msa anesthesia record -...

Anesthesia Record www.massanesthesiology.org

Summer 2013

NURSE ANESTHETISTS SEEK

INDEPENDENT PRACTICE

HOSPITAL IN REVIEW REPORT OF COUNSEL

By Kay Leissner, M.D.

TheVABostonHealthcareSystem,thelargestconsolidatedfacilityinVISN

1-VANewEnglandHealthcareSystem,encompassesthe3maincampusesand4outpatientclinicswithina40-mileradiusofthegreaterBostonarea.Theconsoli-datedfacilityconsistsoftheJamaicaPlainCampus,locatedintheheartofBoston’sLongwoodMedicalCommunity;theWestRoxburyCampus,locatedontheDedhamline;andtheBrocktonCampus,located20 miles south of Boston in the CityofBrockton.Inadditiontothe3mainmedical centers, 5 Community BasedOutpatientClinics (CBOCs) located inFramingham,Lowell,Quincy,CausewayStreet(Boston),andPlymouthmakeupVABHS.

ANESTHESIOLOGYToday,ourstaffiscomprisedof14facultyattending anesthesiologists, 9 nurseanesthetists, 3 anesthesia technicians,2 administrators, 3 rotating anesthesiaresidents, 2 rotating fellows and 6anesthesiainterns.Despiteadiversityofbackgroundsandtraining,theanesthesiateam remains a harmonious groupwith similar interests in improvingpatients'well-being,providing thebesteducationalexperienceforourtrainees,and investigating innovative ideas tofurtherenhancetheservicesofferedto

TABLE OF CONTENTS

(continued on page 9)


www.MassAnesthesiology.org Massachusetts society of anesthesiologists, inc. Vol. 41 No.1 - 2013

MSA Anesthesia Record

Edward J. Brennan, Jr., Esq.

Undertheguiseofallowingadvancedpractice nurses, including nurse

anesthetists, to practice to the “fullestextentoftheireducationandtraining,”nursingadvocatesarepushingforinde-pendentpractice. As reported earlier this year, TheMassachusetts Association of NurseAnesthetistshasjoinedwiththeMassa-chusettsCoalitionofNursePractitionerstofileH.2009andS.1079.Thebills,ifpassed, would eliminate the statutoryJamaica Plain Campus, located in the heart of Boston's Longwood Medical Community

Hospital in Review 1 Report of Counsel 1 MSA Committees 3Editor's Report 4President's Report 5Personality Profile 6Annual Reports 7-23ASA Update 22Lifebox Challenge 24ASA News/AQI 26New CME Requirements 29New MOCA Program 30 Membership Changes 31Advertisements 32Upcoming Events 34


Summer 2013


Summer 2013

Officers, Directors, Delegates and Committees MichaelR.Englnd,MD,PresidentSpiroG.Spanakis,DO,PresidentElectSheilaR.Barnett,MD,VicePresidentCristinA.McMurray,Secretary(2015)DanielJ.P.O'Brien,MD,Treasurer(2014)SelinaA.Long,MD,ImmediatePastPresidentBeverlyK.Philip,MD,ASADirector(2015)DavidL.Hepner,MD,ASAAlt.Director(2015)RichardD.Urman,MD,MBA,NewsletterEditorEdwardJ.Brennan,Jr.MSALegalCounselBethE.Arnold,ExecutiveSecretaryDelegates: ASA House of DelegatesCristinA.McMurray,MD(2014)DanielJ.P.O'Brien,MD(2014)LeeS.Perrin,MD(2014)DavidL.Hepner,MD(2015)SelinaA.Long,MD(2015)SpiroG.Spanakis,D.O.(2015)RubenJ.Azocar,MD(2016)SheilaR.Barnett,MD(2016)MichaelR.England,MD(2016)FredE.Shapiro,DO(2016)Alternate Delegates:GalinaDavidyuk,MD DonaldG.Ganim,II,MDShubjeetKaur,MD NicholasM.Kiefer,MDNeilA.McDonald,MD MaitriyiJ.Shah,MDNikhilThakkar,MD RichardD.Urman,MD,MBAJoshuaC.Vacanti,MD MaryAnnVann,MD M.S.A. District Representatives and Alternate RepresentativesDistrictI NikhailThakkar,MD NaveedA.Tahir,MDDistrictII BronwynCooper,MD ShubjeetK.Kaur,MDDistrictIII NicholasKiefer,MD CharlesC.Ho,MDDistrictIV FernandoAlmenas,MD DipakKumar,MDDistrictV RubenJ.Azocar,MD JeanetteLee,MDDistrictVI NeilA.McDonald,MD KonstantinBalonov,MD

Standing Committees of the Executive Committee:Drs.MichaelEngland-Chair,FernandoAlmenas,RubenAzocar,KonstantinBalonov,SheilaBarnett,JeffryBrand,BeverlyChang,BronwynCooper,GalinaDavidyuk,FredDavis,DonaldGanim,JamesGessner,NormanGould,AlexHannenberg,DavidHepner,MarkHershey,CharlesHo,ShubjeetKaur,NicholasKiefer,DipakKumar,JeanetteLee,SelinaLongNeilMcDonald,CristinMcMurray,DanielO’Brien,BrianO'Gara,LeePerrin,BeverlyPhilip,MaitriyiShah,FredShapiro,SpiroSpanakis,NikhilThakkar,NaveedTahir,RichardUrman,JoshuaVacanti,MaryAnnVannCommittee on Ethical Practice and Standards of Care:D.I CraigE.Collins,DO(2015) MichaelBailin,MD(2014)D.2 StephenP.Kapaon,MD(2015) PaulE.Darcy,MD(2014)D.3 AlbertKalustian,MD(2015) JeffryBrand,MD(2014)ChairD.4 MelvinCohen,MD(2015) RobertHough,MD(2014)D.5 PeterM.Ting,MD(2015) JeffreyJackel,MD(2014)D.6 VladamirKazakin,MD(2015) RichardShockley,MD(2014)Adjunct:Drs.B.Cooper,G.Crosby,L.Dohlman,J.Gessner,R.Holzman,C.Joshi,H.Kummer,A.Lisbon,M.Ricciardone,D.Salter,D.ShookCommittee on Economics:,JeffryBrand,MD(2014),StephenKapaon,MD(2014),RichardBello,MD(2015),AnanthKashikar,MD(2015),AlexanderHannenberg,MD(2016)-Chair,StephenPunsak,MD(2016),RossMusumeci,MD(2017),ShubjeetKaur,MD(2017)Adjunct:Drs.H.Auerbach,J.Gould,K.Gress,N,Kiefer,M.Shulman,R.UrmanCommittee on Bylaws and Rules:LeePerrin,MD-Chair,CoreyCollins,DO,MaryKraft,MD,RubenAzocar,MD,RomanSchumann,MDCommittee on Nominations: FredShapiro,DO-Chair(2014),RubenAzocar,MD(2015),SelinaLong,MD(2015)

M.S.A. Past Presidents1948-1949 UrbanH.Eversole,M.D.*1949-1950 JacobH.Fine,M.D.*1950-1951 MorrisJ.Nicholson,M.D.1951-1952 WilliamJ.Martin,M.D.*1952-1953 LeoV.Hand,M.D.*1953-1954 JuliaG.Arrowood,M.D.*1954-1955 DexterR.Branch,M.D.*1955-1956 RobertM.Smith,M.D.*1956-1957 JohnBunker,M.D.1957-1958 BenjaminEtsten,M.D.*1958-1959 JamesH.Buskirk,M.D.1959-1960 PhillipS.Marcus,M.D.*1960-1961 FrancisJ.Audin,M.D.*1961-1962 CarrollBryant,M.D.1962-1963 PeterG.Lehndorff,M.D.*1963-1964 LeroyD.Vandam,M.D.*1964-1965 JosephG.Murphy,M.D.1965-1966 RobertN.Reynolds,M.D.1966-1967 HenrickH.Bendixen,M.D.1967-1968 DonaldL.Mahler,M.D.*1968-1969 RobertD.Ouellette,M.D.1969-1970 DonaldP.Todd,M.D.*1970-1971 JessB.Weiss,M.D.*1971-1972 FrederickMcAlpine,M.D.1972-1973 C.ThomasO’Connell,M.D.1973-1974 JohnHedley-Whyte,M.D.1974-1975 RussellJ.Rowell,M.D.1975-1976 FrancoR.Dinale,M.D.*1976-1977 JosephL.Murphy,M.D.*1977-1978 RichardA.Kemp,M.D.1978-1979 GeorgeE.Battit,M.D.1979-1980 HerbertL.Everett,M.D.

1980-1981 LawrenceA.Simons,M.D.1981-1982 RaymondJ.Anton,M.D.1982-1983 BebeK.Wunderlich,M.D.1983-1984 KennethW.Travis,M.D.1984-1985 JohnV.Donlon,M.D.1985-1986 DorothyM.Crawford,M.D.1986-1987 JosephR.Beauregard,M.D.1987-1988 D.SeanRestall,M.D.*1988-1989 MarcelleWillock,M.D.1989-1990 LeonardS.Bushnell,M.D.*1990-1991 FredG.Davis,M.D.1991-1992 StephenV.Hall,M.D.1992-1993 GeraldL.Zeitlin,M.D.1993-1994 LeeS.Perrin,M.D.1994-1995 JamesS.Gessner,M.D.1995-1996 AlexanderHannenberg,M.D.1996-1997 RobertH.Bode,Jr.,M.D.1997-1998 JeffryB.Brand,M.D.1998-1999 BernardH.Hand,M.D.*1999-2000 DanielF.Dedrick,M.D.2000-2001 AlanM.Harvey,M.D.2001-2002 MichaelH.Entrup,M.D.2002-2003 PrasadR.Kilaru,M.D.2003-2004 RosemarieMaddi,M.D.2004-2005 StephenO.Heard,M.D.2005-2006 GlynneD.Stanley,M.B.2006-2007 MarkD.Hershey,M.D.2007-2008 DonaldG.Ganim,II,MD2008-2009 BeverlyK.Philip,MD2009-2010 DavidL.Hepner,MD2010-2011 FredE.Shapiro,D.O.2011-2012 RubenJ.Azocar,M.D.2012-2013 SelinaA.Long,M.D.*deceased

MASSACHUSETTS SOCIETY OFANESTHESIOLOGISTS 2013-2014

Committee on Governmental Affairs:DavidHepner,MD(2014),StephenHatch,MD(2014),RossMusumeci,MD(2014),FredShapiro,DO(2014),DanO'Brien,MD(2014),RichardUrman,MD,MBA(2014),SelinaLong,MD(2015)-chair,JamesGessner,MD(2015),SpiroSpanakis,DO(2015),NeilMcDonald,MD(2015),DonaldGanim,MD(2015),BeverlyPhilip,MD(2015)Adjunct:Drs.FredCobey,KayLeissner,DavidStahlJudicial Committee:JeffryBrand,MD(2014),JoshuaVacanti,MD(2015),MichaelBailin,MD(2016),DanielO'Brien,MD(2017),JamesGessner,MD,Chair(2018)Committee on Publications:BhavaniKodali,MD(2014),BeverlyPhilip,MD(2014),RichardUrman,MD,MBA(2015)-Chair/NewsletterEditor,MaitriyiShah,MD(2015),SpiroSpanakis,DO(2016),DavidHepner,MD(2016)Adjunct:Drs.S.Desai,S.Heard,R.Ortega,L.Perrin,G.Stanley,WebsiteSubcommittee:Drs.S.Spanakis-Chair,S.Heard,B.Kodali,R.Ortega,L.Perrin,G.StanleyCommittee on Public Education:SheilaBarnett,MD,(2014),SpiroSpanakis,DO,(2014),DavidStahl,MD(2014),FredShapiro,DO(2014)-Chair,CristinMcMurray,MD(2015),KayLeissner,MD,(2015),NeilMcDonald,MD,(2015),JoshuaVacanti,MD(2015),DavidHepner,MD(2016),MaryAnnVann,MD(2016),RanaBadr,MD(2016),RichardUrman,MD,MBA(2016)Committee on Programs (CME)ManishaDesai,MD(2014),FredShapiro,DO(2014),ToddSarge,MD(2014),DanielO'Brien,MD(2014),ShubjeetKaur,MD(2014),RanaBadr,MD(2015),CristinMc-Murray,MD(2015)-Chair,KayLeissner,MD(2015),SpiroSpanakis,DO(2015),LeePerrin,MD(2015)AdvisorAdjunct:Drs.R.Azocar(advisor),S.Basta,G.Battit,J.Gessner,I.Khayata,R.Schumann,R.UrmanM.S.A. Rep. to the Interspecialty Committee of the Mass. Medical SocietyMichaelEngland,MD,Representative,FredShapiro,DO,Alt.RepresentativeSpecialty Delegate to the House of Delegates of the Mass.Medical SocietyJamesS.Gessner,MDResident Affairs:BrianO'Gara,MD,Chair,BeverlyChang,MD,ViceChair


Summer 2013

Welcome to the41st editionof theMSARecord!Ourgoalistokeep

you informed of what is happening intheworldofanesthesia–bothinMas-sachusettsandonthenationallevel.I’mhonored to continue serving as Chairof Publications Committee and MSAAnesthesiaRecordeditor.Ithasbeenayearsinceourlastnewsletter,andalothashappened thatdirectly impactsourspecialtyandourpatients.Inthisedition,wedescriberecenteventsandactivitiesofaverybusyyear.Asyouwillsee,MSAhasbeenactiveonthepolitical,membership,andeducationalfrontsasdemonstratedinthereportsbyourMSAPresident,ASADirector, Legal Counsel, andCommit-tee Chairs. Highlights include nurseanesthetistsseekingindependentpracticein Massachusetts, healthcare paymentreform,prescriptionmonitoringprogramanditsimpactonanesthesiologypractice,changes to MSA bylaws, news aboutLifebox challenge, and theAnesthesiaQualityInstituteupdate.Inaddition,youwillfindadescriptionofCMEeducationalopportunities,Dr.Suciu’sreportfromtheresident (CORA) component, and Dr.

Philip’sASADirectorupdate.Asusual,wehighlightalocalanesthesiapractice,andwehaveselectedVABostonasourfeaturearticle. Overtheyearwefurtherdevelopedourwebsite (www.massanesthesiology.org)tobetterservetheneedsofourmem-bers.Visititoftenforlatestnews,meeting

andeducationupdates.Thegoodnewsisthatourmembershipnumbersareup,andMSAremainsastrongforceadvocatingforourspecialtybothlocallyandnation-ally. WewouldliketothankourimmediatepastMSApresident,Dr.SelinaA.LongforherextraordinaryleadershipandwelcomeournewpresidentDr.MichaelR.England,aswellas thenewlyelectedExecutiveCommitteeandASADelegation.Ihopethatthiseditionwillhighlightampleop-portunitiestoparticipateandinspireyoutobecomemoreinvolvedwiththeMSA,ASA,andtheirrespectivePACs.Wehavelistedallcurrentofficersandcommitteemembers,sofeelfreetocontactanyofthemwithquestions. Finally,pleasemarkyourcalendarssothatyoucanparticipateinmanyex-citingupcomingeventsincludingCMEcourses, MSA Annual Meeting, ASALegislativeConferenceandourregularMSAExecutiveCommitteemeetingstowhich allmembers are invited. I hopethatyouenjoyreadingthiseditionoftheMSAAnesthesiaRecord.Ifyouhaveanycommentsorinterestedincontributinganarticle,pleasecontactme.~

EDITOR'S REPORT

A NOTE FROM YOUR EDITOR, RICHARD D. URMAN, MD, MBA

Richard D. Urman, MD, MBAChair, Publications Committee

(2012-2015)

ASA Annual MeetingANESTHESIOLOGY 2013

October 12-16New England Caucus Meetings

Saturday 3:00 - 4:30 pm, Yerba Buena 14-15 Tuesday 3:00- 5:00 pm, Pacific HSan Francisco Marriott Marquis


Summer 2013

OnMay23,2013,IhadthehonoroftakingthereignsoftheMassachu-

settsSocietyofAnesthesiologistsfromDr.SelinaLong.Iwastrulyhumbled,forIfeltafeelingofsmallnesstryingtofillhershoes.Shehaddoneanexcellentjobofpositioningthesocietyforthestormthatweallsee(andsaw)justoverthehorizon.Thefieldofanesthesiologyaswellastheprofessionofmedicineisunder“attack”toreinventitself.Physicianextendersofallvarietiesare tryingtoredefinewhattheirpractice isandshouldbe,withorwithout thebelief that theyneed tobe“supervised”byphysicians.Societyingeneral,withthepassageoftheAffordableCareAct,wantsaccesstomedicalcare.Thequalityofthatcareissecondarytogainingaccesstocare. Exactly how this will play out inthecomingyears isunclear. The rela-tionship between anesthesiologists andnurse anesthetists is being constantlychallenged,despite thecleardifferenceintraining,decisionmakingabilityand

Michael R. England, M.D.MSA President

(continued on page 14)Dr. Michael England presenting a Lifebox unit to CEO Mary Muchendu and Dr. Mark Newton of Kijabe Hospital, Kenya, during his visit earlier this year.

PRESIDENT'S REPORT

expertise.Howqualitywillchangeistheissue.Dissolvingtheanesthesiacareteammodelistheintentofmanynon-physicianprovidersofanesthesiacare.Asonenurseanesthetisttoldme“whyshouldtheBoard

HIGHLIGHTS FOR THE UPCOMING YEARof Registration inMedicine tellme (anurse)howtopractice?” Intakingonthechallengewefacein Massachusetts, immediately afterbeinggiventhegavelfromDr.Longattheannualmeeting, therewasaheateddiscussion on the direction the MSAshouldtravel toopposethecurrentbillin the Massachusetts Legislature forindependentnursingpractice.Someintheaudiencefeltthatweshoulduseallofourresourcestohirealobbyingfirmtopresentourcasetoelectedofficials.ThatwascounteredbytherealizationthatwehaveanexcellentpersonwhoisdoinganoutstandingjobattheStateHousekeepinghiseartothegroundprotectingourbestinterestsinMr.EdwardBrennan.Itwasalsopointedoutthatthiseffortonthepartofthenursesisamarathonandnotasprintandthatthehighcostsofaseparatefirm,couldleadustobankruptcy.Afteratimeitwasdecidedtomakemovesslowlyandnotrushtohireacommercialfirm,ratherplantoworkcloselywiththeMassachusettsMedicalSocietyhandinhandtodefeatthisinitiativeandnotmakethis just an “anesthesia” issue. Indeed,itisinfactnotjustananesthesiaissue.The legislation would apply to nursepractitionersaswell.Asimilarbillwouldgrantindependentpracticetopsychiatricclinicalnursespecialists. Shortlyaftertheannualmeeting,IsatdownwithMr.BrennanandMr.BillRyderoftheMMStoseewhatthatorganizationcouldofferusinthewayofsageadviceandplanningastrategywiththem.MrRydernotedthatMMSstronglyopposesthebills.Henotedthatengaginghighpricelobbyistsisnoguaranteeofsuccess.Rather,headvisedthatweneedtoencourageallofustogetinvolved.Weneedtocreateagrassrootspoliticaleffort.Weallneedtogettoknowourlocalstaterepresentativeandsenator.Weneedtotakethetimetogoandvisittheminpersontomakeourpointsclear,andaskfortheirsupport.Theseelectedofficialsrespondtotheirvotingconstitu-ents,nothighpaidlobbyists.Thisisthe


Summer 2013

SpiroG.Spanakis,DO,isapediatricanesthesiologist at University of

MassachusettsMemorialMedicalCen-ter,where he is anAssistant ProfessorofAnesthesiologyandPediatrics.HeiscurrentlyPresidentElectoftheMSAaftercompletinghistermasVicePresident. Longactivewithourstatespecialtysociety,Dr.Spanakisservedasaresidentdelegate for the American Society ofAnesthesiologists Resident and FellowSectionasafirstyearanesthesiaresidentin2003.HehascontinuedtoservetheSocietyinvariouscapacities,includingestablishingawebsitefortheMSAdur-inghisresidency,whichhecontinuestooversee.Sincethattime,hehasservedontheExecutiveCommittee,theProgramCommitteeandasprogramdirectorforseveralMSAcontinuingmedicaleduca-tionprograms,inadditiontoservingasalternate delegate and delegate to theAmericanSocietyofAnesthesiologists. Hewasrecentlyelectedtotheposi-tionofSpeakeroftheHouseofDelegatesfor theAmerican MedicalAssociationYoung Physicians Section. Prior tohis election, he served as chair of theMassachusetts Young Physicians Sec-tiondelegation to theAMA inhis roleasChairof theMassachusettsMedicalSociety’s Committee onYoung Physi-

cians.Currently,heistheViceChairofthe Committee on Preparedness at theMassachusettsMedicalSocietyandisamember of itsCommittee on StrategicPlanning.Locally,heistheSecretaryoftheWorcesterDistrictMedicalSociety. Besideshisextensiveinvolvementinorganizedmedicine,hedivideshistimebetweenhis clinicalpractice at severalWorcestercampuses,residenteducationand patient safety in the Departmentof Anesthesiology at UMASS Memo-rialMedicalCenter.Currentlyheisthe

ClinicalBaseYearDirectorforcategoricalresidents.AstheDirectorofSimulation,heuseshighfidelitysimulationscenariostoexposeresidentstorarecriticaleventsintheoperatingroom.HewasrecentlyawardedanInter-ProfessionalEducationGrantfromtheUniversityofMassachu-settsMedical School to bring togetheraninterdisciplinarygroupofhealthcareproviderstolearncrisismanagementtech-niquesintheoperatingroom.InhisroleasAssociateQualityandSafetyOfficerfor the Department ofAnesthesiology,he organizes the department’s QualityImprovementConferenceswherehepro-motesinterdisciplinarysystemsolutionstopreventmedicalerrorsinthepracticeofanesthesiology. Dr.SpanakisattendedtheCollegeoftheHolyCrosswhereheearnedaB.A.inBiology. He receivedhisDoctorofOsteopathicMedicine degree from theUniversityofNewEnglandCollegeofOsteopathicMedicineinMaine.Boardcertifiedinanesthesiology,hecompletedhisresidencytrainingattheUniversityofMassachusettsMedical Center and hisfellowship in pediatric anesthesiologyatChildren’sNationalMedicalCenterinWashington,DC.HecurrentlyresidesinWorcester.~

PERSONALITY PROFILESPIRO G. SPANAKIS, D.O., PRESIDENT-ELECT OF THE MSA

Spiro G. Spanakis, D.O.MSA President-elect

REMINDER TO MEMBERS INTERESTED IN COMMITTEE APPOINTMENTS

IT WILL SOON BE THAT TIME OF YEAR THAT THE MSA PRESIDENT ELECT, DR. SPANAKIS WILL BE

REVIEWING THE MSA COMMITTEES AND APPOINT-ING COMMITTEE MEMBERS - IF YOU ARE INTER-

ESTED IN GETTING INVOLVED, PLEASE CONTACT THE MSA OFFICE BEFORE JANUARY 2014.(see page 3 for a listing of MSA Committees)


Summer 2013

ANNUAL REPORTS

Sheila R. Barnett, M.D.

Secretary 2011-2013

MSA ANNUAL MEETING - MAY 23, 2013SECRETARY'S REPORT

MSA OFFICERS President MichaelR.England,M.D.President Elect SpiroG.Spanakis,D.O.Vice President SheilaR.Barnett,M.D.Immed. Past President SelinaA.Long,M.D.Secretary(2yearterm) CristinA.McMurray,M.D.Delegates to the ASA (3yearterm)CristinA.McMurray,M.D.(2014)RubenJ.Azocar,M.D.(2016)SheilaR.Barnett,M.D.(2016)MichaelR.England,M.D.(2016)FredE.Shapiro,D.O.(2016) Alternate Delegates to the ASA (1yearterm)GalinaDavidyuk,M.D.DonaldG.Ganim,II,M.D.ShubjeetK.Kaur,M.D.NicholasM.Kiefer,M.D.NeilA.McDonald,M.D.MaitriyiJ.Shah,M.D.NikhilThakkar,M.D.RichardD.Urman,M.D.,MBAJoshuaC.Vacanti,M.D.MaryAnnVann,M.D.

MSA District Representatives (1yearterm)District Representative AlternateRepresentativeD.1 NikhailThakkar,M.D. NaveedA.Tahir,M.D.D.2 BronwynCooper,M.D. ShubjeetK.KaurM.D.D.3 NicholasKiefer,M.D. CharlesHo,M.D.D.4 FernandoAlmenas,M.D. DipakKumar,M.D.D.5 RubenAzocar,M.D. JeanetteLee,M.D. D.6 NeilMcDonald,M.D. KonstantinBalonov,M.D.

The following officers will continue:

Treasurer (2yearterm) DanielJ.P.O’Brien,M.D.(2014)ASA Director (3yearterm)BeverlyK.Philip,M.D.(2015)ASA Alternate Director (3yr) DavidL.Hepner,M.D.(2015)

Delegates to the ASA (3yearterm) CristinA.McMurray,M.D.(2014) DanielJ.P.O’Brien,M.D.(2014) LeeS.Perrin,M.D.(2014) DavidL.Hepner,M.D.(2015) SelinaA.Long,M.D.(2015) SpiroG.Spanakis,M.D.(2015)

REPORT OF THE MSA SECRETARY

Sheila R. Barnett, M.D.

May 23, 2013

Theactivemembership of theMassachusettsSociety ofAnesthesiologistshassurpassedthe900mark;thepresent

countis946activemembers.ThisentitlestheMSAtoten(10)ASADelegatesattheASAHouseofDelegates,October12-16,2013inSanFrancisco,CA. TheMSAisworkingtowardsre-listingofmembersbyhomeaddressandeliminatingMSA’shospitaldistrictsinfavoroforganizingMSAdistrictsalongwithcongressionaldistrictsinordertobetteridentifyconstituentsforlegislativeactivityandforthefuturetheabilitytovoteon-lineviathewebsite.

MembershiptotalsasofMay23,2013 Active 946 Affiliate 19 Resident 490 Retired 193

AmomentofsilenceforourdeceasedmembersHarryE.Bowen,M.D.AbdelMehio,M.D.JosephL.Murphy,M.D.JoanPeterson,M.D.SamuelWiner,M.D.


Summer 2013

e) delineated the differences intraining between anesthesiaassistantsandCRNAs,

d) providedguidelinesfordeep sedationbynon-anesthesiologists.

4) In November, Alex Hannenberg,MD, Ed Brennan, Esq. and I metwith Health and Human Servicesrepresentatives in Massachusettsto clarify anesthesia billing forMassHealth patients.We proposedthat MassHealth adopt Medicarerules andModifiers for anesthesiaservices which recognize medicalsupervision.

5) In January, House Bill 2009 andSenateBill 1079were filed to pe-tition for expanding the scope ofpractice for all advanced prac-tice nurses, including CRNAs. Ifpassed, it would effectively elimi-natesupervisionand thecare-teammodelofanesthesiapractice,allow-ingindependentpractice.TheMSAvigorouslyopposesthislegislation,andmoreoveritwastheimpetusforseveral membership developments

thatwillallowustobettermotivate,organizeandmobilizetheSocietyinopposition.TheASAhasbeenverysupportiveofthemanystateswherescopeofpracticelegislationispend-ing, and I participated in severalconferencecallswithotherstateso-cietypresidentsregardingtheirsimi-lar activity. Because developmentsin this area were fast-moving andrequiredleadershipconsensus,MikeEngland,MD,yourPresident-Elect,andSpiroSpanakis,DO,yourVice-President, and I initiated weeklyconferencecallstodiscussdevelop-mentsandstrategy.

6) InMarch,Isubmittedwrittentesti-monytoDr.LaurenSmith,theinter-imCommissionerofPublicHealth,regarding the burdens proposed byregulations that implementing the“Prescription Monitoring Program”would place upon our specialtypractice, and requested that peri-operative anesthesiologists be ex-emptfromtheprogramaswedonottypically prescribe anymedicationsupon or after a patient’s discharge.Further information regarding thisissue is contained in the Report ofCounsel.

7) The ASA Legislative ConferencemetinlateAprilinWashington,DC,whichfocusedonfederalissues:

g) truth and transparency forhealthcareproviders,

h) easingofdrugshortages,

i) maintaining scope of practiceandthecare-teammodel,

j) apermanentSGRfix.

Asyoucanonlyimagine,thesedevelop-mentsrequiredtheMSAtoupdatemanySociety“fixtures”ofthepastsothatwe

Annual Reports-continued

PAST PRESIDENT'S ANNUAL REPORT - MAY 2013

Selina A. Long, M.D.President 2012-2013


The conclusion of my year as thepresidentof theMassachusettsSo-

cietyofAnesthesiologistslikewisecon-cludes the busiest year for advocacy,membership improvements and educa-tionintheSociety’shistory.Allowmetoelaboratebelow.

MostoftheSociety’senergywentintoadvocacyadvancesthisyear:

1) In July, I submitted testimony re-garding proposed amendments toregulationsoftheDivisionofHealthCare Finance and Policy regardingtheadoptionofactualtimeunitsforMassHealthanesthesiaservices,andcalledforMassHealthtoadoptpay-mentModifiers 25 and59,which Iampleasedtosayhavebeenimple-mented.

2) InAugust,GovernorPatricksignedChapter 224 of the Acts of 2012(health care payment reform) intolaw, which became effective inNovember. We have been closelywatching the evolution of account-ablecareorganizations(ACO’s),thecaponmedicalspendingtothegrossstate product (GSP) and medicalmalpractice reform. The MSA willcontinue tomonitor the implemen-tationofChapter224toensurethatqualityanesthesiaandpainmanage-ment services are not adversely af-fected as Massachusetts transitionsinto new payment methodologiesandsystems.

3) InOctober,theHouseofDelegatesof the American Society of Anes-thesiologists affirmed through fourresolutionsthat:

c) regionalanesthesiaistheprac-ticeofmedicine,

d) OR medications should besafelysecured,


Summer 2013

Edward J. Brennan, Jr., Esq.MSA Legal Counsel


Nursing Board Proposes New Regula-tions for APRNs Scope of Practice The Nursing Board has proposednew regulations for advanced practicenurses (APRNs), includingnurseanes-thetists, which eliminate longstandingphysiciansupervisionrequirementsoverallaspectsofAPRNpractice,exceptforprescribingmedications.Undercurrentlaw,aCRNAcanordertestsandthera-peuticsandprescribemedicationunderthesupervisionofaphysicianduringtheimmediateperioperativeperiodofcare,whichisdefinedas“daypriortosurgeryandendingupondischargeofthepatientfrompostanesthesiacare.”Theproposedregulations do not accurately reflectstatutoryprovisionsrequiringphysiciansupervisionfortheorderingoftestsandtherapeuticsoradministeringmedicationswhereaCRNAdoesnothaveprescrip-tiveauthority(DEAnumber).Nordoesit reflect statutory provisions requiringMedicineBoard involvement in jointlypromulgating regulations involving theordering of tests and therapeutics andprescribing medications. At a hearingbeforetheNursingBoardonAugust7,MSApresident,MichaelEngland,M.D.,testified in opposition to the proposedregulations,remindingtheNursingBoardthatitneedstofollowtheapplicablestatu-

toryprovisionsgoverningphysiciansu-pervisionofCRNAs.Themedicalsocietyandothermedicalspecialtyassociationsalsoopposedtheregulations.

Truth and Transparency for Health Care Providers MSA is supporting S. 1035which would require all health carepractioners to conspicuously post andcommunicatetopatientsandthepublicthe practitioner’s specific licensure. Ahealthcarepractionerwouldberequiredtowearaphotoidentificationnametagduring all patient encounters, whichwould include the practioner’s nameandtypeoflicense.Thenametagmustbe of sufficient size to be visible andapparenttoallpatients.S.1035isbeforethePublicHealthCommittee.Ahearingonthebillhasyettobescheduled.

Prescription Monitoring Program An outside section of the fi-nal FY’2014 state budget amends thePrescription Monitoring Law to makeclear that physicians are required to check the Prescription Monitoring Program only when prescribing a schedule II or III narcotic to a patient for the first time (giving a patient a written prescription to be filled at a pharmacy).Priortothepassageofthisprovisioninthebudget,theDepartmentof Public Health (DPH) was workingonregulationsthatwouldhaverequiredphysicianstoutilizethePMPforeverynewpatient,regardlessofage,diagnosisorintenttoprescribeascheduledmedica-tion.ThiscouldhavebeenconstruedtorequireananesthesiologisttocheckthePMPforeverypatientundergoinganes-thesia.TheMSAwillmonitortheregula-toryprocessnecessarytoimplementthenewrevisedlaw.Enforcementofthelawwillnotbeginuntiltheregulationsareinplace.

Comparison of House and Senate Health Care Payment Reform Bills

provisionsrequiringthesenursestoprac-ticeunderthesupervisionofaphysician,andremovestheBoardofRegistrationinMedicinefromitscurrentroleinjointlyregulatingthescopeofpracticeofCRNAsandNPswiththeBoardofRegistrationofNursing.ThescopeofpracticeofCRNAsandNPswould be left solelywith theNursingBoard.This is tantamount to independent practice. Thebillswouldeliminatethelong-standingstandardofcarerequiringanurseanesthetisttoadministeranesthesiaunderthesupervisionofaqualifiedphysicianandthereforecompromisethesafetyandcareofpatientsintheCommonwealth. Becausethebill'slanguagefailstoplaceanystatutorylimitationsonscopeofpractice,thelegislationcoulddramati-callyexpandnurseanesthetists’scopeofpractice into areas that consist of thepracticeofmedicine;suchas,chronicpainandcancerpain.Notonlyisanurseanes-thetist’s education and clinical trainingmuchshorterthanananesthesiologist’straining,itdoesnotincludeanysignificanttimestudyingandtraininginthediagnosisandtreatmentoftheseconditions. ThebillshavebeenassignedtotheLegislature’sPublicHealthCommittee,andhearingsarelikelytobescheduledlaterthisyearorthebeginningof2014.MSAisvigorouslyopposingthebills,asisthemedicalsocietyandothermedicalspecialtysocieties.Itisvitallyimportant,however, that anesthesiologists speakupforpatientsafety,andtelllegislatorsthat when seconds count, having an anesthesiologist or qualified physician immediately available, working with and overseeing the CRNA reduces risk and ensures the safe delivery of quality anesthesia care. Inthecomingweeks,MSAwillbecallingallmemberstoactionandaskingyoutocontactyourstaterepresentativeand senator. When those calls come,please stand up for your patients andcontactyourlegislators.

Report of Counsel - continued

(continued from page 1)


Summer 2013

ASA also advocated for repeal of thenon-elected Independent PaymentAdvisory Board (IPAB), which wouldhavesweepingpowerstomandateaddedpaymentreductionsontopofSGRcuts.Supportforthisrepealisgrowing,withbillsintroducedinbothHouseandSenatethisyear(H.R.351andS.351). ASAisalsoproactivelyaddressingthe changing health care system withitsincreasedfocusoncarecoordinationand reductionofunnecessary services,to helpASAmembers find productiveopportunities. With our legislators inWashington,wereinforcedASA’scon-ceptofthePerioperativeSurgicalHome,whereanesthesiologistswouldserveasthe medical coordinators of the entireperi-operativepatientcareprocess.ThePerioperative Surgical Home can pro-videstrategicandfinancialsupport fortheanesthesiologistasthePerioperativePhysician.ASA’sCommitteeonFutureModels ofAnesthesia Practice, whichincludesyourDirector, isactivelypre-paring thedetailed componentsof thismodel, includingmonetization, so thatASAmemberscanusethisstructuretodeveloptheirownpractices.

ItismypleasureasyourDirectortogiveyouanupdateonthenationalAnesthe-siologyissues.ASAandMSAadvocatefortheinterestsofyou,ourmembers. Our society’s annual meeting,ANESTHESIOLOGY2013willbeheldinSanFranciscoinOctober.Anexcitingprogram of educational, scientific andadvocacy activities is being readied toaddress the interests of all attendees.TheOpeningSessionwillbe“ChasingZero”,apresentationbyCharlesDenham,MD, Editor-in-Chief of the Journal of Patient Safety, with actor and patientsafetyadvocateDennisQuaid.TheAPSFEllisonC.PierceLectureonPatientSafetywill feature Alan F. Merry, MD, andMassachusetts’ownJeffreyB.Cooper,PhDwillreceivetheASADistinguishedService Award for his achievementsimproving anesthesia patient safety.Check out the meeting website http://www.asahq.org/Annual-Meeting/ andplannowtoattend! MSA leadership and our residentrepresentatives participated in the an-nual ASA Legislative Conference inWashingtonDC. Appropriatepaymentforour services is always important toASAmembers,andweaddressedseveralMedicarepaymentissues.Weremindedour legislators about anesthesiology’suniquely low payment from Medicareat 33% of private payment rates, andthereforeadvocatedthatanesthesiologyshould be “held harmless” for furtherpaymentcutsthroughtheMedicareSGR(SustainableGrowthRate)formulacuts.Wewereabletoshowourlegislatorsthataccording to theCongressionalBudgetOffice, anesthesiology services are notdrivingvolumeor growth inMedicarespending.Thisyear,Housecommitteeshave released a concept proposal toreplace the SGR with a quality-basedprogram, and have sought input fromstakeholdersincludingASAtorefineit;thefutureofthisinitiativeisuncertain.

Manytypesofprovidersareinvolvedinhealthcaretoday,includingphysicians,technicians,nurses,physicianassistantsandotheralliedproviders.Increasingly,the training programs provide doctoraldegreeswithintheirspecialty,allowingthemtobecalled“Doctor”,andrecentstudies confirm increasing patientconfusion. There is a heightenedneed to make sure that patients haveadequateinformationtomakewiseandcost-conscious health care choices anddecisions.Toaddressthis,legislationhasbeenintroducedintheHousetoimprovetransparencyintheidentificationofhealthcareprovidersandinhealthcareprovider-related advertisements and marketing(H.R.1427).ASAactivelysupportsthislegislation. Shortages of critical intravenousdrugscontinue.Centralnervoussystemdrugs, which include drugs used byanesthesiologists,aretheclassofdrugsmost frequently affected by shortages.Thecausesofdrugshortagesarespecificand unique to each drug, and include:legislativeandregulatoryfactors;alackofcontingencyplansforcriticaldrugsthatarevulnerable to shortages;manufacturingfactors such as noncompliance withFDA Good Manufacturing Practiceregulations;businessandmarketfactorssuchasconsolidationoffirmsandlackofbusinessincentivetoenteraspecificproductmarket;market price pressure;anddistributionfactorssuchasjust-in-time inventory. Because the causes ofshortages are multi-factorial, a varietyofsolutionswillbeneededtoalleviatedrug shortages. The Food and Drug Administration Safety and Innovation Act (FDASIA) passed last year newlyrequiresmanufacturerstoreportexpectedinterruptionordiscontinuanceofcriticaldrugs’ manufacture, leaving time todevelopalternatives.ASAandFDAarefrequentlyincontactabouttheevolvingdrugshortagesissues.



ASA DIRECTOR'S REPORT - May 2013

Beverly K. Philip, M.DASA Director


Summer 2013



mightbemorenimbleinnavigatingthecourseahead.Theseinclude:

1) Clarifying and making the officernomination process more transparentandegalitarianthroughby-lawschangestobevotedonatthe2013Annualmeet-ing,

2) Outsourcing CME programming tothe Massachusetts Medical Society tobetter concentrate our office resourcesonmembershipadvances,

3) Website improvements - membersonly areawith log-in protection and alink to the state anesthesiologists PACwebsitefordonations,

MSA Officers and ASA President Elect Dr. Jane Fitch (third from right) pictured above at the Massachusetts State House with Representative Jeffrey Sanchez, State Representative for the 15th Suffolk/Norfolk District (second from left)

4)Re-listingofmembersbyhomead-dress and elimination of former MSA“districts” in favoroforganizingMSAdistricts along with congressional dis-trictsinordertobetteridentifyconstitu-entsforlegislativeactivity,

5)Engagingandstrengtheningourcon-nectionswithboththeState’sacademicandprivatepractice leadership throughinformativemeetingsandsocialevents,

6) Acquiring Officer’s and Director’sinsurance.

In fulfilling our educational mission,wehaveofferedseveralpopularcours-es each year (for example: ultrasound

guided regional anesthesia, difficultairwaymanagement,updateinsedationandanalgesia),andcontinuetosupportanddeveloptheNewEnglandAnesthe-siaResidentsConference,heldthisyearattheBrighamandWomen’sHospital.

I continue to be grateful for the“seasoned”adviceofDr.AlexHannen-berg,thepastpresidentofASA,thele-galcounselofMr.EdwardBrennan,thesecretarialsupportofMs.BethArnold,andYOU.~

SelinaA.Long,M.D.

President2012-2013

Dr. Long's Outgoing President's Report-continued


Summer 2013

TheAnesthesiology, Critical Careand Pain Medicine Service provide arange of clinical, educational, and re-search activities throughout the healthcare system. Clinical services includeanesthesiacarebothintheoperatingroomsuiteandatspecializedsitesthroughoutthe hospital, critical care and medicaldirection in the surgical intensive careunits, pain management for chronicand acute pain symptoms as well asliaisonwiththeemergencydepartment,andemergencyresponseviacodecallsand airway management coordination.Hence,anesthesiologistsinourgrouparespecialty-trainedincriticalcaremedicine,cardiacanesthesia,regionalanesthesia,thoracic anesthesia, patient safety, andpainmedicine.

Weprovidetraininginanesthesiol-ogy, critical care, pain management,regional anesthesia and preoperativeassessment.Anesthesia residents, painfellows and anesthesia interns rotatethroughVHABHSfromMassachusettsGeneral Hospital (MGH), Beth IsraelDeaconess Medical Center (BIDMC),BrighamandWomen’sHospital(BWH)and Boston Medical Center (BMC).MedicalstudentsfromBostonUniversitySchoolofMedicineandTuftsUniversityalso receive opportunities to join theanesthesia teamduringmandatory andelective rotations. Furthermore student

VA Boston Healthcare System-continued

Hospital in Review-continued

West Roxbury Campus


registered nurse anesthetists (SRNA)from Northeastern University and St.Joseph’sHospital,RIhaveanestablishededucational presence at VABHS. Oureducationalopportunitiesincludeclinicaltraining forall levelsof traineesunderclosesupervision,simulationexperiences,didacticandsmallgroupsessionsinclud-ingweeklymultidisciplinaryanesthesia,cardiology,cardiacsurgeryandvascularsurgeryrounds.

Researchareasrangefrombasicsci-encesuchaspainandanestheticmecha-nisms throughclinical studies.Specifi-callyintherealmofperioperativecare,ourgoalsincludeprovidingthehighestqualityanestheticandsurgicalservices,identifying ways to increase operat-ing room efficiency, improving patientoutcomes through earlier rehabilitationandsuperiorpaincontrol,andminimiz-ing postoperative complications in theintensive care unit and hospitalwards.VABHS has been the pioneer for theNationalSurgicalQualityImprovementProgram (NSQIP), the VeteranAffairs

SurgicalQualityImprovementProgram(VASQIP)andnowisactivelyjoininganationalVAanesthesiologygrouptocre-atetheVeteransAffairsAnesthesiaQual-ity Improvement Program (VAAQIP).VAAQIPisplannedtoestablishadatabasefromAnesthesiaRecordKeeping(ARK)systemsofeveryVAhospitalinthenationaswellasreceiveandutilizedatafromother currently existing VA databases.Furthermore,VABHSanesthesiologistsactivelyparticipateinaVHA’sNationalCenterforPatientSafetylessonslearnedproject.

Pain Medicine

TheVABHSPainClinicisaninter-disciplinary clinic composed of BoardCertifiedPainManagementphysicians,behavioralmedicinepsychologists,andadvance practice nurses. Pain clinic’sprioritiesare,1)patientswithneuropathicpain (examples: diabetic neuropathy,trigeminalneuralgia,postherpeticneu-ralgia),2)painrelatedtocancerorcancertherapies,3)painrelatedtotraumaticbraininjuriesandpolytrauma,and4)patientswho may be helped by interventionalprocedures.Theoverridinggoalistohelppatientsbecomeasfunctionalaspossiblewhilerelievingasmuchpainaspossible.Theclinicisdesignedtodoathoroughpainassessment,developaplanofcare,and either implement that plan of careormake recommendations back to thereferringprovider.Painservicerecognizesthatchronicpaincanoftenbereducedbutseldomcompletelyeliminated.Tomaxi-mizeimprovementthePainClinicusesmedications emphasizing non-narcoticstrategies,physicalrehabilitation,mentalhygiene and interventional procedureswhenindicated.Patientsareencouragedto play an active role in their therapy. Wealsoprovideconsultationontheinpatientwardsforpatientswithcancerpain,neuropathicpainandpatientswithpolytraumainjuries.~

to our veteran patients by promotingnew research discoveries in clinicalinvestigation. In addition, theanesthesiology staff, surgeons, ORnurses and support staff have formeda close-knit group that enjoy workingand socializing together. Our rotatingtrainees frequently comment on thisculture of professional and friendlycoexistence between the OR services.VABHS is proud to have been electedtothetopoftheBostonGlobe'100bestemployers' list and this ismirrored byveryhighworksatisfactionbymembersoftheanesthesiateam.


Summer 2013

OtherstateagenciesestablishedbyChapter224aretakingform.Amongtheseis the Health Information TechnologyCouncil,whichwilloverseethedevelop-mentofinteroperativehealthinformationexchangesthatwillallowforthesecureelectronic exchange of health recordsamongallprovidersinMassachusettsby2017. MassHealth (Medicaid) has beguntheChapter224mandatedtransitionto-wardaglobalpaymentsystembasedondeliveryofcarethroughmedicalhomesinwhichprimarycareproviderswillbecoordinatingcare.MassHealthhassetagoalthat25%ofitscoveredliveswouldbeunderglobalpaymentsbyJuly,2013;50%byJuly2014;and80%byJuly2015.

Health Care Payment Reform Bills-continued(continued from page 9)Health Care Payment Reform The comprehensive health carepayment reform law, Chapter 224 oftheActsof2012,isbeingimplemented.A new state agency, theHealth PolicyCommission, has been formed andis charged with implementation. TheCommissionwill set the annual healthcarecostgrowthbenchmark(theamounthealth care spending will be allowedto grow, which for 2013 is 3.6%);certifynewpaymentmethodsandcaredelivery models (ACOs and MedicalHomes);overseethepublishingofcostand quality data and the developmentof a state health plan to determine thefuture medical capital needs of theCommonwealth every 5 years; andmonitor and review the impact ofchangesinthehealthcaresystem.

TheMassachusettshospitalmarketcontinuestoconsolidatethroughmergersand affiliations, as provider networksdevelop to take on risk throughglobalpaymentsandalternativepaymentmeth-odologies. InJune,theLegislatureenactedalawwhichbringsMassachusettsintocompli-ancewiththeAffordableCareAct.TheCommonwealthHealth InsuranceCon-nector,thestateentitycreatedaspartoftheMassachusettshealthcareaccesslawof2006tohelptheuninsuredfindhealthinsurance,willbetheExchangeforthestateundertheACA. MSA will continue to monitorimplementationofChapter224andtherapidlychanginghealth caremarket inMassachusettsveryclosely.~

Dr. Michael England pictured with Mary Muchendu, CEO, Kijabe Hospi-tal, Kijabe, Kenya, with Dr. Mark Newton, on his recent visit.

Report of Counsel-continued


Summer 2013

MSA Plans for the upcoming year - continuedPresident's Report-continued

Pictured above, incoming MSA President, Dr. Michael England and MSA Treasurer, Dr. Daniel O'Brien at the MSA Annual Meeting in May.


EXECUTIVECOMMITTEEMEETINGDATESFOR

2013-2014

Thursday,Sept.12,2013Thursday,Oct.3,2013Thursday,Nov.21,2013Thursday,Jan.16,2014Thursday,Mar.6,2014(All members are welcome)

* note-date change, November and January meetings, same location.

tactic thatournursingcounterparts aretaking.Wehavetogetinvolved.So,whatistheMSAplanning?

1. Updatingourmembershipliststoincludeallmember’svotingzipcodethatwillbelinkedtotheir state senator and repre-sentative.

2. Callinguponyou,ourmembers,to speak out on behalf of pa-tientsandtheneedtomaintainanesthesiasafetybycontactinglegislators with the message:“When seconds count, havingananesthesiologistimmediatelyavailable, working with andoverseeing a nurse anesthetistreducesriskandensuresthesafedelivery of quality anesthesiacare.”

3. Encouragingallresidentstobepoliticallyinvolvedandknowl-edgeableoftheimpactthatnurseindependentpracticemayhaveontheircareer.

4. We received a grant recentlyfromtheASAtopartiallyfundourefforts.Wewilldiscussthepossibility of directing thesefundstoengageafirmtoprop-erlystrategizeour“campaign”tomaximizetheimpactofourmessage.

5. WorkcloselywiththeMMSinformulatingaconcisestrategyduringtheupcominglegislativehearings(tobeheldinDecemberorJanuary)onscopeofpractice.

6. We have testified before theBoardofRegistrationinNurs-ing when they had a publiccommentsessionontheirnewregulationsregardingadvancedpracticenurses.Itwaspointedoutclearlythatthenewproposedregulations do not conformto the state statute requiringphysician supervision in theordering of tests, therapeuticsandprescribingofmedications.IalsopointedoutthatNursingregulations have to be jointlypromulgated with the Boardof Registration in Medicineonthesematters.Thiswasnottheirplan!

This promises to be amost interestingandbusyyear!~Respectfullysubmitted

MichaelR.England,MDMSAPresident2013-2014


Summer 2013

COMMITTEE ON PROGRAMS ANNUAL REPORT - MAY 2013

The Program Committee oversaw anumberofsuccessfulprogramsinthe

pastyear.TheAbdelMehioUltrasoundGuidedRegionalAnesthesiacourse,held,December1,waspopularasusual.Newtopicsincludedcomplicationsofregionalanesthesiaaswellastheuseofcontinu-ouscathetersforblocks.The3rdAnnualWinter Meeting in Puerto Rico, againpresentedinterestingspeakersinagor-geoustropicallocaleandwasenjoyedbyasmallbutenthusiasticgroup;thenumberofregistrantsdoubledthisyear.

TheNEARCSubcommitteeof theProgramCommitteehasbeeninstrumen-talinensuringcontinuationoftheNewEnglandAnesthesia Residents Confer-ence.Thisannualmeeting,intendedtoberunbyresidentsandforresidents,washeldApril18atBrighamandWomen’sHospital.ItwasaresoundingsuccessandtheProgramCommitteehopesinterestinthemeetingwillremainstrongandthattheCORAresidentswilleventuallytakeonamajorleadershiproleforNEARC. UpcomingmeetingsincludetheAir-wayMeeting,whichwaspostponeduntiltheFallatadatetobedetermined.Wearealsohappytocoordinateagainwith

theNewEnglandSocietyofAnesthesiolo-gistsfortheir56thAnnualFallConferenceSeptember19-22intheBerkshires.TheProgramCommittee is currentlywork-ingonanewprogramdesignedtoassistmemberswithunderstandingtherequire-mentsforMOCA,aswellasoffersomeMOCA-approved CME credits. Thisprogramwillbeofferedthiswinteratadatetobedetermined. Asalways,theProgramCommitteeis always seeking interested membersto helpwith planning and steering themeetings of the MSA. Please contactCristin McMurray with questions orcomments.~

SAVE THE DATE

MSA 7TH UPDATE IN SEDATION & ANALGESIA

Saturday, April 12, 2014

Waltham Woods Conference Center, MMS Headquarters

Waltham, MA

Chair2013-2015

Cristin A. McMurray, M.D.


The Third Annual Winter Conference was held at the El Conquistador Resort in Las Croabas, Puerto Rico, January 18-21, 2013. Speakers from left to right, Drs. William Camann, Keith

Ruskin, Program Director Cristin McMurray and Fred Shapiro, enjoying the picturesque view.


Summer 2013

Lee S. Perrin, M.D.

Chair2012-2013

COMMITTEE ON BYLAWS ANNUAL REPORT - MAY 2013

AnumberofdifferentBylawsrelateditemswerereferredtotheCommit-tee. Below are bylaw changes recom-mended by the Executive Committeeduring the past year. It is required byourBylawsthatoncerecommendedbythe Executive Committee of theMSAthattheproposedchangesbemailedtothemembersof theSociety thirtydayspriortotheAnnualMeeting.Thisreportconstitutesthatnotice.

1. Updating our parliamentaryreference. “Sturgis” isno lon-gerbeingpublished.Themostrecentversionbymanyof thesameeditorsofthe4theditionofSturgisisnowcalledthe“Ameri-canInstituteofParliamentariansStandard Code of Parliamen-tary Procedure”. The changesareavailableon theAmericanInstitute of Parliamentarian’sweb site. This bylaw changewas recommended by the EConSeptember6,2012.

11.1 PARLIAMENTARY AU-THORITY

TheAmericanInstituteofPar-liamentarians Standard Codeof Parliamentary Procedureshallgovern theSociety inallcases towhich it isapplicableandisnotinconsistentwiththebylaws and standing rules oftheSociety.[AmericanInstitute

of Parliamentarians (2012-04-12). American Institute ofParliamentariansStandardCodeof Parliamentary Procedure.McGraw-Hill.]

2. During a previous bylaws“cleanup”, we missed remov-ing “Bachelor of Medicine”from the qualification for theretired membership category.There was some confusion asto whether someone with theBachelorofMedicinewasableto become amember ofMSAorASA. ASA’s interpretationofthelanguageisthattheterms“DoctorofMedicineorDoctorofOsteopathy”referstothetypeofphysicianandNOTtoaparticulardegree.Therefore,ASAacceptsanyonewithaDEGREEthatisequivalent.This bylaw changewasapprovedandrecommendedbytheEConSeptember6,2012

3.3.4Retired

3.3.4.1ADoctorofMedicineorDoc-torofOsteopathywhohasbeenacontinuousactivememberofthisSocietyoranothercompo-nentsocietyforten(10)yearsormoreandwhoiseligibleforretiredstatusinTheAmericanSociety of Anesthesiologists,Inc.,andwhohasretiredcom-pletelyfromprofessionalactiv-ity;provided,howeverthattheExecutive Committee may atits discretionmodify the timeuponresumptionofprofessionalactivity.

3. Whenweamendedourbylawstoallowmembershipinthecompo-nentbasedoneitherwhereyoulivedorwhereyouworkedweneglectedtoincludethatchoiceinsection3.6.Section3.6.2doeslimitthemembertobelongingtoonlyonecomponentatatime.It

shouldbenotedthatsection3.6.2(notincludedhere)saysthatanindividual can only belong toone component society. Thisbylaw change was approvedand recommended by the EConSeptember6,2012.

3.6 MAINTENANCEOFOTHER MEMBERSHIPS

3.6.3MembersofTheAmericanSociety of Anesthesiologists,Inc.,upontransferoftheirloca-tionofprofessionalactivityorresidencetotheCommonwealthof Massachusetts shall applyformembershipinthisSocietywithin180daysunlesstheyareamemberofanothercomponentsociety.

4. Earlierthisyeartherewasadis-cussionregardingthenominat-ing,ballotingandballotcount-ingprocess.Itwassuggestedthatwe change our procedure.Wealsodonothaveasatisfactorymechanismforbreakingatieonthemailballot.ThesequestionswerediscussedattheNovember29,2012andJanuary10,2012meetingsoftheExecutiveCom-mitteeandthesebylawschangesapprovedandrecommendedattheJanuarymeeting.

8.2.7CommitteeonNominations8.2.7.3Duties

Topreparealistofnomineesforeachofficewhichistobevacantin thisSocietyand to forwardtheir recommendations to theExecutiveCommitteebyMarch1.TheCommitteeshallsolicitthemembershipfornominationsinDecemberandclosetheperiodfor receiving nominations onFebruary1.

(continued on next page)



Summer 2013

4.3 ELECTION

4.3.1NominationsApproval

Nominationofofficerswillbemade from the recommenda-tions of the Committee onNominations. The ExecutiveCommittee may amend thereport of the Committee onNominationsbyamajorityvoteofthevotingmembershipoftheExecutive Committee presentandvoting.

4.3.2BallotDistribution

Electionshallbebythemem-bers of this Society by ballotdistributed by mail forty-fivedayspriortotheannualsessionbytheSecretaryofthisSocietyusinginstantrunoffvoting.ThevotedballotsmustbereceivedbytheSecretarypriortothean-nualsessionatadatespecifiedby him/her. Nothing in theseBylawsshallprecludeamemberfromcastingaballotforawrite-incandidate.

4.3.3 Ballot Counting andResults

The ballots will be countedby theSecretary and two tell-ersappointedbythePresidentandapprovedbytheExecutiveCommittee.AtiewillbebrokenbyacointossbytheSecretaryaswitnessedbythetellers.TheresultswillbeannouncedattheAnnualMeetingoftheSociety.

5. ReviewoftheBylawsdisclosedthat, unlikemost associations,theMSAdoesnothaveapolicyorbylawregardingtheindem-nificationofthevolunteerswhoserveonourcommittees,ourof-ficersorouremployees.Thepro-

posedbylawbelowwascraftedbyMSAlegalcounselandtheBylaws Committee chairman.ItwaspresentedattheJanuary2013 Executive Committeemeetingandrecommendedforapprovalatthattime.Thiswillbecome a new section of thebylaws in the Miscellaneoussectionofourbylaws.

1.1.1.1 INDEMNI-FICATIONANDINSURANCEOFOFFICERS,EXECUTIVECOMMITTEE MEMBERS,COMMITTEE MEMBERS,EMPLOYEES,ANDOTHERAGENTS11.4.1 Officers, ExecutiveCommitteeMembersandCom-mitteeMembers.EachOfficer,ExecutiveCommitteememberand committee member ofthe Society in each instance,whether or not then in office,shallbeindemnifiedbytheSo-cietyagainstallchargeswhichmaybereasonablyincurredorpaidbyhiminconnectionwithanyclaim,actualorthreatenedaction,suitorproceeding(civil,criminalorother,includingap-peals)inwhichheorshemaybeinvolvedbyreasonofhisorherbeingorhavingbeensuchofficerorcommitteemember,madeorbroughtagainsthimbyreasonofanyactoromission,orallegedactoromissionbyhiminanyoreachsuchcapacity,andalsoagainstallchargeswhichmaybereasonablyincurredorpaidbyhim(otherthantotheSocietyfor its account) in reasonablesettlement of any such claim,action,suitorproceeding.The determination whether asettlementisorwasreasonableshall be made by a majorityof a quorum of theExecutiveCommitteecomprisedofthoseExecutiveCommitteemembers

who are not involved in theclaim,action,suitorproceeding,andiftherebenosuchquorum,thenbyoneormoredisinterestedpersons towhom thequestionmaybereferredbytheExecutiveCommittee.11.4.2 EmployeesandOtherAgents.TheExecutiveCommit-teemay,bygeneralvoteorbyvotepertainingtoaspecificem-ployeeoragentorclassthereof,authorizeindemnificationoftheSociety’semployeesandagents,other than those officers andpersons referred to in Section11.4.1above,towhateverextenttheymaydetermine,whichmaybeinthesamemannerandtothesameextentprovidedinSection11.4.1above.11.4.3Definitionof“Charges”.AsusedinthisSection11.4theterm “charges” shall include,without limitation, judgmentawards, settlement awards,awardsbyothertribunalsorbod-ies,attorneys’fees,costs,fines,penaltiesandotherliabilities.11.4.4LimituponIndemnifi-cation. IndemnificationunderthisSection11.4,whetherun-der Section 11.4.1 or Section11.4.2,shallnotbemade,andno person shall be entitled toindemnification, in any casewhere such claim, action, suitorproceedingshallproceedtofinal adjudication and it shallbe finally adjudged, nor shallany settlement be determinedreasonable if it is found, thatsuch officer, Executive Com-mittee member, committeemember, person, employee oragent (a) is orwas derelict inthe performance of his or herduties in connection with theallegedactsoromissionsgivingrisetosuchclaim,action,suitor

Annual Reports-continuedCommittee on Bylaws Annual Report-continued


(continued from previous page)


Summer 2013

Wegreatlyappreciatethecontinuedeffortsofourdoctorswhovolun-

teer and take the time from their busyschedules to visit the community andeducatethepublicaboutthevitalroleoftheanesthesiologistintheperioperativesetting.


TheMassachusetts Society ofAn-esthesiologistswillcontinuealongwithnationalefforttoinformouranesthesiacommunityaboutthebenefitsofsupport-ingtheASAPoliticalActionCommittee(ASA-PAC). This enables a ‘voice ofsupport’, which has crucial impact oncurrentnationallegislativeissues:healthcarereform,ceasingMedicarepaymentcuts, and extending rural pass-throughpaymentstoanesthesiologists.Thesuc-cessoftheDrugShortagelegislationisatestimonytohowinformation,persis-tence,andvisibilityofourprofessioncanmake.

TherevisedMSAWebsiteenabledvariousMSACommitteestomergetheireffortsandcreativity.ThePublicEduca-tioncommitteehasjoinedtheCommitteesonPublicationandWebsiteinacombined

effortwithDrs.UrmanandSpanakistodesignasectionthatspecificallyaddressestheeducationalopportunitiesMSAcanprovideforbothitsmembersandthecom-munity.TheyhavedevelopedalinkontheMSAwebsiteforthepublictosubmitinquiriesaboutourprofession.

Dr.ShapirohasbeenamemberoftheExecutiveBoardandchairman,PublicEducationCommittee since 2001, PastPresidentof theMassachusettsSocietyofAnesthesiologists andcurrentChair,CommitteeonGovernmentalAffairs.~

COMMITTEE ON PUBLIC EDUCATION ANNUAL REPORT - MAY 2013

Chair2012-2015

Thecommitteeoverseesthepublica-tionoftheMSARecord(Newsletter)

onceayear,usuallyinthesummerfol-

lowingtheAnnualmeeting.Thecontentis based on Committee reports, plusadditionalcontributionsfromtheeditorandmembers.TheRecordisdistributedtotheentireMSAmembershipviaregularmailandisalsoavailableelectronically. Emailblasts(eBlasts)–thecommit-teesupportstheuseofselectiveeBlaststo the entire MSA membership thatconveymajordevelopmentsofregionalandnationalimportance.TheCommitteewillworkwiththerestoftheMSAand,the legislative council to prepare anddistributeasneeded. TheCommitteeChairproposedanideaofforminga looseaffiliationwith

anacademicjournalinawaythatwouldbenefitMSAmembers.Wewillexplorevarious options and report back to theExecutiveCommittee. TheMSAwebsiteisconstantlyevolv-ingandisoverseenbytheSubcomitteeonWebsiteDevelopment.Dr.Spanakishasledtheeffort.~

Respectfullysubmitted,

RichardUrman,MD,MBA

Fred E. Shapiro, D.O.

Chair2011-2014

Richard D. Urman, MD, MBA

COMMITTEE ON PUBLICATIONS ANNUAL REPORT - MAY 2013


Summer 2013

Opt-out pressure continues. Thisyear,therehasbeenlegislationfiledinsev-eralstatestocreatedefactoindependentpracticefornursepractitioners,includingnurseanesthetists.Thislegislationisac-tiveinMassachusetts.Specifically,thelegislationwilleliminatethestatutoryre-quirementthatsuchnursesfunctionunderthesupervisionofaphysicianpursuanttoregulationsdevelopedjointlybytheBoardofRegistrationofNursingandtheBoardofRegistrationinMedicine.Pleasereadthedetaileddiscussionsaboutthisbyourcounsel,EdwardBrennan,Esq. There are many active issues fac-inganesthesiologistsnow. To address them, we need the support of every anesthesiologist. It is important that we all contribute now to MSA-APAC and ASAPAC, to support our state and our national legislative efforts. EachofusknowsmembersofourrespectivedepartmentswhoarenotmembersofMSAandASA.Pleasejoininthechallengetogettheminvolved. IamprivilegedtoserveyouasyourASA Director from Massachusetts. Iespecially thank the MSA ExecutiveCommitteeandyoutheMSAmembersforyourhelpandsupport.Ifyouhaveanyquestionsorcomments,orneedsthatcouldbeaddressed,pleasedocontactmeatMSA.~

RespectfullySubmitted,

BeverlyK.Philip,MDDirector

Pictured above, left to right; Dr. Ruben Azocar, Dr. Fred Shapiro, Dr. Beverly Philip, ASA Director, and Dr. Selina Long at the Annual Meeting in May 2012.

Many Issues Facing Anesthesiologists-continued

proceeding,or(b)hasnotactedingoodfaithinthereasonablebeliefthathisorheractionwasinthebestinterestsoftheSociety.Neitherajudgmentorconvic-tion nor the entry of any pleainacriminalcaseshallofitselfbedeemedanadjudicationthatsuchofficer,ExecutiveCommit-teemember,committeemember,employeeoragentwasderelictoftheperformanceofhisorherdutiesifheorsheactedingoodfaith,forapurposewhichheorshereasonablybelievedtobeinthebestinterestsoftheSociety,andhadnoreasonablecausetobelievethathisorherconductwasunlawful.11.4.5 Other Rem-edies.Therightsofindemnifica-tionhereinprovidedforshallbeseverable,shallnotbeexclusiveof other rights to which anyofficer, Executive Committeemember, committee member,employee or agent may now

or hereafter be entitled, shallcontinue as to a person whohas ceased to be such officer,ExecutiveCommitteemember,committeemember, employeeoragent,andshallinuretothebenefit of the heirs, executorsand administrators of such aperson.11.4.6Insurance.TheSocietyshallhavepowertopurchaseandmaintaininsuranceon behalf of any person whoisorwasanofficer,ExecutiveCommittee member, commit-teemember,employeeorotheragent of the Society, or is orwas serving at the request oftheSocietyasaDirector,offi-cer,employeeorotheragentofanotherorganization,inwhichit has an interest, against anyliabilityincurredbyhiminanysuchcapacity,orarisingoutofhisorherstatusassuch,whetherornottheSocietywouldhavethepowertoindemnifyhimagainstsuchliability.~

Committee on Bylaws Annual Report-continued(continued from page 17)




Summer 2013

COMMITTEE ON RESIDENT AFFAIRS ANNUAL REPORT - MAY 2013

Scott Suciu, M.D.

Chair 2012-2013

TheCommittee on ResidentAffairs(CORA) had a successful year.

Among current members, we have re-mainedveryinvolvedinanesthesiaeventsandissuesoverthepastyear.Residentsfrommanydifferentinstitutionspartici-patedasresidentdelegatesattheannualASAmeeting inWashingtonD.C. thispastOctober.Inaddition,residentrep-resentativesfromBrighamandWomen’sHospital,BethIsrael,andBaystateMedi-calCenterparticipatedinthisyearsASAlegislativeconference.

Anotherendeavorthatwehavetakena larger role in relates tophilanthropy.Dr. Hannenberg has been a fantasticproponent of Lifebox, and has been avaluableadvisorforus.OnMarch2nd,anesthesia residents from across Mas-sachusettscelebratedthecompletionoftheannualin-trainingexam.Over100residentsfromacrossthestateattendedasocialmixerhostedinhonorofLifebox,acharitythatdonatespulseoximeterstodevelopingcountries.Over77,000op-eratingroomsaroundtheworldlackthisequipmentthatissovitaltooureverydaylives. This event is a part of the on-goingLifeboxChallenge,afundraisingcompetitionbetweenBostonUniversity,Brigham andWomen’s Hospital, BethIsrael,MassachusettsGeneralHospitalandTuftsanesthesiaresidencies.$1500wasraisedfromthisevent. The annualNEARCwasheld thisyearatBrighamandWomen’sHospital,andwiththehelpofDr.RomanSchumann,CORAhastriedtobecomemoreinvolved.BevChanghasspentagreatdealoftimeattempting to create a framework thatallowsCORAmemberstohelporganizefutureevents.Ultimately,thegoalwillbe

forCORAmemberstoregularlyupdateawebsitethatwillhostinformationthatallmemberinstitutionscanview.ThiswillhelpthemstayinformedwithimportantnewsandinformationregardingtheNE-ARC.Inaddition,CORAmemberswillbe instrumental in reporting importantinformationtodifferentresidentinstitu-tionsthroughvariouscontactresourcesandmaintainingaconstantcommunica-tionwiththeNEARCsteeringcommittee. Our presence as a committee ofresidents thatworksunder theMSAtopromoteresidentinvolvementfortheim-provementofourspecialtyandultimatelyforbettercareforourpatientshasshown.Wearecurrentlyholdingelections,andapplications from residents to variouspositions on CORA have doubled thisyear.Ihavereceivednumerousemailsfromresidentsthatwanttogetinvolved.Our fundraising efforts resonated withfacultyandresidents,indicatingthatwearenotjustagroupofresidentsthatsitonthesidelines,butcanalsomakeadif-ferenceforpatients inareaswithmoreminimalresources. This upcoming year, we have afantasticgroupofresidentsthatwillbeleadingCORA.Inadditiontocontinu-ingtheaboveendeavors,wehaveothergoals.Personally,Iwouldliketoseeaneasiersystemofcommunication,whereall CORA announcements (elections,Hannenberg scholarship,ASA residentdelegateapplications,etc)aretranspar-entandeasilycommunicatedacrossthestatetoresidents.IwouldalsoliketoseeCORAtakeonalargerroleofencouraging100%involvementintheASAPACfromallmemberinstitutionsinMassachusetts.TheMSAhasbeenverysupportiveofusthisyear,andwelookforwardtoanothergreatyearofresidentinvolvementwiththeMSA.~

Chair BrianO'Gara,M.D.,BethIsraelDeaonessMCVice-Chair BeverlyChang,M.D.,Brigham&Women'sHospitalSecretary RoyaSaffary,M.D.,BostonMedicalCenterTreasurer MichaelKim.M.D.,BostonMedicalCenterSocialChair RichardPedro,M.D.,BostonMedicalCenterSocialChair VeronicaCrespo,M.D.,BostonMedicalCenter

CORA Officers for 2013-2014



Summer 2013

Thispastyear,NEARCreceivedna-tionalattentionwhenthesubcommit-

teechairwascontactedbyTomCooper,on behalf of the Board of Trustees ofthe International Anesthesia ResearchSociety (IARS). The IARS ExecutiveDirectorinformedusofanoutstandingopportunity for NEARC participatingresidents.Forits2013annualmeetinginSanDiegoinMay2013,theIARSwouldsponsorthe2residentswhowouldwintopabstractatNEARCin2categoriestothencompeteinanationalselectionofbestabstractsfromallregionalanesthesia


NEW ENGLAND ANESTHESIA RESIDENT CONFERENCE SUB-COMMITTEE (NEARC) ANNUAL REPORT-MAY 2013

Roman Schumann, M.D.

New England Anesthesia Resident Conference (NEARC)Spring 2014

Baystate Medical CenterGo to MSA website link for details

http://www.massanesthesiology.org/residents-and-fellows/meetings-and-events/new-england-anesthesia-resident-conference-nearc

Chair 2011-2013

residentconferences. Theeventrepre-sents an additional, exciting incentiveforresidencyprogramstoparticipateinNEARC,anditishopedthatIARSwillcontinuethisnewformatforresidentsforitssubsequentmeetings. OnApril13,2013,awellattended7thannualNEARCwashostedatBWHinBoston.Thehostorganizers, BWHprogram director Rob Lekowski, MD,CAIIresidentBeverlyChang,MDandtheiradministrativesupportstaffoffereda delightful program that included anoverviewofhealthcarereform(RichardH.Gregg,MA,MBA),lifeintherealworld(TerenceK.Gray,DO)andORemergencymanagement checklist use (WilliamR.Berry, MD, MPH, FACS). More than40abstractsbyresidentsfrommanyNEinstitutionsweresubmittedthisyear.Asophisticated abstract scoring systemusingASAabstractjudgingcriteriawasimplementedthisyeartoensureproperselection of the winning abstracts forIARSsponsorship.Facultyjudgesfrom5institutions(UMASS,BIDMC,BWH,MGHandTMC)volunteeredtodeterminethewinnersinseveralphaseswithafinalcallfollowingtheabstractpresentations

on thedayof theconference.Thehostforthe8thannualNEARChasyettobedetermined. The subcommittee’s outreach ef-fort to encourage even wider programparticipationoccurredinseveralphasesandincludedwritten,phoneande-mailinformationtoofallNEanesthesiologyprogramdirectorsaswellastoeveryNEanesthesiology state society president.This outreach proposed the establish-mentofaNEARCsteeringcommitteetoformalizecontent,schedulesandfuturedirectionoftheconference.Atthistime,theMSANEARC subcommittee leadsthetransitionintothisNEARCsteeringcommitteeattheMSA.Acoregroupofinterestedanesthesiologistshaveofferedtocollaborateinthesteeringcommittee,whichshouldbegin itsworkshortly. Ithasbecomeevident,thatasaconferencebyresidentsforresidents,suchasteeringcommitteewill includeMSAresidents’componentmembers(CORA)withspe-cificresponsibilitiesforNEARC.ThesubcommitteewishestothankBethArnold of the MSA for her unfailingadministrativeassistanceduringthepastyear.~


Summer 2013

MSA ANNUAL MEETING

Another political battleground foranesthesiologistshasbeenoverproposedinclusion of independently practicingnurse anesthetists in the field of inter-ventional pain management. On thisparticularsubjectDr.FitchseemedelatedtorelaythatstatessuchasAZ,MA,OK,LA,andTNallhadenactedlegislationeitherdefiningthepracticeofpainman-agementasthepracticeofmedicine,orlimitingtheperformanceandsupervisionoffluoroscopybasedinjectionsaroundthespinalcordtophysiciansonly.In2013bothILandIAjoinedthislistofstateswhofoundthatonlypainphysiciansshouldberesponsiblefortheinterventionalcareofthechronicpainpatient.Centraltothesescopeofpracticedecisionswereeffortsmade by both the Pain Care CoalitionandtheASAtoinformbothpatientsandlegislatorsoftheparamountimportanceof patient safety and the integral roleplayedbyanesthesiologistsinensuringsafecare.Dr.Fitchthenwentontode-

ASA Guest Speaker, Dr. Jane Fitch with Dr. Paul Satwicz pictured on the left and Dr. John Hedley-Whyte to the right.

by Brian O’Gara

The2013MSAAnnualMeetingwasanoteworthyevent. Thisyear the

constituentshadthedistinctpleasureoflisteningtoapresentationgivenbytheASAPresidentElectDr.JaneFitch.Thesubjectsofherlectureweretherelevantpolitical issues facinganesthesiologistsandhowtheASAis“workingforyou,”abriefoverviewoftheresponsibilitiesandmakeupofournationalsociety. Dr.Fitch’sdiscussionoftherelevantpoliticalissuespertainingtoanesthesiolo-gistsbeganwithanupdateontheFederalandStatescopeofpracticebattles.CMSin2011determinedthatinordertopartici-pateinMedicarehospitalshadtoagreetocertainconditions,oneofthembeingthatnursescouldnotpracticeindependentlyofphysicians.Theinclusionofthisstipula-tionwasaresultoflobbyingeffortsbytheASAanditsconstituents.Thefederalgovernmentthendecidedthatifindividualstatesdidnotagreewiththisstipulation,then under certain circumstances theycould“opt-out”ofthepreviouslymen-tionedrequirementforMedicarefunding.Asitstandsatthemoment,17stateshaveoptedout,withMichiganandWyomingbothonthe“watchlist”ofthenextstatestopossiblyopt-out.

scribethepresenceoftheanesthesiologyassistant(AA)andtheirintroductionintonewareasofthecountry.Currentlythereare 1800AA’s practicing in 17 states,WashingtonD.C.,andtheVAhealthcaresystem.VariousstatesocietiesincludingrecentlyColoradoandConnecticuthaveplayedakeyroleinhelpingtoexpandtheeducationalprogramsavailabletoAA’ssothattheymaybecomeavaluablepartoftheanesthesiacareteam. As the national healthcare reformprocessmovesforward, therehasbeenanincreasingfocusontheprovisionofbothqualityandsafecaretoallpatients.Dr.Fitchcitedtheleadingroleplayedbyournation’sanesthesiologistsasareasonwhyourprofessionwillbechosenasanexampleofhowtoincorporatequalityandsafetyintoeverydaypractice.Withtheintroductionoftheperioperativesurgicalhomemodel,anesthesiologistsstandattheforefrontofensuringexcellentpatientcareandeffectivemultidisciplinarycom-

SUMMARY OF THE ASA GUEST SPEAKER PRESENTATION, DR. JANE FITCH



Summer 2013

ASA Guest Speaker Presentation-continued

MARK YOUR CALENDAR FOR NEXT YEAR'S MSA ANNUAL MEETINGThursday May 22, 2014

MIT Endicott House, Dedham(All MSA members are invited to attend)

MSA Annual Meeting

municationthroughouttheentiretyoftheperioperativeperiodfrompre-admissionto discharge. TheASA affiliateAnes-thesiaQualityInstitutealsoservesasanexample of how anesthesiologists areuniquelysuitedtoensurebestpracticesonanationallevel. Afterthisbriefdiscussionregardingtherelevantnationalissuesfacinganes-thesiologists,Dr.FitchthentransitionedintodiscussingtheASA’sspecificlegisla-tiveadvocacyeffortswithregardstotheongoing reform ofMedicare physicianreimbursementandbetteroversightofna-tionaldrugshortages.HighlightsfromtherecenteffortsbyASAdelegatesonCapitolHillincludedadvocatingthatreducingre-imbursementstoanesthesiologistsbasedonSGRmodelsdidnotmakeeconomicsense,asmanyindependentstudieshaveshown that anesthesia costs have beenbelowtheSGRrateforwelloveradecade,whereasradiologyandminorprocedurecostshaveexploded.AdvocacyeffortsbyourASAdelegatesandCongressmanDr.AndyHarris(R-MD)continuetoop-posepaymentoversightbytheproposedIndependent Payment Advisory Board(IPAB), fighting for representation byphysiciansinthediscussionofhowMedi-carepaymentsshouldbemade.Finally,inJune2012PresidentObamasignedintolawtheFDASafetyandInnovationAct.ProvisionsadvancedbyASAmembersaidedintheinclusionofstipulationsthatdrugcompaniesmustnotifytheFDAofanyanticipatedinterruptionsorhaltsintheproductionofdrugsspecificallyused

byanesthesiologists,aswellasencour-agingtheFDA’sauthoritytoreverseormitigateanyproductionproblemsoftheseimportantagents.Theinclusionofourprofessioninnationalhealthcarereformlegislaturehasbeenthroughtheimportantworkof theASAdelegatesandgroupslike theASA’sHealthPolicyResearchDivision,aswellaslobbyingeffortsbytheASAPAC,whichlastyearraisedover$1.8M. InadditiontotheASA’stirelessef-fortsfighting for anesthesiologists’ fairrepresentation in national healthcarereform,ournationalsocietyalsoprovidesforabevyofeducationalandcareerad-vancement opportunities on a nationalscale. Dr. Fitch cited theASA annualmeeting, as well as separate nationalmeetingsregardingpatientsafety,quality,andeducationallasexamplesofwhattheASAstaffworksontoaidintheprofes-sional and intellectualgrowthof everyanesthesiologist.AdditionaleducationalmodulessuchastheACEprogramandPractice Performance Assessment andImprovement,aswellasthenewlycus-tomizableEducationCenterontheASAhomepageallenableanesthesiologiststolearnandperformatthehighestlevel. In the next section of her lecture,Dr. Fitch then moved on to describethemakeup of theASA’s constituents,budget and leadership. In 2012 thenumber ofASAmembers increased toover 50,000members, representing anover 3% increase from the year prior.Thisincreaseinmembershipstandsout

amongstpoliticalsocietiesinthemedicalfield,asmostothernationalsocietiesarestrugglingtomaintaintheirnumbers,letalone see annual growth. Despite ourgrowingconstituency,thepercentageofanesthesiologistswhoaremembersoftheASA isdisappointingly low, especiallyin thestateofMassachusetts. Increas-ing this percentage will be incrediblyimportant going forward. The ASA’sannual operating expenses are around$36M, with the largest fractions spentongovernance,advocacy,andeducation.Whencontrastedwithrevenuesofover$40M,nearlyhalfofwhichismadeupofdues,thismeanstheyear2012-2013willallowfortheASAtoaddtoitsreserves.The remainder of the revenue ismadeupofcorporatesupport,exhibitsalesatmeetings,aswellasadvertisinginmeet-ingsandpublications. ToconcludeherlectureonhowASA“works for you,”Dr. Fitch focused onthecharitableandinternationaloutreachprogramssupportedbytheASA.TheseincludetheASACharitableFoundation,theHopefortheWarriorsprogram,andLifebox.Theseserveasshiningexamplesoftheanesthesiologycommunity’sinter-estinprovidingnotonlyexcellentpatientcarebutalsoinprovidingmuchneededsupportforourveteransandunderservedcommunitiesbothathomeandabroad.Dr.Fitch’sdiscussionwonderfullyelucidatedhowtheASAstrivestoembodythecorevaluesofeveryanesthesiologist,andhowournationalsocietyworkstoensurethatthe practice of anesthesiology is wellrepresentedthroughouttheworld.~

(continued from previous page)


Summer 2013

LIFEBOX CHALLENGE

OnMarch2nd,anesthesiaresidentsfromacrossMassachusettscelebrat-

edthecompletionoftheannualin-trainingexam. Over a hundred residents fromacross the state attended a celebratorysocialmixerhostedinhonorofLifebox,a charity that donates pulse oximetersto developing countries without thisresource.Over77,000operatingroomsaround the world lack this equipmentthatissovitalinoureverydaylives.Thiseventisapartoftheon-goingLifeboxChallenge, a fund raising competitionbetween Boston University, BrighamandWomen’sHospital,BethIsrael,Mas-sachusetts General Hospital and Tufts

anesthesiaresidencies.Atotalof$10,000wasraisedby100%residentdonations,which raised over 40 lifeboxes. Pleaseshowyoursupportforourresidentsbyconsidering getting involved or donat-inginthenameoftheresidencyofyourchoice.Every$250buysapulseoximeter.Donations can bemade at http://www.lifebox.org/donations.Pleasebesuretowrite in thenameof theresidencyyouare donating for under the informationbox.Formoreinformation,[email protected].

Dr. Brian O'Gara, Chair of MSA Committee o Resident Affairs, pictured above promoting the Lifebox Challenge Golf Tournament that was held in June 2013.

Dr. Beverly Chang, Chair-elect of MSA Committee on Resident Affairs

LIFEBOX


Summer 2013

www.lifebox.org • 21 Portland Place, London W1B 1PY, UK • + 44 (0) 203 286 0402 • Email: [email protected]

Registered as a charity in England and Wales (1143018) • Registered as a company limited by guarantee (7612518)

Selina A. Long M.D. President Massachusetts Society of Anesthesiologists 318 Bear Hill Road Suite 4A Waltham, MA 02451 Via email: [email protected]

February 5, 2013

Dear Dr Long, I am writing with sincere thanks from everyone at Lifebox for your Society’s very generous donation of $1,000 in memory of Dr Richard Browning of Rhode Island. This gift will help make a life-changing difference to health workers striving to deliver safe treatment in environments where resources, support and training are scarce. Lifebox is slowly and steadily closing the 70,000+ pulse oximetry gap. We won’t stop until every operating room and recovery setting worldwide has access to this essential equipment, and the training to make sure that it is used effectively. So far, we have: sent 4100 pulse oximeters and education kits to facilities in 75 lower-resource

countries worldwide.

supported local training for over 2000 anaesthesia providers

introduced these to the World Health Organization’s Surgical Safety Checklist, proven to reduce surgical complications by more than 30 percent and mortality by nearly 50 percent

worked in collaboration with local organizations, membership groups and ministries of health to foster the communication and collaboration that is the only way to make a permanent, positive change in the quality and safety of care.

Thank you – we are truly grateful for your support. Yours sincerely

Pauline Philip Chief Executive Lifebox Foundation


Summer 2013

What’s New in Anesthesia Quality Management?

An Update from the Anesthesia Quality Institute (AQI)

Richard P. Dutton, M.D., M.B.A., ExecutiveDirector

Qualitymanagementisanimportantfunctionofanyanesthesiapractice.

Individualclinicianshaveaprofessionalobligationtothinkaboutthepatientcarethey provide and attempt to improveit. On the practice level, assessingoutcomes allows for identification ofsystem problems that can be resolvedbychangesinpolicyorgrouppractice.For example,measurement of the rateof postoperative nausea and vomiting(PONV) in the PACU can identifypatient populations at higher risk. Apolicy of providing prophylaxis inthe OR for these patients can reducethe overall rate of PONV. On thenational level, aggregation of data onrare complications (e.g. postoperativevisual loss) can lead to appreciationof problems too rare to be studied atthe local level. Once identified as arecurring problem, detailed review ofcases can suggest common featuresand targets for improvement. Thiskind of national quality management,based only on clinical anecdotes, cannonetheless have substantial positiveeffects on anesthesia practice. Thisprincipleisillustratedbythecaseseriespublished by the Anesthesia ClosedClaims Project (CCP) in the scientificliterature, and by the individual casevignettes from theAnesthesia IncidentReportingSystem(AIRS)whichappeareachmonthintheASANewsletter.

UPDATE ON THE ANESTHESIA QUALITY INSTITUTE


benchmarking of adverse outcomesis a possibility. TheFigure shows thecumulativenumberofcasesinNACORwith associated reporting of clinicaloutcomes (out of 11.2 million totalcases) reported by themonth and yearwhentheoutcomeswereenteredintheregistry. Further good news is shownin the Table, which shows the rate ofoccurrenceofselectedmajorandminoroutcomesfromthepracticesthatgetthisdatatoNACOR.

While CCP and AIRS are positiveexamples for our specialty, one of thelargest national gaps in anesthesiologyis the generation and reporting ofsystematic data on adverse outcomesfromeverycase,everyday.Anestimatefromthe275groupsparticipatingintheNationalAnesthesiaClinicalOutcomesRegistry(NACOR)isthatnomorethanhalf have a system for collecting thiskindofdata,whilefewerthan25%areable to report clinical outcomes toNACORonaroutinebasis. Thegoodnewsisthatthisnumberisincreasinglately,andwillsoonreacha critical mass where true national

ASA NEWS


Summer 2013

AQIBoardofDirectors 8/23/2013 NACOROutcomes ThedatapresentedareroughaggregatesofwhatiscollectedinNACOR,basedonaminimumnumberofpracticeswhichreportthatoutcome.Definitionsvaryfrompracticetopractice,especiallyinthe“minor”category.Theratespresentedarenotriskadjustedinanyway.*Notallpracticesreportalloutcomes.Thiscreatesvaryingdenominatorsforratecalculations.Consequently,someoutcomesmighthaveahighercount(N)butalowerrate(%)ascomparedtoothers. Category SubCategory N %* MAJOR Anaphylaxis 127 0.010 Awareness 134 0.010 CNSInjury 282 0.018 Hemodynamicinstability 1414 0.077 Infection 48 0.021 MalignantHyperthermia 11 0.002 MedicationError 29060 2.462 PatientWrong,Site,Fall,Burn 58 0.005 PeripheralNerveInjury 175 0.015 Respiratory 2134 0.118 Resuscitation 2198 0.263 Spinal/Epidural/NerveBlock 75 0.006 UpgradeofCare 4554 0.276 VascularAccess 227 0.016 VisualLoss 10 0.004 40507 3.302

MINOR Airway/Intubation 4493 0.286 anyPONV 144141 9.660 Blood-Vascular 154 0.036 CentralLine/IVProblem 196 0.032 Dental/Oral/Tooth/Mouth 790 0.043 Dural/Wet/Headache 580 0.037 Equipment/Monitor 471 0.054 Eye/Ocular/Corneal 2291 0.133 Hemodynamicinstability 53499 3.700 Inadequatepostoperativepaincontrol 52142 5.805 Neuro-any 570 0.067 RegionalAnesthesiaProblem 342 0.035 Respiratory-Pulmonary 809 0.073 ReversalNarcotics 262 0.065 ReversalNMBAs 806 0.129 Unanticipatedupgradeofcare 1658 0.129 263204 20.283

MORTALITY Mortality 577 0.033 577 0.033

ASA News-continued

Anesthesia Quality Institute-continued(continued from previous page)


Summer 2013

The outcomes shown in theTableareaggregatedfrommultiplepractices,basedonavarietyofmeasuredefinitionsand data capture mechanisms rangingfrompaperformstoelectronicrecords.This heterogeneity is a barrier toaccurate benchmarking at present, andwhy the data in this table should betakenwithanappropriategrainofsalt.AQItookasteptowardsimprovingthissituation inApril, when we conveneda conference of anesthesia qualitymanagement experts and electronicrecordvendorstorecommendcommondefinitionsfortheoutcomesofgreatestinterest. The consensus documentproduced from this conference(Anesthesia Outcomes of Interest) canbe downloaded at http://www.aqihq.org/qualitymeasurementtools.aspx.

Currently just short of 9,000anesthesiologists participate inNACOR, or 20-25% of clinicallyactive anesthesiologists nationwide.This number continues to grow, asmore practices and facilities recognizetheneed for registrydata and externalbenchmarks. In addition to providinga measuring stick for judging andimproving the quality of patientcare, registry participation will beincreasingly important for meetingfederal regulatory requirements andthe demands of non-federal payors.TheCenterforMedicareandMedicaidServices (CMS) has released draftrules for public comment on thedefinitionandcertificationofQualifiedClinical Data Registries (QCDRs), asa mechanism for meeting incentiverequirements for Meaningful Use of

HealthcareTechnology,hospitalPayforPerformance, and individual providerparticipation in the Physician QualityReporting System. Similar languagehas appeared in several other federalwritingsinthepast6months,includingproposals for new healthcare paymentmodels contained in the draft Houselegislation repealing the SustainableGrowth Rate formula. It is clear thatregistryparticipationisadesiredoutcomeof healthcare reform. While intrusive,this is sensibleasacounterbalance fornewmodelsofpaymentthatincentivizecosteffectiveness.Transparentnationaloutcomereportingisessentialtoassurethepublicthatphysiciansandhospitalsare not skimping on necessary andindicatedcare.

NACOR data is now available tosupport academic and health policyresearch by physician scientists inany AQI-participating practice. AQIreleased the Participant User File(PUF)inearly2013:anaggregated,de-identified, cleaned version of selectedNACOR data fields. These data arealready being studied by more than adozeninvestigators,andseveralpapersareintheworkswhichwillprovideusanew and comprehensive understandingof the nature of anesthesiology in theUnited States. The AQI is using thisinformation internally to providehigh-level dashboards of summary datafor ASA and state-society leaders,anesthesia subspecialty societies, andimportantASAcommittees.InformationandinstructionsforaccessingAQIdatacanbefoundontheAQIwebsite(www.aqihq.org)underthe‘PUF’header.

AQI is also participating in a pair ofnew quality initiatives launched byASA. One is the inauguralAnesthesiaQuality Management meeting,scheduled for November 2013 ingreaterChicago. Thisweekendcourseis intended for anesthesia departmentquality management officers, and isdesigned to teach the basics of qualitymanagement in an anesthesia practice.More information canbe foundon theASAwebsite at http://education.asahq.org/qm2013.

A second initiative is thedevelopment, with ASA’s QualityManagement and DepartmentalAdministration (QMDA) Committee,of a ‘Quality Consultation’ programintended to provide high-functioninganesthesia practices with overallnational benchmarking of their efforts,documentationofclinicalperformance,andsuggestionsforfurtherimprovement.The consultation is based on a reviewof practice structure, NACOR data,personalinterviewsanda1daysitevisitbyateamofpracticing–andexperienced-- anesthesiologists. More informationon this program, including the kind ofdocumentation that canbe sharedwithhospitalleadershiporexternalagencies,[email protected].

Richard P. Dutton, M.D., M.B.A, Executive Director, Anesthesia Quality Institute

ASA News-continued

Anesthesia Quality Institute-continued(continued from previous page)


Summer 2013

S P E C I A L E D I T I O N

N E W S B R I E F

Board of Registration in Medicine

On February 1, 2012, a revision to 243 CMR 3, a portion of the Board’s regulations, will

take effect. Two changes to the regulations involve CME requirements. Physicians renew

ing their licenses after February 1 must have completed 3 hours in effective pain manage

ment, identification of patients at high risk for substance abuse, and counseling patients

about side effects, and the addictive nature and proper storage and disposal of prescription

drugs. This is a statutory requirement that was enacted by the Legislature in 2010.

A free online resource to obtain the necessary credits is available at

www.opioidprescribing.com. If your license is due to expire between now and February 1,

the Board encourages you to take the online course, or obtain credit from another program,

as soon as possible. The 3 credits will qualify as either Category I or II credits, and they

may be counted as risk management credits.

The revised Board regulations also include a new requirement for 2 CME credits in end of

life care. There are a number of programs offering end of life care CME, among them the

Massachusetts Medical Society (www.massmed.org).

The end of life care requirement also takes effect on February 1, and the Board similarly

encourages physicians with license expiration dates between now and February 1, to obtain

the necessary credits as soon as possible. End of life care CME credits also qualify as Cate

gory I or II, and may be counted as risk management credits.

The revised 243 CMR 3 can be found here:

http://www.mass.gov/eohhs/provider/licensing/occupational/physicans/regulations/

regulationsguidelinesandpolicies.html

If you have questions, please email Charlene Morelli at: [email protected]

NEW BOARD REGS BRING NEW CME REQUIREMENTS


Summer 2013

The American Board of Anesthesiology Phone: (866) 999-7501 • Fax: (866) 999-7503 • Email: [email protected] Website: www.theABA.org

ABA Releases Online Tutorial on MOCA® Program

RALEIGH, N.C. (October 27, 2011) — To enhance its ongoing effort to provide clarity on the

Maintenance of Certification in Anesthesiology (MOCA) program, The American Board of

Anesthesiology, Inc. (ABA) has developed an online tutorial to address frequently asked

questions and concerns of constituents.

The Maintenance of Certification (MOC) concept originated with the American Board of

Medical Specialties (ABMS) in 1999 as a professional response to the need for public

accountability and transparency of practice improvement initiatives by physicians.

The ABA recognized the importance of this initiative and developed the MOCA program to help

board certified anesthesiologists demonstrate to society their lifelong commitment to quality

clinical outcomes and patient safety.

The ABA designed this tutorial to familiarize viewers with the pathway to ABA certification and

maintenance of certification as well as educate them on their specific MOCA program

requirements.

Subjects covered by the tutorial include:

• Pathway to Maintenance of Certification

• Evolution of Certification Process

• MOCA Program Requirements

• Entering Requirements in ABA Portal Account

“We hope our diplomates and future diplomates will find this tutorial useful as we make

transparent the road to board certification and the Maintenance of Certification in

Anesthesiology program,” said David L. Brown, M.D., Secretary of the ABA Board of Directors.

“This tutorial is just one more way that the ABA is providing information to our diplomates on

MOCA,” said Dr. Brown. “This video will supplement other resources we have made available

on the ABA website, such as the Frequently Asked Questions section and MOCA requirements

by certification year.”

To view the MOCA tutorial go to:

http://www.theaba.org/Home/Videos


Summer 2013

MEMBERSHIP CHANGES 8/12 to 7/13AffiliateTraceyCacciatore,MD,BostonVAMCJennyFreeman,MDzkoheiIkeda,MD,MGHRinaKato,MD,MGHArminMaghsoudlou,MDBostonMCNathanielSims,MD,MGK

RetiredGiovanniCamerleghi,MD,LongmeadowDanielDedrick,MD,NCDwightGeha,MD,NatickNormanGould,MD,LeominsterSureshGulati,MD.Winchester,MAJohnK.Kim,MD,Andover,MAAstridLiland,MD,Hardwick,MAInderMalhotra,MD,LyndaJ.Means,MD,Portland,MEZoyaMehta,MD,Shrewsbury,MARihardMirabile,MD,Hingham,MALeslieShaff,MD,Newton,MAPeterSilverstein,MD,Canton,MA

DeceasedHarryE.Bowen,MDSamuelWiner,MD(8/1/13)

Active 989 Resident 528Affiliate 25Retired 193

New ActiveKathrynAberle,MD,BWHAjitaAmin,MD,BIDMCDavidAugust,MD,MGHAranyaBagchi,MD,MGHMagdelenaBakowitz,MD,BaystateMCSusanR.Banez,MD,GuardianAnesthesiaAntjeBarreveld,MD,NewtonWellesleyMaximBashkirov,MDSt.Ann'sHospPaulaBokesch,MD,St.Elizabeth'sMCAndrewR.Bond,MD,BWHKatherineBourne,MD,MelroseWakefieldMeredithBrown,MD,AAMPeterCalkin,MDManellyCapriles,MD,HolyokeMCMakaraCayer,MD,MassE&EDoW.Chan,MD,SturdyMemorialChristopherChen,MD,BWHLucyChen,MD,MGHFredCobey,MD,TuftsMCChristopherConley,MD,AAMFrederickConlin,MD,BaystateMCMarthaCordoba-Amorocho,MD,BWHKimberlyA.Cox,MD,BrocktonHospJosephCravero,MD,CHMCDuaneDixon,MDElizabethEastburn,MD,CHMCNasserEl-Mallah,MD,MercyHospDanielEllis,MD,CambridgeHABrianEngles,MD,So.ShoreHospArieFarji-Cisneros,MD,St.VincentKeithFargoza,MD,MGHBrianFerla,MD,BIDMCDevanM.Flaherty,MD,BWHRossFrohn,MD,EMCARECarolynFuruya,MD,HolyFamilyHospJenniferGerstle,MD,BIDMCAmirGholamii,MD,AAMAlexandraGordon,MD,AAMStefanIanchulev,MD,TuftsMedicalCtrOluwaseunJohnson-Akeju,MD,MGHVeselaKovacheva,MD,BWHBhargaviKrishnan,MD,MGHSanjeekKumar,MD,RIHospitalSaraLaFleur,MD,MGHJeanetteL.Lee,MD,NorwoodHospMichaelLeeman,MD,MGHIvanLesyuk,MD,LawrenceGeneralHospMazenMaktai,MD,MassGeneralHospAshishMalik,MD,BaystateMCParagMathur,md.AnethesiaAssoc.ofMAMelissaMatos-Auerbach,MD,MercyHospMarkMcKeen,MD,MGHDennisMcNichol,MD,BWHMarcMercoli,MD,BIDMCVikramNarayan,MD,LowellGeneralEmilyNelson,MD,BWHMichaelNguyen,MD,BWH

StevenNguyen,MD,BerkshireMCTeresaNing,MD,BaystateMCJohnJ.O'Connor,MD,BIDMCChristyPaiva,MD,St.Anne'sHosp.PirawanPan,MD,BrocktonHosp.RaymondPark,MD,CHMCDeeviaPatel,MD,MercyMedicalCtrSolmazPirzaden,MD,HolyFamilyHospAmyReed,MD,BIDMCGaryRoarck,MD,BeverlyHospitalJenniferRodges,MD,BIDMCGretchenRohrs,MD,HolyokeHospitalDerekRosner,MD,BaystateMCNiravShah,MD,TuftsMCMonicaSidor,MD,BaystateMCVictorijaSmith,MD,UMassMemorialMCJ.WilliamSparks,MD,CHMCThomasSung,MD,TuftsMedicalCtrScottSwitzer,MD,BaystateMCMinghamTsay,MD,BIDMCCynthiaTung,MD,CHMCVladimirVolfson,MD,LowellGeneralDongdongVau,MD,BWHCassandreVictor-Vega,MD,BaystateMCCuongVU,MD,BaystateMCMarkWechsler,MD,JordanHosp.AlexanderWolf,MD,BaystateMCZhongcongXie,MD,MGHJoyceYao,MD,BWHMartinZammart,MD,BWHJoseZeballos,MD,BWHMarthaZegarra,MD,AAM

BOX SCOREMEMBERSHIP TOTALS (8/1/13)


Summer 2013

http://placement.asahq.orgOrganizationsmaynowsubmitpositionsdirectlyonline.NewlysubmittedpracticeopportunitieswillbemadeavailableontheASAwebsitewithin24hoursofsubmission.Allpracticeopportunitypostingswillbeavailableforaperiodof60days.Thisonlineservicehasreplacedthequarterlyplacementbulletin,whichhadbeenmailedtointerestedASAmembers.PleasenotethatASAreservestherighttorejectanyjobsubmissionitdeemsinappropriate.

ThisnewfeatureoftheASAwebsitewillallowyourpositiontobemadeavailabletomorethan36,000anesthesiolo-gists.Also,younowhavetheoptionofincludingaphonenumber,faxnumberand/oremailaddresstoyourlisting.Toupdateyouravailablepositionsimplyclickonyourposting,makeanynecessarychangesandclickonthesubmitbutton.Yourchangeswillbeupdatedwithin24hours.Theplacementserviceremainsfreeofcharge.

AnyquestionsregardingtheASAPlacementServiceshouldbedirectedtotheASAExecutiveOfficeat(847)[email protected].

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Summer 2013

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Summer 2013

UPCOMING EVENTS

MSA Airway CourseFeb.2014

Waltham Woods Conference Center, MMS Headquarters, Waltham, MA

MSA 7th Sedation & Analgesia CourseApril 12, 2014

Waltham Woods Conference CenterMMS Headquarters, Waltham, MA

New England Anesthesia Residents ConferenceApril 2014

Hosted by Baystate Medical Center, Springfield, MA

MSA Annual MeetingMay 24, 2014

MIT Endicott HouseDedham, MA

2013 New England Residents' Practice Management ConferenceNovember 16, 2013

Beth Israel Deaconess Medical Center (Leventhal Conference Room) 2nd Floor Shapiro Building

8:00 am - 4:00 pm Topics:

ASA UpdateEvaluating a Prospective PracticeROE: getting paid for what you do

Performance Measurements for Working AnesthesiologistsSurgical Home

Hospital & Medical Staff relationsEmployment Contracts, How to Interview: What's your style?

Private Practice vs AcademiaDoes increased OR efficiency equal patient risk?

(no charge for residents, breakfast & lunch included)Contact info: [email protected]


Summer 2013


Summer 2013

MASSACHUSETTS SOCIETY OF ANESTHESIOLOGISTS318 BEAR HILL ROAD, SUITE 4AWALTHAM, MA 02451781-890-9174 fax 781-890-9173 e-mail [email protected]

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• For General Anesthesia cases, you no longer have to accept $39.00 per unit.

• For Pain Management procedures, you no longer have to accept reimbursement rates of 20% - 30% of your fee.

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