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PAST-PRESIDENT's MESSAGE

Reflections from the 2018 ISA House of Delegates

Gary Tzeng, MD

What a wonderful weekend!  Those who were able to join us at Sunda on Friday evening for the President's Dinner enjoyed fantastic food, libations and company.  We were fortunate to have distinguished guests from across the country including our next ASA President, Linda Mason MD, join us!  Great conversations and food fueled our spirits as well as our bodies!

We honored Timothy Starck, MD with ISA's 2018 Distinguished Service Award for his work in revamping our HOD meeting during his ISA Presidency.  And of course, I had the opportunity to thank all of our members, ISA Delegates & Alternate Delegates, Executive Director Mary Hines, my partners at Dupage Valley Anesthesia, and most importantly, my family, for helping me achieve a very productive year!  I could not have done it without any of you!

Saturday's House of Delegates was equally spirited and stimulating! Our morning District Caucuses were visited by the Candidates for ASA Offices:
ASA Office of First VP:                      Claude Brunson, MD (MS) & Beverly Philip, MD (MA)
ASA Office of VP Scientific Affairs:
Jeffrey Kirsch, MD (OR) & Andrew Rosenberg, MD (NY)
during which each candidate discussed their qualifications and visions for ASA's future.

Following ASA President-Elect Dr. Linda Mason's enthusiastic and informative update on ASA affairs, we quickly moved on to the business of the House electing our next Officers, ASA Delegates and 2019 DSA recipient, Dr. Eric Werner.

But most significantly, the House expressed its rousing opinions and desires regarding the ongoing PHARMA shortages and passed a Resolution to be presented at the 2018 ASA House of Delegates in SF!!  This Resolution requests specific actions for the ASA to act upon to help address this problem.  This Resolution is significant for its mission AND the first to have originated from Illinois in over 20 years!  We thank Dr. Sean Adams for spearheading this Resolution and look forward to even more passionate discussion from across the nation at the ASA Annual Meeting in October!  Join us in SF and add to the conversation!

And by the way, we accomplished all of this by lunchtime!

Have an idea? Have a common issue that ISA should address? Let us know and come to next year's House of Delegates!​  Speak your voice and play an active part of your future!  OF OUR FUTURE!  Until then, please join us in DC for the ASA Legislative Conference in May and in SF for the ASA Annual Meeting in October!

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Featured

A Message from the President

SPRING 2018 UPDATE...

LEADERSHIP CONFERENCES

The Practice Management Dinners have been a resounding success.Organized by Dr. Sean Adams, ISA VP, and Mary Hines, ISA Executive Director, with financial support from ABC and Merus Management as well as ISA, many members have benefited from the camaraderie and timely information from these dinners.We hope that more of you will be able to enjoy these seminars in the forthcoming year. Our last event in February 2018 featured renowned ASA Practice Management speaker, Amr Abouleish, MD MBA, who spoke about performance metrics. It was a resounding success with outstanding attendance and even more spirited discussions.

Along this venue, ISA is expanding its educational mission by also providing Leadership skill development workshops.Many opportunities currently exist for management-focused topics for physicians but less so for developing the necessary skills to implement management strategies and actually "LEAD."To that end, we have embarked on a series of workshops to assist in developing these types of skills.Our first workshop to assess personal leadership skills was well-attended in September.Our next workshop will focus on negotiation skills on MAY 5th in Schaumburg at the ASA Headquarters. Please join us!

These workshops will also help address some of the concerns regarding the changing landscape in anesthesia businesses that were expressed during the House of Delegates.Additionally in response to these concerns, the Ad Hoc Committee on Hospital Contracts, chaired by Dr. Charles Kim, District 3 Director, has been assembling information & referrals and coordinating a conference of leaders from local anesthesia groups.

FINANCE

With the stewardship of your Board, past Treasurers, and current Treasurer, Dr. Brian Birmingham, ISA has enjoyed a favorable return on its investments and will continue to focus on maximizing returns while mitigating risk.Like any other family, ISA wants to share some of its good fortune with its family—YOU, our member. In coordination with the re-branding campaign, we are currently offering a $100 Amazon gift card reward to active members just for updating their contact information.  You must hurry though as the offer expires April 30, 2018.

LEGISLATION passed

As with all successful legislative endeavors, this past year represents a mix of success and compromise:

  • 1.Network Adequacy: While a definition of "adequate" remains elusive, ISMS along with its multiple partners, including ISA, successfully passed legislation that mandates insurers maintain an accurate Network directory with timely updates.
  • 2.Advance Practice Nurse Independence: Beginning in 2018, this compromise provides a pathway for APN independent practice while protecting our patients by clarifying the rigorous requirements.In addition, as recognition of the critical difference in the practice of anesthesia, nurse anesthetists were excluded from this law.
  • 3.Prescription Monitoring Program: In response to the state and national opioid crisis, this compromise spearheaded by our own Dr. Kumar Buvanendram, ASA Alternate Director and ISA Past-President, balances administrative legislation, prescriptive judgment and most importantly, patient well-being.Please note that ALL prescribers must have registered by JANUARY 1, 2018.As the rules have not yet been clarified, we suggest that all anesthesiologists register even if you do not prescribe outpatient narcotics.

LEGISLATION pending

Each year brings challenges and opportunities.2018 will be no different—here are some of our anticipated highlights:

  • 1.Advanced Practice Registered Nursing Compact: The APRN Compact legislates that once ten states "sign on", all states that belong to this Compact will honor an APRN's state licensure and rights of that licensure, regardless of the other states' rules and regulations. In other words, the nursing practice rules of a conservative state's license would not apply to an APRN with a very liberal license. This Compact attempts to supersede state nursing licensing requirements and regulations and is a pathway for national APRN independence.Unlike other medical compacts, it does not respect state law.
  • 2.Anesthesiology Assistants:More education will follow the re-introduction of this bill which allows AAs to practice in Illinois.As the development of an Anesthesiology Assistant School looms in our state and as Illinois becomes surrounded by states that allow AA practice, such AA legislation would allow fellow Illinoisans to practice within our state and supplement the anesthesia workforce.
  • 3.Ad Hoc Committee on Pediatric Dental Sedation/Anesthesia:Dr. Wendy Binstock, ISA Past-President, is spearheading a task force to meet with the Illinois State Dental Society, Illinois Society of Pediatric Dentists and Illinois Dental Society of Anesthesiology to address safety concerns that have surfaced regarding the risks of sedation/anesthesia for pediatric dental procedures.Please contact us if you are interested in participating.
  • 4.further modifications to the PMP are anticipated but patient safety and physician autonomy remain our primary concerns.

Join us on APRIL 21st in the Chicago office for our annual House of Delegates Meeting as we meet the Candidates for ASA Officers who have traveled from all over the country to meet with us!  We also expect a passionate discussion as the ISA will present a resolution about PHARMA shortages for submission to the ASA--WE WANT YOUR INPUT!

See you soon!
Gary Tzeng, MD
ISA President

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ISA Members advocating for you in Springfield

​ISA members Active in the Community 

ISA members & AAAA President, Laura Knoblauch, meet with Illinois State Senators Iris Martinez and Emil Jones, III during the 2018 Lobby Day in Springfield.
ISA members & AAAA President, Laura Knoblauch, meet with Illinois State Senator Don Harmon during the 2018 Lobby Day in Springfield.
ISA members meet with Illinois State Senator William Haine during the 2018 Lobby Day in Springfield.
The ISA Delegation welcomed Laura Knoblauch, President of the American Academy of Anesthesiologist Assistants (AAAA), to Springfield as she joined us for our 2018 Lobby Day.
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The Legislative Journey to Independent Practice Continues

The Legislative Journey to Independent Practice for APRN Continues...

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

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

After numerous negotiating sessions and intense advocacy from physicians, an agreement was reached in 2017.  This agreement was passed by the Legislature, signed into law by Governor Rauner, and took effect on January 1, 2018. 

Below is a summary of the language that was eventually accepted by the APRNs:

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


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

Despite this expansion of privileges, the push for further independence continues. The ISA and ISMS are keeping a sharp eye focused on the APRN Compact legislation that is making ts way across the country. The APRN Compact legislates that once ten states "sign on", all states that belong to this Compact will honor an APRN's state licensure and rights of that licensure, regardless of the other states' rules and regulations. In other words, the nursing practice rules of a conservative state's license would not apply to an APRN with a very liberal license. This Compact attempts to supersede state nursing licensing requirements and regulations and is a pathway for national APRN independence.Unlike other medical and nursing compacts, this legislation does NOT respect state law.

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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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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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