Gasline Newsletter May 2003

Volume 4, No. 5

Pay Your Dues Online

The CSA's web site is undergoing major reconstruction and the first change is enabling members to pay their annual dues on-line. Requests for on-line dues payment have been increasing, and with dues assessments going out the week of June 2, the timing is optimal to have this new function up and running. Visit www.csahq.org to access the payment option. Instructions on accessing the secure site will be included in each member's invoice. By the end of summer the entire CSA Web Site will have a new image, easier navigation, and more information and links.

Annual Meeting Next Week in Disneyland

The CSA/UCSD Annual Meeting and Review Course takes place June 5-8 at the Disneyland® Hotel. Even if you can't attend the entire meeting, you can take advantage of daily registration. Limited space is still available in the workshops on practice management, TEE, difficult airway and regional anesthesia and pain control. See details on the CME meetings page. For those interested in learning about anesthesiologist assistants, an informational session with AA representatives will take place after the House of Delegates at 4:30 p.m. on Saturday.

DHS CONSULTANT CLARIFIES LOCKED CARTS, ASC PATIENT DISCHARGE

Drs. Singleton, Pauker, and Dailey along with our legislative advocates, Bill Barnaby Jr. and Sr., met with Dr. Anthony Way, Medical Consultant for DHS, on April 30 during the CSA/CMA Legislative Day in Sacramento. The following was discussed:

The Locked Anesthesia Cart letter of April 2002 remains in effect. 
Make sure:
your hospital has made the OR suites, C/S rooms, etc. secure areas. Develop a policy as to who are authorized personnel.
emergency drugs (i.e., for CS/trauma cases) which are drawn up in syringes are labeled and dated, with tamperproof caps.
If you are practicing in an Ambulatory Surgery Center (ASC):
CMS requires that a physician discharge the patient.
It is not acceptable to write a discharge note before the patient is ready to be discharged from an ASC. This is in contrast to the requirements for hospitals. In hospitals, patients may be discharged from the PACU based on standardized protocols. In an ASC, if there is a delay between when the physician discharges the patient and the patient leaves, the reasons (ride delayed, nausea) should be documented.

MBC Begins Gathering Demographic Data on California Physicians

The Medical Board of California (MBC) has begun gathering demographic data on all licensed California physicians. As required by CMA-sponsored AB 1586/2001, the law requires MBC to keep track of data on each physician's specialty, training history, percent of time spent on patient care, ethnicity, and foreign-language abilities. The state will use this information to address patient-access and physician-supply issues in California.

By now, physicians should have received a baseline demographic survey from MBC in the mail. The CSA and CMA urge all physicians to complete and return the survey immediately to ensure that there is good current data guiding public policy decision-making where physician supply is an issue. The data will be updated at the time of each license renewal.

In addition, knowing the number of anesthesiologists and pain medicine specialists has long been a goal for the CSA. Until now, no single source of physician counts by specialty has existed within California.

(If you have not received the letter by now, the MBC may not have your current mailing address. Go to the Medical Board's web site http://www.medbd.ca.gov/ and check the address currently listed. If it is not correct, go to http://www.calphys.org/html/bb110.asp for a change of address form.)

Active Military Get Dues Reduction

CSA members who are on active military duty are given a 50% reduction in dues for the time they are deployed. The ASA currently does not have a comparable policy, but at the urging of the CSA the matter will be considered.

Community Memorial Hospital, Ventura, California—Important Legal Battle

In Ventura, there exists a most egregious situation. The Medical Staff of CMH and the administration are embroiled over whether or not the medical staff may operate in an autonomous manner. Requests, or requirements, that medical staff members must sign letters of non-competitiveness as a condition of medical staff membership, committee meetings regarding peer review must allow for hospital administration participation, and exclusive contracts being made unilaterally by administration are among a number of alleged complaints being made.

Dr. Jack Lewin, Executive Vice-president of CMA, and Gary Abrams, Legal Counsel for CMA, participated in a meeting of the Concerned Ventura Physicians on May 17, 2003 (The CMH Medical Staff meets "off campus" due to their inability to hold meetings within the confines of the hospital itself). The outcome of the legal issues being contested in this situation could obviously affect the practice of medicine. AMA and other major medical interest groups have already been alerted regarding this potential debacle.

State Budget Negotiations

On May 22, the Senate Budget Subcommittee No. 3 rejected the proposed across-the-board Medi-Cal provider rate cut of 15%. The "May Revise" had proposed to make the cuts effective October 1, 2003, but even that was rejected at this point. All legislative decisions made to date have kept Medi-Cal provider rates at present levels.

A day later, the Assembly Budget Subcommittee also rejected the proposed across-the-board 15% Medi-Cal provider reimbursement cuts. The change in accounting Medi-Cal payments from an accrual to a cash basis helped significantly in averting a rate rollback. Also word that U.S. Congress has approved additional funding for state Medicaid programs was another positive factor. So far, so good. The next challenge will be the Joint Budget Conference Committee which will commence after each house passes a budget bill by a two-thirds vote.

CRNA Opt Out in Colorado

After two and a half hours of testimony and debate, the Colorado Board of Health voted 5-1 to remove the Dept. of Public Health and Environment hospital rule requiring physician supervision of nurse anesthetists. The Colorado Society of Anesthesiologists will now turn to the courts to prevent the Colorado Governor from opting out of the requirement for physician supervision of CRNAs. More to come.

JCAHO Revises Scoring of Patient Safety Goal on Marking the Surgical Site

Effective immediately, the Joint Commission has modified how it scores JCAHO National Patient Safety Goal #4, which requires organizations to "Eliminate wrong-site, wrong-patient, wrong-procedure surgery."?

Organizations will still be required to mark the surgical site in cases involving right/left distinction, multiple structures (such as fingers or toes), or levels (such as the spine). However, JCAHO is no longer requiring that the site be marked for other types of procedures, including mid-line sternotomies for open-heart surgery, Cesarean sections, laparotomy and laparoscopy, and interventional procedures for which the site of insertion is not predetermined, such as cardiac catheterization procedures.

Workers' Comp Fee Schedule

Several bills are moving through the legislature to reform the workers' compensation and much of the focus is on the physician fee schedule. Senator Alarcon's bill, SB 228, has passed the Senate and is now in the Assembly. The bill includes a provision to adopt the Medicare fee schedule and set physician payment rates at 120% of Medicare. The CSA supports the CMA position of oppose unless amended, with an amendment that would allow the Administrative Director to modify and negotiate the fee schedule. The bill is expected to be amended significantly before it is finalized.

Concurrently, the CSA, CMA, and other specialty societies have been meeting to develop an alternative to Medicare rules and payment policies. DWC Administrative Director Dick Gannon has participated in most of the meetings and provided advice on how to meet the requirements for establishing a new fee schedule.

The DWC has posted draft regulations on its web site, and comments will be accepted until July 11. (The link is no longer available as of 10/04/05.) Anyone may comment directly on the regulations or send them to the CSA, which will submit detailed comments. Comments may be sent to Executive Director Barbara Baldwin at bbaldwin@csahq.org.