AANA Anesthesia E-ssential

Anesthesia E-ssential March 13, 2015

AANA Anestehsia E-ssential
Anesthesia E-ssential

March 13, 2015


Vital Signs

Nurse Anesthesia Annual Congress Registration Now Open!
Come to the 2015 Nurse Anesthesia Annual Congress, Aug. 29-Sept. 1, 2015, for the education and stay for the experience in beautiful Salt Lake City, Utah.
Come for the Education
The 2015 Nurse Anesthesia Annual Congress will offer more education and more opportunities to earn up to 26 CE credits. New this year, educational tracks will help attendees identify sessions relevant to their specialty and interests, including: The Essentials, Clinical, Practice Management, Research in Action, History and Archives, Health and Wellness, and Special Interest.
Stay for the Experience
Beautiful, historic Salt Lake City boasts an amazing variety of attractions, as well as world-class dining and entertainment. Attendees will have the opportunity to explore Salt Lake City and its surrounding areas through exclusive pre- and post-conference tours exclusively for Annual Congress attendees and guests.
Register Now!
Watch your mailbox for the Preliminary Program and visit www.aana.com/naac for more information and to register.

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
Focus on Class A Requirements
The NBCRNA introduced the concept of Class A and Class B requirements to the Continued Professional Certification (CPC) Program to encourage and recognize a range of continuing education alternatives. Class B requirements were highlighted in the February 27 E-ssential. Educational programs that meet the Class A requirement need to be relevant to anesthesia, must include an assessment, and need to be prior approved by an organization such as the AANA. The purpose of the assessment is to validate the learning objectives—does the assessment provide a means to demonstrate what you learned? The following are examples of types of Class A: online learning; AANA Journal CE; life support courses with assessment; webinars; audio programs; core modules (these will have an assessment, so they will count for Class A credit); and state and national anesthesia lectures if they meet prior approval and assessment requirements. Assessments may take many forms—for example, self-assessment, demonstrations, polling, case studies, and simulations are valid forms of evaluation, depending on the type of educational activity.
The CPC program requires CRNAs to earn a minimum of 60 Class A credits during the 4-year recertification cycle; however, if you take more Class A credits than the 60 required, you may apply the excess credits to meet Class B requirements. CRNAs can earn up to 40 Class B credits. More information about Class A and Class B requirements can be found on the AANA and the NBCRNA websites.
CPC Sound Bite: What are the Class A and Class B Requirements of the CPC Program?
This is the second in a series of video messages on the Continued Professional Certification (CPC) Program, recorded by President Sharon Pearce, CRNA, MSN, and President-elect Juan Quintana, CRNA, DNP, MHS. In these brief videos,
President Pearce and President-elect Quintana answer questions about the CPC program. Click here to view the video. (AANA member login and password required.)


The Pulse

  • AANA Election Slate Announced
  • Board of Directors Approves Updated Practice Documents
  • PQRS and the Value Based Modifier
  • New Special Enrollment Period (SEP) for the AHiX Health Insurance Exchange
State Government Affairs
  • U.S. Supreme Court Rules in Favor of the FTC in North Caroline Board of Dental Examiners v. Federal Trade Commission
  • New State Government Affairs Webinar on State Legislative and Regulatory Process
Professional Practice
  • FDA Launches Drug Shortage Mobile App
  • Joint Commission Announces New, Optional Perinatal Care Certification Program
  • Upcoming Webinar: Data Collection and Measurement Issues
  • Apply Now - "State of the Science" Oral and General Poster Presentations
  • AANA Foundation 2015 Award Nominations Deadline Extended
  • AANA Foundation Donor Spotlight... Meet Michael Neft, CRNA, DNP, MHA
  • Advocate for Your Profession and Earn CE Credits at the Mid-Year Assembly
  • Expand Your Practice Potential Through These Popular Hands-on Workshops
  • Business of Anesthesia Conference Focuses on Practice Management for CRNAs
  • New Legislation Introduced in House that Authorizes Full Practice Authority to CRNAs and other APRNs Providing Care for Our Veterans
  • What Is the Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care?
  • U.S. Supreme Court Hears Arguments on King v. Burwell Case
  • AANA Requests that Medicare Advantage Plans Adopt Alternative Payment Systems that Recognize and Reward all Qualified Providers, such as CRNAs
  • AANA Participates in FTC/DOJ Workshop on Examining Healthcare Competition
  • AANA Advocates for Indian Health Service Scholarships for CRNAs
  • To Protect and Advance CRNA Practice, the CRNA-PAC 2015 Development Campaign is Under Way 
  • CRNA-PAC Seeking Donations for 2015 Mid-Year Assembly Silent Auction
  • Amendments

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.

Inside the Association
AANA Election Slate Announced
The AANA Nominating Committee, after reviewing the nominations for elected positions for the upcoming election at its February meeting, has announced the slate of candidates for the 2015 election of the AANA Board of Directors, Nominating and Resolutions Committee members. Click here for the complete slate of candidates and further information about the upcoming elections. (Member login and password required.) The order of names was determined randomly on the ballot by the Nominating Committee. Those elected will begin their fiscal year 2016 terms of office at the conclusion of the AANA 2015 Nurse Anesthesia Annual Congress in Salt Lake City, Utah.
Board of Directors Approves Updated Practice Documents
At its recent meeting, the Board of Directors approved two updated Professional Practice documents:
  • Infection Prevention and Control Guidelines for Anesthesia Care – Topics covered within the newly revised guidelines include: hand hygiene, personal protective equipment, transmission-based precautions, respiratory hygiene, skin preparation, aseptic technique, airway management, safe injection practices, equipment and environmental cleaning, invasive procedure technique, vaccination and post-exposure prophylaxis, and a glossary.
  • Mobile Information Technology, Position Statement The updated position statement continues to support the thoughtful integration of mobile information technology into clinical practice, including topics such as advantages of clinical use, potential for distractions and interruptions, patient safety, patient privacy, infection control, mobile applications, electromagnetic interference, and facility policies.
PQRS and the Value Based Modifier
The Centers for Medicare & Medicaid Services’ application of the Value Based Modifier (VM) on Jan.1, 2015, is in alignment with its mission to further the importance of Medicare quality-based programs. Although the VM payment adjustment will not officially apply to CRNAs until 2018 based on the 2016 performance period (Physician Quality Reporting System (PQRS) 2016 reporting period), individual CRNAs should be reporting PQRS quality measures in preparation for this new responsibility. To learn more about PQRS and the VM please visit our new resource titled Quality-Reimbursement on the AANA website.
For EPs affected by the VM in performance period 2015, nonparticipation in the PQRS Program automatically results in a -2 percent adjustment for both the VM and the PQRS Programs for the 2017 payment adjustment year. Please visit our VM FAQ page to learn more about the payment adjustments for performance period 2015 and 2016.
New Special Enrollment Period (SEP) for the Ahix Health Insurance Exchange
The Federal Government has announced that there will be a special enrollment period this year for those who didn't realize they had to buy health insurance when they did their taxes.
This Special Enrollment Period runs from March 15, 2015, through April 30, 2015.
  • All plans are still Affordable Care Act compliant and you will NOT have to pay a tax penalty if you purchase one.
  • All pre-existing conditions are covered.
  • No medical questions will be asked.
  • You are STILL eligible for subsides if you qualify.
  • Hundreds of plan designs to choose from
  • Calculate subsidies, pick out a plan, and apply right online.
  • Sign up in about 15 minutes
Click here to learn more.


State Government Affairs

U.S. Supreme Court Rules in Favor of the FTC in North Carolina Board of Dental Examiners v. Federal Trade Commission
The U.S. Supreme Court has issued a decision in North Carolina Board of Dental Examiners v. Federal Trade Commission, ruling in favor of the Federal Trade Commission. The U.S. Supreme Court upheld the decision of the lower court, ruling that the North Carolina Board of Dental Examiners illegally thwarted competition by engaging in anticompetitive conduct to prevent non-dentists from providing teeth whitening services. This decision is consistent with the arguments raised by the AANA and its co-amici in an amicus brief supporting the FTC’s position. For more information, see the AANA’s press release.
New State Government Affairs Webinar on State Legislative and Regulatory Process
Visit the AANA State Government Affairs webinar page for a newly released webinar titled “Introduction to State Legislative and Regulatory Process.” This program, brought to you by the AANA Government Relations Committee and AANA State Government Affairs Division, features AANA GRC members Mindy Miller, CRNA, MSN, AANA GRC Chair; Heather Rankin, CRNA, DNP; and Christine Salvator, CRNA, MSN, APN. The webinar discusses the importance of the legislative and regulatory process for CRNAs, including defining common terms, detailing the processes, describing the important committees, and the role of regulatory boards.


Professional Practice

FDA Launches Drug Shortage Mobile App
The FDA has launched the agency’s first mobile app specifically designed to speed public access to valuable information about drug shortages. The app identifies current drug shortages, resolved shortages, and discontinuations of drug products. The app can also be used to report a suspected drug shortage or supply issue to the FDA. More information on how to download the app for Apple and Android devices can be found on FDA’s website.
Joint Commission Announces New, Optional Perinatal Care Certification Program
This optional program, effective July 1, 2015, focuses on integrated, coordinated, patient-centered care for clinically uncomplicated pregnancies and births. The AANA was one of many organizations that collaborated with The Joint Commission during the development of the program standards. Qualified CRNAs, as qualified providers with anesthesia privileges, may serve as the managers of the program’s obstetric anesthesia services.
Upcoming Webinar: Data Collection and Measurement Issues
The Council on Patient Safety in Women’s Health Care will hold the next Safety Action Series webinar titled “Data Collection and Measurement Issues” on Monday, March 16, 2015, at 11 a.m. ET. The session will describe common data quality, data collection, and measurement issues in small- and medium-sized birthing facilities specifically around obstetric hemorrhage, the quantification of blood loss, and severe maternal morbidity. More information and registration is available are available here.

Apply Now – “State of the Science” Oral and General Poster Presentations
“State of the Science” offers an opportunity for CRNAs and nurse anesthesia students to present their research findings and innovative educational approaches at the AANA Nurse Anesthesia Annual Congress. Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics. Click here to access the applications which are currently available on the AANA Foundation website at www.aanafoundation.com.
  • Oral Poster Presentation – April 1 Deadline – Up to $1,000 accompanies oral presentation
  • General Poster Presentation – May 1 Deadline
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
AANA Foundation 2015 Award Nominations Deadline Extended
We must find time to stop and thank the people who make a difference in our lives. -- John F. Kennedy
Each year the AANA Foundation presents awards at the AANA Annual Congress to individuals who have made a difference in the nurse anesthetist community. There is still time to recognize someone you respect, appreciate, or admire. The deadline for award nominations has been extended to April 1, 2015. Click here to access the nomination/application forms for:
  • Advocate of the Year Presented to an advocate committed to supporting the AANA Foundation and encouraging others to do the same.
  • John F. Garde Researcher of the Year Presented to an individual who has made a significant contribution to the practice of anesthesia through clinical research.
  • Rita L. LeBlanc Philanthropist of the Year Presented to an individual who has donated time, talent, and direct financial support to the AANA Foundation and other deserving organizations.
  • Janice Drake CRNA Humanitarian Award Presented to a CRNA who wishes to volunteer and provide anesthesia, education, and training in needy areas.
Forward the completed form to the AANA Foundation. Email it to foundation@aana.com or mail to 222 S. Prospect Avenue, Park Ridge, IL 60068.
Thank you in advance for recognizing a member of the nurse anesthesia community. If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com.
AANA Foundation Donor Spotlight… Meet Michael Neft, CRNA, DNP, MHA
Michael has been a CRNA for 17 years and a generous AANA Foundation supporter. Click here to read more about Michael in his own words. Thank you, Michael, for your generous support!

Advocate for Your Profession and Earn CE Credits at the Mid-Year Assembly
This year's AANA Mid-Year Assembly, April 18-22, in Arlington, Va., is an excellent opportunity for you to participate in the national policymaking impacting our profession, and with 10 educational sessions to choose from, you can earn CEs while you're there. Register today: Early Bird pricing ends March 27.
Expand Your Practice Potential Through These Popular Hands-on Workshops

Register now—these popular workshops fill up fast!

Business of Anesthesia Conference Focuses on Practice Management for CRNAs
Register now for the 2015 AANA Business of Anesthesia Conference, to be held June 26-27, 2015, in San Diego, Calif. The conference will focus on the latest trends in managing your practice, updates on legal and regulatory implications of healthcare and other issues facing your practice.

New Legislation Introduced in House that Authorizes Full Practice Authority to CRNAs and other APRNs Providing Care for Our Veterans
AANA-backed legislation was introduced March 4 in the House of Representatives (HR 1247), which authorizes all advanced practice registered nurses (APRNs), including CRNAs, in the Veterans Health Administration (VHA) to practice as Full Practice Providers.  Now’s the time for AANA members to request that their own U.S. Representatives cosponsor this important legislation, intended to help improve veterans access to quality healthcare.
The AANA was joined by 40 nursing organizations in support of the “Improving Veterans Access to Quality Care Act,” which would grant full practice authority to the roughly 6,000 APRNs practicing in the VHA, including 900 CRNAs. Coupled with additional provisions that would enable the immediate transition of combat medics, medical technicians and corpsmen from the U.S. Armed Forces to the VHA and a provision to make credentialing consistent between the Department of Defense and the VA, this legislation provides a common-sense solution to ensuring veterans have the access to the high-quality healthcare they need and deserve.
The APRN Workgroup, of which AANA is the lead, sent bill sponsoring Reps. Sam Graves (R-MO) and Jan Schakowsky (D-IL) a letter which stated, “By allowing all APRNs to practice as full practice providers, the VHA can maximize care delivery and minimize waits and delays for critical services. The bill is also consistent with the recommendations of the Institute of Medicine report 'The Future of Nursing: Leading Change, Advancing Health,' the National Council of State Boards of Nursing APRN Consensus Model, and with proposals under consideration in the VHA.”
Please take action today and request that your U.S. Representative support and cosponsor HR 1247 because it includes CRNAs: https://www.crna-pac.com/actionalerts.aspx (requires AANA member login and password). See the APRN Workgroup letter, here: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150304%20APRN%20Letter%20for%20Graves-Schakowsky%20IVAQCA%20Final.pdf (AANA member login required). Text for HR 1247 is available at https://www.congress.gov/bill/114th-congress/house-bill/1247/text?q=%7B%22search%22%3A%5B%221247%22%5D%7D
What Is the Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care?
With new legislation in Congress and a regulatory proposal in the Veterans Health Administration (VHA) affecting recognition of CRNAs and other APRNs all under consideration at the same time in Washington, keeping the issues straight can be challenging. But keeping them straight is critical to knowing what to say to your lawmakers in support of veterans access to care delivered by CRNAs. In short:
  • The AANA is supporting new 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). AANA is requesting that AANA members contact their U.S. Representatives to cosponsor this bill. Please do so 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). 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.
  • 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 a 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.
Keep making your CRNA voice heard!
If you have not already done so, please contact your Representative and request that they cosponsor H.R. 1247, here: https://www.crna-pac.com/actionalerts.aspx. See the AANA and APRN Workgroup letter of support, here: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150304%20APRN%20Letter%20for%20Graves-Schakowsky%20IVAQCA%20Final.pdf (requires AANA member login and password). See the Nursing Community letter of support, here: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150304%20Nursing%20Organizations'%20Letter%20to%20Reps.%20Graves%20and%20Schakowsky.pdf (requires AANA member login and password). Text for HR 1247 is available at https://www.congress.gov/bill/114th-congress/house-bill/1247/text?q=%7B%22search%22%3A%5B%221247%22%5D%7D
If you have not yet contacted your Senators, take action today and request that they refrain from cosponsoring or supporting S. 297 until it is amended to include CRNAs: https://www.crna-pac.com/actionalerts.aspx (requires AANA member login and password). See the AANA’s letter at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150209%20FINAL%20AANA%20ltr%20to%20SVAC%20re%20S%20297%20Sec%204.pdf. Text for S. 297 is available at https://www.congress.gov/bill/114th-congress/senate-bill/297/text?q=%7B%22search%22%3A%5B%22s+297%22%5D%7D.
U.S. Supreme Court Hears Arguments on King v. Burwell Case
The Supreme Court heard oral arguments on King v. Burwell on March 4 and a final decision by the Court is expected in late June. The AANA is monitoring the case because the court’s decision will determine whether about seven million low- and middle-income people in 30 states will continue to receive Affordable Care Act (ACA) subsidies to help them buy health insurance, an outcome that would shake up the insurance market.The law’s defenders say the law’s structure and purpose support health plan subsidies in all 50 states. Its opponents, specifically the plaintiffs from Virginia, are challenging whether the ACA authorizes such subsidies in states where Uncle Sam is running the health plan exchange.
AANA Requests that Medicare Advantage Plans Adopt Alternative Payment Systems that Recognize and Reward all Qualified Providers, such as CRNAs
The AANA requested that Medicare Advantage Organizations (MAOs) adopt alternative payment systems that recognize and reward all qualified providers, such as CRNAs, in a comment letter submitted March 4 to the Centers for Medicare & Medicaid Services (CMS). As stated in a letter signed by AANA President Sharon Pearce, CRNA, MSN, “We also recommend that MAOs adopt alternative payment systems that recognize and reward all qualified healthcare providers such as CRNAs, for ensuring patient access to safe, cost-effective healthcare services. …. We believe that alternative 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.” 
AANA Participates in FTC/DOJ Workshop on Examining Healthcare Competition
To help promote and advance the value of CRNA services, members of the AANA staff team attended the Federal Trade Commission (FTC) workshop, “Examining Health Care Competition” on Feb. 24-25 in Washington. With the AANA having provided the FTC a statement in advance about the role and benefits of CRNA services, the workshop examined policy surrounding accountable care organizations; alternatives to traditional fee-for-service payment models; trends in provider consolidation; trends in provider network and benefit design strategies; and health insurance exchanges.
In testimony before the FTC, several health plan executives expressed their desire for all types of providers, including APRNs and CRNAs, to participate in these new types of payment models.
The AANA’s written testimony recommended that alternative payment systems should be organized in the best interests of the patients receiving care, that they encourage improvements in patient care quality and efficiency, and that the alternative payment systems should be developed and deployed in a manner that healthcare professionals deem as valid. AANA members, state associations and state reimbursement specialists should continue their local efforts to educate healthcare industry stakeholders and consumers about the safe, accessible and cost effective anesthesia and pain care CRNAs provide.
View the workshop’s agenda and speaker presentations, at: http://www.ftc.gov/news-events/events-calendar/2015/02/examining-health-care-competition. View the AANA’s testimony to the FTC on the workshop, at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150216%20AANA%20Comments%20on%20FTC%20Examining%20Healthcare%20Competition%20Workshop%20-%20FINAL.pdf (AANA Member ID and password required).
AANA Advocates for Indian Health Service Scholarships for CRNAs
The AANA, and close to two dozen other healthcare organizations, urged lawmakers to amend the tax code to provide healthcare professionals, including CRNAs, who receive student loan repayments from the Indian Health Service (IHS) the same tax free status enjoyed by those who receive National Health Service Corps loan repayments.
In a letter submitted March 9, the Friends of Indian Health coalition, with which AANA participates, stated, “The loan repayment program has proven to be the IHS’ best recruitment and retention tool to ensure an adequate health workforce to serve in the many remote IHS locations.” The IHS scholarship program provides financial support to American Indian and Alaska Native students pursuing professional nursing degrees, including CRNA students.
To Protect and Advance CRNA Practice, the CRNA-PAC 2015 Development Campaign is Under Way
Led by CRNA-PAC Chair Rick Jueneman, CRNA, the CRNA-PAC’s 2015 development campaign is under way. Focused on building member engagement to protect and advance CRNA practice through federal advocacy, the CRNA-PAC is undertaking its 2015 campaign in four major phases. With the theme of “#MyCRNACause,” the first phase involves educating AANA members about the role and benefits of the CRNA-PAC to the nurse anesthesia profession and to CRNAs, particularly in a time of major health policy and industry change. The second phase will reach out to members via email, mail and telephone to ask for their support. In the third phase, the CRNA-PAC will undertake a new peer-to-peer Ambassador Program initiative to raise funds for both the CRNA-PAC and state PACs in 10 selected states. The campaign will conclude with “Great Moments in Time,” the CRNA-PAC gala event being held Sunday, April 19, in Washington, DC, at the Newseum.
Learn more about the CRNA-PAC or make a contribution at www.crna-pac.org (requires AANA member login and password). For more information please contact AANA Associate Director Political Affairs Kate Fry at kfry@aanadc.com.
CRNA-PAC Seeking Donations for 2015 Mid-Year Assembly Silent Auction
Interested in helping the CRNA-PAC in a fun way? Do you have a precious treasure you believe a CRNA colleague might enjoy? Consider donating an item to the CRNA-PAC Silent Auction at the 2015 Mid-Year Assembly. State Associations may also wish to donate an item unique to the states they represent. Donated items are especially appreciated as we seek to contain costs. Auction item donors will receive special recognition from the CRNA-PAC. The auction will take place in conjunction with the PAC’s “Great Moments in Time” event on Sunday, April 19, at the Newseum, one of the premier venues in Washington, DC. Please contact Kate Fry (kfry@aanadc.com) if you or your state association would like to donate an item.
Register for Mid-Year Assembly and the CRNA-PAC event at: http://www.aana.com/meetings/aanaassemblies/Pages/Mid-Year-Assembly-Registration.aspx.
  • CMS has provided instructions on claims processing for anesthesia services under ICD-10. The transition to ICD 10 will take place on Oct. 1, 2015. Contact your biller to provide them with the following new claims processing guidelines, which state, “anesthesia procedures that begin on 9/30/2015 but end on 10/1/2015are to be billed with ICD-9 diagnosis codes and use 9/30/2015 as both the FROM and THROUGH.” To view the complete list of instructions, see: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1408.pdf.
  • CMS has extended the submission deadline for 2014 PQRS reporting to March 20, 2015, for reporting via EHR Direct or Data Submission Vendor that is certified EHR technology (CEHRT) and via Qualified Clinical Data Registries (using QRDA III format). Submission deadlines for all other reporting methods remain the same. To read more about the PQRS reporting requirements: http://www.aana.com/resources2/quality-reimbursement/Pages/default.aspx.
  • According to Rep. Paul Ryan, Chairman of the House Ways and Means Committee, Congress has not yet reached consensus on how to pay for a permanent repeal the Medicare Sustainable Grown Rate (SGR). In order to avoid a 21% Medicare payment cut for providers such as CRNAs, Congress will likely pass another short-term relief bill to avert SGR cuts. The AANA has been advocating on behalf of a permanent SGR fix before the deadline of April 1, but without bipartisan agreement on how to pay its $180 billion cost, a temporary fix is the mostly likely option for avoiding a payment cut.
  • Sen. Barbara Mikulski (D-MD), the longest serving woman legislator in congressional history, announced on Mar. 2 that she is retiring and not running for re-election to the U.S. Senate in Nov. 2016. A longtime friend to nurses, APRNs and CRNAs, Sen. Mikulski was the first woman to chair the powerful Senate Appropriations Committee and today serves as its ranking member. Her retirement opens the gates to candidates considering running to succeed her in Democratic-leaning Maryland, including a notable Republican: the one anesthesiologist in Congress, Rep. Andy Harris MD (R-MD-1), according to the New York Times.
  • The Medicare Payment Advisory Commission met March 5-6 to discuss synchronizing Medicare payment policy across payment models, hospital short stay policy issues, and other topics. Commissioners debated updates to current short hospital stays policy, which have adversely impacted the elderly and persons with disabilities, and also discussed how to best align Medicare payment models so taxpayers and beneficiaries could share in plan savings. The Commissioners also looked into ways to create financial incentives for beneficiaries to choose the most efficient care model. To view the presentations, see: http://www.medpac.gov/-public-meetings-/meetingdetails/march-2015-public-meeting.
  • The Congressional Budget Office raised its estimate of this year’s federal government budget deficit by 4 percent to $486 billion on March 9, but has lowered the 10 year projected deficit overall. The 10 year projected deficit, as a share of gross domestic product, has decreased by 2.7 percent which is its lowest point since before the 2008 financial crisis. The CBO reports the projected decline is due in part to slower growth in health insurance premiums as a result of the Affordable Care Act, but this year’s increase is the result of higher spending on student loans, Medicare and Medicaid. https://www.cbo.gov/publication/49973.
  • Register today for the AANA Mid-Year Assembly and the 2015 CRNA-PAC event. The CRNA-PAC event, “Great Moments in Time” will take place on Sunday, April 19, at the Newseum, one of the premier venues in Washington, DC. The National Park Service predicts Washington’s famous Tidal Basincherry blossoms will reach peak bloom April 11-14, right before Mid-Year Assembly. To register for the Mid-Year Assembly, go to: http://www.aana.com/meetings/aanaassemblies/Pages/Mid-Year-Assembly-Registration.aspx. Tickets for the PAC event can also be purchased, here: https://aptify.aana.com/aptify/meetings/newmeetingregistration.aspx?id=173280 (AANA member login required).
  • See the Medicare 2015 anesthesia conversion factor list by locality at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/201411-anesthesia-conversion-factor-list.pdf (requires AANA member login and password). The new rates took effect for services on Jan. 1, 2015.
  • Stay up to date on CRNA reimbursement issues by obtaining Version 2.1 of the AANA’s “Issues Briefs on Reimbursement and Nurse Anesthesia,” available only for AANA members at http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20140225_AANA_Issue-Briefs_Re_Reimbursement-2.1.pdf (requires AANA member login and password).
  • Engage with your profession’s social media feed on Facebook at https://www.facebook.com/AmericanAssociationofNurseAnesthetists and Twitter at https://twitter.com/aanawebupdates.
  • Keep up with the AANA’s new efforts for educating hospital administrators, healthcare policymakers and other health industry leaders about the role and value of CRNA care at http://www.future-of-anesthesia-care-today.com.
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.  


Effect of Sedative Premedication on Patient Experience After General Anesthesia
French researchers report that routine use of lorazepam as a sedative premedication in patients undergoing general anesthesia appears to offer no benefit. Compared with placebo or no premedication, sedative premedication with lorazepam did not improve patients' self-reported experience following surgery. However, it was linked to a prolonged time to extubation and a reduced rate of early cognitive recovery. The study involved more than 1,000 adults scheduled for various elective surgeries under anesthesia at five French teaching hospitals. Approximately 25 percent of the patients exhibited very high levels of preoperative anxiety, the researchers report. Patients were randomized to receive either lorazepam 2.5 mg, no premedication, or placebo. The researchers determined that preoperative sedation with lorazepam offered no improvement on the perioperative experience or overall patient satisfaction. The authors also found that both the lorazepam and no premedication groups had lower pain scores than the placebo group, and they note that "this nocebo effect suggests that provision of inert pills can be harmful."
From "Effect of Sedative Premedication on Patient Experience After General Anesthesia"
Journal of the American Medical Association (03/03/15) Vol. 313, No. 9, P. 916 Maurice-Szamburski, Axel; Auquier, Pascal; Viarre-Oreal, Véronique; et al.
Paracetamol: Not As Safe As We Thought? A Systematic Literature Review of Observational Studies
Research conducted on the adverse event (AE) profile of paracetamol suggests a considerable degree of paracetamol toxicity, although analysts note that the observational nature of the data means that channeling bias may be involved. Researchers examined eight observational, cohort studies that reported mortality, cardiovascular, gastrointestinal, or renal AEs in the general adult population at standard analgesic doses of paracetamol. In comparing paracetamol use versus no use, one study showed a dose-response and reported an increased relative rate of mortality from 0.95 to 1.63. Four studies reporting cardiovascular AEs showed a dose-response, and one reported an increased risk ratio of all cardiovascular AEs from 1.19 to 1.68. Researchers concluded that the dose-response seen for most endpoints suggests some paracetamol toxicity, especially at the upper end of standard doses.
From "Paracetamol: Not As Safe As We Thought? A Systematic Literature Review of Observational Studies"
Annals of the Rheumatic Diseases (03/02/2015) Roberts, Emmert; Nunes, Vanessa Delgado; Buckner, Sara; et al.
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Perioperative QTc Prolongation Linked to Administration of General or Spinal Anesthesia
QTc prolongation historically has been considered an isolated surgical phenomenon, but new research suggests that it is common during surgery under general and spinal anesthesia. The relative risk for extended QTc prolongation is more than five times greater with general anesthesia compared with spinal. "QTc prolongation is an indicator of abnormal cardiac repolarization," said Dr. Andreas Duma, part of the research team at Washington University of St. Louis in Missouri. "If longer than 450 msec, it increases the risk of potentially life-threatening arrhythmia." The study considered whether QTc prolongation occurs regularly during surgery, and if it depends on the type of anesthesia. Investigators looked at 300 patients for whom QTc duration was continuously recorded from 30 minutes preoperatively to up to 60 minutes postoperatively and compared between patients undergoing different types of anesthesia. Intraoperative QTc prolongation was most pronounced in the general anesthesia cohort, with a median of 33 msec. Significant QTc prolongation also occurred during spinal anesthesia but not during local anesthesia. Dr. Bruce D. Spiess, professor of anesthesiology and director of the Virginia Commonwealth University Reanimation Engineering Shock Center in Richmond, suggested that general and spinal anesthesia be favored in a procedure that involves more inflammatory processes.
From "Perioperative QTc Prolongation Linked to Administration of General or Spinal Anesthesia"
Anesthesiology News (03/01/15) Vol. 41, No. 3 Vlessides, Michael
Long-Term Quit Rates After a Perioperative Smoking Cessation Randomized Controlled Trial
Perioperative healthcare providers are uniquely positioned to help patients stop smoking not only right before surgery but over the long term, new findings suggest. Researchers previously reported short-term results from a study that compared standard perioperative care against a regimen that incorporated various smoking-cessation strategies. Of 168 patients randomized for participation in the earlier study, conducted between October 2010 and April 2012, 127 also participated in the researchers' analysis of their smoking status one year later. Overall, 25 percent of the patients in the intervention group stopped smoking, compared to 8 percent of patients in the control group. The findings suggested that patients in the cohort who underwent counseling, were given smoking-cessation literature, took advantage of a free six-week supply of nicotine replacement, or called a telephone quitline were 2.7 times more likely to achieve long-term tobacco disuse. Besides being randomized to the intervention group, patients with lower nicotine dependency at baseline were more likely to still be abstaining from cigarette use after one year.
From "Long-Term Quit Rates After a Perioperative Smoking Cessation Randomized Controlled Trial"
Anesthesia and Analgesia (03/01/15) Vol. 120, No. 3, P. 582 Lee, Susan M.; Landry, Jennifer ; Jones, Philip M.; et al.
Georgia Postpones Executions Indefinitely So It Can Examine Lethal Injection Drugs
Georgia officials announced Tuesday that the state is indefinitely suspending executions while it tests the drugs that it had planned to use in an execution on Monday night. The Georgia Department of Corrections postponed that execution because the lethal injection drug "appeared cloudy." After a pharmacist was consulted, the execution was called off, and a new date was not announced. This is just the latest issue facing a state that uses lethal injection. In recent years, problems with lethal injection drugs have cropped up across the country. A shortage of these drugs has caused the dwindling number of states still carrying out executions to scramble and improvise. The three-drug combination that had been typical has been replaced by a patchwork system, and the U.S. Supreme Court will hear a case involving lethal injection in the spring after justices questioned one of the drugs adopted in recent years by Oklahoma and Florida for executions. As states have struggled to obtain the necessary drugs, some have also reworked their protocols multiple times.
From "Georgia Postpones Executions Indefinitely So It Can Examine Lethal Injection Drugs"
Washington Post (03/04/15) Berman, Mark
FDA Nixes Exparel as Nerve Block
The Food and Drug Administration (FDA) has declined to approve bupivacaine liposome injectable suspension, or Exparel, for use as a nerve block to manage post-surgical pain. The drug is well-received as a long-lasting analgesic when injected into tissue at the surgical site, but manufacturer Pacira Pharmaceuticals is pursuing regulatory permission to inject Exparel close to targeted nerves in order to achieve widespread numbing following an operation. Clinical trials produced favorable results for the application of Exparel in femoral nerve blocks but less so for intercostal blocks. According to a statement from Pacira, the firm intends to work "actively" with the FDA to get the proposed indication approved.
From "FDA Nixes Exparel as Nerve Block"
Outpatient Surgery (03/01/15) Burger, Jim
The Opioid-Free ED: Coming Soon to a Hospital Near You
Hospital emergency departments should seriously consider the use of nonopioid analgesia for managing pain, experts said at the American Academy of Emergency Medicine 21st Annual Scientific Assembly in Austin. "Relying on opioids as the primary analgesics for moderate to severe pain is inadequate, unsafe, and costly," said Dr. Sergey Motov of Maimonides Medical Center in New York. Pain is a complex and involves a variety of factors that can be targeted in multiple ways. A combination of different classes of analgesics can target the different channels, enzymes, and receptors involved in pain and reduce the need for opioids and their side effects. For example, the treatment of pain in renal colic can involve several different channel-blocking agents, such as lidocaine, and an enzyme inhibitor, such as Cox-1 or Cox-2. Dual or triple analgesic combinations provide minimal sedation and lead to shorter hospital stays, Motov said. Opioids can be used for acute traumatic injury and acute visceral pain, but often they are not properly titrated in the emergency department, and there is no consensus on the optimum dose of opioids.
From "The Opioid-Free ED: Coming Soon to a Hospital Near You"
Medscape (02/28/15) Lowry, Fran
Anesthetic Neurotoxicity—Clinical Implications of Animal Models
A new report calls for more research into the risks of general anesthesia in children. The researchers note that increasing data over the past two decades from both animal and observational human studies have raised concerns that general anesthesia could lead to neurotoxic changes in the developing brain that could have adverse neurodevelopmental outcomes later in life. The authors call for large-scale clinical trials to answer the many questions that still need to be answered, such as whether certain pediatric populations are at greater risk, does the extent of anesthetic-induced neurotoxic effects depend on the cumulative dose, and whether underlying diseases or inflammatory processes raise the risk of brain injury. SmartTots, the public–private partnership with FDA and the International Anesthesia Research Society, has already formed an international working group of experts to provide data on animal models that can aid in the design and execution of clinical trials. The researchers note that parents and care providers should be alerted to the potential risks of anesthetics on the developing brain, and they suggest that until definitive information is available, "surgeons, [anesthesia providers], and parents should consider carefully how urgently surgery is needed, particularly in children under three years of age."
From "Anesthetic Neurotoxicity—Clinical Implications of Animal Models"
New England Journal of Medicine (02/26/15) Vol. 372, No. 9, P. 796 Rappaport, Bob A.; Suresh, Santhanam; Hertz, Sharon; et al.
Analysis of Anesthesia Start Times Aims to Create National Benchmarks
Researchers in New York are looking carefully at how long it takes for anesthesia to start working for dozens of procedures, in hopes of developing a set of national benchmarks. Having this information on hand could increase efficiency and cost-effectiveness in clinical settings. "It's really important to [factor in] anesthesia ready times" because they can have a major impact on scheduling, according to Sudheer Jain, MD, of NYU Langone Medical Center's anesthesiology department. For instance, explains Jain's colleague and research partner Lori Russo, MD, just 18 minutes may be needed to get a patient ready for hip replacement; while the average for coronary artery bypass graft surgery might be closer to 44 minutes. Jain and Russo studied anesthesia induction times—from the moment patients arrived in the operating room until they were ready for surgery—for nearly 23,000 cases at their site over nine months. The data will be crunched based on anesthesia type and administration technique as well as according to the kind and number of healthcare providers involved in anesthesia delivery.
From "Analysis of Anesthesia Start Times Aims to Create National Benchmarks"
Pain Medicine News (02/24/2015) Guillot, Craig
General Anesthesia May Negate Endovascular Benefit in Stroke
Patients who underwent an endovascular clot retrieval procedure with local anesthesia had better results than those who received general anesthesia, researchers discovered when analyzing a new of the MR CLEAN stroke trial. Under local anesthetic, patients had reduced disability and were more likely to have a good functional outcome compared to those who did not receive endovascular therapy. Patients who had general anesthetic showed almost no incremental benefit with the endovascular procedure compared to medical therapy alone. Researchers presented their findings in Nashville at the International Stroke Conference 2015. The main results of the trial showed that stroke patients who underwent endovascular intervention for an occluded major cerebral artery were less disabled. Patients who underwent the endovascular procedure had twice the likelihood of achieving functional independence than those who received thrombolysis. The review included the 216 patients who underwent endovascular therapy in MR CLEAN, of whom 79 received general anesthesia and 137 underwent the procedure without general anesthesia.
From "General Anesthesia May Negate Endovascular Benefit in Stroke"
Medscape (02/17/15) Hughes, Sue
Malignant Hyperthermia Guidelines Updated by MHAUS
Although rare, malignant hyperthermia (MH)—a serious and sometimes fatal complication that can be triggered by the use of anesthetic agents—continues to be a concern in the operating room and, especially, in ambulatory surgery centers (ASCs). The Malignant Hyperthermia Association of the United States (MHAUS) recently updated its guidelines on monitoring for the condition and managing cases that do arise. Because research has uncovered a correlation between lack of core temperature monitoring and increased mortality in MH cases, the new protocols call for core temperature monitoring rather than standard skin temperature monitoring during surgeries lasting more than a half an hour. Providers also are advised to take special steps—using total IV anesthesia or other nontriggering techniques, closely monitoring end-tidal carbon dioxide values, and ensuring the anesthesia machine is free of any residual traces of volatile anesthetics—to protect patients who are predisposed to MH. Other recommendations include immediately moving suspected MH patients from ASCs to the nearest full-service hospital and keeping dantrolene on hand to treat the condition.
From "Malignant Hyperthermia Guidelines Updated by MHAUS"
Anesthesiology News (02/01/15) Vol. 41, No. 2 Dunleavy, Brian

Fetal-Pain Abortion Bill Coming in Ohio
Since 2010, more than a dozen states have passed "fetal pain" laws, which prohibit late-term abortions based on the theory that unborn babies can experience pain as early as 20 weeks. West Virginia and South Carolina are the latest to entertain such legislation, with Ohio expected to introduce a similar bill soon. Despite the spate of proposals popping up, general consensus in the medical and scientific community does not support the claims underlying the bills. The American Congress of Obstetricians and Gynecologists argues that fetal pain is unlikely before 28 weeks and says no new evidence has disproved its stance. And while critics point out that clinicians often administer anesthesia during fetal surgery, Dr. Daniel Grossman, a San Francisco-based OB-GYN, says they do so to relax muscles or prevent problems cause by reflex reactions to stimuli. Grossman adds that the neurological connections needed to feel pain do not start to form in the womb until after 24 weeks. "There is also a lot of evidence that a fetus is not in a state of full wakefulness until birth," he remarks.
From "Fetal-Pain Abortion Bill Coming in Ohio"
Columbus Dispatch (02/15/15) Candisky, Catherine
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