IN THIS ISSUE:
PHYSICIAN ANESTHESIOLOGISTS WEEK 2015
F1RSTAnalytics: Insight at Your Fingertips
Can You Ever Have Too Much of a Good Thing? ABC’s powerful, intuitive F1RSTAnalytics Key Performance Indicators (KPI) Dashboard helps you quickly understand what’s going on and what you need to focus on. The KPI Dashboard is a set of measures specifically for anesthesia practices. At a glance, the dashboard tells you what you need to know, giving you insight into where you are strong − but more importantly − where you need to focus. It allows you to compare year-over-year performance, your payor mix and options to focus on procedures, cases and even your staff.
How Smooth is Your Revenue Cycle? The F1RSTAnalytics Accounts Receivable (AR) Dashboard is a set of measures specifically for anesthesia practices. At a glance, the AR Dashboard tells you what you need to know about where and how revenue is generated, and where you may have issues. The AR Dashboard gives you a multi-year view of your charges, payments and performance trends with in-depth visibility into various aspects of the revenue cycle. The F1RSTAnalytics Dashboards give you actionable insight. Need more data? The KPI and AR related performance reports give you the ability to drill-down into more detailed data. The F1RSTAnalytics suite of dashboards and performance reports give you the knowledge you need to operate your anesthesia practice as an effective clinical organization and successful business.
F1RSTAnalytics – The information you need, provided in a way you can use it. 255 West Michigan Avenue, Jackson, MI 49201 888-242-1131 ext. 4113 • info@anesthesiallc.com • www.anesthesiallc.com
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President Frederick Campbell, M.D. Cedar President-Elect John LaGorio, M.D. Norton Shores Secretary-Treasurer Michael Danic, D.O. Redford Immediate Past President Sam Talsma, M.D. Ann Arbor Communications/ Public Relations Committee Ali Jaffer, M.D. Dominic Monterosso, D.O. Managing Editor Hillary Walilko Cover Photography Courtesy: Wayne Silver Contact for advertising information: Hillary Walilko MSA 120 N. Washington Sq., 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.
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TAB LE OF C O NT ENT S P R E S I D E N T’ S M E SSAGE ................................................................. 4 DIRECTOR’S REPORT............................................................................ 6 CA LE N D A R O F E V E N TS..................................................7 ANESTHESIOLOGIST ASSISTANTS. . ..........................................8 2014 ASA ANNUAL MEETING REPORT.................................... 1 0 RESIDENT EXPERIENCES AT ASA ANESTHESIOLOGY 2014................ 1 1 M S A A P P LA U D S THE DI STI N GUI SHE D CA R E E R O F N E LL K UHN M UE N CH................................... 1 2 ASAPAC REPORT............................................................................... 14 IT’S TIME TO TAKE A SEAT AT THE TABLE............................................... 16 MOCAPEDIA ........................................................................... 18 & 20 LEGISLATIVE CORNER ........................................................................ 22
INDEX TO ADVERTISERS Anesthesia Business Consultants....................................... IFC AA Program at Quinnipiac University...................................9 Lifetime Income Sales Associate, LLC ...................................7 Paragon Service.................................................................... 15 Univeristy of Michigan Health System................................21
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PRESIDENT’S MESSAGE
Frederick Campbell M.D. President
Holiday Time:
Gratitude and Commitments
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s I write this column for the December issue of The Ventilator, the Thanksgiving holiday is fast approaching. This is a time in the year we reflect on our lives and give thanks for the blessings we enjoy. By the time you are reading this, the New Year will be looming with its opportunity for resolutions and commitment. As anesthesiologists we give thanks to those clinicians and scientists who instilled in us the breadth and depth of medical knowledge and clinical reasoning that uniquely qualify us to lead the anesthesia care team. Like you, I easily imagine the faces and recall the names of the mentors who, during medical school, residency training, and the first years of my career, provided me the insights, pearls, judgment, and technical skills which I use every working day. We are indebted to the physician-scientists whose imagination and intellect have lead to the scientific and engineering advances that have improved the administration of anesthesia making it safer for our patients. We are privileged to care for patients at their most
vulnerable times, to provide emotional comfort to the patient and family, to relieve pain and stress, and to guide the surgical patient through a hazardous perioperative maze of their own comorbid conditions, increasingly complex surgical interventions, occasional complications, and demands for accelerated recovery. While we are grateful as physician anesthesiologists for the trust placed in us by our patients, surgical colleagues, and hospital administrators, we acknowledge that we must earn it every day. The inaugural Physician Anesthesiologists Week, developed by the ASA, will be January 11-17 and is a celebration of, and tribute to, the contributions we make each day we go to work. Read more about this special week in this issue of The Ventilator to learn how you may help promote physician-led anesthesia care. We have much to be thankful for as members of the Michigan Society of Anesthesiologists. MSA is regarded as one of ASA’s strong state component societies. This is the direct result of the active role of the MSA Board of Directors as
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well as the consistent and continuous mentoring and leadership provided by many dedicated MSA anesthesiologists many of whom are PastPresidents. I would like to cite many of those individuals but for fear I would inadvertently (or through ignorance of the years predating my active MSA involvement) omit a deserving member, I won’t go there. Be assured that while many of us take shifts in the wheelhouse, there is a steady hand on the wheel. MSA is fortunate to be supported by the outstanding work of our lobbying team and administrative managers from Governmental Consultant Services, Inc. Nell Kuhnmuench, our chief lobbyist for the past 14 years, is retiring at the end of this year (read more about Nell later in this issue). Nell is repeatedly cited as one of the top lobbyists in Lansing and has been a valued source of sage counsel to MSA on political and legislative matters. We are very fortunate that Marcia Hune, who has worked with Nell on behalf of MSA for several years and has developed effective relationships in Lansing by her own right, will step into Nell’s shoes. MSA is in good hands! Hillary Walilko has been MSA’s administrative executive since Theresa Lark passed the baton to her in 2012. Hillary and her staff are invaluable to member services, society operations, and especially to the MSA officers whose tasks are greatly facilitated by their expert assistance. Thank you Hillary! Our advocacy efforts in Lansing have had the added benefit in the last three years of the communications expertise of Matt Resch and his team from Resch Strategies and the work of Cameron Brown of Cameron S. Brown Consulting Services. We are grateful for the expertise each brings to our advocacy on behalf of the physicianlead anesthesia care for Michigan citizens. In the New Year, we will face repeated efforts to remove the physician supervision requirement in Michigan thereby threatening the record of patient safety achieved by physician-led anesthesia care. Advocates of expanded scope of practice will continue their attempts to permit the practice of
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interventional pain medicine by under-trained nurse anesthetists. Let us resolve not to tire in our efforts to protect our patients but, instead, to redouble our commitment to advocate for physician-led, team-based anesthesia care and safe, effective interventional pain management. This is work that requires effort both at home and in the political arena. In our own hospitals and clinics, we will exemplify the professional attributes that distinguish physician anesthesiologistsclinical and administrative leadership promoting patient safety and quality of care, teaching, unselfish dedication to patient-centered service, and expanded medical management of our patients throughout the perioperative period. In Lansing, and in Washington, D.C., we must sustain and strengthen our advocacy. As individual MSA members we can do this by making a commitment to develop a grassroots relationship with a legislator and to increase our support of the MSA PAC and ASAPAC. One-on-one relationships with legislators provide an essential way to inform and educate these politicians. Moreover, established relationships promote your access to the legislator and his or her staff when you are called upon to reach out about impending legislative action. Easier yet, increase your PAC contributions. If you have already contributed for the 2015 year, send another check or log in to donate again! We are grateful we chose to pursue the stimulating and rewarding medical specialty of anesthesiology. Let us appreciate that the living we earn and professional stature we enjoy permit us to commit meaningful contributions, financial as well as through interpersonal relationships, to the advocacy efforts necessary to sustain safe patient care and the medical specialty we love. On an extremely sorrowful note, I am saddened to inform you that one of MSA’s Board Members, Dr. Scott Kuhnert, was tragically killed in a car accident in early December. An educational fund has been established for his three sons. Those wishing to make contributions can send them to: The Kuhnert Children Education Trust, c/o MSU Federal Credit Union, PO Box 1208, East Lansing, MI 48826.
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DIRECTOR’S REPORT
Advocate for Our Specialty During Inaugural Physician Anesthesiologists Week January 11-17, 2015 Kenneth Elmassian D.O. ASA Director, Michigan Chairman, ASA Committee on Communications
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here has never been a more important time to advocate for our specialty and our patients as potential federal and state issues related to scope of practice threaten patient-centered, physician-led care. To help showcase the role physician anesthesiologists play in providng the safe, high-quality care all patients deserve, the American Society of Anesthesiologists® is launching Physician Anesthesiologists Week 2015 January 11-17. The inaugural event provides an opportunity to alert policymakers, the media and the public that when seconds count, physician anesthesiologists save lives. But in order to make our voices heard on critical issues that affect our specialty, we need to mobilize all Michigan Society of Anesthesiologists (MSA) as well as ASA members to take action. During the week, ASA is asking physician anesthesiologists to showcase the role you and every one of our members play in protecting patient safety and to schedule meetings with legislators, talk to local press, engage in social media and connect with colleagues and the community. Planning for these activities can start this month and ASA has developed materials and resources to help you out with a Physician Anesthesiologists Week member engagement webinar in December that will provide specific instructions on how to make the event a success. The webinar will highlight and review the materials contained in the comprehensive support tool kit developed for the week’s activities. The toolkit will provide instructions and materials to help you:
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Set up meetings at the state capital or at your lawmaker’s district office. Advocate for your patients and your MSA as well as ASA colleagues in one-on-one meetings with influential elected officials and staff with tips for scheduling face time — and staying on point — with legislators.
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Showcase your expertise. Invite policymakers and the media to tour your hospital to see your specialty in action. A sample tour agenda and key messages to convey when speaking to the media and policymakers will be provided.
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Engage the media. Increase awareness of the importance of physician-led care in ensuring patient safety by conducting outreach, sending materials and offering interviews with local media. Instructions, sample materials and talking points will be included to help you with your efforts.
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Spread the word online. Use the #PhysAnesWk15 hashtag and ASA’s social media messages to sound off in January about the physician anesthesiologist specialty. You also can post a specially designed ASA physician anesthesiologist banner on your website.
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Connect with colleagues and the community. Make this week an occasion to gather physician anesthesiologists, patient advocates and others from the community in “lunch and learns,” networking events, health fairs and other events to raise awareness of the speciality.
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Share your patient stories. Visit asahq.org/ WhenSecondsCount to share your When Seconds Count stories.
The key messages for the week are based on the research developed for our When Seconds Count™... educational endeavor. The research looked at perceptions the public and policymakers have of physician anesthesiologists and found that the majority are unaware that anesthesiologists are physicians. Even fewer know how we save lives when emergencies occur in surgery or other procedures. To help increase awareness of the critical role we play before, during and after surgery, we are asking ASA members to share key messages on their compreshensive medical edcuation, training and experience and stories of lives they saved. Whether diagnosing an underlying health condition during pre-surgical screenings or stepping in when a routine
procedures becomes an emergency, these stories support our key messages and highlight how our involvement can mean the difference between life and death. Tips for effective storytelling also will be included in the support kit. As you make your voice heard locally, ASA will spread the word nationally through media outreach to generate coverage about the work you, your ASA member colleagues and all physician anesthesiologists do to advance patient safety. We also be working with our State Component Societies to reach out and encourage everyone to get involved. Additional informtaion will be available in ASAP and on our social media sites. I personally challenge all ASA members to play a role, whether it’s just one activitiy or several, you can help us make a difference. Physician Anesthesiologists Week 2015 is our time to say loud and clear, “When Seconds Count, Physician Anesthesiologists Save Lives.”
CALENDAR OF EVENTS
2015 January 11 – 17
ASA Physician Anesthesiologist Week January 23 – 25
ASA Practice Management Conference Atlanta, GA February 28
MSA 60th Scientific Session Southfield, MI March 7 – 8
ASA Board Meeting Rosemont, IL
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Anesthesiologist Assistants:
Valuable and Skilled Professional Members of the Anesthesia Care Team J. Kent Knight, AA-C President MAAA
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here is a professional member of the Anesthesia Care Team (ACT) that many anesthesiologists may be unfamiliar with. That professional is the Anesthesiologist Assistant, better known as the AA. You may be asking yourself, who are these AAs? What is their educational background? What is the history of Anesthesia Assistants? What is their role in the Anesthesia Care Team? How can they benefit my practice? This article will hopefully enlighten and educate anesthesiologists about the benefits and value AAs will bring to their practices. Anesthesiologist Assistants are highly skilled anesthetists who work solely under the medical direction of an anesthesiologist. These professionals do not work under the medical direction of any other type of physician, e.g., surgeon, differentiating themselves from nurse anesthetists. AAs believe that the interest of patient safety is best served with an anesthesiologist’s involvement in the delivery of every anesthetic. The responsibility for medical direction lies with the anesthesiologist who delegates aspects related to the implementation of the anesthetic plan to the AA. AAs are extensively trained in the delivery and maintenance of quality anesthesia care and advanced patient monitoring techniques. Advanced airway management, the insertion of arterial lines, the placement and monitoring of regional anesthesia, and the use of vasoactive drug resuscitation are just a few of the skills mastered by AAs. Prerequisites for admission to an accredited AA program are extensive. An applicant must have a baccalaureate degree and completed a premedicine
background with prerequisites identical to medical school applicants.. This includes but is not limited to biology, vertebrate anatomy, physiology, general chemistry, organic chemistry, physics, and calculus. In addition, the applicant must complete the MCAT and/or the GRE to be considered for admission. AA training programs include a minimum of 2428 months in a masters level program accredited by the Commission of Accreditation of Allied Health Education Programs (CAAHEP). AA programs must be based at, or conducted in collaboration with, a university medical school that has an academic anesthesiology faculty, and the program’s medical director must be a licensed, board certified anesthesiologist. The AA student will complete, on average, 600 hours of classroom/ laboratory education as well as 2600 hours of clinical anesthesia education. Upon completion, the AA student must pass a national certification exam. Unlike nurse anesthetists, AAs must pass a recertification exam every six years in addition to completing a minimum of 40 hours of CME every two years in order to maintain certification. The AA-C recertification exam is conducted by the NCCAA (National Commission for Certification of Anesthesiologist Assistants) and NBME (National Board of Medical Examiners), the same body that tests physicians, to ensure the highest quality anesthesia provider. The first AA program began over 40 years ago at Emory University. Since that time, the value and professionalism that the AA brings to the ACT has become widely accepted. There are now 10 accredited AA educational programs. Centers for Medicare and Medicaid Services (CMS), Tricare, the VA, and private insurers all recognize and reimburse AAs within the ACT model. AAs practice
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in numerous states and the District of Columbia under state licensure or delegatory authority of a state’s medical board. AAs have successfully and safely practiced in Michigan for over 3 decades. How might recruiting Anesthesia Assistants benefit your practice? AAs are committed to working in the ACT practice model, an anesthesiologist-led, team-based approach to anesthetic management. The AA will always play a cohesive and collaborative role within the anesthesia care team under the leadership and direction of physician anesthesiologists. AAs are the only anesthetists who work entirely with this professional philosophy. AAs generally are compensated on a salary basis and practices have varying means of handling overtime and on-call compensation. These midlevel providers have not commonly been exposed to the labor-management antagonism that may color the perspective of employed nurses.
Furthermore, the knowledge and skills of AAs are widely recognized to match those of other midlevel anesthesia providers. Fortune 500 companies, Super Bowl champions, and brilliant military campaigns all have a common thread. Each one is comprised of individuals with complementary experience and abilities that form an efficient and skilled team- a team with defined roles working together for a common successful goal. That is what Anesthesiologist Assistants bring to the Anesthesia Care Team and your practice. For more information on how AAs can benefit your anesthesia practice please refer to the American Academy of Anesthesiologist Assistants (AAAA) website at www.anesthetist.org or the Michigan Academy of Anesthesiologist Assistants (MAAA) website at www.michiganaaa.org. The ASA also provides countless citations and is an invaluable tool for AA information.
New AA Program at Quinnipiac University The Frank Netter MD School of Medicine at Quinnipiac University in Connecticut is a new AA program accredited by the Liaison Committee on Medical Education (LCME) which is the accrediting body for educational programs at schools of medicine in the United States and Canada. The program is looking for clinical sites for AA students in other states at local or university hospitals. Rotations are continuous for approximately six weeks. Quinnipiac will take care of all the details, housing transportation, etc. To date every site we have sent our students has been thankful for the experience and enjoyed the process. Clinical sites will have the ability to evaluate first hand our students in case they need to recruit more staff. We will allow our students to take the last one to two months of their training at sites that have offered them employment so as to allow a smooth transition from student to clinician should that be required. The goal is to promote our university, its AA program, our students and the anesthesiologist profession. Clinical sites interested in hosting AA students from Quinnipiac should contact Tommy Verdone, M.D., AA Medical Director at The Frank Netter MD School of Medicine at (203) 582-7993 or Thomas.Verdone@quinnipiac.edu.
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2014 ASA Annual Meeting Report David M. Krhovsky, M.D. Alternate Director, Michigan ASA Board of Directors
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he 67th ASA Annual Meeting convened in October in New Orleans. Along with the numerous scientific and educational sessions, the ASA House of Delegates (HOD) met on Sunday the 12th and Wednesday the 15th. You were well represented there by your delegation under the excellent direction of Michigan ASA Director Ken Elmassian, D.O. Both Ken and I are especially grateful for the Alternate Delegates who were pressed into service to sit as Delegates to assure that our delegation was able to exercise all ten of its votes. We were all reminded of how important those votes can be by the several very close votes that occurred during Wednesday’s session. There was a lot going on this year and I would like to provide you with a brief rundown of some of the highlights. Besides the election of officers, the HOD is also tasked with developing and updating guidelines, policy statements, and other documents that represent the professional standards of our specialty. Speaking of elections, Jim Grant, M.D. will be running for First Vice President of ASA in 2015, and Ken Elmassian declared his intention to run for ASA Assistant Secretary in 2016. This will place Dr. Grant on track to become the eventual President of ASA. MSA should be very proud of these two excellent leaders. Also of note, J.P. Abenstein, M.D. took over as ASA President from outgoing President Jane Fitch, M.D., who did an excellent job guiding us through some rough waters in 2014. Our sincere thanks to Dr. Fitch for a job well done! In terms of clinical practice, the HOD approved updates for both the “Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging”, and the “Practice Guideline for Perioperative Blood Management”. Please see the ASA website (asahq.org) for more details about these two updates. Also discussed at some length was the subject of trauma anesthesia directors at Level 1 trauma centers. The HOD approved a statement that for Level 1 trauma centers
there should be an in-house presence of a physician anesthesiologist trained in the management of trauma care. In addition, and perhaps more controversially, there should be a designated director of trauma anesthesiology with the following qualifications: Current ATLS Provider or Instructor certification; a minimum of 12 hours of ACCME category 1 CME credits in trauma related educational activities within the past three years, and; completion of a trauma anesthesiology fellowship or at least two years of post-residency experience in the perioperative care of major trauma patients in the operating room or intensive care unit. Of interest, it was pointed out during the discussion that only two such fellowships currently exist. Another subject that garnered much discussion was the Committee on Ethics Statement on Fatigue. The HOD approved the following: “Because fatigue may jeopardize patient safety and physician well-being, an anesthesiologist who becomes impaired by fatigue should not provide routine clinical care until this impairment has resolved. Anesthesia departments and group practices should work within the medical staff structure to develop and implement policies to address fatigue-related provider impairment and its implications for staffing and the delivery of safe patient care.” I commend the Ethics Committee for taking on this difficult task, and feel that the HOD approved a reasonable statement. That said, this writer feels that there will be more to come as we continue to work through this difficult issue. I hope this gives you a small taste of activities of the 2014 ASA HOD. I strongly encourage you to refer to the ASA website to get more detail on these and other issues discussed. As always, please feel free to contact either Dr. Elmassian or myself if you have further questions.
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Resident Experiences
ASA Anesthesiology 2014
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s representatives of the Michigan Society of Anesthesiology Resident Section we had the privilege of attending the annual ASA Conference, held in beautiful New Orleans. For many of us it was the first time attending a conference of such magnitude, and for that, we thank the MSA for providing us with the means and opportunity. The ASA provides residents with the prospect of meeting hundreds of other colleges from around the country and world. With the use of lectures, workshops, and social events, we were allowed to interact and discuss a variety of topics and issues that pertain to our practice. The experience gained is immeasurable, and will help shape our careers as future anesthesiologists. As resident delegates our schedule was filled with a variety of lectures that were paramount to our profession. We began the weekend discussing grassroots efforts and attended a Q/A regarding major issues not only at the national level, but also at the state level as well. It was an opportunity for residents to voice their concerns, but most importantly bring awareness to some of the challenges our profession faces across the country. Throughout the weekend many other lectures regarding practice management, models of practice panel, as well as a written board prep seminar were made available to us in order to further enrich our conference experience. As representatives from Michigan we were invited to join our House of Delegates representatives for a group breakfast to discuss the current issues regarding our practice in the state of Michigan. Dr. Kenneth Elmassian led the discussion that began with current state legislation being discussed in Lansing, as well as, updates on political campaigns for the 2014 election cycle. As our morning meeting concluded we took to the resident House of Delegates meeting where we participated in voting for our future resident representatives to the ASA.
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Once the weekend concluded many of the residents were able to explore the vastness of the ASA conference and attended lectures associated with their areas of interest. One resident who will be a future pediatric fellow was intrigued by a lecture focusing on regional anesthesia techniques in the pediatric population. Another resident who will be starting a pain fellowship found the Q/A discussions informative and in-depth. Others found the posters and presentations in the open sessions enlightening as active research continues to push our field forward. The greatest benefit of the conference is its endless array of topics where any future anesthesiologist could find something worthwhile. Aside from the conference we were all able to experience some amazing southern hospitality. New Orleans rocks! It is a city that is rich in history as well as a culinary playground. There is a restaurant for every palate! The French Quarter is a lively, nonstop, social gathering. Whether it was attending the Louisiana Seafood Festival, listening to live jazz music, or visiting the incredible World War II museum, New Orleans had it all! Thanks again to the MSA for providing this opportunity!
2014 Resident Delegates John Ghanem, M.D., Harper University Hospital/WSU – Resident Section Chair Stephen Sams, M.D., Beaumont Health System – Resident Section Chair-Elect Isaac Zev Davidovich, M.D., University of Michigan Denzil Hill, M.D. , Harper University Hospital/WSU Joshua Hozella, M.D., Beaumont Health System James Leathem, D.O., McLaren Lansing Branden Yaldou, Beaumont Health System
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MSA Applauds
The Distinguished Career of Nell Kuhnmuench
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s. Nell Kuhnmuench, MSA lobbyist for over 18 years, will be retiring at the end of December. While MSA Officers and staff are incredibly sad to see her go, this is well deserved break for an extremely hard working individual. In appreciation of her tremendous efforts over the years, Nell was awarded the MSA President’s award by outgoing-President, Dr. Sam Talsma in March of this year. Ms. Kuhnmuench has been with Governmental Consultant Services, Inc. (GCSI) for more than 25 years following eight years as Chief of Staff for two Speakers of the Michigan House of Representatives. She has been consistently voted among the top lobbyists in the state and is widely recognized for her expertise on healthcare, insurance and environmental issues.
MSA BOARD MEMBER NARRATIVES
If you meet her once, you will never forget who or what she stands for. I had such an eye opening experience several years ago when she asked me to attend a Democratic fundraiser. She mentioned the event would also give me an opportunity to meet the Speaker of the House. After the brief introduction, she then stood toe-to-toe with the very tall, imposing speaker, and for lack of a better description, she basically got in his face on an issue unrelated to anything to do with what I came prepared to discuss. It was an experience I would never forget…she knew she was right and the speaker was wrong, and no one was going to get in her way of letting her feelings known. I honestly don’t recall the issue, and for me it was not important. All I could do after witnessing this encounter was to say to her, “Whatever you said or he did, that was awesome!” If you are ever on the wrong side of an issue, you never want to be lulled by that most inviting smile. ~Ken Elmassian, D.O., MSA Past-President
I have known Nell for many years, and have always been impressed by her honesty and her command of the issues, as well as the inside politics which seems to accompany every advocacy effort that she represented. Besides, I cannot tell you how much I have learned from her through her guidance and wise counsel. Using the words, “knowledge,” “understanding,” “straight-forward,” “clarity,” “toughness,” and “simplicity” in the same sentence would be very descriptive of this tireless advocate everyone refers to as just plain, “Nell.”
I have worked with Nell rather closely on and off over the span of her 18 year tenure as MSA’s lobbyist. In that time I have gained the utmost respect for her knowledge, professionalism and political instincts. Several years ago, Nell and I spent several days visiting members of both chambers of the Michigan State Legislators, primarily Health Policy Committee members, to help educate them about the matters that concern us about the health of our citizens in our role as physician anesthesiologists.
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Having Nell with me made all the difference! The respect she commanded with everyone we encountered was plainly obvious. It has been my distinct pleasure to know her and work with her. She will be missed! ~David Krhovsky, M.D., MSA PAC Chair
NELL KUHNMUENCH GAVE LOBBYING A GOOD NAME Nell Kuhnmuench recently announced her retirement. She has served as the MSA’s Lansing lobbyist for the last eighteen years. I have enjoyed working with Nell, first as an officer of the MSA, then as a state legislator, and more recently as Co-Chair of the MSA’s legislative committee. She has been a tireless advocate for us and I will miss working with her. The American public has a poor view of lobbyists. For the last several years in the annual Gallup poll on the honesty and ethical standards of various professions, lobbyists have come in dead last trailing car salespeople and members of congress. But, this image is wrong and one of the things I most admire about Nell is her proud advocacy for her profession. While serving in the senate, I would often have students visit from the district. They would come to Lansing, tour the Capitol, and sit in the gallery during a legislative session. I might have had a chance to meet with them briefly before or after session. They would often have questions about the legislative process. They may have glimpsed the usual cluster of lobbyists in the hallway and inquired in a sarcastic fashion about their role. On several of these occasions it happened that Nell was nearby, so I would go out of my way to find her and introduce her to my guests. I would ask her to explain her job as a lobbyist. Nell would point out that the right to petition government is enshrined in our constitution; that most people and institutions are busy and naïve of the detailed workings of government, and that lobbyists serve to protect the rights and interests of citizens and institutions in a complex legislative environment. Lobbyists play a key role in a representative government, without whom, the legislative process would not properly function. By the end of the visit, the students were generally more interested in lobbying as a career than becoming a legislator! Nell is known for her high standards and work ethic, but it is her passion for her work and her profession that made her a delight to be around. I will miss working with her and wish her the best in her retirement.
NEW YEAR - - - NEW SESSION - - - - NEW ADVENTURES Words, although a significant part of the trade I have plied for more than the last quarter of a century, are sometimes tough to find when it comes time to take leave of long held roles and the friendships that accompany those roles. Nonetheless, change is afoot, and words on paper provide me the opportunity to share some thoughts with you. I am in a very happy situation, about to make a change that will lead to new happy situations. I am going to retire from GCSI, which includes taking leave of all my friends at MSA, at the end of this calendar year. This has been in the works for a few years though the almost sudden arrival of a time that once seemed so distant has rather surprised me. It has been my honor - and a joy - to work with the Michigan Society of Anesthesiologists through many of my years at GCSI. Together, we have not slayed any dragons though we have managed to assure good public policy with the goal always on patient safety. You have all been amazing to work with and for! You are smart, engaged, contributing, and acquire political astuteness rather quickly. You have made a difference in the path taken by organized medicine in Michigan and set an example for your fellow physicians around the state. As I leave, it is with a sadness that I will no longer be at your gatherings and get to share stories of your families and their growth. Nonetheless, I will be charting new waters for me – the first being catching up on some sleep and some reading that have both been ignored in large part over the years. And I leave, confident that Marcia has learned your issues well and, together with the rest of the team at GCSI, will continue to serve your organization and your goals admirably! Thank you from the depths of my being for all the years of friendship in advocacy. I trust I will see some of you as the road ahead reveals itself. Till then – my thanks and fare thee all well! With deep appreciation. ~Nell
~Tom George, M.D., Former State Senator and MSA Legislative Committee Chair
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ASAPAC REPORT
Michigan Residency Programs
Reach 100% Participation in ASAPAC
2014 Resident Program Recognition – 100% Participation (Bold indicates 100% Faculty participation)
Matthew Eagleson DO Chief Resident MSUCOM ASAPAC Resident Representative
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s residents, our future as physician anesthesiologists not only depends on what we are learning in our operating rooms, but our engagement in professional citizenship on behalf of our patients. It is a simple fact that government has a major impact on the practice of medicine, passing the laws that regulate our future profession. The American Society of Anesthesiologists Political Action Committee (ASAPAC) allows ASA members to develop and maintain political relationships with physician anesthesiologists’ legislative allies on a personal level. ASAPAC is actively engaged with the ASA membership and also is working with Resident ASAPAC Representatives to promote our involvement in the ASAPAC and political activism. Anesthesiology residents around the country have heard the call for political advocacy and helped pave the way for their professional future and the future of physician-led patient care by donating at a 29% participation rate nation-wide. In spite of the need-toimprove percentage participation rate, an even more remarkablenumberwasthethirty-eightresidencyprograms which reached 100% participation in Fiscal Year 2014. Among those programs which did reach the 100% benchmark were two from Michigan: Beaumont Health and Michigan State University College of Osteopathic Medicine [MSUCOM]. Of special note this year, MSUCOM joined four programs nation-wide by receiving the special distinction of reaching 100% participation for both residents and attending physician anesthesiologists. ASAPAC is the only national political voice for physician anesthesiologists. The ASAPAC also has the distinction of being the leading medical PAC in the country, and its activity in the electoral process has been recognized as non-party affiliated with a distinct professional-patient care focus. It is a voluntary organization comprised of over 8,000 ASA members contributing individual dollars for political contributions to anesthesiology-friendly candidates for Federal office, and where legally able, State
Albany Medical
University of Connecticut
Baylor University
University of Iowa Hospital and Clinics
Beaumont Health Cooper University Hospital Geisinger Health Systems Maine Medical Center Mayo Clinic – Arizona Mayo Clinic - Florida Medical University of South Carolina Michigan State University College of Osteopathic Medicine
University of Florida – Jacksonville University of Kansas-Kansas City University of Kansas - Wichita University of Miami University of Mississippi Medical Center University of Missouri, Kansas City University of Nebraska
Ochsner Health System
University of Oklahoma
Penn State Hershey
University of Pittsburgh Medical Center
Rush University Medical Central Scott and White Hospital / Texas A&M University of Alabama Birmingham
University of Tennessee Knoxville University of Texas - San Antonio
University of Arizona
University of Texas – Southwestern
University of Arkansas
Virginia Mason University
University of California - Davis
Vanderbilt University
University of Chicago University of Colorado
West Virginia University Yale University
offices, as well. The mission of ASAPAC is to advance the goals of the specialty through bi-partisan support of candidates who demonstrate their commitment to patient safety and quality of care. Put simply ASAPAC is not red or blue but working for your professional future. In the 2014 elections, ASAPAC had a 94% win rate supporting candidates across the political spectrum. As future physician anesthesiologists, we must each do our part to insure that high quality and safe anesthesiology continues to be practiced in America, and that it’s readily available to our patients when needed. Contributing to ASAPAC is simple. Go to www.asahq.org and donate today, and while you are it, ask your attendings to do the same by contributing to all of our futures.
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15
It’s Time to
Take a Seat at the Table James Grant, M.D. President, Michigan State Medical Society ASA Treasurer
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n old saying in politics distinguishes between those who are committed and those who are involved.
“When you look at a plate of bacon and eggs, you know the chicken was involved, but the pig (or turkey in the event of turkey bacon) was committed.” Both commitment and involvement are needed to cook that meal, so I’m not asking anyone to give up their life to become committed to the political process, but we do have among us a number of physicians, past and present, who gave up a lot and are giving up a lot to run for office and to whom the medical profession is deeply indebted. We need to commit ourselves to at least being involved in the political process if only in gratitude for those who do enter the arena and work on behalf of our profession and our patients. There’s Senator Roger Kahn, M.D., from Saginaw, who is in his last days of the Michigan Legislature after a stellar career there. Senator Tom George, M.D., from Kalamazoo, whose hero is Lincoln and whom he emulated for nearly two decades. Serving at the same time as Senator Doctor George was Representative Doctor Jimmy Womack from Detroit. We have Congressman Dan Benishek, M.D., from Crystal Falls in the Upper Peninsula who is fighting for federal litigation reform and a safe, high quality, and accessible system for our nation’s veterans. The list is admirable and includes our own MSMS Board member, John Schwarz, M.D., who has served in the Michigan House, Senate, and in the U.S. House of Representatives. And now we are supporting physician candidates John Bizon, M.D., a past president of MSMS, and Ed Canfield, D.O., a past president of the Michigan Osteopathic Association, both recently elected to the Michigan House of Representatives. In an increasingly complex world, physician voices on the floor of legislative chambers are increasingly important.
The New York Times recently reported on a Johns Hopkins study that found that from 1960 to 2004 only 24 physicians served in Congress. In our current Congress alone, there are 20 physicians, on both sides of the aisle, coming from diverse medical backgrounds. As this trend continues, the 2014 election cycle had 26 physician candidates for both the U.S. House of Representatives and Senate. So what if there is not a doctor in the House? Or in the Senate? Would it make a difference? If the past is prologue, it would make a tremendous difference. Physicians in legislatures bring a certain background. They bring reason. They bring common sense. They base themselves in the scientific method of analysis and proof versus divisive politics and partisanship. In a word, they bring perspective. Senators Kahn and George quickly rose up the ranks and spoke out for medicine. They spoke out for you. They spoke out for your patients. Congressman Benishek does the same in Washington. And we are confident that Doctors Bizon and Canfield will pick up where Senators Kahn, George, Representative Womack, and Congressman Schwarz left off. The question comes down to how can we become involved to support both of these current physician candidates for the Michigan House as well as develop other physician candidates in the future, and, just as importantly, support existing and future medicine-friendly legislators? And what can we do to educate the legislators who are not so friendly? The entry level to involvement is to become a member of the Michigan Doctors Political Action Committee. Politics is not an easy game, but it is necessary for our future. Those who believe that their professional lives are not affected by politics need to look at every aspect of their daily lives. If our litigation reform is overturned by an activist court, Michigan once again becomes a pariah in recruiting new
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physicians and frivolous lawsuits flourish. If a tax on gross receipts is enacted, it will be really difficult to attract physicians to Michigan. The list goes on. Neither ivory towers nor hospital walls can protect physicians from the miasma of a decaying practice climate. When things get ugly, physicians will still be on the hook. MDPAC works to support and elect legislators who get it. We need more political action as things get messy, not less.
the foe. As Sun Tzu wrote in the Art of War, “Those who do not know the plans of competitors cannot prepare alliances. Those who do not know the lay of the land cannot maneuver their forces. Those who do not use local guides cannot take advantage of the ground.” Our MSMS lobbyists will guide you over unfamiliar ground and make you feel like a seasoned political warrior. Take advantage to get an advantage.
The earliest step of political involvement is very simple and means effectively utilizing the very easy avenue of access through the MSMS Action Center. When MSMS asks you to send an email to your local legislator, just click on the link to the Action Center and you are on your way to political action. A couple of easy clicks and you are done. Legislators tell us that if they get a half-dozen emails or calls on an issue, they take hard notice. If it’s more than that, they figure a crisis is brewing. Your voice matters. Let it be heard.
So don’t waste your breath complaining. Make your voice heard. Commit to being involved in the political process. Many people wish they could get their voices heard. “If only someone would listen!” is a common lament.
One final avenue to political involvement is to join one of our Government Relations staff on a one-on-one visit with your legislator at the Capitol in Lansing. He or she could be friend or foe, but putting your face in their face is essential to either bolstering the friend or educating
Because as they say in Washington and every political body, “If you’re not at the table, you’re on the menu.”
That’s what MSMS does for you. MSMS is first the funnel and then the amplifier. MSMS collects the input from our members and then blasts it out loud and clear with the gravitas of the medical profession behind it. Saddle up and sidle up to your legislator’s desk.
Reprinted with permission from the Michigan State Medical Society.
2015 Scientific Session Resident Poster Competition Planning is underway for the Annual Resident Poster Competition, to be held during the Scientific Session on Saturday, February 28th. Cash prizes will be awarded to selected presentations. The MSA Board of Directors invites all residents to participate in the 2015 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, February 28th
NEW LOCATION
The Westin Southfield-Detroit Winter 2014
1500 Town Center • Southfield, MI 48075
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MOCAPEDIA
Lauryn R. Rochlen, M.D. Clinical Assistant Professor at the University of Michigan Department of Anesthesiology
Maintenance of Certification for Anesthesiology:
Commitment to Improving Your Practice
Clinical Assistant Professor at the University of Michigan Department of Anesthesiology The half-life of knowledge is described as the time span from when knowledge is gained until it becomes obsolete, superseded, or shown to be untrue.(1) On average this time has been estimated to be 5 years, with that time rapidly decreasing due to the current rate of technological advancements and scientific discoveries. So where does that leave you and the knowledge you obtained during medical school and residency? Well, I’ll let you do the math. The good news is we are now in most cases required and in others, highly encouraged, to combat this exponential decay in our education. In 1999 The American Board of Medical Specialties (ABMS) moved from a simple “recertification” process to a 10-year multi-faceted process referred to as “maintenance of certification” (MOC). In 2000 the Maintenance of Certification in Anesthesiology program, more commonly known as “MOCA”, was introduced.(2) MOC emphasizes continual life-long learning and commitment to improving your own personal practice. Those of us who became diplomates of the American Board of Anesthesiology in 2004 and later may just now be learning of these MOC requirements as the first group of diplomates is now completing their initial 10 year MOC cycle. For more details, tutorials on the MOC process and requirements by year in which you received your primary certification are available through the ABA website (www. theaba.org). In brief, the MOC program is comprised of 4 components. •
•
Part I states that you must hold an active, unrestricted license to practice medicine in at least one jurisdiction of the United States (US) or Canada. Part II refers to Lifelong Learning and Self-Assessment, or Continuing Medical Education (CME) credits you must obtain throughout your 10 year cycle. Over 10 years one must obtain 250 Category 1 CME credits. There are restrictions on how many CME credits can be claimed each year. A portion of the credits must come from completing the Anesthesiology Continuing
Education, Self-Education and Evaluation, and Patient Safety programs, all available through the Education Center of the American Society of Anesthesiologists (ASA). • Part III is the cognitive examination. You must be in year 7 or later of your MOC cycle and have at least 125 CME credits in order to be eligible for the cognitive exam. • Part IV is Practice Performance Assessment and Improvement. Part IV has 3 components: Attestation, Simulation Course, and Case Evaluation. ◦ The attestation is made through the ABA Physician’s Portal at the end of the 10 year cycle. You must provide references that can provide evidence for your clinical activity. ◦ Currently anesthesiology is the only specialty requiring completion of a simulation course to fulfill Part IV, a true testament of our specialty’s commitment to patient safety. For an excellent discussion regarding the Simulation Course, I direct you to the recently published commentary by Weinger et al. in the September issue of Anesthesiology.(3) ◦ There are a few options available to complete the Case Evaluation component which include completing a case write-up, participating in an ABA approved quality assurance activity, and completing an on-line module via the ASA Education Center. ◦ A Simulation Course or Case Evaluation must be completed within the first 5 years of the MOC cycle, then the other component completed in the second 5 years. As of January 2010, all diplomates certified in an anesthesiology subspecialty will also participate in the MOC program. There are some subspecialty specific requirements, but much of Part II and IV can have overlapping requirements in order to streamline the process for maintaining both primary anesthesiology and subspecialty certifications.
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Now to those of us who received “Non-Time Limited” certification: you are not required to participate in the formal MOC program. However, it is strongly encouraged by the ABA to enroll. Benefits, in addition to improving your practice, include, staying competitive with junior faculty, having the option to obtain financial incentive through the Physician Quality Reporting System (PQRS) (4) program and the option to withdraw your MOC status at any time. You must also be enrolled in MOCA if you wish to maintain subspecialty certification. A recent survey sponsored by the ABA was sent to 3,000 (out of approximately 40,000) randomly selected ABA diplomates asking their opinions regarding the certification and MOC process.(5) Although a limited response rate prevents making any true conclusions, the overwhelming perception about MOCA is that it is complex, timeconsuming, and expensive. Some of these perceptions may be due to the perceived lack of understanding of the MOC requirements and unclear relevancy to clinical practice. The ABA is working to improve diplomate satisfaction in regards to MOCA. While the overall MOC process is here to stay, the specific requirements within each component will likely continue to evolve in order to keep up with the latest advancements of our specialty, meet the needs of our changing practices, and improve attitudes toward the process.
To truly prevent an overall decrease in knowledge, we must make the commitment to our continuing education and practice improvement. Otherwise we may be left pondering how what we learned during anesthesiology residency has now become obsolete…
References: 1.
Arbesman S. The Half-Life of Facts: Why Everything We Know Has an Expiration Date. New York, NY: Penguin Group (USA) Inc.; 2013.
2.
[cited 2014 November 13]. Available from: http://www. theaba.org/Home/anesthesiology_maintenance.
3.
Weinger MB, Burden AR, Steadman RH, Gaba DM. This is not a test!: Misconceptions surrounding the maintenance of certification in anesthesiology simulation course. Anesthesiology. 2014 Sep;121(3):655-9. PubMed PMID: 24821072.
4.
[cited 2014 November 14]. Available from: http://www. cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/index.html?redirect=/PQRS/.
5.
Culley DJ, Sun H, Harman AE, Warner DO. Perceived value of Board certification and the Maintenance of Certification in Anesthesiology Program (MOCA(R)). Journal of clinical anesthesia. 2013 Feb;25(1):12-9. PubMed PMID: 23391341.
2015 MOCA® Simulation Courses at the University of Michigan Course information and registration available at: http://anes.med.umich.edu/main/programs/moca.html For additional information, contact Dr. Lauryn Rochlen at 734-936-4280 or rochlenl@med.umich.edu. Winter 2014
19
MOCAPEDIA
Maintenance of Certification:
Is it Here to Stay? Reach 100% Participation in ASAPAC Eric Larson, M.D. Board Director, MSA eric.larson@apcpc.net
Maintenance of Certification: Anesthesiology (MOCA).” That phrase is becoming a more common epithet among experienced anesthesiologists and new graduates alike. With each day more anesthesiologists are encountering the MOCA and are trying to navigate its requirements and costs. In addition, Maintenance of Licensure (MOL) has been presented to legislatures at both the state and national levels. Maintenance of Certification is a corporate program administered by the American Board of Medical Specialties, Inc. with our specialty specific certification run by the American Board of Anesthesiology. The Maintenance of Licensure is a corporate program administered by the Federation of State Medical Boards. Both organizations work to impose requirements on physicians in order to improve and assure quality. In fact, thanks to intense lobbying from the ABMS, Congress added increased reimbursements on Medicare payments for a few years through the Physician Quality Reporting System (PQRS) (and penalties for those who do not participate in MOC). However, over the last few years, complaints and a growing resistance has been blooming across the country and specialties to MOC and MOL. There are a number of concerns that physicians have expressed towards the MOC and MOL process. Fourteen state medical societies (including Michigan’s) have passed resolutions opposing the use of MOC as a component of the state licensure process. Indeed, many are concerned that the MOC is an unusually high added burden and expense when combined with our current CME requirements. It is also a way to usurp the state’s ability to regulate its own licensure programs. In fact, the Ohio State Medical Society successfully defeated MOL in Ohio a few years ago. The fact that there is such an ever increasing demand
for health care providers has alerted lawmakers to the potential risk that a MOC program might have on physician retention. Many physicians are now potentially setting their retirement based not on their finances, but on the timing of their MOC cycle and testing requirements. This risk is adding to legislators’ interests in passing legislation to prevent damaging mass defections from the physician ranks within their state. Until fairly recently, once one completed the USMLE Steps 1-3 and oral and written anesthesiology boards physicians were designated as consultants for life. Now that process has changed and become time limited. The consultant status now lasts only ten years at which point one loses one’s expert status in anesthesiology if one fails to re-enroll or complete the process in MOC. The MOC process for anesthesiologists changed so that one needs to complete four components: cognitive exam, professional standing, practice performance assessment and improvement (live simulator course and a fairly time consuming case evaluation or practice improvement plan which requires collection of demographic data over months of practice), and lifelong learning and assessment (90 ABA approved CMEs including 20 ASA safety CMEs). Aside from the significant time required to complete these components every ten years is the concern of the cost of the process. Current costs for anesthesiology include $2,100 per ten year cycle to enroll in MOC, $1,500-2,000 for the live simulator course, approximately $500 for travel and lodging to the simulator course, and the additional cost of $800 if one does not pass the cognitive exam on the first attempt (anesthesiology is rumored to have a less than 10% fail rate). Of course, these fees do not include the money spent by physicians in preparation of passing the exam and a cursory look through a number of sites yielded an expense of a few hundred dollars for
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review books to $1,500 for on-site review courses. The price tag of $6,000+ every ten years in addition to the time consumed completing the modules is not insignificant. This calculation does not even include the income lost spent completing the exams while out of the OR. Most notably, there has been significant resistance to MOC within the primary care specialty ranks. This year the American Board of Internal Medicine (ABIM) had a petition signed by 18,850 internists who opposed removing the grandfather status of all of its diplomates and making everyone enter the MOC process (even though there was no testing or modules to complete - just writing a check to qualify). Indeed, the internists, family practitioners, and pediatricians face ever increasing practice modules and demands to their time every two years in addition to their cognitive exams. ABIM’s cognitive exam has a pass rate of 78% on first attempts and 95% after three attempts meaning many have to retake the exam and pay the reexamination fee. This is the crux of many complaints because the physicians complain that it is in ABIM’s interest to collect more review course materials and tests fees. This in turn leads many to question the motivations of those leading ABIM or the American Board of Pediatrics (ABP) whose leaders make $850,000+ and $1.3 Million respectively. At the AMA’s interim conference in early November of 2014, physicians voted to change the AMA’s policy on MOC to include the following principles: •
•
• •
• • •
MOC should be based on evidence and designed to identify performance gaps and unmet needs, providing direction and guidance for improvement in physician performance and delivery of care. The MOC process should be evaluated periodically to measure physician satisfaction, knowledge uptake, and intent to maintain or change practice. MOC should be used as a tool for continuous improvement. The MOC program should not be a mandated requirement for licensure, credentialing, payment, network participation or employment. Actively practicing physicians should be wellrepresented on specialty boards developing MOC. MOC activities and measurement should be relevant to clinical practice. The MOC process should not be cost-prohibitive or present barriers to patient care.
Time will tell whether MOC and MOL become mainstays of physician accreditation or if some new process takes precedence. Efforts by physicians in Michigan have led to the introduction of bills to prevent MOL from occurring and also from MOC being a requirement to receive insurance payments or used for hospital privileges. Physicians at www. changeboardrecert.com may continue to introduce online petitions and resistance to what they view as onerous requirements and regulations put forth by ABMS corporations. Certainly, there will be more scrutiny of the MOC process going forward as physicians face ever increasing demands on their time for other administrative work while their salaries decline and they face increased competition from non-physician providers. Disclosure: Eric Larson is a board certified anesthesiologist and has completed his first cycle of MOCA with a new time limited board certification through 2025.
References: 1. Schulte BM, Mannino DM, Royal KD, Brown SL, Peterson LE, Puffer JC. Community size and organization of practice predict family physician recertification success. J Am Board Fam Med. 2014 May-Jun;27(3):383-390. 2. Cook DA, Holmboe ES, Sorensen KJ, Berger RA, Wilkinson JM. Getting Maintenance of Certification to Work: A Grounded Theory Study of Physicians’ Perceptions, published 3 November, 2014. JAMA Int Med doi: 10.1001/ jamainternmed.2014.5437 3. Sharp LK, Bashook PG, Lipsky MS, Horowitz SD, Miller SH. Specialty board certification and clinical outcomes: the missing link. Acad Med 2002; 77: 534_42. 4. Kempen PM: Maintenance of Certification and Licensure: Regulatory Capture of Medicine. Anesth Analg. 2014 Jun;118(6):1378-86. 5. Tax returns found at www.changeboardrecert. com 6. www.theaba.org/home for information on MOCA and its fees. Other fees were obtained by visiting a number of live simulator web sites and course review sites through a search engine.
21 Winter 2014 21
LEGISLATIVE CORNER
Congress
GCSI Election Update
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fter the August Primary, there weren’t really any surprises at the Congressional level. When David Trott defeated incumbent US Representative Kerry Bentivolio (R-11th District) in the Primary, he was all but assured victory in the seat. Current State Senator John Moolenaar is replacing Congressman Dave Camp who is retiring and former Senate Majority Leader Mike Bishop will take over US Representative Mike Rogers’ seat after Rogers declared he wasn’t seeking re-election. Our delegation remains split with nine Republicans and five Democrats. Democrats did hold on to the US Senate seat in Michigan after US Senator Carl Levin announced his retirement. Congressman Gary Peters handily defeated former Secretary of State Terri Lynn Land in that bid.
Michigan House of Representatives/Senate
At the state level, similar to what occurred on a national scale, Republicans running for the top statewide offices were swept to victory as voters returned Governor Rick Snyder, Attorney General Bill Schuette and Secretary of State Ruth Johnson to office for another term. Republicans maintained their 5-2 majority on the Michigan Supreme Court as incumbents Brian Zahra and David Viviano won as did newcomer Democrat nominated Richard Bernstein. In the state House and Senate, Republicans achieved even more stunning results. In the Senate, the majority was increased from 26 seats to 27 as incumbent Republican Senators were able to defeat their challengers. They also picked up a seat in the new 20th Senate district where Margaret O’Brien is currently holding on to a razor thin 60 vote lead over Sean McCann. A recount could be possible once the election results are officially certified. In the House, Republicans picked up a total of 4 seats increasing their majority from the current 59 seats to 63. They did this by warding off challenges to incumbents and also defeating two sitting members of the House (Rep. Theresa
Abed in the 71st and Rep. Collene Lamonte in the 91st). Winning candidates in these seats were Tom Barrett in the 71st and former Rep. Holly Hughes in the 91st. It should be noted that the Hughes winning margin over Lamonte currently stands at 58 votes and there could also be a recount in this race as well. In addition, the Republicans flipped two Democrat term limited seats (Rep. Kate Segal’s in the 62nd and Rep. Terry Brown’s in the 84th). Winning candidates were physicians-Dr. John Bizon in the 62nd and Dr. Edward Canfield in the 84th. Leadership elections for the House and Senate were held on November 6th. They put Arlan Meekhof (R-West Olive) in the position of Senate Majority Leader replacing Randy Richardville and Kevin Cotter (R-Mt. Pleasant) in the position of Speaker of the House replacing Jase Bolger. The position of Senate Democratic Leader currently held by Gretchen Whitmer will be assumed by Jim Ananich (D-Flint). Rounding out the top 4 caucus positions is Tim Greimel (D-Pontiac), who will repeat as House Democratic Leader. Senators Richardville and Whitmer and Speaker Bolger are all prevented from serving again due to term-limits.
Lame Duck
After lawmakers returned briefly following the November General Election, there was a recess for Thanksgiving and Hunting Season, and then the lame duck session in December. The House and Senate are tentatively scheduled to be in session through December 18, with a number of issues that still remain such as a solution to the road funding problem, and a host of education matters. Legislative session ended on December 18. Due to the timing of the printing and distribution of this edition of the Ventilator, there may be legislative updates to that which is written here. If you have any questions, please contact Marcia Hune at hune.m@gcsionline.com. Thank you.
Legislative Corner is a regular feature, written by Nell Kuhnmuench and Marcia Hune, Governmental Consultant Services, Inc.
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An item of particular interest to the MSA during the lame duck session includes the content of Senate Bill 180, which expands the definition of the “practice of nursing” to include “the administration of anesthesia by a registered professional nurse who holds a specialty certification as a nurse anesthetist”. This bill would remove the requirement of physician supervision of nurse anesthetists. While SB 180 remains in the Senate Health Policy Committee, and testimony hasn’t been heard again on the issue since the fall of 2013, we continue to believe that amendments removing physician supervision for nurse anesthetists could be added to Senate Bill 2.
Policy Committee, where it could still be considered in December. Among other things, Senate Bill 2 would authorize a licensed APRN to prescribe and administer nonscheduled prescription drugs and Schedule 2 through 5 controlled substances if he or she met certain criteria; allow an APRN to issue a complementary starter dose of a prescription drug or Schedule 2 to 5 controlled substances; and greatly expand their unsupervised scope. We continue to monitor for possible action on SB 2 in the lame duck session and especially are on the lookout for further amendments to the bill which may address removal of physician supervision of nurse anesthetists.
SB 2, which is sponsored by Sen. Mark Jansen (R-Grand Rapids), provides for an expansion of scope for certain advanced practice registered nurses (APRNs), including certified nurse midwives, certified nurse practitioners, and clinical nurse specialists-certified. The bill has passed the full Senate and is currently before the House Health
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 either of us at kuhnmuench.n@gcsionline. com or hune.m@gcsionline.com.
Call for Nominations
The MSA Board of Directors is seeking nominations for MSA Active Members to serve as Directors, Delegates, and Alternate Delegates. The MSA Board meets approximately three times each year, with an additional Delegation meeting at the ASA Annual Conference. Board Members are encouraged to be actively involved in MSA’s legislative advocacy efforts, the ASA Legislative Conference in Washington D.C., and on MSA Committees.
Board Positions
Directors – three-year term Delegates to the American Society of Anesthesiologists – three-year term Alternate Delegates to the American Society of Anesthesiologists – one-year term
If you are interested in being nominated to any of these positions, or in serving on a committee, please contact the MSA office at 517.346.5088 or e-mail admin@mymsahq.org Winter 2014
23
PRESORT STD U.S. POSTAGE
PAID
LANSING, MI PERMIT NO. 234
120 N. Washington Sq., Suite 110A Lansing, MI 48933 Phone: 517.346.5088 Fax: 517.371.1170
MSA - PAC Critical issues affecting your practice will be decided by the State Legislature. Your contribution is needed more than ever! Enclosed, find my contribution for o $500 o $250 o $150 Name ______________________________________________________________________________________ Address_____________________________________________________________________________________ Phone Number ____________________________________Personal Check__________ payable to MSA-PAC N O CO R P O R AT E C H EC K S Visa/Mastercard____________________________________________ Expiration Date________/_________ Cardholder’s Signature______________________________________ Forward your contribution to: 120 N. Washington Sq., Suite 110A, Lansing, MI 48933 Contributions to MSA-PAC are not tax deductible as business expenses or charitable contributions.