ASA Meeting 2011 Highlights
Chicago, IL
“Chicago seems a big city instead of merely a large place”
(A J Liebling)
“ASA - Advancing the practice and securing the future”
(ASA Mission Statement)
Liebling was never more correct in a description of Chicago, at least as presented to those attending the 2011 ASA Annual Meeting. Working with a large footprint of hotels and convention center meeting locations, your SCSA delegation of Steve Getz, Forest Evans, Stan Ulmer and Rob Morgan worked hard at the governance matters of the House of Delegates.
What follows within are a few highlights from the meeting. Complete and very detailed information regarding the many facets of this year’s Annual Meeting and House of Delegates can be found within the ASA website (Members Only section) http://www.asahq.org/For-Members/About-ASA/ASA-Governance/Governance-Resources-for-Members/2011-House-of-Delegates-Meeting-Materials.aspx. The following link will also provide a summary of the meeting activities, day by day, both educational and governance:
http://www.asadaily.com/?utm_source=Exact+Target&utm_medium=Email&utm_term=Oct17&utm_campaign=ASA+Daily
This was the third year for trying a “Opening Session” on Saturday. It began with a lecture by Dr.Atul Gawnde (available at the “Members Only” ASA website at http://education.asahq.org/2011/Gawande ) outlining his experience with creation and institution of surgical safety checklists. After use of his checklists in over 4,000 hospitals worldwide a consistent reduction in deaths and complications from surgery is obtained. Of note, he even highlighted the work being done here in South Carolina on this initiative!
HOUSE OF DELEGATES ITEMS
As I mentioned above, your delegates from the SCSA at the ASA House of Delegates this year were Steve Getz, Forest Evans, Stan Ulmer and Rob Morgan. The reality is that if one is fully engaged in these Governance issues, there is often little time to participate in the Educational aspects of the ASA meeting. Your SCSA delegates and representatives were diligent and fully engaged with 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 represent highlights through my eyes.
The HOD Handbook is available, as noted above, and I suggest reading;
ADMINISTRATIVE AFFAIRS BUNDLE
Report 165-3 Annual Report of the Executive Vice President in Park Ridge, John Thorner. This report gives an excellent overview of the organizational advances that have been achieved in the many aspects of the Strategic Plan of the ASA, including finance, membership services, education, governance, information technology, and human resources. The ASA continues to strive to become the premier medical specialty organization in the world. The recent years have been filled with significant, though not without some strife, advancements in the organizational structure of the ASA refining its mission to its membership as well as the organizational tools to provide for that.
Report 165-4 Annual Report of Ron Szabat, Executive Vice-President and General Counsel in Washington, D.C. This an update of the past year’s efforts of the ASA Advocacy Staff in the areas of PPACA, repeal of the IPAB, ACO regs, drug shortages, and scope of practice issues. Because of House action last year, three new positions were added to the Washington office to help with the regulatory, legislative and political challenges the ASA membership face across the country. Much work remains and Ron along with manuel Bonilla and his staff work very hard on behalf of the membership.
Report 300-2.1 Annual Report of the Administrative Council. This is a view from the top of the ASA leadership and covers actions on a variety of issues from strategic plan course corrections to financial budgeting matters. Of note, the ASA continues to strive to improve capabilities for understanding and predicting our finances. The ASA has built a very good team of financial leaders who have made dramatic improvements to our financial analytics and our accounting. The ASA is finally getting its financial capabilities in line with the demands of the Society. This has not been an easy process but significant progress continues to be made.
In addition, this report outlines the continued reorganization of the staff structure of the ASA with consolidation of all staff reporting to one chief staff officer position and to shift the Chief Executive Officer (CEO) role and title from the President to the chief staff officer. This was approved by the House on Wednesday and one suggested staff organizational chart is pictured in Report 300-2.2
Reports 310-3.1 and 310-5 Annual and Supplemental Report of the ASA President. Mark Warner outlines his year at the helm with updates ranging from the Surgical Home Concept, Drug Shortages, Organizational Improvements, and a Land Update (several parcels for a new ASA building are being evaluated, most promising at this time appears to be in the Schaumburg area).
In his supplemental Report 310-5 Dr. Warner points out the importance to our specialty that we work very hard to become indispensable. I have copied a portion of his remarks, as I concur with this sentiment. I urge the reader to take his thoughts to heart:
“...we must strive individually and collectively to be indispensable. We must be indispensable to our patients, to our colleagues, to our health systems, to our communities, and to society.
• We will be indispensable by expanding and improving the practice scope and services of anesthesiologists. The surgical home concept will play an important role, and we must educate our newest anesthesiologists to play key roles across the entire spectrum of perioperative and pain care.
• We will be indispensable by supporting the development of new knowledge and practices, achieved by the continued strong support of our important foundations. They are vital to advancing our practices.
• We will be indispensable by ensuring that we continue to evolve and grow our advocacy efforts nationally, within states, and locally.
• We will be indispensable by providing essential clinical information and guidelines, and developing high quality educational products that allow our members to be outstanding physicians and leaders.
• We will be indispensable by attracting the best and brightest new physicians into our specialty.
• We will be indispensable by having and implementing the strongest, most relevant strategic plan in organized medicine.
• And most importantly, we will be indispensable because we will lead the most important patient safety efforts in U.S. medicine.”
Report 336-2 Annual Report of the Committee on Bylaws. The House of Delegates (HOD) was asked to vote on a number of significant bylaws changes in this report. All the previous Board actions were approved by the House but the ASA Bylaws change of section 2.09 generated an enormous amount of discussion on Wednesday in the HOD. This section is related to the Board of Directors’ action on Report 300-1.1 (at our March meeting) that included a directive to the Committee on Bylaws to develop Bylaws amendments consistent with consolidating all staff reporting to one chief staff officer position; shifting the Chief Executive Officer (CEO) role and title from the President to the chief staff officer; creating a consolidated senior management team organized around advocacy, education, revenue, and support functions; that the reporting relationships and organizational structure be further clarified; that retention metrics and performance review timeline be defined; that the Bylaws Committee be asked to provide the necessary changes to effect these recommendations, and that recommendations regarding the Board of Director’s role in the hiring and dismissal of executive staff be clarified. The HOD approved this revision to Section 2.09 to read, “The Chief Executive Officer shall be evaluated by the Board of Directors and shall be under the direction and supervision of the President and the Administrative Council. The Board of Directors shall approve the selection of the CEO.”
PROFESSIONAL AFFAIRS BUNDLE
Reports 408-2.1 and 408-2.2 Committee on Performance and Outcomes Measurement. The Committee report recommended approval of:
1. Post-Anesthetic Transfer of Care Measure: Procedure Room to Intensive Care Unit
2. Preoperative Use of Aspirin for Patients with Drug-Eluting Coronary Artery Stents
3. Registry Participation Measure.
The HOD approved the above but amended the “Preoperative Use of Aspirin for Patients with Drug-Eluting Coronary Artery Stents” to read that “...Patients who have documentation that they received aspirin within 24 hours prior to the surgical start time or documentation that the risks of preoperative aspirin therapy are greater than withholding aspirin...”
Report 408-2.4 An outcome measure for Prevention of Post-Operative Vomiting ) Pediatrics - Multimodal Therapy was referred by the HOD to a committee of the President’s choice.
Report 409-2 Committee on Standards and Practice Parameters. This Committee recommended and the HOD approved:
1. Practice Guidelines for Central Venous Access.
2. Practice Guidelines for Acute Pain Management in the Perioperative Setting.
3. Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery.
4. Practice Advisory for Preanesthesia Evaluation.
(all these guidelines and advisories are published on the ASA website)
Report 411-2 Committee on Quality Management and Departmental Administration: Subcommittee on Deep Sedation Education Feasibility Report. This was one of the two reports that generated enormous discussion in reference committee as well as on the floor of the HOD, as Dr. Ulmer referenced in his report. HOD action referred this effort back to committee. For the entire work product that was considered see Report 411-2.2.
Report 428-2 Committee on Governmental Affairs: Annual Report. Good summary of the legislative, regulatory, and political activities as well as advocacy priorities of the ASA.
SCIENTIFIC AFFAIRS BUNDLE
Report 528-1 Committee on Pediatric Anesthesia. Pediatric anesthesia has become a more widely recognized subspecialty and will soon have certification status from the American Board of Anesthesiology. Families with infants and children needing anesthetic services are becoming increasingly aware of the nuances and intricacies of the anesthetic care of their loved ones. Because ASA members are confronted by facility administrators and medical colleagues with questions about the appropriate anesthetic care of pediatric patients with a variety of needs, from the very premature infant to children with comorbidities and congenital conditions, and even normal infants and children in a setting where the facility may not be accustomed to caring for them, this committee recommended an updated and revised statement on Practice Recommendation for Pediatric Anesthesia in report 528-1.3. The HOD approved this report as amended below:
(Report 528-1.3 page 2)
“...3.1 Regular Clinical Privileges
Anesthesiologists providing and/or directly supervising clinical care for pediatric patients
should be graduates of anesthesiology residency training programs accredited by the
Accreditation Council for Graduate Medical Education (ACGME) or its equivalent,
should be a diplomate or in the process of certification by the American Board of Anesthesiology
(ABA), and should have documented continuous competence in the care of patients in
specified categories in order to maintain those clinical privileges. Although a minimum
performance requirement may or may not be required for granting privileges in specified
categories, there should be a requirement to report numbers of cases performed in these
categories....”
FINANCIAL AFFAIRS BUNDLE
Reports 675-2 and 675-7 Ad Hoc Committee on Quality Practice Recognition: Seal of Quality. These reports and the concept addressed, as did the proposed Deep Sedation Education product, generated significant discussion in reference committee and on the floor of the HOD on Wednesday. Final action by the HOD was to defeat this program.
This committee’s reports are numerous, extremely detailed, and require several GPS satellites to navigate in my opinion. Bottom line, budgetary numbers for 2010, 2011 and 2012 can be found in Reports 685-2, 687-3 and 688-2. Notable details include:
• 688-2.1 is an 11 page report outlining in detail the process for creation of the Draft 2012 Budget.
• 688-2.2, page 8 outlines support from the ASA to other Organizations.
• 688-2.4 is 4 pages of detail on the costs for a Capital Expenditures Budget, primary expense being related to the purchase of an Association Management System (hardware and software).
• 688-2.5 is the draft Operating Fund and Capital Expenditures summary for 2012. Final HOD action on Wednesday set final numbers for the 2012 budget at $39,468,191 for revenue with expenses of $38,553,668 to create a change in net assets of $814,523.
(This includes a $25/active member dues increase)
ASA OFFICER ELECTIONS:
There was one contested election this year between Jane Fitch and Robert Johnstone for 1st Vice President. The HOD voted upon and approved the following:
President Jerry A. Cohen, M.D.
President-Elect John M. Zerwas, M.D.
1st Vice President Jane Fitch, M.D.
Vice-President, Professional Affairs Norm Cohen, M.D.
Vice-President, Scientific Affairs Arnold J. Berry, M.D.
Secretary Arthur M. Boudreaux, M.D.
Assistant Secretary Linda J. Mason, M.D.
Treasurer James D. Grant, M.D.
Assistant Treasurer Mary Dale Peterson, M.D.
Speaker, House of Delegates J.P. Abenstein, M.D.
Vice-Speaker, House of Delegates Steven L. Sween, M.D.
ASAPAC
You have already heard that the Southern Caucus states won a portion of the Alabama Cup for 2011 and that MUSC had 100% resident participation in the PAC.
And a reminder that Robert Morgan, MD is now on the ASAPAC Board of Directors, congratulations to Rob for that recognition and opportunity to serve.
STATE ISSUES FORUM
On Sunday morning, after the HOD first session, the ASA leadership organized a state issues forum to address opt-outs, interventional pain management, scope of practice and physician payment. Amongst others, Margarita Pate and I attended and heard valuable information from other states’ experiences and history. We are not alone in some of the challenges we face here in South Carolina. The opportunity to network and learn from others, as well as tap into the expertise of the ASA Staff, will serve us well going forward. A summary of these issues should soon be available at http://www.asahq.org/For-Members/Advocacy/State-Legislative-and-Regulatory-Issues.aspx
****Please note that the 2012 ASA LegislativeConference will be April 30 - May 2 at the J.W. Marriott in Washington, D.C.
As Dr. Ulmer indicated, the South Carolina delegates along with a few spouses and two MUSC resident, Drs. Choi and Branham, had a chance to meet over an authentic Italian dinner at the original Rosebud restaurant in Little Italy on Tuesday evening. It was a good opportunity for fellowship and food in an historic setting.
Allow me to again thank Drs. Morgan, Evans, Ulmer and Getz for their time, energy, and active participation while participating in the activities of the ASA Annual Meeting and in particular the work of the House of Delegates. The physician volunteers working on behalf of you, the membership of the South Carolina Society of Anesthesiologists, both at the state and national level, are striving to make the ASA a better organization that truly serves you. Please give me or any of the SCSA Executive Comm. your thoughts and concerns about your practice and those professional matters that can be influenced.
This summary touches only on the highlights of the meeting and in particular the work of the HOD. And finally, as I have said all along, with all the gloomy news out there about SGR reform (lack thereof!), Medicare cuts, scope of practice issues, (the list is long) 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. But it will take the energy, talents, and persistence of ALL of us.
It remains my privilege to serve the SCSA members as Director to the ASA Board. I am grateful for your input and support. Please do not hesitate to contact me with any questions or concerns.
Respectfully submitted,
Chris Yeakel, MD, FAAP
803-312-2592 (cell)
mailto:cyeakel@sc.rr.com
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