AANA Federal Government Affairs
HOTLINE
Number 2006-01 Week of Monday, January 16, 2006


In This Issue:


* Relief from 2006 Medicare Payment Cuts Awaits Final House Vote
* Healthcare Costs Grow More Slowly, but Faster than Economy
* President's State of the Union to Include Healthcare Focus
* MedPAC Calls for Increase in Medicare Part B payments for 2007
* Amendments




>> Relief from 2006 Medicare Payment Cuts Awaits Final House Vote


House Speaker Dennis Hastert (R-IL) has tentatively scheduled a vote for the fiscal year 2006 budget reconciliation bill (S 1932) on February 1st (CongressDaily, 1/11). Unless the House gives the budget package a final OK and sends it to the President, the 4.4% Medicare payment cuts that took effect for CRNAs and all other Part B healthcare providers January 1, 2006, will stay in effect all year.

The Senate on December 21st voted 51-50 to approve the legislation, which includes $39.7 billion in spending reductions, with $6.4 billion in net savings from Medicare and about $4.8 billion in net savings from Medicaid over five years. The House on December 19th, voted 212-206 to approve the bill, but procedural moves in the Senate require the House to vote on the bill a second time before the legislation can move to President Bush to be signed into law (American Health Line, 1/9).

The package would replace the 4.4% Medicare Part B payment cuts scheduled to take effect January 1, 2006, with Part B payments equal to 2005 levels. CRNAs are affected by the payment cuts and the relief just as anesthesiologists and other physicians are, having in common the ability to bill Medicare Part B for services provided to Medicare beneficiaries.

Considering that Medicare estimates 2006 Part B allowed charges for anesthesiologists and CRNAs' anesthesia services at approximately $2 billion, this turnaround would provide about $88 million more Medicare funding for anesthesia services in 2006 than would otherwise have been allocated, holding case volume, mix and time constant.

The mammoth 774-page measure is also important for what it excludes. The measure does not include any anti-CRNA "poison pill" provisions, which the AANA has been long watching guard against. And the measure does not include provisions establishing Medicare "pay-for-performance" measures for healthcare providers including CRNAs. As a vigorous advocate for improving patient safety, the AANA had expressed support for such provisions pending in legislation in the House and Senate, on the condition that the nurse anesthesia profession had a "place at the table" as such measures and standards are being developed for anesthesia services.

In addition to provisions relating to Medicare, the budget reconciliation package includes language touching just about every part of the Federal government. Among the issues additionally of interest to CRNAs is how the measure treats federal student financial aid, though the measure does not apparently change the rules governing educational accreditation programs such as the Council on Accreditation of Nurse Anesthesia Educational Programs (COA).

If the bill passes, then CMS implements changes retroactive to 1/1/2006, as indicated by CMS at,
http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1746

*Stay tuned for possible CRNA advocacy action*




>> Healthcare Costs Grow More Slowly, but Faster than Economy


US healthcare spending increased 7.9% in 2004 to nearly $1.9 trillion, outpacing inflation and wage growth and amounting to a record 16% of the nation's gross domestic product, according to an annual Centers for Medicare and Medicaid Services (CMS) report published in the January/February issue of Health Affairs. This measurement of the US economy has effects on demand for CRNA services, and the financing of CRNA reimbursements from public and private payors. The combined healthcare spending by consumers, businesses and government totaled $6,280 per person in 2004, compared with $5,670 in 2003 (Miami Herald, 1/10). The rate of growth in healthcare spending was the lowest since 2000's spending increase of 6.3%. The slower growth rate in 2004 is attributable in part to slower growth in prescription drug sales (Wall Street Journal, 1/10). The report states, "Medical spending continues to rise faster than wages and faster than economic growth, and workers are paying much more in healthcare premiums than just a few years ago." The report adds, "Continued spending growth will require difficult trade-offs for businesses, households and governments as other spending also rises. These trade-offs are more stringent for those with fewer resources" (Los Angeles Times, 1/10). According to the report, the overall cost of healthcare in the US doubled between 1993 and 2004. Cost increased by nearly $140 billion from 2003 to 2004 (Washington Post, 1/10).

Read more, http://www.miami.com/mld/miamiherald/business/13588392.htm

Also see http://www.latimes.com/news/printedition/asection/la-na-health10jan10,1,3424277.story

And finally http://www.washingtonpost.com/wp-dyn/content/article/2006/01/09/AR2006010901932.html




>> President's State of the Union to Include Healthcare Focus


When President Bush delivers his State of the Union address Jan. 31, he's likely to include healthcare items prominently, reports the Wall Street Journal Jan. 12. What the President seeks in healthcare is likely to have impact on CRNAs, especially to the extent Congress adopts and moves his agenda this election year.

The items the President is pushing include small-business health insurance affordability (or "association health plans"), implementation of the Medicare drug benefit, increased reporting of hospital and healthcare provider quality and price, and support for "health savings accounts" and other high-deductible health insurance plans.

Read the Journal article at http://online.wsj.com/search#SB113702733443144358 (requires subscription).




>> MedPAC Calls for Increase in Medicare Part B Payments for 2007


On January 10th, the Medicare Payment Advisory Commission (MedPAC) reviewed data that show that Medicare beneficiaries currently have little or no problems with access to Medicare Part B physician services, which include those services provided by CRNAs. However, to maintain access to physician services the commissioners recommended that Congress increase rather than cut payments for physician services in 2007. MedPAC has long held that the Sustainable Growth Rate (SGR) formula that determines Medicare Part B provider payments is not an adequate formula for measuring the true costs of healthcare services nor is it capable of controlling the growing volume and cost of physician services. MedPAC is in the early stages of developing alternatives to the current SGR.

Link to MedPAC website, http://www.medpac.gov/




>> Amendments


* The House and the Senate have adjourned. The House will reconvene on Tuesday, January 31st to receive the President's State of the Union address, while the Senate plans to gavel on Wednesday, January 18th. Among the Senate's first orders of business is whether to confirm Samuel Alito to a seat on the US Supreme Court.

* CMS has posted a new "National Provider Identifier" (NPI) Fact Sheet. All CRNAs are expected to apply, which will save CRNAs from having to have multiple provider identifiers for each insurer he or she bills.

View the fact sheet, http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPIFactSheet_010906.pdf

* Medicare has issued a contractor satisfaction survey; if you are a CRNA and get this survey, answer it and be heard. View the survey, http://www.cms.hhs.gov/MCPSS/downloads/providerfactsheet-11-16-05.pdf and http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1747.

* As Congress and CMS continue considering "pay for performance" issues, Health Affairs published a study January 10 indicating links between nursing care and healthcare quality outcomes. According to a statement from the American Hospital Association, American Hospital Association press release, "As the United States enters its ninth consecutive year of a nurse shortage, new research shows that if hospitals increased their use of registered nurses (RNs) and hours of nursing care per patient, more than 6,700 patient deaths and 4 million days of care in hospitals could be avoided each year." The publication should shortly be available online and in print from Health Affairs, http://www.healthaffairs.org (requires subscription).

* Rep. Tom DeLay's stepping down from his House Majority Leader post has set off elections among House Republicans early February for powerful congressional leadership positions. Running for Leader are Reps. Roy Blunt (R-MO), John Boehner (R-OH) and John Shadegg (R-AZ). The vote-counting Majority Whip post is being contested by Reps. Eric Cantor (R-VA), Todd Tiahrt (R-KS), and Mike Rogers (R-MI). Votes take place early February. House Democrats are also looking to fill a leadership post (NAME IT) vacated by Rep. Bob Menendez (D-NJ), who's been moved to the US Senate. Those candidates include Rep. Jan Schiakowsky (D-IL) and Rep. Jim Crowley (D-NY).

* Jan. 16 was Dr. Martin Luther King, Jr. Day. Please take a moment and reflect on the words of Dr. King and how they changed and shaped America. His "I Have A Dream" Speech can be found at the link below.  View Dr. King's Speech, http://www.holidays.net/mlk/speech.htm

* Frank Purcell and Donna Brighthaupt featured on CNN's American Morning. Frank Purcell, AANA Senior Director of Federal Government Affairs and AANA Lobbyist Assistant Donna Brighthaupt are being featured on the television news network as part of CNN's "New You Resolution." Announced on CNN's morning show November 15th, the pair is being followed on the morning show beginning early January as they both try and reach their wellness and physical fitness goals for the new year. Read more, contribute to their online blog, and see their CNN segments with Dr. Sanjay Gupta at http://www.cnn.com/newyou.

* 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, Senior Director. C 2006 American Association of Nurse Anesthetists.