My Reflections of 2018
Gary Tzeng, MD
- After hard-fought legislative challenges, Illinois finally has significant Workman's Comp reform that enforces the late-payment penalties and advances the process (beyond paper and mail delivery) into the digital realm.ISA is proud to have assisted ISMS in this important endeavor.
- While the APNs were able to advance limited expansion of their services, ISA is reassured that Legislators understand and acknowledge the uniqueness of anesthesia services and importance of the Anesthesia Care Team model and thus did not change any anesthesia-related regulations.
- Sadly, 2018 exacted a toll on ISA as we lost three of our former ISA Presidents this year. Like all ISA Presidents, each was devoted to our specialty but will be remembered for their unique legacies: Dr. John Szcewczyk as an extraordinary Parliamentarian, Dr. Usharani Nimmigadda as an amazing advocate for residents and research, and Dr. John Paul McGee as the gentle soul who strongly advocated involvement in ISA's important missions.We will miss them dearly but remember them fondly by establishing Resident Advocacy Awards that will encourage and financially support chosen residents to attend the Annual ASA Legislative Meeting.If you would like to donate to support these awards, please contact ISA (contact @isahq.org).
So enough of the past, what about the future (at least for 2019)?
- ISA has and continues to address the challenges of its delegates for its Annual House of Delegates Meeting.As you hopefully have noticed, ISA has changed the nomination process into a self-nomination process to better respect individual wishes. So PLEASE REMEMBER to NOMINATE YOURSELF if you wish to remain or become a delegate!
- We hope this change will encourage greater member participation, especially by those members who feel somewhat detached and find it difficult to become involved.And while we hope that all members representing all regions of the state will attend, we understand that logistical impossibility and therefore have removed the geographical requirements/limitations for the future delegates.But we still hope that members from all regions of our great state will want to participate as a Delegate and have their voices heard.
- The Practice Management Dinners remain popular so stay tuned as we continue to develop future dinners.If there are topics that you feel we should address, please let us know.
- The Leadership Skills Workshops have not been as popular, so those will remain on hiatus as we re-allocate those funds into our expected Legislative needs (see below).
- We have many Legislative challenges!50+ freshmen legislators will be inducted in Springfield.Most, if not all, do not have any known experience with existing healthcare legislative issues.Therefore, education will be a paramount mission for ISA and thus, ISA needs all our members' help to realistically achieve any progress.So please join us for Lobby Day in Springfield.
- The Medical Practice Act sunsets in 2019.This sunset along with the new legislature means that 2019 will be a very busy year for scope-of-practice issues.ISMS is expecting legislation from almost all allied healthcare providers including nurse anesthetists.
- As we expect a large legislative burden in 2019, I believe this year will be an opportune time to advance AA Legislation.Stay tuned as ISA continues to formalize its strategy.
- Lastly, ISA would like to thank Dr. Stephen Rublaitus for his years of service transforming ISA Today into its current modern iteration.As he steps down as Editor and I also step down as ISA's website manager, ISA seeks members who are interested in continuing ISA's media transformations.Please contact ISA if you are interested in becoming the Editor of ISA Today and/or managing ISA's website.
Our mission for 2019 remains the same:advancing the specialty of Anesthesiology in our state and ensuring the safety of our patients. So please BE ENGAGED AND INVOLVED FOR 2019!ISA NEEDS AND THANKS YOU FOR YOUR SUPPORT!
" A lot of people are looking to other people for solutions to the world we live in, pointing fingers.But we've all been called to do something for others.Everyone needs to pray about what to do.And to do it."
--Sister Stephanie Baliga, Mission of Our Lady of the Angels in Chicago
HAPPY HOLIDAYS AND HAPPY NEW YEAR!
News, Announcements and Press releases
As always, the ASA Annual Meeting was full of meaningful educational, workshop and networking opportunities. SF remains a beautiful city that surprised this year’s attendees with great weather and yet challenged us with a labor dispute/strike within the Marriott/SPG community.
But for those that are unaware, this meeting also serves as the hard-working governance meeting for your ASA—where policy & positions are decided and monies & energies are allocated. Many housekeeping issues are performed including continued funding of the the AQI. But many controversial issues are also debated and attempted to be resolved in a unified manner.
So for those who are unaware of what ASA did, here are my highlights:
1. Dr. Stan Stead was formally acknowledged for his years of service and leadership as he steps down from the Board. His contribution as our specialty’s advocator for fair compensation is greatly appreciated.
2. The ASA Series on Medical Ethics was retired for the future but the publication “Guidelines for the Ethical Practice of Anesthesiology” was approved and published while the content of the ASA Series on Medical Ethics will be moved to their respective chapters in the Committee on Ethics Syllabus as non-CME questions.
3. ASA Practice Parameters were updated per its usual cycle.The following Performance Measures from CPOM were approved:
- Avoidance of Cerebral Hyperthermia for Procedures Involving Cardiopulmonary Bypass
- Functional Status Assessment and Goal Setting for Chronic Opioid Users
- Neuromuscular Blockade: Documented Assessment of Neuromuscular Function Prior to Extubation
- Neuromuscular Blockade: Reversal Administered
- Consultation for Frail Patients
- Obstructive Sleep Apnea: Mitigation Strategies
- Obstructive Sleep Apnea: Patient Education
5. ASA will partner with Social Finance, Inc. to offer members easy access and discounted loan rates.
6. ASA’s “Statement on the Anesthesia Care Team” has been and continues to be difficult to update as the ASA membership struggles to come to a consensus related to multiple definitions. The Statement has been referred back to Committee again for further refinement.
Lastly, in honor of those members who passed this year and especially our Past Presidents, the Illinois Delegation chartered a Sunset Cruise on the Bay and toasted our past colleagues as we sailed under the Golden Gate Bridge. It was a wonderful tribute and wished all of our members could have been present.
The Legislative Journey to Independent Practice for APRN Continues...
In most other states, Advance Practice Registered Nurses (APRNs) already have full practice authority to diagnose, treat, and prescribe. Currently, there are 24 states and the District of Columbia that don't require any physician involvement for APRNs to diagnose, treat or prescribe. In addition to those, eight states allow APRNs to diagnose and treat independently but require physician involvement to prescribe.
There was strong support this year, within the Illinois legislature to grant APRNs with full independent practice. Instead of voting against physicians, legislators asked that the Illinois State Medical Society (ISMS) draft an alternative. The Illinois Society for Advanced Practice Nursing bill as introduced would have granted full independent practice and full prescriptive authority, after completing additional clinical training under the supervision of either another APRN or physician.
After numerous negotiating sessions and intense advocacy from physicians, an agreement was reached in 2017. This agreement was passed by the Legislature, signed into law by Governor Rauner, and took effect on January 1, 2018.
Below is a summary of the language that was eventually accepted by the APRNs:
- 1.Maintains the requirement that APRNs have a written collaborative agreement, unless the APRN receives substantial post-graduate training under the direct supervision of a physician (4,000 clinical training and 250 hours in additional educational/training components). The physician then must sign a written attestation confirming that the training was completed.
- 2.Does not change current practice within a hospital setting; APRNs must still be recommended for credentialing by the hospital medical staff.
- 3.Requires APRNs to maintain a formalized relationship with a physician that must be noted in the state's prescription monitoring program (PMP) if that APRN wishes to prescribe schedule II opioids and benzodiazepines. The opioids to be prescribed must be specifically noted in the PMP and APRNs and the consulting physician must meet at least monthly to discuss the patient's care.
- 4.Says APRNs are prohibited from administering opiates via injection. APRNs are also prohibited from performing operative surgery.
- 5.Prohibits APRNs from advertising as "Dr.," which is extremely misleading to patients. APRNs who have doctorate degrees must tell patients that they are not medical doctors or physicians.
- 6.Makes clear that nurse anesthetists are NOT included in the agreement; nothing changes as to how nurse anesthetists currently practice.
ISA has worked closely with ISMS on scope of practice issues and greatly appreciates that anesthesia services have been uniquely identified in the medical practice acts. While ISA has traditionally been opposed to the independent practice of non-physician providers, we've conceded that mainstream support exists for APRNs in Illinois. ISA will vigilantly advocate that anesthesia services are not the same as primary health care. We believe that the Anesthesia Care Team model provides excellent access to quality care for our patients.
Despite this expansion of privileges, the push for further independence continues. The ISA and ISMS are keeping a sharp eye focused on the APRN Compact legislation that is making ts way across the country. The APRN Compact legislates that once ten states "sign on", all states that belong to this Compact will honor an APRN's state licensure and rights of that licensure, regardless of the other states' rules and regulations. In other words, the nursing practice rules of a conservative state's license would not apply to an APRN with a very liberal license. This Compact attempts to supersede state nursing licensing requirements and regulations and is a pathway for national APRN independence.Unlike other medical and nursing compacts, this legislation does NOT respect state law.
In 1997 congress passed the Balanced Budget Act (BBA), to replace the Medicare Volume Performance Standard (MVPS), in an attempt to rein in the growth in physician expenditure and healthcare costs. The BBA was designed to ensure that the annual increase in expense per Medicare beneficiary did not exceed the growth in Gross Domestic Product (GDP), and tied physician reimbursement to GDP.
The ASA House of Delegates met this past October 22-26. It brought together hundreds of delegates representing eight regions in the nation. Over the span of five days, I had the opportunity to partake in this gathering of innovative minds as the physician anesthesiologists who function as the primary legislative and governing body of the ASA met in Chicago.
As I reflect upon last weekend’s 2016 ISA Leadership Conference, I am thankful to be a member of our organization. The ISA continues to provide rich educational experiences at minimal to no cost for its members. Drs. Torin Shear and Michael Shane continue to develop an amazing conference with excellent, thought-provoking speakers from around the nation. As a short summary: