ANESTHESIOLOGY 2016, the ASA Annual Meeting, will take place from October 22 to 26 in Chicago. Here are highlights from the recent ASA Board of Directors meeting, previewing some of the issues to be considered in Chicago by your ASA representatives at the House of Delegates (HOD) meeting.
The status of ASA’s finances took up a large portion of the meeting. For a number of years, ASA has been funding both the budget deficit and the capital budget from reserves. In addition, the capital demands for necessary special projects have accelerated over the past few years. These projects included the Anesthesia Quality Institute (AQI), MACRA, and the advocacy efforts around the VA advanced practice nursing issue.
These capital demands led to a situation where large amounts of money were drawn from reserves over the past three years. Unrestricted reserves are now currently very limited due to that fact that restricted reserves must cover 75 percent of annual budgeted expenses, plus the cost of paying off the new headquarters building, should this become necessary.
The proposed budget for 2017 projected a deficit of $2.2 million. A proposed dues increase of 5 percent, to $698/year for active members (basically equivalent to the cost-of-living rise since the last dues increase), would net approximately $1 million. Any dues increase will need to be considered for approval by the HOD in October.
A transfer of $1.2 million from reserves will make up the remainder of the deficit. A special committee headed by Don Arnold, MD, has been tasked with examining all expenses to determine areas where cuts may be made without affecting the underlying mission and strategic plan of the ASA. The staff has already identified 38 areas to be examined, and the committee will consider any and all other areas for possible expense reduction so that the ASA can use fewer reserves for 2017 budget expenses.
Safe VA Care
Manuel Bonilla, ASA’s Chief Advocacy Officer, gave an update on the VA campaign to the Board of Directors during the educational session. ASA has had “unprecedented success generating more than 90,000 comments to the Federal Register expressing support for retaining the VA’s current physician-led, team-based anesthesia policy,” according to the president’s report. In addition, “among the more than 90,000 pro-patient safety comment submissions were more than 10,000 comments from veterans, veterans’ families, and their supporters.”
Just last week the ASA received word that an unreleased final versionof the “Advanced Practice Registered Nurses (APRN)” rule has been transmitted to the Office of Management and Budget (OMB) for final review.
The earlier, proposed version of the rule granted so-called “full practice authority,” or the authorization to practice without physician oversight, to all APRNs in the VA system, regardless of state law. The transmission is one of the last steps as the policy advances toward being released as a Final Rule for implementation. The notice provides no timeline for the release of the Final Rule, nor does it offer insight on the content of the rule prior to its impending release. The VA’s decision on the content of the Final Rule will not be known until the rule is published in the Federal Register.
Also, last week, Congressman Phil Roe, M.D., (R-TN-01), introduced H.R. 6277, a bill that would prohibit the implementation of the proposed VA APRN rule. The legislation would bar the VA Secretary from finalizing the “Advanced Practice Registered Nurses” proposed rule, effectively halting VA’s proposal to grant so-called full practice authority to all advanced practice nurses, including nurse anesthetists.
CSA actively participated in the SafeVACare initiative, accounting for over 7,000 comments to the SafeVACare.org website. CSA members placed several stories and opinion pieces in major California newspapers and electronic media. These included two statewide publications, the Fresno Bee and the Los Angeles Daily News.
Many CSA members spent time communicating with our Congressional representatives in Washington during the ASA Legislative Conference by phone, email and during district visits. CSA leaders were instrumental in obtaining co-signatures on the Benishek-Brownley letter to the Secretary of Veterans Affairs, urging the retention of the care team concept and the current policy directives in the VHA Nursing Handbook. Eleven members of the CA congressional delegation signed onto the latest (June 2016) Benishek-Brownley letter on this issue.
ASA is considering potential legal options should the decision on the VA APRN rule be unfavorable.
Alex Hannenberg, MD, gave a progress update on the work on MACRA. ASA now has multiple resources posted about MACRA on its website. ASA responded to the CMS MACRA Proposed Rule on June 27, 2016. ASA expects the final rule will be posted in late 2016. However, it is possible that implementation of portions of MACRA may be delayed until later in 2017. Recently, ASA posted a series of extremely useful MACRA modules (requires member login), which are audio and slide presentations. The modules include information related to MACRA, and the presentations discuss information from the CMS proposed rule that was released in April 2016. Specific provisions are subject to change pending the release of the final MACRA rule in late 2016.
Patient Safety Bill of Rights
Patient Safety across the Continuum for Deep Sedation/General Anesthesia was passed by the CSA HOD at its June 2016 meeting. This measure was presented to the ASA by CSA President Mark Zakowski, MD, as a resolution in report 605-1 in the Professional Affairs bundle. The Reference Committee and the BOD recommended referral to a committee of the president’s choice.
It was noted that the Committee on Standards and Practice Parameters (CSPP) is in the process of updating its guidelines on deep sedation administration, and the American Association of Oral-Maxillofacial Surgeons (AAOMS) is a part of that CSPP task force. Sedation provided in dental offices is overseen in most states by a separate dental board. Testimony reflected the emergence of multiple “patient bill of rights” documents by various stakeholders. The review committee recommended referral for additional vetting and comprehensive review.
The candidates’ forum in the Board’s Saturday afternoon session featured a speech by CSA Past President Linda Mason, MD, now a candidate for ASA First Vice President, followed by an open question-and-answer session. This was followed by speeches and an open question-and-answer session by the candidates in the contested elections: Patrick Giam, MD, and Lawrence Epstein, MD, for Vice Speaker; and Kenneth Elmassian, DO, and Linda Hertzberg, MD, for Assistant Secretary.
All the Western Caucus candidates presented themselves very well in this session, and the California delegation strongly supports Drs. Mason, Giam, and Hertzberg. Two other California ASA officers, Stan Stead, MD, MBA, Vice President for Professional Affairs, and Michael Champeau, MD, Assistant Treasurer, are running unopposed for reelection.