Anesthesia Record www.massanesthesiology.org Page 1 NURSE ANESTHETISTS SEEK INDEPENDENT PRACTICE HOSPITAL IN REVIEW REPORT OF COUNSEL By Kay Leissner, M.D. T heVABoston Healthcare System, the largest consolidated facility in VISN 1- VA New England Healthcare System, encompasses the 3 main campuses and 4 outpatient clinics within a 40-mile radius of the greater Boston area. The consoli- dated facility consists of the Jamaica Plain Campus, located in the heart of Boston’s Longwood Medical Community; theWest Roxbury Campus, located on the Dedham line; and the Brockton Campus, located 20 miles south of Boston in the City of Brockton. In addition to the 3 main medical centers, 5 Community Based Outpatient Clinics (CBOCs) located in Framingham, Lowell, Quincy, Causeway Street (Boston), and Plymouth make up VA BHS. ANESTHESIOLOGY Today, our staff is comprised of 14 faculty attending anesthesiologists, 9 nurse anesthetists, 3 anesthesia technicians, 2 administrators, 3 rotating anesthesia residents, 2 rotating fellows and 6 anesthesia interns. Despite a diversity of backgrounds and training, the anesthesia team remains a harmonious group with similar interests in improving patients' well-being, providing the best educational experience for our trainees, and investigating innovative ideas to further enhance the services offered to TABLE OF CONTENTS (continued on page 9) (continued on page 12) www.MassAnesthesiology.org MASSACHUSETTS SOCIETY OF ANESTHESIOLOGISTS, INC. Vol. 41 No.1 - 2013 MSA Anesthesia Record Edward J. Brennan, Jr., Esq. U nder the guise of allowing advanced practice nurses, including nurse anesthetists, to practice to the “fullest extent of their education and training,” nursing advocates are pushing for inde- pendent practice. As reported earlier this year, The Massachusetts Association of Nurse Anesthetists has joined with the Massa- chusetts Coalition of Nurse Practitioners to file H. 2009 and S. 1079. The bills, if passed, would eliminate the statutory Jamaica Plain Campus, located in the heart of Boston's Longwood Medical Community Hospital in Review 1 Report of Counsel 1 MSA Committees 3 Editor's Report 4 President's Report 5 Personality Profile 6 Annual Reports 7-23 ASA Update 22 Lifebox Challenge 24 ASA News/AQI 26 New CME Requirements 29 New MOCA Program 30 Membership Changes 31 Advertisements 32 Upcoming Events 34
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1-VANewEnglandHealthcareSystem,encompassesthe3maincampusesand4outpatientclinicswithina40-mileradiusofthegreaterBostonarea.Theconsoli-datedfacilityconsistsoftheJamaicaPlainCampus,locatedintheheartofBoston’sLongwoodMedicalCommunity;theWestRoxburyCampus,locatedontheDedhamline;andtheBrocktonCampus,located20 miles south of Boston in the CityofBrockton.Inadditiontothe3mainmedical centers, 5 Community BasedOutpatientClinics (CBOCs) located inFramingham,Lowell,Quincy,CausewayStreet(Boston),andPlymouthmakeupVABHS.
ANESTHESIOLOGYToday,ourstaffiscomprisedof14facultyattending anesthesiologists, 9 nurseanesthetists, 3 anesthesia technicians,2 administrators, 3 rotating anesthesiaresidents, 2 rotating fellows and 6anesthesiainterns.Despiteadiversityofbackgroundsandtraining,theanesthesiateam remains a harmonious groupwith similar interests in improvingpatients'well-being,providing thebesteducationalexperienceforourtrainees,and investigating innovative ideas tofurtherenhancetheservicesofferedto
TABLE OF CONTENTS
(continued on page 9)
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www.MassAnesthesiology.org Massachusetts society of anesthesiologists, inc. Vol. 41 No.1 - 2013
MSA Anesthesia Record
Edward J. Brennan, Jr., Esq.
Undertheguiseofallowingadvancedpractice nurses, including nurse
anesthetists, to practice to the “fullestextentoftheireducationandtraining,”nursingadvocatesarepushingforinde-pendentpractice. As reported earlier this year, TheMassachusetts Association of NurseAnesthetistshasjoinedwiththeMassa-chusettsCoalitionofNursePractitionerstofileH.2009andS.1079.Thebills,ifpassed, would eliminate the statutoryJamaica Plain Campus, located in the heart of Boston's Longwood Medical Community
Officers, Directors, Delegates and Committees MichaelR.Englnd,MD,PresidentSpiroG.Spanakis,DO,PresidentElectSheilaR.Barnett,MD,VicePresidentCristinA.McMurray,Secretary(2015)DanielJ.P.O'Brien,MD,Treasurer(2014)SelinaA.Long,MD,ImmediatePastPresidentBeverlyK.Philip,MD,ASADirector(2015)DavidL.Hepner,MD,ASAAlt.Director(2015)RichardD.Urman,MD,MBA,NewsletterEditorEdwardJ.Brennan,Jr.MSALegalCounselBethE.Arnold,ExecutiveSecretaryDelegates: ASA House of DelegatesCristinA.McMurray,MD(2014)DanielJ.P.O'Brien,MD(2014)LeeS.Perrin,MD(2014)DavidL.Hepner,MD(2015)SelinaA.Long,MD(2015)SpiroG.Spanakis,D.O.(2015)RubenJ.Azocar,MD(2016)SheilaR.Barnett,MD(2016)MichaelR.England,MD(2016)FredE.Shapiro,DO(2016)Alternate Delegates:GalinaDavidyuk,MD DonaldG.Ganim,II,MDShubjeetKaur,MD NicholasM.Kiefer,MDNeilA.McDonald,MD MaitriyiJ.Shah,MDNikhilThakkar,MD RichardD.Urman,MD,MBAJoshuaC.Vacanti,MD MaryAnnVann,MD M.S.A. District Representatives and Alternate RepresentativesDistrictI NikhailThakkar,MD NaveedA.Tahir,MDDistrictII BronwynCooper,MD ShubjeetK.Kaur,MDDistrictIII NicholasKiefer,MD CharlesC.Ho,MDDistrictIV FernandoAlmenas,MD DipakKumar,MDDistrictV RubenJ.Azocar,MD JeanetteLee,MDDistrictVI NeilA.McDonald,MD KonstantinBalonov,MD
Standing Committees of the Executive Committee:Drs.MichaelEngland-Chair,FernandoAlmenas,RubenAzocar,KonstantinBalonov,SheilaBarnett,JeffryBrand,BeverlyChang,BronwynCooper,GalinaDavidyuk,FredDavis,DonaldGanim,JamesGessner,NormanGould,AlexHannenberg,DavidHepner,MarkHershey,CharlesHo,ShubjeetKaur,NicholasKiefer,DipakKumar,JeanetteLee,SelinaLongNeilMcDonald,CristinMcMurray,DanielO’Brien,BrianO'Gara,LeePerrin,BeverlyPhilip,MaitriyiShah,FredShapiro,SpiroSpanakis,NikhilThakkar,NaveedTahir,RichardUrman,JoshuaVacanti,MaryAnnVannCommittee on Ethical Practice and Standards of Care:D.I CraigE.Collins,DO(2015) MichaelBailin,MD(2014)D.2 StephenP.Kapaon,MD(2015) PaulE.Darcy,MD(2014)D.3 AlbertKalustian,MD(2015) JeffryBrand,MD(2014)ChairD.4 MelvinCohen,MD(2015) RobertHough,MD(2014)D.5 PeterM.Ting,MD(2015) JeffreyJackel,MD(2014)D.6 VladamirKazakin,MD(2015) RichardShockley,MD(2014)Adjunct:Drs.B.Cooper,G.Crosby,L.Dohlman,J.Gessner,R.Holzman,C.Joshi,H.Kummer,A.Lisbon,M.Ricciardone,D.Salter,D.ShookCommittee on Economics:,JeffryBrand,MD(2014),StephenKapaon,MD(2014),RichardBello,MD(2015),AnanthKashikar,MD(2015),AlexanderHannenberg,MD(2016)-Chair,StephenPunsak,MD(2016),RossMusumeci,MD(2017),ShubjeetKaur,MD(2017)Adjunct:Drs.H.Auerbach,J.Gould,K.Gress,N,Kiefer,M.Shulman,R.UrmanCommittee on Bylaws and Rules:LeePerrin,MD-Chair,CoreyCollins,DO,MaryKraft,MD,RubenAzocar,MD,RomanSchumann,MDCommittee on Nominations: FredShapiro,DO-Chair(2014),RubenAzocar,MD(2015),SelinaLong,MD(2015)
MASSACHUSETTS SOCIETY OFANESTHESIOLOGISTS 2013-2014
Committee on Governmental Affairs:DavidHepner,MD(2014),StephenHatch,MD(2014),RossMusumeci,MD(2014),FredShapiro,DO(2014),DanO'Brien,MD(2014),RichardUrman,MD,MBA(2014),SelinaLong,MD(2015)-chair,JamesGessner,MD(2015),SpiroSpanakis,DO(2015),NeilMcDonald,MD(2015),DonaldGanim,MD(2015),BeverlyPhilip,MD(2015)Adjunct:Drs.FredCobey,KayLeissner,DavidStahlJudicial Committee:JeffryBrand,MD(2014),JoshuaVacanti,MD(2015),MichaelBailin,MD(2016),DanielO'Brien,MD(2017),JamesGessner,MD,Chair(2018)Committee on Publications:BhavaniKodali,MD(2014),BeverlyPhilip,MD(2014),RichardUrman,MD,MBA(2015)-Chair/NewsletterEditor,MaitriyiShah,MD(2015),SpiroSpanakis,DO(2016),DavidHepner,MD(2016)Adjunct:Drs.S.Desai,S.Heard,R.Ortega,L.Perrin,G.Stanley,WebsiteSubcommittee:Drs.S.Spanakis-Chair,S.Heard,B.Kodali,R.Ortega,L.Perrin,G.StanleyCommittee on Public Education:SheilaBarnett,MD,(2014),SpiroSpanakis,DO,(2014),DavidStahl,MD(2014),FredShapiro,DO(2014)-Chair,CristinMcMurray,MD(2015),KayLeissner,MD,(2015),NeilMcDonald,MD,(2015),JoshuaVacanti,MD(2015),DavidHepner,MD(2016),MaryAnnVann,MD(2016),RanaBadr,MD(2016),RichardUrman,MD,MBA(2016)Committee on Programs (CME)ManishaDesai,MD(2014),FredShapiro,DO(2014),ToddSarge,MD(2014),DanielO'Brien,MD(2014),ShubjeetKaur,MD(2014),RanaBadr,MD(2015),CristinMc-Murray,MD(2015)-Chair,KayLeissner,MD(2015),SpiroSpanakis,DO(2015),LeePerrin,MD(2015)AdvisorAdjunct:Drs.R.Azocar(advisor),S.Basta,G.Battit,J.Gessner,I.Khayata,R.Schumann,R.UrmanM.S.A. Rep. to the Interspecialty Committee of the Mass. Medical SocietyMichaelEngland,MD,Representative,FredShapiro,DO,Alt.RepresentativeSpecialty Delegate to the House of Delegates of the Mass.Medical SocietyJamesS.Gessner,MDResident Affairs:BrianO'Gara,MD,Chair,BeverlyChang,MD,ViceChair
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Welcome to the41st editionof theMSARecord!Ourgoalistokeep
you informed of what is happening intheworldofanesthesia–bothinMas-sachusettsandonthenationallevel.I’mhonored to continue serving as Chairof Publications Committee and MSAAnesthesiaRecordeditor.Ithasbeenayearsinceourlastnewsletter,andalothashappened thatdirectly impactsourspecialtyandourpatients.Inthisedition,wedescriberecenteventsandactivitiesofaverybusyyear.Asyouwillsee,MSAhasbeenactiveonthepolitical,membership,andeducationalfrontsasdemonstratedinthereportsbyourMSAPresident,ASADirector, Legal Counsel, andCommit-tee Chairs. Highlights include nurseanesthetistsseekingindependentpracticein Massachusetts, healthcare paymentreform,prescriptionmonitoringprogramanditsimpactonanesthesiologypractice,changes to MSA bylaws, news aboutLifebox challenge, and theAnesthesiaQualityInstituteupdate.Inaddition,youwillfindadescriptionofCMEeducationalopportunities,Dr.Suciu’sreportfromtheresident (CORA) component, and Dr.
settsSocietyofAnesthesiologistsfromDr.SelinaLong.Iwastrulyhumbled,forIfeltafeelingofsmallnesstryingtofillhershoes.Shehaddoneanexcellentjobofpositioningthesocietyforthestormthatweallsee(andsaw)justoverthehorizon.Thefieldofanesthesiologyaswellastheprofessionofmedicineisunder“attack”toreinventitself.Physicianextendersofallvarietiesare tryingtoredefinewhattheirpractice isandshouldbe,withorwithout thebelief that theyneed tobe“supervised”byphysicians.Societyingeneral,withthepassageoftheAffordableCareAct,wantsaccesstomedicalcare.Thequalityofthatcareissecondarytogainingaccesstocare. Exactly how this will play out inthecomingyears isunclear. The rela-tionship between anesthesiologists andnurse anesthetists is being constantlychallenged,despite thecleardifferenceintraining,decisionmakingabilityand
Michael R. England, M.D.MSA President
(continued on page 14)Dr. Michael England presenting a Lifebox unit to CEO Mary Muchendu and Dr. Mark Newton of Kijabe Hospital, Kenya, during his visit earlier this year.
HIGHLIGHTS FOR THE UPCOMING YEARof Registration inMedicine tellme (anurse)howtopractice?” Intakingonthechallengewefacein Massachusetts, immediately afterbeinggiventhegavelfromDr.Longattheannualmeeting, therewasaheateddiscussion on the direction the MSAshouldtravel toopposethecurrentbillin the Massachusetts Legislature forindependentnursingpractice.Someintheaudiencefeltthatweshoulduseallofourresourcestohirealobbyingfirmtopresentourcasetoelectedofficials.ThatwascounteredbytherealizationthatwehaveanexcellentpersonwhoisdoinganoutstandingjobattheStateHousekeepinghiseartothegroundprotectingourbestinterestsinMr.EdwardBrennan.Itwasalsopointedoutthatthiseffortonthepartofthenursesisamarathonandnotasprintandthatthehighcostsofaseparatefirm,couldleadustobankruptcy.Afteratimeitwasdecidedtomakemovesslowlyandnotrushtohireacommercialfirm,ratherplantoworkcloselywiththeMassachusettsMedicalSocietyhandinhandtodefeatthisinitiativeandnotmakethis just an “anesthesia” issue. Indeed,itisinfactnotjustananesthesiaissue.The legislation would apply to nursepractitionersaswell.Asimilarbillwouldgrantindependentpracticetopsychiatricclinicalnursespecialists. Shortlyaftertheannualmeeting,IsatdownwithMr.BrennanandMr.BillRyderoftheMMStoseewhatthatorganizationcouldofferusinthewayofsageadviceandplanningastrategywiththem.MrRydernotedthatMMSstronglyopposesthebills.Henotedthatengaginghighpricelobbyistsisnoguaranteeofsuccess.Rather,headvisedthatweneedtoencourageallofustogetinvolved.Weneedtocreateagrassrootspoliticaleffort.Weallneedtogettoknowourlocalstaterepresentativeandsenator.Weneedtotakethetimetogoandvisittheminpersontomakeourpointsclear,andaskfortheirsupport.Theseelectedofficialsrespondtotheirvotingconstitu-ents,nothighpaidlobbyists.Thisisthe
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SpiroG.Spanakis,DO,isapediatricanesthesiologist at University of
MassachusettsMemorialMedicalCen-ter,where he is anAssistant ProfessorofAnesthesiologyandPediatrics.HeiscurrentlyPresidentElectoftheMSAaftercompletinghistermasVicePresident. Longactivewithourstatespecialtysociety,Dr.Spanakisservedasaresidentdelegate for the American Society ofAnesthesiologists Resident and FellowSectionasafirstyearanesthesiaresidentin2003.HehascontinuedtoservetheSocietyinvariouscapacities,includingestablishingawebsitefortheMSAdur-inghisresidency,whichhecontinuestooversee.Sincethattime,hehasservedontheExecutiveCommittee,theProgramCommitteeandasprogramdirectorforseveralMSAcontinuingmedicaleduca-tionprograms,inadditiontoservingasalternate delegate and delegate to theAmericanSocietyofAnesthesiologists. Hewasrecentlyelectedtotheposi-tionofSpeakeroftheHouseofDelegatesfor theAmerican MedicalAssociationYoung Physicians Section. Prior tohis election, he served as chair of theMassachusetts Young Physicians Sec-tiondelegation to theAMA inhis roleasChairof theMassachusettsMedicalSociety’s Committee onYoung Physi-
cians.Currently,heistheViceChairofthe Committee on Preparedness at theMassachusettsMedicalSocietyandisamember of itsCommittee on StrategicPlanning.Locally,heistheSecretaryoftheWorcesterDistrictMedicalSociety. Besideshisextensiveinvolvementinorganizedmedicine,hedivideshistimebetweenhis clinicalpractice at severalWorcestercampuses,residenteducationand patient safety in the Departmentof Anesthesiology at UMASS Memo-rialMedicalCenter.Currentlyheisthe
ClinicalBaseYearDirectorforcategoricalresidents.AstheDirectorofSimulation,heuseshighfidelitysimulationscenariostoexposeresidentstorarecriticaleventsintheoperatingroom.HewasrecentlyawardedanInter-ProfessionalEducationGrantfromtheUniversityofMassachu-settsMedical School to bring togetheraninterdisciplinarygroupofhealthcareproviderstolearncrisismanagementtech-niquesintheoperatingroom.InhisroleasAssociateQualityandSafetyOfficerfor the Department ofAnesthesiology,he organizes the department’s QualityImprovementConferenceswherehepro-motesinterdisciplinarysystemsolutionstopreventmedicalerrorsinthepracticeofanesthesiology. Dr.SpanakisattendedtheCollegeoftheHolyCrosswhereheearnedaB.A.inBiology. He receivedhisDoctorofOsteopathicMedicine degree from theUniversityofNewEnglandCollegeofOsteopathicMedicineinMaine.Boardcertifiedinanesthesiology,hecompletedhisresidencytrainingattheUniversityofMassachusettsMedical Center and hisfellowship in pediatric anesthesiologyatChildren’sNationalMedicalCenterinWashington,DC.HecurrentlyresidesinWorcester.~
PERSONALITY PROFILESPIRO G. SPANAKIS, D.O., PRESIDENT-ELECT OF THE MSA
Spiro G. Spanakis, D.O.MSA President-elect
REMINDER TO MEMBERS INTERESTED IN COMMITTEE APPOINTMENTS
IT WILL SOON BE THAT TIME OF YEAR THAT THE MSA PRESIDENT ELECT, DR. SPANAKIS WILL BE
REVIEWING THE MSA COMMITTEES AND APPOINT-ING COMMITTEE MEMBERS - IF YOU ARE INTER-
ESTED IN GETTING INVOLVED, PLEASE CONTACT THE MSA OFFICE BEFORE JANUARY 2014.(see page 3 for a listing of MSA Committees)
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ANNUAL REPORTS
Sheila R. Barnett, M.D.
Secretary 2011-2013
MSA ANNUAL MEETING - MAY 23, 2013SECRETARY'S REPORT
MSA OFFICERS President MichaelR.England,M.D.President Elect SpiroG.Spanakis,D.O.Vice President SheilaR.Barnett,M.D.Immed. Past President SelinaA.Long,M.D.Secretary(2yearterm) CristinA.McMurray,M.D.Delegates to the ASA (3yearterm)CristinA.McMurray,M.D.(2014)RubenJ.Azocar,M.D.(2016)SheilaR.Barnett,M.D.(2016)MichaelR.England,M.D.(2016)FredE.Shapiro,D.O.(2016) Alternate Delegates to the ASA (1yearterm)GalinaDavidyuk,M.D.DonaldG.Ganim,II,M.D.ShubjeetK.Kaur,M.D.NicholasM.Kiefer,M.D.NeilA.McDonald,M.D.MaitriyiJ.Shah,M.D.NikhilThakkar,M.D.RichardD.Urman,M.D.,MBAJoshuaC.Vacanti,M.D.MaryAnnVann,M.D.
Treasurer (2yearterm) DanielJ.P.O’Brien,M.D.(2014)ASA Director (3yearterm)BeverlyK.Philip,M.D.(2015)ASA Alternate Director (3yr) DavidL.Hepner,M.D.(2015)
Delegates to the ASA (3yearterm) CristinA.McMurray,M.D.(2014) DanielJ.P.O’Brien,M.D.(2014) LeeS.Perrin,M.D.(2014) DavidL.Hepner,M.D.(2015) SelinaA.Long,M.D.(2015) SpiroG.Spanakis,M.D.(2015)
REPORT OF THE MSA SECRETARY
Sheila R. Barnett, M.D.
May 23, 2013
Theactivemembership of theMassachusettsSociety ofAnesthesiologistshassurpassedthe900mark;thepresent
4) In November, Alex Hannenberg,MD, Ed Brennan, Esq. and I metwith Health and Human Servicesrepresentatives in Massachusettsto clarify anesthesia billing forMassHealth patients.We proposedthat MassHealth adopt Medicarerules andModifiers for anesthesiaservices which recognize medicalsupervision.
5) In January, House Bill 2009 andSenateBill 1079were filed to pe-tition for expanding the scope ofpractice for all advanced prac-tice nurses, including CRNAs. Ifpassed, it would effectively elimi-natesupervisionand thecare-teammodelofanesthesiapractice,allow-ingindependentpractice.TheMSAvigorouslyopposesthislegislation,andmoreoveritwastheimpetusforseveral membership developments
thatwillallowustobettermotivate,organizeandmobilizetheSocietyinopposition.TheASAhasbeenverysupportiveofthemanystateswherescopeofpracticelegislationispend-ing, and I participated in severalconferencecallswithotherstateso-cietypresidentsregardingtheirsimi-lar activity. Because developmentsin this area were fast-moving andrequiredleadershipconsensus,MikeEngland,MD,yourPresident-Elect,andSpiroSpanakis,DO,yourVice-President, and I initiated weeklyconferencecallstodiscussdevelop-mentsandstrategy.
6) InMarch,Isubmittedwrittentesti-monytoDr.LaurenSmith,theinter-imCommissionerofPublicHealth,regarding the burdens proposed byregulations that implementing the“Prescription Monitoring Program”would place upon our specialtypractice, and requested that peri-operative anesthesiologists be ex-emptfromtheprogramaswedonottypically prescribe anymedicationsupon or after a patient’s discharge.Further information regarding thisissue is contained in the Report ofCounsel.
7) The ASA Legislative ConferencemetinlateAprilinWashington,DC,whichfocusedonfederalissues:
g) truth and transparency forhealthcareproviders,
h) easingofdrugshortages,
i) maintaining scope of practiceandthecare-teammodel,
The conclusion of my year as thepresidentof theMassachusettsSo-
cietyofAnesthesiologistslikewisecon-cludes the busiest year for advocacy,membership improvements and educa-tionintheSociety’shistory.Allowmetoelaboratebelow.
1) In July, I submitted testimony re-garding proposed amendments toregulationsoftheDivisionofHealthCare Finance and Policy regardingtheadoptionofactualtimeunitsforMassHealthanesthesiaservices,andcalledforMassHealthtoadoptpay-mentModifiers 25 and59,which Iampleasedtosayhavebeenimple-mented.
2) InAugust,GovernorPatricksignedChapter 224 of the Acts of 2012(health care payment reform) intolaw, which became effective inNovember. We have been closelywatching the evolution of account-ablecareorganizations(ACO’s),thecaponmedicalspendingtothegrossstate product (GSP) and medicalmalpractice reform. The MSA willcontinue tomonitor the implemen-tationofChapter224toensurethatqualityanesthesiaandpainmanage-ment services are not adversely af-fected as Massachusetts transitionsinto new payment methodologiesandsystems.
3) InOctober,theHouseofDelegatesof the American Society of Anes-thesiologists affirmed through fourresolutionsthat:
c) regionalanesthesiaistheprac-ticeofmedicine,
d) OR medications should besafelysecured,
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Edward J. Brennan, Jr., Esq.MSA Legal Counsel
(continued on page 13)
Nursing Board Proposes New Regula-tions for APRNs Scope of Practice The Nursing Board has proposednew regulations for advanced practicenurses (APRNs), includingnurseanes-thetists, which eliminate longstandingphysiciansupervisionrequirementsoverallaspectsofAPRNpractice,exceptforprescribingmedications.Undercurrentlaw,aCRNAcanordertestsandthera-peuticsandprescribemedicationunderthesupervisionofaphysicianduringtheimmediateperioperativeperiodofcare,whichisdefinedas“daypriortosurgeryandendingupondischargeofthepatientfrompostanesthesiacare.”Theproposedregulations do not accurately reflectstatutoryprovisionsrequiringphysiciansupervisionfortheorderingoftestsandtherapeuticsoradministeringmedicationswhereaCRNAdoesnothaveprescrip-tiveauthority(DEAnumber).Nordoesit reflect statutory provisions requiringMedicineBoard involvement in jointlypromulgating regulations involving theordering of tests and therapeutics andprescribing medications. At a hearingbeforetheNursingBoardonAugust7,MSApresident,MichaelEngland,M.D.,testified in opposition to the proposedregulations,remindingtheNursingBoardthatitneedstofollowtheapplicablestatu-
Truth and Transparency for Health Care Providers MSA is supporting S. 1035which would require all health carepractioners to conspicuously post andcommunicatetopatientsandthepublicthe practitioner’s specific licensure. Ahealthcarepractionerwouldberequiredtowearaphotoidentificationnametagduring all patient encounters, whichwould include the practioner’s nameandtypeoflicense.Thenametagmustbe of sufficient size to be visible andapparenttoallpatients.S.1035isbeforethePublicHealthCommittee.Ahearingonthebillhasyettobescheduled.
Prescription Monitoring Program An outside section of the fi-nal FY’2014 state budget amends thePrescription Monitoring Law to makeclear that physicians are required to check the Prescription Monitoring Program only when prescribing a schedule II or III narcotic to a patient for the first time (giving a patient a written prescription to be filled at a pharmacy).Priortothepassageofthisprovisioninthebudget,theDepartmentof Public Health (DPH) was workingonregulationsthatwouldhaverequiredphysicianstoutilizethePMPforeverynewpatient,regardlessofage,diagnosisorintenttoprescribeascheduledmedica-tion.ThiscouldhavebeenconstruedtorequireananesthesiologisttocheckthePMPforeverypatientundergoinganes-thesia.TheMSAwillmonitortheregula-toryprocessnecessarytoimplementthenewrevisedlaw.Enforcementofthelawwillnotbeginuntiltheregulationsareinplace.
Comparison of House and Senate Health Care Payment Reform Bills
provisionsrequiringthesenursestoprac-ticeunderthesupervisionofaphysician,andremovestheBoardofRegistrationinMedicinefromitscurrentroleinjointlyregulatingthescopeofpracticeofCRNAsandNPswiththeBoardofRegistrationofNursing.ThescopeofpracticeofCRNAsandNPswould be left solelywith theNursingBoard.This is tantamount to independent practice. Thebillswouldeliminatethelong-standingstandardofcarerequiringanurseanesthetisttoadministeranesthesiaunderthesupervisionofaqualifiedphysicianandthereforecompromisethesafetyandcareofpatientsintheCommonwealth. Becausethebill'slanguagefailstoplaceanystatutorylimitationsonscopeofpractice,thelegislationcoulddramati-callyexpandnurseanesthetists’scopeofpractice into areas that consist of thepracticeofmedicine;suchas,chronicpainandcancerpain.Notonlyisanurseanes-thetist’s education and clinical trainingmuchshorterthanananesthesiologist’straining,itdoesnotincludeanysignificanttimestudyingandtraininginthediagnosisandtreatmentoftheseconditions. ThebillshavebeenassignedtotheLegislature’sPublicHealthCommittee,andhearingsarelikelytobescheduledlaterthisyearorthebeginningof2014.MSAisvigorouslyopposingthebills,asisthemedicalsocietyandothermedicalspecialtysocieties.Itisvitallyimportant,however, that anesthesiologists speakupforpatientsafety,andtelllegislatorsthat when seconds count, having an anesthesiologist or qualified physician immediately available, working with and overseeing the CRNA reduces risk and ensures the safe delivery of quality anesthesia care. Inthecomingweeks,MSAwillbecallingallmemberstoactionandaskingyoutocontactyourstaterepresentativeand senator. When those calls come,please stand up for your patients andcontactyourlegislators.
Report of Counsel - continued
(continued from page 1)
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ASA also advocated for repeal of thenon-elected Independent PaymentAdvisory Board (IPAB), which wouldhavesweepingpowerstomandateaddedpaymentreductionsontopofSGRcuts.Supportforthisrepealisgrowing,withbillsintroducedinbothHouseandSenatethisyear(H.R.351andS.351). ASAisalsoproactivelyaddressingthe changing health care system withitsincreasedfocusoncarecoordinationand reductionofunnecessary services,to helpASAmembers find productiveopportunities. With our legislators inWashington,wereinforcedASA’scon-ceptofthePerioperativeSurgicalHome,whereanesthesiologistswouldserveasthe medical coordinators of the entireperi-operativepatientcareprocess.ThePerioperative Surgical Home can pro-videstrategicandfinancialsupport fortheanesthesiologistasthePerioperativePhysician.ASA’sCommitteeonFutureModels ofAnesthesia Practice, whichincludesyourDirector, isactivelypre-paring thedetailed componentsof thismodel, includingmonetization, so thatASAmemberscanusethisstructuretodeveloptheirownpractices.
ItismypleasureasyourDirectortogiveyouanupdateonthenationalAnesthe-siologyissues.ASAandMSAadvocatefortheinterestsofyou,ourmembers. Our society’s annual meeting,ANESTHESIOLOGY2013willbeheldinSanFranciscoinOctober.Anexcitingprogram of educational, scientific andadvocacy activities is being readied toaddress the interests of all attendees.TheOpeningSessionwillbe“ChasingZero”,apresentationbyCharlesDenham,MD, Editor-in-Chief of the Journal of Patient Safety, with actor and patientsafetyadvocateDennisQuaid.TheAPSFEllisonC.PierceLectureonPatientSafetywill feature Alan F. Merry, MD, andMassachusetts’ownJeffreyB.Cooper,PhDwillreceivetheASADistinguishedService Award for his achievementsimproving anesthesia patient safety.Check out the meeting website http://www.asahq.org/Annual-Meeting/ andplannowtoattend! MSA leadership and our residentrepresentatives participated in the an-nual ASA Legislative Conference inWashingtonDC. Appropriatepaymentforour services is always important toASAmembers,andweaddressedseveralMedicarepaymentissues.Weremindedour legislators about anesthesiology’suniquely low payment from Medicareat 33% of private payment rates, andthereforeadvocatedthatanesthesiologyshould be “held harmless” for furtherpaymentcutsthroughtheMedicareSGR(SustainableGrowthRate)formulacuts.Wewereabletoshowourlegislatorsthataccording to theCongressionalBudgetOffice, anesthesiology services are notdrivingvolumeor growth inMedicarespending.Thisyear,Housecommitteeshave released a concept proposal toreplace the SGR with a quality-basedprogram, and have sought input fromstakeholdersincludingASAtorefineit;thefutureofthisinitiativeisuncertain.
Manytypesofprovidersareinvolvedinhealthcaretoday,includingphysicians,technicians,nurses,physicianassistantsandotheralliedproviders.Increasingly,the training programs provide doctoraldegreeswithintheirspecialty,allowingthemtobecalled“Doctor”,andrecentstudies confirm increasing patientconfusion. There is a heightenedneed to make sure that patients haveadequateinformationtomakewiseandcost-conscious health care choices anddecisions.Toaddressthis,legislationhasbeenintroducedintheHousetoimprovetransparencyintheidentificationofhealthcareprovidersandinhealthcareprovider-related advertisements and marketing(H.R.1427).ASAactivelysupportsthislegislation. Shortages of critical intravenousdrugscontinue.Centralnervoussystemdrugs, which include drugs used byanesthesiologists,aretheclassofdrugsmost frequently affected by shortages.Thecausesofdrugshortagesarespecificand unique to each drug, and include:legislativeandregulatoryfactors;alackofcontingencyplansforcriticaldrugsthatarevulnerable to shortages;manufacturingfactors such as noncompliance withFDA Good Manufacturing Practiceregulations;businessandmarketfactorssuchasconsolidationoffirmsandlackofbusinessincentivetoenteraspecificproductmarket;market price pressure;anddistributionfactorssuchasjust-in-time inventory. Because the causes ofshortages are multi-factorial, a varietyofsolutionswillbeneededtoalleviatedrug shortages. The Food and Drug Administration Safety and Innovation Act (FDASIA) passed last year newlyrequiresmanufacturerstoreportexpectedinterruptionordiscontinuanceofcriticaldrugs’ manufacture, leaving time todevelopalternatives.ASAandFDAarefrequentlyincontactabouttheevolvingdrugshortagesissues.
1) Clarifying and making the officernomination process more transparentandegalitarianthroughby-lawschangestobevotedonatthe2013Annualmeet-ing,
2) Outsourcing CME programming tothe Massachusetts Medical Society tobetter concentrate our office resourcesonmembershipadvances,
3) Website improvements - membersonly areawith log-in protection and alink to the state anesthesiologists PACwebsitefordonations,
MSA Officers and ASA President Elect Dr. Jane Fitch (third from right) pictured above at the Massachusetts State House with Representative Jeffrey Sanchez, State Representative for the 15th Suffolk/Norfolk District (second from left)
4)Re-listingofmembersbyhomead-dress and elimination of former MSA“districts” in favoroforganizingMSAdistricts along with congressional dis-trictsinordertobetteridentifyconstitu-entsforlegislativeactivity,
I continue to be grateful for the“seasoned”adviceofDr.AlexHannen-berg,thepastpresidentofASA,thele-galcounselofMr.EdwardBrennan,thesecretarialsupportofMs.BethArnold,andYOU.~
SelinaA.Long,M.D.
President2012-2013
Dr. Long's Outgoing President's Report-continued
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TheAnesthesiology, Critical Careand Pain Medicine Service provide arange of clinical, educational, and re-search activities throughout the healthcare system. Clinical services includeanesthesiacarebothintheoperatingroomsuiteandatspecializedsitesthroughoutthe hospital, critical care and medicaldirection in the surgical intensive careunits, pain management for chronicand acute pain symptoms as well asliaisonwiththeemergencydepartment,andemergencyresponseviacodecallsand airway management coordination.Hence,anesthesiologistsinourgrouparespecialty-trainedincriticalcaremedicine,cardiacanesthesia,regionalanesthesia,thoracic anesthesia, patient safety, andpainmedicine.
Weprovidetraininginanesthesiol-ogy, critical care, pain management,regional anesthesia and preoperativeassessment.Anesthesia residents, painfellows and anesthesia interns rotatethroughVHABHSfromMassachusettsGeneral Hospital (MGH), Beth IsraelDeaconess Medical Center (BIDMC),BrighamandWomen’sHospital(BWH)and Boston Medical Center (BMC).MedicalstudentsfromBostonUniversitySchoolofMedicineandTuftsUniversityalso receive opportunities to join theanesthesia teamduringmandatory andelective rotations. Furthermore student
VA Boston Healthcare System-continued
Hospital in Review-continued
West Roxbury Campus
(continued from page 1)
registered nurse anesthetists (SRNA)from Northeastern University and St.Joseph’sHospital,RIhaveanestablishededucational presence at VABHS. Oureducationalopportunitiesincludeclinicaltraining forall levelsof traineesunderclosesupervision,simulationexperiences,didacticandsmallgroupsessionsinclud-ingweeklymultidisciplinaryanesthesia,cardiology,cardiacsurgeryandvascularsurgeryrounds.
Researchareasrangefrombasicsci-encesuchaspainandanestheticmecha-nisms throughclinical studies.Specifi-callyintherealmofperioperativecare,ourgoalsincludeprovidingthehighestqualityanestheticandsurgicalservices,identifying ways to increase operat-ing room efficiency, improving patientoutcomes through earlier rehabilitationandsuperiorpaincontrol,andminimiz-ing postoperative complications in theintensive care unit and hospitalwards.VABHS has been the pioneer for theNationalSurgicalQualityImprovementProgram (NSQIP), the VeteranAffairs
SurgicalQualityImprovementProgram(VASQIP)andnowisactivelyjoininganationalVAanesthesiologygrouptocre-atetheVeteransAffairsAnesthesiaQual-ity Improvement Program (VAAQIP).VAAQIPisplannedtoestablishadatabasefromAnesthesiaRecordKeeping(ARK)systemsofeveryVAhospitalinthenationaswellasreceiveandutilizedatafromother currently existing VA databases.Furthermore,VABHSanesthesiologistsactivelyparticipateinaVHA’sNationalCenterforPatientSafetylessonslearnedproject.
Pain Medicine
TheVABHSPainClinicisaninter-disciplinary clinic composed of BoardCertifiedPainManagementphysicians,behavioralmedicinepsychologists,andadvance practice nurses. Pain clinic’sprioritiesare,1)patientswithneuropathicpain (examples: diabetic neuropathy,trigeminalneuralgia,postherpeticneu-ralgia),2)painrelatedtocancerorcancertherapies,3)painrelatedtotraumaticbraininjuriesandpolytrauma,and4)patientswho may be helped by interventionalprocedures.Theoverridinggoalistohelppatientsbecomeasfunctionalaspossiblewhilerelievingasmuchpainaspossible.Theclinicisdesignedtodoathoroughpainassessment,developaplanofcare,and either implement that plan of careormake recommendations back to thereferringprovider.Painservicerecognizesthatchronicpaincanoftenbereducedbutseldomcompletelyeliminated.Tomaxi-mizeimprovementthePainClinicusesmedications emphasizing non-narcoticstrategies,physicalrehabilitation,mentalhygiene and interventional procedureswhenindicated.Patientsareencouragedto play an active role in their therapy. Wealsoprovideconsultationontheinpatientwardsforpatientswithcancerpain,neuropathicpainandpatientswithpolytraumainjuries.~
to our veteran patients by promotingnew research discoveries in clinicalinvestigation. In addition, theanesthesiology staff, surgeons, ORnurses and support staff have formeda close-knit group that enjoy workingand socializing together. Our rotatingtrainees frequently comment on thisculture of professional and friendlycoexistence between the OR services.VABHS is proud to have been electedtothetopoftheBostonGlobe'100bestemployers' list and this ismirrored byveryhighworksatisfactionbymembersoftheanesthesiateam.
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OtherstateagenciesestablishedbyChapter224aretakingform.Amongtheseis the Health Information TechnologyCouncil,whichwilloverseethedevelop-mentofinteroperativehealthinformationexchangesthatwillallowforthesecureelectronic exchange of health recordsamongallprovidersinMassachusettsby2017. MassHealth (Medicaid) has beguntheChapter224mandatedtransitionto-wardaglobalpaymentsystembasedondeliveryofcarethroughmedicalhomesinwhichprimarycareproviderswillbecoordinatingcare.MassHealthhassetagoalthat25%ofitscoveredliveswouldbeunderglobalpaymentsbyJuly,2013;50%byJuly2014;and80%byJuly2015.
Health Care Payment Reform Bills-continued(continued from page 9)Health Care Payment Reform The comprehensive health carepayment reform law, Chapter 224 oftheActsof2012,isbeingimplemented.A new state agency, theHealth PolicyCommission, has been formed andis charged with implementation. TheCommissionwill set the annual healthcarecostgrowthbenchmark(theamounthealth care spending will be allowedto grow, which for 2013 is 3.6%);certifynewpaymentmethodsandcaredelivery models (ACOs and MedicalHomes);overseethepublishingofcostand quality data and the developmentof a state health plan to determine thefuture medical capital needs of theCommonwealth every 5 years; andmonitor and review the impact ofchangesinthehealthcaresystem.
TheMassachusettshospitalmarketcontinuestoconsolidatethroughmergersand affiliations, as provider networksdevelop to take on risk throughglobalpaymentsandalternativepaymentmeth-odologies. InJune,theLegislatureenactedalawwhichbringsMassachusettsintocompli-ancewiththeAffordableCareAct.TheCommonwealthHealth InsuranceCon-nector,thestateentitycreatedaspartoftheMassachusettshealthcareaccesslawof2006tohelptheuninsuredfindhealthinsurance,willbetheExchangeforthestateundertheACA. MSA will continue to monitorimplementationofChapter224andtherapidlychanginghealth caremarket inMassachusettsveryclosely.~
Dr. Michael England pictured with Mary Muchendu, CEO, Kijabe Hospi-tal, Kijabe, Kenya, with Dr. Mark Newton, on his recent visit.
Report of Counsel-continued
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MSA Plans for the upcoming year - continuedPresident's Report-continued
Pictured above, incoming MSA President, Dr. Michael England and MSA Treasurer, Dr. Daniel O'Brien at the MSA Annual Meeting in May.
(continued from page 5)
EXECUTIVECOMMITTEEMEETINGDATESFOR
2013-2014
Thursday,Sept.12,2013Thursday,Oct.3,2013Thursday,Nov.21,2013Thursday,Jan.16,2014Thursday,Mar.6,2014(All members are welcome)
* note-date change, November and January meetings, same location.
1. Updatingourmembershipliststoincludeallmember’svotingzipcodethatwillbelinkedtotheir state senator and repre-sentative.
2. Callinguponyou,ourmembers,to speak out on behalf of pa-tientsandtheneedtomaintainanesthesiasafetybycontactinglegislators with the message:“When seconds count, havingananesthesiologistimmediatelyavailable, working with andoverseeing a nurse anesthetistreducesriskandensuresthesafedelivery of quality anesthesiacare.”
4. We received a grant recentlyfromtheASAtopartiallyfundourefforts.Wewilldiscussthepossibility of directing thesefundstoengageafirmtoprop-erlystrategizeour“campaign”tomaximizetheimpactofourmessage.
6. We have testified before theBoardofRegistrationinNurs-ing when they had a publiccommentsessionontheirnewregulationsregardingadvancedpracticenurses.Itwaspointedoutclearlythatthenewproposedregulations do not conformto the state statute requiringphysician supervision in theordering of tests, therapeuticsandprescribingofmedications.IalsopointedoutthatNursingregulations have to be jointlypromulgated with the Boardof Registration in Medicineonthesematters.Thiswasnottheirplan!
This promises to be amost interestingandbusyyear!~Respectfullysubmitted
MichaelR.England,MDMSAPresident2013-2014
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COMMITTEE ON PROGRAMS ANNUAL REPORT - MAY 2013
The Program Committee oversaw anumberofsuccessfulprogramsinthe
pastyear.TheAbdelMehioUltrasoundGuidedRegionalAnesthesiacourse,held,December1,waspopularasusual.Newtopicsincludedcomplicationsofregionalanesthesiaaswellastheuseofcontinu-ouscathetersforblocks.The3rdAnnualWinter Meeting in Puerto Rico, againpresentedinterestingspeakersinagor-geoustropicallocaleandwasenjoyedbyasmallbutenthusiasticgroup;thenumberofregistrantsdoubledthisyear.
theNewEnglandSocietyofAnesthesiolo-gistsfortheir56thAnnualFallConferenceSeptember19-22intheBerkshires.TheProgramCommittee is currentlywork-ingonanewprogramdesignedtoassistmemberswithunderstandingtherequire-mentsforMOCA,aswellasoffersomeMOCA-approved CME credits. Thisprogramwillbeofferedthiswinteratadatetobedetermined. Asalways,theProgramCommitteeis always seeking interested membersto helpwith planning and steering themeetings of the MSA. Please contactCristin McMurray with questions orcomments.~
SAVE THE DATE
MSA 7TH UPDATE IN SEDATION & ANALGESIA
Saturday, April 12, 2014
Waltham Woods Conference Center, MMS Headquarters
Waltham, MA
Chair2013-2015
Cristin A. McMurray, M.D.
Annual Reports-continued
The Third Annual Winter Conference was held at the El Conquistador Resort in Las Croabas, Puerto Rico, January 18-21, 2013. Speakers from left to right, Drs. William Camann, Keith
Ruskin, Program Director Cristin McMurray and Fred Shapiro, enjoying the picturesque view.
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Lee S. Perrin, M.D.
Chair2012-2013
COMMITTEE ON BYLAWS ANNUAL REPORT - MAY 2013
AnumberofdifferentBylawsrelateditemswerereferredtotheCommit-tee. Below are bylaw changes recom-mended by the Executive Committeeduring the past year. It is required byourBylawsthatoncerecommendedbythe Executive Committee of theMSAthattheproposedchangesbemailedtothemembersof theSociety thirtydayspriortotheAnnualMeeting.Thisreportconstitutesthatnotice.
1. Updating our parliamentaryreference. “Sturgis” isno lon-gerbeingpublished.Themostrecentversionbymanyof thesameeditorsofthe4theditionofSturgisisnowcalledthe“Ameri-canInstituteofParliamentariansStandard Code of Parliamen-tary Procedure”. The changesareavailableon theAmericanInstitute of Parliamentarian’sweb site. This bylaw changewas recommended by the EConSeptember6,2012.
11.1 PARLIAMENTARY AU-THORITY
TheAmericanInstituteofPar-liamentarians Standard Codeof Parliamentary Procedureshallgovern theSociety inallcases towhich it isapplicableandisnotinconsistentwiththebylaws and standing rules oftheSociety.[AmericanInstitute
of Parliamentarians (2012-04-12). American Institute ofParliamentariansStandardCodeof Parliamentary Procedure.McGraw-Hill.]
2. During a previous bylaws“cleanup”, we missed remov-ing “Bachelor of Medicine”from the qualification for theretired membership category.There was some confusion asto whether someone with theBachelorofMedicinewasableto become amember ofMSAorASA. ASA’s interpretationofthelanguageisthattheterms“DoctorofMedicineorDoctorofOsteopathy”referstothetypeofphysicianandNOTtoaparticulardegree.Therefore,ASAacceptsanyonewithaDEGREEthatisequivalent.This bylaw changewasapprovedandrecommendedbytheEConSeptember6,2012
3.3.4Retired
3.3.4.1ADoctorofMedicineorDoc-torofOsteopathywhohasbeenacontinuousactivememberofthisSocietyoranothercompo-nentsocietyforten(10)yearsormoreandwhoiseligibleforretiredstatusinTheAmericanSociety of Anesthesiologists,Inc.,andwhohasretiredcom-pletelyfromprofessionalactiv-ity;provided,howeverthattheExecutive Committee may atits discretionmodify the timeuponresumptionofprofessionalactivity.
shouldbenotedthatsection3.6.2(notincludedhere)saysthatanindividual can only belong toone component society. Thisbylaw change was approvedand recommended by the EConSeptember6,2012.
3.6 MAINTENANCEOFOTHER MEMBERSHIPS
3.6.3MembersofTheAmericanSociety of Anesthesiologists,Inc.,upontransferoftheirloca-tionofprofessionalactivityorresidencetotheCommonwealthof Massachusetts shall applyformembershipinthisSocietywithin180daysunlesstheyareamemberofanothercomponentsociety.
Topreparealistofnomineesforeachofficewhichistobevacantin thisSocietyand to forwardtheir recommendations to theExecutiveCommitteebyMarch1.TheCommitteeshallsolicitthemembershipfornominationsinDecemberandclosetheperiodfor receiving nominations onFebruary1.
(continued on next page)
Annual Reports-continued
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4.3 ELECTION
4.3.1NominationsApproval
Nominationofofficerswillbemade from the recommenda-tions of the Committee onNominations. The ExecutiveCommittee may amend thereport of the Committee onNominationsbyamajorityvoteofthevotingmembershipoftheExecutive Committee presentandvoting.
4.3.2BallotDistribution
Electionshallbebythemem-bers of this Society by ballotdistributed by mail forty-fivedayspriortotheannualsessionbytheSecretaryofthisSocietyusinginstantrunoffvoting.ThevotedballotsmustbereceivedbytheSecretarypriortothean-nualsessionatadatespecifiedby him/her. Nothing in theseBylawsshallprecludeamemberfromcastingaballotforawrite-incandidate.
4.3.3 Ballot Counting andResults
The ballots will be countedby theSecretary and two tell-ersappointedbythePresidentandapprovedbytheExecutiveCommittee.AtiewillbebrokenbyacointossbytheSecretaryaswitnessedbythetellers.TheresultswillbeannouncedattheAnnualMeetingoftheSociety.
posedbylawbelowwascraftedbyMSAlegalcounselandtheBylaws Committee chairman.ItwaspresentedattheJanuary2013 Executive Committeemeetingandrecommendedforapprovalatthattime.Thiswillbecome a new section of thebylaws in the Miscellaneoussectionofourbylaws.
1.1.1.1 INDEMNI-FICATIONANDINSURANCEOFOFFICERS,EXECUTIVECOMMITTEE MEMBERS,COMMITTEE MEMBERS,EMPLOYEES,ANDOTHERAGENTS11.4.1 Officers, ExecutiveCommitteeMembersandCom-mitteeMembers.EachOfficer,ExecutiveCommitteememberand committee member ofthe Society in each instance,whether or not then in office,shallbeindemnifiedbytheSo-cietyagainstallchargeswhichmaybereasonablyincurredorpaidbyhiminconnectionwithanyclaim,actualorthreatenedaction,suitorproceeding(civil,criminalorother,includingap-peals)inwhichheorshemaybeinvolvedbyreasonofhisorherbeingorhavingbeensuchofficerorcommitteemember,madeorbroughtagainsthimbyreasonofanyactoromission,orallegedactoromissionbyhiminanyoreachsuchcapacity,andalsoagainstallchargeswhichmaybereasonablyincurredorpaidbyhim(otherthantotheSocietyfor its account) in reasonablesettlement of any such claim,action,suitorproceeding.The determination whether asettlementisorwasreasonableshall be made by a majorityof a quorum of theExecutiveCommitteecomprisedofthoseExecutiveCommitteemembers
who are not involved in theclaim,action,suitorproceeding,andiftherebenosuchquorum,thenbyoneormoredisinterestedpersons towhom thequestionmaybereferredbytheExecutiveCommittee.11.4.2 EmployeesandOtherAgents.TheExecutiveCommit-teemay,bygeneralvoteorbyvotepertainingtoaspecificem-ployeeoragentorclassthereof,authorizeindemnificationoftheSociety’semployeesandagents,other than those officers andpersons referred to in Section11.4.1above,towhateverextenttheymaydetermine,whichmaybeinthesamemannerandtothesameextentprovidedinSection11.4.1above.11.4.3Definitionof“Charges”.AsusedinthisSection11.4theterm “charges” shall include,without limitation, judgmentawards, settlement awards,awardsbyothertribunalsorbod-ies,attorneys’fees,costs,fines,penaltiesandotherliabilities.11.4.4LimituponIndemnifi-cation. IndemnificationunderthisSection11.4,whetherun-der Section 11.4.1 or Section11.4.2,shallnotbemade,andno person shall be entitled toindemnification, in any casewhere such claim, action, suitorproceedingshallproceedtofinal adjudication and it shallbe finally adjudged, nor shallany settlement be determinedreasonable if it is found, thatsuch officer, Executive Com-mittee member, committeemember, person, employee oragent (a) is orwas derelict inthe performance of his or herduties in connection with theallegedactsoromissionsgivingrisetosuchclaim,action,suitor
Annual Reports-continuedCommittee on Bylaws Annual Report-continued
teer and take the time from their busyschedules to visit the community andeducatethepublicaboutthevitalroleoftheanesthesiologistintheperioperativesetting.
Annual Reports-continued
TheMassachusetts Society ofAn-esthesiologistswillcontinuealongwithnationalefforttoinformouranesthesiacommunityaboutthebenefitsofsupport-ingtheASAPoliticalActionCommittee(ASA-PAC). This enables a ‘voice ofsupport’, which has crucial impact oncurrentnationallegislativeissues:healthcarereform,ceasingMedicarepaymentcuts, and extending rural pass-throughpaymentstoanesthesiologists.Thesuc-cessoftheDrugShortagelegislationisatestimonytohowinformation,persis-tence,andvisibilityofourprofessioncanmake.
lowingtheAnnualmeeting.Thecontentis based on Committee reports, plusadditionalcontributionsfromtheeditorandmembers.TheRecordisdistributedtotheentireMSAmembershipviaregularmailandisalsoavailableelectronically. Emailblasts(eBlasts)–thecommit-teesupportstheuseofselectiveeBlaststo the entire MSA membership thatconveymajordevelopmentsofregionalandnationalimportance.TheCommitteewillworkwiththerestoftheMSAand,the legislative council to prepare anddistributeasneeded. TheCommitteeChairproposedanideaofforminga looseaffiliationwith
anacademicjournalinawaythatwouldbenefitMSAmembers.Wewillexplorevarious options and report back to theExecutiveCommittee. TheMSAwebsiteisconstantlyevolv-ingandisoverseenbytheSubcomitteeonWebsiteDevelopment.Dr.Spanakishasledtheeffort.~
Respectfullysubmitted,
RichardUrman,MD,MBA
Fred E. Shapiro, D.O.
Chair2011-2014
Richard D. Urman, MD, MBA
COMMITTEE ON PUBLICATIONS ANNUAL REPORT - MAY 2013
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Opt-out pressure continues. Thisyear,therehasbeenlegislationfiledinsev-eralstatestocreatedefactoindependentpracticefornursepractitioners,includingnurseanesthetists.Thislegislationisac-tiveinMassachusetts.Specifically,thelegislationwilleliminatethestatutoryre-quirementthatsuchnursesfunctionunderthesupervisionofaphysicianpursuanttoregulationsdevelopedjointlybytheBoardofRegistrationofNursingandtheBoardofRegistrationinMedicine.Pleasereadthedetaileddiscussionsaboutthisbyourcounsel,EdwardBrennan,Esq. There are many active issues fac-inganesthesiologistsnow. To address them, we need the support of every anesthesiologist. It is important that we all contribute now to MSA-APAC and ASAPAC, to support our state and our national legislative efforts. EachofusknowsmembersofourrespectivedepartmentswhoarenotmembersofMSAandASA.Pleasejoininthechallengetogettheminvolved. IamprivilegedtoserveyouasyourASA Director from Massachusetts. Iespecially thank the MSA ExecutiveCommitteeandyoutheMSAmembersforyourhelpandsupport.Ifyouhaveanyquestionsorcomments,orneedsthatcouldbeaddressed,pleasedocontactmeatMSA.~
RespectfullySubmitted,
BeverlyK.Philip,MDDirector
Pictured above, left to right; Dr. Ruben Azocar, Dr. Fred Shapiro, Dr. Beverly Philip, ASA Director, and Dr. Selina Long at the Annual Meeting in May 2012.
Many Issues Facing Anesthesiologists-continued
proceeding,or(b)hasnotactedingoodfaithinthereasonablebeliefthathisorheractionwasinthebestinterestsoftheSociety.Neitherajudgmentorconvic-tion nor the entry of any pleainacriminalcaseshallofitselfbedeemedanadjudicationthatsuchofficer,ExecutiveCommit-teemember,committeemember,employeeoragentwasderelictoftheperformanceofhisorherdutiesifheorsheactedingoodfaith,forapurposewhichheorshereasonablybelievedtobeinthebestinterestsoftheSociety,andhadnoreasonablecausetobelievethathisorherconductwasunlawful.11.4.5 Other Rem-edies.Therightsofindemnifica-tionhereinprovidedforshallbeseverable,shallnotbeexclusiveof other rights to which anyofficer, Executive Committeemember, committee member,employee or agent may now
or hereafter be entitled, shallcontinue as to a person whohas ceased to be such officer,ExecutiveCommitteemember,committeemember, employeeoragent,andshallinuretothebenefit of the heirs, executorsand administrators of such aperson.11.4.6Insurance.TheSocietyshallhavepowertopurchaseandmaintaininsuranceon behalf of any person whoisorwasanofficer,ExecutiveCommittee member, commit-teemember,employeeorotheragent of the Society, or is orwas serving at the request oftheSocietyasaDirector,offi-cer,employeeorotheragentofanotherorganization,inwhichit has an interest, against anyliabilityincurredbyhiminanysuchcapacity,orarisingoutofhisorherstatusassuch,whetherornottheSocietywouldhavethepowertoindemnifyhimagainstsuchliability.~
Committee on Bylaws Annual Report-continued(continued from page 17)
(continued from page 10)
Annual Reports-continued
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COMMITTEE ON RESIDENT AFFAIRS ANNUAL REPORT - MAY 2013
Scott Suciu, M.D.
Chair 2012-2013
TheCommittee on ResidentAffairs(CORA) had a successful year.
Among current members, we have re-mainedveryinvolvedinanesthesiaeventsandissuesoverthepastyear.Residentsfrommanydifferentinstitutionspartici-patedasresidentdelegatesattheannualASAmeeting inWashingtonD.C. thispastOctober.Inaddition,residentrep-resentativesfromBrighamandWomen’sHospital,BethIsrael,andBaystateMedi-calCenterparticipatedinthisyearsASAlegislativeconference.
Anotherendeavorthatwehavetakena larger role in relates tophilanthropy.Dr. Hannenberg has been a fantasticproponent of Lifebox, and has been avaluableadvisorforus.OnMarch2nd,anesthesia residents from across Mas-sachusettscelebratedthecompletionoftheannualin-trainingexam.Over100residentsfromacrossthestateattendedasocialmixerhostedinhonorofLifebox,acharitythatdonatespulseoximeterstodevelopingcountries.Over77,000op-eratingroomsaroundtheworldlackthisequipmentthatissovitaltooureverydaylives. This event is a part of the on-goingLifeboxChallenge,afundraisingcompetitionbetweenBostonUniversity,Brigham andWomen’s Hospital, BethIsrael,MassachusettsGeneralHospitalandTuftsanesthesiaresidencies.$1500wasraisedfromthisevent. The annualNEARCwasheld thisyearatBrighamandWomen’sHospital,andwiththehelpofDr.RomanSchumann,CORAhastriedtobecomemoreinvolved.BevChanghasspentagreatdealoftimeattempting to create a framework thatallowsCORAmemberstohelporganizefutureevents.Ultimately,thegoalwillbe
forCORAmemberstoregularlyupdateawebsitethatwillhostinformationthatallmemberinstitutionscanview.ThiswillhelpthemstayinformedwithimportantnewsandinformationregardingtheNE-ARC.Inaddition,CORAmemberswillbe instrumental in reporting importantinformationtodifferentresidentinstitu-tionsthroughvariouscontactresourcesandmaintainingaconstantcommunica-tionwiththeNEARCsteeringcommittee. Our presence as a committee ofresidents thatworksunder theMSAtopromoteresidentinvolvementfortheim-provementofourspecialtyandultimatelyforbettercareforourpatientshasshown.Wearecurrentlyholdingelections,andapplications from residents to variouspositions on CORA have doubled thisyear.Ihavereceivednumerousemailsfromresidentsthatwanttogetinvolved.Our fundraising efforts resonated withfacultyandresidents,indicatingthatwearenotjustagroupofresidentsthatsitonthesidelines,butcanalsomakeadif-ferenceforpatients inareaswithmoreminimalresources. This upcoming year, we have afantasticgroupofresidentsthatwillbeleadingCORA.Inadditiontocontinu-ingtheaboveendeavors,wehaveothergoals.Personally,Iwouldliketoseeaneasiersystemofcommunication,whereall CORA announcements (elections,Hannenberg scholarship,ASA residentdelegateapplications,etc)aretranspar-entandeasilycommunicatedacrossthestatetoresidents.IwouldalsoliketoseeCORAtakeonalargerroleofencouraging100%involvementintheASAPACfromallmemberinstitutionsinMassachusetts.TheMSAhasbeenverysupportiveofusthisyear,andwelookforwardtoanothergreatyearofresidentinvolvementwiththeMSA.~
teechairwascontactedbyTomCooper,on behalf of the Board of Trustees ofthe International Anesthesia ResearchSociety (IARS). The IARS ExecutiveDirectorinformedusofanoutstandingopportunity for NEARC participatingresidents.Forits2013annualmeetinginSanDiegoinMay2013,theIARSwouldsponsorthe2residentswhowouldwintopabstractatNEARCin2categoriestothencompeteinanationalselectionofbestabstractsfromallregionalanesthesia
Annual Reports-continued
NEW ENGLAND ANESTHESIA RESIDENT CONFERENCE SUB-COMMITTEE (NEARC) ANNUAL REPORT-MAY 2013
Roman Schumann, M.D.
New England Anesthesia Resident Conference (NEARC)Spring 2014
Baystate Medical CenterGo to MSA website link for details
residentconferences. Theeventrepre-sents an additional, exciting incentiveforresidencyprogramstoparticipateinNEARC,anditishopedthatIARSwillcontinuethisnewformatforresidentsforitssubsequentmeetings. OnApril13,2013,awellattended7thannualNEARCwashostedatBWHinBoston.Thehostorganizers, BWHprogram director Rob Lekowski, MD,CAIIresidentBeverlyChang,MDandtheiradministrativesupportstaffoffereda delightful program that included anoverviewofhealthcarereform(RichardH.Gregg,MA,MBA),lifeintherealworld(TerenceK.Gray,DO)andORemergencymanagement checklist use (WilliamR.Berry, MD, MPH, FACS). More than40abstractsbyresidentsfrommanyNEinstitutionsweresubmittedthisyear.Asophisticated abstract scoring systemusingASAabstractjudgingcriteriawasimplementedthisyeartoensureproperselection of the winning abstracts forIARSsponsorship.Facultyjudgesfrom5institutions(UMASS,BIDMC,BWH,MGHandTMC)volunteeredtodeterminethewinnersinseveralphaseswithafinalcallfollowingtheabstractpresentations
on thedayof theconference.Thehostforthe8thannualNEARChasyettobedetermined. The subcommittee’s outreach ef-fort to encourage even wider programparticipationoccurredinseveralphasesandincludedwritten,phoneande-mailinformationtoofallNEanesthesiologyprogramdirectorsaswellastoeveryNEanesthesiology state society president.This outreach proposed the establish-mentofaNEARCsteeringcommitteetoformalizecontent,schedulesandfuturedirectionoftheconference.Atthistime,theMSANEARC subcommittee leadsthetransitionintothisNEARCsteeringcommitteeattheMSA.Acoregroupofinterestedanesthesiologistshaveofferedtocollaborateinthesteeringcommittee,whichshouldbegin itsworkshortly. Ithasbecomeevident,thatasaconferencebyresidentsforresidents,suchasteeringcommitteewill includeMSAresidents’componentmembers(CORA)withspe-cificresponsibilitiesforNEARC.ThesubcommitteewishestothankBethArnold of the MSA for her unfailingadministrativeassistanceduringthepastyear.~
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MSA ANNUAL MEETING
Another political battleground foranesthesiologistshasbeenoverproposedinclusion of independently practicingnurse anesthetists in the field of inter-ventional pain management. On thisparticularsubjectDr.FitchseemedelatedtorelaythatstatessuchasAZ,MA,OK,LA,andTNallhadenactedlegislationeitherdefiningthepracticeofpainman-agementasthepracticeofmedicine,orlimitingtheperformanceandsupervisionoffluoroscopybasedinjectionsaroundthespinalcordtophysiciansonly.In2013bothILandIAjoinedthislistofstateswhofoundthatonlypainphysiciansshouldberesponsiblefortheinterventionalcareofthechronicpainpatient.Centraltothesescopeofpracticedecisionswereeffortsmade by both the Pain Care CoalitionandtheASAtoinformbothpatientsandlegislatorsoftheparamountimportanceof patient safety and the integral roleplayedbyanesthesiologistsinensuringsafecare.Dr.Fitchthenwentontode-
ASA Guest Speaker, Dr. Jane Fitch with Dr. Paul Satwicz pictured on the left and Dr. John Hedley-Whyte to the right.
by Brian O’Gara
The2013MSAAnnualMeetingwasanoteworthyevent. Thisyear the
constituentshadthedistinctpleasureoflisteningtoapresentationgivenbytheASAPresidentElectDr.JaneFitch.Thesubjectsofherlectureweretherelevantpolitical issues facinganesthesiologistsandhowtheASAis“workingforyou,”abriefoverviewoftheresponsibilitiesandmakeupofournationalsociety. Dr.Fitch’sdiscussionoftherelevantpoliticalissuespertainingtoanesthesiolo-gistsbeganwithanupdateontheFederalandStatescopeofpracticebattles.CMSin2011determinedthatinordertopartici-pateinMedicarehospitalshadtoagreetocertainconditions,oneofthembeingthatnursescouldnotpracticeindependentlyofphysicians.Theinclusionofthisstipula-tionwasaresultoflobbyingeffortsbytheASAanditsconstituents.Thefederalgovernmentthendecidedthatifindividualstatesdidnotagreewiththisstipulation,then under certain circumstances theycould“opt-out”ofthepreviouslymen-tionedrequirementforMedicarefunding.Asitstandsatthemoment,17stateshaveoptedout,withMichiganandWyomingbothonthe“watchlist”ofthenextstatestopossiblyopt-out.
scribethepresenceoftheanesthesiologyassistant(AA)andtheirintroductionintonewareasofthecountry.Currentlythereare 1800AA’s practicing in 17 states,WashingtonD.C.,andtheVAhealthcaresystem.VariousstatesocietiesincludingrecentlyColoradoandConnecticuthaveplayedakeyroleinhelpingtoexpandtheeducationalprogramsavailabletoAA’ssothattheymaybecomeavaluablepartoftheanesthesiacareteam. As the national healthcare reformprocessmovesforward, therehasbeenanincreasingfocusontheprovisionofbothqualityandsafecaretoallpatients.Dr.Fitchcitedtheleadingroleplayedbyournation’sanesthesiologistsasareasonwhyourprofessionwillbechosenasanexampleofhowtoincorporatequalityandsafetyintoeverydaypractice.Withtheintroductionoftheperioperativesurgicalhomemodel,anesthesiologistsstandattheforefrontofensuringexcellentpatientcareandeffectivemultidisciplinarycom-
SUMMARY OF THE ASA GUEST SPEAKER PRESENTATION, DR. JANE FITCH
(continued on next page)
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ASA Guest Speaker Presentation-continued
MARK YOUR CALENDAR FOR NEXT YEAR'S MSA ANNUAL MEETINGThursday May 22, 2014
MIT Endicott House, Dedham(All MSA members are invited to attend)
MSA Annual Meeting
municationthroughouttheentiretyoftheperioperativeperiodfrompre-admissionto discharge. TheASA affiliateAnes-thesiaQualityInstitutealsoservesasanexample of how anesthesiologists areuniquelysuitedtoensurebestpracticesonanationallevel. Afterthisbriefdiscussionregardingtherelevantnationalissuesfacinganes-thesiologists,Dr.FitchthentransitionedintodiscussingtheASA’sspecificlegisla-tiveadvocacyeffortswithregardstotheongoing reform ofMedicare physicianreimbursementandbetteroversightofna-tionaldrugshortages.HighlightsfromtherecenteffortsbyASAdelegatesonCapitolHillincludedadvocatingthatreducingre-imbursementstoanesthesiologistsbasedonSGRmodelsdidnotmakeeconomicsense,asmanyindependentstudieshaveshown that anesthesia costs have beenbelowtheSGRrateforwelloveradecade,whereasradiologyandminorprocedurecostshaveexploded.AdvocacyeffortsbyourASAdelegatesandCongressmanDr.AndyHarris(R-MD)continuetoop-posepaymentoversightbytheproposedIndependent Payment Advisory Board(IPAB), fighting for representation byphysiciansinthediscussionofhowMedi-carepaymentsshouldbemade.Finally,inJune2012PresidentObamasignedintolawtheFDASafetyandInnovationAct.ProvisionsadvancedbyASAmembersaidedintheinclusionofstipulationsthatdrugcompaniesmustnotifytheFDAofanyanticipatedinterruptionsorhaltsintheproductionofdrugsspecificallyused
byanesthesiologists,aswellasencour-agingtheFDA’sauthoritytoreverseormitigateanyproductionproblemsoftheseimportantagents.Theinclusionofourprofessioninnationalhealthcarereformlegislaturehasbeenthroughtheimportantworkof theASAdelegatesandgroupslike theASA’sHealthPolicyResearchDivision,aswellaslobbyingeffortsbytheASAPAC,whichlastyearraisedover$1.8M. InadditiontotheASA’stirelessef-fortsfighting for anesthesiologists’ fairrepresentation in national healthcarereform,ournationalsocietyalsoprovidesforabevyofeducationalandcareerad-vancement opportunities on a nationalscale. Dr. Fitch cited theASA annualmeeting, as well as separate nationalmeetingsregardingpatientsafety,quality,andeducationallasexamplesofwhattheASAstaffworksontoaidintheprofes-sional and intellectualgrowthof everyanesthesiologist.AdditionaleducationalmodulessuchastheACEprogramandPractice Performance Assessment andImprovement,aswellasthenewlycus-tomizableEducationCenterontheASAhomepageallenableanesthesiologiststolearnandperformatthehighestlevel. In the next section of her lecture,Dr. Fitch then moved on to describethemakeup of theASA’s constituents,budget and leadership. In 2012 thenumber ofASAmembers increased toover 50,000members, representing anover 3% increase from the year prior.Thisincreaseinmembershipstandsout
amongstpoliticalsocietiesinthemedicalfield,asmostothernationalsocietiesarestrugglingtomaintaintheirnumbers,letalone see annual growth. Despite ourgrowingconstituency,thepercentageofanesthesiologistswhoaremembersoftheASA isdisappointingly low, especiallyin thestateofMassachusetts. Increas-ing this percentage will be incrediblyimportant going forward. The ASA’sannual operating expenses are around$36M, with the largest fractions spentongovernance,advocacy,andeducation.Whencontrastedwithrevenuesofover$40M,nearlyhalfofwhichismadeupofdues,thismeanstheyear2012-2013willallowfortheASAtoaddtoitsreserves.The remainder of the revenue ismadeupofcorporatesupport,exhibitsalesatmeetings,aswellasadvertisinginmeet-ingsandpublications. ToconcludeherlectureonhowASA“works for you,”Dr. Fitch focused onthecharitableandinternationaloutreachprogramssupportedbytheASA.TheseincludetheASACharitableFoundation,theHopefortheWarriorsprogram,andLifebox.Theseserveasshiningexamplesoftheanesthesiologycommunity’sinter-estinprovidingnotonlyexcellentpatientcarebutalsoinprovidingmuchneededsupportforourveteransandunderservedcommunitiesbothathomeandabroad.Dr.Fitch’sdiscussionwonderfullyelucidatedhowtheASAstrivestoembodythecorevaluesofeveryanesthesiologist,andhowournationalsocietyworkstoensurethatthe practice of anesthesiology is wellrepresentedthroughouttheworld.~
edthecompletionoftheannualin-trainingexam. Over a hundred residents fromacross the state attended a celebratorysocialmixerhostedinhonorofLifebox,a charity that donates pulse oximetersto developing countries without thisresource.Over77,000operatingroomsaround the world lack this equipmentthatissovitalinoureverydaylives.Thiseventisapartoftheon-goingLifeboxChallenge, a fund raising competitionbetween Boston University, BrighamandWomen’sHospital,BethIsrael,Mas-sachusetts General Hospital and Tufts
anesthesiaresidencies.Atotalof$10,000wasraisedby100%residentdonations,which raised over 40 lifeboxes. Pleaseshowyoursupportforourresidentsbyconsidering getting involved or donat-inginthenameoftheresidencyofyourchoice.Every$250buysapulseoximeter.Donations can bemade at http://www.lifebox.org/donations.Pleasebesuretowrite in thenameof theresidencyyouare donating for under the informationbox.Formoreinformation,[email protected].
Dr. Brian O'Gara, Chair of MSA Committee o Resident Affairs, pictured above promoting the Lifebox Challenge Golf Tournament that was held in June 2013.
Dr. Beverly Chang, Chair-elect of MSA Committee on Resident Affairs
LIFEBOX
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www.lifebox.org • 21 Portland Place, London W1B 1PY, UK • + 44 (0) 203 286 0402 • Email: [email protected]
Registered as a charity in England and Wales (1143018) • Registered as a company limited by guarantee (7612518)
Selina A. Long M.D. President Massachusetts Society of Anesthesiologists 318 Bear Hill Road Suite 4A Waltham, MA 02451 Via email: [email protected]
February 5, 2013
Dear Dr Long, I am writing with sincere thanks from everyone at Lifebox for your Society’s very generous donation of $1,000 in memory of Dr Richard Browning of Rhode Island. This gift will help make a life-changing difference to health workers striving to deliver safe treatment in environments where resources, support and training are scarce. Lifebox is slowly and steadily closing the 70,000+ pulse oximetry gap. We won’t stop until every operating room and recovery setting worldwide has access to this essential equipment, and the training to make sure that it is used effectively. So far, we have: sent 4100 pulse oximeters and education kits to facilities in 75 lower-resource
countries worldwide.
supported local training for over 2000 anaesthesia providers
introduced these to the World Health Organization’s Surgical Safety Checklist, proven to reduce surgical complications by more than 30 percent and mortality by nearly 50 percent
worked in collaboration with local organizations, membership groups and ministries of health to foster the communication and collaboration that is the only way to make a permanent, positive change in the quality and safety of care.
Thank you – we are truly grateful for your support. Yours sincerely
Pauline Philip Chief Executive Lifebox Foundation
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What’s New in Anesthesia Quality Management?
An Update from the Anesthesia Quality Institute (AQI)
Richard P. Dutton, M.D., M.B.A., ExecutiveDirector
Individualclinicianshaveaprofessionalobligationtothinkaboutthepatientcarethey provide and attempt to improveit. On the practice level, assessingoutcomes allows for identification ofsystem problems that can be resolvedbychangesinpolicyorgrouppractice.For example,measurement of the rateof postoperative nausea and vomiting(PONV) in the PACU can identifypatient populations at higher risk. Apolicy of providing prophylaxis inthe OR for these patients can reducethe overall rate of PONV. On thenational level, aggregation of data onrare complications (e.g. postoperativevisual loss) can lead to appreciationof problems too rare to be studied atthe local level. Once identified as arecurring problem, detailed review ofcases can suggest common featuresand targets for improvement. Thiskind of national quality management,based only on clinical anecdotes, cannonetheless have substantial positiveeffects on anesthesia practice. Thisprincipleisillustratedbythecaseseriespublished by the Anesthesia ClosedClaims Project (CCP) in the scientificliterature, and by the individual casevignettes from theAnesthesia IncidentReportingSystem(AIRS)whichappeareachmonthintheASANewsletter.
UPDATE ON THE ANESTHESIA QUALITY INSTITUTE
(continued on next page)
benchmarking of adverse outcomesis a possibility. TheFigure shows thecumulativenumberofcasesinNACORwith associated reporting of clinicaloutcomes (out of 11.2 million totalcases) reported by themonth and yearwhentheoutcomeswereenteredintheregistry. Further good news is shownin the Table, which shows the rate ofoccurrenceofselectedmajorandminoroutcomesfromthepracticesthatgetthisdatatoNACOR.
While CCP and AIRS are positiveexamples for our specialty, one of thelargest national gaps in anesthesiologyis the generation and reporting ofsystematic data on adverse outcomesfromeverycase,everyday.Anestimatefromthe275groupsparticipatingintheNationalAnesthesiaClinicalOutcomesRegistry(NACOR)isthatnomorethanhalf have a system for collecting thiskindofdata,whilefewerthan25%areable to report clinical outcomes toNACORonaroutinebasis. Thegoodnewsisthatthisnumberisincreasinglately,andwillsoonreacha critical mass where true national
Anesthesia Quality Institute-continued(continued from previous page)
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The outcomes shown in theTableareaggregatedfrommultiplepractices,basedonavarietyofmeasuredefinitionsand data capture mechanisms rangingfrompaperformstoelectronicrecords.This heterogeneity is a barrier toaccurate benchmarking at present, andwhy the data in this table should betakenwithanappropriategrainofsalt.AQItookasteptowardsimprovingthissituation inApril, when we conveneda conference of anesthesia qualitymanagement experts and electronicrecordvendorstorecommendcommondefinitionsfortheoutcomesofgreatestinterest. The consensus documentproduced from this conference(Anesthesia Outcomes of Interest) canbe downloaded at http://www.aqihq.org/qualitymeasurementtools.aspx.
Currently just short of 9,000anesthesiologists participate inNACOR, or 20-25% of clinicallyactive anesthesiologists nationwide.This number continues to grow, asmore practices and facilities recognizetheneed for registrydata and externalbenchmarks. In addition to providinga measuring stick for judging andimproving the quality of patientcare, registry participation will beincreasingly important for meetingfederal regulatory requirements andthe demands of non-federal payors.TheCenterforMedicareandMedicaidServices (CMS) has released draftrules for public comment on thedefinitionandcertificationofQualifiedClinical Data Registries (QCDRs), asa mechanism for meeting incentiverequirements for Meaningful Use of
HealthcareTechnology,hospitalPayforPerformance, and individual providerparticipation in the Physician QualityReporting System. Similar languagehas appeared in several other federalwritingsinthepast6months,includingproposals for new healthcare paymentmodels contained in the draft Houselegislation repealing the SustainableGrowth Rate formula. It is clear thatregistryparticipationisadesiredoutcomeof healthcare reform. While intrusive,this is sensibleasacounterbalance fornewmodelsofpaymentthatincentivizecosteffectiveness.Transparentnationaloutcomereportingisessentialtoassurethepublicthatphysiciansandhospitalsare not skimping on necessary andindicatedcare.
NACOR data is now available tosupport academic and health policyresearch by physician scientists inany AQI-participating practice. AQIreleased the Participant User File(PUF)inearly2013:anaggregated,de-identified, cleaned version of selectedNACOR data fields. These data arealready being studied by more than adozeninvestigators,andseveralpapersareintheworkswhichwillprovideusanew and comprehensive understandingof the nature of anesthesiology in theUnited States. The AQI is using thisinformation internally to providehigh-level dashboards of summary datafor ASA and state-society leaders,anesthesia subspecialty societies, andimportantASAcommittees.InformationandinstructionsforaccessingAQIdatacanbefoundontheAQIwebsite(www.aqihq.org)underthe‘PUF’header.
AQI is also participating in a pair ofnew quality initiatives launched byASA. One is the inauguralAnesthesiaQuality Management meeting,scheduled for November 2013 ingreaterChicago. Thisweekendcourseis intended for anesthesia departmentquality management officers, and isdesigned to teach the basics of qualitymanagement in an anesthesia practice.More information canbe foundon theASAwebsite at http://education.asahq.org/qm2013.
A second initiative is thedevelopment, with ASA’s QualityManagement and DepartmentalAdministration (QMDA) Committee,of a ‘Quality Consultation’ programintended to provide high-functioninganesthesia practices with overallnational benchmarking of their efforts,documentationofclinicalperformance,andsuggestionsforfurtherimprovement.The consultation is based on a reviewof practice structure, NACOR data,personalinterviewsanda1daysitevisitbyateamofpracticing–andexperienced-- anesthesiologists. More informationon this program, including the kind ofdocumentation that canbe sharedwithhospitalleadershiporexternalagencies,[email protected].
Richard P. Dutton, M.D., M.B.A, Executive Director, Anesthesia Quality Institute
ASA News-continued
Anesthesia Quality Institute-continued(continued from previous page)
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S P E C I A L E D I T I O N
N E W S B R I E F
Board of Registration in Medicine
On February 1, 2012, a revision to 243 CMR 3, a portion of the Board’s regulations, will
take effect. Two changes to the regulations involve CME requirements. Physicians renew
ing their licenses after February 1 must have completed 3 hours in effective pain manage
ment, identification of patients at high risk for substance abuse, and counseling patients
about side effects, and the addictive nature and proper storage and disposal of prescription
drugs. This is a statutory requirement that was enacted by the Legislature in 2010.
A free online resource to obtain the necessary credits is available at
www.opioidprescribing.com. If your license is due to expire between now and February 1,
the Board encourages you to take the online course, or obtain credit from another program,
as soon as possible. The 3 credits will qualify as either Category I or II credits, and they
may be counted as risk management credits.
The revised Board regulations also include a new requirement for 2 CME credits in end of
life care. There are a number of programs offering end of life care CME, among them the
Massachusetts Medical Society (www.massmed.org).
The end of life care requirement also takes effect on February 1, and the Board similarly
encourages physicians with license expiration dates between now and February 1, to obtain
the necessary credits as soon as possible. End of life care CME credits also qualify as Cate
gory I or II, and may be counted as risk management credits.
If you have questions, please email Charlene Morelli at: [email protected]
NEW BOARD REGS BRING NEW CME REQUIREMENTS
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The American Board of Anesthesiology Phone: (866) 999-7501 • Fax: (866) 999-7503 • Email: [email protected] Website: www.theABA.org
ABA Releases Online Tutorial on MOCA® Program
RALEIGH, N.C. (October 27, 2011) — To enhance its ongoing effort to provide clarity on the
Maintenance of Certification in Anesthesiology (MOCA) program, The American Board of
Anesthesiology, Inc. (ABA) has developed an online tutorial to address frequently asked
questions and concerns of constituents.
The Maintenance of Certification (MOC) concept originated with the American Board of
Medical Specialties (ABMS) in 1999 as a professional response to the need for public
accountability and transparency of practice improvement initiatives by physicians.
The ABA recognized the importance of this initiative and developed the MOCA program to help
board certified anesthesiologists demonstrate to society their lifelong commitment to quality
clinical outcomes and patient safety.
The ABA designed this tutorial to familiarize viewers with the pathway to ABA certification and
maintenance of certification as well as educate them on their specific MOCA program
requirements.
Subjects covered by the tutorial include:
• Pathway to Maintenance of Certification
• Evolution of Certification Process
• MOCA Program Requirements
• Entering Requirements in ABA Portal Account
“We hope our diplomates and future diplomates will find this tutorial useful as we make
transparent the road to board certification and the Maintenance of Certification in
Anesthesiology program,” said David L. Brown, M.D., Secretary of the ABA Board of Directors.
“This tutorial is just one more way that the ABA is providing information to our diplomates on
MOCA,” said Dr. Brown. “This video will supplement other resources we have made available
on the ABA website, such as the Frequently Asked Questions section and MOCA requirements
by certification year.”
To view the MOCA tutorial go to:
http://www.theaba.org/Home/Videos
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