As a member organization, the American Society of Anesthesiologists® (ASA®) has many channels through which we communicate regularly all the information on issues of importance to your patients, your practice, and you. As your ASA President, I thought it essential to send a communication update letting you know the issues that are the front and center focuses of ASA leadership and staff, as there are many topics critical to your careers and practices occurring right now. These include:
• Implications of the SGR Repeal Legislation
• Augmenting the functionality of our practice data repository (NACOR) and reporting to CMS via the Qualified Clinical Data Registry (QCDR)
• Draft Veterans Affairs Nursing Handbook
• Changes to the American Board of Anesthesiologists Maintenance of Certification process
• Perioperative Surgical Home
First and foremost is the issue of the Sustainable Growth Rate (SGR) repeal. A new physician payment system is on the horizon. On April 16, 2015, President Obama signed into law H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, a bill that permanently abolishes the Medicare Sustainable Growth Rate physician payment formula and establishes a new paradigm for paying physicians under Medicare. The law will require physicians to change their manner of practice in order to successfully participate in key elements of the new system. Specifically, following a period of "stability" in which there will be 5 years of 0.5 percent annual increases to the Medicare physician fee schedule, physicians will need to navigate two new programs, the Merit-Based Incentive Payment System (MIPS) and/or the Alternative Payment Models (APM), in order to have the opportunity to earn annual payment increases. Physicians who participate in MIPS will be scored by the government on their ability to meet various yet to be determined quality requirements contained in predefined "performance categories." Only physicians who score well will be eligible for positive payment adjustments. In addition to the MIPS program, physicians may also participate in new payment models - APMs - defined by the new law to include models tested by the CMS Center for Medicare and Medicaid Innovation (CMMI) such as medical homes, Accountable Care Organizations (ACO), models that bear financial risk and other new models including those for "services provided by non-primary care professionals." Physicians who successfully participate in qualified APMs are eligible for an annual 5 percent lump sum bonus in 2019 and through 2024.
ASA is committed to help you fully and successfully participate in the new MIPS and APM programs. To that end, the Society has already been working to develop important resources. Foremost among these resources is the National Anesthesia Clinical Outcomes Registry (NACOR). Reporting anesthesia practice data to NACOR is free to all ASA members. ASA has been building NACOR, a Medicare-designated Qualified Clinical Data Registry (QCDR) since 2010. NACOR will assist physician anesthesiologists navigate parts of the MIPS program. ASA is also working to identify and prioritize elements of the MIPS that will require continued attention by ASA to make it easier for ASA members to participate. Revisions to the Electronic Health Records (EHR) Meaningful Use (MU) program are an element of MIPS that will need to be prioritized. There will be no cost to ASA members to report their required quality data to Centers for Medicare & Medicaid Services (CMS) via NACOR (although there will be a fee for non-ASA members, physicians and nonphysicians).
The Society has also begun work to facilitate physician anesthesiologists in successful participation in APMs. Work continues by ASA to further build the Perioperative Surgical Home (PSH), a possible vehicle for physician anesthesiologists' participation in APMs. Additionally, we are engaging new resources to explore further opportunities for your participation in Alternative Payment Models such as bundled payments and ACOs. We look forward to partnering with you to ensure that the interests of our patients and profession are advanced as part of the new system.
Another priority issue on which the ASA has been working is halting the U.S. Department of Veterans Affairs (VA) initiative to mandate comprehensive "independent practice" by all Advanced Practice Registered Nurses (APRN), including nurse anesthetists, in VA facilities. The Veterans Health Administration (VHA) Office of Nursing Services (ONS) is advancing this new policy through a document known as the VHA "Nursing Handbook."
ASA first learned that the "Nursing Handbook" was moving surreptitiously through VA in May 2013. We immediately implemented a three-pronged strategy to halt the new policy. First, ASA leaders met with VA leadership on multiple occasions to discuss the patient safety implications of eliminating physicians from anesthesia care delivery to patients in VA. Second, working hand-in-hand with ASA's Grassroots Network and Key Contacts, we called on Congress to exercise aggressive oversight of this ill-advised and dangerous policy. In response to the call, to date, more than 60 members of Congress have contacted VA to express concern about the proposed policy. Additionally, Congress passed language as part of its December federal government funding package asking VA to include the voice of more internal and external stakeholders in the development of the new policy. The language also asked VA to work to ensure that the new policy does not conflict with existing VA policies already in place in VA - a reference to the "Nursing Handbook" nurse-only model of anesthesia care and its inherent conflict with the current VA policy found in the "Anesthesia Service Handbook" which endorses a team-based model of anesthesia care. Finally, we've also worked with prominent national Veteran Service Organizations (VSO) such as AMVETS and the Association of the U.S. Navy to ensure that the voices of Veterans will be heard as part of this policy discussion.
As a result of our work, the implementation of the "Nursing Handbook" has been slowed but not halted. Much work remains to be done on this critically important Veteran patient safety issue. The nursing community, including nurse anesthetists, have a robust campaign in place to push the "Nursing Handbook" forward to implementation. We need all ASA members to contact their local Member of Congress and their U.S. Senators
to urge scrutiny of the "Nursing Handbook" and its goal to abandon physician involvement in anesthesia care within VA. Currently, we expect the VA "Nursing Handbook" to be released, as a proposed rule in the Federal Register, in early fall of 2015. VA has pledged to accept public comments in the Federal Register on the "Nursing Handbook." All ASA members should prepare to comment in the Federal Register on this ill-advised proposal. It is critical for every member to participate in this public process or risk being drowned out by the nursing community.
Last week, we were all notified of the changes to the American Board of Anesthesiology Maintenance of Certification (ABA MOCA 2.0) requirements. It is important to remember that the ABA is completely independent of ASA and these changes were appropriately made solely by ABA. ASA leadership and staff are actively engaged in learning about the new ABA requirements and committed to ensuring that we continue to meet your ABA MOCA 2.0 needs as efficiently, conveniently and cost-effectively as possible. The ABA sets the MOCA 2.0 requirements for certification, and ASA, as your professional society, provides the resources you need to meet those requirements. ASA will continue to offer you the products you need for recertification with ABA MOCA 2.0. We have heard and shared your concerns and suggestions regarding ABA MOCA 2.0 with ABA leadership. We will continue to monitor additional details as the ABA prepares for the January 2016 implementation of ABA MOCA 2.0. As we learn more, we will update you regarding details, how these changes are to be operationalized, and how ASA will respond to these changes.
We continue to make progress advancing the Perioperative Surgical Home (PSH) model of care. The PSH Learning Collaborative has been successful in helping those enrolled launch and move their PSH projects forward. As the work of the collaborative progresses, we will develop additional resources and tools to enable you to successfully implement this important effort in patient-centered care. A PSH bookstore, with resources for those who wish to understand and build the necessary skills to effectively launch and manage a PSH is now available at: https://www.asahq-test.org/psh/PSH%20Products . We hope to see you in Huntington Beach, Calif., this June at the Annual Perioperative Surgical Home Summit, jointly provided by ASA and the University of California, Irvine Department of Anesthesiology and Perioperative Care. This excellent program will give a more in-depth look at the PSH including information on how it improve the patient experience; make surgical care safer, and lower institutional costs. Additionally, you will hear: presentations from world-renowned experts from Europe and the U.S. who will share their theories about the PSH model; didactic lectures, workshops, roundtable and panel discussions to encourage collaboration; and implementation suggestions and how to apply the PSH model of care into clinical practice, strategies for change management, and the importance of teamwork. Physician anesthesiologists are poised to lead the way in implementing the PSH model of care. This meeting is an excellent opportunity to see how to make change happen and bring the many benefits of this integrated care strategy to your patients and practice.
Finally, I want to thank you for your tireless dedication to your patients. Our profession, anesthesiology, has always had one principal goal - to deliver the highest quality and safest medical care to our patients. Through your hard work we have made tremendous strides over the years. It is because of the dedication of the entire profession we are recognized as leaders in patient safety and quality of care. While there are many issues and changes we are engaging, the opportunities for physician anesthesiologists are greater than I've ever seen in my career. I could not be more optimistic concerning our future or our ability to significantly improve the quality and safety of the care we deliver to our patients.
I've briefed you on some of the hot topics affecting your patients, your practices and you. As always, I'm available by email or phone to answer any additional questions you may have.
J.P. Abenstein, M.S.E.E., M.D.
American Society of Anesthesiologists