Like monarch butterflies flocking each year to Monterey, I joined 500 anesthesiologists on May 15-17 traveling to Washington D.C. for the Annual ASA Legislative Conference, #ASAWLC. It’s our responsibility to educate our elected officials about the incredibly important job that we do as physician anesthesiologists.
Maybe because I am a former publicly elected official (on the Seal Beach City Council for eight years, including a term as Mayor), or maybe because I am a current publicly appointed official (Chair of the Board of Directors for CalOptima, a public agency in Orange County that oversees the MediCal program for 800,000 low-income residents), I fully appreciate the fact that many of the decisions about how we practice and where we practice are made in our nation’s capital by people who do not understand or appreciate what we do. They don’t see how we, as physician anesthesiologists, maximize patient safety and comfort around the critical time of surgery.
The Legislative Conference is sponsored by the ASA Committee on Government Affairs(CGA), one of the ASA Committees upon which I serve. The committee typically meets early in the morning, before the conference starts, to review last-minute details. We heard a thorough update from Manuel Bonilla, ASA’s Chief Advocacy Officer, and our excellent ASA lobbying team about what is happening in various states across the country. Frequently, difficult issues in one state – like out-of-network payment – quickly metastasize to other states.
We learned how the ASAPAC is doing, and how California has one of the lowest percentages of participation. We discussed legislative efforts in various states to pass licensure for Certified Anesthesiologist Assistants, the ASA Resident Scholar program, and the ASA’s “When Seconds Count” educational endeavor. The meeting was plutonium-dense with information and collaboration among physician leaders and ASA staff.
The ASA Legislative Conference officially kicked off with a welcome by CGA Chair Erin Sullivan, MD, and ASA CEO Paul Pomerantz, followed by an advocacy overview by Nora Matus, ASA’s Director of Congressional and Political Affairs, and Jason Hansen, ASA’s Director of State Affairs. Attendees enjoyed interactive advocacy training workshops focusing on two key issues: legislative efforts to remove physicians from the care team, and out-of-network payments. We were then treated to a great skills workshop session on topics including:
Increasing professional citizenship and advocacy
New frontiers of technology: public health advocacy and social media
Communication skills for the health care advocate.
These informative sessions laid the groundwork for our Capitol Hill visits.
Every year, the ASA highlights a few issues to focus our advocacy efforts with our elected officials.This year, our top issues were:
Combating the opioid abuse crisis
MACRA: making sure physician anesthesiologists are not unduly burdened and harmed
Follow-up on the VA Nursing Handbook issue: After an excellent decision to protect physician-led anesthesia care in the VA, nurse anesthetists are promoting a bill that would legislatively undo that decision.
Few issues are as centrally located in the sweet spot of physician anesthesiologists as the opioid abuse crisis. We are the pain doctors; we use opioids every day, and more importantly, through multimodal, multidisciplinary pain management, we minimize the use of opioids and their adverse effects. It is very easy to find real-world examples of the importance of our work. I spoke with one elected official who had a major orthopedic procedure at a hospital where physician anesthesiologists are integrally involved in the perioperative process. This person had an ultrasound-guided nerve block which dramatically decreased postoperative pain and hastened the rehabilitation process. It is always helpful to start off a legislative visit talking about the value that we bring as physician anesthesiologists.
The second issue that we discussed was MACRA. In April 2016, Congress repealed the Medicare Sustainable Growth Rate formula (SGR, which is was neither sustainable nor a growth rate) and replaced it with a new payment system, the Medicare Access and CHIP Reauthorization Act (MACRA). This new system of payment establishes two pathways for participation: Merit Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). While these efforts have some positive features, they do not address the 33 percent problem for anesthesiologists, and MACRA’s quality reporting structure is better suited to primary care than to current anesthesiology practice. Our request to our legislators is to recognize the key role physician anesthesiologists play in the healthcare system, and to implement ways that physician anesthesiologists can successfully participate in MACRA and MIPS.
The third and arguably most important issue is the protection of physician-led anesthesia care in the VA system. If you have not heard of this issue, please visit the SafeVACare.org website! While we are grateful for the excellent decision by the VA to maintain physician-led, team-based anesthesia care in the VA system, nurse anesthetists are pushing a bill that would remove physician anesthesiologists from the anesthesia care team in the VA. We spent a lot of time discussing the value and importance of having physician anesthesiologists lead the anesthesia care team, and why this is in the best interest of our veterans and patients overall.
While we were advocating for issues of interest to physician anesthesiologists, it was impossible to ignore the elephants in the room: the polarization and partisanship of Washington politics, the daily breaking news stories, and the efforts to repeal and replace the Affordable Care Act. As advocates for anesthesiology, we don’t take sides; we support physician anesthesiologists, our practices, and most of all our patients.
Do we make a difference in coming to Washington? I spoke about the nurse anesthetist bill with one legislative analyst, who said, “I’m glad you came in today. The nurses were here last week and their bill sounded very reasonable. I am sure glad I got to hear another side to the issue!”
As a sidelight – a fascinating and enjoyable part of my trip was getting introduced to a Washington D.C. icon, Joe Quattrone, by CSA’s Executive Director, Dave Butler. Joe has been the Capitol Hill barber, working in the basement of the Rayburn Office building, for 47 years! He has seen just about everything, and he is both an excellent barber and an excellent sounding board. Regardless of which side of the aisle you sit on, you still need to get your hair cut!
The members of CSA’s delegation at the ASA Legislative conference were: Mark Zakowski, MD, Johnathan Pregler, MD, Paul Yost, MD, Peter Sybert, MD, Narendra Trivedi, MD, Neal Cohen, MPH, MD, MS, Jim Moore, MD, Jeff Poage, MD, Annie Lee, MD, Keith Chamberlin, MD, MBA, Sam Wald, MD, Jody Leng, MD, MS, Harry Miller, MD, Sunny Jha, MD, Rexford Pearce, MD, Robin Robbins, MD, Devangi Patel, DO, Dan Cole, MD, Linda Mason, MD, Stan Stead, MD, MBA, Mike Champeau, MD, and CSA's Executive Director Dave Butler.