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%.
The ASA has had to deal with these hot button topics that have popped up that, if left unchallenged, could be detrimental to the overall practice of anesthesiology. The first was the unanticipated cost of both money and effort defending our military veterans’ access to physician-led healthcare in the VA system. The challenge that was waged against the Department of Veterans Affairs’ VHA Nursing Handbook that would mandate independent practice for all Advanced Practice Registered Nurses (APRN’s) without physician involvement would lower the standard of care for our veterans. Both the ASA and ISA strongly opposed the inclusion of APRN’s in the operating room having independent practice and over the last six months have developed efforts aimed at legislators and VA leadership to defeat or change the proposal to carve out OR APRN’s. This was a costly and time consuming effort.
Another area where both the ASA and ISA have become involved concerns some of the legislation involving out of network payments. The narrowing and readjustment of insurance networks have been a result of losses incurred by insurance companies when originally developing care networks as part of the Affordable Care Act. This has resulted in patients receiving surprise bills from providers, especially when they thought their care was covered by insurance. This has been particularly contentious in Florida and Texas where surprise bills occur in 30% of all patients receiving medical care. Large patient organizations such as AARP and others have joined the fray and have gone to legislators to force physicians to accept charges for inpatient and outpatient services which are far below customary charges. The ASA is becoming more involved with fighting these changes in insurance network coverage, and support for these challenges is becoming expensive. The ISA is also involved in preventing reduced network coverage and is supporting a bill sponsored by the Illinois State Medical Society entitled, “Truth in Out of Network Healthcare Benefits Act” which mandates adequate network directories and information to patients that states that networks must be adequate, accessible and transparent. This will continue to be a hot button topic as insurers back out of ACO’s and other networks where reimbursement is poor and costs are high.
There has also been increasing efforts to prepare all members for the rollout of MACRA which will begin in 2017. MACRA, or Medicare Access and Chip Reauthorization Act, abolished the Medicare sustainable growth rate payment formula and establishes a new merit and incentive payment system or alternative payment system that will determine how providers are reimbursed according to quality and outcome metrics established by the government. ASA has developed a group of experts to work with CMS to ensure the MIPS Program will allow successful participation of anesthesia practices with some of the quality metrics. ASA is also continuing to develop the perioperative surgical home and is developing strategies to allow it to fit into the alternate payment methodology as part of the other method for reimbursement through MACRA. Reimbursement could be affected dramatically if anesthesiologists do not meet the quality metric performance parameters. ISA will also help our members by developing MACRA information sessions through our practice management lecture series.
The other issue that has been looming for the ASA and that has not been as much of a success as originally hoped is the AQI rollout. The initial operation of AQI has been suspect, with members unable to access the quality data necessary for reporting quality metrics to CMS and other quality monitoring agencies. After much effort and increased expenditures, the Anesthesia Quality Institute seems to be operational which should benefit all members who report their quality data.
A final project where ISA has given financial support is in developing and reworking our website to improve information exchanges with our members and make it a reliable access point to obtain information specific to anesthesia practice and the risks to their practice by other non-physician clinical providers. The website structure has been completed and initial content is being added. Look for an official rollout of the new website soon..
There may be other issues that rise to the surface that the ISA may have to address at the state level. Independent practice by nursing is a key issue that may present itself next year. The ISA will definitely be involved with issues concerning independent practice of nursing and preservation of the care team model of clinical care. Further exploration of the credentialing and licensing of anesthesiology assistants in the state of Illinois will also require the attention and financing for sponsorship of this legislation. Advocacy, now more than ever, is a word that holds even more meaning and potential for the future of our specialty.
As always, I look forward to continued and added engagement by all of our members. I was heartened to interact with many of our present members at this year’s ASA meeting, and universally the comments were “How can I get involved?” I hope this increased interest in ISA is sustained and believe that this society will take on additional importance to our members as changes in healthcare rules, regulations and reimbursement ripple through our practice.
My final thought on advocacy is to wish you all a wonderful and joyous holiday season and to advocate for better days ahead in the coming year.