ew Year’s resolutions… It is that time again! Just in case you did not have a chance to pick your resolutions yet, take a look at the United States government Web site (usa.gov), which has a list of the most popular resolutions. Of course, the list includes losing weight, as well as eating right, and reducing stress. However, for anesthesiologists, I would like to add one New Year’s resolution — and this is one that you need to keep. That resolution is to get involved on behalf of our specialty. Whether making a political contribution to a local candidate, volunteering for his or her campaign or simply serving as a local contact for a lawmaker, there is no time better to jump into our nation’s political and legislative processes as they play out in your neighborhood.

Local political and grassroots participation is an absolute necessity these days, as our legislators and regulators are increasingly involved in decision-making that affects anesthesia payments and patient care. Examples include the sustainable growth rate (SGR) formula and the Medicare anesthesiology teaching rule. Local activism — one-on-one contacts with lawmakers — ensures that our specialty is heard in the political and policy-making process. Indeed, personal interaction provides an opportunity to educate lawmakers about the issues relating to anesthesia, and it could be the beginning of a long-term relationship with your legislators. Having relationships with key legislators could tip the balance toward anesthesia in these times of budget cuts and deficits. It all starts in your neighborhood.

A more material benefit that affects all anesthesiologists was made possible through the hard work of ASA and its local activists. Last November, the 2008 fee schedule was announced. To provide a little background, your payment is based on the relative value units (RVU) as well as an anesthesia conversion factor. The anesthesia conversion factor is composed of three factors: physician work, practice expense and practice liability insurance. Work is the actual effort expended by the physician to perform a medical service. Practice expense is the cost of overhead to run a practice as well as the cost of supplies, equipment and employed clinical labor. Professional liability insurance is the estimated cost of professional liability. Payers convert the RVU into a payment amount by multiplying the RVU by the conversion factor that defines the monetary unit of the RVU. Then, a budget neutrality adjustor is added. All of these components are placed into an equation, and from it, payment is calculated. This year, the Centers for Medicare & Medicaid Services (CMS) recognized that the anesthesia work value was undervalued, and we received a 32-percent increase in the physician work portion of the anesthesia conversion factor. When the proposal was issued for this increase, anesthesiologists from all over the country bombarded CMS with letters and e-mails in support of the change. So for 2008, the unadjusted anesthesia conversion factor is now approaching $20. The local voice of our specialty helped to make this happen.

Issues such as the SGR, CMS teaching rule and Medicare reimbursement will affect the future of our specialty, not only in terms of payment but also how our specialty is allowed to grow. This, in turn, will allow us to have enough trained physicians to care for our aging population. As you can see, by participating you are demonstrating leadership in our specialty and helping to influence the course of our future. You are ensuring that our legislators at both the national and state level continue to hear our voice. Through your actions, you are allowing ASA to continue to advocate for our patients.

Last year, the youngest members of our Society realized the importance of local political and grassroots activism. Residents nationally responded to a challenge to increase our ASA Political Action Committee (ASAPAC) participation. In one year, the resident participation tripled and currently surpasses the general membership participation rate. Several states achieved a 100-percent resident participation rate in ASAPAC. Additionally, residents became active at the grassroots level by meeting with lawmakers and sending letters and e-mails at record levels. Even more is expected from our residents in the new year.

Every anesthesiologist benefits from the collective work of individual members becoming active at the local political and grassroots level. It is time for more of us to get involved in these efforts. Be active, and stay involved. Your future depends on it!

Learn more by contacting James L. Becker, M.D., ASAPAC Chair, or Jane C.K. Fitch, M.D., Chair of ASA’s Committee on Governmental Affairs, the home of ASA’s grassroots “Key Contact” program.

Paloma Toledo, M.D., is an obstetric anesthesiology fellow, McGaw Medical Center, Northwestern University, Chicago, Illinois.