January 1, 2013 Volume 77, Number 1
ASA News

ABA Subspecialty Certification Examinations: Pediatric Anesthesiology

The American Board of Anesthesiology (ABA) will administer its first examination for subspecialty certification in pediatric anesthesiology on Saturday, October 19, 2013.

The subspecialty certification examination is a comprehensive four-hour computer-based examination consisting of 200 multiple-choice questions in the single best answer format that are designed to broadly assess knowledge in the field of pediatric anesthesiology. All 200 questions must be answered. The examination will be administered via computer at Pearson VUE testing centers located throughout the United States (U.S.), Canada and the U.S. territories. The ABA will send scheduling information to Diplomates approximately four months prior to the examination.

Applications for 2013 subspecialty certification examinations may be submitted electronically via the ABA Physician Portal through February 15, 2013. Applications received after February 15, 2013 will be considered for the 2014 examinations. The ABA must receive all documentation required to make a decision about an applicant’s qualifications for subspecialty examination by April 1, 2013. An application will NOT be accepted if the required documentation is not received by that date.

Physicians who apply for subspecialty certification in pediatric anesthesiology must:
n Possess an appropriate medical degree or its equivalent; n Hold an unexpired license to practice medicine or osteopathy in at least one state or jurisdiction of the United States or Canada that is permanent, unconditional and unrestricted. Furthermore, all licenses held must be active and unrestricted; n Be a diplomate of the ABA; n Be a participant in the ABA’s Maintenance of Certification in Anesthesiology Program (MOCA®); n Have satisfactorily completed fellowship training in pediatric anesthesiology or possess the required practice experience in pediatric anesthesiology as described below.
Fellowship Training
Satisfactory completion of a one-year fellowship program in pediatric anesthesiology that was ACGME-accredited throughout the time of enrollment, with verification from the program director; OR Grandfathering Criteria (Only for Diplomates who completed anesthesiology residency training before July 1, 2012)

The anesthesiologist’s clinical practice has been devoted primarily to pediatric anesthesiology for the last two years, or at least 30 percent of the anesthesiologist’s clinical practice, averaged over the last five years, has been devoted to pediatric anesthesiology. The anesthesiologist’s practice must include neonates and children under the age of 2 years and procedures considered high-risk.

ABA Diplomates With Non-Time-Limited Certifications (Certified before 2000)
In order to apply for subspecialty certification in pediatric anesthesiology, physicians must be participants in the MOCA® program. As such, diplomates certified in anes-thesiology before the year 2000 must enroll in the MOCA® program via their ABA portal accounts before applying for pediatric anesthesiology subspecialty certification. Participation in MOCA® does not impact a non-time-limited certificate, but rather serves as an extra credential. Please note that previous anesthesiology recertification is not equivalent to participation in the MOCA® program.

ABA Electronic Notifications

The ABA is continuing to transition from paper-based communications to all-electronic communications. As such, application information, examination notices, and other ABA communications such as the Booklet of Information and ABA newsletter will be sent via email. Please keep the ABA informed of any changes to your email address by updating your contact information in your ABA portal account, available at www.theABA.org. Please contact the ABA Communications Center at (866) 999-7501 with any questions.

The Role of Anesthesiologists in the Perioperative Surgical HomeTM Model
I read with great interest the September 2012 ASA NEWSLETTER article “Can Anesthesiologists Survive Under Accountable Care?” by David Young, M.D. and Jeffrey Peters, M.D.1 It is an example of a successful story of the Perioperative Surgical HomeTM concept of care. They demonstrated that by driving improvements in quality, efficiency and surgeon service, anesthesiologists can make themselves indispensable to organizations focused on improving patient outcomes, controlling costs and maximizing O.R. revenue.

The Perioperative Surgical HomeTM concept would more actively integrate anesthesiologists into the patient continuum by increasing their involvement in all parts of the perioperative period, including preoperative assessment, intraoperative stabilization and safeguarding of all body systems and vital organs, and postoperative optimization and pain relief.2 By coordinating the services provided by other health care professionals in the perioperative period, the anesthesiologist also would improve communication and address system issues that frequently contribute to suboptimal outcomes.2

The authors1 proved that the Perioperative Surgical HomeTM model can help anesthesiologists survive under accountable care. The Perioperative Surgical HomeTM helped increase surgery volume and hospital revenue under current fee-for-service payment systems. In fall 2011, the Center for Medicare & Medicaid Innovation (CMMI) introduced a bundled payment demonstration program. A bundled-payment program generally would work as follows: A group of physicians and a hospital get together, propose a lump-sum payment for some episode of care and divide the payment according to an internal formula.3 Anesthesiologists may see substantial and undesired changes in compensation.4

The role of specialists in an ACO can be either as an owner, an ACO CEO, an ACO participant, a member of the ACO governing body, a senior-level medical director, or part of the physician-directed quality assurance and improvement program.5 Therefore, the role of anesthesiologists in the Perioperative Surgical HomeTM concept of care can be the same as the role of specialists in the ACO. Anesthesiologists must actively fulfill these roles and become leaders in many of these bundled payment initiatives and share in the increased payments to minimize reduction in compensation.

Jeffrey Huang, M.D.
Winter Park, Florida

1. Young D, Peters J: Can Anesthesiologists survive under accountable care?” ASA Newsl. 2012, 76(9):40-41
2. American Society of Anesthesiologists (ASA): The Perioperative or Surgical Home: An emerging draft proposal for pilot innovation demonstration projects (May 2011).
3. Johnstone R: A new way to lose a bundle CMS innovation. Anesthesiology News. 2011, 37:10.
4. Cohen, Norman: Medicare accountable care organization and anesthesiology. ASA Newsl. 2012; 76(6):40-41
5. American gastroenterological Association (AGA): Role of specialists in the Medicare Shared Saving Program (MSSP) establishing accountable care organizations (ACOs).

MOCA® Saves a Life
Maintenance of Certification in Anesthesiology (MOCA®) has many critics who have questioned the value of simulation- based practice performance and assessment (Part IV). To those skeptics, I offer a personal account where the skills I learned during a MOCA® course saved a patient’s life. I was called to a “Code Blue” and arrived to find chest compressions in progress for pulseless electrical activity (PEA). The patient had no I.V. access (despite many attempts) and we were unable to administer ACLS medications. Knowing this patient needed immediate vascular access, I obtained an intraosseous (IO) needle and placed an IO line in the tibia. I then administered epinephrine and fluid and quickly achieved a sustainable cardiac rhythm with a return of peripheral pulses.

The most interesting part of my encounter is that I had never before placed an IO line. I participated in the MOCA® course at Penn State Hershey Medical Center in 2010. As part of the curriculum, we learned the fundamentals of IO placement and had hands-on practice in a simulator. It can be very daunting to try a new procedure for the first time on a real patient, but I knew this was a “do or die” situation. The training I received in the simulation center enabled me to take that leap from simulation to “real life’ with confidence.

The 2010 American Heart Association guidelines for cardiopulmonary resuscitation advocates early use of IO access if I.V. access is not obtainable. This is just one example of how our practice can change. Without my simulation training I would not have even considered placing an IO line in this patient. I believe it is critically important that we maintain and utilize educational opportunities such as MOCA® so that we can adapt with future changes that come our way.

Jonathan A. Anson, M.D.
Hershey, Pennsylvania