I’m always amazed by the buzz, the energy, the dynamic vibe of these physician meetings. At this year’s annual meeting of the California Medical Association (CMA), which took place October 15-17 in Sacramento, I had the honor of representing CSA along with Drs. Mark Zakowski, Karen Sibert, Peter Sybert, Jeffrey Poage, Paul Yost, and Michelle Raney, seasoned politicos all.
We were a flurry of suit-jacketed activity. From meeting to meeting, event to event, in the shadow of the State Capitol, the unifying intent was somehow—with a word, idea, or discussion—to advance the anesthesiology cause. I’m incredulous, at times, of my colleagues’ inexhaustible stamina. Do these guys ever get tired?
The CMA Annual Meeting can be an overwhelming place for an anesthesiologist. The key to these giant “smorgasbord” meetings is to focus on political objectives, and to screen topics and resolutions that might threaten the practice and the profession of anesthesiology.
To those unfamiliar with the critical role of the CMA in California politics, the CMA functions as the lead advocate and legislative clearinghouse for all things concerning health care in Sacramento. As a legislator once told me, most politicians are generally ignorant about the medicine and health care issues that they are voting on. They increasingly rely on the CMA to “sign off” on the safety and impact of health care-related legislation.
The CSA delegation generally splits up to take part in the work of two committee delegations: the Specialty Delegation and the Hospital-Based Practice Forum. The CSA has two official delegates and two alternates to the Specialty Delegation, which Dr. Raney will chair this year. I am both a delegate and the Chair of the Hospital-Based Practice Forum. Through these two committees, and the myriad side meetings, we pressed our objectives and screened CMA initiatives.
AB 72 and out-of-network billing: The CSA delegation was able to get a thorough accounting from CMA lobbyists regarding the negotiations, passage, and known details of the final form of AB 72. A longer article about the bill and its impact on anesthesia practice billing will be forthcoming in the future, but suffice it to say – AB 72 and its bureaucratic pathway known as the Independent Dispute Resolution Process (IDRP) for resolving out-of-network (OON) patient bills will present a headache for California anesthesiologists. We all collectively sighed over the bill’s onerous features, but it is still better for anesthesiologists than its predecessor, AB 533, would have been had it passed instead.
Certified Anesthesia Assistants (CAAs): The CSA delegation was able to begin discussions on the framework and strategy of potential CAA licensure legislation with CMA lobbyists both in committee and at the local Starbucks (yes, this is how important meetings occur sometimes!). There will be more to come in future postings, but the CSA will be working closely with the CMA on advancing CAA legislation soon. Potential help is coming one day to your practice—just you wait.
Screening CMA Initiatives
The CMA this year changed the format for resolutions and proceedings at the House of Delegates (HOD). Resolutions seeking CMA approval are now submitted continuously and reviewed quarterly by the CMA. Major topics approved by the Committee of Delegation Chairs (CDC) were discussed at the delegation caucuses and meetings, and presented at the 2016 HOD.
The major topics were MACRA, Opioids (the CURES database), the California ACA Opt-out, Physician Burnout, Maintenance of Certification (MOC), and a 5-Year Public Health Plan. These were reviewed and discussed at length.
CMA will advocate for changes in MACRA, and in the CURES database to minimize physician hardship from financial, legal and time constraints. CMA will work with specialty societies on changes to MOC requirements, and on addressing physician burnout, acknowledging that some specialties are more susceptible. CMA committees will work on a California Public Health Plan to guide future CMA policy, and on a proposal for California to “opt out” of the Affordable Care Act (ACA) insurance exchange and provide a “public option”.
The Red Flags
Overall these major topics were uncontroversial, but the CSA delegation noted two red flags.
Crushing future bureaucratic burdens: AB 72, the formation of the IDRP from AB 72, MACRA, the CURES database reporting, and even the escalation of MOC requirements will result in a time-consuming physician administrative burden that may make future physician practice undesirable and distract physicians from patient care.
The irony (which we expressed to the CMA leadership) is that all of the major topics discussed by CMA, should they become actual policy, are probably going to contribute to more physician burnout. Do we really need any more badly designed EHRs, checklists, or data outcome reporting? I really worry about the well-being of physicians in California, a regulation-happy state. Physicians don’t need more psychological support for burnout—we need fewer regulations.
The long shadow of single-payer California: Every year, multiple physicians at CMA push single-payer California, usually in the form of a resolution, and every year it is defeated by the HOD. This year’s compromise is to have a committee investigate an ACA waiver or “opt-out”, allowing the California health insurance exchange to have a public option (Medicare or MediCal).
I had several long (and interesting) discussions with the single-payer proponents at this year’s CMA HOD. I have repeatedly said at CMA functions that Medicare/MediCal anesthesia reimbursement would decimate and perhaps destroy private and academic anesthesia practices. The single-payer proponents I talked to, while understanding and sympathetic, will continue to push on despite the potential harm to multiple medical specialties. The issue of uninsured patients in California will continue, and we should be aware. We will need to continue to engage in finding a solution to this perpetual concern, because it never will go away until organized medicine finds a political solution.
The highlight of the weekend was the CMA charity gala, with everybody breaking out the formal gala wear. As I sat at the CSA table, amongst the smiles and finery, I wondered about the near future. In the end, the political and administrative challenges ahead for the CSA and California anesthesia practices may appear overwhelmingly daunting and upsetting. Sometimes I fear they will crush my practice, completely removing me from patients, leaving me detached, cynical—perhaps the CMA poster-child for “physician burnout”. Was I burned out?
My concerns seemed so distant as the CSA table laughed about “lighter’ topics such as the upcoming Trump/Clinton presidential election. My political colleagues seemed not to share my worries. The gala, whose purpose was to support medical students in the CMA, was full of fresh-faced future physicians looking forward to a long medical career—all smiles, even from the young.
I looked at Karen, Paul, Mark, Peter, Jeff, Michelle and many of my CSA colleagues, so enthusiastic and united in our cause of advancing physician-led anesthesia care here at CMA and in the State Capitol. For that moment, at least, my colleagues showed no sign of fear or foreboding. No hint of burnout either. They embolden me. They should embolden you. CSA has a lot of fight—a lot of fire in it. Far, so very far, from burned out.
Harrison Chow, MD, is a longtime contributor to CSA Online First, and is in private practice at CEP Anesthesia and Good Samaritan Hospital in San Jose. He currently serves as Advocacy Coordinator for CEP Anesthesia, and holds an adjunct clinical instructor position at Stanford Department of Anesthesia. He chairs the Hospital-Based Practice Forum at the California Medical Association.