John P. Abenstein, M.D.

he ASA 2004 Annual Meeting was held only one week ago as I write this. It was one of the best meetings I have ever attended. We had a record number of attendees, and the quality of the Refresher Course Lectures, panel discussions and other continuing medical education activities was superior. The scientific abstracts presented at the meeting demonstrated the vitality and creativity of our academic anesthesiology community. Finally our House of Delegates worked through the largest-ever volume of reports and recommended actions.

The Reference Committee procedures used by the House to process this large volume of work may not be well understood by most ASA members, so I would like to briefly touch upon how the committee works. Every report is assigned to one of four Reference Committees. The committees hear testimony from ASA members as to what should be done with the reports and then forward their recommendations to the House. Generally they recommend approval, with or without amendment, referral to committee or disapproval.

The Task Force to Study Payment Methodology recommended that the Executive Committee (i.e., first vice-president, president-elect and president) be empowered, in consultation with the Administrative Council (i.e., all ASA officers), to propose a restructuring of Medicare payments. This topic was so important that a fifth Reference Committee was created to hear testimony only on this issue.

The fifth Reference Committee opened hearings early Sunday afternoon, while the other committees started an hour and a half later. The quality of the testimony was outstanding. The ASA members who participated in this process brought forward thoughtful input, recommending changes to improve recommended actions and, at times, respectfully disagreeing with the recommendations from various ASA committees and leadership. The fifth Reference Committee, not surprisingly, had a great deal of testimony, and the hearing lasted more than four hours. After the hearings were completed, the Reference Committees put forward their recommendations.

On Wednesday the Reference Committees’ recommendations were considered by the House, which voted either individually on each report or en bloc as a consent calendar. It is far beyond the scope of this brief article to fully discuss the decisions of the House. The House of Delegates did decide, however, to refer the recommendations of the Task Force to Study Payment Methodology back to the committee for further analysis and refinement. The statements on the safe use of propofol, update on ventilation monitoring during regional anesthesia and anesthesia machine obsolescence were approved by the House.* This is just a small example of what our House of Delegates accomplished this year.

Unfortunately the news was not all good at the Annual Meeting. We have ongoing challenges with reimbursement and regulatory policies from both the private and public sectors. Our academic practices suffer from Medicare payments cut in half when care is delivered with a resident physician while our surgical colleagues are reimbursed fully. National Institutes of Health research funding for anesthesiology research is far less than required to sustain our academic programs. The number of women entering the specialty appears to be decreasing while the proportion of female physicians increases.

Of particular interest, Jerome H. Modell, M.D., from the University of Florida, Gainesville, delivered the 2004 Emery A. Rovenstine Memorial Lecture, “Assessing the Past and Shaping the Future of Anesthesiology.” He discussed our successes and the challenges facing our profession. He highlighted a July 2004 report from the Federal Trade Commission (FTC) on competition and health care <www.ftc.gov/reports/index.htm>. This report calls for a reduction in physician membership on state licensing boards to facilitate removing current restrictions on the independent practice of allied health professionals. The FTC discounted the testimony of the medical community, including that of Dr. Modell, regarding the quality and cost-effectiveness of physician-delivered health care. Cost of care appears to be more important to the FTC than quality of care, even when the evidence for cost-reduction is lacking.

If the legislative and regulatory class persist in their attempts to undermine physician-delivered medical care, I am fully confident that the medical specialty of anesthesiology will adapt and continue to flourish. The Annual Meeting represents a perfect microcosm that supports this view. We not only have forums to learn what is new in medicine or has recently been discovered in the laboratory, we have a vibrant and successful process to consider new policies and approaches to deal with an the ever-changing medical environment. We will need to increase our efforts at “market differentiation” to demonstrate the value of physician anesthesiology to our colleagues in medicine, the public and private sectors and, most important, our patients. The collective wisdom and willingness to engage problems by our House of Delegates, Board of Directors, committees and the membership as a whole are our assurance of a bright future for our specialty and patients.

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