Winter/Spring 2011
MSA Anesthesia Record
www.MassAnesthesiology.org Massachusetts Society of Anesthesiologists, Inc. Vol. 39 No.1 - 2011
ANESTHESIA HISTORY REPORT OF COUNSEL HEALTH CARE PAYMENT REFORM HAS MOVED TO THE TOP OF THE POLITICAL AGENDA
by Edward J. Brennan, Jr. ealth care payment reform has moved to the top of the politi- cal agenda on Beacon Hill, as GovernorH Patrick begins his second term and a new Legislature convenes. The Governor began the process by submitting to the Legislature his long awaited proposal to reform the system of health care payment in Massachusetts (H. Elliott V. Miller, M.D. [retired Anesthesiologist, Massachusetts General Hospital] 1849). House and Senate leaders have addressing a group of visiting residents from Brigham and Women’s Hospital at the indicated that the 52 page bill is just the Ether Dome in 2008. beginning of what will likely be a long and controversial effort to legislate con- EXPERIENCING ANESTHESIA HISTORY (continued on page 6)
IN MASSACHUSETTS TABLE OF CONTENTS Anesthesia History 1 Ryan LeVasseur, M.D. and Sukumar P. The Ether Dome: Located in the Bull- Desai, M.D. finch building at MGH in Boston, this site Report of Counsel 1 oston shares anesthesia heritage is preserved in near original condition, and MSA Committees 2 rights with Jefferson, Georgia, has been designated a National Historic Editor's Report 3 and Hartford, Connecticut. Elliott Landmark. It is here that William Thomas President's Report 4 BV. Miller, M.D. began tours of Mount Green Morton first publicly demonstrated Personality Profile 5 Auburn Cemetery about 30-years ago the use of ether as an anesthetic on Octo- Director's Report 7 for generations of anesthesia residents ber 16, 1846 while surgeon, John Collins Hospital in Review 8 from the Massachusetts General Hospital Warren, founder of the hospital as well Program Committee 10 [MGH]. Fifteen years ago, he also began as Chief of Surgery, performed a brief Economics Committee 11 tours at the venerable Ether Dome. We 7 minute procedure on Edward Gilbert Bylaws Committee 14 describe five sites within Massachusetts Abbott. This blessing of painless surgery Boston Anesthesia 15 that may be visited by history enthusiasts. is considered by many to be one of the ASA News 18 Beyond the scope of this article are two greatest medical advances ever. Thus, important sites in Hartford, Connecticut - anesthesiologists visiting the Ether Dome Anesthesia Quality Insti. 19 Horace Wells’ statue in Bushnell Park and tread on holy ground as they move about Retirement Article 20 his grave in Cedar Hill Cemetery. the small amphitheater viewing the many MSA Annual Reports 21 artifacts still preserved. Padihershef, a Membership Changes 29 Health Volunteers 30 (continued on page 16) Advertisement 31
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MASSACHUSETTS SOCIETY OF M.S.A. Past Presidents 1979-1980 Herbert L. Everett, M.D. 1948-1949 Urban H. Eversole, M.D.* 1980-1981 Lawrence A. Simons, M.D. ANESTHESIOLOGISTS 2010-2011 1949-1950 Jacob H. Fine, M.D.* 1981-1982 Raymond J. Anton, M.D. 1950-1951 Morris J. Nicholson, M.D. 1982-1983 Bebe K. Wunderlich, M.D. Officers, Directors, Delegates and Committees 1951-1952 William J. Martin, M.D.* 1983-1984 Kenneth W. Travis, M.D. Fred E., Shapiro, DO, President 1952-1953 Leo V. Hand, M.D.* 1984-1985 John V. Donlon, M.D. Ruben J. Azocar, MD, President Elect 1953-1954 Julia G. Arrowood, M.D.* 1985-1986 Dorothy M. Crawford, M.D. Vacant, Vice President 1954-1955 Dexter R. Branch, M.D.* 1986-1987 Joseph R. Beauregard, M.D. Selina A. Long, MD, Secretary (2011) 1955-1956 Robert M. Smith, M.D. * 1987-1988 D. Sean Restall, M.D.* Daniel J.P. O'Brien, MD, Treasurer (2012) 1956-1957 John Bunker, M.D. 1988-1989 Marcelle Willock, M.D. David L. Hepner, MD, Immediate Past President 1957-1958 Benjamin Etsten, M.D.* 1989-1990 Leonard S. Bushnell, M.D.* Beverly K. Philip, MD, ASA Director (2012) 1958-1959 James H. Buskirk, M.D. 1990-1991 Fred G. Davis, M.D. Vacant, ASA Alt. Director (2012) 1959-1960 Phillip S. Marcus, M.D.* 1991-1992 Stephen V. Hall, M.D. Richard D. Urman, MD, MBA, Newsletter Editor 1960-1961 Francis J. Audin, M.D.* 1992-1993 Gerald L. Zeitlin, M.D. Edward J. Brennan, Jr. MSA Legal Counsel 1961-1962 Carroll Bryant, M.D. 1993-1994 Lee S. Perrin, M.D. Beth E. Arnold, Executive Secretary 1962-1963 Peter G. Lehndorff, M.D.* 1994-1995 James S. Gessner, M.D. Delegates: ASA House of Delegates 1963-1964 Leroy D. Vandam, M.D. * 1995-1996 Alexander Hannenberg, M.D. McCallum R. Hoyt, MD, MBA (2011) 1964-1965 Joseph G. Murphy, M.D. 1996-1997 Robert H. Bode, Jr., M.D. Daniel J.P. O'Brien, MD (2011) 1965-1966 Robert N. Reynolds, M.D. 1997-1998 Jeffry B. Brand, M.D. Lee S. Perrin, MD (2011) 1966-1967 Henrick H. Bendixen, M.D. 1998-1999 Bernard H. Hand, M.D.* David L. Hepner, MD (2012) 1967-1968 Donald L. Mahler, M.D.* 1999-2000 Daniel F. Dedrick, M.D. Selina A. Long, MD (2012) 1968-1969 Robert D. Ouellette, M.D. 2000-2001 Alan M. Harvey, M.D. Richard D. Urman, MD, MBA (2012) 1969-1970 Donald P. Todd, M.D.* 2001-2002 Michael H. Entrup, M.D. Ruben J. Azocar, MD (2013) 1970-1971 Jess B. Weiss, M.D. * 2002-2003 Prasad R. Kilaru, M.D. Sheila Ryan Barnett, MD (2013) 1971-1972 Frederick McAlpine, M.D. 2003-2004 Rosemarie Maddi, M.D. Beverly K. Philip, MD (2013) 1972-1973 C. Thomas O’Connell, M.D. 2004-2005 Stephen O. Heard, M.D. Fred E. Shapiro, DO (2013) 1973-1974 John Hedley-Whyte, M.D. 2005-2006 Glynne D. Stanley, M.B. Alternate Delegates: 1974-1975 Russell J. Rowell, M.D. 2006-2007 Mark D. Hershey, M.D. Fred G. Davis, MD Michael R. England, MD 1975-1976 Franco R. Dinale, M.D.* 2007-2008 Donald G. Ganim, II,MD Stephen L. Hatch, MD Mark D. Hershey, MD 1976-1977 Joseph L. Murphy, M.D. 2008-2009 Beverly K. Philip, MD Vladmir V. Kazakin, MD Cristin A. McMurray, MD 1977-1978 Richard A. Kemp, M.D. 2009-2010 David L. Hepner, MD Timothy S. Pederson, MD Spiro G. Spanakis, DO 1978-1979 George E. Battit, M.D. *deceased Joshua C. Vacanti, MD vacant M.S.A. District Representatives and Alternate Representatives District I Mark P. Vanden Bosch, MD David L. Pomerantz, MD Committee on Governmental Affairs: District II Spiro G. Spanakis, DO Bronwyn Cooper, MD Selina Long, MD(2011), James Gessner, MD(2011), Alan Harvey, MD(2011), McCal- District III Donald G. Ganim, II, MD Charles C.Ho, MD lum Hoyt, MD(2011), Donald Ganim, MD (2011), Beverly Philip, MD (2011)-Chair, District IV Ben Kaon, MD vacant David Hepner, MD (2012), Stephen Hatch, MD (2012), Ross Musumeci, MD (2012), District V David G. Garrett, MD Susan R. Lisman, MD Fred Shapiro, DO (2012), D.O'Brien, MD (2012), Richard Urman, MD (2012) District VI Cristin McMurray, MD Vladmir Kazakin,MD Adjunct: Drs. J. Ehrenfeld, P. Kilaru, A. Lisbon, J. Pearl, S.Spanakis Standing Committees of the Executive Committee: Committee on Nominations: Fred E. Shapiro, DO-Chair, Ruben Azocar, MD, Jeffry Brand, MD, Bronwyn Cooper, Donald G. Ganim, II, MD (2011)-Chair, Beverly K. Philip, MD (2012), David Hepner, MD, Fred Davis, MD, Michael England, MD, Donald Ganim, MD, David Garrett, MD, MD (2013) James Gessner, MD, Norman Gould, MD, Alex Hannenberg, MD, Stephen Hatch, MD, Judicial Committee: David Hepner, MD, Mark Hershey, MD, Charles Ho, MD, Mark Hoeft, MD, McCal- Stephen V. Hall, MD (2011), Daniel O'Brien, MD (2012), James Gessner, MD (2013), lum Hoyt, MD, MBA, Kenneth Johnson, MD, Ben Kaon, MD, Vladmir Kazakin, MD, Susan Lisman, MD, Selina Long, MD, Cristin McMurray, MD, Daniel O’Brien, MD, Jeffry Brand, MD (2014), Michael Entrup, MD (2015)-Chair Timothy Pederson, MD, Lee Perrin, MD, Beverly Philip, MD, Ellison Pierce, MD(ex Committee on Publications: officio), David Pomerantz, MD, Sheila Ryan Barnett, MD, Spiro Spanakis, DO, Richard Bhavani Kodali, MD (2011), Beverly Philip, MD (2011), Adel Mehio, MD (2012 , Urman, MD, MBA, Joshua Vacanti, MD, Mark VandenBosch, MD, Olof Viktorsdottir, Richard Urman, MD, MBA (2012)-Chair/Newsletter Editor, Spiro Spanakis, DO MD (2013), David Hepner, MD (2013) Committee on Ethical Practice and Standards of Care: Adjunct: Drs.I. Kayata, S. Heard, G. Stanley, R. Ortega, Website Subcommittee: Drs. D.I Craig E. Collins, MD (2011) Stephen V. Hall, MD (2012) S. Spanakis-Chair, B.Kodali, S.Heard, R. Ortega, L.Perrin, G.Stanley D.2 Stephen P. Kapaon, MD (2011) Paul E. Darcy, MD (2012) Committee on Public Education: D.3 Albert Kalustian, MD(2011) Jeffry Brand, MD (2012)Chair Jon Griswold, MD (2011), Prasad Kilaru, MD (2011), Lee Perrin, MD (2011), Fred D.4 Melvin Cohen, MD (2011) Robert Hough, MD (2012) Shapiro, DO (2011)-Chair, Cristin McMurray, MD (2012), Cally Hoyt, MD, (2012), D.5 Peter M. Ting, MD (2011) Jeffrey Jackel, MD (2012) Jesse Ehrenfeld, MD, (2012), Joshua Vacanti, MD (2012), David Hepner, MD (2013), D.6 Vladamir Kazakin, MD (2011) Richard Shockley, MD (2012) Michael Entrup, MD (2013), Rana Badr, MD (2013), Richard Urman, MD (2013) Adjunct: Drs. B. Cooper, G. Crosby, C. Joshi, L. Dohlman, J. Gessner, Adjunct Member: Ashleigh Garza-Byrne, MD R.Holzman, H. Kummer, B. Kupperwasser, A. Lisbon, A. Mehio, Committee on Programs (CME) M. Ricciardone, D.Salter, D. Shook Timothy Pederson, MD (2011), Cristin McMurray, MD (2011)-Chair, Mark Hershey, Committee on Economics: MD (2011), Sasa Periskic, MD (2011), Lee Perrin, MD (2011) Advisor, Manisha Richard Bello, MD (2011), Larry Robbins, MD (2011), Alexander Han- Desai, MD (2012), Fred Shapiro, DO (2012), Michael Entrup, MD (2012), Daniel nenberg, MD (2012)-Chair, Stephen Punsak, MD (2012), Ross Musumeci, O'Brien, MD (2012), Ruben Azocar, MD (2012) MD (2013), McCallum Hoyt, MD, MBA (2013),Jeffry Brand, MD (2014), Adjunct: Drs. S. Basta, G. Battit, J. Bayes, D. Garrett, J. Gessner, S. Kaur, Stephen Kapaon, MD (2014) L. Robbins, S. Spanakis Adjunct: Drs. H. Auerbach, J. Gould, K. Gress, P. Kilaru, M. Shulman, M.S.A. Rep. to the Interspecialty Committee of the Mass. Medical Society R.Urman Fred Shapiro, DO, Representative, Stephen Hatch, MD, Alt. Representative Committee on Bylaws and Rules: Specialty Delegate to the House of Delegates of the Mass.Medical Society Lee Perrin, MD-Chair, Stephen Hall, MD, Mark Hershey, MD, Jesse Ehren- James S. Gessner, MD feld, MD, Roman Schumann, MD Resident Affairs: Olof Viktorsdotti, MD-Co-Chair, Mark Hoeft, MD-Co-Chair
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EDITOR'S REPORT A NOTE FROM YOUR EDITOR, RICHARD D. URMAN, M.D., MBA
elcome to another edition of to better serve the needs of our members. the MSA Record! You will Visit it often for meeting and educational find a lot of useful information updates. toW keep you informed of what is happen- Soon we will be welcoming our new ing in the world of anesthesia – both in MSA president, Dr. Ruben J. Azocar, Massachusetts and nationally. as well as the newly elected Executive As always, this edition highlights Committee and ASA Delegation. I hope recent events and activities of a very that this edition will highlight ample op- busy year! As you will see, MSA has portunities to participate and inspire you been active on the political, membership, to become more involved with the MSA, and educational fronts as highlighted in ASA, and their respective PACs. We have the MSA President, ASA Director, Legal listed all current officers and committee Counsel, and Committee reports. Top- members, so feel free to contact any of ics of interest to our members include them with questions. prescription authority for CRNAs, pro- Finally, please mark your calendars posal for global payment systems in MA, so that you can participate in many ex- proposed changes to the MSA bylaws, Richard D. Urman, MD, MBA citing upcoming events including CME a note about ASA-PAC, reimbursement Chair, Publications Committee courses, MSA Annual Meeting, ASA for labor epidurals, and the Anesthesia (2009-2012) Legislative Conference, and our regular Quality Institute update. In addition, we have selected Tufts Medical Center MSA Executive Committee meetings to read about past and future educational for this edition. Our feature article gives which all members are invited. opportunities, a report of our very active an excellent overview of anesthesia his- I hope that you enjoy reading this resident (CORA) component, and tips for tory in Massachusetts, and should be of edition of the MSA Anesthesia Record. saving for your retirement. As usual, we interest to every MSA member. If you have any comments or interested highlight a local anesthesia practice, and We have further developed our in contributing an article, please contact website (www.massanesthesiology.org) me. ~
SAVE THE DATE
MSA Annual Meeting Thursday Evening, May 26, 2011 Woodland Golf Club,1897 Washington Street, Auburndale, MA ASA Guest Speaker Jerry A. Cohen. M.D., ASA President-Elect
6:00 - 7:00 pm Cocktails - in the Foyer 7:00 - 8:00 pm Dinner (surf & turf) 8:00 - 8:50 pm ASA Update - Dr. Cohen 8:50 - 9:30 pm MSA Business Meeting
Following Dr.Cohen's talk there will be a brief MSA Business Meeting and installation of new officers (all MSA Members are invited and encouraged to attend)
For further information, please contact the MSA office (781-834-9174) • Email [email protected]
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PRESIDENT'S REPORT 2011 IS A YEAR OF TRANSITION
eing the point between the first Society leadership is working to and second decades of the twenty streamline our office and administra- first century, I thought it a great tive services to better carry forward our Bopportunity to highlight some of the Mas- mission in a cost effective manner. sachusetts Society of Anesthesiologist’s The MSA website ( www.MassAn- (MSA) recent advances and some of the esthesiology.org) is being revitalized to challenges we face in the future. be informative and easily accessible for our membership Looking back: We have developed a variety of 1- This past year MSA leaders met with terrific educational CME Programs members of our congressional delegation which have been met with overwhelm- and successfully urged them to vote to ing success. Last year we held programs overturn the scheduled SGR cuts for on practice management, sedation and Medicare. We are relieved that Congress analgesia, ultrasound guided regional and President Obama have agreed to a 12 anesthesia, and the New England Anes- month SGR fix that averts a 25% Medicare thesia Resident Education conference. For payment cut. 2011, we’ve introduced our first MSA Fred E. Shapiro D.O. winter conference Jan 13-17, in San 2- We worked successfully to achieve MSA President, 2010-2011 Juan, Puerto Rico, a difficult airway the law that restored full Medicare symposium in March held at UMass payment to anesthesiologist teaching that your MSA and ASA are well posi- Medical Center, and the New England programs that was implemented this tioned to represent your interests in the Resident Educational conference spon- year, which will help sustain our academic changing healthcare arena. sored this year by Beth Israel Deaconess anesthesia programs for future genera- Medical Center ( BIDMC). Our Annual tions of anesthesiologists. 2- The future for medical practice in Mas- Meeting will be held on Thursday May sachusetts will be challenging. The state 26, 2011 at The Woodland Golf Club 3- We continue to oppose independent is developing legislation which could in Auburndale. MA. (for information: practice for nurse anesthetists. In the past replace the current fee-for-service www.MassAnesthesiology.org ) We hope few years we have fought their attempt to payment system for all providers with that you will join us. win independent prescription authority. a global payment system based on the In order to ensure that the message This year the MSA leadership worked development of integrated provider and concerns of anesthesiologists are with legislators to allow prescription networks, such as Accountable Care heard loudly and effectively in the health authority for CRNAs, but only under Organizations (ACOs). Your MSA care arena, we urge you to consider the the supervision of a physician, and is joining the debate and will represent value of MSA and renew your member- pursuant to regulations developed jointly our specialty and the patients we serve ship as soon as possible. MSA leadership by the Nursing Board and the Board of to ensure that the safe administration of can be most successful with your strong Registration in Medicine. Moreover, the anesthesia by anesthesiologists, either in- support and commitment to advocate prescriptive authority is limited to the im- dividually or through the care team model, for our specialty, especially at this critical mediate perioperative care of a patient. continues to be vibrant and accessible to stage of healthcare reform CRNAs have no prescriptive powers in the citizens of Massachusetts. We welcome your input and sug- pre-operative and pain clinics. See the report of our legal counsel on gestions. If you are interested in becom- page one for more information. ing more involved in MSA activities or Looking ahead: require additional information, please do 1- This is a critical time for our specialty, What the MSA can do for you? not hesitate to contact me at fshapiro@ as healthcare reform is implemented Member services continue to be our bidmc.harvard.edu. ~ nationally and payment reform be- focus, and advocacy on your behalf with comes a priority for state policy makers government, payers and other health care here in Massachusetts. We are fortunate stakeholders is a priority.
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PERSONALITY PROFILE RUBEN J. AZOCAR, M.D., PRESIDENT - ELECT OF THE MSA r. Ruben J. Azocar was born and BMC Anesthesia Department’s Best raised in Venezuela and graduat- Teacher Golden Apple Award (2001), ed from the Universidad Central the Ellison Pierce Award in Education deD Venezuela in Caracas. He continued and Patient Safety (2005, 2009, 2010), his medical education at the University of and a Teaching Recognition Honorable Miami/Jackson Memorial Hospital and at Mention by the International Anesthesia Cook County Hospital in Chicago, where Research Society in 2004. he completed an internship in General Sur- Dr. Azocar has written a variety of gery and a Surgical Critical Care Fellow- book chapters on critical care medicine ship, respectively. Dr. Azocar trained in topics, including analgesia and sedation anesthesiology at Boston Medical Center in the ICU and critical care manage- (Boston University School of Medicine) ment during natural disasters. He was a and completed a Critical Care Fellowship co-author in a recent article in Critical at Beth Israel Deaconess Medical Center Care Medicine where he described the (Harvard Medical School). incidence and implications of delirium in Dr. Azocar is currently an anesthe- the surgical critically ill patient. He has siologist-intensivist at Boston Medical Ruben J. Azocar, M.D. lectured nationally and internationally. Center (BMC) where he serves as director MSA President-Elect Notably, Dr. Azocar co-directed a simu- of both the Anesthesiology Residency lation workshop at the World Congress Program and the Clinical Simulation an active simulation center which is of Anesthesiology in Cape Town, South Center. An associate professor of anes- not only accessible to anesthesiology Africa in 2008. thesiology at Boston University School residents but also to other Departments. Dr. Azocar serves as a member of the of Medicine, Dr. Azocar is also director Recently, Dr. Azocar obtained a grant Society of Critical Care Subcommittee on of the East Newton Campus Surgical from the American Geriatric Society to Fundamentals of Disaster Management Intensive Care Unit at BMC. develop a Geriatric Anesthesiology Cur- and he was recently appointed to the ASA His career at BMC has been charac- riculum. Dr. Azocar has been awarded (continued on page 7) terized by a well-rounded combination of clinical care, education, scholarly activi- ties, and advocacy work. Dr. Azocar’s clinical interests include the management of trauma victims and the critically ill. He divides his time between the operating room and the Surgical ICU. As an educator, Dr. Azocar has devoted himself to the education of resi- dents and medical students. As residency program director he introduced innovative ideas and refined the curriculum which led to the ACGME granting a five year accreditation to BMC’s Anesthesiology Residency Program. Dr. Azocar directs MSA President-elect Dr. Ruben Azocar with President Dr. Fred Shapiro
REMINDER TO MEMBERS IT'S THAT TIME OF YEAR THAT THE IN-COMING PRESIDENT, DR. AZOCAR, WILL BE REVIEWING THE MSA COMMITTEES AND APPOINTING COMMITTEE MEMBERS - IF YOU ARE INTERESTED IN GETTING INVOLVED, PLEASE CONTACT THE MSA OFFICE BEFORE APRIL 1, 2011. (see page 2 for a listing of MSA Committees)
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Report of Counsel - continued Overview of Governor’s Proposal (continued from page 1) trols on health care costs and insurance • requires ACOs to be certified or premiums. licensed by the Division of Health Care Finance and Policy (DHCFP) with finan- I. Overview of Governor’s Proposal cial oversight by the Division of Insurance (H. 1849) and directs the DHCFP to standardize H.1849 is built upon the recommen- alternative payment methodologies; dations of the Special Commission on • aims to expand use of alternative the Health Care Payment System which payment methods and significantly reduce 2 years ago recommended that the fee- fee-for-service payments by the end of for-service payment system be replaced 2015. An alternative payment method by a prospective global payment system includes shared savings components, built around accountable care organiza- bundle payments, episode based payments tions (ACOs) consisting of physicians, and global payments as defined by state hospitals and other clinical providers, and regulation. Alternative payment methods such integrated systems should become Edward J. Brennan, Jr. can not be fee-for-service based. the predominant form of provider pay- MSA Legal Counsel An ACO is defined as “an entity ment in the Commonwealth. comprised of provider groups which op- The preamble of H.1849 states that increase in the rate of reimbursements: erates as a single integrated organization many of the costs and quality problems that accepts at least shared responsibility in health care are either caused or exas- • the rate of increase in the state’s for the cost and primary responsibility perated by the current fee-for-service Gross Domestic Product; for the quality of care delivered to a payment system. It further states that the • the rate of increase in total medi- specific population of patients cared for bill is intended to limit health care costs cal expenses in the region as reported by the group’s clinicians; which operates while improving health care services by the Division of Health Care Finance consistent with principals of a patient to residents of the Commonwealth by and Policy; centered medical home and satisfies the encouraging the formation of integrated • a provider’s rate of reimbursement other requirements of law; which has care organizations (known as Account- for the insurance carrier, especially in a formal legal structure to receive and able Care Organizations – “ACOs”) and relation to the carrier’s state wide average distribute savings; and which complies provide for payment methods that will relative price; with any federal requirement applicable decrease total per capita expenditures • whether the insurance carrier and to ACOs, however named, which have and rate of growth and expenditures for the contracting provider are transform- been or may be enacted or adopted in law health care, and improve the efficiency, ing from a fee-for-service contract to an or regulation.” effectiveness and quality of the Common- alternative payment contract; The bill does not address how physi- wealth’s health care delivery system. • such other factors that the Commis- cians will interact within ACOs other than sioner may prescribe by regulation a requirement that primary care physicians 1. Insurance Commissioner’s Authority To the extent provider rates decline can only participate in one ACO. No such to Oversee Insurance Rate Increases. or increases are contained, insurance car- restriction is placed on specialists, such riers are required to factor such savings as anesthesiologists. The bill prohibits an insurance carrier into premiums charged to consumers. A Payment Reform Coordination from contracting or renewing a contract Council consisting of state officials would with any health care provider in which 2. Accountable Care Organizations be created to oversee the transition to a increases in the rate of reimbursement for (ACOs). global payment system. It would establish the provider exceeds an amount estab- Unlike the recommendation of the a plan of action, timelines, benchmarks lished by the Insurance Commissioner. Special Commission on the Health Care and standards to facilitate the establish- Effectively, this is an indirect state Payment System, the Governor’s bill does ment of ACOs throughout the state by imposed cap on health care provider not mandate a state-wide conversion of June, 2015. The Council’s role is to make reimbursement. Each year the Com- the health care payment system to a global recommendations to government agencies missioner would set by regulation that payment system, but the bill does encour- overseeing payment reform. The Council amount and would consider the following age the formation of ACOs by mandating (continued on page 14) factors in setting the maximum amount of standardized criteria for ACOs:
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DIRECTOR'S REPORT ASA DIRECTOR'S REPORT 2011 - March 2011
t is my pleasure to give you my first focused on three areas to alleviate mem- report as Director from Massachusetts bers’ concerns with the new regulations: to the ASA. Dr. Michael Entrup, our the labor epidural supervision exemption previousI Director, has moved out of state for nurses, pre-anesthesia requirements, and we wish him well in his new endeav- and post-anesthesia requirements. In the ors. What does your Director do for you, new 2011 IGs, ASA secured significant the members of MSA? I represent your changes that benefit ASA members on interests at the ASA Board of Directors each of these topics; the labor analgesia and in the House of Delegates, so that exemption has been removed and pre- and Massachusetts’ concerns are part of ASA post-anesthesia requirements are more in activity. I also provide a national perspec- line with clinical practice. Many of the tive and advice to the rest of the MSA changes included language provided by leadership. ASA. The revised IGs further solidified ASA has been active in the past year the role of the one anesthesia service, on several fronts to serve its members. which has authority over all sedation and ASA continues to lobby and advocate for anesthesia in a facility and must be led by Beverly K. Philip, M.D a permanent fix to the Sustainable Growth the physician Director of Anesthesia Ser- ASA Director Rate (SGR)-mandated cuts in physician vices. Our own Alexander Hannenberg, payments. In addition, ASA worked to M.D., ASA Immediate Past President, was raise the profile of the provider “non-dis- ASA has been active on the regulato- deeply involved in the regulatory process crimination” provisions of PPACA at the ry front as well. The Centers for Medicare including meeting with CMS to obtain 2010 AMA House of Delegates meeting and Medicaid Services (CMS) has issued these changes. Also, an ASA workgroup and gained approval of a resolution calling revised Interpretive Guidelines (IGs) per- led by Beverly Philip, MD with members on the AMA to seek repeal of those provi- taining to its Conditions of Participation of the Committee on Quality Manage- sions. ASA’s advocacy on this issue led for hospitals and ambulatory surgery cen- ment and Departmental Administration to introduction of the Healthcare Truth & ters twice recently. After the December produced documentation templates and Transparency legislation, which was not 2009 IGs were released, ASA members, policies to facilitate members’ ability to enacted in the 2010 legislative session but leadership, and the ASA Regulatory team comply with the requirements of the IGs. will be raised again. These are available to be used and adapted, and can be downloaded from the Members Only page of the ASA website. CMS requires that the single anesthe- Personality Profile-continued sia service must create institutional stan- dards for all sedation/analgesia, and ASA, listening to requests from members, saw MSA President-elect Dr. Ruben Azocar the opportunity to retain leadership of se- (continued from previous page 5) dation privileging in the interest of patient Geriatric Anesthesia Committee. He is an Associate Oral Board Examiner with safety. An ad hoc committee was formed the American Board of Anesthesiology. From 2007 to 2010 he was the Chair of to address this need, led by Beverly Phil- the MSA programs Committee leading the MSA to implement current ACCME ip, MD, and developed the “Statement on regulations. He has served as an MSA district representative, alternate delegate, Granting Privileges for Deep Sedation to and currently delegate to the ASA. Non-Anesthesiologist Sedation Practi- Dr. Azocar has raced in three Boston Marathons, a Chicago marathon and tioners”, setting high education, training many triathlons. He enjoys outdoors activities with his son Jose, his daughter and performance-evaluation criteria for Andrea and his wife Maray. non-anesthesiologist physicians who may There is no doubt that Dr. Azocar’s commitment to education, scholarly potentially qualify for deep sedation privi- activities, advocacy and the safe patient care combined with the guidance of the leges. The advisory was approved by the MSA Executive Committee, will assure that our Society continues to represent House of Delegates in October. Found at its members well and that the highest standards in patient care achieved by our (continued on page 13) specialty are maintained. ~
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HOSPITAL IN REVIEW Tufts is the fastest growing academic medical center in New England by Scott Segal, M.D. t has been 33 years since Tufts was last featured in these pages. In the third of a century since, Tufts Medical CenterI and the Department of Anesthe- siology have seen transformative growth and advancement. New buildings, a new provider network, new missions, and a new name are just a few of the develop- ments that have propelled Tufts into the forefront of the Boston academic medical landscape. The institution now occupying a campus in the Chinatown neighborhood of Boston got its start well over two hundred years ago. Prominent early American patriots, including Paul Revere and Samuel Adams, founded the Boston Dispensary in 1796 to serve the medi- cal needs of the poor. Predating many of Boston’s other prestigious academic hospitals, the Dispensary was noted for many firsts during the century after its founding, including the first medical clinic, dental clinic, lung clinic, evening pay clinic, well-child clinic, preventa- tive health clinic, and food and nutrition clinic in the region or country. In 1894, Tufts Medical Center, the Floating Hospital for Children, 800 Washington Street, Boston, MA a leased hospital ship began operating as the Floating Hospital for Children in Growth of clinical and research facili- time in 2008 to Tufts Medical Center, Boston Harbor, providing a respite from ties followed over the ensuing decades, reflecting the continued strengthening of squalid urban life and offering fresh air including the world’s first pediatric its academic ties. and medical attention to children. The trauma center; Neely House, a first of Today Tufts has 415 licensed beds, Floating was credited with establishment its kind bed-and-breakfast style home including adult and pediatric units, 5 adult of a human milk bank and the first suc- for cancer patients and their families; ICUs, a pediatric ICU, a neonatal ICU, a cessful cows’ milk-based infant formula, Boston’s largest heart transplant program; full-service obstetric unit, and an inpatient still sold today as Similac®. In 1929, the the establishment of four interdisciplinary psychiatric unit. It provides care to over Dispensary, the Floating Hospital (then research institutes in cardiology, cancer 21,000 inpatients, 41,000 emergency operating on land), and Tufts College biology, health policy, and mother and department patients, and approximately Medical School united to form the New infant health; and the Tufts Clinical and 14,000 surgical patients in 23 operating England Medical Center (NEMC). A Translational Science Institute. The rooms each year. Tufts is the fastest diagnostic facility, the Pratt Clinic, was arrival of Ellen Zane as CEO in 2004 growing academic medical center in New opened in 1931 and became the nation’s heralded a new period of growth for the England. It is also one of the lowest cost largest diagnostic hospital by 1938. In institution. Borrowing from a decade of providers in Boston. Most importantly, 1949 it also joined NEMC as the New experience in network development, the it is the only academic medical center in England Center Hospital and was by New England Quality Care Alliance, now New England on the University Health that time a full service general hospital. the second largest physician network in Consortium Top Ten list for quality and To reflect strengthening academic ties to Massachusetts was formed. Working with safety. All of these accomplishments Tufts University, the name was changed Tufts University President Larry Bacow, (continued on next page) to Tufts-New England Medical Center. Tufts-NEMC changed its name one final
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Tufts Department of Anesthesiology is comprised of 33 faculty attending anesthesiologists, 24 residents, 4 fellows (2 cardiothoracic and 2 pediatric), 1 nurse anesthetist, and 3-6 student nurse anesthetists.
(continued from previous page) continue to recognize Tufts’ dramatic residency and fel- growth and its commitment to quality lowship education, care. a long history of The Department of Anesthesiology clinical research, has also grown and evolved in parallel and formal health- with Tufts Medical Center. In 1949, care management Benjamin Etsten MD, whose lineage training to the job. traces back to the very initial branches of Today, the anesthesia chairpersons planted by Ralph Tufts Department Waters, became its first chairperson. He of Anesthesiology established not only an independent clini- is comprised of cal service, but a residency program, and 33 faculty attend- research laboratory specializing in the ef- ing anesthesiolo- fects of anesthetics on the myocardium . In gists, 24 residents, 1974, Dr. Kurt Schmidt, the first of noted 4 fellows (2 car- physicians recruited from across town at diothoracic and 2 Brigham and Women’s Hospital, became pediatric), 1 nurse its second chairperson. Dr. Schmidt was anesthetist, and responsible for the transitioning of a small 3-6 student nurse department working in the basement of the anesthetists. Sup- Farnsworth Building to the new operating port staff include room complex that crosses Washington seven business Street. and administrative Dr. Heinrich Wurm had been instru- positions, three mental in all facets of the clinical missions research adminis- of the Department and became Chair in trators, and eight 1991. He oversaw a great expansion of anesthesia techni- the Department’s missions during his cians. Third and more than 15 years as Chair that included fourth-year medical the introduction of an active obstetric students from Tufts University School unit, cardiac and pediatric fellowships, All faculty are appointed at Tufts University School of Medicine of Medicine rotate a dedicated ambulatory surgical center, and are Diplomates of the American Board of Anesthesiology. outstanding acute and chronic pain ser- through the depart- vices, solid organ transplantation and the is very proud of the outstanding caregiv- ment monthly, and rotators from the expansion of anesthesia services in the ers that we graduate, and their integration Departments of Surgery and Oral Surgery, operating rooms and beyond, including in- into the anesthesia care teams throughout as well as students from the Tufts Uni- terventional radiology and neurosurgery, New England and beyond. Michael En- versity School of Dental Medicine spend adult and pediatric cardiac catheterization trup, MD assumed the chair in 2007 but time with the department throughout the laboratory, electrophysiology laboratory, left to pursue other career opportunities year. electroconvulsive therapy procedures, a year later. In the summer of 2010, All faculty are appointed at Tufts pediatric imaging, and endoscopy. Scott Segal, MD, MHCM became Chair University School of Medicine and are The residency program gradually following a nationwide search. He had Diplomates of the American Board of increased in size as well, from 15 in the previously been Vice Chair for Educa- Anesthesiology. The vast majority is 1970’s to 24 today. Tufts Medical Center tion at Brigham and Women’s Hospital, fellowship trained in one or more spe- has also been engaged in the training of where he had trained 20 years earlier. He cialties. They are active in hospital nurse anesthetists for nearly 50 years and brings experience in obstetric anesthesia, (continued on page 12)
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COMMITTEE ON PROGRAMS ANOTHER SUCCESSFUL YEAR OF CONTINUING MEDICAL EDUCATION PROGRAMS - March 2011 in April at Boston Medical Center. The medical disaster relief missions. The MSA conference, run by residents in programs has been a joint sponsor of this program throughout New England, featured pre- for a number of years. sentations by residents as well as a career We held our First Annual Winter panel focused on exploring options for Conference in Puerto Rico in January. The 2009-2011 job selection; Alex Hannenberg, MD, committee decided that a new approach Chair the then-president of the ASA gave the to a “tropical destination” meeting was keynote lecture. needed, and the program featured a num- We also continued the Annual Seda- ber of excellent presenters from our state. tion and Analgesia Conference in May, The program was a resounding success. designed primarily for non-anesthesiolo- We are also pleased to be offering the gists providing sedation. The 53rd Annual First Annual Difficult Airway Workshop New England Society of Anesthesiolo- in March. Please look for our flyers in gists Annual Fall Conference was held the mail and check out the website for Cristin A. McMurray, M.D. in Newcastle, NH in September, with upcoming programs. As always, we are excellent attendance and a wide variety excited to hear from the members of the he Program Committee of the of topics covered; these included pediatric MSA for suggestions for program topics MSA was pleased to help organize perioperative pain, neuromonitoring, and or other ideas. ~ and support a number of programs inT 2010. We initiated an extremely well attended Ultrasound-guided Regional Anesthesia workshop in the spring. The course offered practical didactics as well as hands-on exposure with live models in small groups; we were fortunate to be able to draw upon a number of skilled and advanced local practitioners to run and teach at the course. Due to the high demand, we repeated the course in the fall as well. The Fourth Annual New England Anesthesia Resident Conference was held
Pictured above; Program Director, Dr. Ruben Azocar with presenters Drs. Keith Lewis, Alexander Hannenberg, Stephen Heard and Sheila Ryan Barnett. A breathtaking backdrop for the First Annual Winter Meeting in San Juan, Puerto Rico.
Dr. Mehio explaining a block at the Ultrasound course in November, 2010
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REPORT OF THE ECONOMICS COMMITTEE LABOR EPIDURALS AND TUFTS HEALTH PLAN - March 2011
using the “insertion through delivery” anesthesia services, there is no single, standard, with a time unit ceiling. (Many widely accepted method of accounting will recall that Tufts claims systems were for time for neuraxial labor anesthesia incapable of implementing the unit ceiling services.” The RVG goes on to cite four 2008-2012 for several years despite their repeated methods for reporting labor analgesia Chair emphasis on the policy). including:
My report in the MSA News- •“Base units plus time units (insertion letter (Winter 1999) included the through delivery) subject to a reasonable following: cap” TUFTS HEALTH PLAN •“Base units plus one unit per hour Alexander A. Hannenberg, M.D. In early August, anesthesiologists for neuraxial anesthesia management participating in the Tufts Health plus direct patient contact time (insertion, ver the past year, MSA members Plan received a bulletin titled “Anes- management of adverse events, delivery, have reported that sporadic audits thesia Billing Tips and Guidelines” removal).” and recoupment requests have which addressed many anesthesia- beenO undertaken by Tufts Health Plan. In specific billing issues. The item Notably, the policy that Tufts purports these activities, the Plan indicates its belief which received the most response to have had in place, i.e., patient contact that they have had a recognized policy of from MSA members was a discus- time subject to a cap, is inconsistent with reporting only time in direct contact with sion of time reporting for epidural any of the standard methods recognized the patient for labor epidural services. labor analgesia. The Tufts document in the Relative Value Guide. The audit seeks to recover payments for indicated that only time spent dosing Representatives from Tufts made time units other than those documented or assessing an epidural could be presentations to MSA conferences in as “face to face” time. accumulated and reported for billing 2003 and 2007. The handouts of those In June of 1999, Tufts circulated a purposes. Many anesthesiologists presentations are in the possession of “tips and guidelines” document that laid pointed out to Tufts (and to MSA) many members. While both speakers out a detailed illustration of reporting that this was a radical departure discussed labor epidurals, in neither face-time for labor epidurals. Then, as from generally accepted practice case was any mention of face-to-face now, this approach was unprecedented in and would have a major impact on time included in the Tufts comments. the region. At the time, I wrote to Tufts reimbursement for this important In 1999, I had made clear to Tufts that to state that we would have a very dif- service. I have had several discus- such a policy represented a “significant ficult time implementing time reporting sions with senior Tufts staff on this departure” from long-standing practice. under different conventions for each of subject and have been told that they A reasonable person would expect such the plans and asked that Tufts revert to intended no policy change, would re- a change to be communicated clearly. the standard “insertion through delivery” consider the issue and that we “need Nowhere in a decade’s worth of bulletins time with a ceiling on the total time units do nothing different.” I hope that from Tufts does the expression “change recognized. Shortly thereafter, a Tufts MSA will be involved in developing in policy” or “effective date” appear in medical director replied in agreement a clarification of the policy statement this context. With this in mind, it’s not and indicated that we should revert to on this and several other ambiguous surprising that an MSA survey of Mas- “insertion through delivery” reporting. items in the Tufts bulletin. sachusetts departments in early 2010 All subsequent documents from Tufts failed to identify a single department that emphasized the time unit ceilings and Tufts asserts that their instructions reported face-to-face time to any health never since the retracted 1999 bulletin pertaining to surgical anesthesia (“time plan or payer. These findings would has Tufts published anything vaguely not in personal attendance is not report- seem to answer the question of whether resembling the 1999 effort to explain able”) applies equally to obstetrical an- Tufts effectively communicated a change “cumulated time for redosing” appeared. esthesia, and that providers should have in policy at any time over the preceding Indeed, in 2003, Tufts itself characterized inferred that face-time was their standard decade. ~ the “face to face” time methodology as in addition to the time unit ceilings. This “onerous and unworkable” and reiterated is in direct conflict with the ASA Relative the expectation that we would report time Value Guide that states “unlike operative
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Hospital in Review - continued Tufts has plans to expand the Pain Management Center
(continued from page 9) committees, including the chair of the sedation oversight committee, vice chair of the IRB, elected membership on the Medical Board, and membership on the trauma, pharmacy and therapeutics, CPR, safety, patient care assessment, research steering, surgical executive, OR management, ethics, graduate medical education, and medical school admis- sions committees. Three are involved with the ABA certification process for the written or oral examination. Tufts Medical Center serves as the academic home of the Tufts University School of Medicine Department of Anesthesiology as well. In this role, Dr. Segal serves as the academic Chair for Tufts affiliates, including St. Elizabeth’s Medical Center in Brighton, Baystate Medical Center in Springfield, and Maine Medical Center in Portland, ME. Each affiliate manages its Today Tufts has 415 licensed beds, including adult and pediatric units, own clinical operations independently but 5 adult ICUs, a pediatric ICU, a neonatal ICU, a full-service obstetric unit, academic appointments and promotions and an inpatient psychiatric unit. are centralized. Tufts anesthesia residents hail from Medical Center clinical departments, with an aggressive plan to grow the pediatric top medical schools across the nation TUSM basic and clinical science depart- cardiac surgery program, expand the ro- and selected international locations. In ments, with the TUSM Clinical Skills botic surgery program, and build a hybrid addition to completing rotations in all and Simulation Center (in addition to its cardiology-cardiac surgery OR. A new aspects of anesthesiology care, 100% own departmental simulator), with the neuroscience ICU will open this spring, are given research experience during Tufts University campus in Medford, and and a state-of-the-art pediatric sedation dedicated rotations, and they are offered with faculty from the School of Dental center funded by a grant from the Ronald electives in advanced practice (including Medicine and the Boston Nutrition and McDonald foundation will open later this international health, advanced pain man- Obesity Research Center. These diverse year. agement, advanced obstetric anesthesia, relationships are driving the expansion of Our mission, however, is unchanged: and echocardiography). Many pursue the department’s research efforts, includ- to be a premier academic department fellowship training following residency ing a record number of grant applications of anesthesiology, providing–clinical and numerous graduates have joined the in the past year. excellence supported and enhanced by faculty at Tufts and other prestigious In the coming year, the department a foundation of evidence-based clinical academic programs around the country, has plans to expand the Pain Manage- and basic research and a commitment to and some of the best private practices. ment Center, overhaul the Preoperative teaching at all levels. As Tufts Medical Tufts Medical Center boasts a Assessment Clinic, introduce software- Center has evolved over its over 200- particularly collaborative academic en- based preoperative screening, install a year history, and the department over its vironment. Collaborations of a clinical, state-of-the-art Anesthesia Information more than half-century, we have strived educational, and research character are Management System (AIMS) in the OR’s, to maintain and expand the collabora- widespread and growing. The Depart- and introduce anesthesiology intensivists tive spirit and tradition of expertise and ment of Anesthesiology has research in the surgical intensive care unit. We will excellence that characterizes this storied collaborations with numerous other Tufts see expansion of the clinical mission with institution. ~
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Director's report - continued The need for strong ASA action on both legislative and regulatory fronts will continue, and ASA needs your support (continued from page 7) http://asahq.org/For-Members/Clinical- Information/Standards-Guidelines-and- Statements.aspx, it can be used in its en- tirety, in part, or adapted as needed, to represent the Anesthesiology viewpoint on deep sedation privileging in your facil- ity. On yet another front, we have all ex- perienced the dramatic and unpredictable shortages of many of our critical drugs. There are many reasons for this increase in shortages, and to find out more about this vexing problem go to http://www.asahq. org/For-Members/Advocacy/Federal- Legislative-and-Regulatory-Activities/ Drug-Shortages.aspx. ASA co-convened a Drug Shortages Summit on November 5, 2010, which resulted in the introduction Pictured above; Dr. Philip with President Dr. Fred Shapiro and of the "Preserving Access to Life-Saving Dr. Mary Ann Vann, both from Beth Israel Deaconess Medical Center Medications Act”. ASA is actively work- ing with the FDA, the American Society of Health System Pharmacists and other by the copilot of the “in the Hudson” US Also, recruit your anesthesiologist col- groups to reduce the frequency of these Airways flight 1529. Such member events leagues to join MSA and ASA if they are shortages. will be continued in future meetings. Plan not yet members – and we invite you to The 2010 ASA Meeting in New now to attend ASA 2011 in Chicago! become more active yourself. Orleans was a resounding success. The The need for strong ASA action on I am excited to serve you in this new educational and scientific portions of the both legislative and regulatory fronts will capacity as your Director to the ASA meeting were strong. Other highlights of continue, and ASA needs your support. Board of Directors. If you have any ques- the 2010 meeting were a Member recep- We all benefit from ASA’s efforts. Ev- tions or comments, or needs that could be tion in PETCO stadium, included in the ery anesthesiologist should contribute to addressed, please do contact me. ~ registration fee, and a stirring presentation ASAPAC to support this critical work.
LEGISLATIVE CONFERENCE 2011
J.W. Marriott Hotel, Washington, D.C. MAY 2 - 4, 2011 visit www.asahq.org for more information
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Report of Counsel - continued
(continued from page 6) would be advised by an 18 member com- H. 1849 has been assigned to the be eligible to obtain DEA numbers and mittee, appointed by the Governor, con- Committee on Health Care Financing for register with the Drug Control Program sisting of state officials, representatives of a hearing and consideration. at DPH. It is important to note the law insurers, hospitals, physicians (2 primary requires that the prescribing of medica- care, 2 specialists), employers, unions and II. Nurse Anesthetist Prescription tions and ordering of tests and therapeutics consumers. Health care providers would Authority during the immediate perioperative care of be in the minority. a patient must be addressed in guidelines The Board of Registration in Nurs- mutually developed and agreed upon 3. Medical Malpractice Reform. ing and the Drug Control Program within by the nurse and supervising physician. The Governor’s legislation also the Department of Public Health are in Those guidelines must be consistent with reforms the medical malpractice liability the process of promulgating regulations the regulations of the Nursing Board and system to emphasize prompt resolution, implementing the new law that allows the Board of Registration in Medicine. deemphasize “defensive medicine”, re- CRNAs the authority to issue written pre- Current guidelines regarding the admin- duce the number of costly lawsuits and scriptions and order tests and therapeutics istration of anesthesia will need to be improve care. The bill specifically: under the supervision of a physician only amended to be in compliance with the new for the immediate perioperative care of law, should the CRNA and supervising • establishes a 180-day cooling off a patient. The law defines “immediate physician agree that the CRNA will have period before a party may initiate suit; perioperative care” as commencing on prescriptive authority. • creates a process for providers and the day prior to surgery and ending upon When the Nursing Board and DPH aggrieved patients to communicate and discharge from post-anesthesia care. The promulgate their regulations, MSA will exchange documents prior to litigation in administration of anesthesia by a CRNA post on its website a link to the new regu- the hope that more open communication to a patient does not require a prescription. lations as well as a link to the regulations by both parties will resolve disputes; The MSA submitted testimony at a hear- of the Board of Registration in Medicine • makes a provider’s apology inad- ing in January proposing clarifications to governing the responsibilities of the su- missible in evidence; the proposed regulations. pervising physician. ~ • amends the peer review laws to Once the regulations are promul- include ACOs. gated, CRNAs, who wish to prescribe, will
MSA BYLAWS COMMITTEE REPORT - March 2011 the requirement that you must have your "voting member" has been interpreted to practice principally in Massachusetts. The mean ASA Active member, as active mem- Executive Committee is considering submit- bers are the only members eligible to vote. Chair ting an amendment that will allow member- One proposal is to delete "voting" from the 2010-2011 ship based on your principal professional bylaw. This would allow time spent as a activity or residence in Massachusetts. resident, fellow or medical student to count Similarly, a change in the bylaw deter- toward the five years. Another proposal is to mining to which District a member belongs allow only those members who have their to allow the member to choose between place of principal professional activity in Lee S. Perrin, MD, where they work or live will be debated. Massachusetts be eligible to be an officer. our Committee on Bylaws has The Executive Committee also is Several items were approved at the been very busy this past year. considering deleting the requirement for January 27 meeting of the Executive Com- You will receive the full report in endorsement by two active members as part mittee. These included a clarification of the timeY to vote on it at the Annual Meeting of the application and approval process. function of ex-officio committee members in May, but first it needs approval by the The other section debated at the March and the addition of the President-Elect and Executive Committee. 23 Executive Committee meeting was the Vice President to the Committee on Head- Last year the ASA changed its defini- requirements for election as an officer of quarters Office Oversight. tion of who can be a member of a component the MSA. Currently, a candidate needs to Watch your mailboxes for the ballots society to allow those state components to be an active member of the MSA for two for officers and the notice of the Annual permit membership by where you work or years and a voting member of the ASA for Meeting where these bylaw changes will where you live. Prior to this, MSA has had five years prior to being elected. The term be voted upon. ~
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Anesthesia History - continued (continued from page 1) stone cutter from Thebes is the first Egyp- book about this famous granite structure tian mummy to be brought to the US, and in 2006 [Written in Granite: An Illustrated was gifted to the MGH in 1823 by Dutch History of the Ether Monument; Publisher, merchant Jacob Van Lennep. This 2500 Plexus Management, Boston]. year old mummy was in attendance dur- ing the ether demonstration and remains Mount Auburn Cemetery: Horticultur- there today. Also present is a marble ist and physician Jacob Bigelow chanced statue of Apollo, son of Zeus, and father to visit Père-Lachaise Cemetery during a of Asclepius [Greek God of Medicine]. trip to Paris. Burial practices in America It was sculpted in Paris, and was a gift and most of Europe were quite squalid th from Edward Everett, the grand orator in the early 19 century. Limited space who spoke for 2 hours at the dedication in municipal burial lots and church yards of the National Cemetery at Gettysburg, led to stacking, subsequent removal of just before President Abraham Lincoln’s remains, foraging by animals, or worse. famous 2 minute address. Everett served Bigelow recreated the concept of the as congressman and senator from Mas- European landscaped garden cemetery sachusetts, as well as President of Har- when he founded Mount Auburn Cem- vard University, and the town of Everett, etery in 1831. A place for meditation Massachusetts is named after him. Since and reminiscence, this was the first such electricity was not available in 1846, the cemetery in the country, and is the final operation was performed in the morning, John A. Fox, M.D. [Anesthesiologist, resting place for many of the participants illuminated only by natural light. The Brigham and Women’s Hospital] describ- of the ether demonstration, including Wil- dome’s generous window-panes provide ing various aspects of the Ether Monu- liam Thomas Green Morton, as well as evidence of the thoughtfulness of Charles ment during a 2010 tour for residents of his principal opponent, Charles Thomas Bullfinch, the first American born and his department. Under his left arm is a Jackson. For decades, it was a must-see trained professional architect. Visiting copy of Rafael A. Ortega’s book, ‘Written destination for visitors to Boston. Its name today, one can stand in the Ether Dome in Granite: An Illustrated History of the derives from Oliver Goldsmith’s poem, feasting eyes on many of the same artifacts Ether Monument.’ ‘The Deserted Village.’ that decorated the dome in 1846. If one Morton Homes: Morton was born in chooses to climb the steep stairs, and take Charlton, Massachusetts in 1819, and a seat where many of the great minds in spent his childhood and youth in homes medicine have been one is automatically The Ether Monument: Erected in 1868, that were made memorable by a series drawn to a stunning painting that con- ironically the year of Morton’s unexpect- of water color paintings by Leroy D. sumes the back wall. This work by Warren ed death, and located within the Boston Vandam, M.D., Chief of Anesthesia and Lucia Prosperi, commissioned for Public Gardens, the first public botanical at Peter Bent Brigham for over three the 150th anniversary celebration of the garden in the US, the Ether Monument decades. Two of the homes are private original event, recreates the drama of Oc- was donated to the city of Boston by residences, while the third, a barn in which tober 16, 1846. Physicians and individu- Thomas Lee, a prominent merchant. This the Morton family carried out a business als related to MGH were photographed magnificent granite structure is full of in farm equipment, is dilapidated. After in period costumes, and the artists used allegorical representations that include a gaining prominence in the late 1840s, these images to recreate a most realistic statue of the Good Samaritan at its apex, Morton moved to a 50-acre estate called scene. Surgical instruments of that era and scenes depicting various aspects of Etherton in Wellesley [then West Need- are displayed in a showcase, and a small science and medical care on its four sides. ham]. The property was later acquired by museum with memorabilia surrounds the It was Boston physician and poet Oliver businessman Horation Hunnewell, who outside of the Ether Dome. As one exits Wendell Holmes who suggested the term in turn donated the land and bore costs the Bullfinch building one should examine anesthesia in a letter to Morton. He wryly for the construction, in 1886, of what remnants of a pier on the outside of the remarked that the monument be called is currently Wellesley Town Hall. The hospital. Much of the land we see around the ‘Either Monument,’ confirming that town separated from West Needham in MGH is a result of landmaking and city claims for the discovery of anesthesia had 1881, and adopted the name Wellesley expansion over water. In 1846, patients remained unresolved. Rafael A. Ortega, in honor of Hunnewell’s wife, whose often arrived at this waterfront hospital M.D., a historian and anesthesiologist at by horse carriage, or by boat. the Boston Medical Center, published a (continued on next page)
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(continued from previous page) maiden name was Welles. Reminders of Morton exist on a plaque outside the building, and an adjacent field and street are named after him.
The Francis A. Countway Library of Medicine was founded in 1960 as a result of the union of Harvard Medical School Library and Boston Medical Library. Lo- cated on the premises of Harvard Medical School, it is also home to the Center for the History of Medicine, and the Warren Anatomical Museum, named after John Collins Warren, founder of MGH, and the surgeon who performed the operation on October 16, 1846. Warren donated his own body to this museum that contains Manisha S. Desai, M.D. [Anesthesiologist, UMass Memorial Health Care] at Morton’s over 15,000 artifacts. Included are several birthplace in Charlton during a 2010 tour for residents of her Department. Shown with ether flasks, the original instruments used her, at the right, are the current owners of the property. A plaque near the door reads – during the operation, a death-mask of Birthplace of William Thomas Green Morton (1819 – 1868) who first publicly demonstrated Horace Wells, portraits of several of the ether anesthesia, October 16th, 1846, erected by the American Society of Anesthetists, participants of the ether demonstration, Inc. [sic] May 6th, 1941. and original specimens of anesthesia records introduced by medical students Harvey Cushing and Ernest Amory Cod- man. Perhaps the item of most interest to anesthesia historians is Robert C. Hinckley’s painting, ‘The First Operation Under Ether.’ Completed a half century after the event, Hinckley found it difficult to sell the painting and almost destroyed it, before it was acquired by the Boston Medical Library. Ignored at the outset, it has become one of the most famous paintings depicting a scene related to the history of medicine. ~
Drs. Alex Hannenberg, Sukran Sahin, current president of the Turkish Society of Anes- thesiologists, and William Camann. Dr. Hannenberg and Dr. Camann were speakers at the Turkish Society of Anesthesiologists annual meeting in Antalya, Turkey, Ocotber 27-30. October 29th is "Republic Day" in Turkey, the day they celebrate the founding of the nation, similar to our July 4th.
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ASA NEWS POLITICAL ADVOCACY IS NOT FREE...... DONATE TO YOUR ASA-PAC TODAY!!
by Donald G. Ganim, II, M.D. in Washington and at their local district he ASA’s political action com- offices. mittee (PAC) was formed in 1991 Federal and state laws prohibit as- as a bi-partisan, non-ideological sociations, like the ASA, from involving politicalT voice of ALL anesthesiologists. itself directly in the political process. Only Its defined mission statement is simply PAC’s can participate. Anesthesiologists to “advance the goals of the medical make donations to their PAC because specialty of anesthesiology through the they recognize the challenges that our bipartisan support of candidates who profession faces: attacks on physician- demonstrate their commitment to patient led anesthesia, underfunded Medicare safety and quality of care.” payments for anesthesia services, and a ASA-PAC supports candidates for burdensome regulatory and legal environ- federal and local offices and lobbys on ment. behalf of the anesthesia profession. As Anesthesiologists who donate to the largest medical specialty PAC, the their PAC understand that political in- ASA-PAC plays a key role in determining volvement is CRITICAL to meeting the Donald G. Ganim, II, M.D. how much we are paid, the regulatory and challenges to our profession. legal environment in which we practice, Like the AANA or the AAJ’s advo- and the role of non-physician providers in cacy for CRNA’s and lawyers, the ASA- Do NOT stand idle and allow your our practices. The PAC allows us to influ- PAC funds newspaper advertisements, colleagues to make contributions on your ence the political decisions that directly radio spots and direct mail campaigns behalf. Call Tracy at the Park Ridge of- impact our practices. The PAC provides during political elections to carry anes- fice 1-847-825-5586 or go on the ASA anesthesiologists access to legislators both thesiology’s message to voters. web site and make your 2011 donation today.~
ONE MEMORABLE MSA DINNER . . .
by Gerald Zeitlin, M.D. We took our time with the dinner and n the early 1970’s the M.S.A. held eventually Dr. Benson arrived. He quickly a monthly dinner on Friday eve- got to the meat of his talk - a demonstra- nings from September to May with tion of mass hypnosis. It was a sight to aI brief business meeting followed by behold as he had us wave a finger in front a lecture of scientific interest. In those of our noses as we all chanted, in unison days there were not to many academic “One, two, one, two and so on.” Heads meetings held in San Diego or Sun Val- usually devoted to vigilance in the operat- ley. These meetings were for the whole ing room nodded and sank on chests and membership - perhaps 150 of us altogether Dr. Benson proudly proclaimed: “There in those days. you are you doubting anesthesiologists. On this particular winter Friday It works!” evening we were gathered at Pier Four What he did not know was that when on Boston’s harbor. Just as we had sat our beloved President announced Dr. down to choose between scrumptious Benson’s delay he also announced that Gerald L. Zeitlin, M.D. scrod or chirping chicken the President the Pier Four management had agreed to (I forget who it was but he or she should hypnosis fame, was coming from out of keep the bar open while we waited. ~ hereby identify themself) announced town to talk to us but had been delayed by that the lecturer, Dr. Herbert Benson of about an hour due to a snowstorm. Quod Erat Demonstrandum
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ASA NEWS Update on the Anesthesia Quality Institute
ambulatory surgery – at both the group and the individual provider level. We believe this kind of private, confidential reporting of local data and national benchmarks he Anesthesia Quality Institute will give the practice a powerful tool to (AQI) was founded in 2009 by improve patient outcomes and business ASA to be the profession’s voice efficiency. forT quality management. To accomplish Aggregated data from NACOR, de- this, AQI is developing the National identified as to location, practice and pro- Anesthesia Clinical Outcomes Registry viders, will be reported to ASA leadership (NACOR), now in its second year of on a regular basis, to provide objective operation. As of December 1, 2010, NA- information for advocacy with payors COR contained data from 34 anesthesia and regulators. De-identified data from practices, representing 24 states, 1800 NACOR will be available for academics, anesthesia providers, and 170 facilities. and will be especially useful in support Case-specific data is available from 21 of ‘comparative effectiveness’ projects practices, and will include more than that seek to examine outcomes from real- 500,000 cases for 2010. Richard P. Dutton, M.D. world clinical practice. In addition to sup- Participation in NACOR is open porting these efforts, the AQI plans two to any anesthesia practice in the United receive quarterly benchmarking reports new ventures in 2011: establishment of States, regardless of their current use from the AQI. These begin with simple pain management data entry software that of information technology. The cost of ‘snapshot’ looks at important practice supports long-term monitoring of patient participation is minimal, and is sharply metrics: number of cases done, distribu- outcomes, and creation of a nationwide discounted for ASA members. NACOR tion of services, duration of cases, and mechanism for reporting ‘near-misses:’ works by capturing reports from existing the like. Each metric is presented in the the Anesthesia Incident Reporting System digital systems, including billing software, context of national benchmarks, so the (AIRS). AIRS will be a secure system anesthesia information management sys- practice can compare their performance to capture detailed information on the tems, quality management programs and with their peers. This is done at both the cases of greatest interest, and allow for hospital information technology. The practice and the facility level, so the group ground level analysis to complement the AQI works closely with both the practice can understand, for example, how the top-down approach of NACOR. and their software vendors to generate a average duration of a cataract extraction AQI is constantly building on the flow of data that will not interfere with at their Surgicenter compares with simi- data we already have by signing on new the daily activities of busy practitioners. lar groups and locations nationwide. In participants. Please visit our Web site All anesthesiologists are going to feel in- 2011 the practice will be able to interact at www.aqihq.org to learn more about creasing pressure to examine and improve directly with the AQI report server, to participation or send any questions to their outcomes. The AQI is committed directly examine their data ‘cube’ for the [email protected]. to easing this process, so that clinicians variables of greatest interest. This will The NACOR initiative will help ASA to can concentrate on what they do best. include the ability to examine outcomes – secure our profession’s well-deserved rep- Practices participating in NACOR like the rate of nausea and vomiting after utation as the leader in patient safety.~
ASA Annual Meeting October 15 - 19, 2011 New England Caucus Meetings Saturday 3:00 - 5:00 pm • Tuesday 4:00 - 6:00 pm Chicago, IL
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WHY CAN’T I SAVE ENOUGH TO RETIRE THE WAY I WANT?
by Dan Heitzman, and invests the remainder, so that $10,000 the rest of your life? A rule of thumb is CFP®, ChFC,CLU,MBA,AIF® of unearned income is generated each that at age 65 you will need one million year. Not too surprisingly, wealth is a dollars for every $40,000 of income that octors like many people are look- result of hard work, perseverance and is needed. ing forward to retirement with discipline. And although many doctors Second, use the results of the latest increasing concern about what certainly have the first two traits, it is less research in behavioral finance to under- theirD retirement will look like. In many clear, relative to other professions, that stand the basic principals which cause cases, the retirement they are looking at is doctors are disciplined towards building people to financially self-destruct. As not the one they had envisioned when they wealth which can create the retirement the cartoon character, Pogo, aptly stated started out in medicine. Yes, doctors are they are seeking. “we have met the enemy and he is us”. amongst the highest earning professions As a group, business owners are the In particular, be aware that our brains in the country and certainly many doctors largest accumulators of financial wealth are hard-wired for investment failure. count themselves as millionaires. So why based on their income. A primary reason There now exists academic research that are so many doctors not as comfortable for this is that they are focused on attain- explains why investors routinely buy high heading into retirement as they should ing a financial goal. As true capitalists and sell low. Herd behavior, loss aver- be based on their incomes? they are willing to sacrifice immediate sion, media response bias and optimism According to Thomas J. Stanley, gratification for future success by re- and over-confidence, are basic human PHD, the author of the best selling book investing in their business. Yes, doctors behavioral characteristics that work The Millionaire Next Door, doctors define make financial sacrifices while in med against building a solid financial future. wealth differently from many people. For school and while doing their residency, Finally, Socrates said that wisdom is many doctors, wealth equals having a but they also graduate with larger amounts demonstrated by those who know what high income. Ignoring the philosophical of debt than their non-doctor classmates. they do not know. No doubt, you have discussion about what being “wealthy” Once in practice, doctors are soon earn- had a conversation with a patient who means, from a financial perspective, true ing very high incomes relative to their has proudly shared with you the fact they wealth means not having to go to work in non-doctor classmates but unlike many were recently awarded an MD degree from the morning if you don’t want to. It is business owners, they spend more of Google University. Patiently you have money making money… and generating what they earn. Good wealth builders listened to them while they questioned a a large enough income stream to cover learn to live below their means while diagnosis or a recommendation. To help all of your lifestyle needs. According they are saving for the future. Because you reach your retirement goals, find a to Stanley, doctors are prodigious under doctors start saving later, and start with financial advisor that you can trust, and accumulators of wealth based on the a high debt level, they need to save even use them to improve your financial health amount of income they earn. True wealth more. Consider this: a person who wants the way you help people with their physi- is based on assets, not income. to live on $200,000/year, excluding social cal health. ~ And why is confusing income with security, beginning at age 65, will need true wealth important? It is important to save $5 Million dollars. A 25 year old The author is a Registered Representative because the government taxes income, can attain this by saving $11,296 per year. and Investment Adviser Representative it does not tax net worth or wealth. The A doctor who waits 10 more years until with/and offers Securities and Advisory true measure of one’s wealth is net worth. age 35 to begin saving will need to put Services through Commonwealth And just like doctors advise people to aside $30,396 a year. As Einstein said, Financial Network, Member of have a physical each year to monitor their the greatest discovery of mankind is not FINRA/SIPC, a Registered Investment physical health, doctors should measure relativity, it is compound interest. Adviser. www.stonebridgefc.com their net worth each year to monitor their So what steps can one take to cor- financial health. Ask yourself the question rect this situation? First, start with the Disclaimer: the Author is not affiliated “Who is wealthier, the person who makes recognition that you need a financial goal. with the MSA and all opinions expressed and spends $500,000/year or the person How much money will you need to have are his own and not of the MSA. who makes $500,000, lives on $200,000 at age X to generate Y dollars a year for
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MSA ANNUAL REPORTS 2009 - 2010
MSA ANNUAL MEETING SECRETARY'S REPORT - MAY 26, 2010
Results of the 2010 Election (152 ballots returned)
President Fred E. Shapiro, DO President-Elect Ruben J. Azocar, MD Secretary Vice President Jesse Ehrenfeld, MD 2009-2011 (position currently vacant) Treasurer (2 year term) Daniel J.P. O'Brien, MD
ASA Delegates (2010-2013) (3 year term) Ruben J. Azocar, MD Beverly K. Philip, MD Sheila Ryan Barnett, MD Fred E. Shapiro, DO
Selina A. Long, M.D. Alternate Delegates (1 year term) Fred G. Davis, MD Jesse M. Ehrenfeld, MD he Active membership of the Massachusetts Society of Michael R. England, MD Stephen L. Hatch, MD Anesthesiologists has surpassed the 900 mark, the Mark D. Hershey, MD Vladmir V. Kazakin, MD present count is 918 active members. This entitles the Cristin A. McMurray, MD Timothy S. Pederson, MD MSAT to ten (10) ASA Delegates at the ASA House of Delegates, Spiro G. Spanakis, DO Joshua C. Vacanti, MD October 16-20, 2010, in San Diego, CA; this is an increase of one delegate over prior years. The Following Officers will continue The MSA membership drive is ongoing. If you are aware of Secretary Selina A. Long, MD (2011) any potential members, please encourage them to join and bring their names to the attention of the membership department. ASA Director (3 year term) Michael H. Entrup, MD Membership totals as of May 26, 2010 ASA Alternate Director (3 year term) Active 918 Beverly K. Philip, MD Affiliate 18 Resident 417 Retired 170 ASA Delegates McCallum R. Hoyt, MD, MBA (2011) Daniel J.P. O'Brien, MD (2011) In Memoriam Lee S. Perrin, MD (2011) Martha Boyd, MD VA David L. Hepner, MD (2012) Francis Callahan, MD Worcester, MA Selina A. Long, MD (2012) Franco Dinale, MD CT Richard D. Urman, MD, MBA (2012) Robert M. Smith, MD Sarita Walzer, MD Newton, MA
2010 MSA District Elections District Representative Alternate District Rep. District 1 Mark Vanden Bosch, MD David L. Pomerantz, MD District 2 Spiro G. Spanakis, DO Bronwyn Cooper, MD District 3 Donald G. Ganim, II, MD Charles C. Ho, MD District 4 Ben Kaon, MD (vacant at this time) District 5 David G. Garrett, MD Susan R. Lisman, MD District 6 Cristin McMurray, MD Vladmir V. Kazakin, MD
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MSA Annual Reports - continued OUTGOING PRESIDENT'S REPORT, MAY 21, 2010
providers. The MSA (Dr. Hannenberg) ascension to ASA President. Dr. Hepner testified at a legislative hearing in October noted that the MSA sponsored a reception cautioning against an across the board here in Massachusetts for Dr. Hannenberg imposition of global payments. The at the Woodland Country Club in Newton, President legislature has put off consideration of which was a great success. Dr. Hepner (2009-2010) payment reform until the next legislative thanked MSA members who contributed session. Dr. Hepner testified at another to the success of the receptions and Dr. legislative hearing in November in op- Mark Hershey for organizing the event position to a bill that would reduce health in Massachusetts. insurance premiums for small businesses Dr. Hepner reminded those present David L. Hepner, MD by setting physician and hospital fees at to visit the ASA Pac booth and make 110% of Medicare and forcing providers contributions for this year. He noted the to accept the fee as a condition of licen- importance for anesthesiologists to be Annual Meeting Minutes, 2010 sure. The bill was referred to the House active politically at the national and state Report of the President Committee on Ways and Means where it levels. is expected to die. Dr. Hepner advised members to r. Hepner introduced Dr. Mark Dr. Hepner saluted Dr. Alex Hannen- read the various committee reports in Warner, ASA President-Elect. berg, President of ASA, for his strong ad- the distributed handout. He thanked the Dr. Hepner summarized the very vocacy for anesthesiology at the national members of the Executive Committee eventfulD year during his presidency. He and state levels. Dr. Hepner reported for their support as well as Beth Arnold, noted: on the very successful reception in New Barbara Kenealy and Ed Brennan. He 1. Successful negotiation of legisla- Orleans last October sponsored by MSA wished Dr. Shapiro much success in his tion giving CRNAs limited prescriptive and ASA for Dr. Hannenberg upon his tenure as President. ~ authority. Nurse Anesthetists are the only APNs without prescriptive authority. The MSA negotiated a compromised bill with the Chairman of the Public Health Committee that would give CRNAs authority to issue written prescriptions and order tests and therapeutics under the supervision of a physician only for the immediate peri-operative care of a patient (commencing on the day prior to surgery and ending upon discharge from post-anesthesia care). He noted that origi- nally the nurse anesthetists had filed a bill three years ago that would have granted them broad authority to prescribe and function without physician supervision. The bill is currently before the House of Representatives and is expected to pass. 2. Payment Reform: Dr. Hepner re- ported on efforts on Beacon Hill to scrap the current fee-for-service reimbursement system used by all payors for a global payment model built around Accountable Care Organizations (ACOs) consisting of Outgoing MSA president Dr. David Hepner conversing with incoming president hospitals, physicians and other clinical Dr. Fred Shapiro at the 2010 Annual Meeting at MIT Endicott House, Dedham
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MSA Annual Reports - continued
ASA DIRECTOR'S REPORT, MAY 2010
every one of our Congressperson’s and of 16 surgical subspecialty groups with Senator’s offices. In addition to ensuring common issues and concerns regarding fair payment for anesthesia services, we the healthcare reform. The recent post- also addressed the Health Care Truth and ing by the ABA regarding the potential Transparency Act and rural pass-through revocation of board certification for any (Former) ASA Director to expand patient access to physician diplomate participating in the lethal in- 2009-2011 anesthesiology services in rural areas. jection process has raised quite a bit of As you are aware, there have been discussion through the listserve and dur- many personnel, structural, and proce- ing our last teleconference. This will be dural changes within ASA to make our addressed at the August BOD meeting. organization more efficient and effective ASA continues its efforts at improv- in improving care and advocating for our ing patient care while advocating for our patients and the 40,000 plus members of patients and our members. Several major ASA. The rapid pace and outcome of undertakings continue towards these Michael H. Entrup, M.D. health reform legislation raised several goals. The Anesthesia Quality Institute ith the change in policy makers issues/concerns for the BOD. These in- is now established, has a physician Ex- after the last national election, cluded the perception that AMA did not ecutive Director, and is beginning to sign there is a renewed effort and support ASA member needs in healthcare on groups for submission of data that will weW are likely to see major reform in our reform and the role of the ASA BOD in the be used for benchmarking, research, and healthcare system with an emphasis on decision-making process of ASA. Alex, assisting members with MOCA require- providing health care to all, increasing as we’ve come to expect, did a terrific job ments. The ASA Branding Campaign value, yet at the same time decreasing in addressing these issues by creating a has entered a new phase of rollout with costs.” BOD listserve and setting up several the implementation of several creative That’s from my Director’s Report to town hall meeting style teleconferences projects as well as a long-awaited revamp- the 2009 MSA Annual Meeting. With the to keep us informed and involved, rather ing of ASA’s web page, which will be election of Scott Brown to The United than waiting for the next BOD or HOD unveiled at the Annual Meeting in San States Senate, who would have predicted meeting. ASA has joined a coalition (continued on page 26) that a major healthcare reform bill(s) would pass in 2010? But it did. Several provisions in the bill, including the lack of a permanent fix to the SGR formula and the creation of the unelected and unac- countable Independent Payment Advisory Boards (IPABs), have major implications for our specialty and our ability to care for our patients. While the bill did not specifically address the issue of Medicare payment disparity for anesthesia services, it did provide for the Secretary of HHS to review and possibly correct mis-valued and potentially under-valued services. This was a major focus of discussion during our congressional visits on Capital Hill last month at the ASA Legislative Conference. Twenty-one MSA members and residents, including ASA President Alex Hannenberg and Legal Counsel/ Lobbyist Ed Brennan, attended the Con- MSA Delegation at the ASA Legislation Conference in May, 2010, ference and made Hill visits to each and at the J.W. Marriott Hotel in Washington D.C.
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MSA Annual Reports - continued
REPORT OF THE COMMITTEE ON ECONOMICS, May 2010 MSA conducted a survey of officers The committee reviewed a new and members to assess the prevailing medical necessity policy issued by Blue practices with respect to reporting time Cross-Blue Shield of Massachusetts ad- units for labor analgesia services. One dressing Monitored Anesthesia Care for of the major health plans in the region gastrointestinal endoscopy. The policy Chair initiated chart audits in several practices indicates that this service is not universally 2008-2012 with the assertion that standard practice considered medically necessary but that limited time unit reporting to time of direct a wide range of co-existing conditions patient contact (“face to face” time). No would justify the service. We indicated respondents to the MSA survey indicated to BCBSMA that the MSA is available that this was their understanding or prac- to confer on such policies in the devel- tice. opment stage and objected to the release Alexander A. Hannenberg, M.D. As payment reform initiatives have of the policy only at the time it became taken shape in the Massachusetts legis- effective. Doing so limited the ability of he Committee sponsored a semi- lature, we participated in a round table of anesthesia and GI practices to adapt their nar on Practice Management in hospital based specialties convened by the practice patterns to conform. This policy November. This was ably chaired Massachusetts Medical Society. There is not dissimilar to multiple such policies byT Dr. Larry Robbins and featured an were multiple areas of common interest in place with other carriers around the excellent and high profile presenters. We and concern and there is an expectation country. ~ continue to seek the optimal scheduling that this group would continue to confer of this conference to make it appealing and strategize. to physicians and practice administra- tors alike. * * * * *
REPORT OF THE PUBLIC EDUCATION COMMITTEE - May 2010
Recently Dr. Cally Hoyt, Director of The newly revised MSA Website will Gynecologic and Ambulatory Anesthesia enable three MSA Committee to merge at BWH lectured and gave a tour of the their efforts and creativity The Public Edu- Longwood Medical Area to the Boston cation committee will join the Committees Chair Latin students on Publication and Website in a combined 2008-2011 The Massachusetts Society of anes- effort with Drs Urman and Spanakis to thesiologists will continue along with design a section that will specifically ad- national effort to inform our anesthesia dress the educational opportunities MSA community about the benefits of support- can provide for the public. They are in the ing the ASA Political Activities Commit- process of developing a link on the site tee (ASA-PAC). This enables a ‘voice for the public to submit inquiries about of support’ which has crucial impact on our profession. Fred E. Shapiro, D.O. current national legislative issues: health Dr. Shapiro has been a member of the care reform, ceasing Medicare payment Executive Board and Chairman, Public cuts, truth and transparency bill and Education Committee since 2001 and any thanks to the doc- extending rural pass-through payments in May 2010, became President of the tors that volunteered and to anesthesiologists. The success of the Massachusetts Society of Anesthesiolo- took the time from their Teaching Rule legislation is a testimony gists.~ busyM schedules to visit the schools to how information, persistence, and and educate the students about the visibility of our profession can make a importance of the anesthesiologist difference.
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MSA Annual Reports - continued
MSA PROGRAM COMMITTEE - May 2010
the evaluation forms. Additionally, we Additionally, the committee jointly will work closely with the MMS to clarify sponsored the always successful and the differences between commercial sup- excellently organized annual NESA Chair port and exhibit fees and establish clear meeting, in September of 2009. The 2008-2010 rules for the participation of the industry New England Anesthesiology Resident in our educational venues. Conference, hosted by the Department of In terms of conferences. the MSA Anesthesiology at Boston Medical Center organized two conferences in the Fall of / Boston University School of Medicine 2009 and two in the Spring of 2010. In was also jointly sponsored by the MSA. the Fall we had the Annual Bermuda con- It should be mentioned that the ference that was moderated by Dr. Mark committee also made a difficult decision Ruben J. Azocar, M.D. Hershey and the Practice Management to change the time and venue of our An- Meeting organized by Dr. Larry Robbins. nual Fall Conference after holding it in he MSA Programs Committee had In the Spring, the first Ultrasound-guided Bermuda for many years. In January of a busy yet very rewarding year. regional anesthesia course took place. 2011 the Annual Conference will take We successfully achieved a four It was an instant success. This meeting place in San Juan, Puerto Rico over the yearT accreditation by the Massachusetts was Co-Chaired by Drs. Cristin McMur- Martin Luther King weekend. An excel- Medical Society to continue providing ray, Abdel Mehio and Arnel Almeda. In lent program and a fascinating location CME credits. However, during the prepa- May the Annual Sedation and Analgesia are being secured for this conference. ration for the site visit and after reviewing meeting had for venue the University of Finally, this May, my term as Chair the citations received, the Committee took Massachusetts Medical Center this year. for this Committee ceases and Dr. Cristin action to assure that compliance with the Drs. Shubjeet Kaur and Manisha Desai McMurray will assume this role for the newest ACCME regulations is achieved. co-chaired this effort to educate non- next two years. I wish her the best of The Committee instituted changes in the anesthesiologists providing sedation and luck and my unrestricted support in this planning of our conferences as well as in analgesia. endeavor. ~
CHECK THE MSA WEBSITE FOR THE NEXT MSA ULTRASOUND-GUIDED REGIONAL ANESTHESIA WORKSHOP TENTATIVELY SCHEDULED FOR FALL 2011
Pictured above; Dr. Fred Shapiro with incoming program committee chair, Dr. Cristin McMurray and Dr. Brett Simon, Chair, BIDMC.
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MSA Annual Reports - continued MSA COMMITTEE ON RESIDENT AFFAIRS, May 2010
With the help of the MSA, nine ogy amongst medical students during their residents and one medical student were preclinical years. Sponsored activities able to attend the ASA Annual Meeting included organized shadowing experi- in New Orleans as delegates. In addi- ences with practicing anesthesiologists tion, three residents were able to take in clinical settings and exposure to the part in the ASA Legislative Conference procedural aspects of our specialty via in Washington, D.C this past April. Both simulation centers. meetings proved excellent opportunities We recently undertook our annual to gain better understanding of issues in nominating process for next year’s of- our specialty, and learn ways in which ficers (2010-2011) and are pleased to to help solidify a successful future for announce the results: anesthesiology as a whole. Furthermore, Olof Viktorsdotti, MD, MGH Kenneth Johnson, M.D. CORA made it our goal to increase resi- Mark Hoeft, MD, MGH dent awareness of and contributions to the CORA Co-Chairs his year, the Committee on ASA-PAC, with the lofty goal of attain- Kenneth Johnson, MD, UMass Residents Affairs (CORA) was ing 100% involvement of Massachusetts Past Chair more active than ever. Our Ex- residents during the upcoming year. This C. Ariel Nason, MD, BU ecutiveT Committee was extraordinarily prerogative will be carried forth by the Secretary productive and sponsored a number of newly elected members of CORA. Chien-Hsiang Chow, MD, St. Eliza- educational and social events throughout Last year CORA made notable beths the year, including the New England An- achievements in establishing Anesthesi- Treasurer esthesia Residents Conference (NEARC) ology Interest Groups at all four Massa- Gassan Chaiban, DO, UMass and the Annual Post-Boards Party. We chusetts Medical Schools. This year, we Social Chair also contributed to the formation of the continued to solidify these groups and to Joyce Lo, MD, Brigham & Women's MSA’s new website. cultivate stronger interest in anesthesiol- Social Chair Satrajit Bose, MD, MHS, St. Elizabeths Health Policy Coordinator New England Anesthesia Resident Conference (NEARC) Maksim Zayaruzny, MD April 2, 2011 CORA Advisor, UMass Beth Israel Deaconess Medical Center http://fs19.formsite.com/NEARC-2011/registration/
ASA Director's Report-continued (continued from page 23) Diego. Speaking of the Annual Meet- are interactions with CMS regarding on your behalf. As a component, MSA ing, our Organizational Improvement our concerns and issues with their recent member contributions to ASAPAC, once Initiative established better accounting interpretive guidelines and addressing again, continues to fair poorly compared principles which surprisingly revealed medication error prevention in neuroaxial to other components. Each of us knows that the Annual Meeting was much more block and infection control of endotra- members of our respective departments costly than previously thought. As a cheal intubation in response to The Joint who are not members of MSA, ASA, result, and in an effort to build a much Commission. or ASAPAC. Please join with us in the more robust organization, there will be a I hope, from this brief update of ASA challenge to get them involved. registration fee for all those attending the activities, you recognize the value of your Again, it’s been an honor and plea- Annual Meeting. This will be reviewed ASA membership. I’m sure Dr. Warner sure to serve as your Director to the ASA with the appropriate committees and ASA will expand on many of these issues Board of Directors. I thank the Executive leadership. ASA has also entered the tonight. Remember, every anesthesiolo- Committee and MSA members for all of third and final year of funding a multi- gist benefits from ASA’s efforts. Every your help, support, and confidence in this institutional study on cerebral function anesthesiologist should be a member of position. ~ monitors. ASA and should contribute to ASAPAC Other advocacy activities of note to support our legislative/political efforts
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MSA Annual Reports - continued A SUMMARY OF ASA PRESIDENT DR. MARK WARNER'S UPDATE AT THE MSA ANNUAL MEETING, 2010 by Kenneth Johnson, MD t the annual meeting on May 27th, 2010, the Massachusetts Society of Anesthesiologists had Athe honor of hosting Dr. Mark Warner, current president of the American Society of Anesthesiologists, as its guest speaker. Dr. Warner delivered a clear and concise, yet thought-provoking speech regarding the past, present and future of our society and our specialty. The following is a summary of the key points that he raised and his thoughts on how we can success- fully move forward together as a group of physicians. Dr. Warner began his speech with the ASA’s mission statement: to advance the practice and secure the future for Pictured above with ASA guest speaker, Dr. Warner, MSA members anesthesiologists. The ASA is a member- Drs. Urman, Shapiro, Hannenberg, and Perrin organization, with the ultimate goal of working for that membership. Much challenged the issue of “hand offs”, thanks subspecialty groups, the question remains akin to leaving a legacy for one’s family, in part to the dedicated work of Dr. Alex “why only 72%?” It is safe to say it is the ASA must focus its actions towards Hannenberg. Now in 2010 health care probably not a monetary issue. The more the next generation of physicians. In reform looms large. And while a lot of likely situation is that anesthesiologists the past few years, the ASA has taken things are still unclear as to its full impact, do not feel the need or responsibility a group historically weak in this regard there are several glaring omissions from to join. Therefore, the ASA plans to and helped gain considerable strength. the bill. These include a long-term fix of increase enrollment by demonstrating Anesthesiologists have become more the SGR, a solution to anesthesiology’s its importance and usefulness: better recognized and respected as experts in all “33% problem,” the need for expansion of advocacy, better educational activities, aspects of perioperative medicine, and that access (a “rural pass-through), and better and better tools to maintain certification hospital administrators continue to take truth and transparency within a rapidly in anesthesiology. In addition, the An- notice of it. As hospitals focus more on broadening medical field. These are all esthesia Quality Institute, will eventually efficiency and cost-containment in the issues that need to be solved in the coming help lead to practice improvements and operating room setting, they will rely on months and years. Thanks in part to the increased patient safety. It is the hope that the valuable input of anesthesiologists in ASA-PAC and people at the ASA office the ASA can eventually obtain 90+% en- making these important decisions. But working through social networking and rollment as these improvements manifest this is only the tip of the proverbial ice- Internet search engines, these issues are themselves to the younger generation of berg.... he followed this with four pertinent being made known to the general public. anesthesiologists. questions that need to be addressed: Of note, the ASA-PAC is now the biggest physician PAC in the country (including 3. How well are we training the next 1. Are we advocating for fair and the AMA-PAC), with over 3,500 donors generation? reasonable compensation to provide and over $2 million dollars raised… and There is a concern that the specialty resources necessary for advances in it does have a real impact! of anesthesiology is not attracting the science and basic care? very best medical student candidates The year 2008 was a great year for anes- 2. How is anesthesiology holding to- possible. How can we attract a greater thesiology as a specialty: the 18-month gether as a specialty? percentage of the “best and brightest”? extension of the SGR, SQRI bonus pay- Currently, 72% of practicing anesthe- It is important to excite medical stu- ments adjustment, and passage of the siologists belong to the ASA. While dents about our specialty through early teaching rule. In 2009, we successfully this is above the median as far as other (continued on next page)
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MSA Annual Reports - continued
COMMITTEE ON PUBLICATIONS - May 2010 by Richard D. Urman, M.D., MBA 3. The Publications committee ad- in the spring. No specific decision Chair 2009-2012 dressed the usage of MSA mem- has been made by the Executive com- 1. The latest edition of the MSA Record bership database (emails, mailing mittee, and discussion will resume was published in April and mailed to addresses) by outside parties. The in the fall. ~ the entire membership. The plan is to issue was brought up for discussion publish it once a year, in the spring. We encourage contributions by our membership.
2. The new website is up and running (www.massanesthesiology.org). The project is being spearheaded by Dr. Spiro Spanakis, Chair of the Website Sub-committee. He and the rest of the sub-committee members deserve a lot of credit for coming up with the website content and overall design. Any feedback about the new website should be addressed to Dr. Spanakis as he continues to work with the MCD Studios on perfecting it. (Pictured above; Dr. Dan O'Brien, ASA President-elect Dr. Mark War- ner and Dr. Richard Urman.)
Summary of ASA President Dr. Warner's Update-continued
(continued from page 27) exposure and interest. An example of in research. The problem begins with want to compete. How will the next this would be through active involve- the fact that only 8% of the annual ASA quantum leap in anesthesia be made if ment and cooperation with anesthesiol- budget supports our research-oriented no one is doing the research to discover ogy interest groups at medical schools. foundations (Foundation for Anesthesia it? Unless this changes, the future of our Anesthesiology has the widest scope of Education and Research (FAER) grant, specialty looks rather dim. any medical practice, with care rang- Wood Library-Museum, Anesthesia In his final thoughts of the evening, ing from the youngest to the oldest of Patient Safety Foundation (APSF)). Dr. Warner emphasized one major point: patients. It involves managing both However, the problem runs much deeper. he urged ASA members to help make our chronic and acute disease processes, The simple fact is that there is a very low society better. This could be through in- while requiring a mastery of a broad percentage of young anesthesiologists volvement at either state or national levels. range of pharmacology and physiol- pursuing scientific advancement. Out Write a newsletter article or letter-to-the- ogy. Medical students need to be made of twenty-four medical specialties, an- editor. Advocate for our specialty and for better aware of the excitement that the esthesiology is number 23 in receiving those issues most important to our future. practice of anesthesiology entails… for federal funding from foundations such Talk to the next generation: students in until this happens, our specialty will not as the NIH. Yet the specialty has the high school, college, or medical school. same success rate in receiving funding Get them interested and excited about reach its true potential for growth and as any other specialty (including internal anesthesiology, because without them greatness. medicine and orthopedics). It is simply we have no future. Everyone needs to the unfortunate truth that applications are do his or her part… because we are all in 4. Have we encouraged new knowledge not being submitted; there are not enough this together. ~ to make our specialty safer? men and women in anesthesiology who The ASA wants to expand interest
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MEMBERSHIP CHANGES 3/10 - 3/11
New Active Peter Anderson, MD, Guardian Anes Anthony Schwergerl, MD, UMass Michael Andrawes, MD, MGH Guy Sciortino, MD, Lahey Clinic Nicole Arboleda, MD, Bwh Stacie Noble Shriver, MD, Martha's V. Sascha S. Beutler, MD, BWH Daryl Smith, MD, Baystate Med. Ctr Sarah Blake, MD, Guardian Robert Stephenson, MD, St. Elizabeth's MC Jessica Bland, MD, Baystate MC Jason Stewart, MD, BWH Amil Bogdanov, MD, Tufts MC Andrew Sukiennik, MD, Winchester Hosp. Carl Borromeo, MD, Lahey Clinic Coral Sun, MD, Brockton Hosp. Kristine Boulanger, MD, BWH Hariharan Sundram, MD, St. Elizabeth's MC Sebastian Bourgeois, MD, Baystate MC Shanthan Sunku, MD, Baystate MC Peter Calkin, MD, Guardian Anes Gary Thal, MD, Vertex Pharm Toni Chahla, MD, Baystate MC Dirk Varelman, MD, BWH Jamie May-Lynn Cheung, MD, BWH Carmelita Wallace, MD, BWH Tomas Cvrk, MD, Lahey Clinic David Whiting, MD, CHMC Galina Davidyuk, MD, BWH Karin Zuegge, MD, Baystate Med. Ctr Rebecca DeCampli, MD, Berkshire MC Christopher Dow, MD, Baystate MC Nasser El-Mallah, MD, Mercy Hosp. Jason Erlich, MD, So. Shore Hosp. Oleg Evgenov, MD, MGH Active, Moved Out of State Eddy Feliz, MD, AAM Meraj Mohiuddin, MD, MO Peter Fischer, MD, BWH Russell Flatto, MD, UMass Retired Gilbert Connelly, MD, W. Yarmouth Sridhar Ganda, MD, Holy Family Ammani Dasari, MD, Lexington Lauren Gavin, MD, BWH Stephen Hall, MD, So. Hadley Meera Grover, MD, BWH William Henderson, MD,Shrewsbury Carlos Guzman, MD, AAM Arpa Mahasaen, MD, So. Natick Brian Hashim, MD, BIDMC Behzad Hejazian, MD, Tufts, MC Deceased Jan Hilberath, MD, BWH Leonard S. Bushnell, MD, NH Humayon Khan, MD, Brockton Hosp. William Cummings, MD, So. Hadley Sonia Kapoor, MD, Tufts MC Enzo Fruggiero, MD, Suzanne Klainer, MD, BWH Timothy Kubicki, MD, AAM Robert Lekowski, MD, BWG Albert Lim, DO, Baystate Med. Ctr Gustavo Lozada, MD, Tufts MC Christine Mai, MD, MGH Angelina Mavropoulos, MD, BWH Jennifer McSweeney, MD, BWG Akmal Mikhail, MD, Norwood Hosp. Noila Moghul, MD, BWH BOX SCORE Charles Nyman, MD, BWH Membership Totals (03/11) Nam Hoon Park, MD, Holy Family Dilip Patel, MD, Winchester Hospital Active 924 Deborah Pederson, MD, MGH Resident 455 Sadeq Ali Quraishi, MD, MGH Affiliate 14 Jay Sarma, MD, MGH Retired 171
Anesthesia Record www.massanesthesiology.org Page 29
Winter/Spring 2011
ASA PLACEMENT SERVICE MOVES ONLINE
http://placement.asahq.org
Organizations may now submit positions directly online. Newly submitted practice opportunities will be made available on the ASA website within 24 hours of submission. All practice opportunity postings will be available for a period of 60 days. This online service has replaced the quarterly placement bulletin, which had been mailed to interested ASA members. Please note that ASA reserves the right to reject any job submission it deems inappropriate.
This new feature of the ASA website will allow your position to be made available to more than 36,000 anesthesiolo- gists. Also, you now have the option of including a phone number, fax number and/or email address to your listing. To update your available position simply click on your posting, make any necessary changes and click on the submit button. Your changes will be updated within 24 hours. The placement service remains free of charge.
Any questions regarding the ASA Placement Service should be directed to the ASA Executive Office at (847) 825-5586 or by email at [email protected].
Anesthesia Record www.massanesthesiology.org Page 30 Winter/Spring 2011
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Anesthesia Record www.massanesthesiology.org Page 31
Winter/Spring 2011
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Anesthesia Record www.massanesthesiology.org Page 32