End of Year Congressional Legislation and ASA Priorities

Updated January 20, 2021

Congress advanced far-reaching year-end federal legislation to fund the federal government for another year and also provide COVID-19 economic relief. The package includes two issues of key importance to the specialty: surprise medical bills and Medicare payment cut relief. President Trump signed the bill into law December 27, 2020. Below is a message from ASA President Beverly Philip, MD, FACA, FASA, summarizing key provisions.

Surprise Medical Bills

I can report that a number of ASA’s priorities were addressed in the final surprise medical bill language in this end-of-year package.

In proposal after proposal, ASA has lobbied for changes to help our members. Our goal has been to make the legislation more functional for our practices and to ensure that the balance between physicians and insurers in the marketplace was not disrupted.

When the Congressional “No Surprises Act” proposal was released, December 11, several key ASA improvements were already included. Yet, even with these improvements, the legislation still included provisions that could disadvantage anesthesiologists’ practices.

Our Advocacy team worked with other physician organizations, the ASA Grassroots Network and our ASA Key Contacts virtually around the clock over the past week to lobby for additional improvements. See our letter to the Congressional leadership here. With additional strong engagement by the broad ASA membership, we were able to secure important additional improvements. These include:

• An explicit prohibition on health insurance companies presenting artificially low Medicare, Medicaid and public payer rates to the arbiter as part of the independent dispute resolution (IDR) system.
• Elimination of unreasonable timelines and other requirements related to patient notification and billing requirements.
• Enhanced physician access to the IDR process by adding clarity to the “90 days cooling-off period” - a mechanism intended to place arbitrary limits on the IDR process.

This legislation remains far short of what is needed. However, between the improvements included in the December 11 proposal and now in this final package, we have been able to move beyond potentially catastrophic earlier proposals – proposals that had aggressive government rate-setting, lack of deference to the marketplace and inaccessible and insurer-friendly dispute resolution processes. We successfully worked with our physician colleagues to effectively block earlier deeply flawed Congressional proposals. Additionally, with an implementation date of January 1, 2022, opportunities exist for ASA and our partners to work for additional enhancements and revisions.

Medicare Payment Cuts

The final package includes some partial relief from the previous draconian Medicare cuts scheduled for January 1, 2021.

For months, ASA has been working in coalition with other physician groups and a broader coalition of allied health providers for relief from the New Year’s Medicare cuts. Many medical specialties, especially hospital-based physicians and surgeons would have faced serious payment cuts if Congress had not acted. The anesthesia Medicare conversion factor would have been cut 10%. We are pleased that Congress took heed of the concerns we expressed and provided modest yet incomplete relief. Based on our current understanding, the scheduled 10% cut to the anesthesia conversion factor will be reduced to 3%. Some relief has been provided, but this Medicare fix remains entirely inadequate for a specialty that is already hampered with a flawed payment rate. Our members are literally on the front-lines of the pandemic, and now is not the time to cut their payments. We will continue to work with other adversely impacted specialties to address this short sighted, less than satisfactory solution.

Going Forward

We did not get all of what we needed in this final package. Both the surprise medical bill provisions and the Medicare payment cut relief remain far less than ideal. But, overall, I believe our specialty will be better off in 2021 than was initially anticipated.

But that is not good enough. Going forward, in 2021 the entire ASA leadership and advocacy teams remain committed to vigorously working on these issues, to ensure that anesthesiologists’ practices are in no way disadvantaged.

In the coming days, we will also report on other issues contained in the massive bill, such as the tax deductibility for the personal purchase of PPE, which ASA members requested during the first surge.

Thank you all for helping us get to this point, and with deep appreciation for your continued advocacy.