CSA Online First

CSA Online First is a weekly blog featuring insights from CSA members themselves.

Edited by Rita Agarwal, MD, FAAP, with contributions from CSA’s Committee on Professional and Public Communications, Online First is a place where knowledge and opinion from any one of our 3200 plus physician-anesthesiologist members can be shared, discussed and deliberated to advance the specialty of anesthesiology, the practice of medicine and society in general.

"Better solutions to difficult problems are usually made when all sides are heard."

Steven Goldfien, MD

 

Spotlight on the ASA: the 2019 Annual Meeting in Orlando and Beyond

by
  • Hertzberg, Linda, MD, FASA
| Dec 02, 2019

Linda-Hertzberg-MD-FASAOrlando is home to a multitude of theme parks and attractions; I became acquainted with nearly all of them thanks to a well-planned visit by my adult daughter after the conclusion of the ASA Annual Meeting.  And yes, the Toy Story reference is accurate - there is a Toy Story area in Hollywood Studios and I did several of the rides there as well.

The first five days I spent in Orlando at the ASA Annual Meeting were all business. The CSA had a full delegation in attendance. The big news for California at the ASA was the nomination of Patricia Kapur, MD, for the 2019 ASA Distinguished Service Award.  The ASA House of Delegates (HOD) voted to accept the nomination and Dr. Kapur will receive the award at the 2020 ASA Annual Meeting.

Dr. Patricia Kapur held many important positions at both UCLA, as well as in the larger Anesthesiology medical community during her distinguished career, including serving as Chair of the Department of Anesthesiology of the David Geffen School of Medicine at UCLA for 17 years. She continues to work in a volunteer capacity at the University of Pennsylvania Department of Anesthesiology & Critical Care, by providing career development mentoring for faculty, fellows, residents, and medical students.

Dr. Kapur served the American Society of Anesthesiologists (ASA) in many capacities over the 36 years of her active membership, including as Chair of the Section on Education and Research for nine years, and Chair of the Section on the Annual Meeting for the 2008 meeting. Dr. Kapur delivered the Emery A. Rovenstine Memorial Lecture at the 2011 ASA Annual Meeting. She served the California Society of Anesthesiologists (CSA) as Chair of the Educational Programs Division, as Secretary and member of the Board of Directors, and as a long-time delegate to the ASA House of Delegates. Dr. Kapur delivered the Forrest Leffingwell Memorial Lecture at the 2015 CSA Annual Meeting and was awarded the CSA Distinguished Service Award in 2017.

Congratulations to Dr. Kapur on the well-deserved honor!!

There were no surprises in the ASA elections since there were no contested positions. CSA congratulates our own Linda Mason, MD, FASA, on an outstanding year as ASA President.  Dr. Mason kept up with a busy, unpredictable and demanding schedule, representing the ASA and its members to the media, lawmakers, other specialties, internationally and internally with wisdom and grace. Her continued presence on the ASA Administrative Council for another year will be a huge asset to the organization.

Other ASA officers for the upcoming year are: Mary Dale Peterson, MD, FASA, President; Beverly K. Philip, MD, FACA, FASA, President-Elect; Randall Clark, MD, FASA, First Vice President; Andrew D. Rosenberg, MD, FASA, Vice President for Scientific Affairs; Jeff Mueller, MD, FASA, Vice President for Professional Affairs; Kenneth Elmassian, DO, FASA, Secretary; Kraig S. de Lanzac, MD, FASA, Assistant Secretary; Michael Champeau, MD, FASA, Treasurer; Donald Arnold, MD, FASA, Assistant Treasurer; Ronald L. Harter, MD, FASA, Speaker, House of Delegates; Patrick Giam, MD, FASA, Vice Speaker, House of Delegates.

Many of the issues that were  considered at the ASA were described in the CSA Online First that  detailed events at the August meeting of the ASA Board of Directors.

However, several things do bear mentioning that are of general interest or changed or updated items from the August BOD:

ASA2020 Strategic Plan:

The strategic pillars for 2020 are:

  • Advocacy
  • Educational Resources
  • Health Systems Leadership
  • Member Growth and Experience
  • Quality and Practice Advancement
  • Scientific Discovery (NEW)

The key initiatives (not all discussed here) related to these pillars include:

Economic Strategic plan

  • Address the 33% problem in compensation for services to anesthesiologists
  • Organizational preparedness for Medicare-for-All
  • Surprise medical bills
  • Payment models and bundled payments
  • Payments for Anesthesia Services over the long term

33% Problem

Committee on Economics (COE) Work Group (Chair: Jonathan Pregler, MD)

  • Assess existing information,
  • Procure additional data
  • Create a report/white paper to make recommendations on next steps.

Medicare for All / Payments for Anesthesia Services

Ad Hoc Committee on Medicare for All (Chair: Neal Cohen, MD)

  • Develop principles for future ASA engagement
  • Assess impact of Medicare-base rates
  • Monitoring of “Partnership for America’s Health Care Future” organization 2019

Surprise Medical Bills ASA Principles

  • Ban surprise medical bills. Patients should be responsible only for in-network cost sharing.
  • Appropriate payments to providers
  • Appeals/Arbitration/Independent dispute resolution system to resolve disputes between physicians and insurance companies
  • Enforceable network standards
  • Look to successful states (NY, TX) for solutions

ASA opposes S. 1895, The Lower Health Care Costs ACT (Alexander-Murray) and H.R. 3060, No Surprises Act (Pallone-Walden).  ASA supports H.R 3502, Protecting People from Surprise Medical Bills Act (Ruiz-Roe), which as of October 2019, has 100 co-sponsors, including a number from CA.

A Public and Professional Awareness and Communications Campaign to include updated messaging for the specialty that meets our goals of informing the public, health systems leadership and policy makers. Included in this plan is the concept that ASA will need to counter the forces that are pushing terminology such as “nurse anesthesiologist” in an attempt to legitimize independent practice by nurse anesthetists.

The preliminary goals of this campaign are to:

  • Raise patient and public awareness and understanding of the role and benefit of anesthesiologists in patient care and safety and perioperative care. 
  • Demonstrate to members that ASA is actively and purposefully reaching their current and prospective patients with positive messaging.
  • Communicate the social and economic value of physician anesthesiologists.
  • Support the business case for the importance and benefits of physician anesthesiologists to employers and peers, including C-suite leaders, institutional and health systems executives and administrators, and surgeons.
  • Support ASA’s advocacy agenda with policymakers and influencers, at federal and state levels.

An extensive campaign is planned but has a very long timeline prior to the start of any public campaign sometime in 2020.  

Member Engagement

  • Value at the component level
  • Meaningful member participation
  • Workplace advocacy and physician well-being activities
  • Online community platforms to support special interest group development
  • Strategies to strengthen resident and early career member engagement
  • Develop resources to strengthen ASA’s opportunities for diversity and inclusion, specifically of women and minorities

Governance

The House of Delegates governance meetings considered several issues that had been previously previewed at the BOD. The most controversial item had to do with The Committee on the Anesthesia Care Team’s revised Statement on the Anesthesia Care Team.  This new version had only one sentence changed from the version passed by the 2019 HOD: “Students are not qualified anesthesia personnel. Therefore, the use of students in place of qualified personnel is inappropriate as well as inconsistent with the ASA Guidelines for the Ethical Practice of Anesthesiology.” This replaced wording that was less stringent than the original Statement and generated extensive discussion in the Reference Committee and again on the floor of the HOD. The change in language to the Statement was not approved. 

The other controversial item was the issue of increasing ASA member dues. Leadership asked for a 3% dues increase for all members, which amounted to a $23/ year increase for active members. This led a to a discussion of the ASA budget and expenses, an item over which the HOD has no control, since the budget is under the purview of the BOD.  Members sought assurances that the ASA’s funds are being used in a considered manner. Ultimately the HOD voted in favor of a dues increase for 2020.  However, it is clear that any future dues increases will again garner a large level of scrutiny.

Items in Standards and Guidelines that were approved by the  2019 House of Delegates include, a revision of the Standards for Postanesthesia Care, a Statement on Compensation Equity Among Anesthesiologists, a Statement on Drug Concentration Standardization, a Statement on Resuming Breastfeeding After Anesthesia, a revised Statement on the Safe Use of Propofol, a revised consensus document on the ASA Physical Classification System, revised Guidelines for Director of Liver Transplant Anesthesia, and Guidelines for Surgical Attire.

Lastly, it is again time to self-nominate for ASA Committees for 2020-2021.  The self-nomination process is open until January 15, 2020.  Follow the link https://www.asahq.org/member-center/appointments-and-nominations to find all the information you need to understand and initiate the process.  Review the committee list and descriptions to find the committee(s) that interest you and then follow the link on the page to self-nominate.  You will need to submit an up to date CV.  It is also helpful to have one or two members recommend you for a committee.  This is ASA at the grass roots level; ASA committee work is often an entry level to other positions within the state component and ASA structure.

 


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