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Winter 2017

Pennsylvania Society of Anesthesiologists Newsletter

PRESIDENT’S MESSAGE

I Ask You To Be Prepared to Act As We Go Forward by Tom Witkowski, M.D. I want to update you on activities which affect us within Pennsylvania and within PSA. We had a very successful strategic planning meeting on November 4 which was led by ASA CEO Paul Pomerantz. Interested PSA members at all levels of practice from across the state shared ideas and experiences. The goals as a result of these conversations is to improve our activities in four areas: advocacy for our patients and for anesthesiology; communication with the PSA membership; provide educational opportunities for our members; and public education opportunities. Steps are already being taken in these areas to improve member experience and more will be done in the future. As an example of improved communication, the PSA website has been redesigned with the goal of improving its ease of use and information availability. This legislative cycle has generated a lot of activity on

many fronts. With regard to Pennsylvania’s drug monitoring program, there is ongoing work to limit the requirement for an anesthesiologist to query the database for every case. This is reasonable as an anesthesiologist practicing in an operating room is not positioned to provide any follow-up care or referral to a patient with an identified problem. There has already been a change to the program’s FAQs regarding anesthesiologists, but we will continue to work on a legislative change to clarify the issue further. Balance billing of out-of-

network patients remains a contentious issue at both the state and national levels. In Pennsylvania, both House Bill 1553 and Senate Bill 678 attempt to address this issue. I think all of us support the concept that patients with health insurance should have some protection from receiving unexpected medical bills that they are unable to pay. This problem exists, in part, because of insurance networks, which do not include all specialists and pose difficulties when determining who is in network with different plans. Many of the proposed solutions, as well as legislation passed by other states, have set rates which significantly disadvantage providers and benefit insurers. The devil is really in the details with this issue. PSA is currently working in a coalition with six other physician groups, negotiating with insurers to provide a framework which will both protect patients and allow fair payment to out-of-network continued on page 9

www.psanes.org Telephone (717) 558-7750 ext. 1596


Winter 2017

Contents Inside This Edition

PAGE 3

The Schaner Cup

PAGE 4

You Will Be Surprised When You Find Out What an Anesthesia Tech Can Do for You!

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Physician Opioid Over-Prescription $1.7 Million Jury Verdict Upheld

PAGE 8

Winter Legislative Update

PAGE 11

Pennsylvania Residents at Anesthesiology 2017

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A Doctor’s Tale

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CMS Releases 2018 Final Rule

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Have You Done Your SRA?

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In Memoriam - Robert Hoffman

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2016-2017 Officers President Tom Witkowski, M.D.

Sentinel

Pennsylvania Society of Anesthesiologists Newsletter

Association Director Libby Dietrich

President-Elect Richard Month, M.D.

Vice President Shailesh Patel, M.D.

Past President Bhaskar Deb, M.D.

Editor Richard P. O’Flynn, M.D.

Secretary-Treasurer

President Tom Witkowski, M.D.

Asst. Secretary/Treasurer

Margaret M. Tarpey, M.D. Patrick J. Vlahos, M.D.

The PSA Newsletter is an official publication of the Pennsylvania Society of Anesthesiologists Inc. Opinions expressed in this newsletter do not necessarily reflect the Society’s point of view. All correspondence should be directed to: PSA Newsletter 777 East Park Drive, P.O. Box 8820 Harrisburg, PA 17105-8820 717/558-7750 ext. 1596

www.psanes.org

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District IX Director Erin A. Sullivan, M.D.

Alternate District Director Joseph F. Answine, M.D.

Delegates to the ASA House of Delegates Joseph F. Answine, M.D. Joshua H. Atkins, M.D., Ph.D. Andrew Boryan, M.D. Robert A. Campbell, M.D. Bhaskar Deb, M.D. Joseph W. Galassi, Jr., M.D. ​David M. Gratch, D.O. Andrew Herlich, M.D. Donna Kucharski, M.D. Richard Month, M.D.

Pennsylvania Society of Anesthesiologists Newsletter

​ ristin Ondecko Ligda, M.D. K Shailesh Patel, M.D. Mark J. Shulkosky, M.D. Margaret M. Tarpey, M.D. Thomas Witkowski, M.D.

Alternate Delegates to the ASA House of Delegates Adam Childers, M.D. Lee A. Fleisher, M.D. Shannon Grap, M.D. Michael S. Green, D.O. Mark Hudson, M.D. Philip A. Mandato, D.O. Gordon Morewood, M.D. Craig L. Muetterties, M.D. Richard P. O’Flynn, M.D. Ben Park, M.D. Stu Sidlow, M.D. Saket Singh, M.D. Patrick J. Vlahos, D.O. Scott Winikoff, M.D.

Delegate, Pennsylvania Medical Society House & Specialty Leadership Cabinet Shannon Grap, M.D.

Alternate Donald Martin, M.D.

Carrier Advisory Representative Gordon Morewood, M.D.


INSIDE

Richard O’Flynn, M.D., Editor

This

EDITION

As 2017 comes to a close, it is a good time to reflect on the past year. The most important issue of 2017 was the proposed VA Nursing Handbook change which would have allowed, and even mandated, independent practice of all VA employed advanced practice nurses including CRNAs. Veterans, anesthesiologists, and concerned citizens posted commentary into the federal register opposing this policy. This strong opposition won the day and veterans still have access to physician anesthesiologists. It should be understood by all anesthesiologists that the reason cited by the federal government for not allowing independent CRNA practice is the assessment that there is not an existing access problem requiring a change in policy. This is a cautionary sign that this policy could re-emerge in the future. The VA bureaucracy has not conceded that physician anesthesiologist involvement in patient care is mandatory or superior. There is still work to do. Pennsylvania Director Dr. Erin Sullivan again planned and hosted another successful ASA Legislative Conference in Washington in May. The value proposition of physician advocacy was clearly demonstrated with the 2017 conference having the highest attendance ever for this event. The Legislative Conference is an annual event providing anesthesiologists an

opportunity to network with physician anesthesiologist leaders from across the country. Leading federal issues are presented in a timely and easily understood manner. Lastly, Capitol Hill meetings with legislators and staff provide an opportunity to strengthen our specialty and advance policies to improve patient care. On another note, PSA will miss Dr. Donald Martin who is stepping down from the Board. Dr. Martin has served as President of our Society, Delegate to the ASA, and District Director. He has long been called “Mr. PSA” by one of our Board members. His contribution to PSA and ASA over the years cannot be overstated. Now looking to the future, in this edition of the Sentinel there is an important article “Reliable Performance of Correct Site Nerve Blocks”. Drs. Martin and Atkins represented PSA on this committee. The evidence shows that 40% of the reported events are related to nerve blocks. Even with the added time-outs and increased awareness, these events still occur and have actually increased in the past two years. This is an area of improvement that PSA will pursue with Dr. Josh Atkins leading on this important issue.

This edition also includes details on the CMS update for endoscopy payment. Kevin Harley from Quantum Communications provides an update on legislative activity in Harrisburg. Dr. Joseph Answine reports on activities of the American Society of Anesthesia Technologists and Technicians Committee and the newly appointed Z-PAC Treasurer, Dr. Craig Muetterties, provides an update on the very important activities of our Political Action Committee. The Sentinel welcomes our new PSA President Dr. Thomas Witkowski and his commentary on the future of our specialty society. As the New Year approaches let us all reflect on our timeless ASA motto, “Vigilance.” This is a critical activity for the care of our patients. It is also a critical activity for the future of our specialty. Always vigilant, PSA exists to serve you and your patients.

Pennsylvania Society of Anesthesiologists Newsletter

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Z-PAC UPDATE

The Schaner Cup by Craig Muetterties, M.D., PSA Treasurer

25 years ago, I attended a conference with a friend. Though we had both known each other for a long time, our relationship was not always amicable. His own life had gone through a series of highs and lows, but he had come to a point of peace in his life as had I. We were now friends and shared many common goals. At the conference, I noticed a cup for sale that contained the statement, “Live A Legacy / Make a Difference in Your Lifetime”. I purchased the cup because the statement it made captivated me. I wanted to make a difference in my life and especially my profession. It was around that time that I joined the PSA. I wanted to donate my time and effort to our Society. My first Society meeting in Harrisburg was humbling. There were people at that meeting who were giants in the field of anesthesiology in Pennsylvania. These people had taken time out of their busy lives

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to assure our profession would be the best that it could be in our state and nationally. One of the first people that I met was Dr. Paul Schaner. He was quite friendly and I was amazed that I was talking to a physician who had been one of the first to describe a now well-known and disastrous complication from succinylcholine1. While his thoughts were weighty, Paul never missed an opportunity to make a pun. Paul was truly “Living A Legacy.” In addition to serving as a longtime delegate, regional director and president of PSA, Paul made a decision to make such difference in our Society that it has been a legacy for over 30 years. He created one of the first medical political action committees in Pennsylvania. He realized that in addition to assuring the purity of our specialty, we needed to be able to educate legislators and talk to them about things that would impact patient safety and the practice of our specialty in the state. This is how PSA’s Z-PAC was born. Over the years, Z-PAC contributions have opened the doors to discussions with legislators and have allowed a rich dialogue that our Society has come to enjoy. Sadly, only a small percent of our membership has joined in this process. I would like to invite you to begin to be a part of that legacy for future anesthesiologists in the state by making a contribution. The decision is yours…

Pennsylvania Society of Anesthesiologists Newsletter

Reference 1.

Schaner, PJ, et. al., Succinylcholine-Induced Hyperkalemia in Burned Patients, Anesthesia & Analgesia: September-October 1969 - Volume 48 - Issue 5 - pp 764-770.

Payroll deductions to Z-PAC The following groups have taken it upon themselves to establish a payroll deduction plan for individual member donations to the PAC. Their contributions greatly help the PAC because they provide a constant stream of funds throughout the year. The PAC would like to recognize these groups: Allentown Anesthesia Associates Anesthesia Associates of Lancaster Anesthesia Specialists of Bethlehem Northeastern Anesthesia Physicians Reading Anesthesia Associates Riverside Anesthesia Associates Society Hill Anesthesia Consultants United Anesthesia Services


You Will Be Surprised When You Find Out What an Anesthesia Tech Can Do for You! by Joseph A. Answine, M.D., FASA ASA liaison to the ASATT

The American Society of Anesthesia Technologists and Technicians (ASATT) was established in 1989 to provide standards for scope of practice and education for a specialty,

that at that time, was made up of individuals receiving only on-the-job training with job responsibilities that were determined by the hospital systems and departments for which they worked. There was extreme variability in their practice based on the needs of the facilities. Since its inception, the ASATT established a coordinated governing body, a scope of practice and curriculum for technologists. The Society has moved away from on-the-job training to a defined education process, and is working on moving away from hospital and department-defined responsibilities to those defined by state boards and national accrediting bodies. While anesthesia services have become much more diverse, technology has advanced, and anesthesia care has expanded from the operating room to include multiple sites throughout a hospital system such as ICUs, radiology suites, cardiac catheterization labs, small procedure rooms and outpatient facilities; anesthesia technologists and technicians are becoming increasingly more valuable members of the anesthesia care team. The ASATT required curriculum for the anesthesia technologist includes, at a minimum, an associate or bachelor of science degree and the following specific courses: continued on page 6

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YOU WILL BE SURPRISED continued from page 5 A. Anatomy and Physiology B. Chemistry (In addition, Medical Terminology and Physical Education are recommended.)

Professional Curriculum Components: A. Introduction to Anesthesia Technology B. Basic and Advanced Principles for Anesthesia Technology C. Anesthesia Pharmacology D. Basic and Advanced Anesthesia Instrumentation (Lab) E. Clinical Experience F. Capstone Project

4.

5.

6. The following is a basic description of the scope of practice of the anesthesia technologist/technician as described by the ASATT as based on common practice within institutions throughout the United States.

The Certified Anesthesia Technologist and Technician: 1. Is proficient in the application, acquisition, preparation, and troubleshooting of various types of equipment required for the delivery of anesthesia care. 2.. Understands and applies universal precautions. 3. Can perform anesthesia machine and monitor checkouts, react to device alarms, and diagnose and correct machine/monitor problems. These devices

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7.

8.

include active warming devices, capnography/ capnometry, drug infusion pumps, electrocardiograms, fluid warmers, neuromuscular blockade monitors, precordial/ esophageal stethoscopes, pulse oximeters, and rapid infusers. Demonstrates knowledge of the indications and processes for placement of the following invasive pressure monitors: arterial pressure, central venous pressure, intracardiac/pulmonary artery pressure, and intracranial pressure. Demonstrates airway management knowledge, comprehension and able to provide assistance in all age groups. Assists with diagnosis and treatment of the following problems in relation to manual or artificial ventilation: accidental extubation, anesthesia machine malfunction, endotracheal tube migration, hypercarbia/ hypocarbia, hypoxia, and increased peak airway pressures. Is proficient in basic airway setup, troubleshooting problems or issues that arise with airway equipment, and assisting with appropriate airway management techniques. Optimizes patient position during airway management, assists with mask ventilation and supports the anesthesia care provider with oxygen delivery during periods of desaturation, identifies various intubation modalities, and assists with confirmation of correct placement of the endotracheal tube following endotracheal intubation.

Pennsylvania Society of Anesthesiologists Newsletter

9. Demonstrates a thorough knowledge of the ASA difficult airway algorithm. 10. Has knowledge of the proper procedure and equipment required for nasal intubations, and demonstrates appropriate knowledge and can assist with placement of airway adjuncts and confirm placement. 11. Demonstrates knowledge, comprehension and practical assistance with relation to fluid, whole blood, salvaged blood and blood component management during patient care. 12. Understands the relationship of fluid deficit, maintenance fluid, blood, and insensible losses to the patient. 13. Understands the complications that can occur as a result of administering blood and blood products, and assists in identifying and provides support in the treatment of transfusion related reactions. 14. Demonstrates the ability to secure intravenous access, understands and provides appropriate fluid types per patient situation, demonstrates knowledge and understanding of ABO and, Rh typing, and assists with proper procedure for checking blood and blood products. 15. Is required to demonstrate knowledge of pharmaceuticals and their practical use by the anesthesia provider during patient care. 16. Identifies side effects of commonly used drugs in anesthesia based on human physiology, patient condition and body habitus, and Identifies potential drug interactions and has knowledge of alternative


medications, and identifies adverse drug reactions. 17. Demonstrates knowledge and basic comprehension of medications in sequence and dose as mandated by the American Heart Association ACLS/PALS guidelines. 18. Utilizes BLS, crisis management knowledge, comprehension, and application to all age groups. 19. Demonstrates knowledge, comprehension and able to practically apply the following factors in relation to pathophysiology and anesthesia management during patient care: cardiovascular, gastrointestinal, genitourinary, hematologic, hepatic, musculoskeletal, neurologic, renal, respiratory. 20. Demonstrates knowledge and aptitude with multiple devices and equipment. Furthermore, an understanding of maintenance standards and regulations should be demonstrated. Guidelines, policies and competencies should minimally include: calibration, functional testing, principles of operation, requisitioning for inspections, recording of inspections, routine maintenance, sterilization, and troubleshooting. 21. Can provide assistance, testing and operation of following devices: blood salvaging devices (Cell Saver), transesophageal Echocardiography (TEE), intra-aortic balloon pump (IABP), mechanical function of infusing local anesthetics as directed and in the presence of an anesthesia care provider, point of care testing and lab equipment,

activated clotting time tests, arterial blood gas analysis, blood chemistry (i.e. I-Stat), glucometry, hemoglobin/ hematocrit testing (i.e. HemoCue), rotational thromboelastometry (ROTEM), and thromboelastogram (TEG). 22. Is knowledgeable in the application of equipment for neuraxial anesthesia and regional anesthesia, and can assist with placement. 23. Comprehends and supports the application of anesthetic principles related to critical event management with the following: airway, acid/ base, electrolyte imbalances, anaphylaxis, cardiac events, disseminated intravascular coagulation, hemorrhage, local anesthetic toxicity, machine malfunction, malignant Hyperthermia, renal dysfunction, shock states, and ventilation. 24. Will maintain and organize the anesthesia environment, equipment, supplies and personnel to facilitate department functions. These functions may include: recognize, adhere and is knowledgeable of The Joint Commission (TJC) accreditation policies and procedures, Sentinel events, national safety goals, environment of care and other TJC recommendations; confirms and maintains sterile supplies within the expiration date according to established practice; understands and complies with inventory rotation and use per accepted standards; ensures accuracy and retains maintenance records of essential anesthetic equipment or has immediate access to records; adheres

to guidelines provided by Material Safety Data Sheets (MSDS) on hazardous materials and supplies within the anesthesia environment; understands Occupational Safety & Health Administration guidelines for anesthesia and patient safety in the perioperative environment; conducts quality control procedures after repair or service to equipment; assists in the preparation of the capital budget for the anesthesia department; provides training and orientation to staff as needed; maintains medications within their expiration date and properly disposes of unused or remnants in appropriate containers; is knowledgeable of the College of American Pathologists (CAP) and the Center for Medicare and Medicaid Services’ (CMS) Clinical Laboratory Improvement Amendments (CLIA) regulations for ancillary laboratories; understands and follows the American Association of Blood Banks (AABB) recommendation and policies regarding banked blood products and cell salvaged blood, and in accordance with employer and professional policies; recognizes and adheres to conduct and ethics rules.

Ok, by now, you should be impressed! The anesthesia technologist/technician is already an incredible asset to our anesthesia care team, yet, as the ASATT continues to standardize their education and practice, their contribution can and will be so much more.

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Physician Opioid Over-Prescription: $16.7 Million Jury Verdict Upheld by Charles I. Artz, Esq. PSA General Counsel In what appears to be the first published decision of its kind, a state appeals court has upheld a jury verdict imposing negligence liability on a physician for overprescribing opioids and a $16.7 Million compensatory and punitive damages award. In Koon v. Walden, ___ S.W. 3d ___ (2017) (2017 WL 4782843), the patient and his wife sued his physician and the physician’s employer for negligence and punitive damages because the physician overprescribed opioids which caused him to become addicted, resulting in damages to the patient and his wife. The jury returned a verdict in favor of the patient and his wife, assessing 67% of the fault to the physician and his employer and 33% fault to the patient. The jury awarded the patient and his wife $1,742,000 in compensatory damages, and

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$15,000,000 in punitive damages. The physician and his employer appealed. The Court of Appeals upheld the jury verdict on both the compensatory and punitive damages awards and held the physician and his employer: 1. Failed to weigh the risks and benefits of prescribing opioids to the patient; 2. Overprescribed opioids to the patient; 3. Failed to monitor the patient’s opioid treatment; and 4. Failed to assess the patient for dependency or addiction. The court of appeals upheld the compensatory damages award for negligence, holding the physician directly negligent and the employer negligent under the doctrine of respondeat superior, which means an employer is vicariously liable for injury-

Pennsylvania Society of Anesthesiologists Newsletter

causing conduct of an employed physician done within the course and scope of employment. There was a significant battle over the punitive damages award, but the court held that there was enough evidence to show complete indifference to or conscious disregard for the safety of the patient, justifying the $15 Million in punitive damages. The court held that the plaintiff did not have to prove willful, wanton or malicious conduct to recover punitive damages. The patient’s escalating dependence on opioids and the physician’s failure to properly monitor the patient’s use of those powerful pain killers appear to be the primary factors in the litigation and the verdict. In 2008, the patient sought treatment from his primary care physician (Dr. Koon), trying to get relief from significant


back pain. The physician initially told the patient to take over-the-counter ibuprofen, but wrote a prescription for hydrocodone when the patient said the less-powerful ibuprofen was not effective. Over the course of one year, the physician authorized refills and increased the hydrocodone dosage multiple times at the patient’s request. The patient alleged the physician did not follow existing medical standards that required physicians to closely monitor patients’ opioid use and intervene if it appeared the patient was becoming too dependent on the drugs. By October 2009, the patient was taking hydrocodone, oxycontin and oxycodone, all prescribed by the physician. The experts who testified at trial stated that the amounts prescribed between 2008 and 2012 were “excessive”, “colossal” and “astronomical”, and exposed the patient to a high risk of injury or death. The plaintiff argued, the jury agreed and the Court of Appeals upheld the findings of the expert witnesses that the physician violated the standard of care. The court of appeals stated there are serious risks associated with opioids, including tolerance, dependency, addiction, life-threatening respiratory disease, depression, overdose and death. All patients who use opioids for long enough will become tolerant and dependent, and some will become addicted. Opioids are obviously dangerous, Schedule II drugs identified by the DEA.

This case is noteworthy because it is the first published decision I have seen imposing negligence on a physician for allegedly overprescribing opioids. The $1.7 Million compensatory damages award is enough to create concern, but the $15 Million punitive damages award obviously creates even more concern. Although we certainly expect an appeal to the Supreme Court, and the Supreme Court might be likely to hear the case, unless and until this decision is reversed, the compliance recommendations are clear. Physicians should follow the standard of care described by the court closely, implement and execute pain management contracts with every patient to whom opioids are prescribed for chronic pain, and implement the assessment and monitoring protocols consistent with the court’s standards as summarized above. continued on page 10

PRESIDENTS MESSAGE continued from page 1 physicians. Mutually agreeable terms can be incorporated into the language of these bills which will permit all parties to be treated fairly. We continue to address issues with delivery of anesthesia care. Supervision is a patient safety issue and not an issue of access to care or control of cost within the state of Pennsylvania. Recently, Senator Killion introduced Senate Bill 960 which would put into law a requirement for physician supervision of anesthesia. The corresponding House Bill 789 was introduced by Rep. Christiana in March. We all need to be involved as these bills progress through the legislature. It is what we need to do to protect our patients. Finally, the Department of Health is rewriting rules for a healthcare provision in Pennsylvania as part of a general change in regulation by the Governor to improve the efficiency of business in Pennsylvania and reduce unnecessary regulations. One of the new proposed regulations would remove a requirement for anesthesia supervision by a physician, and allow individual hospitals to decide on standards for anesthesia care in individual institutions. I think you would agree that this is not an action in the best interests of our patients. We are actively working against this change. It is likely that all of these issues will require your attention and involvement in the future and I ask you all to be prepared to act as we go forward.

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PHYSICIAN OPIOID continued from page 9 The court of appeals made numerous findings regarding the applicable standard of care, which are imperative to consider, as follows: 1. Opioids should only be prescribed for severe enough pain that is not adequately relieved by alternative nonnarcotic treatment. 2. Opioid therapy should begin at the lowest effective dose of immediate-release opioids and go up slowly if needed. 3. Opioids should be stopped as soon as possible. 4. The standard of care requires physicians to conduct a risk assessment with the patient before prescribing opioids, in which the physician discusses the risks versus the benefits of giving opioids to the particular patient for the particular pain. 5. The risks and benefits should be reassessed at an office visit each time the dose of an opioid is increased. 6. Once a patient is taking opioids, the patient should be monitored regularly, meaning regular contact to assess pain levels and functioning and to check for side effects and behaviors that would suggest the patient is becoming addicted. 7. The risk assessments and the results of monitoring a patient should be documented in the medical records. 8. Physicians must also keep track of the amount of opioids – number of pills and dose – that the patient is taking. 9. The physician must have a medication management

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system in place to make sure patients do not receive too many opioids. 10. The maximum daily dose recommended for a patient with non-cancer pain is between 90 and 120 milligrams MED (which means the morphine equivalency dose). 11. Although this upper limit (between 90 and 120 milligrams MED) is not contained in any textbook, law or label, it has been the standard for many years to help physicians recognize when it is time to refer a patient elsewhere. 12. If a patient’s pain is not adequately controlled by about 100 milligrams MED of opioids, the patient should be referred to a pain management specialist because by 200 milligrams MED, the risk of addiction, abuse and dying increases sharply. 13. Warning signs that a patient is dependent or addicted to opioids include patterns of early refills, asking for higher doses, taking multiple doses at once and exhibiting a loss of control over the ability to take the medication as prescribed. 14. Patients who become addicted to opioids cannot themselves articulate the effect the increased doses of medication are having on their lives and will continue taking medicine despite those adverse effects. 15. If a physician suspects the patient is addicted, the physician should cease opioids and help the patient wean off of them.

Pennsylvania Society of Anesthesiologists Newsletter

16. The risks associated with opioids were well known to anyone prescribing these drugs, including the physician and his employer. 17. There was no real dispute at trial that physicians should weigh the risk and benefits of opioids, should prescribe the lowest effective dose for the shortest amount of time and only when other modalities of treatment are ineffective, should monitor their patients carefully and assess them for signs of dependency and addiction. 18. The patient was taking sleeping medication and sedatives at the same time as the opioids, which exposed the patient to a higher risk of life-threatening respiratory depression. 19. Over a period of four years, the patient went from a prescription for six opioid pills a day to almost 40 opioid pills a day. 20. The patient’s expert testified there was no legitimate medical purpose for the physician to prescribe the patient opioids in these amounts and for this length of time. The expert stated that a patient with low back pain should never be treated with chronic opioid therapy by a primary care physician. 21. The expert also testified that the physician did not conduct a risk and benefit assessment that met the standard of care, nor was there any system in place to adequately monitor the patient’s use of opioids in accordance with the standard of care, all of which contributed to the patient’s injuries.


2017 Winter Legislative Update by Kevin Harley Quantum Communications Settlement Fund. by PSA that places into the Medical Much of the House business Practices Act the current Department of is currently at a standstill as Health Regulation that states a physician Penn State Hershey they continue a protracted floor must supervise the administration of Division of Anesthesiology and Perioperative Medicine debate over a severance tax on anesthesia in a hospital. natural gas drilling. This is an important legislative is offering a unique, personalized, regional anesthesia Speaker of the House Mike step, since it is the first time that the and acute pain management preceptorship for physicians Turzai recently announced that Supervision Bill has been introduced he is running for governor. That in the Senate. The bill was placed in Preceptorship includes: sets up an interesting dynamic the Senate Consumer Protection and  In situ, 3-day real-time observation of a comprehensive regional anesthesia practice and acute pain management with Gov. Wolf, not only for Professional Licensure Committee. techniques in an academic setting next year’s budget including: debate, but Rep. Jim Christiania introduced similar  Ultrasound-guided regional anesthetic procedures also for the remainder of the legislation the House (HB 789) earlier  Continuous ambulatory perineural catheter placements for upper and lowerinextremity surgery In late October, the legislature legislative session. this year. ERAS-focused neuraxial anesthesia for abdominal surgery finally agreed to a revenue plan to Sen. Killion has been a strong  Truncal blocks for abdominal and thoracic surgery pay for the spending bill passed supporter PSA throughout his approachesSenator to regional anesthesia and pain management involvingoftotal joint replacement program Killion Introduces at the endof Evidence-based June. After a nearly legislative career, first as House member  Hands-on, one-on-one practice of regional techniques in fresh cadavers five-month delay, the House and Supervision Legislation in and now as a senator and member of  Approaches to acute Senate agreed to fund the statepain management techniques and home regional programs the Senate the Senate one-on-one Consumerscanning Protection and The clinical observation of regional anesthesia will be supplemented with hands-on, workshops budget byexpanding gaming, and cadaver anatomy demonstrations Professional Licensure Committee. Sen. Tom Killion (R - Delaware using surplus money from Sen. Killion is passionate about County) formally introduced restricted accounts and more information, contact Chris Mulvey 717-531-7988 or email cmulvey@PennStateHealth.psu.edu legislation (SB at 960) supported continued on page 12 borrowing from theFor Tobacco

Penn State Hershey Division of Anesthesiology and Perioperative Medicine is offering a unique, personalized, regional anesthesia and acute pain management preceptorship for physicians Preceptorship includes: 

In situ, 3-day real-time observation of a comprehensive regional anesthesia practice and acute pain management techniques in an academic setting

Ultrasound-guided regional anesthetic procedures including:

      

Continuous ambulatory perineural catheter placements for upper and lower extremity surgery ERAS-focused neuraxial anesthesia for abdominal surgery Truncal blocks for abdominal and thoracic surgery

Evidence-based approaches to regional anesthesia and pain management involving total joint replacement program Hands-on, one-on-one practice of regional techniques in fresh cadavers Approaches to acute pain management techniques and home regional programs The clinical observation of regional anesthesia will be supplemented with hands-on, one-on-one scanning workshops and cadaver anatomy demonstrations

For more information, contact Chris Mulvey at 717-531-7988 or email cmulvey@PennStateHealth.psu.edu

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LEGISLATIVE UPDATE continued from page 11 patient safety. He understands the common-sense approach we support that would continue the administration of anesthesia as a team led by a physician. The Supervision Bill faces stiff opposition in the Senate from the Pennsylvania Association of Nurse Anesthetists. It is important for your state senator to hear from you, asking for support of Sen. Killion’s Supervision Bill.

Balance Billing Balance billing legislative activity is in full swing. PSA is vigorously engaged in the legislature helping to create

and lead a coalition of hospital specialists and the Pennsylvania Medical Society (PAMED). The coalition is known as the Pennsylvania Coalition of Out-ofNetwork Services. Most of the legislative activity is taking place in the House where Rep. Matt Baker, the Republican Chairman of the House Health Committee, has introduced legislation that, as it is currently written, is not favorable to providers. We have written language that can be amended into the bill to protect consumers and providers. We have advocated they use an independent, non-profit, thirdparty benchmarking claims database — such as Fair Health

— to determine the payment for an out-of-network provider. PSA and the coalition have been in continual communication and have participated in stakeholder meetings with the House and with insurers. Dr. Don Martin, Dr. Josh Atkins, Dr. Shannon Grap and the PSA Insurance Committee have been invaluable in helping to guide the coalition to consensus. To date, the Senate has not been as active as the House. We have meet with Sen. Don White, the prime sponsor of the Senate balance billing legislation (SB 678), and his committee staff offering suggestions for addressing “out-of-network” billing in a commonsense and equitable manor for consumers and providers. We expect a high level of activity in the House in the coming months on the balance billing legislation.

Advocacy

1515 Market Street, Suite 1100 Philadelphia, PA 19102 888-699-4222 www.SeltzerLegal.com

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Pennsylvania Society of Anesthesiologists Newsletter

As the balance billing debate heats up, we need your help. It is vital to our success that the members of the General Assembly hear from you. Whether it is promoting our supervision legislation or stopping PANA legislation that is harmful to your practice from moving through the General Assembly, you are the strongest lobbying voice we have. Please make an effort to get to know your state senator and representative. If you would like Quantum to help arrange a visit with your senator or representative, please contact us 717-213-4955.


Pennsylvania Residents at Anesthesiology 2017 by Robert S. Schoaps, M.D. President, PSA Resident Component

President, Tom Witkowski, M.D. as he presented Bhaskar Deb, M.D. with a plaque of appreciation for his service over the past year. ASA PAC contributions remained a hot topic this year amongst the resident delegation. We would like to congratulate

The ASA’s Annual Meeting in Boston saw Pennsylvania residents participating in full force. The weekend’s business activities kicked off with the Resident Component’s annual business meeting, with more than thirty Pennsylvania resident anesthesiologists in attendance. In addition to discussing some of the topics below, we also conducted officer elections for the coming year. We wish to congratulate Lucy Guevara, M.D. (Penn State) as the incoming President-Elect and Connie Bruno, M.D. (Temple) as the incoming Secretary! We look forward to a productive year with the new leadership! Following the Resident Component meeting, residents attended the PSA’s Annual Business Luncheon. While there, we heard from ASAPresident James Grant, M.D., who addressed the group and expressed his gratitude for Pennsylvania’s role in our specialty’s national society. We also welcomed the incoming PSA

UPMC and Geisinger for, once again, achieving a 100% resident contribution rate! Both of these programs serve as excellent examples for residency programs across the country, as they continue to demonstrate engagement in the national discussion on advocacy in anesthesiology. During the Resident Component business meeting, we discussed the importance of ongoing resident advocacy and PAC contributions, and brainstormed strategies to increase involvement in an effort to obtain 100% resident contributions from all eight programs in Pennsylvania. This year, the Resident Component

established contacts at each program and plans to work with them throughout the year in order to set a new precedent for resident PAC contributions in Pennsylvania. We also introduced a new initiative for the coming year: a friendly competition called the Keystone Cup! There are several important statelevel advocacy issues in Pennsylvania this year, and we feel it is our duty as resident leaders in anesthesiology to spread awareness of these issues to our colleagues. The competition will begin after the first of the year and will be awarded at the 2018 Legislative Conference in Washington, D.C., so stay tuned for more details! Speaking of the Legislative Conference, we are proud to report there was a resident from every Pennsylvania residency program in attendance last spring. For the Legislative Conference this coming May 14-16, 2018, we would like to continue this trend and, ideally, would like to have at least two residents from each program: one senior (CA-2 or -3) and one junior (CB or CA-1). We continued on page 21

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A Doctor’s

Tale

Editor’s note: The Society is indebted to the courage of this physician who wishes to share his experience. It is his and our hope that this can be an encouragement to someone who is in a similar situation.

I am a practicing anesthesiologist. Twenty-nine and a half years ago, I made a fateful decision. I began to use fentanyl. Since that time, people have told me my decision was immoral, stupid, weak-willed, due to a character flaw, crazy or showed poor judgement. Whatever people think of my motives, I have probably already heard the pronouncements from others and

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I have said most, if not all of them to myself as well. At the time I was early in practice, trying to make a good impression on my future partners. There were many things going on at the same time, starting at a new practice, setting up a home, and working on getting the family moved out to where I was working as the job I took was a few states away from my wife and children. At the same time, I was also exercising daily. Several months into the job I began having neck pain and I lost strength in my left triceps muscle, discovered as I was trying to use my arm to intubate patients. I sought a “curbside consult” with a spine surgeon who agreed that I had lost muscle strength. With a series of tests, I was told that I had

Pennsylvania Society of Anesthesiologists Newsletter

ruptured a disk in my neck and needed surgery. So, despite my fears of future disability, paralysis, letting my family and partners down, I had cervical spine surgery. It went well. Unfortunately, it left me with 6 weeks of healing in my apartment, by myself, worrying if I would have a job to go back to despite assurances from my partners that it would be fine. During that same time, I had a subpoena delivered to me for a case I had during my residency. The attending anesthesiologist had been dismissed a few years earlier but due to the need to have a member of the anesthesia team as part of the trial, I was contacted. Finally, I also suffered a spontaneous pneumothorax during the time rehabbing in my


apartment. Looking back, it is funny recounting all the things that happened during my first six months on that job. Unfortunately, at the time, it was anything but funny. When I was finally able to return to work, having been out half the time I had been employed by the group, I was so concerned about the need to prove my worth that anything preventing me doing my best was not to be accepted. As I performed anesthesia during the day, my neck was giving me a lot of pain. I would go home at night and immediately lie down to get relief. Fears of other cervical vertebral levels developing osteoarthritis would invade my thoughts. Fears of disability were constant despite my attempts at trying to talk myself out of them. One of the ways I could “shut my thoughts off” was drinking. I had always promised myself that I would not become an alcoholic like my father (my diagnosis of him, not his admission). Since his drinking was at the level of 1-2 cases of beer every weekend, I felt I was OK with half a bottle of wine per night. I came to realize later that I was slowly becoming just like my father, just taking a slightly different path to the same end-point of addiction. After two months of fears and pain plaguing me at night, working with pain every day, I finally gave up. I took 2 cc’s of fentanyl home with me. Still living by myself (and my faithful cat), I went into a bathroom, prepped my ankle, shooed the cat out of the room as his stare was bothering me, and injected 50 mcg of fentanyl in my saphenous vein. Was it heaven? Well, the nausea and vomiting that ensued was not a high point, but the pain relief was absolute paradise. It was the first time in months I could

relax within my body. The pain, the fears, the negative thoughts that so troubled me were all gone. Since I knew all about fentanyl and its pharmacology, it’s addictive potential, it’s effect on the mu receptors, I believed I was in control. Yes, I know, I was arrogant. But I was also unable to function without constant pain before, but now I could. I lasted about a year. By the end, I was using daily, multiple times per day. I was going to the men’s room to inject, usually in my saphenous vein, in between cases, during breaks, any time I could. The pain increased, and the narcotic injections were not holding it back anymore. I became depressed to the point of contemplating suicide. I was also, in the craziness, assuming that my spinal cord was becoming damaged by other cervical level osteophytes. I came to this conclusion due to the inability to easily urinate. Yes, looking back I can see that it was all the fentanyl I was using but in the craziness of the time ‑- perfectly “logical”. My anesthesia group suspected drug abuse or depression but without hard evidence (at the time opioid diversion was not well tracked) they called my wife, told her they were suspending me until I sought out psychiatric help. I made an appointment for a psychiatric visit a few days later. The day of the appointment, with my wife at work and my children at school, I didn’t know whether to attend the psychiatric appointment or kill myself. I remember praying for help and the help I received was the ability to sleep for a few hours, waking up with just enough time to drive to the appointment. The next few weeks were rather a blur. I was admitted

to the hospital, recommended by members of my anesthesia group to leave medicine, reported to the state physicians’ health committee, sent to a drug rehabilitation facility away from my family, asked to resign by the anesthesia group just so that it would not be seen as I was fired, and reported to the state medical board by the group. While in rehab, I was offered another job as an anesthesiologist in a public hospital. OK, things were looking up. I also began to receive letters from all the medical boards I had a license with adding stipulations to the same. OK, not so much. So, on top of losing my job, paying for uncovered drug rehab, I now was giving lawyers large amounts of funds. That wasn’t the worst of my problems though. My first day coming back to the operating room, I was a bit nervous, as in any new job. Was I going to work well with the new people at work, would they accept me, were there problems that I hadn’t anticipated? You know, normal stresses. Unfortunately, I walked into the operating room. There on the anesthesia cart was a syringe of fentanyl. I cannot do justice describing the level of fear that I had seeing the drug again. I literally felt like it was going to jump off the cart and inject itself into my arm. It was like seeing an old abusive lover after some amount of time. I had longing for how it had been at the beginning, but I knew it would destroy me. I would have cravings for the drug when I was feeling depressed, I would have cravings when I was not depressed. I could be happy, I could be sad, I could be angry, I could be calm. It just didn’t matter what emotional continued on page 16

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A DOCTORS TALE continued from page 15 state I was in, I would be hit by anxiety or cravings for the drug without cause, without reason, without warning. I could be in the operating room, in the grocery store, at home, I was constantly in fear of having a drug craving. Thank goodness for 12-step programs. The steps of the recovery program gave me a structure and lifeline to hang onto when I didn’t know what to do. I also had people I could reach out to and call when I was out of “willpower”. I can remember many, many times calling up friends in the program, Jack H. or Brad S. saying, “I can’t go on like this! I have everything going for me, but I want to use again!” Imagine what the response would be if I said something like that to a coworker, to a spouse, to someone not in addiction! But in calling a fellow recovering person, I would receive a calm, “Of course you want to use drugs. You’re a drug addict.” Just the fact that someone understood, that someone knew what I was going through, meant so much. After a few minutes of conversation, I would be talked off “the ledge”. Many times, I would go into work wondering if I was going to relapse that day but needing to take it one day at a time. How long did this go on, I can’t recall - months, years. But I got better. I still must explain on some insurance applications, some medical staff applications, ABA and MOCA applications. I wrote down many of the answers and saved them, so I can just “cut and paste” into the requested areas. Why am I writing this? Who cares? I am sure there are some society members who feel I

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should just remain silent, and be grateful that I was given a second chance. Many others like my former partners probably still feel that I should have moved on to a different profession, different specialty, anything other than remaining an anesthesiologist, the “not in my specialty” opinion. I am not writing this for them. I do not expect I would change their opinions and it doesn’t matter to my motive. I have written this to just let members know that despite all the plethora of negative stories, horrible outcomes, sad endings, there are those of us who have fought this terrible disease of addiction and have “one day at a time” held it off for many years. I will have 3 decades of recovery

if I stay sober for about 200 more days. Recovery is an option to those who suffer from the disease of addiction. It does not have to be a disease of constant relapse. I also write to those currently suffering with the desperation, loneliness, depression, and fear that their current addiction is producing. You are not alone. It does not have to be the end. Reach out for help. Getting better is like many other illnesses, initial treatment will be painful. Many life changes that will have to be made by you, forced upon you, with no guarantees as to the benefits you will receive. But if you “hang in there” (many times by just a fingernail), it will be worth it. I wish you all the best.

Looking for Help The Pennsylvania Medical Society offers an established program for healthcare professionals that has been active for nearly 50 years. It can be found at the following link:

https://www.pamedsoc.org/foundation/physicians-health-program/about-php Another useful link is the IDAA or International Doctors Alcoholic Anonymous. https://www.idaa.org/helpline/ . A quote from their website describes the group as : “…a CONFIDENTIAL resource available to health care providers (and their families) seeking recovery. IDAA is not involved officially with agencies or treatment providers that monitor physician recovery. Volunteer contacts do not benefit financially from their work with IDAA. IDAA is not directly related too local, state or national regulatory agencies. Although members may work for treatment or regulatory agencies, IDAA members pledge to protect anonymity of other IDAA members and their families.”

Pennsylvania Society of Anesthesiologists Newsletter


CMS Releases 2018 Final Rule Anesthesia for Colonoscopies get a reduced payment, as well as Invasive Monitoring Lines CMS recently released their “Final Rule” for the 2018 Medicare Physician Fee Schedule. Listed below are the changes that you need to know concerning the specialty of Anesthesia.

Medicare Conversion Factors The CMS national conversion factor used to calculate payment for anesthesia services increased from $22.04/unit to $22.19/unit (+ 0.7 %). The RBRVS conversion factor used to calculate payment for medical and surgical services increased from $35.89 to $36.00 (+ 0.3%).

Anesthesia for GI Endoscopy procedures Medicare created new codes for these procedures, which are referenced in the table below. Of note, the base unit value for a screening colonoscopy was lowered from 5 to 3 units, which will negatively impact payment on Medicare claims, as well as all private insurance plans whose fee schedule is tied to Medicare rates. continued on page 18

Procedural Description

2017 CPT® Code

2018 CPT® 2017 CMS Base Code Unit Value

2018 CMS Base Unit Value

2018 ASA RVG Unit Value

Anesthesia for upper gastrointestinal endoscopic procedures (EGD)

00740

00731

5

5

5

Anesthesia for upper gastrointestinal endoscopic procedures (ERCP)

00740

00732

5

6

6

Anesthesia for lower intestinal endoscopic procedures (Colonoscopy)

00810

00811

5

4

4

Anesthesia for lower intestinal endoscopic procedures (Screening Colonoscopy)

00810

00812

5

3

4

n/a

00813

n/a

5

5

Anesthesia for combined upper/ lower GI procedure (New)

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CMS RELEASES continued from page 17

Invasive Monitoring Lines Medicare payment for invasive monitoring lines were also reduced for CY 2018, due to CMS lowering the work RVUs for these procedures. See table below for a comparison of the 2017 and 2018 allowable amounts for these services.

Procedure 2018 CPT® 2017 Medicare 2018 Medicare Code National Allowable National Allowable (Estimate) Arterial Line 36620 $52.76 $47.52

Reduction %

-9.93%

CVP (age 1-4)

36555

$110.18

$92.52

-16.03%

CVP (age 5+)

36556

$124.89

$98.28

-21.31%

Swan-Ganz 93503 $132.43

$100.08 -24.43%

Registration now Open 8th Annual Ultrasound-Guided /Cadaver Course in Regional Anesthesia and Point of Care Ultrasound Saturday and Sunday May 5- May 6, 2018 Penn State Milton S. Hershey Medical Center, Hershey, PA Saturday Evening Dinner and Discussion with Keynote Speaker Colin McCartney, MBChB PhD FRCA FCARCSI FRCPC Professor & Chair of Anesthesiology and Pain Medicine, University of Ottawa

Internationally-known faculty

NEW— Regional MOCA session available on Friday

POC scanning—lung, bladder/gastric, pre-load assessment & joint injections

Discounted rates for fellows & residents

Hands-on practice on cadavers

Bring your family to Hershey Park!!

Optional sessions on pediatric & one-to-one, hands-on practice

REGISTER NOW: https://ce.med.psu.edu/ultrasound-guided-cadavercourse-anesthesia/

For more information, contact Chris Mulvey at 717-531-7988 or email cmulvey@PennStateHealth.psu.edu

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Pennsylvania Society of Anesthesiologists Newsletter


Have You Done Your SRA? (SECURITY RISK ASSESSMENT)

by Richard T. Edwards, MBA, VP Practice Management and Managed Care MEDAC Anesthesia Business Partners Every company / organization that deals with electronic personal health information (e – phi) has a responsibility to secure that data from both intentional attempts at accessing the files and unintentional, innocent mistakes. As we are all aware, keeping sensitive / confidential health information safe is a top priority of every healthcare organization however the threats to that data are not always as obvious as we think. Periodically performing a security risk assessment to determine if there are any possible areas of exposure is a critical task that is often forgotten about or worse never even considered. Each day your data is submitted over secure emails or with encrypted files, etc. but what about non-secure forms

of electronic communication, (i.e. Text messaging, Twitter, Instagram, etc.). You may innocently send e-phi in a text message not even thinking of the implications. The issue is that you may not be aware that there is a possible exposure until it is exposed. The consequences of sending e-phi on a non-secure medium can be horrendous.

It Is What You Don’t Know That Can Hurt You Exposing e-phi has both financial and legal ramification. So where do you start? With a Security Risk Assessment. What is a security risk assessment? Exactly what it sounds like. Any company that gathers, reports or bills based on confidential patient

information is subject to HIPAA rules and as such must perform a periodic SRA.

Security Risk Analysis Conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the organization. An SRA will challenge the organization to scrutinize the current methods and means by which it transmits e-phi and if it is determined that current processes / security measures are weak then the company has the obligation to fix the process. SRA is an ongoing responsibility. It is not a static process. The method and means continued on page 20

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HAVE YOU DONE continued from page 19

you should review the BAA on a regular basis.

by which e-phi is transmitted changes rapidly and is constantly under assault by hackers.

PRIVACY And Security: Protect Patient Health Information

What Is Involved In Performing Your SRA?

1. Where is all your PHI? IDENTIFY AND DOCUMENT ALL PATIENT INFORMATION REPOSITORIES. Medical practices often operate under the assumption that all patient information is stored in their EHRs. But it can also reside in emails, Excel spreadsheets, and Word documents, PDFs with scanned explanations of benefits, or ultrasounds and MRIs. The SRA should determine exactly where all phi (electronic protected health information) is located. 2. Where are all your endpoints and access points? IDENTIFY AND DOCUMENT POTENTIAL THREATS AND VULNERABILITIES FOR EACH REPOSITORY. Make sure backup and disaster recovery procedures are in place, as well as procedures for dealing with lost or stolen laptops, smartphones, and mobile storage devices containing phi.

First what is e-phi? PHI (protected health information) is any information in a medical record that can be used to identify an individual which was created, used, or disclosed in the course of providing the healthcare services such as a diagnosis or treatment that is protected under HIPAA. The HIPAA privacy rule protects most individually identifiable health information transmitted by a covered entity or its business associate in any form or media whether electronic or paper, present and future. Please note that it’s not just you and your employees that you are responsible for. Your responsibility extends to your business associates such as your billing company, your attorney, your accountant, your benefits administrator, etc. Make sure that you have a Business Associate Agreement with each of them and

3. What can go wrong i.e. Vulnerabilities and Threats? TRAIN EMPLOYEES AND CREATE ACCESS POLICIES. Train employees to recognize phishing scams, phone scams, follow rules for accessing public Wi-Fi, social media posting, and other risky behaviors in order to avoid breaches. Review employee policies to ensure they access only the patient records they need to perform their jobs. Make sure that procedures are in place to prevent terminated employees from accessing phi. 4. What are you doing now to mitigate the risks of those bad things happening? ENCRYPT DATA. Encrypt patient data to not only protect against attacks but to help alleviate any potential penalties as auditors will consider whether a firm took all reasonable steps to protect the data. 5. What is your plan to do better at it? DEVELOP A BREACH RESPONSE PLAN. Have a response plan in case a breach does occur. Specify who will be on the response team, what actions the team will take, and how the practice will prevent another breach from occurring. The SRA will make sure a plan exists and all employees are trained in how to respond. CMS offers a SRA assessment tool and a user guide for the tool. Definitely worth investigating.

https://www.healthit.gov/providersprofessionals/security-risk-assessmenttool

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Pennsylvania Society of Anesthesiologists Newsletter


In Memoriam - Robert B. Hoffman (1949 – 2017) Longtime PSA Attorney Robert B. Hoffman, age 68, of Hummelstown, passed away on Friday, November 3, 2017 at his home with his loving family by his side. Bob, was a great legal leader for our society for many years, since approximately 1995. A highly regarded litigator and appellate lawyer, he was longstanding counselor to the Pennsylvania Medical Society and various physician specialty organizations, and was an advocate for doctors and patients in almost every significant health care law matter in the Commonwealth, including the seminal Pennsylvania Supreme Court decision establishing that a family member may exercise an incompetent patient’s right to make decisions about life-sustaining treatment. He litigated cases in both state and federal courts, including the United States Supreme Court. Bob was a legal genius and a friend to many of us within the society. He will be missed by his family and all of us who knew him.

REGISTRATION OPEN Basic FATE Course (Focused Assessed Transthoracic Echocardiography)

Saturday March 10, 2018

Topics Include:

• • • • •

Basic cardiac views including IVC M–Mode Right and left ventricle function Basic clinical scenario training Pleural scanning

Register here: http://usabcd.org/HMC

PENNSYLVANIA RESIDENTS continued from page 13 also want to remind programs that PSA will reimburse travel expenses and lodging for the Legislative Conference, so if you are interested in attending, please let us know and speak with your program director. Residents are also invited to attend the bi-annual PSA Board of Director meetings in Harrisburg. For anyone interested in Society involvement on a state level, these meetings provide a first-hand experience of the inner workings of our highlyactive state Society. The Spring meeting will be held at 10 a.m. on March 18, 2018. PSA will reimburse travel costs (mileage and tolls) and provide lunch for all in attendance. Finally, in addition to the Sentinel’s ‘Resident Update’ article (typically authored by a Resident Component officer), we want to invite anyone who is interested in authoring a peer-reviewed educational article for the Sentinel to let us know. In the past, we have hosted point/counterpoint perspectives on controversial topics which have proven to be excellent content for the newsletter. We would like to have at least one educational article for each issue, so please contact us at psa. residents@gmail.com if you are interested.

For more information on any of these courses please email: Chris Mulvey cmulvey@pennstatehealth.psu.edu or call 717.531.7988

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Patient-Centered, Physician-Led Care Celebrate With the American Society of Anesthesiologists® WHEN SECONDS COUNT...PHYSICIAN ANESTHESIOLOGISTS SAVE LIVES.® Physician anesthesiologists ensure the safe, high-quality care patients deserve. www.asahq.org/WhenSecondsCount

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Pennsylvania Society of Anesthesiologists Newsletter


RUNNING ON EMPTY? 80% of physicians today are professionally overextended or at capacity, leaving them with no time to see additional patients Physician burnout rates top 50% in latest Mayo study and work life balance continues to worsen

The average time a doctor spends per week on administrative work brought about by healthcare reform efforts and EHRs, with certain specialties closing in on 50% of their day

We’re a national, physician-led organization that gives clinicians the opportunity and the flexibility to grow.

Join us to get fulfilled, plug in to EnvisionPhysicianServices.com/RechargeYourCareer

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