AANA Federal Government Affairs
THE HOTLINE
Number 2009-11 -- Week of Monday, May 18, 2009

 In This Issue:

 *   AANA Submits Testimony to FDA regarding SEDASYS Device
*   AANA Submits Comments on Senate Finance Committee Healthcare Delivery Policy
     Options Proposal
*   House and Senate Committees Continue Work on Health Reform with No Agreement
*   Hospital Trust Fund Will Run Out in 2017
*   Amendments



>> AANA Submits Testimony to FDA regarding SEDASYS Device

In anticipation of a May 28th hearing in suburban Washington, the AANA on May 15 submitted written testimony to a Food and Drug Administration (FDA) advisory panel regarding the SEDASYS™ propofol sedation device.  AANA President Jackie Rowles CRNA MBA MA FAAPM is also slated to present spoken testimony in person that date to the FDA Anesthesiology and Respiratory Therapy Devices Panel of the Medical Devices Advisory Committee.

“In the absence of substantial professional literature available to discuss the SEDASYS™ device, our testimony speaks to the conditions under which the device may be used, if the agency chooses to approve it,” AANA President Rowles wrote to the FDA.  “We will ask why and how the agency anticipates approving a device that allows non-anesthesia professionals (individuals other than CRNAs or physician anesthesiologists) to administer propofol (Diprivan) in direct conflict with the FDA-approved labeling for this potentially dangerous drug.”

According to the FDA, the hearing May 28 is intended to review evidence to the safety and utilization of the device. 

Read more (requires AANA member login & password), http://www.aana.com/federalissues.aspx, in the upper right-hand corner
View hearing docket, click here
Background on FDA website after 5/28/09, click here 
Visit the FDA, click here




>> AANA Submits Comments on Senate Finance Committee Healthcare Delivery Policy Options Proposal

On Tuesday (April 28th), Senate Finance Committee Chairman Max Baucus (D-MT) and ranking member Chuck Grassley (R-IA) released a 48-page document outlining their initial major healthcare reform proposals (Los Angeles Times, 4/29) and discussed it behind closed doors the week of April 27th.   The AANA has been analyzing the proposal in detail for its impact on the patients, practice and profession of nurse anesthesia.  Recently, AANA President Jackie S. Rowles, CRNA, MBA, FAAPM, submitted comments on the paper educating Congress of CRNAs’ contributions to patient safety and specific major health reform priorities.

In her written statement to the Senate Finance Committee, AANA President Rowles indicated CRNAs’ health reform priorities are to  “lower federal barriers to patients’ use of qualified licensed healthcare providers who are not physicians” such as CRNAs, “ensure that health plans incorporate a policy of nondiscrimination among qualified licensed providers,” “adopt Medicare payment reforms that promote high quality and cost efficient healthcare delivery,” and “invest in the development of the nursing and nurse anesthesia workforce we know we need.”

The Senate Finance panel’s proposal aims to increase the number of primary care physicians, reduce hospital readmission rates, increase transparency, overhaul Medicare Advantage (MA) plan payments and create quality benchmarks for physicians and hospitals.  Under the proposal, primary care physicians and rural surgeons who treat Medicare beneficiaries would receive a 5% payment increase, while payments to other specialists could be subject to reductions (CongressDaily, 4/29).  In addition, physicians would be penalized for ordering too many high-tech imaging tests (Richmond Times-Dispatch, 4/29). 

The paper notes that the committee is still looking for a way to permanently fix the Medicare reimbursement formula for CRNAs physicians that leads to annual payment cuts that Congress must halt each year – and that will lead to payment cuts exceeding 20% this coming January 2010 unless Congress acts.  The paper suggests two possible solutions that both include a 1% increase in payments and then a freeze on Medicare physician payments through 2012 (CongressDaily, 4/29). 

The senators also suggest that Medicare reimbursements to hospitals be based on quality-of-care measures for conditions such as heart attacks, heart failure, pneumonia and surgical care, with hospitals that meet or exceed quality standards receiving bonus payments (Richmond Times-Dispatch, 4/29).  In addition, they suggest withholding up to 20% of reimbursements to hospitals that have high readmission rates of patients with chronic conditions.

Read the AANA’s Comment (requires AANA member login & password) at www.aana.com/federalissues.aspx in the upper right hand corner
Read the Baucus/Grassley Proposal Paper, click here
Read the Finance Committee Press Release, click here
Visit the Senate Finance Committee, click here




>> House and Senate Committees Continue Work on Health Reform with No Agreement

On Thursday (May 14th), the Senate Finance Committee and the House Energy and Commerce Committee both worked on healthcare proposals aimed at overhauling the US healthcare system.  The AANA continues to work with Congress to insure that CRNAs are included in health reform. 

In its second of three closed-door meetings, the Finance Committee came to “early, broad agreement” on some issues but continued to disagree over creating a new public health plan intended to compete with private health coverage as part of a reform bill. 

Meanwhile, portions of an overhaul plan being developed by the Energy and Commerce Committee were leaked after Democrats on the committee held a closed-door session on the topic earlier this week (CQ Today, 5/14).

A main point of contention among attendees of the eight-hour Finance Committee meeting was whether to create a public health insurance option as part of a reform plan.  Committee members examined several different models for a public option: a plan that would be administered directly by the federal government, similar to Medicare; a plan that would be administered by regional liaisons under contract with the federal government; a plan that would allow states to choose whether to have a public option and how to run it; and a plan that would require a public option to be regulated under the same rules as private insurers (Salt Lake Tribune, 5/14).  Committee Chairman Max Baucus (D-MT) said that there was no agreement among attendees on a public option (The Hill, 5/14).

Read more, click here
Also see, click here
Visit the Senate Finance Committee, click here
Visit the House Energy and Commerce Committee, click here




>> Hospital Trust Fund Will Run Out in 2017

On Tuesday (April 26th), the Medicare trustees issued a report stating that the trust fund that Medicare uses to pay for beneficiaries’ hospital care will be insolvent by 2017, as the program since last year has been paying out more than it collects in taxes and interest.  This estimated date of insolvency is two years earlier than that predicted by the trustees last year.  Medicare would have to deposit $13.4 trillion, $1 trillion higher than last year's estimate, into an interest-earning account today in order for the hospital fund to pay its scheduled benefits over the next 75 years, according to the government’s nonpartisan Medicare Payment Advisory Commission (MedPAC). 

The Medicare program’s total unfunded obligation, which includes doctor and prescription drug benefits, is $37.8 trillion, the trustees said (Washington Times, 5/13).  These calculations include a 21% payment cut for providers scheduled to take effect this year.  However, Congress typically has eliminated this reduction (Wall Street Journal, 5/13).

Read more from the Social Security and Medicare Trustees, click here 
Also see, click here




>> Amendments

*   The House and Senate will be in session this week.  Both the House and the Senate
     will be in session this week with the House considering the Enhanced Oversight of
     State and Local Economic Recovery Act (HR 2182).  Meanwhile, the Senate will
     continue work on the Credit Cardholders’ Bill of Rights Act (HR 627), sent over from
     the House.

*   Mid Year Assembly attendees, don’t forget!  For AANA DC to follow-up with
     legislators on issues you discussed with their offices at the Mid-Year Assembly,
     please ensure that at least one legislator office report has been filed online for each
     office that was visited.  To file and submit the report, please follow the steps below.

     You will need to use the latest version of Internet Explorer or Mozilla Firefox to
     access the online link.
          1. The link to file your 2009 Mid-Year Assembly Lobby report can be found at
              http://capwiz.com/aanadc/lrm/feedback.tt?event=15221.  If your link is pre-
              populated with profile data other than your own, simply overwrite it with your
              personal information.  Click “proceed.”
          2. Based on your login address on the previous screen, your legislator (s) will be
              shown.  If you visited legislators other than the ones from your own district,
              you will also have to add the other legislator names by clicking the link
              “elected official not shown”.  Follow the steps provided and click “add name”.
          3. Check the names of all legislators you want to file reports for and click
              proceed.
          4. Answer the questions on the screen based on the meetings you had.  You will
              need to do a separate report for each legislator.
          5. If you have any comments from your meeting, please write them in the
              comment section at the end of the online report form.
          6. Click “submit” and your report will be filed with the AANA DC office. 
     If you have any questions about filing your lobby reports, please contact Shari
     Dexter, AANA Political Affairs Manager at 202-741-9087 or sdexter@aanadc.com

*   Beat the Clock for CRNA-PAC!  The AANA’s CRNA-PAC is a separate fund, supported
     by AANA members’ voluntary contributions, that builds AANA and CRNAs’ strength in
     Washington by supporting legislators friendly and influential to CRNAs’ federal policy
     issues. Governed by CRNAs, the CRNA-PAC’s annual fundraising campaign is taking
     place right now!  For more information, see www.aana.com/crnapac.aspx, or email
     info@aanadc.com if you have any questions.

*   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 the Monday following 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.  © 2009 American Association of Nurse Anesthetists.