ASSA Fall 2009 Newsletter

ASSA

ALABAMA STATE SOCIETY

Alabama State Society of Anesthesiologists President’s Letter

OF ANESTHESIOLOGISTS Fall 2009

Health Care Reform – What a Tangled Web We Weave Arthur M. Boudreaux, M.D.

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he Health Care Reform effort is moving at bullet train speed. At the risk of being three train stops behind, I’ll review where we are at this time.

I encourage everyone to read the posts on the ASA website - Members Section about the status of the several pending bills (www.asahq.org). In addition, legislative calls to action will appear. We will not all agree on every issue. I ask all members to consider the calls to action and vote your conscience by calling your congressman or senator if you agree with the pending recommendation.

This is certainly not the time for apathy. For conservative commentary, look DAILY at the Heritage Foundation, Wall Street Journal, Investor’s Business Daily, and the Advisory Board. For more liberal commentary, look to the New York Times, Washington Post, and Commonwealth Fund. Internet searching this topic will keep anyone busy for the foreseeable future.

The U.S. House of Representatives initiated debate in three house committees earlier this year. Each of the three committees produced initial bills, which were consolidated into a “Triple Committee” bill as HR 3200. That bill included a government-run “public option” with payment rates linked to Medicare, a health insurance exchange, a “Health Choices Commissioner”, and numerous other bureaucratic provisions in its 1017 pages. The bill was scored by the CBO at more than a trillion dollars over ten years. The bill did address the SGR physician payment formula. It was a terrible first start. The AMA, the ACS, and numerous other medical societies publically supported HR 3200 because it fixed the SGR formula and improved access to care. Many rank and file physician members of these groups vigorously protested that support and dropped membership. About 21 state medical associations wrote letters of protest. The August Congressional recess was a scene of public protest in almost every venue at congressional town hall meetings. The Tri-Committee bill was re-written as HR 3962 (1990 pages). The public option was delinked from Medicare payment rates and participation made “optional” for physicians. The SGR formula fix was excluded to save costs and reduce the total CBO score to below a trillion dollars over ten years. This bill was voted on and passed by the slimmest of margins, 220-215, along party lines with continued on page 7

ASSA Officers Abe Schuster, M.D. President Greg Bouska, M.D. President-Elect Jenny Dollar, M.D. Secretary-Treasurer Ralph Fillmore, M.D. Immediate Past President Richard Carson Executive Director Michael C. Gosney, M.D Editor P.O. Box 241453 Montgomery, AL 36124 334.954.2577 Fax: 334.269.5200 Email: ASSAexec@aol.com

Website: www.ASSA.md

The President’s Corner Abe Schuster, M.D.

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009 has been an interesting year to be involved in organized medicine.

Immediately upon assuming the Presidency, President Obama announced that 2009 would be the year that comprehensive health care reform (HCR) would occur.

The rising cost of health care to government, businesses, and families, as well as difficulty accessing services for some Americans, motivated our president to pass HCR. From the onset, the ASA supported basic health insurance reforms that would strengthen our nation’s health care system and assure access to quality health care for all Americans. Unlike the AMA and many other specialty societies, however, the ASA did not support HR 3200 which was initially proposed by Congress. The proposed Public Option would include unacceptably low anesthesia payment rates linked to Medicare rates. The ASA has been steadfast in its opposition to a payment rate linked to Medicare. According to Roger Moore M.D., Past President of the ASA, “Medicare has long underfunded payments for Anesthetic services and discounted payments for pain services. An expansion of such a flawed funding and payment mechanism to a larger segment of the population would be unsustainable for the medical specialty of anesthesiology.”

A 2007 report (GAO-07-463) of the Government Accountability Office (GAO) confirmed a payment disparity between Medicare and commercial payments for Anesthesia services. The GAO concluded that Medicare pays an average of 33% of what private insurers pay for anesthesia services. Most other medical specialties are paid an average of 80% of what is paid by private insurers through Medicare reimbursement.

On November 7th the House of Representatives passed H.R. 3962 which included a Public Option. The proposed Public Option will have reimbursement negotiated between providers and the government. With these assurances, the ASA endorsed H.R. 3962 . Interestingly, H.R. 3961, which is a fix to the flawed SGR system, was supposed to be voted on simultaneously. As of November 17th, 3961 has not yet been voted on.

This brings to mind the expression “Be careful what you ask for. You might get it.” For further discussion on Health Care Reform, please see Dr. Boudreaux’s article in this newsletter.

On a more local level, Blue Cross Blue Shield of Alabama (BCBSAL) notified physicians this fall that it was changing its payment methodology to a relative value based system more in line with other organizations around the country. The impact the new reimbursement schedule would have on your practice would depend on your specialty and practice patterns. The BCBSAL web site has a “calculator” that demonstrates how your reimbursement would be impacted based on 2008 billing patterns. Generally speaking, primary care physicians would receive increases and procedure focused specialists would be impacted negatively.

Anesthesiologists who specialize in Pain Management as well as those who do many critical care procedures would suffer severe cuts under this new system.

Shortly after this announcement was made, the ASSA leadership had a meeting at BCBSAL with Mr. Jeff Ingrum, Vice President, as well as several administrators. It is a tribute to our ASSA leadership that over the past 10 years we have developed an outstanding relationship with BCBSAL and that communication is open and honest. In summary, BCBSAL acknowledged that they are moving away from their “locally grown” fee schedule and trying to get more in line with other regional and national carriers. Controlling costs and improving quality are two goals we share with BCBSAL. Due to the economy, they have lost customers and want to ensure value and quality to current and future customers. At this meeting, they did announce that implementation of the new fee schedule would be delayed from December 1, 2009 until July 1, 2010. They also asked us for a proposal that we as a specialty society could endorse to improve quality 2

and value for BCBS patients. At this time we are working on quality initiatives for Pain Management. We are optimistic that we can improve care for chronic pain patients while simultaneously being good stewards of the limited resources available. There will be much more on this topic in the coming months.

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Finally, I would like to bring you up to date on the activities of the ASA 2009 House of Delegates (HoD).

Our Alabama delegation was well represented this year. Our delegates were myself, Blair Smith, M.D., Greg Bouska, M.D. and Mike Gosney, M.D. Our alternate delegates were Tony Jones, M.D., Ralph Fillmore, M.D., Jenny Dollar, M.D. and Mike Lasecki, M.D. Jeff Plagenhoef, M.D. serves as the Director for Alabama.

This year, the ASSA’s Art Boudreaux M.D. was elected to the position of ASA Secretary. His work on the Administrative Council has been exemplary. We should all be very proud of Dr. Boudreaux’s services to the ASA. Dr. Alex Hannenberg was elected President and will be representing our specialty as we navigate the end game of HCR legislation. There were three contested elections this year which allowed for some spirited campaigning. Linda Mason, M.D. from California was elected as assistant secretary. Jerry A. Cohen, M.D. was elected First Vice-President. Dr. Cohen from Gainesville Florida is amongst the experts in this country on anesthesiology reimbursement and governmental regulatory issues. He is certainly a great person to have in this position at this time. Dr. Arnold Berry from Atlanta was elected Vice President for Scientific Affairs in a contested election. His credentials as a Professor, with a Masters in Public Health plus administrative experience, position him well for success as an ASA leader. While it is difficult to predict where HCR will take us, I am confident that we have leadership in place that can effectively communicate and advocate at the national level.

In addition to electing new leaders, the ASA HoD was forced to make some difficult financial decisions this year. Due to losses in investments and the costs of organizational restructuring, the difficult decision of charging a registration fee for the annual meeting was made. While this will be difficult for attendees, it was felt that the financial strength of the ASA could not be compromised by loosing resources on the annual meeting.

The ASA will enter 2010 with a strong financial foundation, superb leadership, a well funded PAC and a motivated membership. While change is certain, I am optimistic that the medical specialty of anesthesiology will continue to flourish.

Abe Schuster M.D., President ASSA

“ ASSA Delegation in NOLA enjoy a meal together

Tad Cherry, Peter Loux and Jenny Dollar in New Orleans

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2009 ASAPAC “Wrap Up” “It has been said that the ability to accept victory graciously and take defeat without bitterness is what makes heroes.”

The ASSA is full of heroes if the measuring stick is ASAPAC. After raising more contributions for the ASAPAC for the past eight consecutive years, Alabama was finally surpassed. In fact, the ASSA finished the 2008-09 year in third place! We finished well behind two states with membership bases much greater than ours, Texas and Florida. Though Alabama broke its past contribution level (in 2006 we raised $106,000, this year we raised $109,000), the sheer numbers “caught up with us” as Florida was responsible for roughly $111,000 and Texas shattered all records by raising $180,000.

In reality, the leadership of the ASSA could not be more pleased that other states have finally begun to answer the call to advocacy through the political action committee that represents the interests of anesthesiologists across the country. So what has been the catalyst for such a change? Clearly, the current political discussion centered around health system reform has heightened the awareness of all physicians and caused more to “leave the sidelines” and engage in political advocacy. However, even before we knew health care reform would dominate the political landscape in D.C., several state leaders warned Alabama that they were tired of being embarrassed “year after year” by their political apathy and watching as we proudly paraded in front of anesthesiologists from across the country to receive the coveted “Alabama Cup.” Several Texas anesthesiologists placed a picture of the Alabama Cup on their cell phone screens so that they could be reminded daily (each time they received a call) of their irritability. The plan could not have been executed any better. The creation of the “Alabama Cup” was to stir competition among the states and to engender a sense of pride in the state that is able to “bring home the gold” each year. For the next year, the Texas Society of Anesthesiologists is allowed to keep the Alabama Cup in their possession, displaying it proudly and boasting of their great achievement. Truly, the winners are ultimately the anesthesiologists who are in the “trenches” daily making patient safety their battle cry. With a healthy balance in our national PAC, we are able to participate in the political process and impact the decisions that affect our patients.

Now that the Alabama Cup has been removed from the ASSA, it will be interesting to witness if Texas is able to continue its domination or if other states with similar membership rolls answer the call and increase their participation. Judging from the increases in overall contributions, the trend is upward. The ASSA graciously accepts defeat when it comes in such form and not an ounce of bitterness will be displayed if Texas, or any state for that matter, is able to duplicate the 8 year streak that Alabama was able to achieve. After all, we are a state of 400 plus heroes!

The following list has the names of many of our members who felt it necessary to participate in the political process by contributing to the ASAPAC. Many members gave for the first time ever and many groups had 100% participation. If you did not contribute and it was an oversight, please make certain to join us this year and continue the momentum that has spread across the country. If you did not give consciously, please share your reasoning with your colleagues. It would help us to know what motivates your lack of participation, particularly in “times such as these.”

Finally, attention must be given to the UAB residents who once again had 100% participation. This is the third year in a row for them to reach such a milestone. Their efforts are now being duplicated by other programs across the country who recognize that such a goal is possible. The ASSA is still grateful to Colin King for his efforts in this regard three years ago and to Brian Thoma, West Cordell and Jon Hughes for encouraging their respective classes to contribute. Another “cause and effect” has been that for the first time ever, the UAB Department had over 33% participation in ASAPAC and of those who contributed you will note substantial amounts given by several. Thanks to these leaders who not only teach by example but who lead by example!

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2009 ASAPAC Contributors Tim Adams, $250 Tim Aiken, $500 Jack Anderson, $500 Mark Arnall, $500 Eddie Ash, $500 Matthew Atkins, $20 Jennifer Badia, $20 Mark Baker, $500 William Baker, $500 Alethia Baldwin, $20 Brian Barki, $20 Michael Barlow, $500 Greg Beer, $100 Frank Benesh, $1,000 Susan Black, $100 Bill Blackburn, $1,000 Rett Blake, $20 Suzi Blaylock, $1,000 Marc Bloomston, $1,000 Jason Boehm, $20 Lee Booker, $500 Art Boudreaux, $1,000 Greg Bouska, $1,674 Emmett Bowers, $20 Jim Boyce, $500 Gwen Boyd, $300 Fran Boyette, $500 Gray Bridges, $500 Kathryn Brock, $250 Harris Brodsky, $20 Ronnie Brown, $500 John Bullington, $500 Michelle Byrne, $20 Brian Campbell, $500 Thomas Cash, $500 Tony Cecchini, $1,000 Kathryn Chance, $20 James Chaney, $500 Dean Chassay, $250 Bayer Cheng, $1,000 Subba Chenumolu, $1,500 Tad Cherry, $1,000 Jamie Clark, $1,000 Mandy Clay, $20 Kelly Conaty, $500 Kim Conner, $500 Doug Constant, $20 Anthony Cook, $500 Suzane Cooper, $500 David Corbett, $20 West Cordell, $20 Jerry Cox, $500 Jack Crawford, $20 Clark Cross, $500 Sarah Cumbest, $500 Leisa DeVenny, $500 Gary Dial, $500 Paul Diaz, $20 Tim Doles, $500 Jenny Dollar, $500

George Dumas, $500 Jeff Dyer-Smith, $20 Brad Edwards, $20 Charles Elliott, $250 Paul Elliott, $500 Mitchell Engle, $20 Dustin English, $20 David Evans, $1,000 Bob Evans, $250 George Fant, $500 Ralph Fillmore, $1,000 William Fitzpatrick, $500 Bill Fitzpatrick, $500 Michael Flanagan, $500 Qian Fleming, $50 Reid Fletcher, $250 Howard Friedman, $500 Murali Gadde, $250 Richard Gallo, $1,000 Gene Gordon, $500 James Gordon, $20 Brad Gosdin, $500 Michael Gosney, $1,000 Jeff Graham, $500 Ryan Gray, $20 Shawn Green, $50 Steve Gross, $500 Juan Gutierrez, $500 Mary Gutzke, $20 Cooper Hagerty, $500 James Hale, $500 Barry Hall, $20 Amy Halliburton, $50 Phil Hanlon, $500 Robert Hannahan, $250 Nancy Haring, $500 Scott Harper, $400 Martin Hayes, $500 Pete Hendricks, $1,000 Bob Henry, $500 Rachel Hight, $20 Chris Hillman, $500 Robert Hodson, $250 Douglas Hof, $20 Michael Hoger, $1,000 Joseph Houser, $500 Hayden Hughes, $250 Jon Hughes, $20 Lee Hughes, $1,250 Lewis Hunt, $1,000 Rea Hunt, $1,000 Kelly Hyde, $500 Matthew Jennings, $1,000 Jake Jessop, $100 Neal Jeter, $1,000 Joseph Johnson, $1,000 Bryan Jones, $20 Kyle Jones, $500 Bill Jordan, $1,000 Rick Judson, $500

Scott Kane, $20 Amber Keller, $20 Jon Kentros, $500 Ed Kezar, $500 Collin King, $500 Steve Klein, $500 David Kraftsow, $500 Susan Kreher, $500 Ira Kupferberg, $500 Hung-Chi Kwok, $1,250 Mike Lasecki, $500 Mickey Lathem, $500 Robert Lee, $20 Wayne Lewis, $500 Rick Lewis, $500 Li-Herng Liu, $20 Rene Llera, $500 Lajuana Logan, $500 Gary Long, $250 Peter Loux, $1,000 Brit Lovvorn, $1,000 Lannon Lucas, $20 Brian Macha, $20 Mark Mandabach, $500 Scott Margolies, $1,100 Jerry Marsella, $500 Barry Martin, $1,000 Thomas Martin, $500 Richard Massey, $20 John McArthur, $500 Chandra McCall, $500 William McRae, $500 Barry Moody, $500 Tom Moore, $1,000 Larry Morgese, $100 Caroline Morris, $50 Jason Morris, $25 Michael Mueller, $1,000 Dodd Mullican, $250 Peter Nagi, $500 Paul Nagrodzki, $500 Tetsuzo Nakayama, $20 Emily Natarella, $25 Joe Nicholson, $500 Teresa Nolen, $250 Craig Nordhues, $1,000 Andy Osborne, $500 Kevin Pace, $500 John Panico, $250 Megan Paskitti, $20 Everett Perry, $20 Tristan Pico, $20 Christine Piefer, $20 Jeff Plagenhoef, $1,000 Vernon Pruitt, $1,000 Jeff Prylinski, $500 George Purves, $1,000 Rick Quincy, $20 Keith Rathel, $1,000 Joseph Rayburn, $500

Puli Reddy, $1,000 Staci Ridner, $500 Ronald Roan, $20 Kai Rodning, $20 Michael Routman, $500 James Rudulph, $500 Sammy Sabri, $500 Paul Samuelson, $250 Shannon Savage, $1,000 Anthony Savoie, $250 Abe Schuster, $1,000 Larry Segers, $500 Stephanie Seiler, $20 Kurt Senn, $500 Steve Sheils, $50 Michael Shelton, $30 Daniel Sherrer, $500 Bernis Simmons, $1,000 James Simril, $20 Sandy Sipe, $500 Phil Sissons, $500 Blair Smith, $500 Jeremy Smith, $1,000 Josh Smith, $1,440 Perry Smith, $250 Sharron Smith, $20 Charles Spivak, $500 Steve Starling, $1,000 Ann Still, $100 Russell Stuermann, $20 Steve Sykes, $1,000 Jenny Tarziers, $250 Jeff Taylor, $500 Brian Thoma, $50 Tommy Tomlinson, $500 Brian Torgerson, $20 Matthew Townsley, $20 Greg Umphrey, $500 Bill Uncapher, $500 Pam Varner, $1,000 Tom Vetter, $100 Meredith Vickers, $60 Trey Wages, $500 Marsha Wakefield, $500 Ben Walker, $500 Teresa Walker, $1,000 Aimee Walsh, $1,000 William Ware, $1,000 David Warren, $20 Nicholas Weitenberner, $100 Jane Williams, $500 Mark Williams, $1,000 Mark Willis, $500 Bill Womack, $500 Glenn Woods, $500 Jim York, $1,000 Nerrin Zaharias, $1,000

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Update on Anesthesia Quality Institute “AQI” and National Anesthesia Clinical Outcomes Registry “NACOR” Jeffrey S. Plagenhoef, M.D., ASA AL Director Chair, AQI BOD

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ith the Health Care Reform (HCR) winds continuously swirling through our minds with the threats of potential doom and gloom for anesthesiology, it may be a stretch at the moment to expect anesthesiologists to focus on disruptive changes in clinical practice such as converting to an electronic medical record (EMR) or forwarding their clinical data to a national clinical outcomes data registry. To ignore these pressures and to refuse to prepare for the changes is to ignore reality and assure greater difficulties in the future.

While many may be disheartened trying to deal with overwhelming feelings of frustration relating to actions taken by Congress, the AMA and the ASA, I say please try to focus on several positive things still very much a part of the ASA and the value that it brings to all of us and our patients. Even if the worst things possible come with whichever HCR package may pass, current public and governmental demands for value improvements (increased quality and decreased cost) and transparency will only increase. The big question is how you and those with whom you practice intend to address these obvious demands.

Those outside of our specialty with limited knowledge and conflicting interests should not… no, must not… know more about your work performance than you do! We must be unified and organized to address the future. We must be at the helm as we sail deeper into the information age, and we must assure proper and valid data collection, data analysis and data reporting, lest we subject ourselves to the consequences and misguided desires of competing stakeholders. We need the AQI and NACOR. Realize that this endeavor is one of the top priorities for the ASA and quite possibly the greatest future membership benefit from the ASA. We must get this up and running quickly to assure our specialty’s future in the forefront of medicine and particularly patient safety and quality of care. This essential project is funded by the ASA, and the ASA is funded by your membership.

The AQI will provide an unbiased, national, and internal source of the main substrate of quality improvement - data, and will arm our specialty with the tools to directly influence the creation of quality indicators and standards. Rather than having mandates forced upon our specialty by private payers, federal agencies and regulators, the goal is for our specialty to lead in this arena. The perioperative experts must determine appropriate standards for perioperative care! As our vision statement says, the AQI will become the primary source of information for quality improvement in the clinical practice of anesthesiology. The grander vision of the AQI is seeing it become the information hub through which all related registries will flow, including subspecialty and ASA’s patient safety efforts. From the Anesthesia Patient Safety Foundation to the Closed Claims Project, our specialty is nationally recognized as the leader in data and systems-driven improvement of patient care outcomes. We will build on this expertise for the benefit of all.

As the Chairman of the AQI BOD, I report that unbelievably rapid progress is being made. This hyper development pace is to be primarily credited to our gifted Executive Director, Richard Dutton, M.D., who was hired in July. As Professor and anesthesiologist at the Shock Trauma Center of the University of Maryland Medical System in Baltimore, Rick has been instrumental in creating a quality management program centered on the trauma data registry. Numerous business, quality improvement and research projects have been accomplished leveraging their data. Dr. Dutton has been the Physician Director of the Quality Management program and one of the senior administrative physicians at the Shock Trauma Center for the past decade. His experience, skill and intellect are already proving to be gifts for the benefit of all ASA members as he diligently applies himself in this critical effort.

Dr. Dutton was directed by the Board to concentrate on hiring staff and gathering information about other data registry efforts, especially those by other ASA committees, organizations and subspecialties. Recognizing that numerous ASA members have the ability to positively impact the AQI in its infancy, we organized the “AQI Advisory Panel” to engender an “all inclusive” identity and development process. The Panel is comprised of thought leaders in this area, some of whom are involved with other registries. We invited them and all interested parties, even AIMS vendors, to an AQI “Stakeholders Forum” at the ASA Annual Meeting in October to escalate sharing of information vital to AQI’s rapid advancement. This forum was a huge success. Most comforting to all AQI BOD members was learning that every concern expressed about 6

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Health Care Reform . . . continued from page 1

39 Democrats voting against – including ALL of the Alabama delegation. The ASA executive committee, with advice from our lobbyists, voted to “urge a yes vote” on the bill. This action created great angst and consternation among many ASA members. Appearing similar to the earlier actions of the AMA on HR 3200, members were confused by the new stance. ASA President Alex Hannenberg, MD, held a TeleTown Hall Meeting on Wednesday night (11/10) to explain the action. HR 3962 contains a “public option” NOT linked to Medicare payment rates, increases access and insurance coverage to most Americans, and claims to maintain the doctor-patient relationship. These items were the three ASA legislative priorities.

Since we all knew HR 3962 was going to pass, support of the house bill would give us support when the legislation went to the combined conference committee after senate action. In the Senate, two bills from HELP and Finance have passed out of committee. Majority leader Harry Reid (D-NV) is in the process of combining the bills now. The HELP bill has a public option linked to Medicare payment rates and several provisions that would likely lead to a single payer government system in the future. The finance committee bill is similar to HR 3962 but finances the bill with significant Medicare funding cuts. Mr. Reid tried to push through an SGR “Fix” bill in October that would reset the SGR deficit to zero and freeze physician payment rates for the foreseeable future. It cost 245 billion dollars and was a sleight of hand move to keep the combined senate bill below a trillion dollars in cost over ten years. It failed to pass on a procedural vote. ASA is now calling for support of a house companion bill, HR 3961, which is an SGR formula fix for physicians. Again, this bill removes the cost from HR 3962, allowing the CBO score to land below a trillion dollars. Like the senate bill, this is a sleight of hand to hide $245 billion. All of these major reform laws raise taxes, increase costs of insurance for most, and place mandates on businesses, providers, and patients.

Distilling the volumes of information from many sources, there are two schools of thought regarding this entire complex mess. 1. One should anticipate global reform legislation making it through to the President’s desk. Lobby to mold a bill that will help the most people and not kill medicine as we know it or harm our specialty. 2. Fight passage of any global reform legislation on the principle of removing government intervention from medicine. Allow market reforms to force change. I personally believe some intervention is necessary. True competition, elimination of antitrust protections for insurance companies, removing barriers to purchase insurance across state lines, elimination of pre-existing illness exclusions, and transparency mandates would fix many of the current problems. Reducing the third party payment system with high deductable Health Savings Accounts would slow or “bend” the cost curve downward.

Most of these provisions were included in the Republican house health reform bill amendment voted down on party lines (with limited allowed debate) last Friday. This amendment was part of three Republican health reform bills that were introduced and never debated in committee. I’m sure few even knew there were such alternatives. If the pending bills become law, the promulgation of regulations will require our utmost attention and participation.

We have seen a great deal of disagreement on the issue of health reform in the US. There has been considerable disagreement among our members. My only hope is that we do not throw the baby out with the bath water, or the bathtub out of the bathroom, or the bathroom out of the house for that matter. That is the direction we currently are headed. There are many issues that will arise in this debate. We should all be vigilant and participate at every step of the way. Changing the way we operate, becoming champions for patient safety, standardizing and eliminating waste, and always putting the interests of patients first will go a long way to improve healthcare in the future, with or without these laws.

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UAB Update Blair Smith, M.D.

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hen asked at the state component meeting of the ASA to write an article for the ASSA newsletter concerning activities at UAB, I wondered what I could write about. However, as I’ve started collecting information, I’ve now begun to wonder if I will have to save some of the information for a future date.

Let me begin by describing the some of the activities of the residency program at UAB. Dr. Susan Black has been the Residency Director for the past 3 years and has done an outstanding job. UAB currently has a total of 69 residents in the four year curriculum. The current breakdown in numbers is CA-3 – 18, CA-2 – 21, CA-1 – 21, and PGY-1 – 9. That number will increase to 72 residents starting in July 2010, giving us 21 residents in each of the CA years.

July 2009, saw the beginning of the new PGY-1 (categorical) position at UAB. This part of the residency program is under the direction of Dr. Marsha Wakefield. It allows the UAB Department of Anesthesiology to offer residents who are interested the option to complete all four years of residency at UAB. There will continue to be 12 CA-1 positions available through the match.

All of the resident positions were filled within the match this year. We are seeing a more diversified group of applicants from outside the Southeast. We continue to see increasing board scores among the applicants to the program. The March 2009 match class show an average board score of 233 on Part I and 241 on Part II compared to the national average of 224 (I) and 230 (II). Also, ten percent of the class is AOA which is the national average. The 2009 match class had almost 600 applications submitted with 110 people interviewed for 21 positions. As of October 22, 2009, the program has already received over 600 applications for the 2010 match class.

The recent graduates have done exceptionally well. There has been a 100% success rate for the graduates in 2007 and 2008 on the first attempt on the written boards. The oral board success rate on the first attempt is averaging approximately 92% over the past three years. These numbers are above the national average. Over the past 5 years, 73% of the graduates have entered private practice and 27% have entered academics.

Our current residents continue to excel. They had 100% participation in the ASAPAC for the third straight year. Dr. Colin King deserves the credit for creating this atmosphere of involvement among the residents.

The department has had a FAER recipient for 9 out of the last 10 years. Mitch Engle, M.D., Ph.D. is the department’s most recent FAER scholarship recipient. He received this award at the ASA Annual Meeting in New Orleans. Dr. Engle is also a recipient of the UAB Department of Anesthesiology Academic Career Development Award. Amy Halliburton, M.D. is the first UAB recipient of the FAER Practice Management Scholarship to attend the January 2010 ASA Practice Management Conference Meeting in Atlanta, Georgia.

Drs. West Cordell (CA-3) and Jonathan Hughes (CA-2) attended the ASA as resident delegates. They attended Resident component activities as well as observing caucus meetings and House of Delegate meetings. This continues a long tradition of ASA involvement by the residents. Drs. Cordell, Engle, and Hughes also attended the 2nd Annual Medical Student Reception while attending the ASA. 8

The faculty members at UAB continue to be very involved with the ASA and ASSA. Dr. Art Boudreaux was elected as Secretary of the ASA at the New Orleans meeting. Dr. Boudreaux has served as Assistant Secretary of the ASA for the past 4 years. Many other faculty members actively participated in the activities of the ASA meeting. Drs. Mark Mandabach (secretary) and Jason McKeown (member at large) and Mr. A.J. Wright attended the Anesthesia History Association meeting. Mr. Wright also had a poster presentation at the meeting. Dr. Peter Nagi attended the Pain Fellowship Directors meeting. Drs. Susan Black, David Miller, and Tom Moore attended the SNACC meeting. Dr. Susan Black gave a Refresher Course Lecture on Anesthesia for Spine Surgery. Dr. Gwen Boyd was on the ASA subcommittee on Geriatric Ambulatory Anesthesia as well as being a moderator for two presentations on Geriatric Anesthesia. Drs. Boyd and Marsha Wakefield also attended the Society for Education in Anesthesia meeting. Dr. Michael Froelich attended the SOAP component as a member of the Education and Research Committee. Dr. Tony Jones was an alternate delegate in the House of Delegates. Dr. Jones also attended the Editorial Board of Anesthesiology and the FAER Academy meetings. Dr. Tad Cherry, adjunct faculty Birmingham VAMC, was a member of the Blood Management Committee.

Erica Johnson, with sponsorship by Karen Iles, Ph.D. and Sadis Matalon, Ph.D., is a UAB medical student who made a presentation at the FAER Medical Student Research Symposium. Drs. Iles and Matalon are members of the Department of Anesthesiology.

Finally, I would like to mention the faculty members who made a donation to the ASAPAC last year. We had 37% of the faculty participate last year. Hopefully we can continue to increase the participation next year. Maybe one day, I can write that we matched our residents with 100% participation. Our participation as faculty and residents in the ASA and the ASSA is extremely important, as they are the voice of anesthesiologists and continue to advocate for the profession and us.

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9

CMS Releases Final Rule For 2010 Physician Fee Schedule: Key Points Include Full Teaching Rule

Implementation, PQRI Measures, Phase-in of Practice Expense Updates ASA is extremely pleased to report that in the recently-released final rule for the 2010 Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) will fully implement Medicare anesthesiology teaching rule reforms beginning Jan. 2010 as intended by Congress and advocated by ASA. The final rule represents a culmination of many years of work by ASA members, leadership and legislative and regulatory staffers in the Washington, D.C. office, to rectify the 50 percent payment penalty for anesthesiology teaching programs. The newlyreleased rule will correct this payment inequity, strengthening residency programs in the process.

“This is a huge triumph for the medical specialty of anesthesiology, and ASA members are to be commended for their dedication to this legislative and regulatory priority,” said ASA President Alexander A. Hannenberg, M.D. “After a long- and hard-fought battle, academic programs will finally receive full Medicare payment for the expert anesthesiology medical care they provide to patients. This victory proves what ASA can achieve through unrelenting advocacy efforts.”

Due in large part to the overwhelming response to the ASA calls to action to submit comments to CMS, the Agency did not formally address the issue of anesthesia “handoffs” in its final rule. Thus, different anesthesiologists in the same anesthesia group practice can be considered the teaching physician when fulfilling the statutory requirement that the teaching anesthesiologist be present at the key or critical portions of the anesthesia service. ASA is pleased that the Agency followed legislative intent and did not focus on unrelated topics.

Other key provisions of the proposed rule include: Removal of Physician-Administered Drugs for Purposes of Computing Update – CMS is finalizing its proposal to remove physician-administered drugs from the definition of “physician services” for purposes of computing the Medicare physician fee schedule update. While the proposal will not change the projected update for services during CY 2010, CMS projects that it would reduce the number of years in which physicians are projected to experience a negative update.

Physician Payment Refinements to Practice Expense – In its final rule with comment period, CMS adopted several refinements to Medicare payments to physicians, which are expected to increase payment rates for primary care services. For 2010, for purposes of establishing the practice expense (PE) relative value units (RVUs), CMS had proposed to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association (AMA). While CMS is finalizing the proposal, it will phase it in over a 4-year period.

The impact to the PE relative value units for anesthesiologists and pain medicine physicians, as estimated by CMS is as follows: Previous Indirect PE/ Final Rule Indirect Previous Indirect % Final Rule Indirect % HR PE/HR Anesthesiology $19.76 $29.36 56% 82% Interventional Pain Medicine

$59.04

$156.79

67%

70%

Pain Medicine

$59.04

$122.42

67%

70%

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Physician Quality Reporting Initiative (PQRI) – CMS finalized the incorporation of the new Perioperative Temperature Management measure in PQRI. Technical specifications for the measure can be expected in December 2009.

Physician Payment Update – Under the final rule, and consistent with current law, CMS will move forward in implementing the slated rate reduction of -21.2% for CY 2010 (rather than the 21.5% projected in the proposed rule – the difference attributed to the most recent data available to CMS). Since 2003, however, Congress has acted to avert significant reductions in Medicare physician payments, with the latest of these interventions occurring last July via the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). MIPPA provided physicians with a 0.5% update for the remainder of 2008 followed by a 1.1% update through December 31, 2009, thereby preventing what was at the time a projected 10.6% Medicare payment reduction. ASA is committed to continuing its work with Congress to support SGR reform legislation.

ASA will continue to analyze the final rule. In the meantime, please use the following links for additional information: Copy of Final Rule for 2010 Physician Fee Schedule http://www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf CMS Press Release http://www.cms.hhs.gov for more information CMS Fact Sheet http://www.cms.hhs.gov for more information Update .... continued from page 6

unintended consequences that could be associated with such an endeavor had been raised by us and addressed as responsibly as possible.

The core task of the AQI will be development of the National Anesthesia Clinical Outcomes Registry (NACOR). A brilliant system architect, Hubert Kordylewski, PhD, has been hired, and he also hit the ground sprinting along side Dr. Dutton. The architectural design is finished, and the requisite livewire and hardware have been acquired. Word got out quickly and at this point over 100 practices, both academic and private, have eagerly volunteered to be early adopter participants, including at least one from Alabama. Legal contracts between practices and the AQI have been finalized and are now being sent to the initial early adopters selected for specific reasons by Dr. Dutton. Contribution of data is designed to be as painless as possible, and does not require use of an AIMS, although as would be expected, this will be a key benefit gained from taking the electronic leap.

Data sent to NACOR will be analyzed and presented in the aggregate only. All data will be de-identified - specific patients, providers and practices will not be revealed. However, at their discretion and under their control, practices and individuals will have the ability to authorize ‘unlocking’ of their own data to permit such benefits as benchmarking (e.g. “How do our outcomes compare with other groups of the same size and demographics?”). The next article in this newsletter related to the AQI and NACOR will focus more specifically on the benefits to individuals and groups delivered through participation.

Please feel free to contact me (jsplag@aol.com) or our ED (r.dutton@asahq.org) with your advice, concerns and suggestions.

Mark your Calendars

Have you paid your 2009-10 ASSA membership dues? December 31, 2009 is the deadline, but November 30 is the deadline to pay if you want to avoid the $50 late charge. Almost 85% have paid already. Get your dues in today!

ASSA Annual Business Meeting in February 2010 We will conduct our annual business meeting on Saturday, February 20 on the 3rd Floor of the Wynfrey Hotel in the Buckingham room immediately following the last lecture of the UAB Refresher Course. Please join us or make certain at least one member from your group participates. We value your ideas and need your input.

Happy Holidays from ASSA 11

ASSA P.O. Box 241453 Montgomery, AL 36124