Jeffrey L. Apfelbaum, M.D.

ast month I asked an anesthesiology residency applicant why she chose a career in our medical specialty. Her response was striking. “How many people get the opportunity to profoundly change lives? How many people get the opportunity to protect a patient’s life when they cannot do so themselves? How many people can live the noble goal of relieving pain and suffering?”

Unfortunately, in the year 2007, patient care does not simply begin and end at the bedside. Regulation and legislation affect virtually all aspects of the patient care we render each and every day. CMS. Federal law. Federal rule. State law. State regulation. We all must participate in advocacy or we risk the erosion of our specialty as the practice of medicine. We risk the capitulation of the doctor-patient relationship to those without knowledge and understanding of medicine.

Are you one of the nearly 90 percent of anesthesiologists who have failed to “invest” in your profession? This NEWSLETTER article is an appeal. It is a plea to each and every anesthesiologist to invest in yourself and make a difference!

By all accounts, an overwhelming percentage of our members are spectators when it comes to advocacy, while a small percentage are participants and an even smaller percentage are on the front lines.

What? You say it doesn’t matter that you are a spectator? Read on to see a very brief summary of what advocacy by ASA has done for YOU and think of how much more effective we could be if all were involved.

The Executive Committee recently asked Norman A. Cohen, M.D., chair of the ASA Committee on Economics, to assess the fiscal impact of recent advocacy efforts by ASA. Dr. Cohen has graciously agreed to permit me to briefly summarize his response. ASA, individually and collectively with the house of medicine, has focused its advocacy efforts to improve payment for medical services and to correct errors where they have occurred with the following results:

• Five-year review of work, worth a 15.95-percent increase in the conversion factor (1997).

• Correct Medicare payment calculation error in 2001, worth 3.2 percent.

• Second five-year review of work, worth 1.6 percent (2005).

• Modification of practice expense payments for anesthesia care, worth 1 percent (2006).

• Joint effort with organized medicine to delay planned cuts in the sustainable growth rate (SGR) in each year from 2003-07, worth 26.4 percent.

Without these advocacy efforts, the 2007 conversion factor would have been worth approximately $8.39, or 48 percent of its current value. In 1992 dollars, that is only $5.84 per unit. It is unfathomable to think of where anesthesiology would be without the advocacy efforts of ASA and simply untenable to consider how the quality of patient care would suffer.

In addition to the more global efforts as outlined above, anesthesiologists also have benefited from ASA’s code development and evaluation efforts for the American Medical Association (AMA) Current Procedural Terminology (CPT™) Committee and Relative Value Scale Update Committee (RUC). Between 2001 and 2004, ASA successfully shepherded 56 new and revised anesthesia procedural codes through the process. When combined with the bullet points outlined above, the cumulative financial impact of ASA advocacy efforts from 1992-07 is estimated to be $3.2 billion, or approximately $5,700 per member per year.

Regulation and legislation affect virtually all aspects of the care we render each and every day. Still think it doesn’t matter?

• Effective January 1, 2007, the Centers for Medicare & Medicaid Services mandated reductions or slashed the already undervalued anesthesia conversion factor by 8.9 percent.

• The National Council of State Boards of Nursing recently issued a “vision paper” titled “The Future Regulation of Advanced Practice Nursing” in which it declared that the vision of future regulation of advanced practice registered nurses (APRNs) will be achieved through a number of recommendations, including the following:

– “Fully licensed APRNs will be independent practitioners. After licensure, there will be no regulatory requirements for supervision.”

– Reporting of outcomes measures, the first step of pay for performance (P4P), is linked to Medicare payment effective January 1, 2007.

– The viability and future of our specialty continues to be threatened by the grossly unfair Medicare anesthesiology teaching rule.

The Power of One
Regulation and legislation affect virtually all aspects of the care we render each and every day.

41,000 strong. If each U.S. ASA member were to contribute the income from one case per year toward federal political activity, one case per year to their state component society PAC and contribute one day per year to advocacy (yes, 41,000 days!), imagine how strong our advocacy efforts could be. If you are not someone who is comfortable talking to a state or federal legislator, that’s OK for now. Simply find someone in your area who is comfortable with taking an active role in lobbying and “donate” your day to him or her.

Now is the time to have us come together.

Now is the time for 41,000 strong to speak with one voice.

In 2006, approximately 90 percent of practicing anesthesiologists failed to participate in any type of political activity — supporting candidates, supporting political action committees or working on campaigns. A substantially higher number failed to participate in any advocacy effort. If you wish to be one of those ASA members who runs and hides, I can’t and won’t stop you. But if you care and want to make a difference and enact meaningful, long-lasting change for the profession, for your children and your grandchildren, I urge you to direct your frustrations and energy to both a dysfunctional government and your peers who are perfectly happy to complain about the inequities in regulation and legislation and to ride on the backs of the few who advocate for the many. Stand up, speak out, and get involved in advocacy. And do it now. If you are already involved, now is the time to make demands of your peers that they do the same.

The anesthesiology residency applicant mentioned earlier got it right. The medical specialty of anesthesiology is a noble profession. Now it is time for us to get it right and get involved. With every spectator who becomes a participant, our voice gets louder, and our patients are the winners. Now is the time for all of us to act.

The power of ONE: YOU.

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