The More Things Change…

  • Hertzberg, Linda, MD, FASA
| Aug 18, 2013

We are on our way back from a weekend spent near the Chicago airport in lovely Rosemont Illinois, where the ASA Board of Directors (BOD) meets. Sometimes it seems like we are in a time loop where we keep discussing the same things over and over again at the ASA BOD in different manners and formats. At least in the end there does appear to be some forward motion.

Last year, I wrote about the ASA Board in a piece titled “Who and What do We Represent?” In it, I wrote about the tension that exists between the ASA BOD and the ASA House of Delegates (HOD) on issues of governance and finance. “There are some who would assign more power, especially in the financial arena, to the BOD and elected officers, retaining the HOD as a representative and policy setting body only; others resist this change, believing that the voice of the membership will not be properly heard or considered if the powers of the HOD are limited. The ASA officers—as a consequence of living with the need to respond to issues quickly—tend to believe that is generally best to vest more operational power with the officers and the BOD.” 

This issue returned this year with the new wrinkle. The ASA attorneys are now concerned that the ASA could be at risk in an IRS audit if the final fiscal and financial authority and responsibility is not vested with the BOD and remains with the HOD. Consequently, the BOD approved new suggested bylaws changes that would vest the final responsibility and authority for budgetary and fiscal matters with the BOD. It will be interesting to see what the HOD does with the new information. The ASA is responsible to its elected representatives for the proper stewardship and allocation of financial resources consistent with the ASA mission, and the HOD generally believes that it is the body responsible for those decisions.

Another item that reared its head again concerned the relationship of the ASA to the AMA and how the ASA could have more influence at the AMA. Many individual physicians think that after the AMA’s much-maligned stance on PPACA, it is time to give up on the AMA as an organization. Unfortunately, legislators and regulators still believe that the AMA speaks for organized medicine as a whole. Consequently, in an effort to gain seats and influence at the AMA HOD, there was a proposal to have the ASA enroll resident members into AMA membership. This was defeated by a good margin (including opposition from your California representatives), but will surely come up again in October at the HOD as some in ASA leadership will again try to gather support for the concept.

The good news about forward progress has to do with the concept of the peri-operative surgical home (PSH). A number of pieces have been written in this space about the concept, including “It’s a Jungle Out There!” by Dr. Andre Atoian and “It’s a Jungle Here Also…” by Dr. Keith Chamberlin. The ASA Committee on Future Models of Anesthesia Practice has done a large amount of work on the concept. An extensive and well-written white paper on the topic was in the board packet. More importantly, a proposal was introduced as to how to begin to make the PSH model operational and have anesthesiologists properly paid for the work and value we provide in this model. With an eye as to how the future of anesthesia practice and payment may develop under health care reform, the ASA BOD enthusiastically approved spending a significant sum on this project to work with legislators, regulators, other specialty societies, and anesthesia practices to introduce the model. I believe that if properly executed, this project has the potential to advance the practice of anesthesiology and secure the future for the younger members in our specialty. This proposal and expenditure will also go to the HOD for review and action in October. Although there may be more skeptics in the HOD, it is the first time I have seen this degree of enthusiasm for the PSH concept. I hope that with proper education and explanation the HOD will approve the project as well.

It would not be the ASA Annual Meeting as we know it, without a contested election for an ASA officer position. This time one of California’s own, Dr. Stanley Stead, is running for Vice President for Professional Affairs (VPPA) against Dr. Erin Sullivan of Pennsylvania. The VPPA coordinates ASA’s interactions with the government and payers: the Centers for Medicare and Medicaid Services (CMS), private payers, regulators and accrediting agencies. The VPPA has overall responsibility for the Division of Professional Affairs and oversees two very diverse sections: Professional Standards and Professional Practice.

Both candidates kicked off their campaigns in addresses to those attending the BOD meeting on Saturday. Stan’s speech addressed the following concepts:

“It’s unacceptable that we are recognized as leaders in patient safety, yet current quality reporting systems do not recognize the contributions we make and the superiority of physician-led anesthesia outcomes.

It’s unacceptable that Medicare pays us at the lowest rate of all physicians.

It’s unacceptable that the government allows nurses to claim to be our peers.

Here is what we need:

“We [Anesthesiologists] need recognition that we are physicians, with the education and the clinical judgment to inform our decisions.

We need fair payment—NOT reimbursement—for our professional services inside and outside of the operating room...”

As Section Chair for Professional Practice, Dr. Stead has worked closely and constantly with Dr. Norman Cohen, the incumbent VPPA, and has established himself as a national leader in health care economics, billing and coding for physician and hospital services, information technology, and quality measurements in health care. As a board-certified anesthesiologist as well as a former board examiner, Dr. Stead has applied his diverse experiences in clinical practice, academic medical centers and corporate environments to improving health care for over thirty years.

California anesthesiologists should be proud of Stan’s candidacy and unique qualifications for the VPPA position. I urge you to learn more about Stan and his candidacy for ASA office by visiting his website at

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