ASA Meeting 2008 Highlights

Orlando, Florida

The length and breadth of our annual meeting covers so many areas that a comprehensive review is not possible.

As your state director, I would like to highlight some of the issues which I felt merit further comment and explanation.

Your ASA continues to strive to become the “world’s premier medical society”.  The annual meeting is the culmination of ongoing efforts in areas of education, advocacy, research, legislative, regulatory and yes, just having some fun too.

Your delegates this year were Rob Morgan, Scott Reeves, Rick Kennedy, Iva Chapple, Mitch Siegan and Keith Stevens.  As you are well aware, the House of Delegates (HOD) has the Herculean job of reviewing reports and hearing testimony at reference committees concerning nearly every aspect of the ASA and its mission.  The items below are just some of the issues that were voted on.

DUES   Dr. Moore and others have ably describe the reasons for the needed increase in recent communications directly to the membership.  Allow me to highlight how seriously the leadership, starting with the Administrative Council, took this proposed increase.  This was not taken lightly or considered without much discussion dating back to a Board of Directors (BOD) meeting in August where it was initially introduced and approved for submission to the HOD.  Of note, there is a realistic hope for non-dues revenue to become more of a reality in the future.

SUBSPECIALTY CERTIFICATION IN PEDIATRIC ANESTHESIA   The ASA Board of Directors was asked evaluate the request from the American Board of Anesthesiology and submit a statement to the ABA on behalf of ASA in support of or in opposition to the application by the Society of Pediatric Anesthesiology (SPA) to ABA for subspecialty certification in pediatric anesthesia.  This request generated enormous discussion and testimony in the reference committees at our August BOD meeting.  The BOD voted to oppose the application by the SPA.  Again, after much testimony, the HOD approved Board action.  This matter will probably resurface in the future and not just with Pediatric Anesthesia but in other subspecialties as well.

ASA QUALITY INSTITUTE    The ASA has recognized that a National Clinical Data Registry is needed.  Earlier this year the Administrative Council of the ASA proposed the creation of such an institute to the BOD.  This proposal was for a separate but related organization that focused on quality improvement in anesthesiology.  The Quality Institute will be not-for-profit organized under Section 501(c)(3) of the Internal Revenue Service Code.  This Institute’s purpose will be to inform and assist the ASA to maintain and strengthen its position in quality of care and patient safety.  Such a position is also very important in demonstrating and documenting improving quality for patient to various bodies such as legislative and executive branches as well as commercial payers and the public at large.  The HOD approved the creation of this Institute as well as start-up funding of $750,000.

            Also approved was a request for a report back to the March BOD meeting that details the structure, the oversight and review process, plans for on-going funding, long-term member value and metrics pertaining to the Quality Institute.  The following five individuals were also approved to be appointed by the ASA Board of Directors to serve as the initial Directors of the ASA Quality institute: Thomas Braillar, M.D., Donald E. Arnold, M.D., Keith J. Ruskin, M.D., Douglas G. Merrill, M.D., Jeffrey S. Plagenhoef, M.D.

STATEMENT ON THE ANESTHESIA CARE TEAM   I have not seen such a hotly debated item in my recent years in the ASA BOD.  Jeff Plagenhoef had the undoable task of gathering input from the entire ASA membership and then vetting and presenting a proposed statement to the BOD and eventually the HOD at the meeting.  The debate was at times intense and even slightly rancorous, with proponents of the many facets of this issue very strongly stating their feelings.  But I am proud to say that the democratic process, perhaps clumsy at times, served us all well and a statement was agreed to which is posted on the ASA website.  For those of you who work with SRNAs, this statement is a worthwhile read.

ADMINISTRATIVE PROCEDURES MANUAL   This might seem to be largely a housekeeping item but the Administrative Procedures Manual covers every aspect of our Society’s activities, ranging from dues collection, membership, Board of Directors, Annual Meeting, budget methodology, selection of liaison representatives to other organizations, investment policy, Legislative Conference, disciplinary procedures and much more.  Its last review was in 1994 and the ASA, especially in light of the OII, needs a comprehensive review and rewrite of this document.  The HOD approved this endeavor and Provisional Administrative Procedures were written and submitted for approval at the BOD meeting which followed the HOD meeting.  Revisions will continue to be made and the next edition submitted to the March BOD for consideration.

WELLNESS INITIATIVE   The Anesthesia Foundation (AF) has appointed John R. Moyers, M.D. and Carol A. Warfield, M.D., as liaisons to the ASA Committee on Occupational Health involved in the Wellness Initiative. The concept of the Wellness Initiative is being considered to expand its mission to provide benefits to practicing anesthesiologists as well.  As such, the Anesthesia Foundation will offer loans and grants to anesthesiologists deemed acceptable for such help by an Advisory group made up of members of the Committee on Occupational Health and the liaisons from the Anesthesia Foundation.  This is an initiative of Dr. Moore’s and as he puts it “ Since we are all slowly feeling our way in the development of this concept, many issues will need to be defined and many concerns answered. Initial operation of the Wellness Initiative might be most easily and logistically accomplished by extending a helping hand primarily to anesthesiologists recently graduated from residency programs. The extent and type of help that will be afforded to individual physicians will also need to be defined. Use of funds might be limited, at least initially, to anesthesiologists caught in natural disasters, such as Hurricane Katrina. Also, use of low interest loans, rather than grants, in order to preserve the capital necessary to administer this program well into the future, will be a key consideration.”  In August of this year the BOD approved a grant of $300,000 to the Anesthesia Foundation with the recommendation that it be used for the initiation of a wellness program for practicing anesthesiologists in a manner similar to the one presently limited to anesthesia residents. The HOD approved this board action so be on the lookout for more information about this Wellness Initiative as it takes shape and form.  And if you have any ideas about this matter Dr. Moore welcomes input as our current president.

ETHICAL GUIDELINES FOR PATIENTS WITH DNRs   These guidelines are available on the ASA Website and were approved at the August BOD meeting and approved by the HOD.

CLOPIDOGREL (PLAVIX)   The Committee on Standards and Practice Parameters had recommended a practice alert be developed concerning perioperative management of clopidogrel (Plavix™).  The BOD approved this in August and the HOD approved that action so be on the lookout for this alert in the future.

COMMITTEE ON STANDARDS AND PRACTICE PARAMETERS   This committee is responsible for the creation of the many guidelines and advisories for our society.  They had created and recommended approval of the Practice Guidelines for Perioperative Transesophageal Echocardiography.  These guidelines were disapproved by the with comment that testimony at the HOD indicated that there was insufficient evidence to support the recommendation that TEE should be used for all cardiac or thoracic aortic surgery patients.  The committee was directed to come back with a new version.

ASAPAC ANNUAL REPORT   This report was both informative and encouraging.  We have seen record growth in contributions but participation of our membership nationally remains very low.  Jim Becker was the outgoing chair of the committee and as part of his PowerPoint our very own state and Rob Morgan were featured for participation in fundraising for politicians.  This report is to the entire HOD and we should all be proud of our participation in this vital process at the national level and state level.  With Rob as our liaison to the ASAPAC we saw our state contributions increase from the prior year but we can continue to do much better.  You may also have noticed that a new level of contribution has been created at the Chairman Level ($1,000) of the ASAPAC.  Please consider contributing as much and as often as possible!  We all benefit from this vital process.  The monies give our very talented legislative team the tools to promote our society’s priorities. This contribution process is important enough that the HOD approved a recommendation from the ASAPAC Executive Board that, beginning in 2009 and thereafter, the District Directors’ annual reports contain at least one paragraph on political advocacy within that state and one sentence minimum quantifying the percent participation within ASAPAC for that state at the time of writing.

I realize this is quite long but for those who wanted the extra detail of the annual meeting this behind the scenes look might be helpful.  Allow me to stress how hard your delegates worked for you while there.  They are required to juggle multiple and sometimes conflicting priorities at least in terms of scheduled and allotted time.  The Southern Caucus, of which South Carolina is a member, met twice to discuss many of the above matters as well as elect new leadership.  We are fortunate to have such talent within our caucus and many members of the Administrative Council of the ASA have been or are currently from our caucus.

And finally, I want to say that I firmly believe that we have many reasons to be very hopeful for our specialty and for our role as physicians in the brave new world of U.S. healthcare.  It may be headed down some paths that are looking gloomy at the moment but there is reason to believe that we are not able to exert influence on the process.  Our legislative team has enormous talent and has carefully built relationships over the years in Congress (Baucus and Grassley for starters).  Within the ASA, its Foundations, its staff and you, its membership, we have very deep resources to draw upon.

It remains my privilege to play a small role in this process for you and our state.

Respectfully submitted,