The largest meeting of anesthesiologists in the best city on the circuit has now concluded. Yes, the Annual Meeting of the American Society of Anesthesiologists (ASA) in San Francisco closed to the sound of the gavel at 12:35 pm on Wednesday, October 16, and the results are impressive. The takeaway message: we have work to do.
We took the first step toward tackling this work by electing Stan Stead, MD, MBA, as Vice-President for Professional Affairs. Dr. Stead’s immense knowledge of the business of our specialty and medicine as a whole (for starters, he developed the Crosswalk and he serves on the AMA's Relative Value Update Committee, aka RUC), combined with his wide ranging business acumen, government contacts, and intimate familiarity with all things regulatory make his selection an enormously positive step for both the CSA and the ASA. We are lucky to have him in this new position. Congratulations to Dr. Stead, and on behalf of CSA members, I would like to say thanks for running.
Additionally, the CSA is very proud to announce the installment of two CSA Past Presidents to ASA leadership roles: Dr. Daniel Cole has secured the position of First Vice President (stepping stone to the ASA presidency in two years), and Dr. Linda Mason was awarded a second term as ASA Secretary. Congratulations to both.
Then there is Adrian Gelb, MB ChB: you will not find a more gracious and knowledgeable local host. He welcomed anesthesiologists from around the world to our great state, and through his attention to detail, constant availability, steady and pleasant demeanor, Dr. Gelb represented the CSA impeccably and raised the bar for hosting the ASA’s Annual Meeting. Again, on behalf of CSA members, thank you Dr. Gelb.
In case you weren’t able to attend, here’s a recap: For all attendees, I believe, it was abundantly clear that anesthesiology – like all physician specialties – is under attack. The air of concern and uncertainty was palpable – concern for our patients and their safety, and for the future of our profession. We heard the Emery A. Rovenstine Memorial Lecture, presented by Dr. John B. Neeld, about the ongoing war to retain and maintain physician-led anesthesia – this is a significant concern in virtually every state. We heard a presentation about robots administering sedation. We heard a variety of state component representatives express grave concern about developing an ASA educational product on deep sedation education for non-anesthesiologists – a perennially contentious topic.
And we heard a lot about scope of practice: nurse anesthetists attempting to, and at times succeeding in, practicing independently of physicians and practicing subspecialties of anesthesia such as pain management with minimal training. There are advanced practice nurses (ANPs) invading primary care, physical therapists invading physiatrists and podiatrists, and optometrists moving into ophthalmology ... It seems that everyone wants to be a doctor without having to do the work and training to actually become a doctor. And the government appears to be dead set on just paying less for a service without regard for training and expertise.
Absorbing these perspectives on the current state of our specialty was scary – but it made me angry and motivated me to be a part of solutions that will work for the future of our great specialty, as I hope it will for you. I truly believe that times of great change and angst provide many opportunities for success.
So, what to do: We need to take the right steps to protect our patients, and by doing so we also protect our specialty. And we do this by definitively, undeniably and obviously showing our value to those who do not understand it, or choose to ignore it.
Many presentations at the ASA Annual Meeting spoke to the changing medico-economic environment and the transition to "value-based care." The sticky part is figuring out who defines "value" and how? The government is already doing this to some extent, and if we as a specialty do not speak up to find a way to show and define our "value" the government and payors will. We often take ourselves and what we do for granted – we make it look easy, when it is not.
And it is getting harder, not easier, to administer anesthesia safely. Patients are getting sicker. More than ever, we need to find a way to demonstrate what we all know – that there is enormous importance in physician-led anesthesia.
Fortunately we have a way (I know you were waiting for this): the Perioperative Surgical Home (PSH.) This model encompasses and clearly demonstrates both the hands on and cognitive skills we developed through our medical school education and residency training. In fact, it is so important that the ASA approved over $750,000 for further PSH research and implementation. You will be hearing more about the PSH and Accountable Care Organizations (ACOs) in future CSA Online First blogs. We can waste no more time – we need to get involved now. Clearly anesthesiologists will be moving away from the current system of billing patients piecemeal. Exactly what future payment models will look like remains to be seen, but certainly we can expect a larger overall model – perhaps bundled payments for episodes of care, capitation, or an ACO or ACO-like solution.
Patient safety was the also focus of the exhibits. Multiple exhibitors offered new and improved, non-invasive ways of getting the job done. Apparently, direct laryngoscopy is going to be a lost art – everyone now has either video laryngoscopy or some type of indirect laryngoscopy. Ultrasound has taken leaps forward – now, all that is left for improvement is finding a way to put labels on the structures! Noninvasive cardiac output, better temperature control, cool data gathering devices generating more reports than you can possibly use, and some excellent poster presentations rounded out the offerings.
The governance sessions were vibrant and generated extensive and passionate discussion. We experienced parliamentary procedures that some of us had never seen in action before. A hot topic of discussion was the House of Delegates’ (your representatives to the annual meeting) determination to keep final authority for financial and budget matters. It turns out the IRS thinks that is not the way to go, so after hours of debate, the decision went the way of the IRS (how unusual…)
The bottom line is that while the message of this ASA Annual Meeting could be viewed as depressing and distressing, I was invigorated and excited by watching my colleagues show determination and conviction in the face of challenges that face our great specialty. A fire was lit: A fire to fight for patient safety, a fire to stay active and involved, ensuring that our society fights with us and for our patients.
It is a time of great uncertainty and great change. It is a great time to be part of the CSA and ASA.