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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.


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July 1, 2013 Volume 77, Number 7
ASA Task Force on State Advocacy: A New Nationwide Outreach Initiative Joseph F. Cassady, Jr., M.D., Chair Committee on Governmental Affairs State Advocacy Task Force

In this era of rapidly accelerating governmental regulation, effective advocacy of ASA’s core values has ascended to a new level of priority for ASA members. This objective continues to require our carefully coordinated leadership in legislative and regulatory forums across the nation. ASA’s Task Force on State Advocacy is the newest participant in this process. This new task force operates as a strategic component of ASA’s Committee on Governmental Affairs.

Prominently featured on the homepage of ASA’s website is our Society’s most important core value:

“Our members are leaders in patient safety…”
To ASA members, patient safety means compassionate application of physician-driven standards of perioperative care, employing expert medical judgment and state-of-the-art clinical science.

While comprehensive medical care systems integrate the services of many professional disciplines, only physicians are educated and trained to make medical decisions and medical diagnoses. In order to ensure that a comprehensive medical evaluation will be performed correctly, participation of a physician is essential. Accordingly, surgical patients cannot be confident that their prior medical conditions and perioperative medical developments are properly assessed and factored into their anesthetic care unless it is planned and prescribed by an anesthesiologist. This guiding principle must remain at the foundation of ASA’s advocacy agenda. Our patients need and deserve no less.

Through the ASA Committee on Governmental Affairs, ASA Political Action Committee board and ASA staff, our Society exercises robust advocacy for these essential principles in Washington, D.C. Over the last two decades, this Washington-based methodology has become deeply engrained in ASA’s advocacy culture. ASA’s Washington-based advocacy initiatives have resulted in a series of key victories. For example, on a number of occasions, payment cuts scheduled for anesthesiologists under the Sustainable Growth Rate formula have been delayed or “fixed” as a result of ASA’s advocacy activities in the U.S. Congress. In 2007, a General Accounting Office (GAO) study highlighted problems with Medicare payments to anesthesiologists. This GAO study was a product of years of focused advocacy by ASA’s Washington office. Important progress has also been made in resolving restrictions imposed by the Medicare Teaching Rule. In a more recent development, ASA representatives successfully lobbied CMS to forego plans for a federal “opt-out” from its CRNA medical supervision rule.

ASA’s contemporary advocacy agenda has steadily expanded to include regulatory issues in individual states. Increasingly, issues with key implications for patient safety, including scope of practice and access to medical care, are legislated in our 50 state capitols. In order to address issues of this nature, ASA maintains functional relationships with her 50 state component societies.

In the beginning, state component societies were primarily conceived as entry-level organizing structures for membership and participation in ASA. Their purpose has evolved to meet contemporary local and regional advocacy objectives. Important instances of progress have been made in individual states in recent years. As a direct result of advocacy work by ASA component societies, anesthesiologist assistants currently practice in 17 states and the District of Columbia. In a series of individual states, ASA component societies have succeeded in stopping nurses from expanding their scope of practice in prescriptive authority as well as the nursing practice of chronic pain management.

However, in partnership with hospital associations and nursing boards, nurses have successfully expanded their scope of practice in many states where their signature mantra of “access to care” has successfully reverberated. Where it substitutes nurses in medical decision-making roles, we believe this expansion poses a threat to public safety. In recent years, Medicaid payments to anesthesiologists have been subject to repetitive cuts in many state capitols. As a direct result of counterintuitive public policies that discourage medical practice and recruitment of physicians, many states suffer from shortages of anesthesiologists and other physicians. Since 2001, seventeen states have “opted-out” of the federal CRNA medical supervision rule under the CMS executive exemption alternative. Currently, the nursing lobby is pushing hard for “opt-outs” in other states. These developments pose potential crises that must be confronted effectively in executive, legislative and regulatory forums in our state capitols.

Under existing ASA rules, state component societies have been able to call on ASA for financial and intellectual assistance once local advocacy objectives are recognized and reported. Because each state component society has its own culture and capabilities, local recognition of advocacy priorities has sometimes been reactive rather than proactive. Where our advocacy efforts have been reactive, they have sometimes failed.

In order to meet future regulatory challenges, ASA must develop a versatile comprehensive model, capable of preparing and empowering each state component society proactively according to local and regional advocacy requirements. In 2012, in order to address this strategic priority, ASA Immediate Past President Jerry Cohen, M.D. authorized the establishment of ASA’s Task Force on State Advocacy.

In addition to appointment of this new task force, Dr. Cohen’s strategic plan created a position for a state advocacy officer. Last November, this new administrative position was filled when Jason Hansen was appointed as ASA’s first Director of State Affairs. Mr. Hansen works in close coordination with the chairs of the Committee on Governmental Affairs and the Task Force on State Advocacy. He has already taken important steps to facilitate communications and tactical coordination between ASA’s Advocacy Division and the state component societies.

Due to the complex, resource-intensive nature of the task force’s strategic mission, its rollout will require staging. To date, strategic planning discussions have identified opportunities to improve ASA’s network of contacts in media outlets across the nation. Randomized polling performed in a handful of states has demonstrated that U.S. voters overwhelmingly want their medical care to be prescribed and administered by licensed physicians, rather than by nurses. Other initial task force goals will include prospective facilitation of state component society infrastructure and tactical support of state-specific objectives. While these initial objectives are developed and implemented, the full agenda of the Task Force on State Advocacy will continue to evolve.

Through our state component societies, regional caucuses and pertinent ASA committees, all ASA members must rededicate to advocacy of ASA’s core values in all accessible venues. This means regular attendance of annual state component society meetings as well as annual contributory participation in federal and state poltical action. Through mentorship, organizational networking and other forms of collegial example, these avenues of participation must become standard operating procedure for all ASA members if we are serious about supporting and saving our specialty for the future.

Our roles as advocates for patient safety require that we effectively assist our governors, legislators and regulators in making safe, responsible public policy decisions. As we fortify our advocacy capabilities in our state capitols, we must address our core objectives from strategic and tactical points of view. More ASA members must reach out to form substantive relationships with our elected officials, and ASA must develop new ways to encourage these relationships. Every ASA member must pay thoughtful attention to ASA and component society grassroots action alerts. When key ASA advocacy initiatives are under way in Congress and in state legislatures, more ASA members must respond by contacting our elected representatives with coherent advocacy messaging. Here again, ASA’s tactical support for advocacy messaging must continue to evolve as we learn from our experiences. As we move forward together, the Task Force on State Advocacy will work closely with Jason Hansen, with other ASA committees and with our component societies to facilitate advocacy of ASA’s core values in our state capitols.

Joseph F. Cassady, Jr., M.D. is an attending anesthesiologist, Blank Children’s Hospital and Iowa Methodist Medical Center, Des Moines. He is ASA Director from Iowa and a member of the ASA Board of Directors.

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