www.mymsahq.org
Spring 2016
IN THIS ISSUE: OUT-OF-NETWORK LEGISLATION IN FLORIDA MSA PAC UPDATE
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President John LaGorio, M.D. Norton Shores President-Elect Roy Soto, M.D. Bloomfield Hills Secretary-Treasurer Neeju Ravikant, M.D. Bloomfield Hills Immediate Past President Fred Campbell, M.D. Cedar Communications/ Public Relations Committee Ali Jaffer, M.D. Dominic Monterosso, D.O. Managing Editor Hillary Walilko
TAB L E OF CONT ENT S P R E S I DE N T ’S ME S SA GE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 D I R E C TO R ’S R E P O RT .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 C A L E N DA R O F E V ENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 S C I EN T I F I C S E SS I ON 2 0 1 6 R ECA P. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 P E R S O N A L C O S T PUR VIEW .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 A S A U P DAT E S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 4 MS A P O L I T I C A L A CTIO N CO MMITTEE UP DATE.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6 L E G I S L AT I V E C O R NER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 8
Contact for advertising information: Hillary Walilko MSA 120 N. Washington Square Suite 110A Lansing, MI 48933 Phone: 517.346.5088 Fax: 517.371.1170 email: walilko.h@gcsionline.com The Ventilator is published four times annually by GCSI Association Services. It is funded by the Michigan Society of Anesthesiologists and with advertising revenues. The Michigan Society of Anesthesiologists is a nonprofit, statewide organization. No part of this publication may be reproduced without permission of the publisher and MSA. All article submissions will be considered for publication and accepted at the approval of the Editor and the Communications/Public Relations Committee. We reserve the right to edit submissions for accuracy, clarity, and length.
Spring 2016
INDEX TO ADVERTISERS Anesthesia Business Consultants................................................. IFC MedComm Billing Consultants........................................................5 Paragon Service.................................................................................12
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PR E S ID E N T ’ S M E SSAGE John LaGorio M.D. President
THANK YOU
I
would like to begin my first President’s Message with a heartfelt “Thank You” to my predecessor, Dr. Fred Campbell. As you know, Fred did an enormous amount of work over the past two years as President of the Michigan Society of Anesthesiologists (MSA). He led our organization with dedication, guided our advocacy mission with confidence, and defended patient safety for the citizens of Michigan. Fred also worked to expand continued collaboration throughout our state. Internal to the organization, he sought ways to increase member communication and value. Externally, he welcomed ideas that have expanded our outreach to prospective partners in our healthcare communities. His leadership was and still is, an asset to us all. Please join me in thanking Fred for his service when you have the opportunity. Part of my challenge will certainly be living up to the legacy of leadership that has blessed our organization for years. I am both honored and humbled to serve as President of the MSA, as this opportunity brings together two great joys in my life. The first is being a physician anesthesiologist. I am sure you share my feelings that this is a tremendous privilege. The second is my love for this great state and all it has to offer. As a multigenerational Michigander, I have family living from Monroe to Keweenaw Counties. Helping to ensure the best healthcare to the citizens of Michigan is of tremendous importance to me, as I know it is to you.
Unfortunately, there seems to be those who would otherwise seek to oppose us in this goal. There are those who work to diminish or devalue what physicians bring to both the anesthetic and overall care of Michigan citizens. Specifically, you have heard about current activities like the VA Nursing Handbook, and legislation like Michigan Senate Bill 320 that would remove physicians from anesthesia care. You have undoubtedly also heard of proposed payer policies that ignore our positive contributions and advancements in care. I can assure you we will continue to remain vigilant and work tirelessly to prevent those who undermine value and safety for our patients. You will read about several of our efforts in this and future issues of The Ventilator. In Michigan, we have ever expanding opportunities to assist advocacy beyond traditional methods. We have some of the best medical education infrastructure in the nation. With several new medical schools added to our state’s portfolio in recent years, we have thousands of fresh medical minds experiencing what both our state and our profession have to offer. The relationships built through these schools and individuals will continue to promote physician leadership in our state’s healthcare systems for years to come. I want to thank those in academic roles who nurture these resources. Michigan is also a national leader in quality and safety. Our state’s patient safety activities and
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quality collaboratives have been the model that many others have followed. Michigan’s very own ASPIRE anesthesia collaborative1 is one such example. In fact, physician anesthesiologists are participating in many quality and safety projects at every level. From local department efforts in High Reliability, to service line level Enhanced Recovery, to larger projects such as development of the Perioperative Surgical Home2; physician anesthesiologists are at the forefront of helping to lead the healthcare system as it moves from volume to value. Through these efforts, we will continue to differentiate ourselves and illustrate the positive contribution of physician anesthesiologists to the Triple Aim3. I want to thank those who are leading and participating in these activities.
message, but our greatest strength comes from all of you, doing what you do, every day in caring for your patients and influencing those around you. In that vein, over the next two years there will be times that I will call on each of you for your help. Again, our strength will not come from a few, but rather all one thousand of us working and speaking together. Thank you for this opportunity and thank you in advance for your help.
Lastly, I want to thank all members of our state society for being active in promoting our profession. Our leadership helps to organize our
3) Institute for Health Improvement, www.ihi. org
References: 1) The Anesthesiology Performance Improvement and Reporting Exchange, www.aspirecqi.org 2) American Society of Anesthesiologists, www. asahq.org/psh
Your World is Complicated As a Health Care Provider, it’s often one challenging thing after another: :: Proper documentation and coding of the procedures you perform
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:: Capturing that documentation in an Electronic Health Record compatible with your external constituencies
:: Understanding how YOUR PRACTICE will fit into the world of the Affordable Care Act
:: Billing those coded procedures in a timely, efficient and complete manner
:: Taking care of your patients
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Spring 2016
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DIRECTOR ’S REPORT
OUT-OF-NETWORK LEGISLATION IN FLORIDA
Kenneth Elmassian D.O. ASA Director, Michigan Chairman, ASA Committee on Communications
U
nlike our daily routine, where we as physician anesthesiologists render our patients unconscious for their procedures, the American Society of Anesthesiologists never “sleeps.” As of this writing, there have been a number of issues being juggled by the ASA. The issues not only encompass national concerns, but also involve specific challenges facing State components around the country which could be coming to Michigan’s own backyard. One relatively new item in particular deserves mention, especially as insurers look for ways to maintain their operating margins in the new environment surrounding the Affordable Care Act. On March 11, the Florida Legislature approved legislation (S1442 / H221) requiring new payment processes for out-of-network providers of emergency and nonemergency services. The legislation was strongly opposed by the Florida Society of Anesthesiologists and a number of stakeholders including the Florida Radiological Society. Most importantly, the measure would detail new processes for payment to providers of emergency and nonemergency services when the provider is not a preferred provider at a facility that is in network. Specifically, the bill requires that an insurer pay a nonparticipating provider (such as a physician anesthesiologist) of such
services, as follows, reduced only by insured cost-share responsibilities as specified in the health insurance policy and within the applicable provided timeframe: 1.
Reimbursement for services shall be the lesser of: 1. The provider’s charges; 2. The usual and customary provider charges for similar services in the community where the services were provided (which is not defined in law and will be determined only if contested which involves a financial burden on the provider); or 3. The charge mutually agreed to by the insurer and the provider within 60 days of the submittal of the claim.
This legislation is very concerning as it removes any patient responsibility whatsoever, even in non-emergent settings, and places insurers in the position of independently dictating payment for emergency and nonemergency health services. Under this legislation, providers are at the whim of insurers’ determination on usual and customary charges as no independent benchmarking system is provided within the language. Although, the Florida legislation has been advocated by some as a consumer protection product, it is plain and
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simple an insurance industry driven initiative which short changes its subscribers. http://www.miamiherald.com/news/health-care/ article64317617.html FSA and other stakeholders are strongly encouraging Governor Scott to veto this illconsidered measure, and there is strong opinion he will not do so. Regardless, as patients are confronted with insurance plans with higher deductibles and with ever increasing limitations as to choice of providers, out-of-network billings could be a future reality for many hospital based physicians. Recognizing the evolving impact out-of-network payment has on the advocacy and public relations efforts of state component societies, the ASA recently formed an Ad Hoc Committee on Outof-Network Payment (AHCONP). The mission of the AHCONP is to develop public relations and legislative strategies, as well as payment benchmarking resources. The AHCONP will
also lead efforts to ensure medical specialty organizations and the AMA are working together on these issues. For now, Michigan has no out-of-network payment legislation pending, but it is no less important for us along with the Michigan State Medical Society to remain vigilant. Of course, it goes without saying, the best way to keep abreast of any new developments on this topic and other issues is to stay connected…ASA weekly e-newsletter, ASAP; social media via ASA’s Facebook and ASA’s Twitter @ASALifeline; ASA website, www.asahq.org. References: 1. ASA Website www.asahq.org; FDA & Washington Alerts
C A L E ND A R OF E V EN TS
2016 May 16 - 18 ASA LEGISLATIVE CONFERENCE WASHINGTON DC
June 8 MSA BOARD MEETING UNIVERSITY CLUB, LANSING
June 10 ASPIRE QUARTERLY MEETING RADISSON, KALAMAZOO
June 24 - 26 PERIOPERATIVE SURGICAL HOME SUMMIT CHICAGO, IL
September 14 MSA BOARD MEETING UNIVERSITY CLUB, LANSING
October 22 - 26 ANAESTHESIOLOGY 2016 CHICAGO, IL
November 19 - 20
ASA QUALITY MEETING SCHAUMBURG, IL Visit www.mymsahq.org for current events and training opportunities. Spring 2016
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S C IE N TI FIC S E S S ION RECAP
Attendees visit the exhibit hall
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he Michigan Society of Anesthesiologists held its 60th Annual Scientific Session & Annual Meeting on February 27th at the Diamond Center in Novi. We were honored to have had American Society of Anesthesiologist President, Daniel J. Cole, M.D., as the speaker for the Jensen Memorial Lecture. Other session topics included:
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Goal Directed Therapy Marek Brzezinski, M.D.
• Management and Complications of Continuous Ambulatory Peripheral Nerve Catheters Wael Ali Sakr Esa, M.D., Ph.D. •
Turning Big Data into Small Decisions: ASPIRE & MSHOP Sachin Kheterpal, M.D.
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Transthoracic Echocardiography in the Perioperative Environment Jason Harig, M.D.
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Should I add Sugammadex to my Clinical Practice? Roy Soto, M.D.
Wayne State University Andrew Letayf, M.D. took second place for Heart Rate Variability in Health Male Subjects Given Propofol Measured Via Plethysmography. And in third place was Peter Papapetrou, M.D. from Detroit Medical Center/Wayne State University for Comparison of Complication Rates Between Ultrasound Guided and Landmark Place (Non-ultrasound Guided) Central Venous CathetersL A Retrospective Study. Congratulations to our winners! Our Annual Meeting saw the election of MSA Directors, ASA Delegates and Alternate Delegates. The recipient of this year’s President’s Award was Robert F. Murray, III, M.D. of Pleasant Ridge. Thanks once again to our sponsors: Anesthesia Business Consultants, the American Society of Anesthesiologists and the Medicines Company.
Once again, residents submitted posters for our Annual Resident Poster Session. Sixteen posters were submitted from Residency programs across the state. First place went to Valerie Howell from Henry Ford Hospital for Regional Anesthesia Pre-Procedure Checklist Initiation and Improvements. From Detroit Medical Center/
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Judges and attendees listen to presentations during the Annual Resident Poster Session
Dr. Fred Campbell presents the MSA President’s Award to Dr. Robert Murray for his many years as CME Program Chair
MSA President, Dr. Fred Campbell presents the Jensen Memorial Cup to ASA President, Dr. Daniel Cole
MSA Board Members Drs. Maria Zestos, Neeju Ravikant and Rosalie Tocco-Bradley
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PERSONAL COST PURVIEW: CONTINUING MEDICAL EDUCATION AND MAINTENANCE OF CERTIFICATION: ALWAYS FOLLOW THE RULES BUT DO NOT HESITATE TO QUESTION THE RULES Deepak Gupta MD, Clinical Assistant Professor, Department of Anesthesiology Wayne State University/Detroit Medical Center, Detroit
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n my limited understanding (and I may be incorrect), one of the potential underlying concepts behind continuing medical education (CME) including maintenance of certification (MOC) is to prove to one self that one is still worthy of the remuneration one is receiving after years of toil that ensured top-brass paychecks (from societal economical hierarchical point of view; secondary to personal responsibility for safeguarding quality-quantity of human life) to start with immediately after graduation/ certification. However, sustaining real-time inperson CME/MOC may be costlier for the society than the cheaper but not cost-free (and still may not turn out priceless) virtual CME/MOC in the current world-view of alternative methods for disseminating education that are evolving at light speed. How are these costs defined in the first place can be altogether a different talk for a different time because pricing is presumably always discretionary depending on supply and demand as well as exclusivity of those supplies to match the mandatory demands for the sake of survival. Do we need that? I do not know. Once primary certification has been achieved, each physician finds his/her niche. Why one needs to assess their all-round educational/skill capacity at the time of re-certification, because even if one assesses oneself based on the “examination” medicine in the timeline of re-certification, how
often these updated tidbits contribute the changes (if any) in the actual practice of medicine by that particular examinee whose practice scope has been consciously getting limited and becoming niche-focused with each passing time. I do not know but neither do any of you. Do you? Moreover, old school seemed to tackle it better by ensuring society’s post-hoc but prompt responses to poor outcomes of outclassed physicians who were not keeping up/updating their education/skills voluntarily (not by mandate) wherein the society’s appropriate responses were accommodative to constantly evolving market demands of healthcare business. If those physicians under the societal scanner lagged behind in the acquisition of new education/skills, automated pressures of the markets automatically forced those physicians out from taking care of the covered population entities and made way for the new generations of well verse physicians with updated education/skills. There can be alternate argument that with CME/ MOC, the societies are attempting at pre-hoc preemptive interventions against potential dwindling of quality care/patient outcomes. However, CME/MOC can only enforce attendance/completion but may not have the way of knowing whether they have forced the hands in changing the processes of medicine
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practiced by the active/passive “successful” attendees/examinees. Comparatively, broadening the reporting of mandatory assurance of quality care to not only include morbidity/mortality but each and every near-hits-near-misses happening daily would provide a significant lead time for corrections (without waiting for actual patient harms) to trigger early post-hoc management of slipping physicians. For this process, society does not have to wait for predefined years/timeline for getting recertification because re-certification itself may not ensure that the re-certified physician will change his/her ways in the real world. Eventually, it is the society again who will have to step-in and take a stand in phasing out slipping physicians’ scope of practice either through national quality institutes’ retributions or closed claims projects or citations/suspensions/revocations by local/state/ national licensing authorities/bodies. Thereafter is there any logistic need to contribute to costly redundancies in the re-examination process with preparatory CME/MOC processes contributing to a major chunk of mandatory re-certification economics. There is one hiccup (to which I may not have an answer), that maintenance of license is also linked to sustaining mandatory CME but license processes would have been much better served if licensing were only linked
Spring 2016
to much more objective individual physicians’ practice quality/patient outcomes data-metrics (potentially mandatory per patient per day per year). The societies (general and professional) should think and reflect what the harm can be if the practicing physicians do not want to expand their consciously limited scope of practice after primary certification and want to delve/ explore themselves primarily in their niches as long as their regular quality-assurance data and corresponding patient outcomes remain superlatively above standards of care with/without the ample support of voluntary (and not mandatory) CME/MOC. In summary, it is my limited understanding that when it comes to continuing medical education and maintenance of certification, one must always follow the rules (mandatory or voluntary as defined by the local-national legislations for individual’s survival as a practicing licensed physician) but one should never hesitate to question the rules (as an enlightened educated but still a common person who has chosen to practice medicine by own volition). All legislations are amenable to amendments when logically, logistically and scientifically critiqued, reviewed and reaffirmed to attune with changing times.
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Anesthesiologists_fullpage_10.375x21.5.qxp__ 2/3/16 12:56 PM Page 1
This ad ran in local newspapers near Sheridan Community Hospital as part of the MSA’s public relations/ advocacy campaign.
Your spouse. Your parent. Your child. Serious surgery, requiring deep sedation... a drug induced coma. No required physician supervision? No way. While Hollywood has made anesthesia appear simple on TV, in reality it carries significant risks. Every anesthetic requires careful planning and proper administration to see a patient safely through what would otherwise be a painful procedure. Unfortunately, some groups – including the leadership of Sheridan Community Hospital – want to eliminate patient safety laws by removing physician supervision of anesthesia care requirements across the state and in Montcalm County. Their efforts put politics ahead of patient safety. Changes to the current law would not improve the quality of health care for Michiganders, nor would it reduce costs or improve access to care. Removing physician supervision from operating rooms in Montcalm County threatens patients and could literally cost lives.
Call Sheridan Community Hospital. Ask its leaders to stand with local patients, not Lansing interests.
(989) 291-3261 Paid for by the Michigan Society of Anesthesiologists.
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A SA UP D AT E S
OPTING OUT OF FEDERAL RULE REQUIRING PHYSICIAN SUPERVISION DOES NOT INCREASE ACCESS TO ANESTHESIA CARE, STUDY FINDS
T
he Medicare “opt-out” rule that allows anesthesia to be administered without physician supervision does not increase patient access to anesthesia care, according to a study recently published online in Anesthesia and Analgesia. The study shows that overall, opt-out states experienced a lower growth in anesthesia cases (anesthesia utilization rates) compared with non-opt-out states, suggesting that opt-out is not associated with an increase in access to anesthesia care. “The decision over whether to ‘opt out’ remains contentious in many states,” said Eric Sun, M.D., Ph.D., study author and instructor in the Department of Anesthesiology, Perioperative and Pain Medicine at the Stanford School of Medicine, Stanford, California. “Previous studies have attempted to examine patient outcomes in opt-out states, but none has investigated whether opting out of the federal rule improved access to care. This study shows that ‘opt-out’ alone is not the silver bullet to improving access.” Since 2001, 17 state governors have exercised the option to opt-out of a federal requirement that physicians supervise the administration of anesthesia by nurse anesthetists, citing increased patient access to anesthesia care as the rational for the decision. In the study, investigators took the number of Medicare fee-for-service claims and divided it by the population aged 65 and older (U.S. Census
Bureau) to get the “anesthesia utilization rate.” Optout states included in this analysis were organized into groups based on opt-out year: Group 1-Iowa (2001); Group 2-Idaho, Minnesota, Nebraska, New Hampshire and New Mexico (2002); Group 3-Alaska, Kansas, Oregon and Washington (2003); Group 5-Wisconsin and South Dakota (2005); and Group 6-California (2009). Investigators then calculated the anesthesia utilization rate for the three years before and three years after opt-out and compared it to the anesthesia utilization rate for non-opt-out states in the same time period. For Group 1, the average anesthesia utilization rate for non-opt-out states increased 32 percent compared to the opt-out state’s 16 percent increase. Group 2 showed an increase of 26 percent for nonopt-out-states compared to the opt-out states’ 18 percent increase. Group 3 increased 10 percent in non-opt-out states, while opt-out states increased 7 percent. For Group 5, the rate increased -5 percent in non-opt-out states compared to -9 percent in opt-out states. Finally, Group 6 was the only group to show a slight increase in the optout state with an increase of 5 percent compared to the non-opt-out states’ increase of 4 percent. The analysis included 13 of the 17 opt-out states. The remaining four were excluded from the analysis for the following reasons: Kentucky opted out in 2012 and there was not enough data for it to be included. Colorado’s opt-out rule was not consistently applied across the state. Montana opted out in 2004, reversed the decision in early 2005 and then restored its opt-out status in mid-2005.
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North and South Dakota were excluded because the data for both states were combined until 2007. The study, “In the United States, ‘Opt-out’ States Show No Increase in Access to Anesthesia
Services for Medicare Beneficiaries Compared with Non-opt-out States,” was funded by the American Society of Anesthesiologists. © 2016 American Society of Anesthesiologists
STATES URGED TO SUBMIT COMMENTS ON VHA NURSING HANDBOOK
I
n preparation for the release of the VHA Nursing Handbook, all states are encouraged to prioritize participation in the Protect Safe VA Care initiative at www.SafeVACare.org. Online, members can draft comments on the importance of physician-led anesthesia care and maintaining the Anesthesia Service Handbook for our Veterans. The VA continues to advance the VHA Nursing Handbook, which would mandate nurseonly practice of anesthesia within VA, and its publication is expected in the coming weeks. In preparation, ASA has launched www.SafeVACare. org, where users can build from suggested text to discuss their education and training, a personal experience, or work with Veterans. These comments are collected and will be submitted to the Federal Register once the Handbook is published.
comments, but also making sure that their group or department reach a 100 percent response rate, and finding five other individuals to respond. Members can use email, social media, or phone calls to find others to comment. Sample email language, social media posts, and resources are available at www.asahq.org/SafeVACare. A strong response rate will be a key factor in the final VHA Nursing Handbook. ASA members should comment as leaders of patient safety on behalf of the specialty and Veterans they treat. Those who have served our country have earned and deserve only the safest possible care. Please feel free to contact Amanda Ott in ASA’s Advocacy division at a.ott@asahq.org or 202-2892222 with any questions. © 2016 American Society of Anesthesiologists
In addition to ASA-member participation, each physician anesthesiologist is encouraged to continue outreach on this initiative to colleagues, friends and family as part of the “1+5 plan.” Every ASA member is charged with not only completing
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M SA PA C R E P ORT
MICHIGAN SOCIETY OF ANESTHESIOLOGISTS POLITICAL ACTION COMMITTEE UPDATE Zulfiqar Ahmed, M.D, F.A.A.P. Michael Lewis, M.D. MSA PAC Co-Chairs
VISION The Michigan Society of Anesthesiologist’s Political Action Committee (MSA PAC) is your advocate in state legislative and political arena. We are surrounded by complex and fluid political changes. Political decisions directly impact our practices. They play a key role in determining how much we are paid, the regulatory and legal environment in which we practice and the role of non-physician providers in our practices. The MSA PAC provides anesthesiology access to legislators, whether they are home in their local Congressional District or at the State Capitol.
ACHIEVEMENTS The members of MSA PAC keep are keenly observant of the every changing political and legislative environment. With the help of all members of the Michigan Society of Anesthesiologists, we aggressively pursue various political challenges to ensure patient safety and professional longevity. Over the years, MSA PAC has participated in several meetings with Michigan legislature, health policy hearings and testimonies as well as meetings with Michigan Hospital Association and business leaders. We work closely with Michigan State Medical Society among other medical societies in order to be effective and campaign on your behalf. One example is SB 320, under this bill, a CRNA’s scope of practice includes:
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Performance of all patient assessments, procedures and monitoring to implement the plan of care or to address patient emergencies that arise during implementation of the plan of care.
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Selection, ordering or prescribing the administration of anesthesia and analgesic agents, including pharmacological agents that prescription drugs as defined in section 17708 (prescription medications or controlled substances as defined in section 7104 (controlled substances).
To date, the bill has never had a hearing in the committee. The reason is the difference of ONE vote. If the vote changes, the bill proceeds to the floor as the chairman of the committee is a huge proponent of this bill. This bill also has support from the Michigan Hospital Association. We have successfully spent about one thousand hours of our own time in meetings and road trips to advocate on behalf of members of Michigan Society of Anesthesiologists and have been able to maintain the delicate balance tipped in the favor of patients and physicians.
CHALLENGES While we have been successful on most of our efforts, situational awareness is key to future effectiveness. SB 320 can still come up for vote, if one or more members of the committee change his or her mind. With term limits in Michigan Legislature,
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the balance in favor or against our interest can change significantly. We have help from some of the best professional Michigan lobbying firm GCSI (Governmental Consultant Services Inc.). All these efforts come at a price. We rely entirely upon the members of Michigan Society of Anesthesiologists and we are working tirelessly to protect patient safety and your professional integrity.
PLANS We will stay vigilant and continue to stay ahead of the curve. We will look after the best outcomes for
our patients and profession. We will need the help of our members to stay involved, advocate for the cause and donate to the MSA PAC. This will help us to be effective and relevant. Please feel free to contact any of the MSA PAC committee with any questions or concerns or suggestions. We sincerely thank Dr. Dave Khrovsky for his years of commitment to MSA and MSA PAC. He is now Vice President of Medical Affairs at Spectrum Health Group. We wish him good luck in his new adventure.
MSA PAC LEADERSHIP Zulfiqar Ahmed, M.D., F.A.A.P Anesthesia Associates of Ann Arbor, Dearborn MI zahmedz@yahoo.com Michael Lewis, M.D. Henry Ford Hospital, Detroit MI Mclewis1957@gmail.com
MSA PAC COMMITTEE William Telford, D.O. biltel@aol.com Matthew Price, M.D. drmatthewprice@gmail.com Vivek Loomba, M.B., B.S. vivek.loomba@gmail.com Alys Long, D.O. abdoalys@msu.edu Robert M. Kuzel, M.D. rmkuzel@att.net Courtney Hancock, M.D. hancock.courtney@gmail.com
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LE G IS LAT IV E C ORNER
Licensure of Anesthesiologists Assistants The Michigan Society of Anesthesiologists recently worked with Representative Hank Vaupel (R-Fowlerville) to introduce House Bill 5507 which provides for the licensure of anesthesiologist assistants (AAs). Rep. Vaupel is the Vice Chair of the House Health Policy Committee. Committee chair Representative Mike Callton (R-Nashville) is a co-sponsor of the legislation. Other co-sponsors of the bill include Representatives George Darany (D-Dearborn), Ed Canfield (R-Sebewaing), John Bizon (R-Battle Creek), and Jason Sheppard (R-Lambertville). The bill outlines the licensure of AAs in the State of Michigan and defines the “practice of anesthesiologist assistants” as being the practice of anesthesiology performed under the supervision of an anesthesiologist. The bill has been referred to the House Health Policy Committee and the MSA along with GCSI will work diligently to pass legislation recognizing this profession in our state. A similar bill has also been introduced by Senator Margaret O’Brien (R-Portage) in the Senate. Senate Bill 872 has been referred to the Senate Health Policy Committee and also provides for the licensure of AAs. The Senate bill was co-sponsored by Senators Tonya Schuitmaker (R-Lawton), Mike Nofs (R-Battle Creek), and Jack Brandenburg (R-Harrison Twp.).
Legislation on Supervision and Scope of Nurse Anesthetists The issue of broadening the scope of practice for nurse anesthetists remains a priority of GCSI and the MSA. Senate Bill 320 was introduced by Senate Majority Leader Floor Leader Senator Mike Kowall (R-White Lake) and includes the following provisions: •
The bill would remove the physician supervision requirement for nurse anesthetists
Legislative Corner is a regular feature, written by Marcia Hune and Chris Iannuzzi, Governmental Consultant Services, Inc.
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It would allow them to develop a plan of care, which would permit them the ability to diagnose unsupervised
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Allow nurse anesthetists to be responsible for addressing patient emergencies that arise during the implementation of the plan of care
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Would allow them to prescribe controlled substances (schedules 1-5) unsupervised
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Allows the nurse anesthetists to practice in a facility licensed under Article 17 of the Public Health Code (ie. Nursing home, home for the aged, mobile dental facility) or in ANY OTHER MEDICAL SETTING-so this is not just limited to hospitals.
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The nurse anesthetist would be able to deliver anesthesia/analgesia services performed for operative, obstetrical, interventional, or diagnostic purposes during the pre-, intra-, and post-operative periods.
In an effort to partner constructively on the issue with members of the Senate Health Policy Committee yet protect patients, the MSA has proposed language that would codify the anesthesia team model, allow written physician oversight agreements, and mandate that the patient care team must include an immediately available physician. In exchange for keeping intact physician supervision, the MSA has suggested allowing the nurse anesthetists to increase their
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scope as originally suggested under the bill, by allowing the nurses to become prescribers, so long as that authority is delegated by a physician. Last year, the Senate Health Policy Committee held one hearing on Senate Bill 320. However, as both the Michigan Association of Nurse Anesthetists (MANA) and the Michigan Health and Hospital Association (MHA) are again supporting this issue, GCSI and members of the MSA continue to discuss our concern with regard to patient safety under the bill with lawmakers in the State Senate and House of Representatives, as well as members of Governor Rick Snyder’s Administration. Many MSA members have already contacted their lawmakers in opposition to Senate Bill 320 as currently written. We appreciate the outreach and encourage all members to continue to have conversations with their representatives and senators about the patient safety concerns with removing physician supervision and expanding the scope of nurse anesthetists without physician oversight. GCSI and your MSA Legislative Committee remain vigilant in advocating on behalf of anesthesiologists and physician supervision in regard to this legislation.
According to the U.S. Department of Health & Human Services, OPOs must be certified by the Centers for Medicare and Medicaid Services (CMS) and abide by CMS regulations. Because CMS guidelines, and Michigan state law, require physician supervision of the administration of anesthesia services, the MSA supports the removal of a human organ for transplantation, implantation, infusion, or injection under this scenario. Senate Bill 592 has been signed in to law by Governor Rick Snyder as Public Act 71 of 2016. GCSI continues to work diligently to be the eyes, ears, and representatives of the Michigan Society of Anesthesiologists in Lansing, as we advocate for policies that ensure the safety of patients. If members have questions, please do not hesitate to contact Marcia Hune or Chris Iannuzzi at hune.m@gcsionline.com or iannuzzi.c@gcsionline. com.
Organ Procurement Organizations The MSA supported Senate Bill 592, sponsored by Senator Curtis Hertel (D-East Lansing), which expands the list of designated places to perform surgical removal of a human organ by adding a facility operated by a federally designated organ procurement organization (OPO), such as Gift of Life. Physician anesthesiologists are often involved in the organ procurement process and understand the public health benefits of facilitating the donation process. Therefore, the MSA supports the efforts to include OPOs in state law as another avenue for organ procurement.
Spring 2016
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