AANA Federal Government Affairs
HOTLINE
Number 2004-21, Week of Monday, September 06, 2004
In This Issue:
* CMS Publishes 2005 Part B Update, with 1.5% Increase in CFs
* HHS Announces 17% Increase in Part B Premiums for 2005
* Senate Passes Bill To Establish Patient Safety Reporting System
* Amendments
>> CMS Publishes 2005 Part B Update, with 1.5% Increase in CFs
The Centers for Medicare and Medicaid Services (CMS) on July 27 published online
its proposed 2005 Medicare Part B update, noting conversion factors for
physician services including those of CRNAs would likely climb 1.5 percent in
2005 in concurrence with the provisions of the Medicare Modernization Act of
2003. This notice of proposed rulemaking was published in the Federal Register
August 5, 2004 (68 FR 47487, 8/5/2004). Ordinarily the final rule is published
November
before the January in which it takes effect.
Under the notice, CMS estimates Medicare allowed charges for anesthesiology will
amount to $1.416 billion in 2005, with nurse anesthetist allowed charges coming
in at $481 million, out of a total $66.395 billion in Medicare physician allowed
charges in calendar year 2005. CMS estimates both anesthesiology and nurse
anesthetists have faced changes in malpractice insurance costs too small to
warrant increasing the malpractice relative value unit portion of the anesthesia
conversion factor (CF), with anesthesiology paying 2.1 percent and nurse
anesthetists paying 0.7 percent of Part B charges toward malpractice coverage.
In a related matter, together with some 90 healthcare associations, AANA wrote
CMS' McClellan July 16 acknowledging that major change in the Part B sustainable
growth rate (SGR) formula demands congressional action. But some
adjustments could be made administratively, the letter says. Because the
SGR formula includes certain prescription drugs as a factor,
"Removing drugs from the SGR formula thus is a logical step towards improving
the accuracy of the formula." Further, the SGR formula does not account for the
ways the new Medicare law's prescription drug and screening benefits will change
spending for healthcare services - "changes in law and regulation that are
likely very beneficial for patient care, but inappropriately result in negative
payment updates through the SGR calculation," the letter states. Beginning
January
2006, SGR-driven cuts in Medicare payments carve a $95 billion, 30-some percent
crater out of Medicare provider payments between now and the year 2014. Everyone
agrees that such cuts are unsustainable. The solution is to fix the SGR formula
that generates the automatic cuts. But the expense of this fix bumps up
against the federal budget deficit, now projected to run some $450 billion per
year for some time.
The 2005 update is posted online at
http://www.cms.hhs.gov/regulations/pfs/2005/1429p.asp
or from the Federal Register directly at
http://a257.g.akamaitech.net/7/257/2422/06jun20041800/edocket.access.gpo.gov/2004/pdf/04-17312.pdf
>> HHS Announces 17% Increase in Part B Premiums for 2005
Monthly premiums for Medicare Part B, which covers physician services,
outpatient hospital care, some home health services and durable medical
equipment, will increase about 17% to $78.20 in 2005, Health and Human Services
(HHS) officials announced Friday (New York Times, 9/4). The increase of $11.60
per month is the single largest dollar increase in Medicare's history. Premiums
rose 13.5% this year and 8.7% last year (Wall Street Journal, 9/7). According to
HHS, the major factor behind increased premiums is higher spending under
traditional, fee-for-service (FFS) Medicare, particularly in higher payments to
physicians. Under the new Medicare law, payments to physicians in 2005 will rise
by 1.5% instead of decreasing by 4.5% as was planned initially. The new Medicare
law also calls for increased payments to private Medicare
plans, which also contributed to the premium increase (HHS press release, 9/3).
HHS also announced on Friday (September 3rd) that the deductible for Medicare
Part A, which covers inpatient hospital care, skilled nursing facilities and
some home healthcare, will increase by $36 to $912 in 2005 (USA Today, 9/4).
For more info,
http://www.nytimes.com/2004/09/04/politics/04health.html
HHS Press Release,
http://www.hhs.gov/news/press/2004pres/20040903a.html
Also see,
http://www.usatoday.com/news/washington/2004-09-03-medicare_x.htm
>> Senate Passes Bill To Establish Reporting System
The U.S. Senate on July 22 adopted the patient safety reporting legislation (S
720) that AANA has helped advocate this Congress, most recently as our lead item
at AANA Midyear Assembly. The House had passed similar legislation (HR 663) in
March 2003 with the support of AANA.
Both measures include CRNAs by name as healthcare providers, whose
nonidentifiable patient safety outcomes information may be reported to Patient
Safety Organizations (PSOs) for the purpose of aggregating healthcare data for
use in research, education and practice. There was a time during the
consideration of this bill that CRNAs were left out, for whatever reason.
Kristen Pugh of the AANA Washington staff did extensive work in 2003-4 within
the committees of jurisdiction to
ensure CRNAs were recognized by name as healthcare providers that can
participate in this system. The legislation contains other important provisions
authorizing PSO certification, confidentiality of data, and enforcement.
The measure now goes to House-Senate conference committee for resolving
differences between the House- and Senate-passed bills. The Senate conferees are
Republican Sens. Judd Gregg (R-NH), Bill Frist (R-TN), Mike Enzi (R-WY) and
Lamar Alexander (R-TN), and Democratic Sens. Ted Kennedy (D-MA), Chris Dodd
(D-CT) and Jim Jeffords (I-VT). At press time the House had not named conferees,
having gone on August recess. Congress may circumvent the conference committee
process, with one body just taking up and adopting the other's bill.
With this important legislation now closer than ever to enactment, CRNAs may be
contacted via grassroots alert to help push it over the top. Stay tuned! To read
the bills, see http://thomas.loc.gov and
enter at the bill number prompt HR 663
(House bill) or S 760 (Senate bill).
>> Amendments
* Both the House and Senate are in session this week, with the House working on
agency and departmental appropriations. Meanwhile, Senator Chuck Grassley (R-IA)
wants to see new legislation calling for the end of the expiration of homeland
security funds.
* The House schedules Labor, Health and Human Services, and Education
Appropriations for this week. However, no announcement has been made with regard
to the Senate. Thus, it may be after the November 2nd election before the issue
is fully addressed.
* AANA and the National Political Conventions. The nurse anesthesia profession
was represented at both the Democratic and Republican National Conventions in
Boston and New York respectively this past July and August. At the Democratic
Convention, AANA Washington staff and Massachusetts CRNAs represented AANA at
events and in an AANA cosponsored blood drive hosted at Fanueil Hall. At the
Republican Convention, the profession was represented by AANA President Frank
Maziarski CRNA MS, AANA PAC Chairman Larry Hornsby CRNA MS, and the AANA
Washington staff.
* Representatives Jim Greenwood (R-PA) and Ed Schrock (R-VA) Call It Quits,
Rodney Alexander (D-LA) Switches Party (R). Chairman of the House Energy and
Commerce, Oversight and Investigation Subcommittee Jim Greenwood has announced
plans to retire at the end of this year. The move sent Pennsylvania Republicans
scrambling to find a ballot replacement for the incumbent. Greenwood has
accepted a lobby position at the Biotechnology Industry Organization or BIO.
Congressman Ed Schrock (R-VA) announced over the August recess that he would not
seek reelection this coming November. While the announcement is extremely late
for an incumbent, Schrock cited personal reasons for not wanting to seek another
term. Last, first-term Rep. Rodney Alexander began August as (D-LA) but switched
to the Republican Party to become an (R-LA)
just before the election-filing deadline closed.
* For up-to-date Congressional floor & committee schedule information, see
http://thomas.loc.gov/
>> For More Information
The AANA Federal Government Affairs Hotline is published for the nurse
anesthetist members of AANA each week Congress is in session by the AANA Office
of Federal Government Affairs, Washington DC, 202-484-8400,
info@aanadc.com, Frank Purcell, Director.
C 2004 American Association of Nurse Anesthetists.
(posted 9-12-2004)