ASA Board of Directors Annual Meeting 2009

The Board of Directors of the American Society of Anesthesiologists held its annual meeting in Chicago the weekend of August 22-23, 2009. Norm Cohen from Portland and Chuck Anderson from Bend represented Oregon as your Director and Alternate Director respectively.

While much of the hallway talk at the meeting centered around healthcare reform proposals circulating in Congress, including the perils that a Medicare-based public option holds for the specialty, the Board addressed a number of items of business that are important to ASA members. The ASA Speaker divides the business of the Board into four categories, each heard by a separate Board Committee. Board members and others may testify on any item of business during the Board Committee hearings held on the first day of the meeting. These committees then recommend to accept, accept with modifications or reject each action item. The Board Committee chairs present these recommendations to the full board on the second day of the meeting. The Board can accept, accept with modifications or reject each Board Committee recommendation. Usually, only a few items lead to significant debate during this session. Final approval for all items rests with the ASA House of Delegates, which meets each October.

The items of note in Administrative Affairs, which had, by far, the longest hearings, include a recommendation to begin charging a registration fee for the ASA Annual Meeting beginning in 2010, mergers of several committees, creation of two new committees, change in time period in which residents transition to active member status, and funding an educational opportunity for residents at the ASA Washington Office.

The ASA Annual Meeting has historically had no registration fee for ASA members. Both free and paid educational opportunities are plentiful at the meeting. In recent years, the costs of the Annual Meeting have exceeded the revenue generated. After benchmarking against other similar medically specialty organizations, we learned that all comparable organizations charge a registration fee. The Board approved an ASA leadership proposal to institute a registration fee in 2010. This will allow the meeting to become profitable, institute new, innovative educational opportunities and help reduce ASA dependence on dues revenue for financing. The Annual Meeting Oversight Committee will present additional information to the House of Delegates this October to aid in determining the appropriate level for this registration fee.

The ASA has a large number of committees. A systematic review identified four committees whose activities significantly overlap other committees. These committees will be merged. In addition, the Board approved Bylaws changes to create two new committees: Committee on Cardiac and Thoracic Anesthesia and Committee on Neuroanesthesia. In March, the Board approved creation of these committees.

Residents have typically been given two years after graduation to move to Active member status. Based on a recommendation from the Committee on Membership, the Board approved moving to a one year grace period.

The Board approved a resolution from Texas to fund and create an educational opportunity for residents to learn about advocacy first hand at the ASA Washington Office. This will be an exciting chance for residents to learn directly about the political process and the regulatory and legislative frameworks that control our practice in so many ways.

Scientific Affairs only had one issue of interest. The Committee on Transplant Anesthesia produced new guidelines for directorships of liver transplant programs. These guidelines include that liver transplant programs name a director, that the director be board certified, that the director have specific fellowship training or experience as qualifications, and that ongoing CME be completed.

The Board review committee for Professional Affairs also had a relatively light agenda. Items of note included some recommendations on new performance measures, retirement of one and revision of another Committee on Economics statements, and retirement of and revision of several Committee on Practice Management Publications.

The Committee on Performance Outcomes and Measures recommended submission of a new measure that addresses redosing intervals for short acting antibiotics during surgery and two new measures on post-operative nausea and vomiting and post-operative hypothermia continue through the process with the goal being inclusion in the Medicare Physician Quality Reporting Program.

The Committee on Economics recommends retirement of the Statement on Fluoroscopic Guidance for Spinal Injection Procedures due to changes in the coding system expected to make the discussion moot. Also, the Committee proposed several additions to the Statement on TEE, that will include several congenital TEE codes not previously listed in the statement, but believed to be relevant to the discussion of bundling issues in this document.

The Committee on Practice Management has determined that several publications are no longer relevant and several others need significant revision. The Board approved the recommendations to proceed with revisions to these publications.

The Committee on Finance reviewed the 2010 budget and discussed a recommendation from the Task Force on Governance to realign fiscal responsibilities within ASA.

ASA, like many organizations, had significant losses in investment expenses in late 2008 and early 2009. Fortunately, the recent rally in the markets has helped ASA recover significantly. One of the lessons learned from recent events is the need to assure that operating expenses match operating revenue, lessening dependence on investment income to fund continuing operations. Improved accounting mechanisms will allow ASA to dramatically improve operations through enhanced reporting. Early initiatives are already yielding dividends. As previously mentioned, ASA is working to increase non-dues revenue and reduce expenses. The 2010 budget includes the registration fee for the annual meeting, reduced committee meeting expenses, and efforts to replenish our reserves.

The Task Force on Governance, convened after House of Delegates action last year, focused on recommendations to improve transparency of process and improve ASA’s nimbleness in responding to unexpected challenges or opportunities. A fairly contentious recommendation was to remove all fiscal responsibility from the Board of Directors, transferring day-to-day fiscal responsibility to the Administrative Council (AC). The AC consists of all the elected officers of the ASA. Recognizing that the Board can not be convened on short notice but also noting that Board oversight is a necessary check and balance for the Society, the Board approved a recommendation that certain urgent financial decisions exceeding a defined amount will require approval by the AC and the members of the Board Committee on Finance. This will provide Board input prospectively for these time critical matters.

The educational session at the Board covered several topics. First, ASA member and Chair of the AMA Board of Trustees Rebecca Patchin provided insights into the reasons behind AMA’s endorsement of the tri-committee House of Representatives bill on Healthcare Reform. Many Board members were upset that the AMA supported a bill that, at the time of endorsement, included a public option based on Medicare. Dr. Patchin described the efforts that took place behind the scenes to remove that provision as well as several other aspects of the AMA’s lobbying efforts.

ASA Secretary Greg Unruh presented the results of a recent ASA member survey. The results suggest that the state components can do a better job of providing value to our members. Your OSA leadership will discuss these findings and seek input from our members on ways we can improve.

Finally, ASA Executive Vice President Ron Szabat and ASA Washington Office state affairs director Lisa Albany provided important updates on healthcare reform at the national level as well as recent state-level activities of importance to the specialty.

The ASA continues to evolve and is beginning to see the improvements that the Organizational Improvement Initiative sought to provide. This is fortuitous as the threats to our specialty continue to grow. Each and every one of us needs to help spread our thoughts on healthcare reform and other challenges. The ASA has created a Grassroots Network to help us help ourselves. Please visit this link today and sign up. You will then receive email action alerts and guidance on ways to respond. This is easy, quick and of great help to the specialty. And if you have not joined the ASAPAC, now is the time to do so. We have had terrific access to our members of Congress in recent years due to ASAPAC’s help in local campaigns. You can sign-up for ASAPAC online here (this requires login to the Member’s Only area of the ASA website) or contact me through the OSA website for assistance.