SCSA off to Capitol Hill!

Submitted by Jennifer Root, MD

The first week of May found four of your members and two MUSC residents attending the annual ASA Legislative Conference in Washington, D.C.  Dr. Iva Chappel, SCSA president, Dr. Jennifer Root, Pres-elect, Dr. Scott Reeves, Chairman MUSC Dept. of Anesthesiology and Perioperative Medicine, and Dr. Gus Allinger of Rock Hill, SC.  Our two MUSC residents in attendance were Dr. Jerrell Brown and Dr. Caroline McKillop. 

The conference included several talks by sitting members of Congress, as well as the ASA legislative director and its chief lobbyist.  We heard several talks about current legislation that the ASA is asking its members to support, as well as a great deal of speculation about the upcoming health care reform.  There are several members of Congress pushing for a private sector remodel with regulatory changes that separates out the employer mandated coverage, removes the exclusion for people with pre-existing conditions ,opens up an expanded and more competitive insurance marketplace for consumers,  and creates a series of tax refunds to help citizens pay for their family’s insurance premiums.  There are also more than a few members of Congress pushing for a public option that will have the ultimate goal of taking us to a single payer, government system.  It is likely that something will change over the next twelve months. The more astute individuals I spoke with during my Capitol Hill visits seem to think that we will simply expand our current Medicare/Medicaid system, fully implement the P4P system, and continue the hostage taking of our reimbursement rates by keeping the current (flawed) SGR payment system.  It was very discouraging to see how few people are truly interested in reform, and more focused on increasing Governmental oversight and control.  The nation’s insurers have prostrated themselves before the current administration and appear willing to take any regulatory changes that come their way with little or no fight.  This does not bode well for the House of Medicine.

The top five legislative priorities for the ASA this year are as follows:

1. SGR reform- as indicated above, we need to somehow get our reimbursement rates on par with the rest of the specialties of medicine.  Our average reimbursement rate is approximately 34% of the usual and customary, with the rest of medicine between 70-85% u/c.   Other statistics show that we are on average receiving only .50 cents more than we were receiving in the early 1990’s.  When adjusted for inflation we are receiving tremendously less money than we were in the ‘90’s.  All of this combined makes for a problem if a governmental health plan takes over a significant portion of the health care market that uses the current SGR system and its extremely low benchmark for anesthesia payments.  I foresee that as a specialty we will be unable to remain independent, pay our overhead, and make a decent wage that is large enough to offset the significant debt of the average medical student graduate ( now close to $300K).  It doesn’t take a psychic to see where we are headed if the most likely outcome occurs.

2. Health Care Truth and Transparency Act.-  There is a bill in the House (2260) that would require all health care professionals, midlevel providers, etc.. to identify themselves to patients as to the kind and level of training they have received.  With many masters level programs moving to doctorate programs, hospitals will have too many ‘doctors’ about, which we believe will cause too much confusion to patients.  As we head down this road of health care reform- already with significant physician shortages- we will have a system that becomes increasingly reliant on mid level providers to fill in the gaps.  Patients need to be informed at all times as to who is taking care of them.  Without this information, they will not be able to make informed choices.  In South Carolina, we passed a bill 4 years ago requiring interns, residents, and attending physicians to identify themselves to patients and families, and that this information is clearly found on the nametags that they wear.  The bill currently in Congress would expand this to include all physicians, nurses, physician assistants, nurse practitioners, nutritionists, pharmacists, podiatrists, optometrists, chiropractors, etc.  Furthermore, it would be a requirement for any advertisements to include the persons training, not just medical degree vs. non medical degree, but also any board certification (or lack of J).   This bill in no way attempts to infringe on scope of practice for any health care practitioner, it only creates transparency as to the level and type of education the provider has so the patients can make better and well informed decisions. 

3. Rural Pass-through Reform bill- Currently several hundred hospitals throughout the US are classified as rural hospitals and they receive a higher rate of reimbursement by our federal government.  Unfortunately, these moneys cannot be used to pay for physician services or salaries.  This in turn limits a rural hospital’s ability to recruit or employ physicians.  This bill would remove the current restrictions on using the funds for physicians.  Currently, these funds can only be used to pay for mid or lower level providers. We only have two hospitals in our state that currently qualify for these rural pass-through funds, (Allendale and Hampton); however, we should fight any discriminatory practices by the federal government, of which this is one.

4.  Pain Care Act- This bill would increase the amount of federal dollars to be spent on education, training, and research into Chronic Pain.  Although this is a worthwhile bill, I believe that in this current economic climate and a government looking for ways to cut spending in heath care, that this bill will probably not get any traction in this current legislative cycle.

5. Health Care Reform- As I have already given a synopsis above, I won’t go into too much detail, except to say that there will probably not be any true reform so much as expansion and a major increase in our deficit. 

In addition to the lectures and receptions to meet and mingle with other anesthesiologists across the country, our last day was spent visiting with the South Carolina delegation to Congress.  We met with each office, and in most cases had an opportunity to sit down with our House and Senate members to discuss the ASA’s legislative priorities.  As always, we have a very strong ally in Sen. DeMint, who seeks to protect the doctor-patient relationship and is a strong free market advocate.  For those who are unaware, prior to his involvement in Congress, Sen. DeMint worked as a consultant to the medical profession.  He has, more than most, a keen understanding of the issues that physicians and hospitals face.  When our president says that the Republicans are not offering any alternatives, I can say without hesitation that that statement is not true.  I have spent time with Senator DeMint and I have heard his proposals for health care reform for the past 2 years.  I was also able to spend some time with Congressman Barrett, and he gave all appearances of listening to our opinions about health care reform and the Healthcare Truth and Transparency Act.  I hope to have him signed on to the latter by the end of summer.  He also was quite complimentary of our own Margarita Pate… and we all agreed that we are so very lucky to have her!  Congressmen Wilson was able to sit down with us and we learned a lot about his family.  He is so proud of his physician son, and lawyer son… but we explained to him that the ratio was ten lawyers for every one physician, so he had better hope his grandkids all went into medicine!  He will probably sign on to the rural pass through bill since the two affected hospitals are in his district.  We made sure to explain that this was not meant to reduce money spent on nurse practitioners or nurse anesthetists (of which his nephew is!), but only to allow the decision to rest with the hospital in how best to spend their money.  We only saw Rep. Spratt for a few minutes as he was between meetings and had to go testify for his own bill that was shortly going to be marked up in sub-committee, but since I arrived with a cookie delivery from one of his constituents we certainly caught his eye!  We spent a bit of time with his legislative aide, and again we hope to get at least his support with the Truth and Transparency Bill.  The only other visit I was able to participate in that day was with the chief of staff for Congressman Clyburn.  I am not sure how effective we were, as she appeared to be very preoccupied with other matters that day.  I would imagine being the chief of staff for the number two guy in the House can be a very busy place to be. 

It was a very informative and worthwhile meeting that was extremely well attended this year.  Almost nowhere to sit!  I highly encourage any of our members who would like to be better educated as to our political process and learn how to engage in it to attend next May.  We also scored a lapel pin made of grits in the shape of the palmetto state from Congressman Barrett…had the state flag painted on it and everything!  Wouldn’t you like one of your very own??