J.P. Abenstein, M.S.E.E., M.D., 2015 ASA President, talked with the ASA Daily News about what he learned from his term, how the ACA and MACRA will affect health care, and where he sees the specialty headed in a rapidly changing health care system.
Q: Daily News: You join a very select list of individuals who have served as ASA President. Can you share your thoughts on what it means to be the physician leader of this society?
Dr. Abenstein: I began my term on ASA’s Executive Committee and complete my year as ASA’s President with an incredible sense of honor of being allowed to serve our patients and our specialty. It’s been the most incredible experience of my professional life. I’d like to think I left the ASA just a little bit better than when I started.
Q: Briefly share some of the things you learned during your year as ASA President.
Dr. Abenstein: Probably the most important thing I’ve learned is patience. Those of us who choose to serve ASA in a leadership role always have a number of issues they wish to engage and changes they wish to manifest. What I learned quickly was that you can’t accomplish significant change in a short time frame. Steady, incremental change is the key to success.
Although I knew this long before I became ASA President, the degree of dedication our members have for their patients and specialty is remarkable. We have a greater degree of engagement by our members than any other specialty organization.
Finally, I’d like to remark upon the quality of ASA’s professional staff. Without their knowledge and expertise, we would not be able to deliver the benefits of membership.
Q: In your opinion, what does ASA do best for its members and the specialty? In what ways could ASA improve?
Dr. Abenstein: I believe the most important activities that ASA does for our members are our education products and advocacy.
The rate of change of medical knowledge relentlessly increases and it is a real challenge for all physicians, particularly anesthesiologists, to keep up. ASA’s education products allow busy practicing physicians to keep up with medical advances and allow them to provide the highest quality of medical care. In addition, ASA’s education products fulfill ABA’s MOCA® requirements, and CME credits automatically are forwarded to the ABA.
ASA’s advocacy efforts have been a huge success over the years and provide real value to ASA members. The interest of our patients and profession are respected in the halls of Congress and our state capitals. Our Washington office is staffed by one of the most effective lobbying teams in D.C.
The AQI and our data repository, NACOR, is gathering practice data from thousands of anesthesiologists around the country. The designation of NACOR as an anesthesia Qualified Clinical Data Registry (QCDR) means that we can report quality data to CMS, fulfilling our reporting requirements and avoiding cuts in our Medicare fees. The information in NACOR is already being used to decrease anesthesia complications, and I expect this trend to continue.
Of course ASA has room for improvement. We need to update our education products to meet the changing requirements of MOCA and to be consistent with how our members wish to receive their CME. Government involvement in health care continues to grow, and we’re going to need to up our game in D.C. and state capitals. Also, we need to communicate more effectively with our members. We’re increasing our use of social media, but we have a ways to go.
Q: How do you think MACRA is going to affect physician anesthesiologists?
Dr. Abenstein: MACRA is a very complex change in how physicians are going to be paid by Medicare in the future. I think it’s too new to know how it’s going to affect us. CMS is going to have to make a lot of decisions (i.e., rule making) on how MACRA is going to be applied. We also don’t know how these new rules will specifically apply to anesthesiologists and their practices. ASA is committed to providing our members with the tools they will need to successfully navigate the complex changes to our payment system.
Q: As you said, the new payment rules laid out in MACRA are very complex. What will ASA members need to do to master them?
Dr. Abenstein: Right now, ASA members need to stay as informed as possible. ASA has initiated several MACRA workgroups to develop the education products our members will need to succeed within this new payment system. Also, we are actively engaging CMS to ensure that the rulemaking process adequately addresses the unique practices of anesthesiology.
Q: What are a couple of the other critical issues facing physician anesthesiologists in the coming years?
Dr. Abenstein: I think the two biggest issues, maybe bigger than disruptive public policy such as the ACA and MACRA, are demographics and workforce. The U.S. population is growing … and growing older. This means that demand for medical services will grow substantially. For example, 10,000 baby boomers per day are entering the Medicare system, and these patients access health care at twice the rate of those who are younger.
Demand for anesthesia services is also growing as anesthesiologists deliver more and more medical care outside of the O.R. In some organizations, more than half of their anesthetics are delivered outside of the O.R.
While we are seeing explosive growth in demand for anesthesia services, the output of our training programs remains flat. Older anesthesiologists are reaching retirement age and are expected to leave their practices at a rate greater than the output of our training programs. In addition, changing attitudes regarding work-life balance puts further pressure on the available workforce.
Bottom line: we are faced with a significant increase in demand for anesthesia care and, at best, flat and most likely a decrease in the supply of anesthesiologists. Our profession is going to have to reinvent how we deliver anesthesia care with an eye toward both quality and productivity.
Q: You have a background in engineering; can you share with us how this informs your experience as a physician?
Dr. Abenstein: Engineering is a problem-solving discipline. Engineering school teaches you how to identify and analyze problems and how to formulate solutions to these problems. Medicine teaches you how to diagnosis and treat disease. I’ve always believed that engineering is a perfect background for a physician, particularly anesthesiologists.
This approach to problem-solving is how we’re going to solve the issues of increased demand and decreased supply, not to mention the tightening economics of medicine. Improving productivity, quality, reproducibility and reliability of our medical care is how we’re going to address these issues.
Q: What do you plan to do after your presidential term is officially over?
Dr. Abenstein: I’ll remain very involved with ASA, but certainly not at the level of the president. I’ll return to my full-time clinical practice and have more time with my family. I’m confident I’ll find new challenges in the future.
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