged to report experiences where problems resulted, or almost occurred, from delayed access to medications. E-mail responses can be sent by logging on to the following CMS Web Site: http://www.cms.hhs.gov/regulations/ecomments [This link is no longer active as of 1/26/06.]. Additionally, the proposed changes in the CMS regulations addresses requirements for history and physical examinations, authentication of verbal orders, and postanesthesia evaluations.

AB 1321/YEE, PROHIBITION AGAINST BALANCE BILLING

This is a bill that would prohibit balance billing by hospital-based physicians. It is scheduled to be heard in the Assembly Health Committee on April 19. The CSA is sending a letter of strong opposition in an effort to keep the bill from being passed out of committee. Members are urged to send personal letters of opposition to their representatives. You can find your representative's contact information by logging on to www.leginfo.ca.gov, then click on "Your Legislature" and input your zip code. Send a cc to The Honorable Wilma Chan, Chair, Assembly Health Committee, State Capitol, Sacramento, 95814. See the CSA Web Site members only area www.csahq.org for the text of the letter.

CHIROPRACTIC MANIPULATION UNDER ANESTHESIA

The CSA sent a letter of strong opposition to draft regulations on chiropractic manipulation under anesthesia. Regulations were proposed in late 2004 and amended after vigorous protest by the CSA and other medical societies, particularly because of liability issues. The CSA is concerned about the use of drugs for manipulation by chiropractors, which are not allowed by the chiropractic act, and by a new proposed amendment intended to permit CRNAs, who are not allowed to act upon orders from chiropractors, to administer the anesthesia. Comments were due by April 9.

CSA BOARD OF DIRECTORS HIGHLIGHTS

The CSA Board of Directors met Saturday, April 2 and acted on several recommendations for new activities, all of which will be considered at the CSA Reference Committee Friday, May 13 and the House of Delegates on Saturday, May 14. Any CSA member can address issues at the Reference Committee Hearing.

A subcommittee of the Membership Committee will review the demographics of the current CSA districts and develop recommendations for changes in the boundaries of districts.
As part of the CSA efforts to defeat AB 1321, the CSA will emphasize that fair contracting practices by health insurance companies are the proper solution to the concerns raised by balance billing of patients for medical services by non-contracted physicians, not AB 1321.
CSA representatives will meet with representatives of other hospital-based specialties to share information on abusive payment practices for non-contracted physician billings and attempt to develop a strategy to address health plan payment abuses.
The Legislative and Practice Affairs Division will develop a policy statement on ethical billing practices by anesthesiologists to be presented to the House of Delegates at the May 2005 meeting.
The CSA Peer Review Committee will be empowered to review patient complaints arising from billing practices by California anesthesiologists.
The CSA will support AB 681, which would maintain the workers' compensation fee schedule at current rates until 2011. In the interim, the RBRVS fee schedule and Medicare-based conversion factors would not be adopted.
The CSA Communications Committee will consider a project to engage patients to advocate for Medicare Fee Reform and report back to the Board.
A letter will be sent to the Chair of the CMA Board of Trustees that the CSA has serious concerns about CMA-sponsored SB 932 (Kuehl) because of potential negative effects on legitimate peer review. CSA concerns include provisions that may discriminate against physicians who have any financial relationship with a hospital, including receiving stipends or payments for administrative services related to medical staff governance; and provisions that only independent non-profit entities would conduct medical staff hearings. Unless amended, organizations created by hospitals could be engaged to conduct medical staff hearings.
The CSA will continue to work with the CMA to resolve its concerns.

Finally, the CSA welcomes three new staff: Chief Operations Officer Michael Whitelock, Education and Member Services Coordinator Terrie Rowe, and Executive Administrative Assistant Susan Weiner.

Linda J. Mason, M.D.
President