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    Articles, press releases and announcements about what is happening for anesthesiologists and our patients.

The Legislative Journey to Independent Practice

The Legislative Journey to Independent Practice

In most other states, Advance Practice Registered Nurses (APRNs) already have full practice authority to diagnose, treat, and prescribe. Currently, there are 24 states and the District of Columbia that don't require any physician involvement for APRNs to diagnose, treat or prescribe. In addition to those, eight states allow APRNs to diagnose and treat independently but require physician involvement to prescribe.

There was strong support this year, within the Illinois legislature to grant APRNs with full independent practice. Instead of voting against physicians, legislators asked that the Illinois State Medical Society (ISMS) draft an alternative. The Illinois Society for Advanced Practice Nursing bill as introduced would have granted full independent practice and full prescriptive authority, after completing additional clinical training under the supervision of either another APRN or physician.

After numerous negotiating sessions and intense advocacy from physicians an agreement was reached. Below is a summary of the language that was eventually accepted by the APRNs:

  • 1.Maintains the requirement that APRNs have a written collaborative agreement, unless the APRN receives substantial post-graduate training under the direct supervision of a physician (4,000 clinical training and 250 hours in additional educational/training components). The physician then must sign a written attestation confirming that the training was completed.
  • 2.Does not change current practice within a hospital setting; APRNs must still be recommended for credentialing by the hospital medical staff.
  • 3.Requires APRNs to maintain a formalized relationship with a physician that must be noted in the state's prescription monitoring program (PMP) if that APRN wishes to prescribe schedule II opioids and benzodiazepines. The opioids to be prescribed must be specifically noted in the PMP and APRNs and the consulting physician must meet at least monthly to discuss the patient's care.
  • 4.Says APRNs are prohibited from administering opiates via injection. APRNs are also prohibited from performing operative surgery.
  • 5.Prohibits APRNs from advertising as "Dr.," which is extremely misleading to patients. APRNs who have doctorate degrees must tell patients that they are not medical doctors or physicians.
  • 6.Makes clear that nurse anesthetists are not included in the agreement; nothing changes as to how nurse anesthetists currently practice.

ISA has worked closely with ISMS on scope of practice issues and greatly appreciates that anesthesia services have been uniquely identified in the medical practice acts. While ISA has traditionally been opposed to the independent practice of non-physician providers, we've conceded that mainstream support exists for APRNs in Illinois. ISA will vigilantly advocate that anesthesia services are not the same as primary health care. We believe that the Anesthesia Care Team model provides excellent access to quality care for our patients.

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ISA Members being Active in the Community

​ISA members Active in the Community 

Members meet with Senator Tammy Duckworth during the ASA Legislative Conference
Members meeting with Congressman Raja Krishnamoorthi during the ASA Legislative Conference
Dr Asokumar Buvanendran present State Representative, Patti Bellock with ISA's Legislator of the Year Award at ISA's Annual House of Delegates Meeting.
Gary Zheng, MD recognized W. Scott Jellish, MD for his service as ISA president.
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HB 2975: Anesthesiologist Assistants Add Value to the Team

HB 2975 would license Anesthesiologist Assistants as part of a physician-led team. New health care delivery system reforms hinge on a team-based approach to patient care. Anesthesiologists have been the leaders by practicing in a team care model for decades. Anesthesiologist Assistants are a welcome addition to the anesthesia team!

Contact your state legislator and ask for their support :

* A physician-led team model of care with flexibility under physician leadership ensures access to cost-effective and high quality health care. 

* The team model of care was found to be the safest compared to working alone. 

* Anesthesiologist Assistants (AA's) are providers that will help ensure that physician-led team based anesthesiology care will be available to all patients in Illinois.

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HB 3382: Tell Legislators to Keep Physicians In the Room Where It Happens

HB 3382 seeks to remove the requirement that physicians remain physically present and available during delivery of anesthesia administered by a nurse anesthetist. 

Contact your state legislator and let them know that: 

​* Anesthesia is unlike other care settings, and is particularly different from the primary care setting. It is a complex, high-risk care setting where complications can present quickly that require immediate medical attention to prevent serious injury or death. 

* Physician anesthesiologist prevented 6.9 excess deaths per 1,000 cases in which an anesthesia or surgical complication occurred, according to an independent outcomes study published in the peer-reviewed journal Anesthesiology

* Physician-led medicine can save patients and payers money. A review article in the New England Journal of Medicine cites when a physician anesthesiologist was involved: 

1) medical consultation requests reduced by 75 percent; 

2) cost of laboratory tests reduced by 59 percent; and, 

3) cancellation of operations for medical reasons reduced by 88 percent.

Want to be alerted when this - and other important - legislation needs your voice? Click here to sign up to advocate with ISA.



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MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA)

Background

In 1997 congress passed the Balanced Budget Act (BBA), to replace the Medicare Volume Performance Standard (MVPS), in an attempt to rein in the growth in physician expenditure and healthcare costs. The BBA was designed to ensure that the annual increase in expense per Medicare beneficiary did not exceed the growth in Gross Domestic Product (GDP), and tied physician reimbursement to GDP.

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CONFESSIONS OF NEW DELEGATES AT THE ASA HOUSE OF DELEGATES

CONFESSIONS OF NEW DELEGATES AT THE ASA HOUSE OF DELEGATES

The ASA House of Delegates met this past October 22-26. It brought together hundreds of delegates representing eight regions in the nation.  Over the span of five days, I had the opportunity to partake in this gathering of innovative minds as the physician anesthesiologists who function as the primary legislative and governing body of the ASA met in Chicago. 

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A WIN FOR THE ANESTHESIA CARE TEAM AT THE VA!

The Veteran Affairs Department has finalized a rule that will allow advanced-practice registered nurses to practice to their full authority at VA facilities, however the new permission will not expand to certified registered nurse anesthetists following lobbying from anesthesiologists.

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NEW APPROACHES TO SUCCESSFUL USES OF PATIENT SURVEYS: A DISCUSSION WITH SURVEY VITALS

NEW APPROACHES TO SUCCESSFUL USES OF PATIENT SURVEYS:  A DISCUSSION WITH SURVEY VITALS

The ISA had a practice management dinner seminar at Carlucci’s Restaurant in Rosemont in August with a discussion on the uses and misuses of patient surveys.   Our lead speaker was Bob Vosburgh, the President and Founder of Survey Vitals, who offers a specialized patient satisfaction survey tool dedicated to anesthesiologists. 

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PRESIDENT'S MESSAGE

Advocacy! If you attended the ASA in Chicago in late October, this phrase was utilized continuously. Why get involved, why not let others do the heavy lifting? It was obvious that the leaders of our specialty had a lot of actionable items to deal with. It was also obvious that their decision to raise yearly membership dues came about because of the continuous assault on our practice of medicine by the government, payors, non-physicians, and insurers which could affect the way we practice and cut our reimbursement by 15-20%.

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ISA LEADERSHIP CONFERENCE HIGHLIGHTS

As I reflect upon last weekend’s 2016 ISA Leadership Conference, I am thankful to be a member of our organization.  The ISA continues to provide rich educational experiences at minimal to no cost for its members.  Drs. Torin Shear and Michael Shane continue to develop an amazing conference with excellent, thought-provoking speakers from around the nation.   As a short summary:

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