Anesthesiologists Visit Congress


May 9, 2011

Several hundred anesthesiologists, including a generous proportion of residents, came to Washington, D.C. last week to participate in the annual Legislative Conference organized by the American Society of Anesthesiologists.

At the conference, the anesthesiologists learned about the issues and heard presentations by several Members of Congress including House Majority Leader Eric Cantor (VA) and Administration officials. Delegations of anesthesiologists from 43 states also received extensive practical education in the art of advocacy before proceeding to the Hill to meet with their Senators and Representatives.

Four key issues dominate the anesthesiology legislative agenda. In ASA’s alliterative shorthand, they are:

  1. Ensure fair payment (see discussion below)
  2. Expand access
    1. Extend Part A “pass-through” payment arrangements to anesthesiologists, so that rural hospitals with low volumes will be able to offer incentives to physicians as well as nurse anesthetists and anesthesiologist assistants.
    2. Support H.R. 1044, the Medicare Access to Rural Anesthesiology Act.
  3. Ease drug shortages
    1. Support S. 296, the Preserving Access to Life-Saving Medications Act.
  4. Empower patients
    1. Foster patient autonomy and decision-making through accurate information about providers; apply Federal Trade Commission Act consumer protections to the new healthcare marketplace.
    2. Support H.R. 451, the Health Care Truth and Transparency Act.

Ensuring Fair Payment

Medicare continues to pay for anesthesia services at just 33 percent of private payment rates. Other professional services are paid at approximately 80 percent of private rates. Given this well-known disparity, and given that anesthesia does not drive increases in the cost or volume of Medicare services, ASA urges that the specialty be exempt or “held harmless” from the Sustainable Growth Rate (SGR) cuts in physician payments.

ASA vigorously opposes the Independent Payment Advisory Board (IPAB) established by last year’s Patient Protection and Affordable Care Act. The IPAB would have unprecedented authority to mandate across-the-board reductions in payments – over and above the SGR cuts. Recommendations for targeted spending decreases would go into effect automatically unless blocked or modified by Congress. The board members would be appointed by the President. None of them could be practicing physicians, or even otherwise employed. The expected cuts would affect physicians disproportionately, however, since hospitals, hospice and other providers representing nearly 40 percent of Medicare spending would be exempted until 2020.

Along with the American College of Surgeons and the other specialty societies that form the Joint Surgical Advocacy Conference, ASA supports two bills that would repeal the IPAB:

  • H.R. 452, the Medicare Decisions Accountability Act of 2011, and
  • S. 668, the Health Care Bureaucrats Elimination Act

The derogatory title of S. 668 might cast some doubt on the viability of the legislative attempt. As one wag has explained, the House of Representatives votes to repeal some part of the Affordable Care Act “every Monday,” though, so perhaps the IPAB does not have much of a future. Since it is clearly a major threat to Medicare physician payments, and an unusual transfer of the legislative role to a non-elected body in the executive branch, health care professionals should actively seek the abolition of the IPAB.

Last but perhaps most important, looking decades down the road, ASA leadership is working hard to develop the exciting concept of a peri-operative surgical home analogous to the “medical home” through which primary care would be coordinated. The anesthesiologist citizen-lobbyists who visited the Hill on May 2-4 requested support for innovative health care delivery pilot programs. Expect to hear a great deal more about the surgical home.

On May 4, after the anesthesiologists had left Washington, D.C., senior Republicans in the House conceded that a plan to replace Medicare as an entitlement program with a system of premium supports to buy insurance policies in the private marketplace was likely not going anywhere. As the budget talks resume, other approaches to reducing Medicare spending will be the subject of negotiations. The issues that ASA is advancing are very much on the table. If you would like further detail, please visit the ASA website,


Tony Mira
President and CEO