ASA NewsLetter 2015 Q1

Greetings NMSA members,
With you, we welcome in the Spring of 2015 and look forward to a great year ahead.  At the NMSA, we 'd like to point out some of the great accomplishments of the society over the last quarter.  We will certainly not forget the timing of our annual meeting on a historic snowfall day at the Sandia Resort.  We welcomed speakers from across the country who gave us a wonderful meeting and we all felt re-energized to do our jobs a little better.  We've already begun the planning stages for next year's annual meeting on Saturday, February 27, 2016 and hope you will now mark the date to attend.  
Art Hull, our NMSA lobbyist, worked hard in tandem with Anesthesiologist Assistant (AA) legislation efforts to pass HB 54 which lifted the geographic restrictions of practice on AAs here in New Mexico during this Spring's long session.  The exact legislation, as it was signed in its final format, is on the website, nmsahq.org.  We encourage Physician Anesthesiologists across the state to utilize physician-led team care models if their practice permits and to work in tandem with both nurse anesthetists and anesthesiologist assistants.  The NMSA PAC, Patient Safety Advocates of New Mexico, is alive and well and we hope to boost efforts across the state in regular payments to the PAC on an ongoing basis. Safepatientsnm.org is the link for the PAC.  These funds are collected and utilized in Santa Fe and other arenas to give the NMSA a recognition and presence when important issues are brought up that affect the practice of anesthesia delivery in our state.  We encourage all to donate regularly if you haven't already done so.  We will be sending a survey in the next month or so to get some feedback from you, as you are the society, and we are always looking to improve.  Please take the small amount of time in your busy schedules to give us some feedback.  We are a large, professional, yet volunteer society that relies on the efforts of many individuals.  Thanks and hope to see you soon.
Please, see the 2015 first quarter newsletter from the ASA below.
Best,
Cameron Burrup

Updates from the ASA

Federal Legislative Update

·      ASA Legislative Conference 2015

·      Senate Passes Medicare SGR Formula Repeal

·      House Passes SGR Permanent Repeal Legislation

      o   Statement of ASA President on Congressional Action to Repeal and Replace the MedicareSustainable Growth Rate (SGR) Formula

·      Senate Bill Would Address Colonoscopy Screening

·      APRN "Independent" Practice Legislation Introduced in the U.S. Senate

·      New House "Independent" Practice Legislation for VA Includes Nurse Anesthetists

·      ASA Urges Congress to Support SmartTots to Fund Pediatric Anesthesia Research

·      IPAB Repeal Legislation Introduced in House

·      ASA Submits Formal Comments to US Congress Regarding GME Reform

·      Both Chambers of Congress Pass Budgets

 

Federal Regulatory Update

·      NIH Releases Draft National Pain Strategy and Solicits Comments

·      FDA Issues Final Guidance on the Evaluation and Labeling of Abuse-Deterrent Opioids

·      CMS Publishes Meaningful Use Stage 3 Proposed Rule

·      GAO Report: DEA and FDA Should Work Together

·      HHS Secretary Burwell Announces Plan to Address Opioid Use

·      FDA Unveils Drug Shortages Mobile App

·      ASA Publishes PQRS FAQs;CMS Issues Guidance on the MAV Process

·      FDA Commissioner Stepping Down

 

Public Relations Update

·      ASA President Discussed Patient Recovery in WSJ

·      ASA President Discusses JAMA study with Modern Healthcare

·      Supreme Court Arguments Completed in King v. Burwell

·      Patient Safety on KevinMD

·      USA Today Features When Seconds Count™ for Patient Safety Awareness Week

·      Anesthesia Care Team Commentary Featured on The Health Care Blog

·      Physician Anesthesiologist Appointed to Working Group for President Obama’s Precision Medicine Initiative

·      Dr. Emery Brown Elected to National Academy of Engineering

 

Payment and Practice Management Update

·      ASA Member Kevin Vorenkamp, M.D. selected to serve on the AMA CPT® Editorial Panel

·      Modifications to Medicare’s MUE Program

·      CMS Issues Information on How it Will Resume Claims Processing After Vote on SGR repeal

·      CMS to Implement Fix for Anesthesia Payments for Colonoscopies

       o   Previous Posting: Denials of claims for anesthesia for screening endoscopy that becomes diagnostic (Code 00810 withmodifier PT)

       o   Previous Posting: CMS issues ICD-10-CM guidance for Anesthesia Services

·      Registration for July 2015 End-to-End Testing of ICD-10 claims opening

       o   Prevous Posting: ICD-10 Testing!

·      CMS Publishes Results from First Year Implementation of Value-Based Payment Modifier

·      New ASA Payment and Practice Management Articles

      o   Tools and Resources: Staying Up-To-Date with the Medicare Physician Fee Schedule (April 2015)

      o   Medicare Provider Enrollment Programs: General Information and New Policies (April 2015)

      o   How Do You See the Payment Landscape Post SGR? (March 2015)

      o   ICD-10: Resources to Help in Your Transition (February 2015)

      o   Know Your MAC: Different MAC’s May Have Different Policies (January 2015)

 

Utah Increases Medicaid Anesthesia Payment

The Utah Society of Anesthesiologists (USA) successfully convinced the legislature to increase the Medicaid anesthesia payment rate from $18.27/unit to $23.73/unit starting July 1, 2015 -- a 30 percent increase! Physician anesthesiologists received the full amount proposed -- $870,000 of state money with a $2,030,000 federal match totaling $2,900,000 in new funding for anesthesia care. USA President Robert Blocker, M.D., reported Utah anesthesia providers have never seen such a significant increase in Medicaid rates. Similar to many states, the low payment rate in Utah has historically made it very challenging to serve the growingpopulation of Medicaid patients.

“I am grateful to the members of the Utah legislature who recognized the unsustainability of the low anesthesia rate and were willing to take action. This was not an easy task -- it took many long hours of discussion, education, and lobbying to make thishappen” said Dr. Blocker. 

Dr. Blocker further provided high praise for USA’s earlier decision to invest in its own lobbyists, thus providing a lobbying team accountable only to the USA. The Utah Association of Nurse Anesthetists and the Utah Medical Association also supported the payment rate enhancement initiative.

In the coming months, USA will be working with the Utah Division of Medicaid and Health Financing, toensure that the enhanced anesthesia rate is reflected in the payment rates of managed care plans.

Please feel free to email Dr. Blocker with any questions concerning this success.

© 2015 American Society of Anesthesiologists

New Law in New Mexico Expands Anesthesiologist Assistants’ Practice Settings

On April 7, 2015, New Mexico Gov. Susana Martinez (R) signed House Bill 54 (HB 54). The measure expands the settings in which anesthesiologist assistants can practice. Prior to this bill, New Mexico anesthesiologist assistants were restricted to practicing at the University of New Mexico. New Mexico is the only known state with such a practice setting restriction for anesthesiologist assistants. The new law authorizes anesthesiologist assistants to practice in specified settings outside the University of New Mexico. 

“The New Mexico Society of Anesthesiologists lobbied heavily for the bill,” said New Mexico’s ASA District Director, David Siegel, M.D. “Several New Mexico anesthesiology groups are already making plans to establish a care team model using AAs as a result.”  

To date, anesthesiologist assistants may practice in 17 jurisdictions, Guam, the Medicare Program, and the Department of Veterans Affairs system.  

Anesthesiologist assistants are highly skilled health professionals who work under the medical direction of physician anesthesiologists to implement anesthesia care plans. Anesthesiologist assistants work exclusively within the Anesthesia Care Team environment as described by ASA. All anesthesiologist assistants possess a premedical undergraduate background and complete a comprehensive didactic and clinical program at the graduate school master’s degree level. Anesthesiologist assistants are trained extensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques.

ASA endorses efforts to educate, train, and allow for the practice of anesthesiologist assistants in as many states as physician anesthesiologists request their services. For additional information, please contact Ashli Eastwood, ASA state affairs associate. 

© 2015 American Society of Anesthesiologists

Wisconsin’s Doctor Day Demonstrates Again the Positive Outcome of Physician Anesthesiologists’ Initiative 

On March 11, 2015, the 2nd annual Doctor Day took place in Wisconsin’s state capitol, Madison. “Doctor Day grew out of WSA Day, which started about five years ago,” according to Wisconsin's ASA District Director Jay Mesrobian, M.D. The current Doctor Day is a day-long

session involving more than 15 physician organizations, including the Wisconsin Medical Society. After presentations from state legislative leaders and Wisconsin Gov. Scott Walker (R), physician participants fanned out, wearing their white coats, into the State House to discuss key issues with legislators. The priority issue this year was the Wisconsin Nursing Association's proposed legislation and administrative rule effort to eliminate the state's existing collaborative requirement for advance practice nurses.Other issues included narcotic abuse and the formation of the regional multi-state licensing compact.

According to Dr. Mesrobian, “having 275 physicians, in white coats, speak against this proposal sent a strong message to state legislators. Furthermore, we are optimistic that this kind of collaboration between physician specialties will be a winning strategy.”

21 members of the Wisconsin Society of Anesthesiologists (WSA) participated in Doctor Day 2015 including current and past WSA presidents Rose Campise Luther, M.D. and Lois Connolly, M.D. Please contact WSA Lobbyist Eric Jensen, with any questions concerning Doctor Day 2015.

© 2015 American Society of Anesthesiologists 

Supreme Court Issues Ruling in North Carolina State Board of Dental Examiners v FTC

On February 25, 2015, the U.S. Supreme Court issued its opinion in the North Carolina State Board of Dental Examiners v FTC case, affirming the lower court’s decision against the dental board. The FTC accused the dental board of anticompetitive behavior when it sent cease and desist letters to non-dentists offering teeth whitening services. The dental board argued it was acting on behalf of the state and therefore was immune from antitrust prosecution under the state action doctrine.  In a 6-3 decision, the Court found the dental board was not entitled to immunity because it was not “actively supervised” by the state. 

In North Carolina, the Board is comprised primarily of actively practicing dentists elected by dentists. The Board can promulgate regulations consistent with the State’s Dental Practice Act and that are approved by the North Carolina Rules Review Commission (comprised of members appointed by the state legislature).

North Carolina’s Dental Practice Act did not specify whitening as the practice of dentistry. In response to complaints about non-dentist whitening from dentists, the dental board initiated an investigation with neither the Board’s dental hygienist nor the consumer member participating. The dental board did not subsequently promulgate regulations on tooth whitening, which would have been reviewable by the State’s independent Rules Review Commission. Rather, the dental board sent nearly 50 cease-and-desist letters to non-dentist whitening service providers as well as product manufacturers. The dental board also convinced the North Carolina Board of Cosmetic Art Examiners to caution cosmetologists against offering whitening services, and warned mall operator’s that kiosk whiteners were violating the dental practice act and recommended considering removing them from mall properties. Non-dentists thereafter stopped offering whitening services.

The Federal Trade Commission (FTC) claimed the Board’s actions were an anticompetitive and unfair method of competition. It ultimately ordered the Board to stop issuing communications that non-dentists could not offer whitening services and products. The dental board was further ordered to advise all earlier recipients of the Board’s cease-and-desist orders of the Board’s appropriate sphere of authority and that recipients were within their rights to seek declaratory rulings in state court.  

In siding with the FTC, the Court explained antitrust immunity is available for states meeting certain criteria. Doing so respects federalism while at the same time protecting competition. Included in that criteria, states wishing to allow active market participants to control a market as regulators, must provide active supervision to invoke state-action immunity. The Court determined the Board failed to meet the active supervision requirement. The supervision requirement “stems from the recognition that ‘[w]here a private party is engaging in anticompetitive activity, there is a real danger that he is acting to further his own interests, rather than the governmental interests of the State.’”  

Active supervision can be flexible and context-dependent, according to the Court. Daily involvement is not required in an agency’s operations. More importantly, the State’s review mechanisms must ensure the promotion of state policy.   

Per the ruling, the Court has noted only a few requisites of active supervision: 

  • “The supervisor must review the substance of the anticompetitive decision, not merely the  procedures followed to produce it,” 
  • “The supervisor must have the power to veto or modify particular decisions to ensure they accord with state policy;” and
  • “The “mere potential for state supervision is not an adequate substitute for a decision by the State,”
  • “Further, the state supervisor may not itself be an active market participant.”

This was a case the ASA and the health care community took very seriously. In 2014, ASA joined the American Medical Association, the American Dental Association, and other health care groups in an amicus brief before the Supreme Court. In 2013, ASA joined a similar brief before the Supreme Court in support of the Board’s request for review of the lower court’s decision. ASA staff will continue to monitor the impact of this ruling on health care regulatory agencies and report developments in future ASA communications.  

© 2015 American Society of Anesthesiologists

New Anesthesiologist Assistant Program Explored for Medical College of Wisconsin 

The Department of Anesthesiology Medical College of Wisconsin (MCW) has commenced a formal feasibility assessment to bring an anesthesiologist assistant educational program to the Wisconsin market. “The Anesthesiologist Assistant program will aim to advance the mission of the AHW [Advancing a Healthier Wisconsin] to be a catalyst for positive change in the health of Wisconsin communities,” said Lois Connolly, M.D., ASA alternate district director, Wisconsin, past president of the WisconsinSociety of Anesthesiologists and Professor of Anesthesiology at MCW.

To realize this goal, the Department of Anesthesiology has secured grant funding from the Advancing aHealthier Wisconsin (AHW) endowment to analyze and further develop the Master of Science in Anesthesia program at MCW. Assuming all proceeds as planned, the targeting matriculation date of the inaugural call will be August 2016. 

Dr. Connolly further added: “We have partnered with a national consulting firm to develop an innovative curriculum model that will train the AAs of the future and prepare them to practice within future patient care models, such as the Perioperative Surgical Home.”

ASA endorses efforts to educate, train and allow for the practice of anesthesiologist assistants. There are currently 10 accredited anesthesiologist assistant program locations in the United States.

Anesthesiologist assistants are highly skilled health professionals who work under the direction of physician anesthesiologists to implement anesthesia care plans. Anesthesiologist assistants work exclusively within the Anesthesia Care Team environment as described by the ASA. All anesthesiologist assistants possess a premedical undergraduate background and complete a comprehensive didactic and clinical program at the graduate school master’s degree level.  

© 2015 American Society of Anesthesiologists 

New Mexico Enacts Non-Compete Law

On April 8, New Mexico Gov. Susana Martinez signed Senate Bill 325 (SB 325) into law (Chapter No. 96). The new law applies to contracts, renewals or extensions executed on or after July 1, 2015. SB 325makes non-compete provisions unenforceable in clinical health care servicescontracts entered into by physicians, nurse anesthetists, dentists, and podiatrists. Specifically, such clauses are made unenforceable upon the termination of the contract, its renewal/extension, or the health care professional’s employment with a group seeking to enforce the contract.

Under the new law, certain contract provisions will remain enforceable including those governing full/partial repayment of loans; relocation expenses; signing bonuses; and recruiting,  

education and training expenses for health care professionals working less than three years for

their employer. SB 325 does not apply to contracts between health care professionals that are shareholders, owners, partners or directors of a health care practice. For additional information, please contact Jason Hansen, ASA director of state affairs.  

© 2015 American Society of Anesthesiologists 

GuamAuthorizes Anesthesiologist Assistant Licensure

Guam recently made history by becoming the first United States territory to enact legislation providing for the licensure of anesthesiologist assistants. The bill, 381-32, establishes the Anesthesiologist Assistant Act, which authorizes anesthesiologist assistants to practice within the supervision of a physician anesthesiologist. The measure passed unanimously and was signed into law onDecember 21, 2014. 

Anesthesiologist assistants are highly skilled health professionals who work within the supervision of physician anesthesiologists to implement anesthesia care plans. Anesthesiologist assistants work exclusively within the Anesthesia Care Team environment as described by the American Society of Anesthesiologists (ASA). All anesthesiologist assistants possess a premedical undergraduate background and complete a comprehensive didactic and clinical program at the graduate school master’s degree level. Anesthesiologist assistants are trainedextensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques.    

Anesthesiologist assistants are also authorized to practice in 17 jurisdictions, the Medicare Program, and the Department of Veterans Affairs system.  

If your state is considering anesthesiologist assistant legislation, please contact Ashli Eastwood, ASA state affairs associate.

© 2015 American Society of Anesthesiologists

ASA Member Named Mississippi 2015 Diversity Educator of the Year

Claude Brunson, M.D., ASA director for the Mississippi Society of Anesthesiologists, was recently recognized as the 2015 Diversity Educator of the Year by the Mississippi Board of Trustees of the State Institutions of Higher Learning. Dr. Brunson is the Senior Advisor for External Affairs to the Vice Chancellor for Health Affairs and Dean of the School of Medicine at the University of Mississippi Medical Center (UMMC), where he is a Professor of Anesthesiology.

Dr. Brunson was recognized for his work as "an outstanding and effective faculty member, mentor and role model who is deeply committed to diversity" and one who brings "voice and action to the concept of promoting cross cultural understanding at the Medical Center andwithin the campus community."

Dr. Brunson also serves as a member of the ASA Committee on Scientific Affairs, as president of the Mississippi State Medical Association, is a member of the Mississippi Board of Nursing, as well as the Mississippi Board of Medicine. 

A graduate of the University of Alabama and the University of Alabama School of Medicine in Birmingham, Dr. Brunson completed his residency in anesthesiology at UMMC and later earned a Master’s degree in clinical health sciences as UMMC. He is also a veteran of the U.S. Navy. 

Congratulations to Dr. Brunson on this recognition! 

© 2015 American Society of Anesthesiologists

Governor Cuomo Appoints ASA Member to Serve as New York Health Commissioner

On January 13, 2015 Gov. Cuomo (D-NY) appointed ASA Member Howard Zucker, M.D., J.D., LL.M. to serve as commissioner of the State Department of Health. Dr. Zucker has been serving as acting commissioner since June of last year. Prior to serving as acting commissioner, Dr. Zucker served as the department’s first deputy commissioner.

Dr. Zucker previously served as a clinical professor of anesthesiology at Albert Einstein College of Medicine of Yeshiva University and as a pediatric cardiac anesthesiologist at Montefiore Medical Center. Dr. Zucker trained in pediatrics at Johns Hopkins Hospital, anesthesiology at the Hospital of the University of Pennsylvania, pediatric critical care medicine/pediatric anesthesiology at the Children's Hospital of Philadelphia, and pediatric cardiology at Children's

Hospital Boston/Harvard Medical School.

Congratulations to Dr. Zucker on his appointment! 

© 2014 American Society of Anesthesiologists 

ASA Member Appointed to North Carolina Medical Board

On January 8, North Carolina Gov. Pat McCrory (R) announced the appointment of ASA Member Bryant Murphy, M.D., M.B.A. to the North Carolina Medical Board. The North Carolina Medical Board consists of 12 members, each serving three year terms and appointed by the Governor. 

Dr. Murphy is the immediate-past president of the North Carolina Society of Anesthesiologists and is a delegate to the ASA House of Delegates. Dr. Murphy is an associate professor of 

anesthesiology at University of North Carolina-Chapel Hill and also serves as vice chairman of clinical operations at the Department of Anesthesiology for UNC Health Care. Dr. Murphy chaired the anesthesiology section of the National Medical Association in 2012.

Congratulations to Dr. Murphy on his appointment!

© 2015 American Society of Anesthesiologists