A Message from the President

by Joseph F. Answine, M.D. Joseph F. Answine, M.D. is the President of the Pennsylvania Society of Anesthesiologists, Alternate Representative, to the Specialty Leadership Cabinet of the Pennsylvania Medical Society Alternate Delegate to the Pennsylvania Medical Society and Delegate to the American Society of Anesthsiologists. Whatever happened to the day when medicine was practiced by physicians? “It isn’t what we say, but what we do that defines us.” Very profound, isn’t it. I think that I heard it while watching a BATMAN movie. Nevertheless, it is still a profound statement, and fits very well here. At our last membership meeting in San Francisco, we introduced a very extensive and challenging agenda for our society covering the next few years. We have begun to work on many of the objectives that we discussed during the meeting. Our strategic plan as well as the defining of our organization and specialty are well underway. We have hired a public relations firm to help with our branding process, to get our message out through the media especially when important issues arise, and to reorganize and put a new face to our website. The western Pennsylvania chapter of the PSA (WPSA) already has monthly membership meetings, and we are in different stages of planning for PSA membership meetings in other regions of the state. House Bill 1256 is at a standstill within committee, and we are working to keep it there. We have also worked aggressively to keep nurse anesthetists from having independent practice while performing pain management procedures. At the time that we are going to press with the newsletter, Aetna has decided to delay the implementation of their policy on anesthesia coverage for endoscopies. Health American pulled their policy effective 2/29/08. One of our most aggressive efforts, however, has been directed towards reversing the current policy by Aetna, Health America and Humana to refuse payment for anesthesia care during routine endoscopies. They seem to feel that anesthesia services and providing moderate to deep sedation is too expensive, and it does not provide an added benefit to the patient. Why should we care? Most endoscopies are performed without an anesthesiologist present. Most have nurse anesthetists supervised by the endoscopist if there is an anesthesia provider present at all. We are fighting to keep the decision as to what is medically necessary in the hands of the doctors. We are also fighting for patient safety. Again, those that are non-medical are dictating medical practice. Whatever happened to the day when medicine was practiced by physicians? Whatever happened to the day when physicians decided, in a collaborative effort with their patients, on a medical regimen and it was carried out without the influence of outside forces? I am starting to think that we, the physicians, are the only ones that do not have a say in the care of our patients as well as the future of medicine. Fighting this policy change seems to be what this organization is about. Protecting the future of anesthesiology and more importantly our patients is a major part of our mission as a society. Well, it is time we take the offensive. It is time we take back medicine. We are attacking this from multiple directions. We have written a letter, using all our resources such as our legal and legislative teams, to the insurance carriers involved. This letter mimics the sentiments of the American Society of Anesthesiologists; however, we have also stressed the risks involved with going back to conscious sedation with benzodiazepines and narcotics such as Midazolam, Fentanyl and Demerol.Risks such as prolonged respiratory depression when personnel specializing in airway management are not around as well as the rare but potentially fatal serotonin syndrome come to mind. We are using our public relations firm to take this to the patients and their employers. These are the consumers and they need to know what their insurance carriers are doing or not doing on their behalf. The patients should be made aware before they arrive in the gastroenterology suite or ambulatory surgery center for their procedure, only to find out at the last minute (after they have endured a bowel prep) that their anesthesia care is not covered by their insurance carriers. We also realized that we could not do this alone. This has become a group effort. We have discussed this issue whether in person, by e-mail, or by phone with the gastroenterologists and general surgeons of this state, anesthesiologists and endoscopists from other states, representatives for the state’s ambulatory surgical centers, representatives from the Pennsylvania Medical Society, specialty group administrators and the Pennsylvania Association of Nurse Anesthetists. We have formed alliances with many of the organizations. We are a unified front. Democrats and Republicans may fight over an election, but later come together to pass a law to benefit all people regardless of party affiliation. Nothing is different here. We will always continue to fight over our roles in this healthcare world. Healthcare is our concern for the process and the patient. It is still what we do. We want informed decisions made. While the outcome is undecided, we will use every measure to insure the best outcome for our patients. The carriers will know we are involved.