WASHINGTON -- Anesthesiologists and nurses are spending millions of dollars fighting each other about who should put patients under before surgery.
It has become the most contentious issue in a set of proposed new rules for hospitals caring for Medicare and Medicaid patients. The battle shows how lobbying groups roll into action when their interests are threatened -- and the disparities that can exist between them.Both sides in the doctor-nurse battle have met with federal health officials, written letters and persuaded congressional supporters to intervene as they try to shape the Health Care Financing Administration's final rule.
They also have piled up lobbying expenses and boosted their political contributions, according to federal records.
The American Society of Anesthesiologists spent $1.2 million on lobbying in the first half of this year -- more than five times the $222,316 that the doctors' group spent during the same period in 1997.
The nurse anesthetists' group increased its lobbying, too, on a smaller scale. The nurses spent $335,000 over six months, 16 percent more than the $290,000 they spent in the first half of 1997.
Over the last two years, the anesthesiologists have made more than $1 million in political action committee donations to lawmakers, and the nurses have given $650,504.
While the doctors have far outspent the nurses, "we have certainly been competitive," said David Hebert, chief lobbyist for the American Association of Nurse Anesthetists.
The proposal at issue would allow states to decide whether nurse anesthetists should be allowed to work on their own, without being supervised by anesthesiologists. The federal government now requires doctor supervision when a nurse anesthetist is used during surgery on a Medicare or Medicaid patient.
Eliminating the requirement could encourage hospitals to hire more nurse anesthetists -- who earn about one-third as much as anesthesiologists -- and decrease work for the doctors.
But neither side discusses economics. Rather, the nurse anesthetists call for returning power to the states, while the anesthesiologists worry about a patient's health if a doctor is not there to supervise.
The nurse anesthetists support the proposed change and the anesthesiologists oppose it. Officials of the Health Care Financing Administration said they do not know when a final decision will come.
HCFA has received 60,000 comments on its package of proposed changes to Medicare and Medicaid rules; 30,000 of them addressed the anesthesia issue.
Letters were sent by some 200 members of Congress, including Rep. Bill Archer, R-Texas, chairman of the House Ways and Means Committee, which has jurisdiction over health care legislation; and Senate Minority Leader Tom Daschle, D-S.D.
Two congressional supporters of the anesthesiologists -- Sen. Lauch Faircloth, R-N.C., and Rep. Dave Weldon, R-Fla. -- introduced legislation blocking HCFA from issuing any rules that eliminated the requirement that doctors supervise nurse anesthetists.
"Millions of elderly beneficiaries receiving critical care have benefited from the knowledge and expertise of a nurse and physician working as a team," said Weldon, a physician.
Faircloth, who lost re-election in November, tried unsuccessfully to put the provision into the omnibus spending bill at the end of the congressional session, settling for nonbinding language that said HCFA should examine the relevant data before issuing a final rule.
The anesthesiologists' political action committee boosted its contributions to $1,021,134 for the 1997-98 election cycle, a 39 percent increase over the $737,153 in contributions it made during the same period in 1995-96.
"Political contributions help you to gain a voice," said Dr. John Neeld of Atlanta, president of the American Society of Anesthesiologists. "You never buy votes, but you do buy an opportunity to make your point."
The society also held a reception for Weldon during its Washington legislative conference in June.
Nurse anesthetists boosted their PAC contributions by 20 percent, from $543,142 in 1995-96 to $650,504 in 1997-98.
The nurses' donations included $15,000 to the North Carolina Democratic Party. In November, Democratic challenger John Edwards defeated Faircloth, who had taken the doctors' side.