www.mymsahq.org
IN THIS ISSUE:
Winter 2016
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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
TA B L E OF CO NTENTS P R E S I DE N T ’S ME S SA GE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 P H Y S I C I A N A N E ST H ES IO LO GIS T WEEK 2 0 1 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 MS MS U P DAT E .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 C A L E N DA R O F E V ENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 MS A PA C R E P O R T .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 A S A A N N U A L ME E TING R ECA P S .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 A N E S T H E S I A C A R E F O R ENDO S CO P Y S ER VICES.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 4 A S A U P DAT E S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6
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 three 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.
Winter 2016
L E G I S L AT I V E C O R NER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 8
INDEX TO ADVERTISERS Anesthesia Business Consultants......................................................2 MedComm Billing Consultants......................................................11 Paragon Service.................................................................................15
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P RESID E N T ’ S M E SSAGE John LaGorio M.D. President
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s we approach year’s end, we often reflect on the events of the previous year, the hopes of the year to come, and resolve our actions to influence the future. We give thanks for aid in our fortune, celebrate our success, and console our hardship with the promise of what is yet to be. In the first year of serving as the President of this society, I’m without a shortage of items to do just that. This year has provided significant challenges and unexpected changes, but I have learned a great deal in terms of what we have to be thankful for in our organization. We faced several issues that depended upon each of our members to take an active role. At the time of this writing, we await the final result on many of these items. Regardless, I found that overwhelmingly the membership of the MSA rose to the challenge and became a collective voice speaking on behalf of anesthesiologists and the patients we serve. This included the proposed Veteran’s Affairs APRN rule, which would mandate removal of physician supervision of advanced nurses caring for our veterans. The overwhelming response resulted in more than 90,000 turning in comments on the Safe VA Care site to oppose this alarming rule. Michigan was among the top in the country as a percentage of those responses. Closer to home, we have asked for your help with SB 320 and most recently SB 1019, both of
which would strip the requirement for physician supervision of anesthesia care in Michigan. Passage of this bill would make Michigan only the fourth state in the country to have statutory language removing physicians from the anesthesia team. Once again the membership rallied to assist. This came in many forms, such as outreach to legislators, engagement of the public and colleagues, or simply through MSAPAC donations. It was through these efforts that our voice was heard. This cannot be done by a singular individual or even a group of society representatives. It must involve grassroots member activity, and I am thankful for the hundreds of you who did exactly that. In addition, I have become increasingly aware of the tremendous work that our consultants and partners provide assisting our benefit. Marcia Hune, Hillary Walilko, and many others from GSCI literally work day and night on our behalf, assisting our administrative duties, and leading our advocacy efforts. We would not be nearly as successful of an organization without their work. Matt Resch and his team at Resch Strategies have also done a wonderful job in executing our public and advocacy outreach. You have likely viewed and heard much of their material on our behalf. Lastly, and most importantly, our fellow medical societies have stood by our side, watched our back, and even led the charge. The ASA has provided counsel, outreach, and financial support to our efforts, and the Michigan State Medical Society
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has been a tremendous partner, literally right by our side at legislative meetings, outreach, and with financial support. In addition, several others such the Michigan Osteopathic Association, the Michigan Chapter of the American College of Surgeons, and the Michigan Orthopaedic Society have also spoken out with similar positions on these important items. As mentioned previously, at the time of this writing, we still do not have closure on either of the issues above, as well as others on which our society has been working. Looking forward to work left undone, we will continue to be challenged by pressure to allow scope of practice through legislation rather than education. We continue to work on payer payment policy that threatens to place barriers to access anesthesia care such as in endoscopy. We watch vigilantly and prepare for the rising threat of out-of-network payment policy that has affected so many other states recently. We also continue to work to understand
the impact of healthcare reform and policy effects on our practices such as MACRA. This issue of The Ventilator will outline some of those efforts. My reflection of the year and an assessment of work left to do leads me to my resolution for the New Year. I am likely no different from you in receiving requests for annual membership in our medical societies. Now more than ever, I have come to learn the value of membership. Firsthand, I have seen the impact of membership being put to work and the return on investment it pays back to us as physicians. We need our individuals to create our voice, but collectively our membership gives us a platform to speak with influence. We have too many challenges to work independently or just hope for the best from non-physicians to do what is right for healthcare. We need to work together collectively both as anesthesiologists and as physicians. Please join me in membership of our anesthesia and medical societies for the New Year.
Breaking News Prior to Print On December 13th the VA removed CRNAs from their APRN rule. On December 15th the Michigan Legislature adjourned the 2015-16 Session without taking up SB 1019. Thank you again to each of our physician members, team members, family, and friends for your help in defeating SB 1019 and defending physician led anesthesia care in our state and for our country’s veterans. With your continued help, the MSA will continue to work proactively to protect patient safety. ~John LaGorio
Winter 2016
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T
he third annual Physician Anesthesiologists Week will be taking place from January 29 to February 4, 2017. This provides an ideal opportunity for ASA members to alert policymakers, the media and the public that when seconds count, physician anesthesiologists save lives. In 2016, members from coast to coast made their voices heard on critical issues affecting the specialty through visits with legislators, media interviews, state proclamations, inhospital activities, member-developed podcasts and videos, billboards and more. There's never been a more important time for members to come together and help fulfill ASA's mission, "Advancing the Practice, Securing the Future." There are many ways to get involved and take action: ;; Get social. A tweet or Facebook post using the hashtag #PhysAnesWk17 will help spread the word about our specialty. Have questions about how or what to post? Check out our toolkit for more information. ;; Set a meeting with local legislators. Use the week as time to set up a meeting to talk with your local policymakers to discuss the importance of physician-led care.
;; Order and display a poster. Posters are available to display in hallways or breakrooms at your institution. ;; Post a Web banner. Use the specially designed Physician Anesthesiologists Week Web banner on your website or forward it to your webmaster or institution’s public relations staff for assistance. The banner showcases your advocacy for the specialty and leads visitors to the patient-centered, physicianled resources on the When Seconds Count website. ;; Share your patient stories. Visit asahq.org/ whensecondscount to share your When Seconds Count stories. ;; Contact local media. To increase awareness of the importance of physician-led care in patient safety, connect with local media, offer them the opportunity to hear about the important work you do for you patients every day and use sample talking points in interviews. Make sure to also be on the lookout for updates and resources including a comprehensive Physician Anesthesiologists Week 2017 Toolkit. For additional information, please contact Theresa Hill at t.hill@asahq.org.
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A copy of the Governor Snyder’s Proclamation from Physician Anesthesiologists Week 2016. Winter 2016
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M SM S UP DAT E David Krhovsky, M.D. President Michigan State Medical Society
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ver the years I’ve worn many hats in organized medicine, and I currently have a few here at MSA. This time around I want to address you as the current president of the Michigan State Medical Society (MSMS) who also happens to be an anesthesiologist. My message is a simple one: every anesthesiologist in the state of Michigan should be a member of MSMS. Yes, we are proud of our specialty, and so we should be, but we are physicians first and foremost and it is essential that we stand with the rest of our colleagues from other specialties in one unified voice. I have often been asked “What is MSMS doing for me?”, so let me provide you with a concrete example. As you know, MSA is in the midst of a tough battle to defeat SB 1019 which seeks to eliminate all physician supervision of nurse anesthetists in the state of Michigan. This bill was passed out of the Senate and currently lies in committee in the House of Representatives. This bill strikes at the very heart of anesthesiology and the anesthesia care team, and must be defeated. I cannot stress enough the resources that must be brought to bear to fight this ill conceived legislation. Happily, I can report that MSMS has been close at our side, providing much needed staff support, as well as significant financial support. Julie Novak, Colin Ford and others at MSMS have all been outstanding in their support of our cause. Additionally, MSMS staff have had significant involvement in meetings with Blue Care Network regarding our opposition to a new BCN policy
that will require pre-authorization of anesthesia services for GI procedures. This policy seeks to save money at the expense of the safety of our patients, as well as posing a challenge to what the citizens of Michigan want and deserve for their health care. This support does not happen by accident. Over the last dozen years or so there has been significant representation by anesthesiologists on the MSMS Board, and MSMS committees. Three of the last four MSMS Presidents have been anesthesiologists, with Dr. Kenneth Elmassian paving the way for Dr. James Grant and myself. Together, we have been in a position of great influence within the society. MSA leadership must work to foster continued involvement of anesthesiologists in MSMS. In fighting these battles we must never take for granted the MSMS brand, and the force of it’s fifteen thousand members. MSMS has significant clout with the governor and the legislature, which helps MSA and other specialty groups. In my mind, we cannot rightly seek that support without participating as members ourselves. I urge each and everyone one of you to join MSMS today. If you are already a member, please accept my thanks. Being a member is, without a doubt, the right thing to do! Short bio: Dr. Krhovsky is the current President of the Michigan State Medical Society and a Past President of MSA. He is also a member of the ASA Board of Directors.
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C ALEN DA R O F E V E N T S
2017 January 27 - 29
ASA PRACTICE MANAGEMENT CONFERENCE GRAPEVINE, TX
January 29 - February 4 PHYSICIAN ANAESTHESIOLOGISTS WEEK
March 11
MSA 62 ND SCIENTIFIC SESSION & ANNUAL MEETING ROYAL PARK HOTEL, ROCHESTER, MI
April 28
MSQC/ASPIRE MEETING SCHOOLCRAFT COLLEGE, LIVONIA, MI
May 15 - 17
ASA LEGISLATIVE CONFERENCE WASHINGTON D.C.
Visit www.mymsahq.org for current events and training opportunities.
SAVE THE DATE! MSA 62 nd Annual Scientific Session March 11, 2017
Royal Park Hotel - Rochester
REGISTRATION COMING SOON! Winter 2016
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M SAPAC R E P O RT
MICHIGAN SOCIET Y OF ANESTHESIOLOGISTS POLITICAL ACTION COMMITTEE UPDATE Michael Lewis, M.D. & Zulfiqar Ahmed, M.D. MSAPAC Co-Chairs
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e have been writing to you over the last several months asking each of you to make what is to you a meaningful contribution to our MSA Political Action Committee (PAC). However, it struck us that many of you may not know or understand the role of this very important body within our anesthesiology community. Most simply the term (PAC) is a popular term for a political committee organized for the purpose of raising and spending money to elect and defeat candidates, ballot initiatives, or legislation. Because our organization is diverse and bipartisan in nature our PAC contributes to candidates from both parties that share our strategic goals and are friends to the house of medicine, and most importantly to the cause of anesthesiology. PACs have been around since 1944, when the Congress of Industrial Organizations (CIO) formed the first one to raise money for the reelection of President Franklin D. Roosevelt. The PAC's money came from voluntary contributions from union members rather than union treasuries, so it did not violate the Smith Connally Act of 1943, which forbade unions from contributing to federal candidates. Although commonly called PACs, federal election law refers to these accounts as "separate segregated funds" because money
contributed to a PAC is kept in a bank account separate from the general corporate or union treasury. This holds true to both our MSAPAC and the ASAPAC to which many of our members contribute. The MSAPAC is governed by state election laws whereas the ASAPAC is governed by the Federal Election Campaign act and monitored by the Federal Election Committee. Therefore, in light of this discussion we can see that the MSAPAC is a political action committee that is maintained as a fund separate from the Michigan Society of Anesthesiologists (MSA). The purpose of the MSAPAC is to help preserve the integrity of anesthesiology in the State of Michigan; to promote and maintain good relations and communications between Michigan legislators and anesthesiologists; to educate Michigan legislators of the role of anesthesiologists in maintaining patient safety. It is essentially our war chest for political battles. As you all know we were engaged in a heated battle in Lansing to preserve the supervision model that has long governed the clinical relationship between physician Anesthesiologists and CRNAs in our clinical work. Senate Bill 1019 would have destroyed this relationship, create independent CRNA practice, and in our judgement have a significant detrimental effect on patient safety.
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Our MSA has been actively fighting what we consider a very bad bill. This battle has dwindled down our reserves. Although, our opponents almost to the person contribute to their PAC- our participation is at a much lower rate. We need EACH and EVERY MEMBER to contribute to the MSAPAC. It is easy:
Each and every gift helps our MSA troops on the ground. Many thanks, Michael C. Lewis M.D. Ahmed Zulfiquar M.D. MSAPAC Co-Chairs
1) Go to: https://www.mymsahq.org/ AboutMSA/MSAPAC.aspx 2) Log in using your username and password 3) Contribute
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ANESTHESIOLOGY 2016 MSA MEMBERS TAKE POSITIONS AS ASA OFFICERS At the recent ASA Annual Meeting in Chicago, two Past Presidents of the MSA ascended into new leadership roles in the ASA. James D. Grant, M.D., M.B.A., Oakland County, was named President-elect and will become ASA President in October 2017 in Boston. He will be the first ASA President from Michigan in over 36 years. Kenneth Elmassian, D.O., Ingham County, was elected Assistant Secretary of the ASA. Prior to his elevation, he served in multiple ASA capacities, including Chair of the ASA Committee on Communications.
recognized and they will do well in their new positions. In particular, John L. Pappas, M.D., Oakland County, assumed the role of SecretaryTreasurer of the ASA Political Action Committee and Michael Lewis, M.D, Wayne County, will continue as the Section Chair on Subspecialties. Please join me in congratulating Drs. Grant, Elmassian, Pappas, Lewis and all Michigan physician anesthesiologists in their ASA roles as they continue to represent our specialty. This is the first time that two Michigan anesthesiologists are on the ASA Administrative Council which is a testament to the leadership and engagement of Michigan’s physicians anesthesiologists.
In addition, multiple Michigan physician anesthesiologists were named to key ASA committees and their skills and talents were well
MSA Board Members at the 2016 ASA President’s Dinner. (l to r): John Pappas, Ali Jaffer, Fred Campbell, Asif Malik and Sam Talsma.
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CHICAGO, IL RESIDENT REVIEW
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he ASA conference in Chicago was a resounding, great experience for all our respective residency programs and we would like to express our gratitude to the MSA for all of their support. It was nice to catch up with colleagues we met during the ASA legislative conference in May, as well as to meet new friends at the conference. We all walked away with a much deeper understanding of the advancement of technology in anesthesiology and the importance of collaborative learning from the experience of others through structured and prepared presentations. The meeting also served to emphasize the direction our field is going through legislation, and the need for political action. The poster presentations from our friends and future colleagues, along with the interactive presentations by our mentors, were integral in our growth as physicians. The structure of the event made it simple to participate both as a presenter, as well as a learner. The discussions brought up due to the presentations from enhanced recovery after surgery to OR safety was educational and will further help shape our practice for the better in the future. In terms of advocacy, the delegate meetings allowed us to hear from those that may lead our profession politically, while meeting with the
MSA internally gave us strong insight into the state of current affairs. One recurrent topic of discussion is the importance of preserving the physician-led, team based approach to patient care in anesthesiology. At the ASA legislative conference in May, our efforts were largely directed toward the national issue of Safe VA Care. Our collective efforts were now needed at the local level to oppose Michigan’s proposed bill SB1019, which would remove physicians from the anesthesia care team, thus threatening the safety of our Michigan patients. While SB1019 passed in the Senate, we urge everyone, including nonphysician friends, to contact your representative to vote NO on SB1019 to prevent this bill from passing in the House. In order to continue providing the highest standard of care to all of our future patients, we must stay active. The MSA and ASA serve to protect our professional interests, and we urge you to consider contributing to our state and national political action committees. These groups ensure our voices are heard in Lansing and on Capitol Hill respectively. As always, we appreciate the chance to work with the MSA and the ASA, and are grateful for the opportunity to do so. With their help we continue to move forward to usher in a new phase of medicine as lifelong learners and physician leaders. We are excited about the potential the future holds in anesthesiology.
2016 MSA RESIDENT DELEGATES TO ASA
Patrick Robertson, M.D., DMC/Wayne State, Resident Chair Boris Vidri, M.D., Beaumont Health Systems, Resident Chair-Elect Taghreed Alshaeri, M.D., DMC/Wayne State James Jeltema, D.O., McLaren Lansing Nishankkumar Nooli, M.D., Wayne State School of Medicine Jeffrey Olech, M.D., Henry Ford Health System Anna Pashkova, M.D., University of Michigan Winter 2016
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P RAC T I C E M A N AGE ME N T
ANESTHESIA COVERAGE FOR ENDOSCOPY SERVICES Harry Parr, D.O., MBA Chair, MSA Practice Management Committee
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p until the day of publication of this newsletter, Blue Care Network had planned to implement a restrictive coverage policy for endoscopy services in January, 2017. On our final day for publication submission, the MSA received notice of the plan to abandon that implementation, indefinitely. I want to take a moment to recognize the many MSA members that contributed to effectively combating a proposed policy that would have meant significant risks to our patients. Witnessing the state-wide effort to educate this payor on behalf of patient safety and satisfaction was impressive and a testament to our commitment to being a patient-centered organization. We are very sensitive to the challenges insurers bring to the day-to-day operations of each of our practices, our facility partners, our specialist colleagues, and, most importantly, the real risk this would have created for the patients we serve. In addition to receiving assistance from the Michigan State Medical Society, your MSA leadership had been evaluating alternative legal and public relations pathways to assist
us in advocating for our patients. Your voice is instrumental in making a difference for the insurers’ understanding of what is safe anesthesia care. Some have taken to social media, https:// twitter.com/truthfuldoc, to spread the word. Although the outcome with BCN is positive, there is no rest for the weary‌.HAP is also planning a re-implementation (it was put on hold last year) of a similar policy at the end of February 2017 as well. We will continue to aggressively challenge any insurance policy change that restricts the delivery of high quality safe anesthesia care. We welcome input and participation from our membership. Harry Parr, DO, MBA Chair, MSA Practice Management Committee harryparr@gmail.com
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ASA UP DAT E S
ASA PRESIDENT-ELECT URGES STAKEHOLDERS DURING PANEL TO TURN FOCUS TO INSURANCE GAPS AS ROOT CAUSE OF OUT-OF-NETWORK PAYMENT ISSUES
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n October 13, then-ASA PresidentElect Jeffrey Plagenhoef, M.D., spoke at the Brookings Institution forum, Protecting Patients from Surprise Medical Bills. The think tank briefing was timed with the release of a Brookings policy paper on this topic and featured two panels: stakeholder and policymaker perspectives. During the stakeholder panel, Dr. Plagenhoef explained that balance billing is a symptom of a much larger problem and pointed to “gaps in insurance coverage” as the root cause. Much like with the treatment of disease, he explained, it is insufficient to merely treat symptoms. Instead, a comprehensive approach that includes “accessible networks with an adequate number of all providers and all services, as well as a mechanism for fair out-of-network payment” is key to solving this multi-faceted issue. ASA has shown strong leadership and is a leading voice on Out-of-Network payment issues. To that end, Dr. Plagenhoef has worked tirelessly with ASA’s Ad Hoc Committee on Out-of-Network Payment to educate physician leaders on this emerging advocacy issue and cautions that “if we do not aggressively respond to this threat, access to care and the future of physician anesthesiologists’ groups, departments and practices are very much at risk!" Dr. Plagenhoef ’s Brooking’s comments highlighted the failure of insurance companies to maintain adequate and readily accessible networks. He also shared that there are increasing reports of insurance companies narrowing networks to limit
their costs and shift those costs to patients and other stakeholders. Tiering, where a physician can be in-network with a carrier in one tier and out of network with the same carrier in a different tier, is an additional problem. Tiering further underscored the need for lawmakers considering pre-treatment/procedure cost estimate legislation to put the onus on insurance companies as they are the only ones who know whether a treating physician for a particular patient is in or out of that patient’s network at any given time. To underscore the complexity of modern health insurance products, Dr. Plagenhoef shared his family’s personal experience with the subject. After extensive research prior to purchasing health insurance and before a procedure, his family received a bill 12 times what they had been told to expect. Dr. Plagenhoef participated on the stakeholder panel, “Addressing the Growing Problem of Surprise Medical Bills: Stakeholder Perspectives.” In addition to Dr. Plagenhoef, other panelists included representatives from Consumers Union, Cedars-Sinai Medical Center, and Anthem, Inc. The second panel, “Addressing the Growing Problem of Surprise Medical Bills: Policymaker and Policy Thinker Perspectives,” included a representative from the Council of Economic Advisers, and professors of economics or political science from the University of Southern California, Yale University, and Georgetown University. In the past several years, there has been a dramatic increase in media attention concerning bills
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patients receive from health care professionals who are not in the network of providers their insurance company contracted with to provide health services. The out-of-network bills these patients receive have been termed “surprise bills” by the insurance industry, but are also often termed “balance billing” or “out-of-network billing.” Balance billing occurs when a patient receives a bill for the amount remaining between the out-of-network provider’s charge and the payment made by the insurer after copay and deductibles. Instead of researching why insurance companies are contracting with fewer and fewer providers, lawmakers are being called upon to promote legislation including: bans on out-of-network payments, requirements for cost estimates delivered to patients prior to procedures, and detailing dispute resolution measures. Out-of-network payment is a high-level issue
of concern for ASA, state component societies, and a growing number of stakeholders including medical specialty organizations, insurers, patients and consumer groups, large group practices, and others. To address the growing impact this subject has on state component societies advocacy and public relations efforts, the Executive Committee (EC) approved an Ad Hoc Committee on Out-ofNetwork Payment (AHCONP). Chaired by Sherif Zaafran, M.D., AHCONP is developing materials for state component societies, messaging for ASA, and serving as a resource for states engaged in out-of-network payment initiatives. Additionally, AHCONP is leading efforts to ensure medical specialty organizations are working together on these issues. In the event your state is considering out-ofnetwork legislation, please contact ASA Director of State Affairs Jason Hansen, at j.hansen@asahq. org.
2018 ASA COMMITTEE NOMINATIONS NOW OPEN ASA is now accepting nominations for 2018 committee membership through January 15, 2017. To standardize the nomination process and better facilitate appointments, ASA utilizes a Web-based system. The electronic nomination forms can be accessed at https://www.asahq.org/ member-center/appointments-nominations.
Self-Nominations Current members and adjunct members of committees and subcommittees whose terms expire in October 2017 are required to complete a self-nomination form in order to be considered for reappointment. ASA members who are interested in serving on a committee are also required to complete a self-nomination form to be considered for a new appointment. ASA is fortunate to have many able volunteers seeking nomination; not all nominees can Winter 2016
be appointed, as there are a limited number of positions. ASA seeks a proper balance of continuity, experience, diversity and new talent on each committee.
Colleague Nominations ASA’s foremost goal is effective and productive committees; therefore, colleagues are asked to limit their nominations of others to individuals who have the interest, time and commitment to serve. ASA members may recommend others for appointments via colleague nominations; however, nominees are required to complete a self-nomination form by January 15, 2017 in order to be considered. For a complete list of current ASA committees and their members and chairs, see www.asahq. org/about-asa/governance-and-committees/asacommittees. 17
L E GI S L AT I V E C O RN E R
LEGISLATION ON SUPERVISION AND SCOPE OF NURSE ANESTHETISTS The issue of broadening the scope of practice for nurse anesthetists and granting them independence was the highest priority of GCSI and the MSA. Thanks to the efforts of our team and through your hard work on the ground back in the district with your lawmakers, we were successful in defeating Senate Bills 1019 and 320 this session. Many of you know that this has been long road during this particular session on the issue as the Michigan Health and Hospital Association (MHA) along with the Michigan Nurse Anesthetists Association (MANA) tried a number of avenues to jam bills through the Legislature. You may recall that throughout last year and prior to the summer of 2016, we were previously fighting against Senate Bill 320, which was introduced by Senate Majority Floor Leader Senator Mike Kowall (R-White Lake). The bill not only removed the physician supervision requirement for nurse anesthetists but it greatly expanded the nurse anesthetist scope of practice by allowing them to practice medicine as they were tasked with developing the plan of care for a patient and performing all patient assessments, procedures, and monitoring to implement the overall plan of care. In addition, the nurse anesthetists were given full prescriptive authority, which would have been a new role as they currently are prohibited by state boards from even being delegated the authority currently to prescribe schedules 3-5 drugs. The Senate Health Policy Committee held one hearing on Senate Bill 320. In an effort to partner constructively on the issue with members of the Committee yet protect patients, the MSA had proposed language that would keep intact physician supervision, but also allow the nurse anesthetists to increase their scope as originally suggested under the bill, such as permitting the nurses to become prescribers, so long as that authority is delegated by a physician. However, as
Legislative Corner is a regular feature, written by Marcia Hune, Governmental Consultant Services, Inc.
there weren’t enough votes in the Senate Health Policy Committee to move Senate Bill 320 without some amendments adding back in more physician involvement, the MHA and MANA instead asked for a new bill to be introduced on the issue and sent to another committee for consideration. The last week of session prior to the summer recess for the Legislature in June, Sen. Kowall introduced Senate Bill 1019 which also granted independent practice for nurse anesthetists as well as increased their scope of practice. The bill was referred to the Senate Michigan Competitiveness Committee and it was voted on the day after introduction. The MHA again testified in support of the legislation and while MANA did not testify, they did submit a card of support for the bill. Supporters were able to get Senate Bill 1019 out of the full Senate just after the Labor Day holiday and the bill was then referred to the House Health Policy Committee. We continued to fight hard against the legislation. Following the November General Election when lawmakers returned, the House Health Policy Committee held a hearing (testimony only) on November 29th on Senate Bill 1019. The MSA had a great showing at committee and because of the follow up to committee members, the votes weren’t there to pass the bill and therefore wasn’t taken up again for discussion or a vote.
18 www.mymsahq.org
During the last few days of lame duck session for the year, we remained vigilant to not only monitor Senate Bill 1019, but also ensure that the issue of nurse anesthetist independent practice didn’t come up in another form. We thank all of the MSA membership for your help at the grassroots level to defeat this dangerous legislation! We are certain it will come up again in the 2017-2018 session as the MHA is already saying they expect SB 1019 to be reintroduced next year. With your help, we can continue to advocate for policies
that ensure the safety of patients via maintaining physician supervision in anesthesia. GCSI looks forward to fighting alongside the MSA on this issue again! If in the meantime members have questions, please do not hesitate to contact Marcia Hune at hune.m@gcsionline.com.
2017 Scientific Session Resident Poster Competition Planning is underway for the Annual Resident Poster Competition, to be held during the Scientific Session on Saturday, March 11th. Cash prizes will be awarded to selected presentations. The MSA Board of Directors invites all residents to participate in the 2017 Competition. Competing posters are submitted through the Residency Training Programs. See your Program Coordinator for more information or email admin@mymsahq.org.
Mark Your Calendars — Saturday, March 11th
Royal Park Hotel - Rochester 600 E. University Drive, Rochester, MI 48307
Winter 2016
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