Payments to Teaching Anesthesiologists: Policy Update 2004

1
Payments to Teaching Anesthesiologists Policy
Update2004

• Alexander A. Hannenberg, M.D.
• Vice President for Professional Affairs
• American Society of Anesthesiologists
• Tufts University School of Medicine
• Newton-Wellesley Hospital
• Newton, MA

2
Welcome to Red Sox Nation !
3
History Medicare Policy on Teaching
Anesthesiologists

• Pre-1994
• Medicare Intermediary Letter (IL) 372 Two full
  fees if attending physician relationship
  established
• 1991 Final Rule
• Implements Medicare Fee Schedule (RBRVS)
• 29 Anesthesia Fee Reduction
• Actual Time Preserved !
• Full Anesthesia Fee one teaching case only.
• Implementation Opposed Delayed until 1994

4
Surgical Teaching Policy
In order to bill Medicare for two overlapping
surgeries, the teaching surgeon must be present
during the critical or key portions of the
procedure.
5
Medicares PRIT
6
Chronology ASA Teaching Rules

• July 2003 -- ASA meets w/ CMS Administrator
  Scully PRIT Staff
• August 2003 CMS proposes SRNA rules for
  teaching anesthesiologists
• September 2003 ASA comment OK if (1) interim
  (2) optional alternative
• December 2003 Administrator Scully resigns
• January 2004 SRNA rules available
• January 2004 ASA meets PRIT staff re 2005 rule
  change
• March 2004 Resident teaching rule change a
  done deal
• May 2004 ASA Legislative Conference on
  track for Jan 05
• July 2004 CMS Baltimore staff no change for
  2005
• August 2004 Federal Register no rule change
  proposed
• August 2004 ASA engages CMS lobbyists
  Congressional Administration interest developed
• September 2004 ASA files official comment

7
CMS Reverses ItselfJuly 20, 2004

• 34 MM Cost Estimate
• Denies capacity to adjust within Part B pool
• Anesthesiology Payment Consistent with Time
  Based Services
• SRNA option impact not yet known.

8
Remaining Options

• Demonstration Project
• Stand-Alone Federal Register Notice of Rule
  Change
• 2006 Implementation Date

9
2005 Fee Schedule Final RuleNovember 15, 2004

• the teaching physicians presence during the
  key or critical period criteria applies to both
  the services of the teaching surgeon and the
  teaching anesthesiologist. The key or critical
  services are different for the service of each
  specialty.
• The AANA commented that our rules should not
  favor one type of provider over another.
• We plan to explore these issues further prior
  to deciding whether to include this change in the
  proposed rule for 2006.

10
Poised for Victory

• CMS Objections Addressed
• Legal Foundation Established
• Congressional Support Mobilized
• White House Interest Developed

11
Workplan

• Senate Majority Leader Role
• Medicare Committees of Jurisdiction
• Senate Finance Committee
• House Ways Means Energy Commerce
• All Politics is Local
• Focused Data Collection

Tip ONeill Speaker of the House
12
Private Payer Issues

• ASA Role Limited by Anti-Trust Hazards
• Medicare Solution Engineered to Control Private
  Payers
• Payment Reductions via Modifiers
• No HIPAA Requirement for Claims Modifier Use
• Restoration of Full Fee in 21 Teaching
• Instruction to Omit Modifier
• Compensatory Conversion Factor Adjustment
• Non-Participation (Contract Termination)