American Society of Anesthesiologists

State Component Society News- May 2014

Message from NMSA President

 Dear NMSA member,

With so many changes looming on the horizon for our profession, the board of the New Mexico Society of Anesthesiologists in conjunction with the American Society of Anesthesiologists will be entering new territory in 2014 and in the years to come.  Specifically, we are committed to making sure that our voices are heard both in Santa Fe and other regulatory arenas here in New Mexico as well as in Washington D.C.  We are aware that changes to our scope of practice are being proposed, debated, and implemented by others, and we will continue to fight for patient safety across the state.  We will monitor these proposed changes that affect our profession and will be actively engaged in campaigning policies of our own, in order to ensure that our patients remain safe.  In order to accomplish this, we will need the support of our members.  We are in the final stages of establishing our own PAC, the New Mexico Safety Advocates and more information will be forthcoming.  Our new Twitter account will also keep you updated on upcoming events; follow us @nmsahq.  These newsletters will provide updated state and national information on a quarterly basis.  We hope you find them informative and timely as we embark on this new path together. 

Best,

Cameron Burrup, MD

President, NMSA

NM Medical Board Meeting Dates

August 7-8, 2014

 

November 13-14, 2014

 

 

NM Nursing Board Meeting Dates

June 19-20, 2014

August 21-22, 2014

October 23-24, 2014

December 11-12, 2014

 

Federal Affairs Update

Federal Legislative Update

 Federal Regulatory Update

 Payment and Practice Management Update

 Health Policy Research Update

 2012 Study Finds Association between Physician Anesthesiologists and Better Outcomes

Thomas R. Miller, Ph.D., M.B.A.

Nicholas M. Halzack, M.P.H.

ASA Health Policy Research would like to highlight a 2012 study published in the Journal of Clinical Anesthesia that uses data from 2006 and 1996. The data come from the National Survey of Ambulatory Surgery (NSAS), which is conducted by the Centers for Disease Control and Prevention and is the only national survey of ambulatory surgical care in hospital-based and freestanding ambulatory surgery centers. After examining almost 2.5 million cases of knee and shoulder surgeries conducted in 2006 and 1996, the authors found:

  • The odds of “unexpected disposition” after surgery were 80 percent higher when the anesthesia care was provided by only a nurse anesthetist as opposed to a physician anesthesiologist.

The implications of an “unexpected disposition” are associated with adverse patient outcomes and higher costs. Additionally, these results are supported by a comparable 2005 study conducted by some of the same authors that reached similar conclusions.

Health Policy Research has created a useful one page summary about this study available at (https://www.asahq.org/For-Members/hpr). If you have additional questions about this study or any others, please email [email protected].

The Studies:

  • Memtsoudis SG, Ma Y, Swamidoss CP, Edwards AM, Mazumdar M, Liguori GA: Factors influencing unexpected disposition after orthopedic ambulatory surgery. J Clin Anesth 2012; 24(2):89-95
  • Memtsoudis SG, Besculides MC, Swamidoss CP: Factors influencing patient disposition after ambulatory herniorrhaphy. J Ambulatory Surgery 2005; 12:67-73

 Research Terms Explained:

  • Unexpected Disposition: Occurs when a patient follows an unexpected care path. Example: In the outpatient setting, patients are expected to undergo a relatively low-risk surgery and be discharged to their place of residence on the same day. Any other outcome is considered an unexpected disposition.

State Affairs Update

 ASA Urges FTC to End State-Level Overstep

On April 30, the American Society of Anesthesiologists® (ASA®) submitted formal comments to the Federal Trade Commission (FTC) strongly urging the FTC to modify its current position on the application of the state action doctrine to state licensing authorities and end its related enforcement policies against those agencies. The comments provided “The FTC has no particular expertise in regulating health care and risks inflicting serious harm on patients by adopting enforcement policies that appear intended to promote competition over quality of treatment and patient safety.” ASA’s comments further explained the importance of states being able to regulate health professionals, promoting competition that leads to high quality patient care and protects patient safety.

The comments were submitted in response to the FTC’s March 2014 Public Workshop “Examining Health Care Competition.” The purpose of the Workshop was to examine trends and activities potentially impacting competition in the growing health care industry.

While commending the FTC for its efforts to learn more about the importance of professional regulation, ASA’s comments focused on the positive impact of professional regulation in anesthesiology and pain medicine and the need for FTC deference and application of the state action doctrine to professional regulation by state medical boards. The comments provided in part “There are important patient safety reasons to limit the full practice of anesthesiology to physician anesthesiologists and to require physician supervision of nurse anesthetists. These regulations are actually pro-competitive in that they reduce costs to patients and society, and enhance informed patient decision-making.”

The state action doctrine provides immunity for certain policy actions by state and local authorities. Historically, the FTC has honored the state action doctrine regarding health care. Unfortunately during recent years, the FTC has become increasingly more activist, seeking to interject itself in state health statutory and regulatory matters. The ASA is ensuring the FTC is aware of physician anesthesiologists’ profound patient safety related concerns with the agency’s expanding involvement in state-level legislative and regulatory activity.

In March, the FTC released a policy paper titled “Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses” (APRN). The paper opined that broader APRN scope of practice is good for consumers and competition.

Also in March, the U.S. Supreme Court announced it would hear arguments in North Carolina State Board of Dental Examiners v. FTC. At issue is whether the antitrust state action doctrine protects the work of state licensure boards. Previously, the ASA joined the American Medical Association, the American Dental Association, and other health care groups in a friend of the court brief in support of the North Carolina State Board of Dental Examiners’ request for review of the appellate court’s decision. That brief was filed November 27, 2013. Arguments for the case will likely be heard in the fall.

In correspondence and a face-to-face meeting, ASA had previously expressed grave concern to the FTC about the Commission’s letters to state medical boards and legislatures inducing boards and legislatures to take action contrary to patient safety.

Previous ASA letters:

Physician Anesthesiologists Elected Presidents of Illinois and Michigan State Medical Societies

In April, American Society of Anesthesiologists® (ASA®) members William A. McDade, M.D., Ph.D. and James Grant, M.D., became presidents of the Illinois and Michigan State Medical Societies (MSMS) respectively.

Dr. McDade is the Deputy Provost for Research and Minority Issues and an Associate Professor of Anesthesiology and Critical Care and Associate Dean for Multicultural Affairs at the Pritzker School of Medicine. He also is a director with the Accreditation Council for Graduate Medical Education and is chair-elect for the American Medical Association’s (AMA’s) Council on Medical Education.  

Dr. Grant serves as ASA’s Treasurer and is Chair of the Department of Anesthesiology at Beaumont Hospital in Royal Oak, Michigan. He is also vice chair of Michigan’s delegation to the AMA and a former chair of the MSMS Board of Directors and the Michigan Board of Medicine.

Congratulations to Drs. McDade and Grant for representing physician anesthesiologists within the house of medicine and their efforts to ensure patient centered, physician-led care for all patients.

Truth in Advertising Bills Signed into Law in Utah and West Virginia

On March 28, Utah and West Virginia’s Governors signed legislation concerning truth in advertising. Utah Governor Garry Herbert (R) signed SB 137 which updates the state’s truth in advertising laws to additionally require a healthcare provider to wear a badge identifying their name and license type during a patient encounter. This law goes into effect January 1, 2015. Utah already requires such information in healthcare provider advertisements.

In West Virginia, Governor Earl Ray Tomblin (D) signed SB 602 which similarly requires employees to wear an ID badge during patient encounters. Compliance is required as of July 1, 2016.

Congratulations to the leadership of Utah and West Virginia for these patient safety related legislative successes! 

Indiana Governor Signs Anesthesiologist Assistant Licensure Bill

On March 24, Indiana Governor Mike Pence (R) signed into law Senate Bill 233, which authorizes licensure for anesthesiologist assistants. This legislative success was the result of a multi-year effort by the Indiana Society of Anesthesiologists and the American Academy of Anesthesiologist Assistants. Indiana will be 17th jurisdiction to authorize anesthesiologist assistant practice. Anesthesiologist assistants are also recognized federally by the Centers for Medicare and Medicaid Services and the Veterans Affairs system. 

Anesthesiologist assistants have served patients as members of physician anesthesiologist-led anesthesia care teams for more than forty years. Anesthesiologist assistants are highly skilled non-physician anesthesia care providers who only provide care under the medical direction of a physician anesthesiologist. Qualified by graduate school level academic and clinical education, anesthesiologist assistants participate in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques.

Anesthesiologist Assistant Practice States:

  • Alabama
  • Colorado
  • District of Columbia
  • Florida
  • Georgia
  • Indiana (July 1, 2014)
  • Kentucky
  • Michigan (Delegation)
  • Missouri
  • New Mexico (University Hospitals)
  • North Carolina
  • Ohio
  • Oklahoma
  • South Carolina
  • Texas (Delegation)
  • Vermont
  • Wisconsin

The 2015 legislative session is around the corner. If your state is interested in pursuing legislation to authorize anesthesiologist assistants, please contact Jason Hansen at [email protected].

Wisconsin Governor Signs Physician Apology Legislation

On April 8, Wisconsin Governor Scott Walker (R) signed into law legislation (2013 Wisconsin Act 242 ) prohibiting the inclusion of a health care provider’s apology in a related future lawsuit or administrative hearing. The Wisconsin Society of Anesthesiologists supported this measure (Assembly Bill 120), which was introduced in the Senate and Assembly to coincide with Wisconsin’s 2014 Doctors Day at the Capital.  

Congratulations to the Wisconsin members that made this possible!

Upcoming State Primaries: Your Vote Counts!

A citizen’s right to vote is one of the most fundamental hallmarks of the great republic in which we live. This year, there are many different political races where you will have the opportunity to support your preferred candidate with your all-important vote. This spring and summer is replete with political primaries. Please check if your state’s primary is coming up soon.

If you have moved recently, remember you need to be registered to vote at your new address, and that some states have residency requirements of a certain length prior to registration. If you are interested in verifying that your voting registration is current, finding out where your voting precinct is, and what will be on your ballot on Primary Day and General Election Day, please visit the nonpartisan website, www.vote411.org. This website is a wonderful resource for voting requirements and ballot information.

 Voting in your state’s primary sets the direction for the general ballot on Election Day, November 4, 2014. As you know, the 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!

                       Upcoming 2014 state primaries

  • May 6: Indiana, North Carolina, Ohio
  • May 13: Nebraska, West Virginia
  • May 20: Arkansas, Georgia, Idaho, Kentucky, Oregon, Pennsylvania
  • June 3: Alabama, California, Iowa, Mississippi, Montana, New Jersey, New Mexico, South Dakota
  • June 10: Maine, Nevada, North Dakota, South Carolina, Virginia
  • June 24: Colorado, Maryland, New York, Oklahoma, Utah
  • August 5: Kansas, Michigan, Missouri, Washington
  • August 7: Tennessee
  • August 9: Hawaii
  • August 12: Connecticut, Minnesota, Wisconsin
  • August 19: Alaska, Wyoming
  • August 26: Arizona, Florida, Vermont
  • September 9: Delaware, Massachusetts, New Hampshire, Rhode Island
  • November 4: Louisiana

If you have any questions about voting in your state, please contact Jason Hansen or Erin Philp at [email protected] or [email protected], or via phone at (202) 289-2222. 

Poll Confirms Florida Patients Want a Physician Anesthesiologist Directing Anesthetic Care

More than 92 percent of Florida’s registered voters want a physician anesthesiologist directing their anesthetic care, as revealed in a scientifically conducted public opinion poll released by the Florida Society of Anesthesiologists (FSA).

 The FSA sponsored poll queried the public’s views on exactly whom they preferred leading or conducting their anesthetic. By substantial margins, physician-led anesthesia was the clear preference of Floridian voters. The poll’s findings all pointed to the public’s strong agreement that only a physician should be in charge when a patient is anesthetized for procedural or surgical cases.

 Survey findings of note:

  • 92 percent said they “want an anesthesiology physician directing my anesthetic care.” 
  • 87 percent agreed that “giving anesthesia to patients is a complicated and difficult job that should only be performed directly by or under the supervision of a trained physician.”
  • 79 percent felt a physician anesthesiologist was best qualified to administer anesthesia during surgery, versus 9% who said a nurse was best qualified. The margin of that preference was a substantial nine to one.
  • 74 percent answered that “having nurses administer anesthesia without the supervision of a doctor is a very dangerous idea.”
  • Nearly three in four disagreed with the statement that “doctors and nurses should work in equal collaboration with each other and neither one should be in charge.”

 The polling results, performed by Clearview Research, were based on interviews of 750 registered voters located throughout Florida with a margin of error of +/- 3.57 at the 95 percent confidence level. Members of the public were chosen based upon their voting participation in the 2010 and 2012 elections. The poll was designed to capture those Floridians most likely to be a part of the voting population in the state’s 2014 elections.

 This latest poll confirms findings of previous surveys, which repeatedly show patients want physicians in charge of their care. In a recent American Medical Association survey, 77 percent of consumer respondents said they believed only a physician should administer and monitor anesthesia levels before and after surgery.

 To learn more about anesthesia and the importance of patient-centered, physician-led anesthesia care, please visit ASA’s When Seconds Count™ website.

 © 2014 American Society of Anesthesiologists