any ASA members detest anything having to do with political and legislative advocacy, feeling that it is beneath them and illogical to need to advocate for common sense and scientific truths. The legislative and regulatory processes, however, have never been known to use common sense or logic when expediency, fuzzy math and reelections intervene. Governmental advocacy by ASA members has never been more important because medicine and anesthesiology are under attack. Politicians, governmental agencies and big business are all making decisions that impact physicians. Mid-level providers are trying to expand into medical practice, and third-party payers are making arbitrary cost-saving policies. Eventually all of us must become active in governmental affairs to survive. Will you be proactive or reactive? Will you wait until it is too late for your specialty and your livelihood? Or will you become involved and contribute time and money now?

There are members who devote enormous amounts of time, energy and finances to ensure your ability to continue practicing your chosen specialty. Every member who is involved in ASA leadership, ASA governance and on ASA committees is devoted to furthering your specialty. The members of the Committee on Governmental Affairs are tasked “to obtain, evaluate and review as far as possible all matters of substance pertaining to proposed Federal and State laws, regulations and administrative actions that may affect the specialty and practice of anesthesiology.” The committee reviews information from news articles, Web sites and member concerns. ASA staff and Committee on Governmental Affairs members utilize the committee’s listserve to disseminate information and discuss issues important to anesthesiology.

This committee believes we must aggressively address: the unfair “Medicare Anesthesiology Teaching Rule”; discrimination by the “anesthesia rural pass-through” law; disinformation and misinformation of “opt-out” requirements; regulatory and judicial mid-level provider creep using state nursing boards and regulations to replace education as a means to become a medical doctor; and adverse decisions by third-party payers using arbitrary medical necessity determinations.

ASA tried correcting many federal regulatory wrongs by working within the Centers for Medicare & Medicaid Services (CMS) bureaucratic system with varying results. Therefore, two years ago, the ASA Washington Office adopted a proactive legislative agenda to help address these issues. The addition of focused legislative advocacy to address regulatory policy allows the identification and education of supporters and opponents rather than working in the faceless bureaucracy. It allows each of you to have a direct impact on your legislator(s). This paradigm shift makes it essential that anesthesiologists make this a grassroots effort. We are only as strong as our weakest links, and we have many within our specialty who are not engaged and do not participate. It only takes one legislator on one committee to sink the whole process. Legislative activism is a marathon, not a sprint. In the past year, we have been close to legislatively requiring anesthesiology academic physicians to be paid using the same methodology as other academic physicians and rural anesthesiologists to be treated by Medicare the same as lesser qualified individuals. We will continue to press legislators to pass common sense bills that address inequities and improve patient safety and access. ASA has four bills this year. Go online to the “What’s New” section of the Office of Governmental Affairs to read them. Contact your legislators and encourage them to cosponsor and support each bill.

Anesthesiology has many friends and supporters within the new Congress. Thanks to the many anesthesiologists who express their views and visit their elected representative as well as those who contribute individually and through the ASA Political Action Committee (ASAPAC). Your ASAPAC continues to work with members on both sides of the aisle to advance anesthesiology’s issues.

State opt-outs have stagnated over the past year. Perhaps opt-outs have not increased access to care or improved patient safety. Many state leaders have come to realize that this issue is politically charged and not in the best interests of their citizens. To remove the requirement of physician supervision of patient care seems counter to a state’s mission and CMS’ stated goal of patient safety and quality care. With a surgeon present, a physician’s medical responsibility for a patient should never be relinquished to any mid-level provider who provides nursing and supportive care.

Recognizing the importance of state issues, the Committee on Governmental Affairs expanded to include a legislative representative from each component society. Utilizing this legislative listserve, state representatives have been able to disseminate events and issues nationally to other members and to the Washington Office staff for collection, comment and response. The Washington Office serves as an information repository on state legislation, judicial proceedings and regulatory language on matters relating to the provision of anesthesia and the medical practice of anesthesiology.

Opposing judicial challenges to the medical practice of anesthesiology may become a focus for the Committee on Governmental Affairs and ASA as the court system seems to be an avenue of choice for mid-level providers trying to obtain the right to practice medicine. ASA has entered the judicial arena, providing friend-of-the-court briefs where appropriate, and is available to help financially.

As third-party payers consolidate, the likelihood of using medical necessity policies to save money will become more prevalent. Recent decisions have been met with aggressive ASA responses. ASA will continue to recognize and aggressively report arbitrary payer decisions that are contrary to patient safety and sound medical practices.

This summer the Committee on Governmental Affairs is going to examine its role within ASA. We will determine how this committee can become more efficient, more responsive and better represent your concerns and issues nationally and in each state.

Two ongoing committee advocacy activities are the Lansdale Public Policy Fellowship and the ASA Legislative Conference. The Lansdale Fellowship allows an interested anesthesiologist to spend a year as a legislative aide or intern on Capitol Hill to participate in the legislative process. This novel idea allows an anesthesiologist to have input into and gain insight from the activities of the legislative branch. It is felt that Lansdale Fellows will be a valuable resource for our Society. The annual ASA Legislative Conference allows attendees to hear presentations from national policymakers, updates on ASA governmental advocacy efforts and visit with their legislators’ offices. This is a critical time to educate congressional staff on the issues important to medicine and anesthesiology. Your attendance is appreciated and welcomed.

ASA and the Committee on Governmental Affairs encourage each of you to become actively involved, personally and financially, to advocate for your chosen profession. Contact any ASA officer, committee member, Washington Office staff or your state component society officers for information or guidance on how you can be most effective. If you are not able or willing to be an active participant, support colleagues who do make the commitment to be involved and support ASA’s membership-wide requests for action and support.

Michael C. Gosney, D.V.M., M.D., J.D., M.B.A., is Medical Director, Shoals Pain Center, and President, Anesthesia Medical Consultants, P.C., Muscle Shoals, Alabama. He is Alternate Director for Alabama.