ASA Legislative Conference 2023 Resident Recap

By Eric Reilly, DO, Abigail Smith, MD, Olivia Sonderman, MD, MPH, Matthew Tan, MD, and Justin Yuan, MD

What is it?
The delegations for each state anesthesia society as well as additional engaged ASA members attend a 3-day conference in Washington DC from May 15-17, 2023. The conference has three main goals:

1. Educate ASA members about current issues facing anesthesiologists and our patients.
2. Provide skills and tools for ASA members to address Congress to fix these issues.
3. Send ASA members to Capitol Hill to meet directly with their members of Congress to ask for support on our issues.

California sent 13 attending anesthesiologists and 4 resident anesthesiologists. We met with the offices of 24 representatives (Rep. Barragan, Rep. Brownley, Rep. Calvert, Rep. Cardenas, Rep. Chu, Rep Correa, Rep. Eshoo, Rep. Huffman, Rep. Kamlager, Rep. Lee, Rep. Levin, Rep. Lieu, Rep. Matsui, Rep. McCarthy, Rep. Obernolte, Rep. Panetta, Rep. Peters, Rep. Porter, Rep. Ruiz, Rep. Sanchez, Rep. Schiff, Rep. Steel, Rep. Takano, Repl. Thompson, Rep. Valadao) and both our senators (Sen. Feinstein, Sen. Padilla). In total, we engaged in 26 meetings over the course of these 3 days.

Why go?
The ASA has a legislative team in DC who does this work every day. They similarly have a state affairs team who supports the state component societies with state-related legislation and regulation. The ASA public affairs staff reviews new legislation, supports or rallies against other legislation, meets with members of Congress, secures letters to help advance our needs, inspires phone calls, and lobbies for our causes. Those efforts by the ASA are critical, but showing our faces and telling our stories as physicians truly moves lawmakers to be responsive to their constituents. At this past meeting alone, we encountered many inspirational examples. For instance, all the members of Congress from one State were so moved by their anesthesiologists’ stories that they decided to write a joint letter to the Veterans Affairs undersecretary to demand that anesthesiologists remain the leaders of the anesthesia care team in the VA. Another State’s senator was so motivated that they plan to introduce a Senate bill to support our efforts to maintain physician-led care. In yet another State, one representative was not aware of some of our workforce issues, and now they plan to co-sponsor many of our bills to support residents and the physician workforce.

On the flipside, there are groups who will show up if we don’t. The logbooks in our Congress members’ offices had the names of individuals lobbying against our stance who had visited the offices just a few weeks ago. If we don’t speak up, somebody else will. Our voice matters. Your voice matters.

What was discussed with lawmakers?

1. Preserving Safe Care for Veterans
   1. What is it?
      1. The Department of Veterans Affairs (VA) is proposing a National Standards of Practice which would allow CRNA’s to work independently in the VA. This movement has been largely influenced and promoted by nursing groups both within and outside of the VA.
   1. The Implication
      1. If this passes, the VA standards could supersede State law and allow independent CRNA practice in every single State.
   1. What did we accomplish?
      1. Multiple members of Congress plan to send letters and make phone calls to the VA in our support.
      1. Rallied support and co-sponsors for bill HR 3347 which would keep anesthesiologists in the VA.
      1. Inspired support for a similar bill to be introduced into the Senate.
      1. Spoke with VA officials directly to voice our concerns.

• No Surprises Act (NSA)
  • What is it?
    • The NSA was passed in 2020 to protect patients from out-of-network ‘surprise’ medical bills. The bill outlines an independent dispute resolution (IDR) process which insurance companies are supposed to honor to fairly compensate physicians. Often, insurance companies are not honoring the IDR process and it is leaving physicians unpaid. The IDR process is poorly enforced, prohibitively expensive, and does not allow batching of claims. – all which creates a system where physicians are not paid for their work.
  • The Implication
    • This act is too frequently being exploited  by insurance companies to pay physicians near Medicare rates, if anything, for their services. If physicians and groups cannot bill, then they cannot remain in practice. This act alone has caused numerous private practices to sell to hospitals or private equity groups. Those groups often reduce staff and cut services to cash out – at the expense of their patients and their physicians.
  • What did we accomplish?
    • Numerous members of the Committee on Ways and Means (the committee who oversaw the passing of the NSA) attended our conference and recognize the bill is not being implemented as intended. They plan to start an extensive oversight process to fix it.
    • Our asks for batching, IDR fee limits, insurance accountability, etc. were all well-received by the Congress members who will be leading oversight efforts.

• Medicare Payment Reform
  • What is it?
    • Currently Medicare pays less than 30% of commercial rates for anesthesia services. In other words, if a private insurance pays you $500 for providing anesthesia for a CABG, then Medicare would pay you about $150. These rates have not been adjusted for inflation and are grossly outdated with current healthcare expenses.
  • The Implication
    • Low payment rates lead to physicians refusing to accept Medicare, as the expense of caring for those patients can sometimes eclipse the expected payment. When private practices refuse Medicare, then patients rely on hospitals for their healthcare, and then the hospital takes a hit and struggles to pay its physicians, which leads to the hospital decreasing its staff and services, which worsens working conditions and access to care. Low Medicare payment rates also make it difficult for private practice groups to survive – especially if those groups serve a large proportion of Medicare patients – which could force them to sell to hospitals or private equity.
  • What did we accomplish?
    • We rallied support for the bill HR 2474 which would add an annual Medicare inflation update for physician reimbursement.
    • We spoke with Congress about how low Medicare rates create access issues for patients in both well-served and underserved areas, and our messages were well-received.

• A Robust Anesthesiology Workforce
  • What is it?
    • Our workspace is changing as more surgeries are moved from hospitals to surgery centers. Workforce needs are exacerbated by physician retirements, a national nursing shortage, a lack of new residency spots, and the financial burdens of medical education.
  • The Implication
    • Some groups use ‘workforce shortages’ and ‘access’ as their number one talking point to try and achieve independent practice for CRNAs. We have the data to show that opt-outs and independent practice laws DO NOT increase healthcare access in rural or under-served areas. We have data that shows non-physician independent practice worsens outcomes, increases costs, increases readmission rates, etc. We have a strong anesthesiologist workforce, however there is often a lack of incentive for anesthesiologists to practice in underserved areas. Our goal is to expand the physician workforce in a way which preserves equity with access.
  • What did we accomplish?
    • Gathered support for HR 2389 and S 1302, two bills which would provide funding for 14,000 additional residency spots.
    • Gathered support for HR 1202 and S 704, two bills titled the Resident Education Deferred Interest (REDI) Act. This act would allow borrowers to qualify for interest free deferment on their student loans while in residency. This act IS NOT direct loan forgiveness, but rather cuts the accrual of loan interest while in residency – thus is it well supported on both sides of the aisle.
    • Gathered support for the Specialty Physicians Advancing Rural Care (SPARC Act HR 2761 and S 705), which would authorize loan repayment programs to encourage specialty medicine physicians to serve in underserved and rural communities.

• Expanded Access to Naloxone
  • What is it?
    • Deaths from illicit opioids have grown rapidly in the past decade, and one of the best defenses is affordable access to naloxone. The ASA has long supported efforts to expand naloxone access, and even pioneered REVIVEme – a program designed to educate the public about how to recognize and treat an opioid overdose. We applaud the recent FDA decision to approve over-the-counter naloxone.
  • The Implication
    • Anesthesiologists are key players in battling the opioid epidemic. Our ability to treat pain safely while also addressing the opioid epidemic is an invaluable skill. We are well-suited to be leaders in addressing the opioid epidemic and educating the public.
  • What did we accomplish?
    • We heralded the work done by the ASA, the FDA, and anesthesiologists every day to help expand access to naloxone in the fight against illicit fentanyl and the opioid epidemic.
    • We ensured that Congress is aware of our past efforts and that they recognize the invaluable role of the ASA and anesthesiologists in this battle.