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NewsletterNew SCA Task Forces Because of significant changes in our practice environment, I am in the process of appointing two new SCA Task Forces. The first task force will focus on economic issues. SCA's not-for-profit status [501(c)(3) corporation] precludes it from lobbying activities and it has, therefore, traditionally delegated most economic issues to other societies, such as ASA. Unfortunately, the economic challenges to the practice of cardiothoracic anesthesiology continue to increase and a more active SCA involvement seems essential. In recent weeks, several members from around the country have called me or sent me messages after Medicare denied them payment for TEE. One recent message offered the following explanation for this sudden change in reimbursement. "It would appear that at the national level, the Health Care Finance Administration (HCFA) has subjected TEE to bundling under the Correct Coding Initiatives (CCI) and to "black box" edits. Under CCI, bundling and unbundling initiatives occur on a quarterly basis. TEE was recently bundled into all cardiac procedures, with or without cardiopulmonary bypass. It would also appear that attachment of the "-59" modifier to the TEE service to obtain payment may be inappropriate and considered fraudulent. In addition to the CCI, HCFA contracts with outside consulting firms to develop additional edits. Because such edits are not published and cannot be obtained, even under the Freedom of Information Act, they are called "black box" edits. Congress recently upheld the non-disclosure clause. Since the open-heart bundling provisions are at the national level, local carriers cannot change the policy." If HCFA is indeed proceeding in this fashion, urgent action is mandatory. The SCA Economics Task Force will be asked to fully explore the HCFA rulings and to suggest an official SCA position to the Board of Directors, as well as possible redress mechanisms. Once such an SCA position has been accepted, it will be forwarded, in a formal fashion, to the ASA and possibly other societies, such as the American Society of Echocardiography (ASE), that are allowed to lobby. The second task force will be established in collaboration with ASE and will be charged with the development of training guidelines for perioperative transesophageal echocardiography. While the ASA/SCA Practice Parameters for Perioperative Transesophageal Echo-cardiography alluded to training, the recommendations were more focused on "what" to learn rather than on "how" to learn. Recent developments at the National Board of Echocardiography (NBE) indicate that the time for more specific training guidelines has come. The NBE has decided to proceed with an actual "board certification" process that is much broader than the existing certification of successful completion of an examination. Board certification will include demonstration of specific training in addition to successful passing of an examination. For board certification in general echocardiography, the applicant will be assessed on the successful completion of training dedicated to the study of cardiovascular diseases, with specialty training in echocardiography, and success in the comprehensive echocardio-graphy examination of the NBE. While most anesthesiologists will probably have little interest in becoming board certified in general echocardiography, it is worth noting that nothing precludes qualified anesthes-iologists from obtaining such board certification. The SCA/ASE Training Task Force will be asked to define the clinical training that is needed to complement training in perioperative TEE, the scope of knowledge and skills of perioperative TEE, the duration of training, the training components, the training environment, the required supervision, and the equivalence for those who trained before the guidelines were developed. Once the training guidelines are adopted by SCA and ASE, an individual who successfully completes the training and passes the examination of Special Competence in Perioperative Trans-esophageal Echocardiography will become board certified in perioperative TEE. If you have comments or suggestions on these issues, please feel free to communicate them to me at sca@societyhq.com or at dthys@slrhc.org. After editorial review by the Newsletter Committee, they will be published. Daniel M. Thys, MD |