Colleagues: It is once again the time for your annual update on the activities of the ASA board of directors:
Safevacare.org project: This has been a major success. The ASA was able to log over 90,000 comments supporting patient -centered physician-led anesthesia care for upload to the federal register on its safevacare.org site, far outpacing the opposition’s comment numbers. In addition, the ASA and the state components (including the NMSA) submitted written comments in hard copy. ASA leadership met several times with VA leadership face to face. The ASA was able to ally with several veterans groups and over 130 members of congress to oppose changes to CRNA medical direction. A media blitz put our position out to over 300 million people. As a result, the VA secretary has indicated that no changes will occur to CRNA medical direction at this time. Final language is due to be released in January. ASA leadership anticipates a favorable outcome, but is prepared to initiate legal action should the language prove unacceptable. This illustrates what can happen when members are really engaged and active---we can win!
MACRA: As you probably know (and was discussed in last years report), the old SGR Medicare payment formula has been replaced by the Medicare Access and CHiP Reauthorization Act (MACRA). This is a very complicated, outcomes-based payment scheme for Medicare that is supposed to begin in 2018---but the reporting period for data upon which payments will be adjusted is supposed to begin in January 2017. (For a good summary, I highly recommend the article written by the ASA chief advocacy officer Manny Bonilla in the August issue of the ASA newsletter. I also understand that our own Dave Leachman is an expert in this area.) But because the final rules have not yet been published, the start date may be pushed back to June 2017. The ASA has devoted considerable resources toward making this process as painless as is possible for its members. The ASA has made doc-friendly reporting measure suggestions to CMS that are likely to be adopted and have also developed tools to help each practice adopt to this new scheme. This toolkit is available to members at asahq.org/quality-and-practice-management/macra. Finally, MACRA bonuses are linked to outcomes reporting on a federally qualified registry such as the ASA’s NACOR, which is free of charge for ASA members—yet another benefit of ASA membership.
Balanced Billing: This is becoming a major issue nation –wide as insurers narrow their networks and patients are being presented with unexpectedly high out-of-network bills for services such as anesthesia. This has placed political pressure on legislators to essentially outlaw billing patients these charges. Obviously, this has the potential to have a major adverse impact on payments for anesthesia services. Once again, the ASA is out in front of the issue, working on a national and state level to protect our interests. Individual state component societies such as California and Alaska are actively working with hospitals and insurers on this issue. The ASA state affairs office, under the capable leadership of Jason Hansen, continuously monitors state legislatures across the country for bill submission. The NMSA has Art Hull on the lookout here in NM. Be prepared for some sort of legislation to be introduced in NM during this winter’s long session.
Fellow of the American Society of Anesthesiology (FASA): The ASA is developing this designation for distinguished ASA members. It is similar in concept to the FACS title for surgeons. The exact requirements for this designation are under development. It may become available in a year or so.
Financial issues: The ASA has been running a budget deficit for several years, which has required it to spend reserve funds. This is partially because of unforeseen expenses such as the VHA nursing handbook fight and issues surrounding the re-organization of the AQI. But given the ongoing probability of future challenges, the ASA leadership will be requesting a vote of the house of delegates to increase the dues to $800 per year at the annual meeting. As you might expect, this proposal triggered quite a bit of discussion and debate. Many directors voiced concerns about the financial burden on already strapped practitioners and cited the multiple obligations of component dues, ASAPAC and state PAC contributions, etc. Some were very worried about a loss of membership on a national and state level. The ASA is actively working to reduce expenses and cultivate non-dues revenue streams (about half of the ASA income is from dues, which is a much higher proportion than that of other national professional societies). They presented very detailed financial data in support of the proposal. I am guessing it will pass at the HOD meeting. We have two votes there—if you have strong feelings either way on this issue, please contact your delegates Mary Billstrand and Ruth Burstrom before October.
ASAPAC: It had been a record year for ASAPAC, with total contributions approaching $2 million. New Mexico is doing well in terms of participation (18%) but is behind in total contributions. FYI next year the top level of contribution will increase to $2, 500. I will therefore be putting off new wheels for the mountain bike.
In closing, I once again have to say how impressed I have been with the ASA leadership and staff. They are truly top notch and we are extremely lucky to be members of such an organization. I know the dues seem pricy—especially with the increase--but there is absolutely no question in my mind that they remain a huge bargain. The work the ASA is doing on MACA alone will more than offset the cost of membership when you consider the penalties and bonuses in this system and the complexity of compliance. Then there is the message that the ASA sent everyone on a national level with vasafecare. Regulators, nurses and others will think twice before threatening out patients or profession the next time.
But we still have a significant number of anesthesiologists in New Mexico—incredibly including at least two at the VA who may actually now owe their jobs to the ASA—who are not members. Plus there are some on the UNM anesthesiology faculty who would certainly not be in their current positions if the teaching rule had not been revoked as a direct result of ASA advocacy, yet many of them are not ASA members. Its time for us to start holding our colleagues accountable for their indolence and indifference. Every anesthesiologist needs to shoulder the burden of protecting patients and our profession. If more anesthesiologists were ASA /NMSA members, no dues increase would be necessary. In fact there might be a reduction!
It is an honor and a privilege to serve as your state director. Please feel free to contact me with questions or concerns.
As the summer season comes to a close, we hope you’ve had a chance to reconnect with loved ones and recharge your batteries. Here at NMSA, we’ve certainly had an eventful quarter! In June, our Board of Directors had a very productive meeting: we finalized a great list of speakers for the annual meeting next February, and began coordinating with several exciting vendors and exhibitors, too. We’re really looking forward to the meeting - be sure to mark your calendars for February 27, 2016 at Sandia Resort and Casino.
In addition, it’s been a red-letter summer for several of our members. We at the NMSA are honored that they have been recognized by the community for their efforts in the field.
Dr. Penny Lindgren was featured in Albuquerque the Magazine as one of the Top Docs in the city. In her interview, she discussed her passion for helping others, and the privilege of being able to do so on a daily basis. Let’s face it: surgery can be scary. Her goal of helping people feel safe and comfortable definitely earned her a place on the list. Way to go, Penny!
In August, member Dr. Phil Styka was appointed to the New Mexico Medical Board. We’re very excited at the NMSA to have one of our own represented among such distinguished physicians. In the words of the State Legislature, the Board was created “in the interest of the public health, safety and welfare and to protect the public from the improper, unprofessional, incompetent and unlawful practice of medicine.” We’re certain that Dr. Styka’s commitment to patient care and safety will serve the board well. Congratulations, Phil!
And finally, we are humbled and honored to know Dr. John Wills, whose longstanding service to NMSA and the community at large has had an incredible impact. Dr. Siegel, our NMSA Immediate Past President, first met John when he was a resident in 1988 at UNMH where Dr. Wills was a brand-new assistant professor. John was not afraid to take on anyone when it came to doing what was best for the patient—including his chair and some powerful surgeons.
Dr. Wills almost single-handedly brought anesthesiologist-assistant practice to New Mexico over a decade ago and has been a tireless advocate for the anesthesia care team ever since. He was never reluctant to make the drive up to the statehouse at any time of the day or night to advocate for our profession.
As chair of the anesthesiology department at the UNM school of medicine, John oversaw a large expansion of the program and department. Under his leadership, many high-quality faculty members have been hired. The department flourished, particularly in the field of regional anesthesia.
John also served on the NMSA board for many years. Our scientific meetings owe much of their success to his willingness to tap into his extensive number of contacts in the worldwide anesthesiology community for quality speakers. When Dr. Siegel was suddenly thrust into the office of NMSA president following the abrupt resignation of his predecessor, Dr. Wills’ mentoring and guidance were invaluable to Dr. Siegel. John also had a long and distinguished term as the New Mexico District Director to the ASA. And when the time came for Dr. Siegel to take his place, his gracious help and advice were greatly appreciated.
We are grateful to have had Dr. Wills as a friend and colleague, and the NMSA owes him a huge debt of gratitude.
Join us October 24-28, 2015, in San Diego for the ANESTHESIOLOGY® 2015 annual meeting. This five-day, everything anesthesiology event attracts upward of 15,000 attendees from around the world to grow, share and network. This year, we will be reinvigorating the science and helping you learn about the specialty’s latest science and technologies. With more than 600 sessions, special lectures and hands-on workshops, this is a meeting you will not want to miss.
IL HB 421 was recently signed into law (Public Act 099-0173). This advanced practice nurse (APN) licensure bill would have eliminated the requirement for a collaborative agreement for nurse anesthetists among other things, as it was originally written. The Illinois Society of Anesthesiologists (ISA) strongly opposed the measure. Compromise language that was signed into law with the Illinois Society for Advanced Practice Nursing made no changes whatsoever to the Nurse Practice Act with respect to the provision of anesthesia services by nurse anesthetists. In addition to other assistance, ASA submitted comments on this measure to the Health Care Licenses Committee in February.
Congratulations to the ISA for its effective safeguarding of patient safety!
Georgia Governor Signs Truth in Advertising Legislation into Law
On May 12, Gov. Nathan Deal (R-GA) signed into law HB 416, legislation which requires health care professionals to disclose professional information in advertisements and clinical identification.
Specifically, the bill requires health care practitioners to wear an identifier that includes their name and the types of license or educational degree they hold during all patient encounters. Advertisements for health care practitioners must also identify the type of license held. In a health care practice or facility other than a hospital, there must be a display in the reception area providing a notice that clearly identifies the type of health care practitioners employed and a notice of the patient’s right to inquire about a practitioner’s license. The bill also requires health care practitioners who practice in multiple offices to place identifier information noticeably on their website if they have one.
To date, 19 states now have Truth in Advertising laws in place, though they differ in their requirements. If you’re interested in learning more about getting truth in advertising legislation in your state, please contact Ashli Eastwood, state affairs associate, at firstname.lastname@example.org.
This August 3-6, ASA members and staff represented the Society at the National Conference of State Legislatures’ (NCSLs’) 41st annual Legislative Summit at the Washington State Convention Center. Since its inception in 1975, NCSL has become one of the largest bipartisan organizations of state lawmakers in the country. It currently serves all 7,383 state lawmakers and more than 20,000 legislative staff throughout the United States with policy research and technical assistance. Each year, NCSL’s Legislative Summit offers the opportunity for state legislators and staff to meet and exchange ideas on important state topics.
This year, more than 5,000 state legislators, legislative staff, government officials, business representatives and educators attended the summit, where they were offered more than 100 policy sessions on topics varying from health care and telehealth, taxation, the environment, energy, and every issue in between. The Legislative Summit also welcomes legislators from other countries so they may learn about state legislative processes in the United States. Legislative Summit attendees had the chance to visit a wide variety of exhibitors in the exhibition hall at the Washington State Convention Center.
For the past 15 years, ASA has participated as an exhibitor at NCSL’s Legislative Summit, and this year ASA represented physician anesthesiologists as part of a larger joint physician booth called “Physicians Advocating for Patients.” This joint exhibit booth included representatives of the American Academy of Dermatology, American College of Surgeons, American Urological Association, and the Coalition of State Rheumatology Organizations.
During this year’s Legislative Summit, Washington’s ASA Director Peter Dunbar, M.B., Ch.B., M.B.A., Washington Alternate Director Mark Flanery, M.D., Robert Hsiung, M.D. of Seattle, and James Stangl, M.D. of Tacoma, joined ASA staff in interacting with state legislators and legislative staff at the exhibit booth. Tennessee State Senator and ASA Member Steve Dickerson, M.D. also visited ASA’s booth.
The NCSL Legislative Summit provides ASA an important opportunity to increase the visibility of physician anesthesiologists and educate state legislators about the specialty and physician anesthesiologist’s achievements in advancing patient safety. State legislators and staff stopped by the ASA’s booth to speak with ASA staff and Washington State Society of Anesthesiologists representatives, as well as others at the joint booth representing their respective medical specialties. ASA is already planning for NCSL’s 2016 Legislative Summit, which will be held in Chicago from August 8-11, 2016.
The Interstate Medical Licensure Compact was created to enhance medical license portability thereby making it easier for physicians to work across state lines. Specifically, it is a new licensing option under which qualified physicians seeking to practice in multiple states would be eligible for expedited licensure in all states participating in the compact. This would make it easier for physicians to practice in multiple states and would strengthen public protection by allowing states to share investigative and disciplinary information that currently cannot be shared with other states.
Facilitated by the Federation of State Medical Boards (FSMB), the compact itself was drafted by a team of state medical board representatives and specialists from the Council of State Governments (CSG). The state medical board representatives were from a diverse collection of states and worked closely with compact experts from CSG and FSMB staff to define the component principles that guided the subcommittee tasked with creating a draft compact.
The full list of eight consensus principles included:
Participation in an interstate compact for medical licensure will be strictly voluntary for both physicians and state boards of medicine;
Participation in an interstate compact creates another pathway for licensure, but does not otherwise change a state’s existing Medical Practice Act;
The practice of medicine occurs where the patient is located at the time of the physician-patient encounter, and therefore, requires the physician to be under the jurisdiction of the state medical board where the patient is located;
An interstate compact for medical licensure will establish a mechanism whereby any physician practicing in the state will be known by, and under the jurisdiction of, the state medical board where the practice occurs;
Regulatory authority will remain with the participating state medical boards, and will not be delegated to any entity that would administer a compact;
A physician practicing under an interstate compact is bound to comply with the statutes, rules and regulations of each compact state wherein he / she chooses to practice;
State boards participating in an interstate compact are required to share complaint / investigative information with each other; and
The license to practice can be revoked by any or all of the compact states.
Drafting of the Compact has been completed and the model Compact can be found here. To date, 11 states have enacted the Interstate Compact: Alabama, Iowa, Idaho, Illinois, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, and Wyoming. An additional eight states have introduced legislation in the 2015 legislative session.
The Anesthesia Quality Institute (AQI) this year celebrates six years as an organization and in those six years there has been a wealth of growth. Through the six-yearexperience AQI has learned and grown immensely. AQI’s National Anesthesia Clinical Outcomes Registry (NACOR) Participant User File (PUF) is close is reporting 30 million cases and 5.7 billion data points). AQI has been published in multiple journals including Anesthesiology, Anesthesia & Analgesia, and the Journal of the American Geriatric Society. It’s safe to say that in these six years AQI has experienced great success and with the continued quality improvement, AQI will see even more growth in the upcoming years. A huge part of AQI’s success can be attributed to AQI’s own Richard Dutton, M.D. who has been with the ASA affiliated organization from day one.
Dr. Dutton will be leaving AQI at the end of August to start a new chapter as the inaugural chief quality officer for U.S. Anesthesia Partners (USAP) and he will be missed by all. Dr. Dutton will remain involved with ASA on key initiatives such as working on quality reporting aspects of the Medicare Access and CHIP Reauthorization Act (MACRA). He will work with the AQI Board of Directors, elected leadership and ASA staff to help ensure the smoothest possible transition of his ASA responsibilities. Dr. Dutton started AQI and helped in leading its success.
On a related note, ASA recently announced that DeLaine Schmitz will be joining the ASA and AQI teams as AQI Executive. DeLaine most recently served as director of quality for the Society of Thoracic Surgeons (STS). She has nine years of experience as director of quality for both STS and the American Society of Plastic Surgeons (ASPS). She directed the development, marketing and day-to-day operations of the Adult Cardiac, General Thoracic and Congenital Heart Surgery registries at STS. At ASPS, DeLaine directed the ASPS clinical outcomes database ensuring that the appropriate vendor and technical architecture were in place to meet ASPS’ goals and future needs. She holds a Masters of Science Health Law from Nova Southeastern University, Shepard Broad Law Center in Ft. Lauderdale-Davie, Florida. DeLaine’s first day at ASA will be Sept. 28.
AQI is staying strong through these transitions and expects to report on 72 practices via the Qualified Clinical Data Registry (ASAQCDR). AQI also is hosting its first Anesthesia Data Conference at the end of August. With the increased interest it is hoped that this will be a continued event in the future.
Please stop-by the AQI booth in the resource center at the ANESTHESIOLOGY® 2015 annual meeting. For other questions please contact AskAQI.
Physician Anesthesiologist Elected to Georgia House of Representatives
On July 14, Republican Elizabeth “Betty” Price, M.D., was elected to the Georgia House of Representatives, representing District 48. Dr. Price is married to Congressman Tom Price (R-GA-6), an orthopaedic surgeon. ASAPAC and GSA-PAC supported Dr. Price, who is the only physician in the State House.
This was a special election following the death of Harry Geisinger (R). Dr. Price received her medical degree from McGill University and completed her residency at Emory University School of Medicine.
Presently, physician anesthesiologists serve in five other state legislatures: Alabama, Kansas, Oklahoma, Tennessee, and Texas.
Maryland Society of Anesthesiologists Name Murray A. Kalish, M.D., First Lyles Award Winner
ASA congratulates Murray A. Kalish, M.D., who was named the winner of the first Robert L. Lyles, Jr., M.D., Award for Physician Advocacy by the Maryland Society of Anesthesiologists.
The Robert L. Lyles, Jr., M.D., Award for Physician Advocacy was created to recognize individuals demonstrating a “deep and enduring commitment to enhancing the representation and recognition of anesthesiology at all levels of government.”
Dr. Kalish currently serves as Director of the Maryland Society of Anesthesiologists. He is an active member of ASA, and currently serves on the society’s Committee on Critical Care Medicine and Committee on Finance.
Congratulations to Dr. Kalish, and thank you for your extraordinary advocacy!
ASA Member to Complete Tenure on Nebraska Board of Medicine and Surgery
In November, ASA member Vonn Roberts, M.D. will complete his second and final term on the Nebraska Board of Medicine and Surgery. Dr. Roberts began serving on the Board in December 2005 and will have fulfilled two five-year terms, the limit for Nebraska Board of Medicine and Surgery members.
Dr. Roberts attended medical school at the University of Nebraska Medical Center College of Medicine, followed by residency at the University of Nebraska Medical Center. Dr. Roberts currently works in private practice in Lincoln, Nebraska.
A number of physician anesthesiologists are currently serving on their boards of medicine or osteopathy in nearly 30 states. In addition, physician anesthesiologists are serving their state departments of health in several states as well.
We congratulate Dr. Roberts on his accomplishments and thank him for his service!
Physician anesthesiologists from across the country are eagerly waiting for Thursday, August 20. On this day, ASAPAC will host the Second Annual Day of Contributing "DoC" Challenge!
ASAPAC current, past and future donors will show their ASAPAC support through online donations beginning at midnight Central Time and ending at 11:59 p.m. Thursday, August 20.
ASAPAC has set a goal to raise $200,000 during this "DoC" Challenge! Although last year's "DoC" came close, ASA members have NEVER donated $200,000 in one day!
The state with the largest number of contributors and the state with the largest amount contributed on August 20 will be deemed the winners of the ASAPAC "DoC" Challenge. Those states will also receive special recognition in ASAPAC publications and presentations.
ASA members are encouraged to make a contribution on Thursday, August 20 and show ASAPAC their support! All contributions will count towards ASAPAC's 2015 Fiscal Year ending on September 30.
Contributions to ASAPAC are not deductible as charitable contributions for federal income tax purposes. Participation in ASAPAC is voluntary. You may refuse to contribute without reprisal. You must be a U.S. citizen or legal resident to contribute.
As the last quarter of 2015 draws to a close, it's exciting to look back and see what we've accomplished. Obviously, the greatest achievement for the NMSA was successfully assisting the Anesthesiologist Assistants with their legislative efforts to remove the geographic restrictions at UNMHSC. We are now striving to close a small loophole in their malpractice insurance that once fixed, will allow them to work throughout the state and give all practices another option for physician-led anesthesia care.
On the horizon, you will all be receiving the brochure for our upcoming annual meeting on Saturday, February 27th. Please register for the meeting as soon as possible by going to: http://www.nmsahq.org.
The meeting will be informative and aggressive with rescue echocardiography as a work shop and Dr. Jeff Plagenhoef from the ASA will be joining us as our featured speaker. Also at the meeting, we will be filling some positions on our board. If you are interested in serving in 2016 and giving back to your specialty in this capacity with the NMSA, please contact our administrator, Jason Marshall, at email@example.com.
Also, I know many of you have asked about advocacy and how to get more involved. Our NMSA PAC, Patient Safety Advocates of New Mexico, has been in limbo for a few months. We hope to have it up and going again by the end of the month.
Keep in mind that in November, the ASA will request membership dues for both the ASA and NMSA collectively again. Please pay these dues immediately as they help drive the society and its efforts throughout the year and prompt payments allow us to budget effectively throughout the year.
Both the ASAPAC and the New Mexico PAC are also looking for new leadership and there are opportunities for service in these capacities as well. These positions serve as meaningful advocates to both what we do here in New Mexico to protect our specialty and to helping efforts on a national level. Please consider giving up some of your time and inform Jason Marshall of your interest, firstname.lastname@example.org.
Thanks again for all your efforts and your dedication to our great specialty. I hope everyone has a wonderful holiday and I look forward to seeing you all in February.
Don't forget to check out the web page nmsahq.org and follow us on twitter @nmsahq for important updates and information.
As we head into the 2016 renewal season ASA would like to thank members for their continued support of the specialty. Whether it is professional education to improve patient outcomes, quality improvement, practice management, or advocating for the specialty, ASA is working on your behalf.
ASA is continually developing products, resources and services to keep you at the forefront of the profession. These membership benefits add up in a real practical and tangible way. If you want to see how far your dues will take you in 2016 check out ASA’s ROI calculator tool at www.asahq.org/roi. You’ll receive an immediate return
on every dues dollar you spend.
With the addition of 14 state component societies to the unified dues billing program, over 72 percent of ASA members will see their component society dues on their 2016 ASA dues invoice. This program has been well received by members and their practices for the ease it brings to invoice and payment processing. Be sure to watch your email and print communications for more information.
ASA membership matters to your patients, your practice and your specialty.
States Urged to Prepare for VHA Nursing Handbook Publication
A tireless and well-executed outreach strategy must be accomplished to maintain the highest levels of patient safety and quality of care for Veterans receiving anesthesia within the Department of Veterans Affairs (VA). The most essential tactic required in order to maximize the success of any advocacy effort is passionate and repetitive physician-to-physician communication and leadership.
Mindful of this, ASA has developed a bidirectional communication tree to offer a structure to better organize and facilitate accomplishing our goal of an immediate and overwhelming blitz of physician anesthesiologists' responses to the Federal Register posting. All states are encouraged to put a plan in place now to be used immediately when the VHA Nursing Handbook is posted for comments.
ASA is urging all physician anesthesiologists to be prepared to respond electronically, and then to get all of their partners and family members to respond as well. With VA still planning to undermine physician-led, team-based surgical anesthesia care, it is essential that each and every physician anesthesiologist assumes responsibility to not only respond, but to get at least another 10 people to do the same.
Once a group or department is at the 100 percent response rate, members should tell their state component's Executive Director or officers so that group-to-group peer pressure and accountability can be used to achieve additional motivation.
Now is the perfect oportunity to begin to establish a preliminary outline of who will be responsible for what within each state — from leadership to each physician anesthesiologist — and how the results will be reported to state and ASA leadership and staff.
Please feel free to contact Amanda Ott in ASA’s Advocacy division at email@example.com or 202-289-2222 with any questions or concerns about this plan.
PRACTICE MANAGEMENT 2016 is the most relevant and timely conference of its kind. Physician anesthesiologists, practice administrators and leaders in the specialty unite to share insights and strategies to improve operational efficiency, financial performance, quality, safety and overall practice performance. Succeed in today’s evolving health care environment and transform your practice by staying at the forefront of practice management.
Michigan Society of Anesthesiologists Annouces Michigansdrugcrisis.com
In an effort to help patients, families, and lawmakers better understand the potential patient safety implications of pending legislation, the Michigan Society of Anesthesiologists announced a new website michigansdrugcrisis.com. Similar to many other states, Michigan is facing a prescription drug abuse epidemic. The website seeks to educate the public on the dangers of Senate Bill 320, legislation that would remove physician supervision of nurse anesthetists, authorize prescribing authority and pain medicine services (under physician delegation). According to MSA, the additional 3,000 new non-physician prescribers this bill would create is one of the many patient safety problems with the legislation. Physician anesthesiologists throughout Michigan have been adamant that the legislation risks patients’ health — and even lives — by ending physician supervision of the anesthesia care team.
Critical messages from the website include:
…while some of the best and the brightest minds in the state work together to get prescription pain killers off the street, a little-discussed provision in one Lansing bill, Senate Bill 320, would add 3,000 new non-physician prescribers overnight, threatening to make the problem worse!
Between 2009 and 2012, 36 percent of fatal drug overdose victims obtained prescriptions from 5 or more prescribers. (MDHHS). Adding 3,000 new, unsupervised prescribers will only make matters worse!
SB 320 would remove all physician oversight of opioid prescription by nurse anesthetists.
Current law protects Michigan patients by ensuring advanced practice nurses are prescribing only under the supervision of a physician for Schedule 2-5 drugs.
SB 320 would give 3,000 nurse anesthetists full prescribing authority, including Schedule 2 opioids, all without additional training or the common sense legal oversight required of other advance practice nurses.
ASA Thanks Members for Federal Advocacy During August Recess on VHA Nursing Handbook
During the Congressional August "district work period," 71 ASA members contacted their lawmakers asking to schedule meetings to discuss concerns with the proposed VHA Nursing Handbook, which threatens patient safety by removing physicians from Veterans' anesthesia care.
Thank you to members from Alabama, Arizona, California, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Massachusetts, Michigan, Missouri, Nebraska, New Hampshire, New Jersey, Ohio, Oregon, Pennsylvania, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin, and the District of Columbia who requested a Congressional meeting.
If you were unable to meet with your lawmaker, you are encouraged to write them on the issue or consider requesting a site visit for a lawmaker to visit their local facility.
Please report your August recess meetings online or contact Amanda Ott in ASA's Advocacy Division at firstname.lastname@example.org or (202) 289-2222.
FTC Issues Guidance on Active Supervision of State Regulatory Boards
Earlier this year, the U.S. Supreme Court issued its long awaited ruling in the North Carolina State Board of Dental Examiners v the Federal Trade Commission (FTC). In the case, 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 its 6-3 decision, the Court found the dental board was not entitled to immunity because it was not “actively supervised” by the state.
On October 14, in response to requests for guidance after the Court’s ruling, the FTC announced a staff guidance document to assist state officials charged with ensuring antitrust compliance for their boards that regulate occupations (i.e. boards of medicine, boards of nursing, and so forth).
The document is designed to help state officials seeking to ensure their occupation boards are positioned to claim a state action defense if challenged by the FTC. However, the document only addresses one of the elements necessary for this defense, the active supervision component. Specifically, it addresses two questions:
When does a state regulatory board require active supervision in order to invoke the state action defense?
What factors are relevant to determining whether the active supervision requirement is satisfied?
The document does not address the other component required for this defense by states with regulatory boards that have a controlling number of market participants, namely the clear articulation component.
ASA staff is reviewing the document and will follow up with more comprehensive guidance in the near future. In the meantime, the document may provide more direction for the states in the aftermath of North Carolina State Board of Dental Examiners v FTC — which may help avoid similar future court decisions.
Judge Agrees with Anesthesiology Group in Balance Billing Case
A New Jersey judge ruled in favor of a physician anesthesiologist who billed an out-of-network patient the balance of an anesthesiology services bill from an emergency C section. In Bergen Anesthesia v Cristiano (DC 5290 15), the insurer paid less than one-half the full amount of the $3,300 bill, leaving a balance of $1,852. The judge ruled the bill was reasonable and ordered the patient pay the remaining balance.
When the defendant was admitted, her husband wrote and initialed “Do not agree” on the area of the General Consent to Hospital Care Services form that explained the patient may receive services from individuals not in-network, that the patient could be balanced billed, and that the patient is responsible for payment. The judge ruled the form is not a contract and that while the patient believed she informed the hospital of her wishes to accept services from only in-network professionals, it does not mean the patient can command which medical group can provide her services while in the hospital. Per the judge, “It also does not impress an obligation on the plaintiff to investigate at midnight and determine whether the defendant’s medical plan will cover the anesthesia that she needed, on an emergency basis, so that she could deliver her baby.”
The judge found the bill in alignment with the billing practices of other anesthesia groups in the county. According to the judge, “But for the insurance plan that the defendant selected, the plaintiff's bill would have been fully paid."
In 2015, New Jersey successfully defended against a legislative effort to limit balance billing. A number of other state component societies have similarly dealt with balance billing initiatives in recent legislative sessions. In 2016, more state legislatures will likely consider this topic as well.
Here’s a reminder that November general elections are coming soon so make sure you are registered to vote. Louisiana, Kentucky, and Mississippi will have gubernatorial elections this year. Louisiana, Mississippi, New Jersey, and Virginia will each have legislative elections, as well.
Registration deadlines are quickly approaching in many states. If you are going to be out-of-town or otherwise unavailable on Election Day (November 3, 2015), consider voting absentee, or voting early in-person if your state allows it. Candidates we elect to office can help or hinder our policies promoting patient safety, so it is essential to choose carefully and encourage your friends and family to vote, too!
To check on your state’s registration and voting laws and to see which candidates and issues will be on your ballot, go to www.vote411.org. This is a nonpartisan website run by The League of Women Voters which provides both general and state-specific election information.
If you have specific questions about your state that the website does not cover, please contact Erin Philp at email@example.com.
Mark your calendars and get ready to advocate for our specialty by increasing awareness of how when seconds count, physician anesthesiologists save lives during the second annual Physician Anesthesiologists Week Jan. 31 – Feb. 6. We need every member to get involved and help share key messages about the importance of physician-led care. Whether you tweet, meet with a legislator or send a letter to the editor of your local newspaper — any activity can help us make a huge impact.
During the inaugural Physician Anesthesiologists Week, members made their voices heard across the country through local media outreach, online engagement, in-person meetings with colleagues and policymakers, record-breaking social media engagement and more.
We can make Physician Anesthesiologists Week 2016 an even bigger success, but we can’t do it without you. Take part in one activity or several and help us meet our goal of increasing awareness of the role physician anesthesiologists play in protecting patient safety.
Here are ways you can take action during Physician Anesthesiologists Week 2016:
Set up meetings with legislators at the state capital or district office. Advocate for your patients and your ASA colleagues in one-on-one meetings with influential legislators and staff with tips for scheduling face time and staying on point.
Showcase your expertise. Invite policymakers and the media to tour your hospital and see our specialty in action. A sample tour agenda and key messages will be provided.
Contact the media. Increase awareness of the importance of physician-led care in patient safety by conducting outreach, sending materials and offering interviews with local media, using sample materials and talking points.
Be Social. Use the #PhysAnesWk16 hashtag and ASA’s social media messages to sound off this week about the physician anesthesiologist specialty.
Post a web banner. Use the specially designed Physician Anesthesiologists Week web banner on your website or forward it to your webmaster or institution’s PR staff for assistance. The banner showcases your advocacy for the specialty and leads visitors to the patient-centered, physician-led resources on the When Seconds Count® website.
Order and display a poster. A specially designed poster about the specialty can be ordered for display in pain clinics, surgery centers, academic departments and hospitals large and small.
Shoot a video. Produce a short video about the role physician anesthesiologists play in protecting patient safety. Post it on YouTube and share on social media.
Connect with colleagues and the community. Make this week an occasion to gather physician anesthesiologists, patient advocates and others from the community in “lunch and learns,” networking events, health fairs and other functions to raise awareness of the specialty. A slidedeck on preparing for surgery will be available for these opportunities.
A Physician Anesthesiologists Week member engagement webinar is scheduled for December to showcase the member support kit containing the materials and resources available to help make the event a success.
As you make your voice heard locally, ASA will spread the word nationally through media outreach to generate coverage about the work you, your ASA member colleagues and all physician anesthesiologists do to advance patient safety.
We each have a critical role to play in advocating for our specialty. Join us in a week of action by engaging in one advocacy activity or all ten and help us spread critical patient safety messages.
ASA Committee on Economics Requests Private Payor Information
In order to better serve our members and track trends in private payer coverage policies, the ASA would like to follow changes to private payer policies in each state. This information will be used to help members around the country keep up with changes in healthcare and to be proactive in addressing new or changed policies. We do not want information regarding rates of fee schedules as this would be a violation of antitrust laws.
We are interested in policy information and medical necessity guidelines. As an example, Anthem of Virginia recently adopted a policy that requires American Institute of Ultrasound in Medicine (AIUM) certification to bill ultrasound guidance for line or block placement. The ASA was very involved in helping the state society address this with Anthem's medical director.
Please send any information to: K.Chisolm@asahq.org. The ASA is available to assist you in addressing private payer policies in your state, but will only do so upon your request.
The American Society of Anesthesiologists (ASA) invites you to participate in our 13th survey of commercial payment rates. As with previous surveys, we will publish the results in the ASA NEWSLETTER later this year. We would greatly appreciate your help with this update. As a reminder, the Statements of Antitrust Enforcement Policy in Health Care issued jointly by the Department of Justice and the Federal Trade Administration make it possible for us to gather this information as long as certain conditions are met. The most important condition, besides only publishing aggregate statistics, is that the data you provide be AT LEAST THREE MONTHS OLD.
Please provide the following information for your five (5) highest-volume commercial payers (not Medicare, Medicaid, other government payers) based on volume of services provided on an annual basis. If you have fewer than five contracted commercial payers, please enter information for all of your commercial payers. AGAIN, PLEASE ENSURE YOUR DATA IS AT LEAST THREE MONTHS OLD.
TO OUR PHYSICIAN ANESTHESIOLOGISTS: Please ask your practice manager or billing service to complete this questionnaire. It is important that we receive only one response from each anesthesia group. We ask that you or your staff complete the survey NO LATER THAN JUNE 30, 2015.