Congratulations - Queens Birthday Award


Congratulations to  Prof Holland, Dr Paul Graham Luckin who were awarded an AM in the General Division – “for significant service to the community through Emergency Medicine and as an authority on survivability in search and rescue operations”.

Media release re Grattan Institute report

The ASA released a media release regarding some of the findings and recommendations from the Grattan Institute Report April 2014.

Read it here

Representing our Members - Senate Standing Committee Hearing on Out-Of-Pocket Expenses

A hearing by the Senate Standing Committee on Community Affairs was held in Melbourne on 3 July 2014. The Committee’s concerns were about Out-Of-Pocket expenses in our healthcare system. The ASA was invited to speak with the presiding federal senators. The ASA was represented by President - Dr Richard Grutzner, and Economic Advisory Committee Chair Dr Mark Sinclair.  Their role was to explain our submission to the Committee. It was a successful day with Dr Grutzner delivering a great introduction and Dr Sinclair fielding questions and promoting the ASA’s position very effectively. 

Reference was made to several issues that were of concern to our members. For example that the majority of anaesthesia services involved no out-of-pocket expense to the healthcare consumer, that there is a low level of available Medicare rebates, indexation has been inadequate and at times non-existent over the years. The response from the senators were predominantly interested. It was a great opportunity to allow the Senate or the House of Review hear and understand our members’ concerns.  

Members will be kept up to date on further outcomes and discussions.  If you have any questions or comments please contact the policy team policy@asa.org.au

In the Financial Review 13/8/2014: "Doctors have a fat co-payment scheme of their own" ASA President Response.

Response to Terry Barnes 13/8/14 from Dr Richard Grutzner President Australian Society of Anaesthetists

The numerous outrageous accusations levelled at the medical profession in Terry Barnes’ article “Doctors have a Fat Co-payment Scheme of Their Own” (Financial Review, 13/8/2014) cannot go unchallenged, particularly as several statements show Barnes’ complete ignorance of the facts.

The AMA is not a “trade union”. Surely Barnes is aware that the issue of doctors’ fees relates to private medical practice. Almost all doctors involved are essentially self-employed businesspeople. I am prepared to stand corrected, but I believe trade unions are not interested in assisting small business owners, but rather, salaried employees. I do however agree with Barnes in that the AMA schedule of fees, which indeed represents a fair and reasonable reflection of the financial value of doctors’ work, could be used as a baseline in any discussions with government. My own Society (the Australian Society of Anaesthetists – ASA) is repeatedly on the record as stating that the AMA fee represents a reasonable maximum.

Barnes states that private health insurers “should be permitted” to cover the gap between Medicare rebates and AMA fees.  This again demonstrates his ignorance of basic facts. Health insurers can already cover such gaps if they wish. The Doctors’ Health Fund (DHF) provides a policy which does so. The problem is that health insurers have certain fiscal and budgetary targets to meet. The “woefully inadequate” level of Medicare rebates to which Barnes refers (which is indeed an accurate description of their worth) means that the insurers would be faced with vastly larger payments than they already make. DHF can provide their policy only at a higher premium cost to their customers.

Barnes is clearly ignorant of the fact that Medicare rebates have not always been “woefully inadequate”.  When the Medicare system was introduced in the mid-1980s, the Medicare Schedule Fees were in general closely aligned to the AMA schedule. However, over the ensuing three decades, the annual indexation of Medicare rebates has been abysmal, and in some years non-existent. Previous federal governments from both sides of politics bear the total responsibility for this situation.  The “secret” method of AMA indexation (Barnes’ completely  inaccurate description), is carefully considered each year, based on factors such as inflation, and indices such as Average Weekly Earnings, all of which have a direct effect on doctors’  practice costs.

In my own specialty of anaesthesia, the Medicare rebates in 2014 now stand at less than 25% of the AMA schedule. Their last indexation was in November 2012, and there will be no further indexation until July 2016 at the earliest. Far from depending on Medicare “like a smoker depends on his nicotine fix”, the Medicare rebate is rapidly falling into insignificance as far as anaesthetists are concerned.

Additionally, Barnes savagely criticises my own specialty. To accuse myself and my colleagues of “blatant” ignorance of patients’ rights regarding fee information is intolerable. I acknowledge that the provision of fee information by anaesthetists, who may only meet their patient for the first time on the day of service provision, is more difficult than for our surgical colleagues. However, the efforts of both the AMA and the ASA in improving informed financial consent practices has been outstanding in recent years, and the ASA’s efforts have been specifically acknowledged by independent sources such as the Private Health Insurance Ombudsman.

Finally, anyone reading Barnes’ biased and uninformed diatribe would be forgiven for thinking that the “ripping off” of patients, “excessive charging practices” and “fee-gouging” are the norm. If Barnes had actually taken the time to check the government’s publicly available statistics, compiled by its Private Health Insurance Administration Council (www.phiac.gov.au) he would see that approximately 90% of hospital inpatient services are provided at no out-of-pocket expense to the patient, and that furthermore, where anaesthetists’ fees do involve such costs, they are significantly lower than those for almost all other specialties.

Barnes has demonstrated an unwillingness to check on the facts, and has made energetic and enthusiastic criticisms while either deliberately, or through failure to do his research, ignoring these facts. Furthermore, he has described Australian doctors (recognised as providing a quality of care equal to that of any developed nation in the world) of  “stubborn, arrogant and contemptuous disregard for their patients”.  The ASA remains committed to open, transparent and reasoned discussions on the essential issue of the healthcare costs borne by the Australian community. Barnes clearly deserves no part in such discussions.

Dr Richard Grutzner
President

New ASA submission

The ASA has put together a submission on Out-of-pocket expenses being examined by the Senate Standing Committees on Community Affairs.

To read more about this please login to the member's section and go to the Submissions page under News.

ASA Relative Value Guide App

The Android and Apple version of the App is available for download now – simply search for ‘ASA RVG’ and look out for the ASA RVG fan icon and developed by Rose Technology.
Please use your member ID number and password that you use to access the members section of the website to login into the app.
Please contact membership@asa.org.au if you have misplaced your login details.

Right patients, right surgery, right facility


The 14th of February, 2014 may represent a watershed moment in the model of care provided within the private sector of South Australia, if not nationwide. On this day, the South Australian Coroner released her Finding of Inquest into the deaths of two patients who were retrieved from a private hospital to a nearby tertiary referral centre1.

Following the release of these findings and the response from the Australian Commission on Safety and Quality in Health Care; the Australian Society of Anaesthetists invited a number of varying medical specialities to attend a one-day meeting to review the Coroner’s recommendations and the impact they have for the future of the delivery of perioperative healthcare in both public and private sectors.  The potential expanded role of the anaesthetist as the perioperative physician is an area that is generating much debate

The event was held on Saturday, 7 February at the Adelaide Convention Centre and was attended by over 150 people including Nurses, Anaesthetists, Clinical Directors, Chief Executive Officers, Orthopaedic Surgeons, Physicians with an interest in Perioperative medicine, Directors of Nursing, Pain Management Specialists, Theatre Managers and medical supply organisations from across Australia.

 
Dr Simon Macklin, Convenor said “It was great to see so many different specialities and interested parties represented, coming together with the combined goal of improving health services in Australia. The purpose of the day was to instigate the development of guidelines that engage safe perioperative management of patients and I believe we have certainly made a step in the right direction”. 

 
Right patients, right surgery, right facility.
http://www.courts.sa.gov.au/CoronersFindings/Pages/Findings-for-2014.aspx

 

Workforce Modelling: Submission to NMTAN

Following a meeting between the AMA, ASA, and ANZCA a joint submission on the anaesthetic workforce has been prepared and forwarded to the National Medical Training Advisory Network (NMTAN). The results obtained from the 2014 ASA member survey and the 2015 young member survey formed the basis of the submission. ASA will remain involved in this debate, and will keep members informed of developments.

Interruption to Supply
Suxamethonium Chloride Injection BP 100 mg in 2 ml

AZ Product Code        4591
Product Description   Suxamethonium Chloride Injection BP 100 mg in 2 ml
Pack Size                  50×2 ml
        
We have received advice that AstraZeneca is currently experiencing a temporary disruption to the supply of Suxamethonium Chloride Injection. This is due to difficulties experienced with sourcing the active ingredient and is not a product quality or safety issue.
We have been advised that a very limited stock of this product is available and AstraZeneca anticipate that normal supply will resume by the end of April 2015.
AstraZeneca have advised directors of anaesthesia and directors of accident and emergency to reserve current supply of this product strictly for essential and emergency situations only.
We will keep all members updated if we hear anything further.

MSAC Application 1183 – Ultrasound in the Practice of Anaesthesia

At this stage it appears MSAC application 1183 will be rejected. The ASA has a number of concerns with MSAC’s draft Public Summary Document (PSD), which summarises the evidence  relevant to the application, and attempts to justify its rejection. The draft PSD is available below. The ASA has been allowed a one-paragraph response to be included in the PSD. However, much more than one paragraph is required to address the numerous flaws in the PSD. A detailed commentary is available below.

MSAC Public Summary Document (PSD)

ASA One-Paragraph Response

Detailed ASA commentary


2015-16 Federal Budget


The 2015-16 Federal Budget papers state that the government intends to spend $2.3 billion more on health in the next financial year. This is an overall net increase of 3.5% totalling to $69.7 billion. There were no cuts to MBS beyond the reduction of duplication for health assessments with child health. There is the expectation that there will be an increase of $22 billion with an additional outlay to assist primary and mental healthcare. However the Minister for Health did announce previously that the Federal government intends to pursue a wholesale review of MBS items over the next two years which may have an impact on the specialty of anaesthesia. The Medical Services Advisory Committee will continue its activities and “deliver an expanded process of MBS Review overseen by a clinician led Medicare Benefits Schedule Review Taskforce” which will cost $34.3 million over the next 2 years. For further information please refer to the Federal Budget website http://www.budget.gov.au/index.htm


Economics Advisory Committee Update
As most members will already be aware, on 1 July 2015 the health insurer HCF will introduce a completely new system of rebates for medical services. HCF has a market share of approximately 11% of the insured population. Therefore, this new system will be highly significant to the specialty of anaesthesia.For the first time, a “known gap” product will be available for HCF patients. If the total fee charged by an anaesthetist is higher than the “known gap” rebate, the full rebate will still apply, provided the total out-of-pocket expense to the patient does not exceed $500. Previously, only a “no gap” system applied. Here, if the anaesthetist did not accept the “no gap” rebate as their full fee, the rebate available to the patient dropped to the level of the MBS Fee.There will still be a “no gap” system in place, with a completely separate schedule of rebates. This “no gap” system will provide a slightly higher rebate, ($34.70 as opposed to $33.50), as shown in the example below (Table 1). However, in order to access this system, anaesthetists must enter an agreement to accept “no gap” rebates as their full fee.Interestingly, the HCF terms and conditions state, “Whether you choose the No Gap or Known Gap option you will still be able to decide to use or not use your chosen gap arrangement on a patient by patient basis”. An agreed “no gap” provider can choose to charge a patient at a level above the “no gap” rebates, but the patient will only receive the MBS Fee. On the other hand, a “known gap” provider can charge the same fee, and their patient will still receive the higher “known gap” rebate. The financial implications of a patient receiving only the MBS rebate can be seen below (table 1).There is no compulsion to register for either system. If an anaesthetist does not register as either a “no gap” or “known gap” provider, they will automatically be considered as being “known gap”.The ASA has always had significant concerns regarding anaesthetists entering into compulsory “no gap” agreements with insurers. To do so removes one’s financial independence, and places reliance on a third party payer, who is motivated to minimise expenditure on medical fees. Both “known gap” and “no gap” rebates across all insurers have been subject to repeated instances of inadequate, and even zero, annual indexation. This effectively erodes the value of the rebates, year by year. The HCF “no gap” system makes no mention of future indexations. There is also no mention of indexation of the $500 “known gap” limit except to say this is the level at which it is “currently set”.Both the “no gap” and “known gap” systems also require that the anaesthetist agree to various other terms and conditions. There is a requirement that practitioners have professional indemnity cover to a minimum of $20 million, and that practitioners “comply with all standards, guidelines, obligations and legislation”. These matters are clearly outside the scope of an insurer’s role. Furthermore, there is a requirement that “You must not deal or act differently with HCF Members because they are covered by private health insurance or due to their membership with HCF”. The accusation that anaesthetists might treat patients differently, based purely on their insurance status, borders on being offensive.The ASA recommends that members give these matters careful consideration before making a decision.Table 1 (below) serves as an example of the rebates that would be paid for the same anaesthesia service (a 1 hour anaesthetic for an inguinal hernia repair) under each of the two schedules.
Table 1. Example of HCF “No Gap” and “Known Gap” rebates compared to MBS

 

Pre-anaesthesia Anaesthesia Anaesthesia Time Total Rebate
MBS Item

17610

20830

23043

 

MBS Fee

$43.00

$79.20

$79.20

$201.40

HCF “Known Gap”

$73.00

$134.50

$134.50

$342.00

HCF “No Gap”

$90.30

$138.85

$138.85

$368.00

The “no gap” rebate is clearly higher. However, under the “known gap” terms and conditions, if the anaesthetist’s fee is over $342, the full “known gap” rebate will still be paid, provided the total out-of-pocket expense to the patient does not exceed $500. A reasonable patient co-payment, obtained after best possible IFC practices are followed, will bring the total fee to well above the $368 provided by the “no gap” scheme.Members should also be aware that the “no gap” unit value of $34.70 (for most items) is the same as in the existing schedule, and has not been indexed. However certain individual items have, for some reason, been allocated a unit value of approximately $41.58 (see table 2, below).The “known gap” unit value of $33.50 represents a 3.5% decrease on the current HCF unit value, but of course leaves open the option of a patient copayment.
Table 2: MBS Items with higher HCF “no gap” rebates
Item Anaesthesia for: RVG Units HCF "No gap" rebate

20192

Extensive surgery – facial

10

$415.80

20756

Diaphragmatic hernia repair

9

$374.20

20791

Bariatric surgery

10

$415.80

20802

Lipectomy - lower abdomen

5

$207.90

20940

Vaginal procedures

4

$166.30

21202

Hip arthroscopy

4

$166.30

21403

Bilateral TKR

10

$415.80

21472

Achilles tendon repair

5

$207.90

21482

Radical bone resection - leg

5

$207.90

21484

Osteotomy – lower leg

5

$207.90

21520

Venous surgery – lower leg

4

$166.30

21732

Elbow arthroscopy

4

$166.30

21834

Wrist arthroscopy

4

$166.30

22900

Dental extractions

6

$249.50

Both the “known gap” and “no gap” schedules do not set a single monetary value per unit. Apart from the $41.58 items mentioned above, the schedule appears to apply a payment of a fixed percentage above the MBS, and rounds this off to the nearest 5c. The ASA has had preliminary discussions with HCF on this apparent distortion of the philosophy of the RVG and will continue to liaise with HCF on this matter.
Summary
Where an anaesthetist enters the HCF “no gap” arrangement, and bills at this level, a slightly higher rebate per RVG unit will be paid ($34.70 compared to $33.50, and $41.58 for certain items as per table 2).A “no gap” anaesthetist can still choose to charge individual patients more than $34.70 per unit. However, in this case the patient will only be entitled to the MBS rebate ($19.80 per unit). The implications for patient out-of-pocket expenses are obvious.If an anaesthetist does not enter this agreement, he/she will automatically be considered to have agreed to a “known gap” arrangement. Provided a “known gap” anaesthesia fee results in an out-of-pocket expense of $500 maximum, HCF will pay $33.50 per unit for all patients.The ASA hopes this analysis assists member to make their decision, given the potential disadvantages of the “no gap” scheme to both anaesthetists and patients, as discussed above. Members are welcome to forward any queries to policy@asa.org.au

WFSA Safety and Quality of Practice Committee Member Awarded a Churchill Scholarship

Phoebe Mainland, a member of the WFSA’s Safety and Quality of Practice Committee and our International Organisation for Standardisation (ISO) star from Alfred Hospital Melbourne, has just been awarded a Churchill Scholarship as a result of her work with connectors. Continue reading...


Astra Zeneca Marcain 0.5% Spinal Heavy solution

There have been a number of case reports in recent weeks of incomplete/failed spinal blocks using Astra Zeneca Marcain 0.5% Spinal Heavy solution.

Astra Zeneca are aware, and have requested that the vial with any unused solution be retained by the anaesthetists so they can arrange for collection and analysis.   

 



NIB – Read Between the Lines

The health insurer NIB will introduce new terms and conditions pertaining to its “MediGap” scheme on 17 August 2015. (See http://www.nib.com.au/providers/medigap/schedule-of-benefits).

 

In summary, from August 17, if you send a MediGap claim to NIB, you are entering an agreement to:

  • Face an NIB audit at any time, with 2 business days’ notice
  • Bear the costs of any audit yourself
  • Accept the task of obtaining patients’ consent (possibly multiple patients) to share their private medical information with NIB

Some of the terms and conditions are not new, and are already well understood by anaesthetists. For example, it is still the case that “If you accept the MediGap benefit as payment for your services then you agree not to charge the NIB customer additional fees for inpatient hospital services”.  Should an anaesthetist’s fee exceed that paid by the MediGap scheme, the patient will receive only the Medicare Benefits Schedule Fee (MBS Fee) as their rebate. Of note, NIB is the only remaining insurer without a “known gap” scheme.

However, there are a number of new terms and conditions that are of significant concern to the ASA. A meeting will be held with NIB representatives in the near future, but this will be after the date of the introduction of these terms. The document states “You agree to be bound by these terms and conditions ….. each time you submit a claim through the NIB MediGap Scheme” (Section 1.0, page 4).

Section 7.0 (page 11) of the document states: “You agree that NIB may …….. carry out an audit of your patient and treatment records for NIB customers without charge provided that NIB gives you at least two business days’ notice.” Furthermore, “You agree, at your own cost, to use best endeavours to assist NIB in undertaking the audit, including providing NIB with access to clinical data and other necessary documentation”.  This immediately raises questions relating to patient confidentiality. However, section 7.0 of the document also states “In compliance with Privacy Law, you agree to obtain the customer’s consent to disclosing their medical information to NIB as well as their consent to NIB collecting their medical information from you for audit purposes”.

If an anaesthetist lodges a MediGap claim, he/she automatically agrees to these terms, and cannot refuse to comply without risking action being taken for a breach of agreement.

Other sections of the document are also of concern. By agreeing to the terms and conditions, a doctor is giving permission for NIB to disclose certain information to its customers. This includes
  • The percentage of times, over 12 months, you participated in the MediGap scheme

    Average gap charges for non-MediGap accounts

The usefulness of such data is questionable, as it gives NIB customers no guarantee of how they might be billed for their own episode of care. Nevertheless, lodging a MediGap account will automatically allow NIB to publicise such data.

The ASA recommends that its members seriously consider these issues before lodging any MediGap accounts, from August 17 onwards.  If members do not wish to abide by the NIB terms and conditions, they are quite at liberty to bill their patients privately. This will however require best possible informed financial consent practices, as the patient is likely to face a larger out-of-pocket expense. 

The ASA has also been receiving queries from members who are concerned about the new schedule introduced by the insurer HCF. A meeting with HCF has also been arranged in late August. Members will be promptly updated with any important information.



Who pays for complications that happen in hospitals and after surgery?

Australia's biggest private health insurer Medibank Private has been locked in bitter negotiations with hospital chain Calvary over who pays for complications that happen in hospitals and after surgery.

Read the transcript or watch the video from the ABC 7.30 show on Thursday 27 August here.


Media release - Anaesthetists warn of risks associated with cosmetic surgery


The following media release has been sent out on behalf of the ASA - Anaesthetists warn of risks associated with cosmetic surgery.
 

NIB update

Members will recall that President, Dr. Guy Christie-Taylor, and Economics Advisory Committee Chair, Dr. Mark Sinclair, recently met with representatives of the insurance company NIB, to discuss the ASA’s concerns about certain terms and conditions applying to the NIB 'Medigap' product. NIB has now modified some of these terms and conditions. These are available here.

Medicare Benefits Schedule Review update


The Medicare Benefits Schedule (MBS) Review, announced as part of the “Healthier Medicare” initiative by federal Health Minister Ms. Sussan Ley in April 2015, is about to commence its formal review of all 5,700 Medicare items.

The ASA has a meeting scheduled with Health Minister Ley in Canberra on Tuesday November 10, where the MBS Review will form part of the discussions.


Importantly, the ASA has submitted the names of a number of representatives to join the respective panels charged with reviewing the item numbers.


The Australian Society of Anaesthetists fully supports the Australian Medical Association’s (AMA) view that the aim of MBS Review must be modernisation of the Schedule, not simply cost savings. The fact that we are in the middle of an unprecedented 6 year freeze of Medicare rebates indicates that the current government is firmly committed to cutting Medicare expenditure wherever possible.  The AMA has already expressed a lack of confidence in government and Review Taskforce statements that decreasing expenditure is not part of the agenda.

The ASA also supports the AMA’s stance that the process must be clinician led, and that the various specialist Colleges and Societies should be intimately involved. It is not sufficient to simply state that review committee members can consult their College/Society for advice. This risks fragmentation and communication failures between stakeholders. The firm commitment of the entire medical profession will be required if the Review is to succeed in its plan to deliver evidence-based best practice, and to convince the profession that this is indeed the ultimate aim, as opposed to simply cost-cutting.


If the aim of the Review is indeed to modernise the MBS, there must be scope for the addition of new Medicare items, as medical practice develops and improves.  The current process involving the government’s Medical Services Advisory Committee (MSAC) is slow, cumbersome, and expensive, and is inappropriately slanted towards economic considerations rather than best patient outcomes. Patients are currently receiving modern, high quality anaesthesia services, backed by sound evidence, but these patients are not being supported by the Medicare system, purely due to economic considerations. If the profession is to be convinced that modernisation of the MBS, based on best available evidence, is indeed the aim, this situation must be given consideration during the Review.


For the MBS to support quality patient care, there must be:

  • a clear and overarching vision and specific direction for the Australian healthcare system to guide the final outcomes of the reviews;
  • specific and quantifiable aims;
  • the direct involvement of specialist colleges, associations and societies;
  • full transparency of the individual reviews as they progress and the decisions that will come from them; and
  • new items are able to be added to the MBS.

The ASA will be represented at the November 10 meeting with the Health Minister by myself, Vice President David M Scott, Economic Advisory Committee Chair Dr Mark Sinclair, Specialty Affairs Advisor Dr Jim Bradley and CEO Mark Carmichael. Members will be further updated following that meeting.


CSC recordings

Recordings from the recent Combined Scientific Congress are available for members to view.
Simply login to the members section of the website and go to NSC Presentations under the Education & Events tab. 


2015 Bangkok Global Surgery Declaration


ASA recently provided support to the 2015 Bangkok Global Surgery Declaration to promote the implementation of the World Health Assembly Resolution for Surgery and Anaesthesia Care.

Building upon tenets of the Amsterdam Declaration on Essential Surgical Care ratified in November 2014 which called for the passage of WHA A68/15 and action towards its key components, the 2015 Bangkok Global Surgery Declaration promotes global collaboration among all countries and regions to work towards implementation solutions for ensuring “universal access to safe, affordable surgical and anaesthesia care when needed.”

For more information on the 2015 Bangkok Global Surgery Declaration, please download here.

Peter Cook's letter about the anniversary of the Townsville Blackhawk Disaster is published in the Australian Anaesthetist September 2016 issue.
http://www.asa.org.au/UploadedDocuments/Publications/PCook_Letter.pdf

Read Katherine Breen-Kurucsev's article in the Bulletin magazine, 6 October, 1995:
http://www.asa.org.au/UploadedDocuments/Publications/TheBulletin_6Oct1995.pdf

Lifebox Australia & New Zealand


Lifebox Australia & New Zealand - a partnership between Lifebox, the ASA, Interplast Australia & New Zealand, the NZSA and ANZCA has been finalised. This partnership will allow Australian and New Zealand tax payers to make tax deductible donations to Lifebox. Lifebox distribution and education will be overseen by representatives of the five organisations.

You can now raise funds to support safer surgery by donating to Lifebox Australia & New Zealand at https://www.interplast.org.au/get-involved/donate/


ASA member Dr Haydn Perndt wins a WFSA Presidential Award for Service to Anaesthesiology


7 January 2016

The ASA is delighted to announce that long standing ASA member and member of the Overseas Development and Economic Committee Dr Haydn Perndt has been awarded a 2016 WFSA Presidential Award for Service to Anaesthesiology.

For  over thirty years he has had extensive experience working and teaching in developing countries including missions with the Red Cross on the Thai Cambodian border, Somalia, East Timor and Darfur, Sudan and as well as work with Medecins Sans Frontiers in Burundi. He has spent extended periods training anaesthetists in Vanuatu, the Solomon Islands and the Cook Islands. He has been involved in the establishment of Postgraduate Anaesthesia training programs in Fiji and East Timor.

To read more please visit http://www.wfsahq.org/latest-news/latestnews/528-wfsa-announces-winners-of-service-awards.

Australia Day Honours to ASA’s members

Date: 27 January 2016

The ASA is delighted to announce that Australia Day Honours have been awarded to our members Dr Brian Spain – AM, Professor Kate Leslie – AO and Dr John Tucker – OAM for their distinguished services.

Dr Brian Spain – AM was awarded for his significant service to medicine in the discipline of anaesthesia, as a clinician, to healthcare standards, and to professional medical bodies. Brian has made a tremendous contribution to anaesthesia and healthcare in the Northern Territory and his contribution to our Overseas Development and Education Committee and the 2015 Combined Scientific Congress has been very significant.

Professor Kate Leslie – AO was awarded for her distinguished service to medicine in the field of anaesthesia and pain management as a clinician and researcher, to higher education, and to professional medical groups. Kate has served on the WFSA Scientific Affairs Committee for the past 4 years.

Finally, Dr John Tucker – OAM’s service to medicine, particularly anaesthetics, to the blueberry industry, and to the community made himself a well- deserved recipient.

For a full list of the Australia day honours please visit: http://ow.ly/XBZAL

Australian Anaesthetists March issue

Date: 2 March 2016

The March issue of Australian Anaesthetists is now available online and via the Magazine App. This issue focuses on the Overseas Development and Education Committee (ODEC) and World Anaesthesia. We feature articles surrounding current issues in global anaesthesia and global health. We profile an Anaesthetist working in Papua New Guinea; provide a review of the Real World Anaesthesia Course held last year, and take a look at the ODEC Database, plus much more. Please sign in to download a copy here.


PIAC Update

Date: 17 August 2016

The ASA acknowledges the recent release of the Expert Advisory Group interim report on revalidation (August 2016). A more detailed response will be circulated shortly.
The ASA welcomes the work of the MBA in advancing the issue of revalidation to fulfill its statutory obligations to register medical practitioners and protect the public by maintaining professional standards. Part one ‘providing a strengthened CPD’ is consistent with the ASA position on revalidation. Part two ‘identifying and assessing practitioners at risk of poor performance and poorly performing practitioners’ raises issues of appropriateness, effectiveness, fairness, natural justice, discrimination and privacy. More transparency and consultation needs to occur before this part can be endorsed.

Date: 30 August 2016
Please click here for ASA's detailed response to the MBA's Expert Advisory Group interim report on revalidation.

Real World Anaesthetic Course (RWAC) - 24-28 October 2016.

Date: 24 March 2016

Applications will be open on 30 March for the RWAC course being held at Frankston Hospital 24-28 October 2016.
The aim of RWAC is to prepare anaesthetists for work in low and middle income countries (‘the real world’) in a variety of humanitarian aid situations. The course consists of a series of interactive lectures, case based discussions, hands on practical equipment sessions and in-theatre teaching of draw over anaesthesia.
We would like to remind you that the number of participants is limited to 18 to maximise interaction and hands-on learning.

To apply for a place on this course please complete the application form and return to Dr Chris Bowden cbowden@phcn.vic.gov.au Frankston RWAC course convenor by Monday 11 April 2016.

The course cost is AUD$ 3300 (including GST) and is payable if your application is successful.
For further information please contact Dr Chris Bowden cbowden@phcn.vic.gov.au Frankston RWAC course convenor.

Real World Anaesthetic Course (RWAC) - 24-28 October 2016.

Date: 24 March 2016

Applications will be open on 30 March for the RWAC course being held at Frankston Hospital 24-28 October 2016.
The aim of RWAC is to prepare anaesthetists for work in low and middle income countries (‘the real world’) in a variety of humanitarian aid situations. The course consists of a series of interactive lectures, case based discussions, hands on practical equipment sessions and in-theatre teaching of draw over anaesthesia.
We would like to remind you that the number of participants is limited to 18 to maximise interaction and hands-on learning.

To apply for a place on this course please complete the application form and return to Dr Chris Bowden cbowden@phcn.vic.gov.au Frankston RWAC course convenor by Monday 11 April 2016.

The course cost is AUD$ 3300 (including GST) and is payable if your application is successful.
For further information please contact Dr Chris Bowden cbowden@phcn.vic.gov.au Frankston RWAC course convenor.

Meeting with Medical Board of Australia

Date: 20 April 2016

Chair of PIAC Dr Grossi and ASA CEO Mark Carmichael are meeting with the Medical Board of Australia’s Chair Dr Joanna Flynn AM today to discuss the future of revalidation in Australia and how will it affect anaesthetists.

The MBA’s commissioned report ‘Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA)’ has been in circulation. The NHS in the UK has already adopted this process with mixed results and budgeting concerns. Dialogue in Australia has been ongoing since 2013 and the MBA has yet to adopt a model but is progressing with its consideration of revalidation.

More information please visit http://www.medicalboard.gov.au/Registration/Revalidation.aspx
 

Meeting Prime Minister’s Office Senior Health Policy Adviser 

Date: 20 April 2016

ASA representatives will meet  Prime Minister Malcolm Turnbull’s most senior health policy adviser on 21 April to advocate and discuss issues affecting your profession. These include greater transparency of health insurance products, Scope of Practice, out-of-pocket costs, workforce, the MBS Review, Scope of Practice and revalidation.

We will inform the Prime Minister’s Office of the ASA’s long involvement in the Australian healthcare system as is evident by this year’s 75th ASA National Scientific Congress.


2016 CIG Scholarship Winners Announcement

Date: 27 April 2016

Congratulations to Drs Monique McLeod, Maryann Turner and Brigid Brown for winning the 2016 CIG Scholarship.
 
$4,000 grant will be awarded to each winner to attend leading international conferences in the UK, Canada and the USA.
 
More information on the scholarship announcement can be found here.
 
We would like to thank all trainee members who applied this year. The applications were of a very high standard.

World Federation of Societies of Anaesthesiologists Fund a Fellow campaign

Date: 15 June 2016

A recent report by The Lancet Commission on Global Surgery found that more than 5 billion of the world’s 7 billion people do not have access to safe and affordable anaesthesia and surgical care when needed.

Safe anaesthesia is an essential component of safe surgical care and the World Federation of Societies of Anaesthesiologists (WFSA) has funded initiatives to improve anaesthesia care worldwide since the Federation’s foundation in 1955.

One such initiative is to expand the WFSA’ Global Fellowship Programme which celebrated its 20th anniversary this month.

The WFSA’s Global Fellowship Programme offers low cost, high quality training to anaesthesiologists across Africa, Asia, Europe and Latin America. Fellows are selected on merit, but can only access these opportunities if we support their travel and living expenses. 

By making a one off or regular donation you will enable more colleagues to access training, strengthen our profession and improve outcomes for thousands of patients around the world. Please donate to Fund A Fellow today.

ASA/ODEC Scholarships to attend the WCA

Date: 13 July 2016

The ASA Overseas Development and Education Committee is funding four Scholarships for Pacific Society of Anaesthetist (PSA) members to attend the 2016 World Congress of Anaethetists meeting in Hong Kong in August.

Dr Aquila Naqasima and Dr Maika Seru from Fiji, Dr Colom DaSilva from Timor Leste and Dr Graziela Mandavah from Vanuatu have been selected by the PSA as Scholarship recipients.

These Scholarships facilitate opportunities for young anaesthetists from the Pacific Society to represent their countries and benefit from attending the World Congress.

For more information please contact Committees Assistant Maxine Wade at MWade@asa.org.au


Bequest to Westmead Children's Hospital
Date: September 2016

The George and Roberte Lomaz Fund is a generous bequest in 2015 that will be used to further excellence in research and education in paediatric anaesthesia and pain management at The Children’s Hospital at Westmead (CHW), Sydney.
Please read the full article on Dr George Lomaz's career and his contribution to paediatric anaesthesia here.
This article was written by Dr Michael Cooper - February 2016.

ASA 2016 Awards, Prizes and Research Grants

Date: 28 September 2016

Congratulations to all the winners of ASA 2016 Awards, Prizes and Research Grants as below:


ASA
Gilbert Troup Winner: Dr Natalie Kent.

“Neostigmine induces restrictive ventilatory impairment pattern in awake healthy volunteers”

ASA 1st Best Poster Prize: Dr Andrew Messmer

“Levels of Oxygen in Labour (LOL) Study”

ASA 2nd Best Poster Prize: Dr Diyana Ishak

“Remifentanil Patient-controlled Analgesia in Labour – The Effects of Implementing a More Restrictive Protocol”

The Kevin McCaul prize: Dr Patrick Tan

“High flow humidified nasal oxygenation in pregnant women”

ASA PhD Support Grant: Dr Julie Lee

Rotational Thromboelastometry (ROTEM) in Obstetrics

The Gilbert Brown Award: Dr Elizabeth Feeney

The Ben Barry Medal for outstanding contribution to the Society’s Journal, Anaesthesia and Intensive Care: Professor Michael Paech

NSC Lifebox Diamond Raffle Winner: Dr Erica Hewitson.

Thank you for our delegates support we raised over $20,000 from the Raffle and all proceeds will be donated to Lifebox.

NSC Exhibitor Passport Prize: DrRonita Majumdar

ASA New President and Office Bearers

Date:  28 September, 2016

At the ASA AGM in Melbourne, A/Prof David M Scott was elected ASA New President. Thank you to Guy Christie-Taylor for his time and efforts as President over the past two years, and Richard Grutzner who has now left the role of Immediate Past President.
Other office bearers confirmed at the AGM are Peter Seal as Vice President, Andrew Miller as Honorary Federal Treasurer and Suzi Nou as Executive Councillor.
World Anaesthesia Day Seminar

On Sunday, 16 October 2016 the ASA celebrated World Anaesthesia Day that was held at the Harry Daly Museum and Richard Bailey Library.  

The workshop for the day consisted of two sessions that covered a diverse range of historical topics. The first session Dr Michael Cooper, Dr Rajesh Haridas and Dr John Paull presented on the topics of Hypoxia, Oliver Wendell Holmes, and Dr Pugh respectively. In the second session, Dr Rod Westhorpe, Professor Laurie Mather, and Dr Tamara Eichel discussed anaesthesia in China, Dr John Snow, and the Iron Lung. 

Throughout the day, participants had the opportunity to view the Richard Bailey Library and Harry Daly Museum. 

Overall, the sessions generated many thought-provoking insights into some major historical developments in anaesthesia. The day also provided a wonderful opportunity for research to be shared. The ASA would like to thank the speakers and participants for their contributions. 

Practice Manager Conference update

Date:  24 October 2016

The ASA Practice Manager’s Conference on 21 October in Melbourne received a good response with over 40 attendees. Representatives from the Department of Human Services and TressCox provided guidance in relation to the processing of item numbers and privacy issues. MediTrust and Black Collection Services gave lecturers on time saving tips and the management of debtors. 

The ASA Policy Team highlighted recent committee achievements in the past year which included 8 submissions to government as well as ministerial visits and the 200-average number of queries answered each year. 

Chair of EAC Dr Mark Sinclair provided a very informative talk covering updates to the MBS Review, MSAC, ACCC, private health insurance and the continual need for maintaining good IFC practices amongst our members. 

The Australasian Symposium on Ultrasound and Regional Anaesthesia (ASURA) 2017 - Registration now open 

Date: 31 October 2016

Join us for The Australasian Symposium on Ultrasound and Regional Anaesthesia 2017!

ASURA 2017 will combine both regional anaesthesia and education themes. This combination will be valuable for both faculty and delegates. The program consists of a mix of plenary talks, concurrent sessions, workshops and social functions.

Date: 23 – 26 February 2017                                                        
Venue: Peppers Resort, Noosa

Click here to register online and visit www.asura2017.com.au for all the latest information. 

ASA RVG Unit Value

Date: November 2016

Members are advised that the ASA RVG unit value will be communicated via email on Monday 7 November. 

ABC Radio intereview with Dr John A. Crowhurst

On Sunday 27th November, on ABC Radio-National’s ‘Ockham’s Razor, Dr John A. Crowhurst gave a presentation of: ‘The Legacy of the Anaesthesia Events at Pearl Harbor, 7th December 1941’ on the 75th anniversary of the infamous Japanese attack on Pearl Harbor.

Listen to the interview here.

REAL WORLD ANAESTHESIA COURSE (RWAC) - REGISTRATIONS CLOSED!
Date: 7 April 2017

Due to an overwhelming response applications for the Real World Anaesthesia Course have now closed. 
You are welcome to send an email enquiry if you would like information about the next course, please contact Sally Gelton Smith.
 
The aim of RWAC is to prepare anaesthetists for work in low and middle income countries (“the real world”) and a variety of humanitarian and civil disaster situations. The course consists of a series of interactive lectures, problem discussions, practical equipment sessions and in-theatre teaching of drawover anaesthesia. A simulation session is also planned.

Topics will include:

• Drawover equipment
• Ketamine
• Oxygen concentrators
• Equipment maintenance
• Obstetric and paediatric challenges
• Teaching – who, how and what
• Psychology of adaptation
• Ethical dilemmas
• Tropical medicine
• Trip preparation

The number of participants is limited to 18 to maximise interaction and hands-on learning. The course has previously been oversubscribed and places are allocated on a “first in, first on” basis.

Medical specialists - maintaining a high standard and duty of care.

By DAVID M SCOTT and PETER SEAL
Date: 23 March 2017

In recent times, several articles have appeared in the print and electronic media about the alleged ‘high fees’ and ‘poor accountability’ of medical specialists. A few weeks ago on his ‘Pearls and Irritations’ blog, John Menadue posted one such piece titled ‘Medical specialists – high fees and poor accountability. The ASA believes that some of John Menadue’s strongly asserted claims merit a measured response, and wishes to address some misconceptions that have arisen. There are almost 5,000 specialist anaesthetists in Australia, and they comprise approximately 4.5% of the nation’s medical workforce. To read the full article please click here.


President's Letter to the West Australian's Editor 

Date: 09 March 2017

Re: ‘WA’s Specialist Fees Verge on greed’ article by Cathy O’Leary Medical Editor 

Dear Editor

I write following your article ‘WA’s Specialist Fees Verge on greed’ by Cathy O’Leary Medical Editor (West Australian 8 March, 2017). It is disappointing that this article confuses increasing medical costs and an ongoing eight-year freeze on Medicare and Health Insurance benefits with greed. The report in the MJA highlights that although the costs associated with running medical practices continue to be subject to inflation, income from Medicare has been continually cut by successive governments and is now in the middle of an eight-year freeze. Yet during this time secretarial wages and nursing wages have increased, rents have gone up, as have electricity costs. Doctors must meet the cost of running a practice to ensure they provide the highest quality service to their patients. There is no desire to disadvantage their patients, but without the support of their staff and the ability to cover the costs of doing business there would be no service at all.

The author then discussed the case of their relative who had a ‘bit of a toothache’. If this were the case then a simple visit to the dentist should have solved the problem. Clearly the need to go to a surgeon and have general anaesthesia indicated something far from trivial. From the information in the article it would appear that the health insurer did not provide a full level of benefit cover for this patient. Unfortunately, many health funds have a myriad of technical rules that allow them to reduce the level of benefit paid to their policy holders. This is often not clear to them. It appears likely the insurer’s arbitrary fee was inadequate, and in this case of was well under half of the AMA fee.

As the freeze on Medicare rebates continues your readers should know that 76% of services for anaesthesia attract no out of pocket expenses at all. Of those services that do have out of pocket cost the average is about $85 per service.

Specialist doctors and General Practitioners will continue to charge patients for the work they do. Costs will continue to rise. If the Medicare freeze and lack of indexation of health insurance benefits continues then it will be the patient who pays more out of their own pocket. It is important that our patients are aware of this. It is also important that doctors should ensure that our patients are not surprised by these costs and that their ability to pay be considered when setting fees that will result in out of pocket payments.

Kind Regards

Associate Professor David M Scott
President 
Australian Society of Anaesthetists

 
2017 VIC Annual General Meeting & Annual Dinner

 

DAY:     Sunday, 5th March 2017
TIME:    7.00 pm to 10.00 pm
VENUE:  Kooyong Lawn Tennis Club, 489 Glenferrie Road, Kooyong VIC 3144


We will be honoured and proud to welcome our guest speaker, Dr Tony Atkinson.
Tony, a retired anaesthetist, has published a book about his memoirs called A Prescribed Life. While he forged a successful career as an anaesthetist, his greatest gift may be for telling rousing tales. Listen to Tony tell incredible true stories from his life in England and Australia, providing a behind-the-scenes glimpse of England’s royal family.
Please advise of any special dietary requirements along with RSVP to Mary Vassilacos by Sunday, 26th February 2017.

Please download papers for the 2017 AGM:
1.    AGM Notice
2.    AGM Agenda
3.    AGM Minutes 2016
4.    Appointing a Proxy Form
5.    Request for Notice of Motions Form
6.    Office Bearer’s Nomination Form

Letter to The Australian's Editor

Date:  25 January 2016

Our President Associate Professor David M Scott wrote a letter to The Australian's Editor in response to the recent article “Specialists’ fees drive up out of pocket costs for patients” (The Australian, published on 23 Jan 2017).
Please click here to read the letter.


Anaesthesia and Intensive Care Junior Research Award

 

Date: 12 January 2017

Applications are invited from ASA, NZSA, or ANZICS members who are in training or within five years of their specialist qualification for the Anaesthesia and Intensive Care Junior Research Award.
To be eligible, applicants must be the first author of a paper published in ‘Anaesthesia and Intensive Care’ in 2016. Ideally the paper would describe work conducted in Australia or New Zealand.
The award will be made on the basis of the scientific merit and originality of the paper. The award will be made separately to the ‘Jeanette Thirlwell Anaesthesia and Intensive Care Best Paper Award’.
The prize consists of AUD $2,000 plus expenses to attend the annual ASA National Scientific Congress to receive the award.
Applications in the form of a letter indicating the name of the paper and the date published should be addressed to the Chief Editor, Anaesthesia and Intensive Care via email aic@asa.org.au by 30 April 2017.


AIC Journal 45.1 now available!

Date: 12 January 2017



The January issue of Anaesthesia and Intensive Care discusses the use of strychnine for the treatment of shock in the cover note, while the editorial Correctly name your poison by L.S. Weber reports on the use of new drug names as decreed by the Therapeutic Goods Administration.

Abstracts of the recent Australian Society of Anaesthetists 75th National Scientific Congress held in Melbourne, are also featured in this issue. For more information please update the AIC App or visit http://aaic.net.au/

 

Call for Nominations for ASA Trainee Members Group  - Committee Chair 2017 - closes 13 February 2017
Date: January 2017

All ASA Trainee Members are eligible to nominate themselves for this position. 
Please contact Maxine Wade, ASA TMG Secretariat on trainees@asa.org.au for information.


ASA Trainee Members – International Scholarship Guidelines 2017
Date: January 2017

The ASA has developed close relationships with other international anaesthetic associations under the banner of the Common Interest Group (CIG). This includes a broad scope to the advancement of anaesthesia, patient safety, workforce issues, training and development.As part of this, the ASA understands the value of trainees attending these conferences - learning and sharing experiences and common issues. The ASA is offering three scholarships each year valued at $4,000 to assist trainees with the travel costs to attend one of these international meetings.

Canadian Anesthesiologists Society Annual Meeting
Ontario, 23-26 June 2017

 Association of Anaesthetists of Great Britain and Ireland Annual Scientific Meeting
Cardiff, 5-7 July 2017

American Society of Anesthesiologists Annual Meeting
Boston, 21-25 October 2017

Please click and download Guidelines and Application form.


Relative Value Guide (RVG)
 - History and Advantages
Date: 6 December 2016

In light of the current Medical Benefits Schedule review, I believed it timely to provide a brief history of the origins of the Relative Value Guide and its advantages over the previous system. Please read below:

Dear Colleague,

Some information about the Relative Value Guide (RVG) for anaesthesia.

History and Introduction

  • Introduced into the Medicare Benefits Schedule (MBS) in 2001 after a 30-year campaign by the ASA. It had been first devised in 1951 and then adopted by the American Society of Anesthesiologists in 1961. It has been developed and improved by anaesthetists over 70 years and accurately reflects the relative value of anaesthesia work for every anaesthetic.
  • The previous (bundled) MBS system was tied to the work said to be done by the surgeon. This meant that the anaesthetist could wait weeks or months to obtain the surgeon’s item numbers before an account could be sent. Payment was calculated on a time estimate which was nearly always incorrect, and there were no modifiers for age, physical status nor emergencies.
  • The RVG was introduced in 2001 after a 5-year planning process with the Government, on a cost neutral basis. (Government had agreed in 1996 that it was a vastly superior system for determining fees and rebates however insisted it be introduced at no extra cost)
  • New items such as modifiers and emergency loadings meant the then unit value was reduced to keep cost neutrality, and that it was subsequently frozen for two years to achieve this.


Advantages of the RVG over “bundled billing” (previous MBS system)

  • Fees and rebates are based on the anaesthesia performed, not the surgery. Through its design, the RVG as a limited number of base items which automatically accommodate new surgical techniques, (e.g. “Anaesthesia for cardiac surgery” covers any new heart surgery that the surgeons develop.)
  • The use of real time means every anaesthesia fee and rebate accurately reflect the actual time taken, and as procedures become quicker or slower the fees and rebates change accordingly. 
  • The RVG in that sense is virtually always “up to date” (unlike almost every other part of the MBS)
  • Modifiers for age, physical status and emergencies acknowledge the increase in anaesthesia risk and complexity associated with these patients.
  • Items such as for insertion and monitoring of arterial or central venous catheters and blood transfusions had been in the MBS for all doctors since the MBS was first introduced, acknowledging the risks and skills required for these procedures. When the RVG was introduced  these items were given a unit value and incorporated on a cost neutral basis. These procedures are done by a wide range of doctors other than anaesthetists, particularly 
  • The RVG is regarded as simple to use and understand by insurers as well as anaesthetists and their patients. If an insurer wishes to increase or decrease their total anaesthesia expenditure they simply adjust the unit value up or down. 


In summary


The Relative Value Guide is a simple, elegant system for determining anaesthesia fees and rebates which accurately reflects the relativity of different anaesthesia services and automatically adjusts to changes in medical practice.

A/Professor David M Scott
ASA President