The 2013 Annual Meeting of the House of Delegates

by
  • Sibert, Karen, MD, FASA
| May 20, 2013

Dr. Johnathan Pregler, in his last official act as CSA President, passed the gavel to the incoming president, Dr. Peter Sybert, at the annual meeting of the CSA’s House of Delegates on Sunday in Los Angeles. “This is the gavel of infinite power and knowledge and authority,” he quipped, at the end of a long morning’s work for more than 100 of the society’s officers and delegates.

The society elected three new officers for the 2013-14 term: Dr. Paul Yost, president-elect; Dr. Mark Zakowski, chair of the Legislative and Practice Affairs Division (LPAD); and Dr. Jeffrey Poage, LPAD vice-chair for legislative affairs.

As more anesthesiologists face the need to enter the Maintenance of Certification in Anesthesiology (MOCA) process, the House of Delegates decided to focus attention this year on the requirement to complete a simulation course at an endorsed center. This requirement creates a heavy burden of cost and inconvenience for working anesthesiologists, the delegates agreed, although it provides educational benefit. The delegates passed a resolution for the ASA Committee on Simulation to “evaluate the business model for simulation centers and make written recommendations to reduce the cost and improve access for pursuing simulation training.”

The House of Delegates also deplored the recent proposal by Noridian Administrative Services, a Medicare contractor for several western states, to deny payment for epidural or other pain blocks “unless the block is placed following discharge from PACU due to documented inadequate pain control.”

The delegates passed resolutions to oppose “any administrative policy that could result in needless pain and suffering of patients,” and “any policy that would create a financial disincentive to appropriate medical care for the treatment of surgical pain of Medicare beneficiaries.” The CSA plans to designate a representative to California’s Carrier Advisory Committee to address these issues.

The CSA welcomed special guests Dr. Jane Fitch, president-elect of the ASA, Dr. Paul Phinney, president of the California Medical Association (CMA), and Paul Pomerantz, the new chief executive officer of the ASA.

Dr. Phinney opened the meeting on Saturday afternoon with his talk, “Not Your Daddy’s Profession: Patient Care in the New Millenium.” He advised the audience to think about their practices differently as market changes are causing a “mad dash” to align financial incentives and promote large-group integrated practices.

He compared the progress of health care reform under the Affordable Care Act (ACA) to “changing engines on a jet plane while in flight, fully loaded, and the runway is still being built.” Nonetheless, California’s new insurance exchange, which has been named “Covered California,” will begin enrollments this fall as a marketplace where insurers may offer qualified plans. “Physicians will not know payment rates until the contracts have been negotiated,” he warned.

How can the capacity of the health care system expand to handle increasing demand? Dr. Phinney pointed out that an unprecedented 19 bills before the California legislature this year attempt to expand the scope of practice for non-physicians. One in particular — SB 491 — would give nurse practitioners independent practice and prescriptive authority without physician involvement. The CMA is lobbying intensively in opposition to expanding scope of practice, Dr. Phinney said, and he urged CSA members to lend support.

Dr. Jane Fitch updated the CSA about anesthesiology concerns at the national level in her address, “ASA Working 4 You.” She noted that the new Independent Payment Advisory Board (IPAB) is a “very scary” presidentially appointed entity with the unchecked power to determine Medicare payments. The ASA’s legislative advocacy arm is working to reform Medicare physician payment, Dr. Fitch said, and to promote national truth and transparency legislation so that physicians, nurses and other staff members are clearly identified to patients.

The recent appointment of a California anesthesiologist, Dr. Rebecca Patchin, as chair of the Board of Directors of The Joint Commission, raises hope for “more common sense” about rules and regulations in the hospital setting, Dr. Fitch said.

In his parting address as President, Dr. Pregler offered a comprehensive report card of the CSA’s initiatives. A strategic planning retreat in January identified major goals for the next three to five years:

1.     Legislative agenda: Protect MICRA against threat from trial lawyers; support Anesthesiology Assistant licensure in California; oppose expansion of scope of practice by non-physicians.

2.     Communications agenda: A public relations firm has been engaged to promote the CSA message, support legislative efforts, increase membership and educate the public about anesthesiology.

3.     Educational programs: The decision was reached to move the CSA’s spring educational meeting to San Francisco for 2014 and 2015, using New York’s Post-Graduate Assembly (PGA) as a model.

Dr. Peter Sybert’s inaugural address emphasized that improvements in the safety of anesthesia have been due to the efforts of physician anesthesiologists to develop new monitoring techniques and practice standards. “We have a terrific track record,” he said. “Change has been a constant.”

At the same time, Dr. Sybert said, progress in the context of the ACA is uncertain. Regulators are overwhelmed with trying to write new rules, and even Senator Max Baucus, one of the authors of the ACA, says a “huge train wreck” is coming. With almost 40 new legislators in Sacramento this year, Dr. Sybert explained, the CSA has a great deal of work to do in educating them about anesthesiology and patient safety. He urged members to contribute to GASPAC, the CSA’s political action fund, to respond to legislative alerts, and to become active in CSA committees.

Dr. Stanley Stead, who holds an MBA in addition to his MD degree, spoke to the CSA audience about the current trend for medical practices to be purchased by health systems, practice management entities, and private equity investors. In his talk, “You Are Offering Me How Much?” Dr. Stead educated listeners about how to value a practice, how to evaluate an offer, and the risks and rewards of making the transition away from physician ownership. The text version of his presentation can be accessed online at the CSA website: click here.

CSA officers who will remain in their current positions for another year include:

Speaker of the House: Dr. James Moore
Vice-Speaker: Dr. Christine Doyle
Secretary: Dr. Earl Strum
Assistant Secretary: Dr. Karen Sibert
Treasurer: Dr. William Feaster
Assistant Treasurer: Dr. Judi Turner
Chair, Education Programs Division (EPD): Dr. Adrian Gelb
Vice-Chair, EPD: Dr. Samuel Wald
Vice-Chair, LPAD (Practice Affairs): Dr. Keith Chamberlin

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