Zotec Partners’ Anesthesiology Digest | November 2020

November 20, 2020

Radiology Digest: News from November 2020.

ASA Joins Coalition in Applauding Congressional Legislation to Prevent Medicare Cuts

November 14, 2020

The American Society of Anesthesiologists (ASA) joined a coalition of health provider groups and medical organizations in applauding the introduction of HR 8702, a bill that would offset January 1, 2021 cuts to Medicare payment rates for physician anesthesiologists, among other specialties.  The letter was sent to Congressman Ami Bera, MD, Congressman Larry Bucshon, Congressman Brendan Boyle, Congresswoman Abby Finkenauer, Congressman George Holding, Congressman Roger Marshall, MD, Congressman Phil Roe, MD and Congressman Raul Ruiz, MD and was signed by more than 70 organizations.
As proposed, Medicare payments for many medical specialties would be cut significantly in the new year.  The Medicare anesthesia conversion factors would be cut by 10%, which will harm practices already suffering due to the COVID-19 pandemic. ASA previously endorsed HR 8702, which would temporarily offer payments to mitigate the pay cuts in the 2021 Medicare Physician Fee Schedule, ensuring a payment level that is at least equal to 2020 rates.
In the letter, the organization state: “This critical legislation recognizes the importance of allowing significant scheduled pay increases to primary care and others who primarily provide E/M services to take effect while also avoiding the devastating corresponding cuts for physician and non-physician providers that will occur because of Medicare’s budget neutrality requirements. Given the ongoing COVID-19 pandemic, it is more important than ever to halt the implementation of any payment reductions that could inadvertently limit patient access to care as well as further exacerbate the financial instability of health care provider practices. Our organizations support H.R. 8702 and its approach for providing two years of much-needed stability for Medicare providers as they continue to strive to meet the needs of patients during this public health emergency.”
ASA remains deeply concerned about the proposed cuts, which could destabilize health system financing, and drastically diminish the opportunity physician practices to recover financially from COVID-19. As Medicare payment already undervalues anesthesia care, anesthesia practices will suffer even more.  ASA will continue to strongly promote this legislation and encourage additional lawmakers to join as cosponsors.

Read the letter
Send a message to your lawmaker asking them to cosponsor HR 8702

COVID-19 Public Health Emergency Declaration Set to Expire on Inauguration Day

By Rachel Cohrs | November 13, 2020

An HHS COVID-19 public health emergency declaration tied to regulatory flexibilities and funding for healthcare providers is set to expire on Inauguration Day.

A drawn-out vote count and the lack of a concession from President Donald Trump has slowed the transition process for President-elect Joe Biden’s team. Stakeholders and public health experts say the emergency declaration will likely still be necessary as case numbers are trending upward and potential vaccine distribution is on the horizon.

The current administration could choose to renew the declaration ahead of time, or the incoming team could make it one of its first healthcare priorities when power officially transitions.

“They just need to add that to their list of day-one activities,” said American Public Health Association Executive Director Dr. Georges Benjamin.

HHS declined to comment on whether it would renew the declaration, and the Biden transition team did not respond to an inquiry on the issue.

The Biden transition team has announced in recent days a COVID-19 advisory panel and Agency Review Teams, including 30 individuals focused on HHS.

“They won’t want to upset the apple cart by letting the public health emergency lapse when they are trying to make the transition,” said Winston & Strawn partner T. Reed Stephens.

Some notable policies tied to the public health emergency are the Medicare inpatient 20% add-on payment for COVID-19 patients, increased federal Medicaid matching rates and maintenance of effort requirements, requirements that insurers cover COVID-19 testing without cost-sharing and waivers of telehealth restrictions.

Adjustments CMS made to the Medicare Shared Savings Program for accountable care organizations are also connected to the length of the public health emergency. The number of months the emergency lasts affects the amount of shared losses an ACO must pay back to CMS.

The potential COVID-19 vaccine distribution will add a new dynamic to 2021’s designation. Congress conditioned increased Medicaid funds on states covering vaccines without cost-sharing for enrollees, but that requirement expires with the public health emergency, said Andy Schneider, a professor at Georgetown University’s public policy school.

HHS has renewed the public health emergency three times since January. Each renewal extended the emergency for 90 days. The second renewal in July caused significant anxiety in the provider community before its approval.

To read more, go to Modern Healthcare.

VA Rule on Practice Authority Released – ASA Urges Reaffirmation of Physician-led Anesthesia Care for Veterans

November 12, 2020

In response to the release of a new U.S. Department of Veterans Affairs (VA) rule, the American Society of Anesthesiologists (ASA) cautioned the VA not to weaken current anesthesia safety standards. The rule issued today is an Interim Final Rule titled “Authority of VA Professionals to Practice Health Care.” It is effective immediately but includes a 60-day comment period.  ASA members are strongly encouraged to provide comments.

While the Interim Final Rule does not directly address the issue of existing anesthesia patient safety standards, it codifies VA’s claim that they have the authority to circumvent state scope of practice laws.  Most relevant to ASA, the rule leaves open the possibility that VA could attempt to change the anesthesia standards in the future. ASA opposes any weakening of protections that ensure patients have access to the safe, physician-led model of anesthesia care. ASA will continue to work to ensure that the Department retains the well-established, physician-led anesthesia care team model that is the national standard for anesthesia care. ASA urges VA to uphold its current patient-centered policies governing anesthesia care including the Advance Practice Nurses final rule (38 CFR § 17.415), and Directive 1123, which provides for physician-led anesthesia care for Veterans.

Our nation’s Veterans have earned and deserve the safest, highest-quality anesthesia care. This was reaffirmed after an exhaustive, multi-year rulemaking process that garnered a record-breaking number of comments—more than 200,000 comments during two comment periods overwhelmingly directing VA to ensure our nation’s Veterans do not receive a lower standard of anesthesia care than the general public. ASA will work strenuously to ensure that VA upholds the standard of care for Veterans and that VA does not take any action that diminishes VA anesthesia care through any new policy or sub-regulatory action following this Interim Final Rule.  

Because of the generally poorer health of patients in VA facilities, VA must continue to ensure the involvement of a physician anesthesiologist in Veterans’ care. This is particularly important for Veterans with existing compromised health status who are also suffering from COVID-19.  The care of these complex, very sick patients should not be compromised by the removal of a physician from their health care team.       

To date, both the Trump and prior Obama Administrations have recognized the unique nature of the acute care surgical setting and preserved the longstanding and nationally recognized standard of physician-led anesthesia care. ASA looks forward to a robust and ongoing dialogue with VA to ensure Veterans continue to receive high-quality anesthesia in VA facilities.

In April, VA’s Executive in Charge, Dr. Stone, issued a memo encouraging VA medical facilities to temporarily change their hospital bylaws to allow for the provision of nurse-only anesthesia care. The memo is strongly opposed by more than 350 of VA’s own frontline anesthesia medical experts who urged VA to rescind the “Stone Memo” by invoking VA’s “Stop the Line” patient safety initiative – an initiative through which any VA employee can notify VA leadership of any risk to Veterans’ health. In invoking “Stop the Line,” the VA anesthesiologists noted that the Executive in Charge had excluded VA’s own National Anesthesia Service from  the development of this memo. ASA will continue to work for the “Stone Memo” to be rescinded immediately.

ASA believes removing physician anesthesiologists from the care of Veterans lowers the standard of care in VA and places Veterans’ health and safety at risk.  

ASA urges all members to submit public comments during the 60-day comment period on the Interim Final Rule at www.safevacare.org.

Read the rule here.

Proposed Medicare Cuts Threaten Anesthesiology Practices Strained by Pandemic

November 11, 2020

The Centers for Medicare & Medicaid Services (CMS) has proposed cuts to the Medicare fee schedules for anesthesia services that could return payment rates for anesthesiologists to levels last seen nearly 30 years ago.

The proposed cuts come months into the COVID-19 pandemic, a time when anesthesia professionals have become front-line providers against spread of the virus.

“Physician anesthesiologists are at the forefront of the pandemic,” said Mary Dale Peterson, MD, the immediate past president of the American Society of Anesthesiologists (ASA). “With their medical expertise in anesthesiology and critical care—specifically intubation and ventilation—they are taking care of critically ill patients and putting themselves at risk by working inches away from patients’ airways, where the virus is transmitted.”

Each year, CMS proposes updates to its Medicare Physician Fee Schedule. The proposed 2021 physician payment schedule includes several increases, including a significant rise in payment for office visits.

However, due to a congressional budget neutrality requirement, any increases in the fee schedule must be offset so the total remains budget-neutral within a range of $20 million. Anesthesia-related services have been targeted with cuts to meet that requirement.

For anesthesiologists, this change means a new conversion factor for many services will result in payment at lower rates. For example, the 2021 proposed anesthesia conversion factor of $19.9631 is practically the same as the 1991 counterpart of $19.27. The proposed resource-based relative value scale (RBRVS) conversion factor of $32.2605 is $4 less than the 1998 one of $36.6873, the first year that CMS established a single RBRVS conversion factor.

“The requirement does not consider the resources required to provide care,” said Sharon K. Merrick, MS, CCS-P, the director of payment and practice management at the ASA. The “ASA has grave concerns about the magnitude of the cuts to payments for the services of anesthesiologists.”

To read more, got to Anesthesiology News.

Healthcare Trade Groups Ready to Work with Biden on COVID; Affordability and Access

By Matthew Weinstock | November 7, 2020

Trade groups representing insurers and hospitals Saturday pledged to work President-elect Joe Biden and a new administration on combating the coronavirus pandemic and continuing to reshape the nation’s healthcare system.

“There are many healthcare challenges that our nation must face together—from continuing to battle the COVID-19 crisis, to making healthcare and prescription drugs more affordable, to protecting patients from surprise medical bills, to ensuring stable coverage markets for those who need it most,” Matt Eyles president and CEO of America’s Health Insurance Plans, said in a statement.

Those comments were echoed by heads of the American Hospital Association and the Association of American Medical Colleges.

AHA President and CEO Rick Pollack said the group has the same top priority as President-elect Biden: fighting COVID-19, adding, “As we continue on the front lines in this fight, we will work as partners to protect our patients and communities, as well as support our brave healthcare workers.”

He listed access to coverage, affordability and improving quality of care as other priorities for working with the new administration.

To read more, go to Modern Healthcare.

GOP Senate Majority May Mitigate Policy Risk for Healthcare Industry

By Rachel Cohrs and Tara Bannow | November 4, 2020

Republicans appear likely to hang on to control of the Senate as more races were called on Wednesday, and a divided government would mitigate the risk of the most extreme healthcare policy reforms industry feared.

Democrats’ healthcare wish list items such as a public health insurance option and allowing Medicare to negotiate drug prices will likely be off the table if either party holds a narrow Senate majority. That improves the predictability of financial prospects for health insurers and drugmakers. However, divided government could also make it more difficult for Congress to nimbly respond to courts’ decisions on the Affordable Care Act.

Control of the Senate has not yet been officially called, though Democrats’ path to a majority is narrow.

“The real swing factor here was the Senate for everybody in healthcare,” said Stephen Tanal, a managing director with SVB Leerink.


A narrow Senate majority in either direction means one thing: status quo. For health insurers, that’s the best possible outcome.

“If you’ve got a really narrow Senate majority one way or the other, you can pretty much bet you’re not going to get huge, wholesale policy change,” Tanal said. “That’s what it comes down to.”

Though Washington had buzzed in recent weeks about the possibilities of a public insurance option and other coverage expansions under an authoritative Democratic trifecta government, those possibilities have evaporated.

“Even if Democrats were to control the Senate, I think there are not enough individual Democratic senators who would feel they had a mandate to pursue aggressive coverage expansion,” said Philo Hall, senior counsel at Epstein Becker Green.

Most health insurer stocks soared Wednesday as election results settled into a narrow Republican majority in the Senate, with Anthem up almost 12% at Wednesday’s close from Tuesday’s close. Cigna’s share price jumped almost 15% in that time, while UnitedHealth Group grew by more than 10%. Shares of Centene, meanwhile, fell by about 1%.

Insurers have for years operated under the vague threat of Medicare for All or a public option, which analysts say lowered their stock value even before the 2020 Democratic presidential primaries, in which Sen. Bernie Sanders touted his Medicare for All plan. The most radical iterations of those plans sought to wipe out commercial insurers altogether.To read more, go toModern Healthcare.

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