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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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Featured

A Message from the President

Gary Tzeng, MD

ISA President

Why Professional Societies are Worth It

In March 2017, Amol Utrankar (Vanderbilt MS4, ASA Med Student Governing Council) blogged

"Why pay an annual subscription fee to join a club, add a line to your CV, and pay respects to the Guild? At first, I felt similarly skeptical.As a digital native, I was confident that I didn't need my professional society.I had a blog. I had a Twitter account and LinkedIn profile.I could advocate and network for myself."

Or so he thought.However, he quickly realized that he needed his Society in order to:

  • 1."Know what's happening in your field and where it's headed"
  • 2."Learn, do, and network at the Annual Meeting!"
  • 3."Support the people who are fighting for your future."

Dr. Scott Jellish answered the question of why ISA membership matters. He described how the ISA has been busy working on your behalf -- monitoring and creating legislation, reaching out to you, our members, and trying to create opportunities for personal as well as professional development.Thank you, Scott, for your hard work.

The ISA is your organization.During the upcoming year, we will be re-examining the roles of your Board members and Officers to seek opportunities to improve and enhance service.The ISA not only serves as your voice as an Illinois anesthesiologist, but also as a voice to the ASA as well as to our non-anesthesiologist colleagues, both medical and non-medical, local and national. The ISA functions to enact what you feel and what you think. In order to accomplish that goal, we need to hear from you.Resolutions, directives, complaints…all of it.While the ISA frequently tells you what we need or want you to do, I want YOU to tell us what the ISA needs or should do!We are a team. So please speak up!

The HOD meeting is about learning and networking and hopefully, doing!After the HOD meeting, all of us should have better insight into what is happening in our field -especially in our crazy state. We will continue our pursuit of enabling Anesthesiology Assistants to practice in our state.We will continue to educate our Legislators about the potential perils of enabling lesser-trained medical professionals to expand into non-supervised roles.We will continue to work as a team to improve the opiate and benzodiazepine crises. Thanks to Dr. Asokumar Buvanendran for his tireless work in this arena.But most importantly, we will continue to advocate for our patients and their accessibility to appropriate healthcare.We will engage in an arduous but ultimately useful task of examining and interpreting the various practice acts.The intention of this interpretive guideline is to clarify the roles of all healthcare providers to facilitate the evaluation of future healthcare legislation. The ISA and its members and allies have devoted countless amounts of energy to keep our specialty functioning in our primary role as our patients' advocate during their times of great vulnerability. Our mission has always been and will always remain to protect the practice of medicine and protect anesthesiology as a practice of medicine so that we can protect our patients. Join us as a supporter, as a lobbyist, but most importantly, as a physician constituent.

To that end, we have finally completed our multi-year effort at improving communication by developing a contemporary, fresh and agile website!I will be redefining the Electronics Communications & Media Subcommittee of our existing Communications Committee to better maintain this webpage so that it remains updated, relevant and most importantly, a useful tool for all of our members. This Subcommittee will also continue to evaluate other potential forms of communication. (please let me know if you want to be involved)While membership dues will still be collected by the ASA, our new website will allow for ISAPAC contributions, member event registration and even legislative initiatives.Please check out www.isahq.org and provide feedback.We do listen!

The ISA has made important progress in engaging our members that reside below I-80, but acknowledges that we need to do more. We want to represent all of our members, not just greater Chicagoland.In response to our membership, we no longer provide CMEs.Rather, we have modified our educational mission to provide locally focused education about non-academic topics such as regulation, legislation, practice management, and leadership.Therefore, expect more Practice Management seminars and social engagements. Also, we will expand our excellent Fall Leadership Conference to include a workshop to enhance personal leadership development.We will continue to address MACRA, QCDR and any other acronym or topic that affects us all.As much as is feasible, we want to provide the local resources that you need and/or desire for your local practice.So please let us know how we can help you.

On a fiscal note, multiple strategies enacted over multiple years by multiple Boards along with a little luck have resulted in a monetary surplus this year.As an effort to reduce the sting of membership dues, the ISA will reward active members with a $200 rebate gift card of their choosing.More details will follow and it will require minimal participation. It really does pay to belong and participate!

In conclusion, we, the ISA, have had a few successes in the recent past but as all of you know, there continue to be ongoing battles.In order to remain successful, we need you to help us help all of us. As the VA Handbook dilemma demonstrated, we must act as a team to accomplish significance.

I cannot promise to fix all, if any, of our problems, but I will promise that you will not face them alone. As the Peace Pilgrim from NY has said, "One little person, giving all of his or her time, makes news.Many people, giving some of their time, can make history."

Join me and let us make history…together. 

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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.

Want to be notified about the legislation that is important to you and your profession? Click here and sign up to receive information and opportunities to advocate with the ISA.
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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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