The ASA Board of Directors (BOD) met on August 17-18 in Chicago for what is referred to as the annual meeting of the Board. The Board is comprised of one director and an alternate director from the 56 component societies, 12 officers, and the section chairs. For more information on the duties and composition of the BOD you can visit the governance page on the ASA’s website.
Since this is the final meeting of the BOD before the society’s Annual Meeting in October, most committees present their final annual reports for Board review before the House of Delegates. In addition, there are educational sessions with a presentation by the CEO, President, President-Elect and other officers or Board members on the general state of the society, goals and achievements regarding the strategic plan, and new initiatives. Candidates who are running for a new office also address the Board as a warm-up for the elections that occur at the House of Delegates.
The CSA sends a significant delegation to the BOD. The ASA automatically sponsors the attendance of all ASA officers and the state Director. The CSA routinely sends three additional people to the ASA Board of Directors per our Administrative Procedures: the President, President-Elect, and ASA Alternate Director. In addition, the CSA will send other officers and members as budgeted to increase our state’s engagement in the ASA. In attendance at this meeting were ASA President Linda Mason, Immediate Past President Jim Grant, Treasurer Michael Champeau, ASA Director Linda Hertzberg, ASA Alternate Director Johnathan Pregler, ASA President Elect Jeff Poage, Chair of ASA Section on Professional Practice Neil Cohen, Antonio Conte, Sunny Jha, Phil Levin, Chris Tirce, and Paul Yost.
The festivities started early on Saturday morning with a Western Caucus meeting at 7 a.m., so your representatives met on Friday night to review the materials with special attention to items of interest to the CSA membership. Reviewing the material is no easy task given that this meetings handbook weighed in at 623 pages! The Handbook has 4 sections: Administrative Affairs, Professional Affairs, Scientific Affairs, and Finance. The bulk of Saturday is spent in Educational Sessions for the Board, and Review Committee Hearings where each item in the sections is presented for testimony. Each review committee then prepares a report for the Board’s consideration at its formal Sunday meeting.
The Saturday morning educational session was opened by our own Dr. Linda Mason. Paul Pomerantz, the ASA’s Chief Executive Officer, spoke first about the status of the ASA. Membership growth remains an important focus for the ASA following a year where growth while meeting targets, was in the single digits. The ASA is hoping to partner more with the component societies, incentivizing new members, reaching out to group practices, and connecting with residency programs. The ASA estimates that they have a 64 percent market share and would like to get to 80 percent. Mr. Pomerantz commented on the external challenges that the American Association of Nurse Anesthetists is creating with their new messaging campaign. The ASA will respond with a strong public communications message that advocates for physician-led anesthesia care. Positive news came in form of improved Anesthesia Quality Institute financial performance requiring significantly less support from the ASA. The ASA PAC also had substantial growth in revenue and currently has the highest amount of contributions at this point when compared to prior years. The ASA’s focus over the upcoming year will be on the ASA’s economic strategic plan including renewed messaging and communication to the public and stakeholders important to our profession, education for the care team and continued support of scientific discovery.
A financial update was provided by Dr. Michael Champeau, Treasurer, and Lisa Steininger, Chief Financial Officer. The ASA is in its second year of using a new budget preparation timeline that uses more of the current year’s financial data to make projections for next year. The current budget projection for 2020 has the ASA finishing with a deficit of $1.7 million dollars on revenue of 52.9 million and expenses of 51 million. Dr. Champeau proposed that after cost cutting initiatives, the society will seek a membership dues increase of two percent. The proposal will be finalized prior to the Annual Meeting in October and may include a request to the House of Delegates to approve a small dues increase each year to keep up with increases in wages and benefits, which make up approximately 50 percent of the society’s expenses. Dr. Champeau then took an informal poll of the members present to determine the level of support for an incremental due increase proposal.
Dr. Ken Elmassian, Secretary of the ASA, followed with a presentation on a new communications strategy. He reviewed the longstanding problems due to the lack of the public’s awareness of the length and depth of training required to become an anesthesiologist. He discussed the latest public relations initiative from the AANA and its creation of confusion among the public regarding the differences between physician anesthesiologists, and certified registered nurse anesthetists. Dr. Elmassian proposed a major new initiative to improve messaging to the public and key stakeholders in government and healthcare administration roles. The plan includes determining the best messaging and tactics, and will use a combination of in-house ASA resources, and consultants. The goal will be to present a draft proposal by the March 2020 BOD meeting. Dr. Elmassian asked for a total of $2.4 million to fund complete execution of the campaign through 2022 with $400k budgeted to start the project this year.
The other major focus of the afternoon session was advocacy and included two major topics: surprise medical billing, and the Medicare 33 percent problem. The ASA’s Chief Legislative Advocate Manuel Bonilla presented a summary of the current activity in Washington, D.C. regarding surprise medical bill legislation (aka out-of-network billing) that is currently being proposed at the federal level. Several proposed bills are not being supported by the ASA since they incorporate rate setting provisions. The Ruiz-Roe bill is endorsed by the ASA since it relies on an independent dispute resolution process with a support floor at 80 percent of charges. You have probably seen multiple emails from the ASA encouraging all members to contact their legislators in support of this bill. Please support the ASA’s efforts by contacting your federal representatives. More information can be found here.
Medicare Payment Issues:
The ASA’s Vice President for Professional Affairs, Dr. Jeff Mueller, presented on update on the ASA’s efforts to improve Medicare payment for anesthesia services and to address the potential of a universal health care program based on Medicare. Linda Hertzberg’s state report to the board included an action item based on the Resolution passed by the CSA House of Delegates called the Fair Payment Resolution that requested the ASA work toward correcting the “33% problem” of low Medicare reimbursement. The phrase “33% problem” refers to the fact that Medicare’s reimbursement rates for Anesthesia services are approximately 33% of average commercial rates. This percentage is low compared to the Medicare rates for non-anesthesia services. The ASA has chosen to assign the process of review of Medicare payment rates to a task force of the Committee on Economics that will be chaired by Dr. Johnathan Pregler, the CSA’s Alternate Director to the ASA. The task force will start by reviewing all of the source documents that created our current Medicare valuation. It will look to identify the flaws in the analysis done at the time. The committee work product will facilitate our understanding today of what occurred 27 years ago and hopefully provide the insights that enable us to communicate better and to craft our arguments to reverse our current valuations.
Three additional committees will also be working on the other aspects that will affect payments in the future. Dr. Neal Cohen from UCSF will continue to Chair the Ad Hoc Committee on Medicare for All. This group is tasked with developing the approach the ASA should take for any future legislation that would impose a federal universal health care program. Dr. Don Arnold from Missouri will Chair the Ad Hoc Committee on Payment and Care Delivery Models. Their task will be to develop consensus on anesthesia practice models and related billing methodologies. The Committee on Economics also has a Task Force that is addressing Alternative Payment Models and is being Chaired by Dr. Jonathan Gal from New York.
The CSA received special recognition during the Board meeting on Sunday when it was announced that we received an award as part of the inaugural Component Society Recognition and Awards Program. We were recognized for our governance restructuring project that occurred last year leading up to the June, 2019 CSA House of Delegates that resulted in consolidated geographic districts and the addition of the practice forums with BOD representation. We received the award for “Innovation & Continuous Improvement Initiative” for a very large component.
Committee Reports of interest included:
Statement on the Anesthesia Care Team
The Committee on the Anesthesia Care Team presented a revised statement of the document that establishes best practices when working with residents, CRNA’s and Anesthesiologist Assistants that will be discussed at the Annual Meeting in Orlando. The current document can be found here. The committee recommended one change to the last sentence in the statement so that it states, “Therefore, the use of students in place of qualified personnel is inappropriate.” This replaced wording that was less stringent and referred the reader to another document, the Guidelines for the Ethical Practice of Anesthesia. The Board approved the new statement and it will be considered by the House at the Annual Meeting.
Statement on Medication Administration
The Statement on Medication Administration was revised by the Committee on Quality Management and Departmental Administration to reflect changes made by the US Pharmacopeial Convention to the infamous Chapter 797. The USP document created confusion among accreditation surveyors who frequently ruled that intravenous anesthetics had to be used within one hour of preparation. The QMDA committee submitted comments on behalf of the ASA to the USP suggesting changes to reflect the administration of medications in the daily practice of anesthesia. The USP revisions removed the administration of medication from the chapter and also the application of the “one hour” rule to sterile medications prepared for administration in the OR. These changes will go into effect in December. The board approved the new statement with some revision and will be considered by the House.
State Advocacy for Residents
The Committee on Governmental Affairs report proposed the creation of a pilot program for state advocacy and political affairs based on the ASA Policy Research Rotation in Political Affairs in Washington D.C. The proposal would provide support to the state component societies to address the increasing demand for resident advocacy training. This would be similar to the program that is already being piloted in California as crafted by our Legislative Affairs Committee. The board approved wording to support the concept of the program.
ASA Statement on Compensation Equity
The Ad Hoc Committee on Women in Anesthesia reported on their findings on the issue of gender-related pay discrepancies which was tasked to the by Immediate Past President Dr. James Grant. As a result of their survey and findings they proposed approval of a new document, “ASA Statement on Compensation Equity Among Anesthesiologists”. The statement lists a series of recommendations to guide departmental administrators and academic chairs in policy creation and departmental decision-making regarding compensation. The board approved the statement and it will go to the House of Delegates for approval.
Guidelines for Surgical Attire
A new document titled “Guidelines for Surgical Attire” was submitted by the Committee on Occupational Health that developed out of their advisory role to the AORN’s Guidelines for Perioperative Practice. The AORN’s guidelines came under criticism that lead to a collaborative effort among the ASA, AORN and American College of Surgeons to revise the document. There was testimony at the Scientific Review Committee regarding the content of the document and its proper place among ASA documents. The Board voted to refer the document back to the Committee for revision.
Overall the ASA Board of Directors meeting in August was extremely busy with many important updates on the society’s work on strategic initiatives and new proposals. The ASA is making significant progress on the issues that are important to the membership. As you can see from the list above, there will be a lot of material for consideration by the House of Delegates in Orlando in October. Any CSA member who wishes to add input may attend the California or Western caucus meetings on Saturday and Tuesday and may also attend the Reference Committee hearings on Sunday to provide individual testimony. You may also contact any of the CSA’s Delegates to the ASA or me at firstname.lastname@example.org or Linda Hertzberg at email@example.com to provide us with input.