Dear colleagues: 

Please make every effort to submit comments to the Centers for Medicare and Medicaid Services (CMS) about the proposed rule for the 2010 Physician Fee Schedule.  Comments must be received by Monday, Aug. 31.

Because of its lack of understanding of the medical specialty of anesthesiology, CMS has added new payment criteria that run contrary to Congressional intent, as well as common sense.

Specifically, CMS proposes to "narrowly interpret the law and require that only one individual teaching anesthesiologist be present during all of the key or critical portions of the anesthesia procedure."  This interpretation would severely limit "anesthesia handoffs" for anesthesiologists teaching residents, thus impacting O.R. staffing, workflow, payment and safety.  If this regulation is implemented, it may also serve as the basis for restricting anesthesia handoffs in non-academic settings.

ASA has submitted its comment letter to CMS, covering this and many other issues.  Now I ask that you do the same if you haven't already.  (I applaud and thank the nearly 2,000 ASA members who have submitted comments!)

Please follow these steps to submit a letter to CMS electronically.  Remember, comments must be submitted by Monday, Aug. 31.

1. Go to this link: http://www.regulations.gov/search/Regs/home.html#submitComment?R=09000064809f0082
2. Complete your personal information.  For "category," make sure you scroll down to select "Physician."
3. Copy the sample letter at the end of this message.
4. Paste the sample letter in the comment box on the CMS website.  Make edits as you see fit, sticking as closely to the message as possible.
5. Click "Submit."
6. When you successfully submit comments, you will receive a confirmation code.  Please retain this information for your records as it will not be emailed to you.
7. Tell your colleagues/partners/administrators/practice managers/students that we need their help, too.  Please encourage others to take this important action.
8. Let ASA know that you've done your part! To report that your comments have been sent, please email Moriah Merkel in the ASA Washington Office at m.merkel@asawash.org.

Please note:

• CMS has changed the link and commenting procedure several times since the proposed rule was released.  If you have difficulty submitting comments, please contact Moriah Merkel (m.merkel@asawash.org) or Sarah Byun (s.byun@asawash.org) in the ASA Washington Office at 202-289-2222
• There is a 2,000 character limit on comments.  Please keep this in mind if you choose to edit the sample message. If you wish to submit a longer comment, please create a separate Word document, save it to your computer and attach it where it says "attach a file (optional)" on the website.

Thank you for your participation in this important effort!

Sincerely,

Roger A. Moore, M.D.

President

Comment Letter:

As an anesthesiologist I am commenting on the proposed rule for the 2010 Physician Fee Schedule, CMS-1413-P.

I agree with CMS's proposal to pay the full Medicare fee for cases involving a teaching anesthesiologist and one or two residents, or one resident case that is concurrent to another case paid under medical direction.

I was also pleased to see that in the proposed rule CMS recognizes the "significant difference in experience, education and other qualifications between anesthesia residents and student nurse anesthetists."

However, I disagree with CMS's decision to "narrowly interpret the law and require that only one individual teaching anesthesiologist be present during all of the key or critical portions of the anesthesia procedure."

"Anesthesia handoffs" are a common and necessary part of running a safe and efficient operating room, especially in academic settings where the cases are often longer and more complex than in smaller, non-teaching settings, and where medical expertise is often needed to teach a particular skill or to staff a particular case at any given time. Raising this issue disregards anesthesiology's nationally recognized patient safety record, as well as the Congressional intent of providing full funding for overlapping cases as they are currently staffed in every academic program in the country.

Arbitrarily prohibiting or regulating anesthesia handoffs, without evidence to support such action, would create staffing problems in hospitals, lead to longer wait times and generally compromise safe and efficient patient care.

In the final rule please implement the option that was articulated but not proposed, and "permit different anesthesiologists in the same anesthesia group practice to be considered 'the teaching physician' for purposes of being present at the key or critical portions of the anesthesia case."