he ASA Board of Directors uses a Review Committee structure much like the Reference Committee structure of the ASA House of Delegates. Members of the ASA Board are elected to one of four standing committees of the Board — Administrative, Finance, Professional Affairs or Scientific Affairs. At the March and August meetings of the ASA Board, all reports, resolutions and recommendations submitted for consideration, discussion, review and recommendation for action by the Board of Directors are assigned to a committee. The committees each hold open hearings on Saturday morning at the Board meetings where ASA officers, directors, alternate directors, committee chairs or members, component leaders and any interested ASA members are encouraged to attend and provide testimony and comment to the committee.

Subsequent to the Review Committee hearings, each committee prepares a report for submission to the ASA Board at the Sunday morning meeting to follow. These reports in a consent calendar format are discussed and acted upon by the Board. All actions taken are then reported to the ASA House of Delegates meetings at the next ASA Annual Meeting for review and ratification, amendment or rejection.

The ASA Committee on Professional Affairs (formerly Legislative Affairs) is charged to receive, investigate and review, so far as possible, all matters of substance pertaining to all pending federal and state legislative and administrative actions affecting the specialty of anesthesiology and its practice intended to be brought before the Board of Directors. Additionally the Review Committee is charged to review and re-evaluate on a continuing basis all legislative and regulatory affairs referred from the Committee on Governmental Affairs or otherwise referred to the Board of Directors and to report to the Board at its annual or other meetings all pertinent conclusions and recommendations for action.

At the March 2007 Board meeting, the Committee on Professional Affairs spent considerable time and effort on a report from the Committee on Performance and Outcomes Measurement (CPOM). CPOM has the responsibility for overseeing the initiatives of ASA that pertain to the measurement of clinical performance and outcomes. Currently any decision on the implementation of an ASA performance measure and clinical outcomes database is being directly affected by a number of new forces. Some of these forces include increasing governmental pressure to pursue value-based health care purchasing (e.g., Deficit Reduction Act, Tax Relief Act), potential financial incentives (pay for performance) and the developing interest among subspecialty societies and large anesthesia group collaborations.

ASA is ably represented on the American Medical Association’s Physician Consortium for Performance Improvement by Ronald A. Gabel, M.D., CPOM past chair. The Consortium is using an evidenced-based approach to develop performance measures aimed at performance improvement and accountability in health care. In 2005 the Consortium formed the first Perioperative Care Workgroup (PCWG1), co-chaired by Dr. Gabel and Scott Jones, M.D. (American College of Surgeons). When developing physician-level performance measures, the specialty society has served as lead organization in authorship and/or contribution of the evidence-based guidelines from which these performance measures are derived. The second workgroup (PCWG2) has released proposed measures that impact the specialty of anesthesiology. The final measures developed by the Consortium are submitted to the AMA Performance Measures Advisory Group for CPT^® coding as well as the National Quality Forum for endorsement and the Ambulatory Quality Alliance for implementation. The Centers for Medicare & Medicaid Services Physician Quality Reporting Initiative for 2007 includes measures produced by the workgroup.

In existence since March 2000, the Consortium took on greater significance when AMA signed the Joint U.S. House-Senate Working Agreement that promised the development of 140 performance measures covering 34 clinical areas. Physician specialties were to enact voluntary reporting of three to five measures each. Legislation completed in 2006 failed, however, to keep this structure or timetable, and the tying of future Medicare payment to performance measures is currently unsettled. It is, however, clear that future reimbursements overseen by CMS will utilize (be tied to) some elements of measurement of clinical performance and outcomes.

Testimony to the March 2007 ASA Board Review Committee affirmed the desirability for ASA to act as a clearinghouse for performance data but recognized the necessity of our representation being able to respond in a timely fashion when participating in the Consortium workgroups. The 2006 ASA House of Delegates approved the recommendation that all ASA-endorsed performance measures be evaluated by CPOM prior to their release as an ASA work product. These work products will be presented to the ASA House of Delegates at the Annual Meeting. Further discussion by the ASA Board of Directors resulted in an approved compromise to allow ASA representatives to these workgroups to react quickly when necessary to negotiate with such “pay for performance” programs, relieving our representatives of the constraint that the development and promotion of quality measures would be limited by the annual House of Delegates meeting calendar.

Rodney C. Osborn, M.D., is a Clinical Assistant Professor of Surgery (Anesthesiology), University of Illinois College of Medicine at Peoria, Illinois. He is President of the Illinois State Medical Society.