[Congressional Record Volume 153, Number 137 (Monday, September 17, 2007)]
[Senate]
[Pages S11592-S11593]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER (for himself, Mr. Kyl, Mrs. McCaskill, Mr. 
        Vitter, Ms. Snowe, Mr. Coburn, Mrs. Dole, Mr. Domenici, Mr. 
        Inhofe, Mr. Coleman, Mr. Cornyn, Mr. Martinez, Mr. Hagel, Mr. 
        Cochran, and Mr. Lott):
  S. 2056. A bill to amend title XVIII of the Social Security Act to 
restore financial stability to Medicare anesthesiology teaching 
programs for resident physicians; to the Committee on Finance.
  Mr. ROCKEFELLER. Mr. President, I rise today with Senators Kyl and 
McCaskill, as well as 12 original cosponsors, to introduce an important 
piece of legislation, the Medicare Teaching Anesthesiology Funding 
Restoration Act of 2007. This legislation would restore equitable 
Medicare reimbursement for teaching anesthesiologists and address our 
nation's growing shortage of trained anesthesiologists.
  As many of my colleagues are aware, in 1991, the Centers for Medicare 
& Medicaid Services, CMS, rolled out a new rule that singled out 
academic anesthesiology programs for a 50 percent reduction in Medicare 
reimbursement when teaching anesthesiologists supervise residents in 
two concurrent cases. The rule took effect in 1994. No other medical 
specialties or nonphysician providers were affected by this policy 
change. In fact, payments to nonanesthesiology teaching physicians 
continue to be paid using the conventional Medicare Physician Fee 
Schedule. All teaching physicians, except anesthesiologists, can 
collect the full Medicare fee for working with one resident and also 
collect an additional full Medicare fee for working with a second 
resident on an overlapping case as long as the teaching physician is 
present during the ``critical and key'' portions of each procedure and 
is immediately available to return to a case when not physically 
present.
  This arbitrary and unfair payment reduction has had a devastating 
impact on the training of anesthesiologists across the country, 
anesthesiologists who we rely on daily for safe surgical procedures, 
cesarean deliveries during childbirth, emergency and critical care 
procedures, pain management, and care of our wounded warriors. Because 
of this policy change, teaching hospitals

[[Page S11593]]

receive only half the cost of anesthesiology treatment for Medicare 
patients. This shortchanges academic anesthesiology programs an average 
of $400,000 annually, with some programs losing more than $1 million 
per year. As a result, academic anesthesiology programs have 
experienced increased difficulty filling faculty appointments and 
sustaining vital research and development programs. But even more 
disturbing is the fact that this inconsistent and arbitrary payment 
policy has forced 28 academic anesthesiology programs to close since 
1994, leaving only 129 programs nationwide.
  In my home State, we have only one academic anesthesiology program, 
at the West Virginia University in Morgantown. This program is losing 
nearly $700,000 per year because of this unfair Medicare payment 
policy. When you take into account the fact that many private insurance 
companies follow Medicare's lead on reimbursement, the final dollar 
impact is even greater. Other departments within the medical school are 
being called upon to subsidize these losses instead of using their 
resources to advance important research initiatives or recruit highly 
qualified faculty.
  West Virginia students interested in studying anesthesiology are also 
at risk. Because this is the only academic anesthesiology program in 
the State, far fewer West Virginians will have the opportunity to enter 
the specialty of anesthesiology if this program is forced to close. 
This will have a direct impact on our State's health care 
infrastructure because the majority of graduates from West Virginia 
University's anesthesiology residency program stay in West Virginia. If 
this program closes, the number of qualified anesthesiologists in West 
Virginia could plummet, leaving residents with severe access problems 
for surgery, emergency care, and other high risk procedures.
  This is not just a West Virginia problem. This is a national problem 
with severe implications in every community. Academic anesthesiology 
programs treat the sickest of the sick, patients with multiple 
diagnoses, unusual conditions and/or in need of highly complex and 
sophisticated surgeries. The arbitrary Medicare payment reductions for 
teaching anesthesiologists could mean that patients of all ages and in 
all communities could see increased anesthesiology shortages in 
operating rooms, pain clinics, the military, critical care units, labor 
and delivery rooms, and emergency rooms.
  In order to address this problem, the Medicare Anesthesiology 
Teaching Funding Restoration Act eliminates the Medicare payment 
inequity for physicians who teach anesthesiology. It restores Medicare 
reimbursement for academic anesthesiology programs to the level in 
existence before 1994 and subjects teaching anesthesiologists to the 
same ``critical and key'' portion rule as other physicians under 
Medicare. This payment restoration will provide physician residents 
with sufficient opportunities to pursue the specialty of 
anesthesiology. It will also provide patients, especially high risk 
patients, with continued access to quality anesthesia care when they 
need it. And, finally, this vital legislation will allow academic 
anesthesiology programs to continue making advances in patient safety 
through research and development.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2056

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Anesthesiology 
     Teaching Funding Restoration Act of 2007''.

     SEC. 2. SPECIAL PAYMENT RULE FOR TEACHING ANESTHESIOLOGISTS.

       Section 1848(a) of the Social Security Act (42 U.S.C. 
     1395w-4(a)) is amended--
       (1) in paragraph (4)(A), by inserting ``except as provided 
     in paragraph (5),'' after ``anesthesia cases,''; and
       (2) by adding at the end the following new paragraph:
       ``(5) Special rule for teaching anesthesiologists.--With 
     respect to physicians' services furnished on or after January 
     1, 2008, in the case of teaching anesthesiologists involved 
     in the training of physician residents in a single anesthesia 
     case or two concurrent anesthesia cases, the fee schedule 
     amount to be applied shall be 100 percent of the fee schedule 
     amount otherwise applicable under this section if the 
     anesthesia services were personally performed by the teaching 
     anesthesiologist alone and paragraph (4) shall not apply if--
       ``(A) the teaching anesthesiologist is present during all 
     critical or key portions of the anesthesia service or 
     procedure involved; and
       ``(B) the teaching anesthesiologist (or another 
     anesthesiologist with whom the teaching anesthesiologist has 
     entered into an arrangement) is immediately available to 
     furnish anesthesia services during the entire procedure.''.

  Mr. KYL. Mr. President, today Senator Rockefeller and I introduce the 
Medicare Anesthesiology Teaching Funding Restoration Act of 2007.
  I want to thank Senator Rockefeller for his leadership, as well as 
Senator Vitter who introduced a similar bill last Congress.
  As my colleagues may be aware, Arizona is the Nation's fastest 
growing State, and as its population grows, so does the demand for 
health care services. Yet Arizona suffers from a critical shortage of 
health care professionals.
  Inadequate Medicare reimbursement exacerbates physician shortages and 
disrupts patient access to care. In fact, each year Medicare 
shortchanges academic anesthesiology programs nearly $40 million.
  Currently, a teaching physician may receive the full Medicare fee 
schedule if he or she is involved in two concurrent cases with 
residents.
  In 1994 the Centers for Medicare and Medicaid Services, CMS, singled 
out anesthesiology teaching programs and implemented a payment change. 
The payment change required that teaching anesthesiologists receive 
only 50 percent of the Medicare fee schedule if he or she is involved 
in two concurrent cases with residents.
  As a result, 28 academic anesthesiology programs have closed, leaving 
129 academic anesthesiology programs in existence today.
  As one of the remaining teaching programs, the University of Arizona 
loses over $300,000 each year.
  This is likely a conservative estimate as private payers are 
increasingly adopting Medicare's payment policy, compounding a teaching 
program's total financial loss. Medicare's policy challenges a teaching 
program's ability to fill vacant faculty positions, retain expert 
faculty, and train residents, particularly in rural and underserved 
communities.
  Additionally, and perhaps most importantly, as training I programs 
close, patients will increasingly encounter anesthesiologist shortages.
  In Arizona alone, the Health Resources and Services Administration, 
HRSA, projects that between 2000 and 2020 the State's population will 
grow 18 percent and the population 65 and older will grow 72 percent.
  The Medicare Anesthesiology Teaching Funding Restoration Act of 2007 
repeals the 1994 payment change and restores Medicare payment to 
teaching anesthesiologists.
  Under this bill, the clear winners are patients. Restoring funding 
helps preserve patient access to safe, quality health care and 
alleviate growing health professional shortages.
  I urge my colleagues to cosponsor this critical legislation.
                                 ______