AANA Anesthesia E-ssential
AANA Anestehsia E-ssential
Anesthesia E-ssential

May 15, 2015


Vital Signs

Be Sure to Vote in the AANA 2015 Election!
Voting Ends June 2 at noon CT
The AANA 2015 election started on May 5, 2015, and will continue until June 2, 2015, 11:59 a.m. CDT. By now, active AANA members should have received their ballot materials, including their election passcode and voting instructions, electronically or in the mail from Survey & Ballot Systems (SBS), AANA's election coordinator. The email with the voting credentials originates from noreply@directvote.net. Please make sure this email did not end up in your spam or junk mail folder.
To vote online and view candidates’ biographical information and position statements, visit the election site (https://www.directvote.net/aana/) and enter your member number and the election passcode provided to you by SBS.
If you do not have your election login information, click on the “Email me my login information” link on the login page, enter the email address on file with AANA, and your election login information will be emailed to you. SBS can be reached by phone at (952) 974-2339 (Monday through Friday, 8 a.m. to 5 p.m. CDT) or by email at support@directvote.net.
If it’s more convenient, please feel free to contact lrivera@aana.com or vgiannopoulos@aana.com, and they will ask SBS to re-send you your voting credentials.
To View Board Candidates’ Video Speeches
Board candidates’ speeches presented at the April Mid-Year Assembly are available on the AANA website through the Video Speeches page: http://www.aana.com/myaana/AANABusiness/electioncenter/Pages/AANA-Board-of-Directors-Candidates-Speeches.aspx.
Online Forum for Board of Directors Candidates Open Now
Take advantage of this opportunity to become better acquainted with the candidates seeking election to the AANA Board of Directors. This un-moderated forum is located in the members-only section of the AANA website at http://www.aana.com/electioncenter. The forum will be available until June 2 (the voting cut-off date).


The Pulse

CPC Pulse
  • About the CPC Program Initial Examination
Hot Topics
  • Board of Directors Approves Updated Practice Documents
  • AANA Pain Management Fellowship
  • Don't Miss Webinar 2: PQRS Reporting Scenarios for CRNAs
  • NYSANA Marches in Pride Parade
  • Webinar Explores Postoperative Delirium
  • Free Perioperative Noise Reduction Resource Available Through CSPS
  • Support Important Research: Donate to the AANA Foundation Annual Campaign Today
  • Friends for Life Deadline – June 15, 2015
  • One Night – Twice the Fun... Register Now for Annual Congress Fundraiser
  • What is Enhanced Recovery After Surgery?
  • ONC Releases Updated Privacy and Security Guide
  • Register Now for Business of Anesthesia Conference
  • Register Now for the Nurse Anesthesia Annual Congress
  • Fall Leadership Academy: Save the Date!
  • VHA Process for Recognizing CRNAs to Their Full Practice Authority Affirmed by U.S. House of Representatives
  • Senators Send VHA Support for Nursing Handbook Full Practice Authority Proposal
  • Update on Current Status of AANA’s Efforts to Ensure Veterans Access to Quality Care
  • AANA Submits Support for Medicare Coverage for Therapeutic Colorectal Cancer Screening
  • HHS Tells Insurers That They Cannot Impose Cost Sharing on Anesthesia Services for Screening Colonoscopies
  • U.S. House, Senate Adopt Concurrent Budget Resolution, Shaping 2016 Appropriations Bills and Other Legislation
  • ASA Was on the Hill May 6 – Have You Completed Your Mid-Year Assembly Follow-up Assignments?
  • Medscape Releases 2015 Anesthesiologist Compensation Report
  • AANA Urges AMA Panel to Include Ultrasound Guidance
  • Members of the VA Special Medical Advisory Group Named
  • 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
About the CPC Program Initial Examination
Some of the questions CRNAs ask most often about the CPC Program concern the initial examination: What will it cover? What if I score low? How often will I have to take it? The answers to these questions are pretty straight forward. If you recertify in even years, you will take the first exam between 2020 and 2024 and if you recertify in odd years, you will take the first exam between 2021 and 2025. You choose when you take it in the four-year period. The exam is not intended to test specialized knowledge; its focus will be on the four core areas of anesthesia practice: airway management, clinical pharmacology, physiology and pathophysiology, and anesthesia technology. Most important, the first exam is not considered a pass/fail exam. This means that if you don’t achieve a certain score on an area of the exam, you don’t need to repeat it, regardless of the outcome. But, it will help you identify areas to focus on as you plan your continuing education. The AANA and NBCRNA are working to help you be successful in the CPC Program.
For more information, go to the AANA and NBCRNA websites.
Board of Directors Approves Updated Practice Documents
At Mid-Year Assembly, the Board of Directors approved two updated Professional Practice documents:
The entire contents of the Professional Practice Manual for the CRNA can be accessed online at www.aana.com/practicemanual or purchased though the AANA Marketplace.

AANA Pain Management Fellowship
CRNAs play a vital role in providing patients accessible, safe, cost-effective pain management services. As part of AANA’s educational mission to its members, AANA offers CRNAs various continuing educational opportunities to enhance their knowledge and skills in pain management through the AANA Pain Management Curriculum, which includes AANALearn® online modules and several pain management workshops. The curriculum also includes AANA’s accredited postgraduate pain management fellowship program which prepares CRNAs for the new, voluntary subspecialty certification, the Nonsurgical Pain Management credential offered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).
Through its ongoing commitment to enhance and expand its pain management offerings for CRNAs, AANA is issuing a request for proposals to accredited academic institutions of higher education to partner with AANA to enhance and expand its postgraduate pain management fellowship program. To learn more, please contact AANA at painmanagement@aana.com.

Don’t Miss Webinar 2: PQRS Reporting Scenarios for CRNAs
May 27, 2015
5 - 6 p.m. CT
A new AANA live webinar titled“PQRS Reporting Scenarios for CRNAs” will review the fundamentals of Physician Quality Reporting System (PQRS) reporting for CRNAs plus discuss a number of real-world reporting scenarios pertaining specifically to CRNAs. Meeting materials, along with a recording of the webinar, will be made available at a later date for those unable to attend the live program. Click here to register for this second live webinar. If you were unable to attend our previous live AANA webinar, "Medicare Quality Reporting Essentials for CRNAs and Their Billing Office," please click here to watch a recording and review additional resources. (AANA member login is required to access both the live and recorded webinars and resources.)
NYSANA Marches in Pride Parade
The New York State Association of Nurse Anesthetists (NYSANA) is taking part in this year’s NYC Pride Parade on June 28. The association would like to invite all CRNAs who would like to join the march supporting diversity to email NYSANA at NYSANAPR@gmail.com. The parade kicks off at noon on 35th St. and Fifth Ave. in New York City. For information on the parade, visit www.nycpride.org/events.
Free Webinar Explores Postoperative Delirium
Join AANA Corporate partner, Covidien, May 19 at 2pm MST, for an educational webinar regarding postoperative delirium. This comprehensive web-based presentation will provide an overview on delirium, its prevalence, causes, treatment, and anesthesia’s role in its occurrence. For more info, or to sign up, visit: http://covidiensolutions.covidien.com/deliriumwebinar.
Free Perioperative Noise Reduction Resource Available Through CSPS
The Council on Surgical and Perioperative Safety (CSPS)endorses a safe surgery resource chart to reduce the risk of noise and distraction in the perioperative period. The chart emphasizes attention to the elements of noise and distraction, infection control, and privacy. In the chart, which can be downloaded for free at www.cspsteam.org, CSPS recommends a multidisciplinary team approach to reduce the level of noise and create a safer environment for patients. It stresses that noise takes away from the silence team members may need to perform operations safely. It also warns that the use of cellular phones and accessories can cause distraction and bacterial contamination, which may compromise a sterile perioperative environment. The CSPS is an incorporated multidisciplinary coalition of professional organizations whose members are involved in the care of surgical patients. Member organizations are the AANA, American Association of Surgical Physician Assistants, American College of Surgeons, American Society of Anesthesiologists, American Society of PeriAnesthesia Nurses, Association of periOperative Registered Nurses, and Association of Surgical Technologists (AST).

Support Important Research: Donate to the AANA Foundation Annual Campaign Today
The AANA Foundation supports important research with the help of individuals, state associations, and corporations. Evidence provides proof, and proof is power! Take a moment to make your tax-deductible gift to AANA Foundation’s Proof is Power campaign—access the Foundation’s secure donation page here.
Donations of $100 or more made by July 1, 2015, will be included in the AANA Foundation Fiscal Year 2015 Annual Report and Recognition booklet. Thank you in advance for your contribution and support of nurse anesthesia through the AANA Foundation!
Friends for Life Deadline – June 15, 2015
Friends for Life help support the future of the nurse anesthesia profession through meaningful, lasting gifts. Contributions through Friends for Life help fund and sustain programs that further research and education in anesthesia.
Friends for Life receive a medallion at the AANA Annual Congress Opening Ceremonies, an engraved plaque in the AANA Park Ridge office, and an invitation to the Annual Awards and Recognition Event. 
The minimum gift commitment to join Friends for Life is $25,000. Members may fulfill this commitment through a cash gift, but there are many other ways to meet the commitment through planned gifts. Some of the most popular planned gift options for becoming a Friend for Life include:
  • A gift (bequest) in the will for a specific amount or a percentage of the total estate
  • Gift of personal property or real estate
  • Including the Foundation as a beneficiary on a retirement plan or a whole life insurance policy
For further information, please contact Nat Carmichael at (847) 655-1175 or ncarmichael@aana.com.  The Friends for Life submission deadline for recognition at this year’s Annual Congress in Salt Lake City, Utah, is June 15, 2015.
One Night – Twice the Fun... Register Now for Annual Congress Fundraiser
Plan to attend a fabulous and fun event on Sunday, Aug. 30, 2015, at The Grand America Hotel in Salt Lake City, Utah. One Night – Twice the Fun will feature fabulous live entertainment by Hollywood Revisited, followed by an awesome dance party. This event has two parts—twice the fun—at two different ticket prices.
Part 1 – Star-Studded Main Event
7:00 - 9:30 p.m. – Dinner and Entertainment featuring Hollywood Revisited
Part 2 – Shake It for a Cause Dance Party
9:30 - 11:45 p.m.
This AANA Foundation fundraising event offers something for everyone. One Night – Twice the Fun includes a full evening of food and entertainment—dinner, drinks, Hollywood Revisited extravaganza, and Shake It for a Cause Dance Party. 
Hollywood Revisited is a tribute to the golden age of Hollywood in costume and song. Concert pianist and well-known collector of movie costumes Greg Schreiner provides movie and scene anecdotes and musical accompaniment while acclaimed vocalists sing and dance while wearing the actual costumes worn by Hollywood legends such as Marilyn Monroe, Elizabeth Taylor, Gene Kelly, Bob Hope, Judy Garland, and many more.
Shake It for a Cause Dance Party will feature a DJ playing all your favorite songs. Nurse anesthetists love to go all out on the dance floor, so plan to boogie, kick up your heels, and groove the night away.
The registration fee for the complete package is $250. For those who only wish to attend the dance party, the registration fee is $50 for CRNAs and $25 for SRNAs.
Registration is now open—be sure to purchase your ticket when you register for the AANA 2015 Nurse Anesthesia Annual Congress.
If you have any questions, please contact Luanne Irvin at the AANA Foundation at (847) 655-1173 or lirvin@aana.com.

What is Enhanced Recovery After Surgery?
Enhanced Recovery After Surgery refers to multimodal care pathways designed to reduce patients’ stress response to surgery, support their physiologic function, and accelerate the return to normal daily function. These care pathways form an integrated continuum, as the patient moves from home through the preoperative, intraoperative, and postoperative phases of surgery and home again. Find resources and learn more about how CRNAs can be involved at www.aana.com/enhancedrecovery.
ONC Releases Updated Privacy and Security Guide
The Office of the National Coordinator (ONC) recently released the revised Guide to Privacy and Security of Electronic Health Information to help organizations integrate federal health information privacy and security requirements. The updated guide features information about compliance with the privacy and security requirements of CMS’ Electronic Health Record (EHR) Incentive Programs as well as compliance with HIPAA Privacy, Security, and Breach Notification Rules.

Register Now for Business of Anesthesia Conference
Join us in San Diego on June 26-27 for a two-day conference that will arm you with critical tools for navigating the business aspects of anesthesia practice. Get real-world advice from expert speakers with experience in building and maintaining a successful practice. Whether you are still in training or have owned your practice for years, you’ll benefit from best practices and strategies for success in an ever-changing healthcare climate. Register before May 26 and Save $50!
Register Now for the Nurse Anesthesia Annual Congress
August 29-Sept. 1
Salt Lake City
The Nurse Anesthesia Annual Congress is the world's largest educational, professional, and social event for Certified Registered Nurse Anesthetists. Choose from seven education tracks, including practical hands-on learning and networking, in addition to the largest exhibit of its kind. Register Now!
Fall Leadership Academy: Save the Date!
November 6-8, 2015
Westin O'Hare, Rosemont, Ill.
Watch the AANA website and future issues of the NewsBulletin and E-ssential for more information!

VHA Process for Recognizing CRNAs to Their Full Practice Authority Affirmed by U.S. House of Representatives
The Veterans Health Administration (VHA) process for recognizing CRNAs and other advanced practice registered nurses (APRNs) to their Full Practice Authority, with the involvement and participation of the AANA and CRNAs, was affirmed in advisory report language adopted by the House Appropriations Committee on April 22. The U.S. House of Representatives followed suit on April 30 with a vote of 255-163, adopting HR 2029, the FY 2015 Military Construction and Veterans Affairs Appropriations bill. Senate committee action is next.
The AANA-backed language within the FY 2016 Military Construction and Veterans Affairs Appropriations bill report (H Rept 114-92) states as follows: “Nursing handbook. The Committee understands that the VHA Nursing Handbook is currently under review. The Committee encourages the VHA to seek input from internal VA program offices and external professional stakeholders, prior to possible regulatory action and submission to the Under Secretary for Health for final approval. The Committee believes all possible outreach efforts should be used to communicate the proposed changes, to gather public comment, and to collaborate with Congress, stakeholders, VA nursing staff, and external organizations. Finally, the Committee requests that the VHA ensure that any changes to handbooks within the VHA do not conflict with other handbooks already in place within the VHA.” The language is identical to language Congress approved for the current fiscal year.
Senators Send VHA Support for Nursing Handbook Full Practice Authority Proposal
Seven U.S. Senators sent a letter of support for the Veterans Health Administration (VHA) Nursing Handbook proposal that would grant advanced practice registered nurses, including CRNAs, full practice authority in the VHA. Directed to Secretary Robert McDonald, the group of Senators argued that this proposal would allow for greater team-based clinical practice in the VHA and most importantly improve access to critical services for our nation’s veterans. Senator Richard Durbin (D-IL), who spearheaded the letter, was joined by Senators Jon Tester (D-MT), Sherrod Brown (D-OH), Ed Markey (D-MA), Sheldon Whitehouse (D-RI), Jeanne Shaheen (D-NH) and Jack Reed (D-RI).
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.
A clear understanding of the complex procedural aspects of this VHA issue 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). The bill has 23 bipartisan cosponsors. The AANA is requesting that 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 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 13,000 messages to their federal legislators expressing support for HR 1247 and concern for S 297 as written.
If you have not already done so, please contact your Representative and request that he or she cosponsor HR 1247: https://www.crna-pac.com/actionalerts.aspx. See the AANA and APRN Workgroup letter of support at 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 at http://admin.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.
AANA Submits Support for Medicare Coverage for Therapeutic Colorectal Cancer Screening
The AANA submitted letters of support May 5 for legislation that would cover separate anesthesia services and eliminate patient coinsurance and deductible payments for Medicare colorectal cancer screening procedures, when such procedures become therapeutic. Currently, Medicare covers the patient’s coinsurance and deductible for the colonoscopy screening and also covers the separate medically necessary anesthesia service. However, if such a colonoscopy service becomes therapeutic – that is, if the surgeon sees a polyp and removes a polyp consistent with standards of care and patient need – then the patient may be responsible for coinsurance for the procedure and the separate anesthesia service. Sponsored by Rep. Charles Dent (R-PA) in the House and Sen. Sherrod Brown (D-OH) in the Senate, the Removing Barriers to Colorectal Cancer Screening Act” (HR 1220 and S 624), would eliminate barriers to Medicare beneficiaries undertaking these preventative services.
HHS Tells Insurers That They Cannot Impose Cost Sharing on Anesthesia Services for Screening Colonoscopies
The Departments of Labor, Health and Human Services, and the Treasury issued new guidance May 11 clarifying that if a colonoscopy is scheduled and performed as a preventive screening procedure for screening colonoscopies, health plans or issuers cannot impose cost sharing with respect to anesthesia services performed in connection with the procedure. The Departments specified this would be the case if the attending provider determines that anesthesia would be medically appropriate for the individual. The AANA is currently reviewing this guidance and will further report on impacts to CRNAs if they arise. To view the guidance see, http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/aca_implementation_faqs26.pdf. To read about Medicare coverage of separate anesthesia services on screening colonoscopies, see http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20141104%20Hotline%20EXTRA%202014-23a_updated.pdf (requires AANA member login and password).
U.S. House, Senate Adopt Concurrent Budget Resolution, Shaping 2016 Appropriations Bills and Other Legislation
Congress has approved its Fiscal 2016 budget resolution (S Con Res 11), setting overall spending and revenue levels for next year’s appropriations bills and shaping policy Congress may tackle later this year. The U.S. House of Representatives passed it on April 30 with a 226-197 vote, and the Senate approved it on May 5 with a 51-48 vote.
The 2016 budget resolution agreed by congressional majority Republicans recommends spending levels for Fiscal 2016, sets forth budgetary levels for FY 2017-2025, and does not need to be signed into law by the President. If future appropriations, tax and other revenue legislation follows the budget outline, the resolution would reduce spending over the next 10 years by $5.3 trillion compared with current anticipated levels. Relative to the levels allowed by current policy, the budget directs Congress to follow through by reducing spending for Medicare and Medicaid and repealing the Affordable Care Act – both of which would require legislation that that requires the President’s signature for its enactment into law. The AANA is monitoring this process closely and will keep you abreast of any new developments. To read the conference report, see: https://www.congress.gov/bill/114th-congress/senate-concurrent-resolution/11/text?q=%7B%22search%22%3A%5B%22s+con+res+11%22%5D%7D. See how your Representative voted, here: http://clerk.house.gov/evs/2015/roll183.xml. See how your Senators voted, here: http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=114&session=1&vote=00171.
ASA Was on the Hill May 6 – Have You Completed Your Mid-Year Assembly Follow-up Assignments?
With the American Society of Anesthesiologists (ASA) hosting its annual Washington Legislative Conference the week of May 4, CRNAs can leave a positive impact on Capitol Hill and in congressional offices for the patients, practice and profession of nurse anesthesia by diligently completing post-Mid-Year Assembly follow-up activities.
If you have not done so already, please remember to follow up with the congressional offices you met with during Mid-Year Assembly and remind them of the quality anesthesia care provided by CRNAs. Please also remember to log your lobby reports online. Post your best pictures on Facebook and Twitter with the hashtags #AANAMYA, #CRNA, and #MyCRNACause. Email your favorites to info@aanadc.com with the names of people in each photo listed left to right. To follow the ASA’s conference on social media, see #ASAWLC on Twitter. The AANA thanks the more than one thousand CRNAs and student registered nurse anesthetists who took to Capitol Hill during Mid-Year Assembly and to those who made this year’s event such a success!
At the first-ever Rally for CRNAs on Capitol Hill, AANA President Sharon Pearce, CRNA, MSN, (center front) and President-elect Juan Quintana, CRNA, DNP, MHS, (to the left of Pearce) joined hundreds of AANA members on the west front lawn of the U.S. Capitol building.

Medscape Releases 2015 Anesthesiologist Compensation Report
Late April, Medscape released its yearly compensation survey results where anesthesiologists described their compensation, number of hours worked, practice changes resulting from healthcare reform, and how they have adapted to the new healthcare environment. Anesthesiologists were ranked fourth in physician specialty annual earnings at $358,000, behind orthopedists, cardiologists and gastroenterologists in Medscape’s 2015 Anesthesiologist Compensation Report. When comparing 2014 compensation with the prior year's data, anesthesiologists reported an increase of 6 percent. To see how different practice settings compared in compensation or to view the full report, see:
AANA Urges AMA Panel to Include Ultrasound Guidance
The AANA, in two letters written April 23, stated the American Medical Association panel considering changes to Coding Procedural Terminology (CPT) codes for chronic pain management procedures, including epidural injections, should add ultrasound to the list of imaging guidance technology included in the proposed revisions.
In commenting to the AMA Coding Procedural Terminology (AMA CPT) Editorial Panel meeting in May, the AANA stated, “Innovations in the use of technology for guided regional anesthesia techniques have improved the safety and quality (e.g., block onset, block duration) of the nerve block. Sympathetic nerve blocks using ultrasound guidance do translate to the epidural space. Furthermore, ultrasound imaging technology has become increasing available at the bedside and may improve patient safety and accuracy of invasive diagnostic and therapeutic procedures, and has a decreased cost to purchase and maintain. One in five pain management professionals are integrating ultrasound guidance into acute and chronic pain management. Ultrasound has the advantage of reduced radiation exposure risks as opposed to other imaging techniques.” Read the AANA’s letters on Epidural Injections, here: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150423%20AANA%20comment%20to%20AMA-CPT%20Editorial%20Panel%20re%20codes%20for%20caudal%20and%20lumbar%20epidural%20space-%20FINAL.pdf and Caudal and Lumbar levels, here: http://www.aana.com/myaana/Advocacy/fedgovtaffairs/Documents/20150423%20AANA%20comment%20to%20AMA-CPT%20Editorial%20Panel%20re%20codes%20for%20caudal%20and%20lumbar%20epidural%20space-%20FINAL.pdf.
Members of the VA Special Medical Advisory Group Named
On April 24, the Department of Veterans Affairs (VA) announced a new 11-member Special Medical Advisory Group (SMAG) charged with “providing advice to the Secretary of Veterans Affairs and the Under Secretary for Health on matters relating to the care and treatment of veterans and other matters pertinent to the operations of the Veterans Health Administration (i.e., research, education and training of health manpower, and VA/DOD contingency planning).” Included on the panel is the American Association of Colleges of Nursing Chief Executive Officer Deborah Trautman, PhD, RN, and other leading healthcare experts. The SMAG Committee is scheduled to conduct its first meeting on May 13, 2015. To learn more about the committee, see www.va.gov/ADVISORY/SMAG.asp
  • Medicare says that its pioneer accountable care organization (ACO) care delivery model saved nearly $400 million over two years, or about $300 per beneficiary, according to a statement that the agency released May 5. According to the Medicare actuary, the ACO model now qualifies for expansion from a pilot project to a larger initiative covering more Medicare beneficiaries. Learn more at the Pioneer ACO Model here. And if you have a CRNA-focused perspective on the impact of an ACO on your clinical practice or reimbursement, share it with us at info@aanadc.com.
  • The AANA sends a special thank you to outgoing Association of Veterans Affairs Nurse Anesthetists (AVANA) President, Sherry Swearngin, MHS, CRNA, for her leadership in support of improving veterans access to quality healthcare, and welcomes incoming AVANA President Garrett Peterson, DNP, CRNA. Thank you to all of the AANA’s AVANA partners and colleagues for all of their hard work and dedication to the nurse anesthesia profession on behalf of America’s veterans.
  • 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 with the theme of #MyCRNACause. View #MyCRNACause videos via the video section of www.crna-pac.com and join the conversation today!
  • Four additional candidates have recently entered the field to succeed President Obama in the 2016 elections. Among Republicans, new contenders include pediatric neurosurgeon and author Ben Carson, MD, former Arkansas governor Mike Huckabee and former Hewlett-Packard CEO Carly Fiorina. Sen. Bernie Sanders (I-VT) entered the Democratic field. 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.
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.


Advil vs. Tylenol. Which to Use, and When
Although many people believe ibuprofen, acetaminophen, and other over-the-counter analgesics are mostly interchangeable, medical experts say that is not the case. These medications are each at their best when taken for certain ailments, in part because they work differently in the body and can have different adverse effects. The medications, which are taken by millions of Americans every week, continue to be studied for other possible adverse effects. How acetaminophen works in the body is not fully understood, says Norman Tomaka, a pharmacist in Melbourne, Fla., and a spokesman for the American Pharmacists Association. Experts believe the drug works on the central nervous system, blocking pain receptors in the brain. In contrast, ibuprofen and other nonsteroidal anti-inflammatory drugs work in various parts of the body by inhibiting production of prostaglandins, chemicals released by injured cells that trigger inflammation and pain. Acetaminophen, which is metabolized in the liver, should be limited by people with liver conditions or who drink a lot of alcohol. Generally the drug takes at least 45 minutes to start working and twice that to see measurable pain relief. That may lead some people to take more than they should, says Tomaka. "The problem with acetaminophen and why it's the leading cause of acute liver failure is people take too much of it," notes Tomaka. "Add alcohol to the picture and you're adding another competing drug cleared by the liver."
From "Advil vs. Tylenol. Which to Use, and When"
Wall Street Journal (05/12/15) Reddy, Sumathi
Pre-MRI Counseling for Pediatric Patients Reduces Need for Anesthesia: Study
Anesthesia is often required to keep children still when they undergo MRI, but new research indicates that counseling them ahead of the hour-long procedure helps avoid sedation in many cases. In the Johns Hopkins study, pediatric patients were educated by certified child life specialists about the test and taught coping skills to help deal with anxiety during the MRI. The results showed that, under this protocol, overall anesthesia use declined to 19 percent from 23 percent. The drop was even more pronounced—10 percent—among patients between the ages of five and 10 years. "Anesthesia will always be necessary in some cases," according to researcher Dr. Daniel Durand. "But the results indicate that more children can avoid the discomfort and risk of anesthesia — which may decrease stress and expense to the parent as well."
From "Pre-MRI Counseling for Pediatric Patients Reduces Need for Anesthesia: Study"
Dotmed (05/11/15) Mitchell, John W.
Abandoned Painkiller Makes a Comeback
The Food and Drug Administration (FDA) approved a new version of oxymorphone (Opana—Endo Pharmaceuticals) in 2006. Abuse of this analgesic is linked to overdose risk, an outbreak of HIV in rural Indiana, a rise in hepatitis C infections in several states, a blood-clotting disorder, and permanent organ damage. The Milwaukee Journal Sentinel and MedPage Today found that oxymorphone's re-appearance on the market followed a pattern of close relationships between regulators and pharmaceutical executives. The investigation focused on IMMPACT, an organization funded by analgesic makers that brought together regulators and pharmaceutical executives and helped develop enriched enrollment, a new approach for drug approval that allows pharmaceutical companies to weed out people who do not respond well to a medication before an actual clinical trial begins. Independent physicians say that this approach is cheaper for companies and makes it more likely a drug will be found effective. The FDA originally said that oxymorphone did not appear effective enough in clinical trials, so Endo conducted trials under enriched enrollment, after which the agency approved the drug in 2006. FDA's own advisory committee voted against the approval.
From "Abandoned Painkiller Makes a Comeback"
MedPage Today (05/10/15) Fauber, John; Fiore, Kristina
Preoperative Fasting in Children Unnecessarily Prolonged
Standard protocol recommends no liquids or solid foods two hours and six hours, respectively, before surgery; but researchers say pediatric patients routinely fast for much longer than that. A review of nearly 23,000 records at Boston Children's Hospital found that 76 percent of kids who had surgery there over a year-and-a-half period did not eat for more than 12 hours prior to their procedure. Some 20 percent stopped eating eight to 12 hours preoperatively, and fully 10 percent of them fasted 18 hours or more. More than a third abstained from drinking anything for more than six hours preoperatively, 16 percent took no liquids for six to 12 hours ahead of time, and 20 percent refrained from drinking for more than 12 hours before surgery. The investigators found that fasting duration was longer as the day progressed, from about 10 hours at 8 a.m. to nearly 20 hours by late afternoon. Fasting also was higher the older the patient, with infants less than one year old going without solids for 9.6 hours but children between five and 12 not eating for 14.5 hours ahead of their operation time. Lead researcher J. William Sparks, MD, suspects that parents and/or patients may be overly worried about aspiration and also that parents may not be receiving accurate information about how long their child needs to abstain from food and drink. The next step, he says, is to look at the metabolic impact of prolonged pre-surgery fasting in kids. "Obviously," Sparks concludes, "the big picture is whether a prolonged fast affects patient outcomes."
From "Preoperative Fasting in Children Unnecessarily Prolonged"
Anesthesiology News (05/01/15) Vol. 41, No. 5 Van Voorhis, Scott
Nitrous Oxide Improves Satisfaction With IUD Insertion
Women who inhale nitrous oxide during intrauterine device (IUD) insertion, a procedure that causes moderate pain in the average patient, report greater satisfaction with the experience. Researchers at the University of New Mexico recruited 80 subjects for their randomized study, with half inhaling a 50-50 blend of nitrous oxide and oxygen through a scented mask and the other half inhaling 100 percent oxygen. Even though the difference in pain scores between the two groups was negligible, women who inhaled nitrous oxide were significantly more likely to report being satisfied or very satisfied with the procedure. Lauren Thaxton, MD, speculated that the nitrous oxide may simply have calmed anxiety in some patients or blunted the memory of pain. However, she and her colleagues believe that tailoring dosage of the gas to individual women might produce a bigger result in pain scores; and they are now planning a study to that effect.
From "Nitrous Oxide Improves Satisfaction With IUD Insertion"
Medscape (05/08/15) Harrison, Laird
FDA Approves Spinal Cord Stimulation System That Treats Pain Without Tingling Sensation
The Food and Drug Administration (FDA) on May 8 approved the Senza spinal cord stimulation system (Senza System), manufactured by Nevro Corp., for the management of chronic pain of the trunk and/or limbs.  The Senza System provides high-frequency stimulation (10 KHz) and low-stimulation amplitudes to reduce pain without producing the tingling sensation known as paresthesia.  In a review of safety and effectiveness, FDA looked at a clinical study in which 198 subjects with chronic intractable pain were randomized to either the Senza System test group or a control group.  Seventy-five percent of subjects treated with the Senza System achieved a 50 percent reduction in pain at three months, with no related neurological deficits.  The Senza System is implanted in a minimally invasive procedure, where it delivers electrical stimulation to the thoracolumbar area of the spinal cord.  A rechargeable pulse generator, programmed by a clinician, is implanted in the patient's upper buttocks region or abdomen.  Patients can use a remote to control the pulse generator within programmed output ranges.
From "FDA Approves Spinal Cord Stimulation System That Treats Pain Without Tingling Sensation"
FDA News Release (05/08/15)
Potential New Painkiller Provides Longer Lasting Effects
Researchers out of the University of Missouri believe a promising new compound could offer more anesthetic staying power than lidocaine and other painkillers. Boronicaine outperformed lidocaine in pre-clinical trials, providing 25 minutes of pain relief compared to 5 minutes. "Having a longer lasting anesthetic reduces the dosage or number of doses needed, limiting the potential for adverse side effects," said lead researcher George Kracke, PhD. He noted that while there already are painkillers that outlast lidocaine, those options also run the risk of serious negative outcomes. Preliminary findings for boronicaine, however, detected no toxicity in single-dose studies. The findings are published in ChemMedChem.
From "Potential New Painkiller Provides Longer Lasting Effects"
Medical Xpress (05/07/15)
Abuse of Pain Pills Fuels Virus's Spread, Confounding Regulators
U.S. regulators approved a hard-to-abuse version of oxycodone hydrochloride in 2010, but an unintended consequence has led to an increase in hepatitis C virus (HCV) infection among people with drug addictions. While the move was successful in the sense that the drug was not abused, it failed to take into account that users would move to different drugs, such as oxymorphone hydrochloride (Opana—Endo Pharmaceuticals) and its generics. The wide needle used to inject these products also helps to spread bloodborne diseases more easily. While Endo only sells an abuse-resistant version of the drug now, the Food and Drug Administration (FDA) said in 2013 that the abuse-deterrent features were not yet good enough to block generic versions without those features. The FDA says that it is working hard to assist the industry in creating more difficult-to-abuse drugs in the midst of an opioid analgesic epidemic that has seen overdose deaths more than triple since 1999. Health experts say that abuse-deterrent drugs are a very positive development, but more research is needed to make them safer.
From "Abuse of Pain Pills Fuels Virus's Spread, Confounding Regulators"
Bloomberg (05/07/15) Edney, Anne
Penn Researchers Looking for a Knockout Anesthesia
A team of University of Pennsylvania researchers is searching for better anesthesia alternatives using robotics and tadpoles. With currently available methods, such as propofol, there is a fine line between an amount that will put people to sleep and an amount that will kill them. Researchers are hoping to prevent death from anesthesia as well as more subtle side effects, such as cognitive problems in the elderly and very young patients. The researchers first used a robotic system to screen more than 350,000 drug candidates from a library of compounds at the National Institutes of Health, then tested several dozen substances on tadpoles, with plans to go on to mice. They found two candidates that were especially effective with few side effects. The robotic, high-throughput method is a fast and relatively inexpensive way to evaluate thousands of compounds by measuring their ability to bind with a kind of protein known to have an affinity for existing anesthetics. "We don't know if these two molecules are ultimately going to make it into people," said researcher Roderic G. Eckenhoff. "But the process is very likely to produce molecules that we can put into people."
From "Penn Researchers Looking for a Knockout Anesthesia"
Philadelphia Inquirer (05/04/15) Avril, Tom
Opioids Gateway Drug for Many High-Risk Patients
Patients with chronic noncancer pain have shown a tendency to become dose-dependent even when opioids are properly taken, according to addiction expert Molly Feely, MD, of the Mayo Clinic in Rochester, Minn. Speaking at the American College of Physicians Internal Medicine 2015 in Boston, Feely noted that 80 percent of current heroin users started using the drug when prescription opioids were no longer financially feasible. She suggested that clinicians should consider opioids a last resort in most cases, and that planning and documenting all activities concerning high-risk patients is a must. A sense of urgency is needed, especially after the Centers for Disease Control and Prevention deemed prescription opioid abuse as the "worst drug overdose epidemic in history." It often falls on the physician's shoulders to identify which patients are high-risk. Opioid abuse is most commonly associated with patients who have a personal or family history of drug abuse, and patients with a comorbid psychiatric condition such as depression or bipolar disorder. Feely recommended using a free risk-assessment tool on opioidrisk.com to help identify these patients, and she suggested treatment agreements and adherence monitoring to help protect against opioid misuse.
From "Opioids Gateway Drug for Many High-Risk Patients"
Medscape (05/04/15) Osterweil, Neil
Emergency Department Opioid Prescribing
New research shows that almost all opioid prescriptions in the emergency department (ED) were immediate-release formulations. The researchers, who report their findings in the Annals of Emergency Medicine, found that the median number of tablets per prescription was 15, with just a small fraction of the prescriptions for more than 30 tablets. The findings suggest that "emergency physicians generally follow guideline recommendations to limit opioid prescriptions to only 3–5 days, and avoid long-acting opioids," said Scott G. Weiner, MD, MPH, corresponding author of the study and emergency physician at Brigham and Women's Hospital in Boston. The study used a national sample of ED patients treated during a single week of October 2012 to help analyze the characteristics of patients and opioid prescriptions. Of the more than 27,500 patient visits evaluated, 70 percent of patients were discharged and 17 percent of all discharged patients received a prescription for an opioid analgesic, most commonly for musculoskeletal back pain and abdominal pain.
From "Emergency Department Opioid Prescribing"
Brigham and Women's Hospital (05/04/15)
Longer-Term, High-Dosage Opioid Use an Ongoing Danger
Patients maintaining a high daily level of at least 100 milligrams per day of opioids for up to six months are at a greater risk of overdose than patients taking high levels of the drugs for a shorter period, according to a study published in the Journal of Pain. Managers of workers' compensation programs continue to struggle with rising claim costs because of opioid abuse, and many are seeking new metrics to quantify dosages that are safe. In Washington state, medical treatment guidelines, which are considered a benchmark in the workers' comp industry, recommend that doctors not increase opioid dosage beyond an average daily morphine equivalent of 120 milligrams to curb the risk of addiction or overdose. However, CompPharma LLC President Joseph Paduda says, "We really don't know what a 'safe' dosage is, and it's highly likely that what is a safe dosage for one person is not a safe dosage for somebody else who has a different profile." He also notes that the study calls into question whether injured workers and other patients should be given long-term opioid prescriptions for chronic pain unless their pain is lessened or their function has improved.
From "Longer-Term, High-Dosage Opioid Use an Ongoing Danger"
Business Insurance (04/30/15) Harrison, Sheena; Kenealy, Bill
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