ASA Financial Security. Advancing the Practice, Securing the Future 6/28/2013. Advancing the Practice, Securing the Future. Financial Security

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1 Millions Millions Advancing the Practice, Securing the Future ASA 2013 Indispensible to Your Practice John M. Zerwas, MD President, American Society of Anesthesiologists GEORGIA SOCIETY of ANESTHESIOLOGISTS JULY 2013 Financial Security Organizational Excellence Exceptional Member Benefits 2 Advancing the Practice, Securing the Future Financial Security $43 $41 $39 $37 $35 $33 $31 $29 $27 $25 $23 $21 $19 $17 $15 Operating Revenue and Expense Proj Bud Bud Total Revenue Total Expense 3 4 Operating Revenues 2012 Projected Operating Revenue $40.1 Million Advertising & Corporate Support $2.2 Publications $3.7 Meetings $4.0 Exhibits $3.8 Educational Products & Other Revenues $7.2 In Millions Dues $19.2 ASA Total Reserves ASA Total Reserves Estimated at 12/31/2012 $66.4 million $70.0 $60.0 $50.0 $40.0 $30.0 $20.0 $10.0 $

2 Millions Non-Dues Operating Revenue Operating Expenses Non-Dues Operating Revenue $ $ $ $ $ $ $ $ $ $ $ Estimated Annual Meeting Publications & Education Other* *Other Meetings, Professional Fees and Other 2012 Estimated Operating Expense $36.6 Million Support, $7.6 Related Organizations, $3.9 Governance, $7.1 In Millions Education, $10.1 Advocacy, $ Financial Processes and Systems Over the past five years we have: Hired a CFO Instituted Generally Accepted Accounting Principles Unqualified audits for past 4 years, last two years no management letter issued Created a budget process Increased revenue Controlled expenses Rebuilt reserves Advancing the Practice, Securing the Future Organizational Excellence 9 Paul Pomerantz, ASA CEO Current Park Ridge Headquarters 11 2

3 New Headquarters Property: Schaumburg 6.6 acres Not Just Quantity, Quality 13 Our Staff Experience Comes From Advancing the Practice, Securing the Future Exceptional Member Benefits 16 Membership- We Continue to Grow ASA Education Department 60,000 50,000 Lead by Chief Learning Officer Diane Gambill, PhD 40, ,000 20,000 10, Continuing ASA s position as the leader in anesthesia education Developing educational products and services based on member needs Maintaining highest level ACCME accreditation 3

4 A Strategic Education Focus NEW: ASA Joint Sponsorship Program for Component Society CME meetings NEW: MOCA offerings including Subspecialty and Patient Safety NEW: 2013 ASA s first ever Quality Meeting Member Benefit: A Customized Learning Center Track CME credits & activities Purchase course material Take online education Manage pre- and post-requirements Interact with MOCA ASA will convene its 2 nd Education Summit Continuous updates and revision of current educational products Maintaining a Strong Meetings Team Strong leadership and committee support ensures successful meetings & programs Experienced director and staff with medical meeting and event management experience Focused on customer service, improving process, and superior logistics A. Bendo, M.D Annual Meeting, Chair J. Mesrobian, M.D CoPM Chair Improved the attendee experience at the Annual Meeting and all ASA meetings Introducing the use of today s medical meeting technology into ASA meetings C. Wehking Director of Meetings Growing revenues and controlling expenses through stronger contract negotiations 21 A. Rosenberg, M.D. Annual Meeting, Past Chair A. Abouleish, M.D. CoPM, Past Chair Focusing on Quality Outcomes & Patient Safety in San Francisco More than 2,800 sessions & presentations, hands-on workshops and late-breaking panel discussions ASA Opening Session featuring Charles Denham, M.D., Chair TMIT, and Editor Journal on Patient Safety with Dennis Quaid, C. Denham, M.D Chasing Zero: Winning the War on Opening Session Healthcare Harm APSF Pierce Lecturer and ASA Honorary Member, Professor Alan F. Merry Emery A. Rovenstine Lecture, Winning the War with John B. Neeld Jr. M.D. Todd Sacktor, PhD to present the John W. Severinghaus Lecture ASA 2013 Distinguished Service Award recipient, Jeffrey Cooper 23 J. Neeld, M.D. Rovenstine Lecture Dennis Quaid Opening Session Todd Sacktor, PhD Severinghaus Lecture Alan Merry Pierce Lecture Jeffrey Cooper 2013 DSA 24 Corporate Development Following Executive Committee discussion and approval, a change will be made to the upper tier of the ASA Corporate Supporter Program beginning January 1, 2013: No longer two distinct categories at the top tier Industry Supporters and Practice Management Supporters Top tier will be called Industry Supporters and will encompass all fields that relate to the practice of anesthesiology Medical Device companies Pharmaceutical companies AIMS providers Practice Management providers (billing, coding, etc.) There will be no more than 12 Industry Supporters First Conference Supporter for PRACTICE MANAGEMENT 2013 signed Staff continues to work to sign additional Industry Supporters to bring it to its full compliment of 12 4

5 ASA Corporate Supporters (December 2012) ASA Communications Brand ASA Industry Supporters: 2013 Conference Supporter: Journal Anesthesiology 2012 Media Coverage Year in Review ASA/Anesthesiology Journal Press Release program continued to highlight key research studies each month, resulting in top tier media coverage. Monthly journal podcasts recorded by Editor-in-Chief James C. Eisenach, M.D. to discuss highlights from each issue Public Awareness Efforts Looking ahead to 2013 ASA and Iowa Society of Anesthesiologists launched public education campaign across state to inform residents about surgery and anesthesia. Audio news release (ANR) distributed to radio stations across nation to educate public about anesthesiologists. ASA Wikipedia page updated with more robust information. ASA proud strategic partner of The Medicine Abuse Project to raise awareness about drug abuse. Podcast KevinMD.com article Enhanced collaboration among communications and advocacy departments. Patient-centered pain website to stress importance of physicianled pain care with centralized content: Physician-paincare.com. YouTube video for patients and legislators on role of physicians in pain procedures. Roxanne Pipitone Manager of Public Relations Terri Navarrete Senior Graphic Designer Katie Looze Public Relations Associate Bryan Shuy Manager of Governmental & Political Outreach Roy Winkler Communications Associate

6 Supporting Foundations and Related Organizations Making a Difference Advancing the Practice, Securing the Future Washington, DC Office Building Advocacy Update 33 Our Washington, DC Team Congressman Andy Harris, MD Anesthesiologist & ASA Member

7 Surgeons in the House Doctors in the House Joe Heck, D.O. (NV-3) Scott Desjarlais, M.D. (TN-4) 37 Larry Bucshon, M.D. (IN- 8) Dan Benishek, M.D. (MI-1) 38 Raul Ruiz, M.D. (CA-36), Ami Bera, M.D. (CA-7) GOP Doctors Caucus The Patient Protection and Affordable Care Act (PPACA) PPACA is the law of the land. Legal challenges to the individual mandate failed. A full repeal of the law is unlikely with a Democratic President. Changes to individual pieces of the law are possible. Chairman Tom Price, M.D. (R-GA) As part of the law, a tsunami of regulations will be issued over the coming years impacting anesthesiology and the rest of medicine. 39 ASA Top Issue No Proliferation of Medicare Payment rates No public option tied to Medicare rates No Medicare Buy-in aka 33% Problem : We Win! ASA Post-Enactment Initiatives Opportunities to Repeal or Revise Onerous Provisions* Working with Strong Surgical Coalition Preparing for Massive Regulatory/ Rulemaking Effort to Implement Law *Legislative Repeal of Entire Bill is a Non-Starter under Current Democratic Administration

8 Legislative Advocacy Key Issues Medicare Physician Payment IPAB repeal SGR reform Rural Pass-through Truth and Transparency Drug Shortages Anesthesia Services Not Driving Medicare Volume or Growth 44 Regulatory Advocacy CMS CoPs Efforts by ASA helped avert a national optout of the physician supervision standard. ASA has led the charge in opposing nonphysician providers obtaining hospital staff privileges. Interpretive Guidelines ASA achieves victories in revised IGs Regulatory Advocacy HITECH and meaningful use FDA Drug shortages GAO Report ASA Efforts on New Medicare CRNA Chronic Pain Rule Organized over 2000 comments to CMS as part of the rule making process Met face-to-face with CMS Worked with other physician stakeholders to generate opposition Congressional Doc Caucus there is no evidence that chronic pain is a part of nurse anesthetists education and training. What is the Company Model? Referring physicians, who own the facility where surgical procedures are performed, form a separate anesthesia company in order to share in anesthesia revenue. The referring physicians pay the anesthesiologists a portion of the anesthesia revenues (the anesthesia professional fee) and retain the balance as profit. 47 8

9 What has ASA done about the Company Model? What has the federal government done about the Company Model? Since 2009, ASA has repeatedly brought this issue to the attention of the Department of Health and Human Services Office of Inspector General (HHS- OIG). Most recently, in February 2013, ASA again brought this issue to the attention of the HHS-OIG. HHS-OIG issued an Advisory Opinion (No ) on a "company model" arrangement and concluded that it could violate the Federal Anti-Kickback Statute. It appeared that the referring physicians were doing indirectly what they could not do directly that is, receiving compensation for their referrals to the anesthesiologists This applies only to the facts listed in the Advisory Opinion. It still is considered to be very important guidance regarding the HHS-OIG s views of these types of arrangements Company Model Next Steps The Perioperative Surgical Home or Surgical Home If you think you may be involved in a company model or similar arrangement? Seek the advice of counsel. Other ways to get involved: Talk to State Attorney General for a determination that these arrangements violate state law. For more information about the company model visit asahq.org. or Grant Couch with ASA at g.couch@asawash.org. A new concept of care: Reflects the great potential that coordination and management of surgical patients have to reduce complications and improve efficiencies and costeffectiveness of perioperative care. The Perioperative Surgical Home concept paper released as part of the 2011 Legislative Conference, now being further developed by a new ASA Committee lead by Dr. Norm Cohen 51 Advisory Group on Health Policy The Joint Commission Chair 2013 Established as a result of HoD action 2010 Intended to help drive policy regarding anesthesiology as opposed to always being reactionary Tom Miller, PhD, Director of Health Policy ASA Member Rebecca Patchin, M.D. was appointed Chair of the Board of Directors for the Joint Commission for Former nurse who is an anesthesiologist and a pain management specialist out of Riverside, Calif. Assistant professor of anesthesiology at Loma Linda University School of Medicine and a Director at the Norcal Mutual Insurance Company The Joint Commission is one of the leading accrediting bodies for health care organizations and programs in the U.S. 53 9

10 SEDASYS & ASA And a Few Others. Computer- Assisted Personalized Sedation (CAPS) Intended for ASA I-II patients, minimal to moderate sedation Premarket Approval by FDA in May 2013 ASA Engagement Ad hoc Committee, chaired by Dr. Rebecca Twersky Direct meetings with J&J FDA engagement initiative Corporatization Large Groups Hospital Ownership Scope Challenges Opt Outs Largely a State by State Battlefield Jason Hansen, ASA Director State Affairs Positioning ASA in Future Paradigm Committee on Future Models of Anesthesia Practice Advocacy Your Role 2013 Legislative Conference Join the ASA Grassroots Network Join ASAPAC Know the issues Get your colleagues involved Theme: Focus on the Future April 29 May 1, 2013 JW Marriott Washington, DC 57 How does positive change happen? The politics of getting and giving ASAPAC raised and spent nearly $3 million in the 2012 election cycle (2 years) making it the largest physician PAC ASAPAC is now among the top 35 of the 4,000 PACs nationally FY 2012 Total: $1,803,549 (record year) ASA is force to be reckoned with Donors: Amount: 2012 Final Contributions Totals Participation Rate: ,781 $1,668, % 2012* 7,387 $1,803, % * ASAPAC All-Time Record 59 10

11 GEORGIA and ASAPAC Others are Fully Engaged. FY 2012 Total Raised $51,090 Participation Rate 24.3% (20.3%) Avg Contribution $249 ($244) FY 2013, (APRIL 13) Total Raised $31,682 (112 donors) Participation Rate 12.7% (10%) Avg Contribution $283 ($251) CRNA-PAC $1.36 M AHAPAC $3.9 M ASAPAC $3.2 M AAJPAC $6 M AMPAC $2.35 M AAOSPAC $3.03 M 61 Source: Federal Election Commission filings for Election Cycle Do we want a seat at the table? Or do we want to be on the menu? CLOSING THOUGHT. Don t lose the heart of medicine to the business of medicine, Thank You! its too heroic! Kevin Freiberg, PhD Author, NUTS! 66 11