Colleagues,
In this past year we have had to overcome
many obstacles before we could begin to move forward as an association. Some of those obstacles have been re-educating
members in government—legislators and staff members in key positions who have
been replaced, retired, etc. within the federal and state government and the private
insurance industry. It is the same
battle PANA has faced over and over again.
Introducing our association, explaining the role a CRNA plays in the
field of anesthesia, explaining our regulatory status. So one might wonder what our state has
accomplished in this past year.
One of the most
consistent concerns and issues that has always been a hurdle for PANA’s board to overcome is the “apathy” we are accused of
by our colleagues. It was very clear to
your board and members of the state legislature such as the Professional
Licensure Committee and the Governor’s Office that there is no such word as
apathy in the Pennsylvania Association of Nurse Anesthetists. The strength and unity that you have shown
over this past year is a credit to you and speaks to the character of this
association. When I have asked for your
help to address HB 1256 by sending emails and letters to the legislators your
response was overwhelming. You have
spoken with such a loud united voice; the computers in
This past year PANA
continued to develop our website to provide information-based materials. Throughout the year, when time-sensitive
issues required immediate responses, you have done so without hesitation.
PANA’s web based forum page
came on-line 24/7 by the middle of the first quarter this past year. This Forum gives you direct access to members
of your board and association to address questions and concerns. The development of this Forum was a positive
step bringing us closer together. PANA’s Board of Directors has already seen the advantage of
this web based Forum page by the many issues and concerns we have addressed
over this past year.
A hurdle we continue to
face as an association is the regulatory statute that will give CRNAs the right
to anesthesia reimbursement for non-medical direction by the Department of
Public Welfare. For more than five years
I have been addressing this issue with DPW.
In past meetings, we have presented the regulatory language taken from
Medicare’s regulations and presented them to DPW to use as a guideline in
writing their regulation. Yet, PANA
continues to meet obstacles in getting it done.
DPW recently has had a change in administration and again, I have
addressed our concerns. We continue to
have our lobbyists (Mark Singel and Peg Moyer) and
legal advisor (Tim Barry) working with DPW and it is my hope that we will see
closure soon. To date, DPW is the only
insurance provider that does not recognize a CRNA in providing anesthesia
services when utilizing the modifier QZ (non-medical direction).
Another great hurdle you
have overcome in this past year occurred in January when
In the past, PANA and the PSA have had
many differences. An area that has been
very difficult to discuss has been CRNA scope of practice. Over the course of this past year I have had
the pleasure to speak to and work with the president of the PSA, Dr. Joseph Answine. In
addressing the threats to stop reimbursement for anesthesia services during
endoscopy procedures, the PSA and PANA sent joint position statements to
members of the Insurance Commissioner, Senate Banking and Insurance Committee
and the House Insurance Committee, which were posted on our website. Working together we stopped
PANA has continued to maintain
communications with Dr. Answine in hopes that the
PSA/PANA can come together on other issues of common interest. At the forefront
now is the proposal by the State Board of Nursing requesting that non-anesthesia
providers such as RNs and CRNPs be given the right to
administer and monitor the usage of propofol for procedural sedation. As you are all aware from recent
publications, I have presented that the Gastroenterologists, Emergency Room
Physicians, Emergency Room Nurses, Society of Gastroenterology Nurses and the CRNPs, are requesting the right to give propofol for
procedural sedation. In recent
conversations, Dr. Answine assured me that the PSA
would stand united with the PANA to keep this from happening. Issues like these will always continue to be
a threat to the PSA/PANA. I applaud the
PSA for their willingness to stand unified with the PANA to ensure safe
practice in our state.
As mentioned earlier, a
topic that has always been taboo by both societies and one that was unwilling
to be spoken of is the scope of practice for CRNAs. With vision and an open mind from both
presidents, we have been able to develop an ad hoc committee to speak of issues
that the PSA/PANA could never have addressed before. Both societies have recently met with members
of each other’s executive board and legal advisors. From this meeting we have
developed a position statement, which I share with you…
PSA AND PANA JOINT
STATEMENT:
PSA and PANA have established a Joint
Ad Hoc Task Force to discuss common issues and concerns, including patient
safety. The members of the Ad Hoc Task Force are PSA President Dr. Joseph Answine, PSA Secretary/Treasurer Dr. Donald E. Martin, PSA
Legal Counsel Robert B. Hoffman, Esquire, PANA President Joseph D’Amico, PANA
Secretary
This is a tremendous accomplishment that
will bring both associations closer and one PANA will continue to nourish. This statement makes clear that the PSA
understands the importance of CRNAs and the vital role we play in providing
anesthesia services in our communities.
It is my belief that if PANA is going to succeed with legislative issues
and regulatory statutes, especially a statute that defines CRNA scope of
practice as a law, discussions with the PSA must be included. For decades we have fought each other
through our lobbyists and have accomplished very little. Both of our lobbyists are powerful in their
ability to sway legislatures to prevent each other from moving forward. I am not saying we will always agree on every
topic we discuss with each other, but I am saying that in order to move forward
on topics of sensitivity, we will need to include each other in doing so.
Accomplishments…. In my
opinion, your board this past year has gone beyond expectations. From starting our year off with reestablishing
damaged relationships with legislators in Harrisburg, preventing the potential
loss of hundreds of jobs from insurance carriers for endoscopy procedures,
developing a line of communication with the advance practice of nurses,
protecting our scope of practice from our nursing colleagues’ proposal in the
SBON, developing a line of communication with the PSA leading to the
development of an ad hoc committee, with the …….
“Intent of the Task Force
to define the scope of practice for CRNA’s but not to change, expand or
diminish existing protocol, practices or service delivery models as they exist
currently at licensed hospitals and ambulatory surgical facilities.”
It becomes more and more
important that you as a member of this great association vote for those who
will protect, educate and ensure that the best interests of PANA is always
their top priority. Less than five
hundred of our more than 2,800 members voted in this past election. Please do not treat these elections
lightly. The members you elect can
change the dynamics of how each of us work and change the face of PANA. Take advantage of your rights, use them
wisely and never forget how fragile this association can be.
In this next year we will
face many challenges and I am looking forward to doing just that with you. As your president, I am always available to
you. If you need to speak with me,
please utilize my office phone, email address or our Forum page on the web. It is a pleasure and honor for me to
represent you.
Have a wonderful year!
Joseph D’Amico, CRNA, PhD.
President,