ALERT from Washington DC: CMS Final Rule for 2018 Medicare Physician Fee Schedule

As you may be aware, in the beginning of November CMS released its Final Rule for the Medicare Physician Fee Schedule. This federal document is more than 1,200 pages, and although there were many changes, below highlights the one aspect followed closely by ASA and NJSSA – a change in the number of base units that CMS has assigned to screening colonoscopy.
Please see the highlights below provided to us by ASA President James Grant:
  • The good news is, because of the work of our leaders, engaged physicians and staff, we were able to convince CMS not to change its process on updating one component of the overall fee schedule. That change would have decreased our ANESTHESIA conversion factor, and our success on this issue actually culminated with an INCREASE in the conversion factor.
  • That being said, the 2018 Anesthesia Conversion Factor increases from $22.0454 to $22.1887 (geographic adjustments pending), while the conversion factor for your non-anesthesia codes has gone up from $35.8887 to $35.9996.
  • The not-so-good news and of interest to many of us is that CMS decreased the base units for screening colonoscopy to 3 base units (00812).  ASA strongly disagrees with this decision. Our member survey data supports 4 units, and our Relative Value Guide (RVG) will reflect that. Differing values in the RVG and CMS are not common, but when we strongly disagree and we have survey data to support it, we will be transparent and make the appropriate notations in our RVG.
  • All the remaining GI endoscopy codes are 4 or greater, and because of the strong work by our economic advocacy team, the complexities of anesthesia for ERCP were recognized and affirm the recommendation of 6 units.
The process of assigning values to codes is very complex with multiple layers. Probably one of the key components are the surveys sent out to clinicians. If you should ever get a survey, please take the time to review it and give us appropriate and thoughtful responses. All the processes leading up to CMS valuation take the surveys very seriously and often are the major criteria in the code value assignment process.
For any additional information about codes for other procedures, particularly pain procedures, please click here.


American Society of Anesthesiologists Supports Trump Administrations’ Declaration of Opioid Crisis as Public Health Emergency


CHICAGO – The American Society of Anesthesiologists (ASA) today announced its support of President Donald J. Trump’s announcement officially declaring the opioid crisis a public health emergency. ASA applauds the president’s administration for taking this important step toward addressing drug addiction and opioid overuse and abuse.  As pain medicine specialists, physician anesthesiologists are at the forefront of the issue, working with numerous regulatory agencies, health care organizations, and other stakeholders to advance opioid safety. Of particular note, ASA has partnered with the hospitals of Premier Inc. to launch a national opioid safety pilot. The pilot seeks to decrease opioid use during and after surgery as well as at discharge, by employing multimodal therapy, through evidence-based medical practices and patient education.

“Today’s announcement will have a lasting effect on physicians and patients, by enabling federal agencies to take whatever steps necessary to address the epidemic, as well as increasing treatment capacity for those with substance abuse disorders,” said ASA President James D. Grant, M.D., M.B.A.  “The opioid crisis is devastating and affects everyone, rich and poor.  It’s got to stop, and reducing opioid use during recovery after surgery and providing the necessary treatment people need are a big part of the solution. Physician anesthesiologists are most equipped to understand the intricacy of post-surgical pain and alternative treatment options to best manage this pain rather than relying solely on opioids.”

Although the declaration does not provide for any new or additional funding, it will allow for the shifting of resources in existing programs to help address the epidemic. The president also announced a massive advertising campaign against drug use and highlighted the current work federal agencies are already doing, including the Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration and Veterans Health Administration.

More than 2 million Americans abuse opioid pain medications. Since 2000, the rate of opioid overdose deaths in the U.S. has increased 200 percent. To help deter future incidents of addiction, ASA collaborated with the CDC on the Guideline for Prescribing Opioids for Chronic Pain, which provides recommendations for primary care providers on opioid prescribing, including when to initiate or continue opioids for chronic pain; follow-up and discontinuation; and addresses risk and harm of opioid use. Because of ASA’s involvement, the CDC modified the guideline’s recommendation on acute pain.

ASA has collaborated with other pain societies, through the Pain Care Coalition (PCC) — comprised of the American Academy of Pain Medicine, American Pain Society, and ASA. The coalition works together to support policies to further responsible pain care. Most recently, the PCC submitted comments to the White House Opioid Commission, in response to the commission’s interim report.

Taking a unique approach to tackling this epidemic, ASA is partnering with Premier Inc., and its network of hospitals, on a national opioid safety pilot to reduce patient harm from opioid misuse, dependence and addiction. The six-month pilot, which began in September, is geared at addressing opioid misuse and abuse, through implementation of evidence-based practices and education provided by ASA physician members, aimed at improving pain management and reducing opioid prescriptions after surgery. This is one way to reduce the number of medications in America’s households and prevent them from getting into the wrong hands, a large contributing factor to this epidemic.

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at To learn more about the role physician anesthesiologists play in ensuring patient safety, visit Like ASA on Facebook and follow ASALifeline on Twitter.


ASA-member Jerome Adams, M.D., Officially Sworn in as new U.S. Surgeon General


Yesterday, ASA member Jerome Adams, M.D., was officially sworn in as the 20th Surgeon General of the United States. He is the first physician anesthesiologist to hold this position.

As the “Nation’s Doctor,” Dr. Adams said his motto in the office would be “Better Health Through Better Partnerships,” reflecting a career of successful bridge building and consensus finding, based in science. ASA President Jeffrey Plagenhoef, M.D., and ASA Chief Advocacy Officer Manuel Bonilla attended the ceremony.

As the Surgeon General, Dr. Adams will work to provide Americans with scientific information on improving their health and reducing their risk of illness and injury. The Office of the Surgeon General is part of the Office of the Assistant Secretary for Health in the U.S. Department of Health and Human Services.

Dr. Adams will be leaving his position as Indiana Health Commissioner, only the second African American to ever serve in that position. In that role, he oversaw the Public Health Protection and Laboratory Services, Health and Human Services, Health Care Quality and Regulatory, and Tobacco Prevention and Cessation Commissions. He was appointed in 2014 by Vice President Michael R. Pence, then governor of Indiana. Dr. Adams is recognized as a leading expert in the substance abuse epidemic, and his swift and robust response to one of the largest HIV outbreaks in United States’ history helped avert a larger public health crisis amid the ongoing opioid abuse epidemic.  He has testified before Congressional committees on the subject.

ASA applauds Dr. Adams and looks forward to continue to work with him in his new role as Surgeon General. Congratulations, Dr. Adams!

Read more about Dr. Adams in ASA’s release after his confirmation by the Senate of the United States.

Watch a recording of the ceremony here.

Read a transcript of the ceremony here.

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