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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, 2014 Volume 78 Number 7
Advocacy: Working Toward Perfection in a Time of Change David M. Broussard, M.D., M.B.A.
Committee on Governmental Affairs

“To improve is to change; to be perfect is to change often.”
– Winston Churchill 

When I first heard this quote the other day, I was embarrassed that I had not noticed it before. How could such a powerful phrase have eluded my awareness for so long? I was struck by the meaning behind Churchill’s words. As much as we, as physicians, resist change, Churchill’s statement acknowledges that to improve, first we must undergo change. Extrapolating this concept to the extreme, the excerpt finishes by establishing that improving to the point of perfection requires frequent change. A tremendous focus on change within the medical profession brings this quote into relevance for physician anesthesiologists everywhere.

How can we best navigate change in our pursuit of improvements for our profession and our patients? In his widely read business book, The Happiness Advantage, Shawn Achor discusses a principle he calls the Tetris effect. This concept is based on research findings that people who spent long hours playing the famous videogame Tetris began to see the “building blocks” of the game everywhere they looked in the real world. From this finding, psychology researchers determined that individuals who focused on and wrote about three positive things that happened in the past day became better at spotting opportunities in their lives. This principle doesn’t prescribe “positive thinking” as the solution itself, but rather establishes that focusing on positive events teaches our brains to better see chances for improvement in our world going forward.

What are the exciting opportunities for advocacy when looking ahead in this time of profound change? For the purposes of this article, I’ll focus on three:

1. Electronic Medical Record (EMR) Investments in Anesthesiology: The Patient Protection and Affordable Care Act (PPACA) created incentives that provide significant payments for meaningful use of EMRs by physicians of all specialties. I was pleasantly surprised to find that, despite the option for exemption, successful attestation to meaningful use was accomplished by nearly 3,000 physician anesthesiologists in 2013. We must work together to quickly get this number higher as payments are being used to fund large-scale investments in anesthesia information management systems (AIMS) throughout the country. More physician anesthesiologists successfully attesting to meaningful use will mean that massive amounts of patient-level clinical outcome data can be uploaded into the databases of the Anesthesia Quality Institute (AQI) over the next several years. This data can be used to quickly generate outcome studies that will be powerful tools for advocacy in the hands of physician anesthesiologists around the United States. Even better, we will have access to continuously up-to-date data to make these compelling arguments, as opposed to the one-offs of locally abstracted, labor-intensive data-gathering efforts of previous years.

2. Advancing the Perioperative Surgical Home: The most current draft of sustainable growth rate reform legislation heavily emphasizes the development of alternative payment models (APMs). We know that physician anesthesiologists are better equipped than any other provider to safely navigate the sickest of the sick through the often turbulent waters of the perioperative period. This model of care is designed around principles that have been understood, in some cases for decades, but never fully assembled or operationalized because of lack of funding. We can and will successfully advocate for full funding of this model because we know it is in the best interest of our patients. The advocacy will occur on two fronts. The first is at the organizational level where physician anesthesiologists are educating other physician anesthesiologists and hospital administrators, hosting visiting professors on this topic and piloting surgical home programs in order to help refine and focus the details of importance to successful surgical home outcomes. The second is via the legislative and regulatory arena. Surgical home topics are being covered annually at the ASA legislative conference, resulting in an army of well-equipped advocates for the future of the profession. With the continuing maturation of the AQI allowing proof of concept on a broad base, I see no reason why the surgical home could not become the “poster child” for APMs in the very near future.

3. Parity for Rural Anesthesiologists: Existing Medicare policy allows qualifying rural hospitals to use “reasonable-cost” based funds from Part A (as opposed to conventional provider payments under Part B) to induce non-physician anesthesia providers to provide services. Currently, these so called “pass-through” funds cannot be used to employ or contract with physician anesthesiologists. This flawed policy sets in place a double standard, unfairly denying rural Medicare patients access to the highest-quality physician-led anesthesia care. PPACA, for the first time, establishes “non-discrimination” provisions that prohibit health plans from “discriminating” against non-physician providers. For the federal government to simultaneously allow discrimination against physicians from participating in the rural pass-through program creates an inconsistent policy that unfairly jeopardizes the health of rural Medicare beneficiaries. We can and must demand equal treatment of physician anesthesiologists to allow them to provide this important standard of care. Our rural patients deserve no less.

While facing these changes in the health care environment, we will seek out and find – through advocacy – the chance to advance the practice and secure the future on behalf of our patients. The frequent and large-scale changes created by PPACA will finally allow us to see the “Tetris blocks” of opportunity we need to revolutionize and revitalize the specialty for the foreseeable future. Think about a world with improved patient experience and coordination of care, an abundance of meaningful outcome studies that demonstrate the value of physician-led care and payment parity for rural physician anesthesiologists. To improve is to change; to be perfect is to change often. With change and advocacy on our side, the future looks bright indeed for anesthesiology!

David M. Broussard, M.D., M.B.A. is System Vice Chair and Program Director, Adult Cardiothoracic Anesthesiology, Ochsner Health System, New Orleans.

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