AANA Anesthesia E-ssential


Vital Signs

Introducing Our New Look

Since 2009, the Anesthesia E-ssential has appeared in your email inbox biweekly with concise, pertinent news about your practice and professional organization. With this issue, we are proud to introduce our updated design, which we hope will provide our readers with enhanced readability and ease of navigation.

The editorial staff has also been gathering feedback from members about the information you want and need in this publication. As we move forward honing the E-ssential's editorial content and design, we look forward to bringing you the latest on the future of technology, business, and healthcare trends while still providing important news about your profession and the AANA.
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CPC Pulse

Information in this section is provided to help CRNAs keep their finger on the pulse of what's happening with the NBCRNA's Continued Professional Certification (CPC) program, which will launch on Aug. 1, 2016

Locum Tenens and Class B Credits

Are you a locum tenens CRNA wondering how to earn 40 Class B credits for the CPC program? It’s important to know that the CPC program is flexible and recognizes many options for earning Class B credits. For example, if you earn more than 60 Class A continuing education credits over four years, you can choose to apply those excess credits to help fulfill your Class B requirement. In fact, Class A credits can be used to fulfill your entire Class B requirement (all 40 credits). If your state has RN or APRN licensing requirements, such as infection control, communications, ethics, or pain management, that are not prior approved or assessed, you can apply those credits to meeting your Class B requirement. If your employer has in-services focused on patient safety or nursing, those also would be Class B activities. Credits from state or national nurse anesthesia meetings can be applied to Class B requirements if the meetings are not assessed or prior approved. The CPC Program is meant to support your practice and your educational plan. If you have questions about Class B, you can find a table of activities on the NBCRNA website, or contact the NBCRNA to talk about how the activities you are already doing may meet the Class B requirement.
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Hot Topics

Proposed Bylaw Amendments and Resolutions to be Published Online

Due to the changed submission deadline that took effect this year, proposed AANA Bylaw Amendments and Resolutions will be published online instead of in the July issue of AANA NewsBulletin because of a conflict with printing deadlines. The proposed Bylaw Amendments and Resolutions to be debated at the August 30, 2015, AANA Business Meeting will be posted online by July 15 at: http://www.aana.com/myaana/AANABusiness/governance/Pages/AANA-Annual-Business-Meeting-Agenda-and-Information.aspx. In the event a member does not have online access, you may request that a hard copy be mailed to you via a message to mscheuermann@aana.com or phone (847) 655-1101.
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CRNA-PAC Committee Seeking Applications: Deadline June 30

The CRNA-PAC Committee is currently seeking applications to fill a vacant CRNA seat for FY2016 and FY2017. Deadline for submission is June 30, 2015. Submit an application via this link. The Board of Directors will consider CRNA-PAC applications at its July meeting. A slate of three candidates will be forwarded to the CRNA-PAC Committee, and a special election by the Committee will be held in August 2015. The selected member will be notified by the Committee.
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Open Session of AANA BOD Meeting to be Live Streamed

Pre-registration is required for the live stream of the Open Session of the AANA Board of Directors Meeting, which will be held on Saturday, July 11, at 9 a.m. CDT. Click here for more information. Registration deadline is July 10. All AANA members are welcome to attend the Open Session, to be held at the AANA office, 222 South Prospect Avenue, Park Ridge, IL.
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New AANA Infographic Promoting CRNA Quality and Safety

"CRNAs: Ensuring Safe Anesthesia Care," the third infographic developed by the AANA as part of the public education campaign CRNAs: The Future of Anesthesia Care Today, is now available on the official campaign website at www.future-of-anesthesia-care-today.com/get-involved.php. The new infographic explains why surgeons and other healthcare providers rely on CRNAs to ensure patient safety, referencing a recent landmark study and report, and explaining how surgeons and other professionals face no increase in liability when working with a CRNA versus an anesthesiologist. The infographic is intended for members to utilize when lobbying, being interviewed, testifying, public speaking, and more. Other infographics available on the website include: "CRNA Education and Training" and "Anesthesia and the Changing Healthcare Landscape: CRNAs' Valuable Role." Check them out, use them often!
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AANA Launches CPC Facts Website for Members

Visit CPC-facts.aana.com today to stay on top of requirements for the NBCRNA's Continued Professional Certification (CPC) program.
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Coming Soon: New Book to Explore Legendary CRNA Ira Gunn's Writings and Wisdom

An invaluable collection of articles, letters, papers, and musings from the mind and typewriter of Ira Gunn, CRNA, is set for publication at the end of August 2015, in time for the Annual Congress. Ira P. Gunn, Nurse Anesthetist: Writings and Wisdom from a Legendary Nursing Leader compiles the best of Gunn's prolific written and spoken defense, analysis, celebration, and record of the nurse anesthesia profession. A long-time clinician, soldier, educator, and AANA volunteer, Gunn passed away in 2011 at the age of 84 and was interred at Arlington National Cemetery in Arlington, Va., but her impact lives on in the thoughts and words she left behind. Ira P. Gunn, Nurse Anesthetist, compiled by editors Jay Horowitz, BSN, CRNA, ARNP; Rita Rupp, MA; and Maura McAuliffe, PhD, CRNA, FAAN, will be a is a must-read for every CRNA and student registered nurse anesthetist.
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Professional Practice

Guidelines for Evaluation of Patients for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection

The Centers for Disease Control and Prevention (CDC) recommend that healthcare providers and health departments throughout the US be prepared to detect and manage cases of MERS. CDC recommends that healthcare providers continue to routinely ask their patients about their travel history. Detailed recommendations and resources can be accessed at on the CDC’s website: Updated Information and Guidelines for Evaluation of Patients for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection and Middle East Respiratory Syndrome (MERS) information page.
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NPSF Issues Guidelines on Root Cause Analysis

The National Patient Safety Foundation (NPSF) has released guidelines developed to help healthcare organizations improve the way they investigate medical errors, adverse events, and near misses. Download RC²: Improving Root Cause Analyses and Actions to Prevent Harm to learn more about root cause analysis best practice methodologies, and techniques.
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Overcoming the Challenges of Providing Care to LEP Patients

If your organization hasn’t experienced the challenges of providing care to a patient with limited English proficiency (LEP), the likelihood of it happening in the near future is very good. Approximately 57 million people, or 20 percent of the U.S. population, speak a language other than English at home, and approximately 25 million, or 8.6 percent of the U.S. population, are defined as being LEP. Read the Joint Commission’s May 2015 Quick Safety issue which highlights considerations for providing care to LEP patients.
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Professional Practice and SGA Staff Present at Becker’s Healthcare Conference

On Thursday, June 11, 2015, Lynn Reede, CRNA, DNP, MBA, senior director, Professional Practice, and Sarah Chacko, JD, assistant director of State Government Affairs and Legal, spoke at the Becker’s Healthcare: 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference. The topic of their presentation was “CRNAs: Value for Your Team and Your Bottom Line.” The audience included individuals interested in incorporating CRNAs into their anesthesia practices. Check out the AANA Facebook page for a picture of Lynn, Sarah, and Anna Polyak, RN, JD, senior director, State Government Affairs, with the conference’s keynote speaker and Pro Football Hall-of-Famer Deion Sanders.
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Meetings and Workshops

Coming This Fall: Popular Hands-On Workshops

Check out the Meetings and Workshops webpage on the AANA website and future issues of the AANA NewsBulletin and Anesthesia E-ssential for further information.
  • Essentials of Obstetric Analgesia/Anesthesia Workshop: October 21, 2015, Park Ridge, Ill.
  • Spinal and Epidural Workshop: October 22-24, 2015, Park Ridge, Ill.
  • Jack Neary Advanced Pain Management Workshop Part II, October 10-11, 2015, Rosemont, Ill.
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Fall Leadership Academy: Save the Date

This year's Fall Leadership Academy will be held Nov. 6-8, 2015, at the Westin O'Hare, Rosemont, Ill. The Fall Leadership Academy is a unique opportunity to meet current and future leaders, catch up with old friends, and create new relationships. Watch the AANA website and future issues of the NewsBulletin and E-ssential for more information!
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Register Now for the Upper and Lower Extremity Block Workshop

To be held Sept. 26-27, in Park Ridge, Ill., this program will expand the skills and expertise of CRNAs using upper and lower extremity block anesthesia. The program will include case studies, hands-on demonstrations, return demonstrations, and skill validation. Register now.
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Foundation and Research

Calling All Photographers and Artists... Create and Donate – Support the AANA Foundation – You May Win a Prize

The AANA Foundation is hosting an Art on Canvas silent auction at the upcoming Annual Congress. We are inviting CRNAs and SRNAs to print a favorite photo on canvas, or paint a picture on canvas, and donate it to the AANA Foundation to be entered in the auction. Artwork will be on display in the AANA Foundation Poster room at the 2015 AANA Nurse Anesthesia Annual Congress in Salt Lake City, Utah.

Participants may enter any original photo or painting, but are asked to adhere to the following guidelines:
  • Photographs*/artwork should be printed/created on canvas
  • Standard gallery wrap (3/4")
  • No larger than 20" X 28"

* http://www.canvasworld.com/product/size is one option to get canvas prints produced.

Visitors to the AANA Foundation Poster Room will have an opportunity to vote for their favorite photo or painting. All donors will receive a gift-in-kind letter and the artist with the most votes will win a prize.

Proceeds benefit the AANA Foundation and its mission to advance the science of anesthesia through education and research.

To enter a photo or painting in the auction, contact Luanne Irvin at (847) 655-1173 or lirvin@aana.com to announce participation (limited to the first 20 participants). Please respond no later than July 31, 2015.
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Donate Today for Annual Congress Recognition

Thank you to all AANA members who have supported the AANA Foundation in fiscal year 2015. Your support is so important in advancing nurse anesthesia education and research. If you haven’t made your donation yet, please do so by July 1, 2015 to be included in the AANA Foundation’s FY15 Annual Report (donations of $100 or more will be included). Click here to access the Foundation’s secure donation page. Again, thank you for your support!
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Fundraising Events at Annual Congress – Purchase Your Tickets Today

Support the AANA Foundation and purchase your tickets when you register for the AANA 2015 Nurse Anesthesia Annual Congress.

One Night – Twice the Fun

This fabulous and fun event featuring Hollywood Revisited and Shake It for a Cause Dance Party will take place on Sunday evening, August 30, 2015. Visit our event web page at One Night – Twice the Fun to learn more.

18th Annual Golf Tournament at Eaglewood Golf Club
Plan to join us on Friday, August 28, 2015, at 1:30 pm when we tee off. Click here to visit the golf tournament webpage and learn more.

Questions? Please contact Luanne Irvin, AANA Foundation Development Officer, at (847) 655-1173 or lirvin@aana.com.
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Federal Government Affairs

AANA Members in Key Districts Urged to Oppose ASA-backed Rural Anesthesia Legislation

An ASA-backed piece of legislation would increase rural healthcare costs without improving quality, and the AANA is urging members residing in districts represented on the Senate Finance Committee and House Ways and Means Committee to contact their members of Congress in opposition to this legislation.

The problematic bill, the “Medicare Access to Rural Anesthesiology Act of 2015” (HR 2138) introduced by Rep. Lynn Jenkins (R-KS), seeks to establish “parity between anesthesiologists and certified registered nurse anesthetists (CRNAs) by allowing anesthesiologists to receive pass-through payments in the same fashion CRNAs receive pass-through payments.” In a letter authored by President Sharon Pearce, CRNA, MSN, the AANA said, “As proposed, HR 2138 will increase the overall cost of anesthesia delivery in rural America without improving outcomes or access for rural Americans, placing additional financial burdens upon rural hospitals already facing financial challenges.” Similar legislation was introduced in past Congresses, but efforts by the AANA halted the legislation from moving.

If you reside in a district or state whose legislator serves on the Senate Finance or House Ways & Means Committees, please take action here. You should also have received a CRNAdvocacy Alert message you can use to take action. See the AANA’s letter (requires AANA member login and password), here. Read HR 2138 at
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Update on Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care

The AANA and its members continue to advocate for legislation and a Veterans Health Administration (VHA) proposal that would authorize all advanced practice registered nurses (APRNs), including CRNAs, to practice as Full Practice Providers in the VHA and help improve access to quality healthcare for all veterans. Here is a status update:
  • The AANA is supporting legislation in the House, HR 1247, the “Improving Veterans Access to Quality Care Act,” sponsored by Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL). The bill now has 31 bipartisan cosponsors, up two from last week. The AANA encourages members whose U.S. Representative has cosponsored this legislation to send a thank you note (here). Please continue to contact your U.S. Representative and encourage co-sponsorship of this bill. Please do so here. View the AANA and APRN Workgroup letter of support here and also view the Nursing Community letter here.
  • The AANA has expressed strong concerns about legislation in the Senate, S 297, the “Frontlines to Lifelines Act,” sponsored by Sen. Mark Kirk (R-IL), which is now scheduled for markup in the Senate Veterans Affairs Committee on July 14. Unlike the House bill (HR 1247), S 297 recognizes only three of the four APRN specialties for Full Practice Authority in the VHA, omitting CRNAs. The AANA encourages CRNAs to contact their U.S. Senators with similar concerns about S 297, and to request that the bill be amended to include CRNAs. Please do so here. See the AANA testimony on S 297 here, and the APRN Workgroup testimony here.
  • The AANA continues to strongly support the VHA’s efforts to update its Nursing Handbook to recognize CRNAs and other APRNs to their full practice authority, consistent with the recommendations of the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. According to the VHA, the agency intends to publish regulatory rulemaking later this year recognizing CRNAs and other APRNs to their full practice authority in the VHA. Thousands of AANA members have already contacted the VHA in support of this work; AANA members are currently being requested to focus on contacting Congress.
Since mid-February, AANA members have sent over 13,500 messages to their federal legislators expressing support for HR 1247 and concern for S 297 as written.
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Reauthorization for Nursing Workforce Development Funding, Nurse Anesthesia Traineeships Introduced in the U.S. House with AANA Support

The co-chairs of the U.S. House of Representatives Nursing Caucus, Reps Lois Capps (D-CA) and David Joyce (R-OH), introduced legislation on June 10 that would reauthorize funding for nurse workforce development programs, including Advanced Nursing Education and Nurse Anesthesia Traineeships for qualifying CRNA programs. The AANA joined the nursing coalition called the Nursing Community in supporting the “Title VIII Nursing Workforce Reauthorization Act of 2015” (HR 2713), which reauthorizes funding for these critical programs through fiscal year 2020. In the statement, the coalition writes that the legislation “is a critical investment that will enhance the future of the nursing profession as it continues to provide our nation’s patients with the high-quality healthcare services needed for a healthier tomorrow.” The AANA continues to monitor this legislation and will continue to provide updates regarding HR 2713. To read more information on the legislation, see here. View the full statement submitted by the Nursing Community here.
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U.S. House and Senate Markups Scheduled for Fiscal Year 2016 Healthcare Funding Bills

Both the House and Senate are moving health funding bills earlier than in past years, but their prospects for enactment later this summer remain challenging. Within these Labor-HHS-Education appropriations bills, the AANA works to support nurse workforce development funding and health research, and to oppose attacks on CRNAs.

The U.S. Senate Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee approved its fiscal year 2016 spending draft legislation in time for full committee action on the bill scheduled for Thurs. June 25. In the U.S. House, the full Appropriations Committee was scheduled to review the healthcare appropriations bill Wed., June 24.

The U.S. House version includes a $299 million funding decrease from current levels for the Health Resources and Services Administration, but maintains level funding for Title 8 Nursing Workforce Development programs at $231.6 million for FY 2016. Nursing Workforce Development funding covers loan repayment programs, nurse anesthesia traineeships, and other initiatives for which nurse anesthesia educational programs apply competitively. The legislation includes a $1.1 billion increase in funding for the National Institutes of Health, which is over the Administration’s requested amount. The AANA will keep you informed as additional details emerge. To read more about this legislation, see here.
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AANA and 144 Healthcare Organizations Oppose Termination of Agency for Healthcare Research and Quality

Joining with 144 other healthcare organizations in a letter to Congress, the AANA expressed concern that the FY 2016 U.S. House Labor, Health and Human Services, Education and Related Agencies appropriations bill would eliminate the Agency for Healthcare Research and Quality (AHRQ). AHRQ, an agency charged with generating the evidence necessary to propel the healthcare system forward and help implement evidenced-based techniques into practice, would be eliminated if the draft appropriations bill moves forward without modification.

“AHRQ-funded research is being used in hospitals, private practices, health departments, and communities across the nation to make our health care system less complex and costly,” the letter stated. “To ‘terminate’ AHRQ in the current fiscal environment is pennywise and pound foolish. Our nation spends $3 trillion annually on health care—the largest share of which are federal purchases through Medicare, Medicaid, the Federal Employees Health Benefits Plan, insurance exchanges, TRICARE, and veterans’ health care.” The AANA is actively engaged in the appropriations process and will keep you informed as the process moves forward.

Read the Friends of AHRQ Coalition letter here (AANA member login and password required).
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AANA Submits Recommendations to Senate Finance Committee to Improve Healthcare for Patients with Chronic Conditions

The AANA submitted to a Senate Finance Committee working group on June 22 a letter outlining policy options that show how CRNAs can make healthcare delivery more efficient for patients with chronic conditions.

In a letter signed by AANA President Sharon Pearce, CRNA, MSN, the AANA expressed that by allowing CRNAs and other APRNs to practice as full practice provides, the Medicare system would eliminate several barriers to practice that restrict team-based care and could help slow the growth of Medicare spending. President Pearce wrote, “Full practice authority for APRNs is a positive step toward transitioning from the current fee-for-service structure toward a more coordinated team-based care approach for patients with chronic conditions; utilizing the full capabilities of all qualified members of the healthcare delivery team… Eliminating costly and unnecessary requirements for physician supervision and medical direction of CRNA anesthesia services within the Medicare system supports the efficient delivery of healthcare for patients with chronic conditions and allows the appropriate member of the care team the ability to deliver the highest quality of care in the most cost effective manner.”

To read the full letter, see here (AANA member login and password required).
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AANA Urges CMS to Recognize and Reward CRNAs in Bundled Payment Systems

As the Centers for Medicare & Medicaid Services’ (CMS) Bundled Payments for Care Improvement (BPCI) initiative is expanded, CMS should recognize and have a role for the full range of qualified healthcare providers, such as CRNAs, according to AANA’s June 11 comments on the agency’s Hospital Inpatient Prospective Payment System proposed rule.

AANA President Sharon Pearce, CRNA, MSN, stated that “bundled payment systems should recognize the full range of qualified healthcare providers delivering care, including CRNAs and other APRNs, and avoid physician-centricity that increases costs without improving quality or access. Every bundled payment model that involves anesthesia services should recognize and account for, and so be able to hold accountable, the qualified healthcare professionals who delivered care to the patient.”

The comment letter also recommended that CMS:
  • Consider including the cost of anesthesia delivery models and cost of anesthesia subsidies per anesthetizing location as part of the efficiency of cost reduction measures for the Hospital Value-Based Purchasing Program.
  • Should be wary about allowing large group practices, such as those comprised solely of anesthesiologists, to have control over administering bundled payment amounts.
  • Provide payment data transparency with respect to components in the bundled payment.
  • Not institute any policy or requirement for the bundled payment program that would result in differential payment for the anesthesia service based on whether it is furnished by an anesthesia care team or by an anesthesia provider working solo.

Read the AANA letter here. Read the CMS proposed rule here.
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New HHS Office of Inspector General Mid-Year Update for 2015 Work Plan Includes “Personally Performed” Anesthesia Services Notice

The Health and Human Services Office of Inspector General (HHS OIG) issued a mid-year update of its 2015 work plan that continues including 2014 and 2015 plans’ language on “personally performed” anesthesia services.

The 2015 mid-year work plan states, “We will review Medicare Part B claims for personally performed anesthesia services to determine whether they were supported in accordance with Medicare requirements. We will also determine whether Medicare payments for anesthesia services reported on a claim with the ‘AA’ service code modifier met Medicare requirements. Physicians report the appropriate anesthesia modifier code to denote whether the service was personally performed or medically directed. (CMS, Medicare Claims Processing Manual, Pub. No. 100-04, ch. 12, § 50) Reporting an incorrect service code modifier on the claim as if services were personally performed by an anesthesiologist when they were not, will result in Medicare paying a higher amount. The service code ‘AA’ modifier is used for anesthesia services personally performed by an anesthesiologist, whereas the QK modifier limits payment to 50 percent of the Medicare-allowed amount for personally performed services claimed with the AA modifier. Payments to any service provider are precluded unless the provider has furnished the information necessary to determine the amounts due. (Social Security Act, §1833(e).)”

See the mid-year update of the 2015 work plan starting on p. 24 here.
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Healthcare Payment and Learning Action Network Holds its First Webinar and Discusses Next Steps

AANA staff participated in a webinar of the Healthcare Payment Learning and Action Network (LAN) on June 10. Hosted by the Centers for Medicare & Medicaid Services (CMS) in partnership with private entities, the LAN is intended to examine issues and challenges associated with the development and deployment of alternative payment models for Medicare. The AANA is a stakeholder and member of the LAN and was invited to participate in the webinar.

Mark McClellan, MD, PhD, who serves as co-chair of a 24- member committee guiding the LAN, discussed four areas of focus of the group moving forward; 1) define terms and concepts associated with alternative payment models, 2) make the business case for building and implementing alternative payment models, 3) remain cognizant of how the movement toward alternative payment models will impact low income and vulnerable populations, and 4) share best practices, early results, and learning from alternative payment models. Next, the LAN is convening four workgroups, the first of which will be responsible for developing a standard set of alternative payment model terms. The LAN also will host an in-person meeting in Washington, DC, this fall. The AANA continues to advocate for CRNA practice and reimbursement in the new LAN process and to monitor the activities of the LAN, and will provide updates. To learn more about the Health Care Payment Learning and Action Network, visit
and to register for the Health Care Payment Learning and Action Network, go to http://innovationgov.force.com/hcplan.
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  • If you see your legislators or their staff at home, let us know how your visits went by logging your visit on the CRNA-PAC website (AANA login required) and sending us pictures to info@aanadc.com. To see when Congress is in Washington or at home, go to House schedule, Senate schedule.
  • At press time, the U.S. Supreme Court was expected to rule by July 1 on the King v. Burwell case on whether individuals are eligible for insurance subsidies if their state does not run a state-based insurance marketplace under the Patient Protection and Affordable Care Act (ACA). The Administration has not unveiled a contingency plan if the Court rules with the plaintiff. U.S. House and Senate Republican leaders have said that they discussed several legislative options should the Court strike down subsidies in states with federal healthcare exchanges – but the Administration has not expressed support for any of them. Federal legislative options include: 1) extending the subsidies for up to two years and repealing the individual and employer mandates, 2) repealing insurance mandates and extending subsidies through 2015, and then in 2016 states could opt out of all ACA rules and regulations but continue to receive ACA funding through 2017, or 3) keep the health insurance subsidies in place regardless of a state or federally facilitated exchange through 2017, and repeal the law entirely in May 2017. The AANA will keep you informed when the Supreme Court unveils their ruling on King v. Burwell and any legislative contingency plans. Read more information on the King v. Burwell case here.
  • On Thursday, June 18, the U.S. House passed legislation (HR 160) repealing a tax on medical devices by a vote of 280-140. The tax is part of the Affordable Care Act’s financing, and is one of several bills that congressional Republicans are promoting to repeal various aspects of the Act. The legislation is now headed to the Senate for debate, but President Obama has said that he will veto the legislation if it passes both chambers. See how your U.S. Representative voted here.
  • The Federal Trade Commission (FTC) will be issuing guidance following a recent U.S. Supreme Court decision (North Carolina Board of Dental Examiners v. Federal Trade Commission) that ruled medical and other professional state boards must act in a manner consistent with federal antitrust laws. The high court ruling was consistent with an amicus brief filed by the AANA and several nursing groups. According to FTC Commissioner Julie Brill, the Court ruling has caused many states to question what next steps are necessary for regulating their state professional licensing boards. The AANA will continue to keep you informed as further guidance is released. See information about this case at http://www.scotusblog.com/case-files/cases/north-carolina-board-of-dental-examiners-v-federal-trade-commission/. See the AANA amicus brief here.
  • Former Florida Governor Jeb Bush and businessman Donald Trump formally announced their candidacies for President in June, bringing the total of Republican 2016 contenders up to more than 12. For the Democrats, Sen. Bernie Sanders (I-VT), former Senator and Secretary of State Hillary Clinton, Former Maryland Governor Martin O’Malley, and Former Rhode Island Governor Lincoln Chafee have announced their candidacies for the 2016 Democratic Presidential nomination. The AANA encourages CRNAs to engage with the presidential campaign of their choice, particularly in the early caucus and primary states of Iowa, New Hampshire, South Carolina and Nevada. Neither the AANA nor the CRNA-PAC support or endorse candidates for President. If you have any questions, contact your AANA team in Washington at info@aanadc.com.
  • Stay up to date on CRNA reimbursement issues by obtaining Version 3 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members here (requires AANA member login and password).
  • How do you like your Hotline? How can we improve it? Let us know at info@aanadc.com.
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The following is an FEC required legal notification for CRNA-PAC:

Gifts to political action committees are not tax deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a US Citizen.
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Visit www.crnacareers.com to view or place job postings.
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Featured Career Opportunities

CRNA – Great Lakes Practice Solutions
Bay City, MI

The rapid success of our company has created exciting opportunities for qualified CRNAs to join us in Michigan. Our strength allows us to offer competitive compensation and benefit packages.

Read more about this position

Certified Registered Nurse Anesthetist (CRNA) - Franciscan Children's Hospital
Brighton, MA

The only facility of its kind in the Northeast-Best known as a center of excellence in pediatric rehabilitation. Direct patient care during the perioperative period, patients from neonates through adulthood.

Read more about this position
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Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

Patient-Controlled Analgesia in the Emergency Department Is Effective, Show Twin Studies

A pair of U.K. studies have demonstrated, for the first time, that patient-controlled analgesia (PCA) works not only for people recovering from surgery but also for visitors to the emergency room. The approach allows patients to get relief as needed with the simple push of a button on a PCA device, rather than have a nurse stop—sometimes repeatedly—to administer pain drugs for the patient. One study found that PCA was the better option, both from a clinical and a statistical perspective, when applied to patients presenting with non-traumatic abdominal pain. Pain scores for emergency patients using PCA averaged 35.3 compared to 47.3 for those who received standard pain relief. Level of pain was more closely aligned, meanwhile, among patients suffering a traumatic injury, with those using PCA reporting pain scores of 44 compared to 47.2 for those not using PCA. In light of the surprisingly different results in the two studies, lead researcher Jason Smith speculated that trauma patients may also be affected by other factors, "such as the effect of splinting on limb injuries." The findings were reported in the British Medical Journal.

From "Patient-Controlled Analgesia in the Emergency Department Is Effective, Show Twin Studies"
Medicalxpress (06/22/2015) Gould, Andrew

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To Ease Pain, Reach for Your Playlist

According to the results of a Northwestern University study, listening to a personalized music playlist or audiobook reduces pain for kids and teens recovering from major surgery. While previous research has long established the analgesic properties of music, it also has been limited primarily to adult subjects and classical music. Northwestern's father-and-daughter team of Santhanam Suresh and Sunitha Suresh looked at 60 surgical patients aged nine to 14, all of whom received opioids for pain control following their procedures. The next day, they were separated into groups: one that listened to 30 minutes of their choice of music, one that listened to 30 minutes from an audiobook of their choosing, and a third that sat in silence for 30 minutes while wearing noise-canceling headphones. Pain levels declined by one point on a 10-point scale among the patients who listened to music or a book that they selected compared to those who were offered no distraction. The researchers said the drop is equivalent to taking Advil or Tylenol and that doctors possibly could administer less pain drugs to their pediatric charges.

From "To Ease Pain, Reach for Your Playlist"
NPR Online (06/22/15) Neighmond, Patti

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Certain Anti-Nausea Medications Used After Operation Could Increase Risk for Irregular Heartbeat

A pair of new studies reveal an elevated risk for irregular heartbeat in patients who take certain a certain drug combination during or after surgery. It is not unusual for patients to experience nausea and/or vomiting after being under anesthesia, explains lead researcher Andrea Tricco, MD; and they often are prescribed a class of drugs known as serotonin receptor antagonists to quell these symptoms. However, Tricco and colleagues at St. Michael's Hospital in Canada say one of these drugs in particular—the combination of the antiemetic granisetron with the steroid dexamethasone—can boost the risk of arrhythmia. Reporting in BMC Medicine, the researchers say the combination least likely to raise arrhythmia risk in children is ondansetron plus dexamethasone. For patients of all ages, meanwhile, the best choices of seratonin receptor antagonist are ondansetron plus dexamethasone, and dolasetron.

From "Certain Anti-Nausea Medications Used After Operation Could Increase Risk for Irregular Heartbeat"
News-Medical (06/19/15)

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UC Irvine Researcher Finds Biological Link Between Chronic Pain, Mental Illness

Catherine Cahill, an associate professor of anesthesiology and perioperative care at the University of California Irvine, teamed with colleagues at the Los Angeles campus to explore the relationship between chronic pain and mood disorders. Based on rodent studies, they determined that individuals suffering from chronic pain are more susceptible to mental and emotional illnesses like depression and anxiety and that there is a biological connection between the physical and mental pain. The research, published in the Journal of Neuroscience, revealed that chronic pain causes inflammation in parts of the brain associated with reward and motivation. That inflammation subsequently triggers the activation of microglia cells, which suppress the release of dopamine and, thus, make these patients more likely to suffer mental problems. The findings dovetail with previous research on depression, which has shown that a disruption in dopamine circuitry is one of the main causes for the development of mood disorders.

From "UC Irvine Researcher Finds Biological Link Between Chronic Pain, Mental Illness"
Orange County Register (CA) (06/15/15) Min, Charles

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Lorazepam Not Linked to Higher Postoperative Satisfaction

French researchers have disproved a theory that administering the anti-anxiety drug lorazepam prior to general anesthesia improves patient satisfaction after surgery. In the PremedX study, the 1,062 participants were randomly assigned to receive either lorazepam, a placebo, or no premedication at all. Patients who received premedication—even those who experienced a hyper sense of anxiety—did not report a superior experience compared to other study enrollees. To the contrary, more time was needed to fully restore cognitive function and complete extubation in the lorazepam group compared to patients who were not sedated ahead of general anesthesia. Additionally, the lorazepam patients were more likely to report amnesia and sleep-related issues. Overall, satisfaction scores were highest among patients who received no premedication and lowest in the lorazepam group. According to lead researcher Axel Maurice-Szamburski, MD, the sedated patients probably received the same quality of care and treatment as the other cohorts—but likely did not remember it later. Although the research was limited to lorazepam, he said the findings likely would apply to a whole class of benzodiazepines. The study was published in the Journal of the American Medical Association.

From "Lorazepam Not Linked to Higher Postoperative Satisfaction"
Anesthesiology News (06/01/15) Vol. 41, No. 6 Van Voorhis, Scott

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Efficacy of an Acute Pain Titration Protocol Driven by Patient Response to a Simple Query: Do You Want More Pain Medication?

Researchers report success using a pain protocol strategy based exclusively on patients' response to the question of whether or not they wanted additional pain medication. The study involved more than 200 emergency department patients suffering from acute severe pain. After initially being administered 1 mg of hydromorphone intravenously, patients subsequently were asked at 30-minute intervals if they wanted more of the painkiller. Those who responded in the affirmative were given another 1 mg; while those who responded negatively were simply asked again at the next interval, until all patients had been queried four times. The primary outcome for the research was satisfactory pain control—defined as declining extra hydromorphone on at least one occasion—which was achieved by 99 percent of the study population.

From "Efficacy of an Acute Pain Titration Protocol Driven by Patient Response to a Simple Query: Do You Want More Pain Medication?"
Annals of Emergency Medicine (06/11/15)

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Study: Midazolam Eases Children's Predental Surgery Anxiety

To calm separation anxiety in pediatric dental patients who must be sedated, researchers suggest giving them a pre-surgical dose of oral midazolam. In a study of 78 children undergoing full dental rehabilitation under general anesthesia, half were randomly assigned to receive oral midazolam about 30 minutes prior to induction. About 67 percent of the kids in that group experienced an "acceptable separation" from their parents compared to just 7.9 percent of patients in the control group, who received a placebo. Children who were given midazolam also were more receptive to wearing the anesthesia mask than were the placebo patients. "The time spent in the operating room holding area prior to surgery is often traumatic to children's psychology, especially for children who already suffer dental fear," said Hisham Yehia El Batawi, DDS, MDS, PhD from the University of Sharjah in the United Arab Emirates. "This may contribute to extreme anxiety during the induction of anesthesia. The current stud demonstrates that midazolam in a dose of 0.5 mg/kg is an effective adjunct in managing preoperative dental anxiety and in facilitating induction of general anesthesia." He reported the findings in the Journal of International Society of Preventative & Community Dentistry.

From "Study: Midazolam Eases Children's Predental Surgery Anxiety"
DrBicuspid.com (06/11/15) Pablos, Theresa

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Benzodiazepine Prescribing Patterns and Deaths From Drug Overdose Among US Veterans Receiving Opioid Analgesics

Using data from the Veterans Health Administration (VHA), researchers have concluded that receipt of benzodiazepines was linked to a higher risk of death from drug overdose in a dose–response fashion among veterans taking opioid analgesics. The study looked at U.S. veterans who received opioid analgesics in 2004-2009, using a random sample of more than 420,000 veterans who received VHA services and opioid analgesics. According to the data, 27 percent of the veterans who received opioid analgesics during the study period also received benzodiazepines. There were 2,400 deaths from drug overdose while patients were receiving opioid analgesics, and 1,185 occurred when veterans were prescribed both benzodiazepines and opioids. The risk of death from drug overdose increased with history of benzodiazepine prescription and as the daily benzodiazepine dose was raised. The dosing schedule for benzodiazepine was not linked to risk of death from overdose. The researchers suggest that "although the design of this study does not allow for the determination of the extent to which benzodiazepines cause deaths from overdose, it does indicate a need for clinicians to be aware of the increased risk among patients currently receiving benzodiazepines and opioids and that the risk might be higher among those receiving higher doses of either or both drugs."

From "Benzodiazepine Prescribing Patterns and Deaths From Drug Overdose Among US Veterans Receiving Opioid Analgesics"
BMJ (06/10/15) Park, Tae Woo; Saitz, Richard; Ganoczy, Dara; et al.

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Why Do 'Never Events' Continue to Occur?

The complexity of prevention plans, not careless behavior, is the reason why "never events" continue to occur during surgery, researchers suggest in the journal Surgery. A review of 1.5 million surgeries at the Mayo Clinic identified 69 never events over five years. These events included wrong procedures, wrong-site surgeries, incorrect implants, and retained objects. Senior author Juliane Bingener, MD, a Mayo Clinic gastroenterologic surgeon, said that a "never event" involves multiple missteps. Four major levels of errors have numerous potential causes. These include preconditions for action, such as poor hand-offs and inadequate communication, and unsafe actions, such as breaking rules or failing to understand proper protocols. Other causes of errors include oversight and supervisory factors, such as staffing deficiencies and planning problems, and organizational influences, such as issues with processes. "Speaking up and taking advantage of the entire team's capacity to prevent errors is very important, and so is adding systems approaches that improve patient safety," says Bingener.

From "Why Do 'Never Events' Continue to Occur?"
Outpatient Surgery (06/09/15) Cook, Daniel

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After Surgery, Resuming This Rx Might Help Patients

Because angiotension receptor blockers (ARBs) can cause low blood pressure under general anesthesia, patients may be advised to stop taking the medication for a brief period prior to surgery. However, researchers say patients with hypertension increase the odds of postoperative survival if they resume their ARB regimen as soon as possible afterwards. Led by Susan Lee, researchers reviewed records for more than 30,000 patients in the Veterans Affairs Healthcare system who were on ARBs and underwent noncardiac surgery between 1999 and 2011. Patients who still were not taking the drugs two days after surgery—roughly a third of the study population—had a higher death rate than the two-thirds who had started back on their ARBs by the second day. While the risk of dying was low for both cohorts, the 3.2 percent of patients who took their blood pressure medication within a couple of days and subsequently died was more than double the 1.3 percent of patients who quickly returned to their ARB routine but died within 30 days of surgery. "Our study highlights the importance of resuming medications that patients were previously taking at home as soon as it is feasible after surgery," said Lee, who reported the findings online in Anesthesiology.

From "After Surgery, Resuming This Rx Might Help Patients"
DailyRx (06/04/15) Jones, Morgan

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Low Rates of Unplanned Admissions After Ambulatory Surgery Demonstrate Good Planning and Cooperation

An orthopedic ambulatory surgery center in New York City has low rates of unplanned admissions after surgery, the result of a screening clinic and collaboration between anesthesia providers and surgeons. Researchers reviewed the medical records of patients undergoing orthopedic surgery at the center between March 2010 and February 2014. They found that only 37 of 15,471 patients were admitted to the hospital from the ambulatory surgery center, an incidence of 2.4 per 1,000 patients. Seventy-three percent of cases involved general anesthesia. Asthma and diabetes were the most common comorbidities. Common reasons for transfer included pulmonary problems, cardiac issues, and postoperative pain. Patients at the center pass through a preadmission clinic operated by anesthesia providers. Patients who may need extra monitoring are not recommended to be seen in the outpatient center. Germaine Cuff, PhD, director of quality assurance and outcomes analysis in New York University Langone Medical Center's Department of Anesthesiology, reported the findings at the 2015 annual meeting of the International Anesthesia Research Society.

From "Low Rates of Unplanned Admissions After Ambulatory Surgery Demonstrate Good Planning and Cooperation"
Anesthesiology News (06/01/15) Vol. 41, No. 6 Vlessides, Michael

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Last Laugh for Laughing Gas?

At the annual Euroanaesthesia meeting in Berlin, Profs. Rolf Rossaint of the University Hospital Aachen in Germany and Daniel Sessler of the Cleveland Clinic will debate the pros and cons of nitrous oxide use in operating rooms. Newer options have led to nitrous oxide gradually being phased out over the last several years, and a European Society of Anaesthesiology (ESA) task force says this is due to "strong emotional viewpoints" that have falsely painted the gas as a less than ideal option. While the ESA task force said "there are no arguments to state that the use of nitrous oxide should be abandoned," Rossaint pointed to large studies which found that adverse events such as nausea and vomiting increased with nitrous oxide use, and there have even been cases of death. Sessler agreed with the task force, asserting that there is "no compelling evidence that nitrous oxide causes important clinical complications." The task force did note a few contraindications for nitrous oxide use, including where the lungs could not handle the gas or abnormalities in the patient's metabolism with regard to vitamin B12.

From "Last Laugh for Laughing Gas?"
MedPage Today (05/31/15) Wallan, Sarah Wickline

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June 30, 2015

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