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ASA and ASRA Pain Medicine: Partnering for a Better Future for Our Patients

Feb 8, 2024, 05:30 AM by Ronald L. Harter, MD, FASA

Cite as: Harter R. ASA and ASRA Pain Medicine: partnering for a better future for our patients. ASRA Pain Medicine News 2024;49.

The American Society of Anesthesiologists (ASA) and our subspecialty organizations are importantly intertwined. Not only do subspecialty organizations have a say in ASA’s governance, they also help with providing input on appointments to related committees and identifying representatives of their societies to serve on ASA’s Committee on Specialty Societies. Additionally, formal and informal opportunities for collaboration frequently arise that benefit from ASA incorporating the deep subject matter expertise of our subspecialty societies.

ASA’s relationship with ASRA Pain Medicine is particularly strong when it comes to the ANESTHESIOLOGY® annual meetings. Last year in San Francisco, there were 26 regional anesthesia and pain sessions. Anyone who has shied away from submitting a session to ASA because of pessimism about your likelihood of acceptance may be interested to know that 81% of submitted regional anesthesia and acute pain presentations were accepted, and 68% of submitted pain presentations were accepted. ASRA Pain Medicine also presented two panels in San Francisco, “ASRA Pain Medicine Centennial: A Historical Look at the Practice of Regional Anesthesia and Pain Medicine and a Glimpse into the Future” and “ASRA Pain Medicine 2023: Expand, Enrich, Evolve.”

Equally important is our work together on advocacy efforts. This past year ASA and ASRA Pain Medicine worked with the American Medical Association (AMA) on shared efforts to ensure support of AMA on key payment and coverage issues. Several of ASA’s pain medicine physician members represent ASA on both the Current Procedural Terminology and Relative Value Scale Update committees. In recent years, ASA and ASRA Pain Medicine have collaborated on the valuation of the following pain codes: somatic nerve injection; spinal cord stimulators; dorsal sacroiliac joint arthrodesis, and transversus abdominis plane blocks. We also work together to ensure patients’ access to pain therapies through commercial payors and have advocated that they cover peripheral nerve stimulation and radiofrequency ablation (rhizotomy).

This past year ASA and ASRA Pain Medicine worked with the American Medical Association (AMA) on shared efforts to ensure support of AMA on key payment and coverage issues.

ASA’s Committee on Pain Medicine addresses issues important to the practice of pain medicine and garners consensus from multiple stakeholders on issues such as scope of practice and access to safe physician-led pain care. Due to the increased number of non-physicians and non-anesthesiologist pain specialists administering ketamine and practicing pain medicine, the committee developed the Statement on Ketamine for the Treatment of Chronic Pain, the Statement on Access to Pain Care, and the Statement on the Practice of Pediatric Pain Medicine, which were all approved by the ASA House of Delegates in October 2023. ASA, along with ASRA Pain Medicine and other leading medical specialty organizations, collaborated on Pain Summits 1 and 2 to develop foundational principles for the perioperative treatment of acute pain and identify best practices to manage acute pain in complex surgical patients. These principles were published in Regional Anesthesia & Pain Medicine.

ASRA Pain Medicine members also participate in quality measure development and quality reporting. One of the most important measures anesthesiologists report as part of the Merit-based Incentive Payment System (MIPS), is the Multimodal Pain Management Measure, which was developed by a joint ASA-ASRA Pain Medicine measure development panel. Over the past 5 years, anesthesiologists and pain medicine physicians have reported millions of cases for that measure, showing continued improvement year-over-year. The ASA-ASRA Pain Medicine measure development panel also drafted five measures, including a measure for use of regional anesthesia in total knee replacements, which are currently reportable in the Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry.

Our two societies share advocacy objectives when it comes to participation in the Quality Payment Program (QPP). For those individuals and practices meeting the participation threshold, the QPP consists of two pathways – MIPS and Advanced Alternative Payment Models (AAPMs). ASA and ASRA Pain Medicine’s goal has been to ensure that anesthesiologists are appropriately assessed within the program, and our members have every opportunity to earn payment bonuses. In recent years, anesthesiologists and their practices have realized several challenges to participating in both MIPS and AAPMs. For MIPS, pain medicine physicians may encounter fewer opportunities to report non-topped out measures as well as difficulties in meeting the performance threshold. Other pain medicine physicians may begin to be scored in the cost category where a measure related to lower back pain was approved for the 2023 performance year. For AAPMs, pain medicine physicians may have better, albeit still limited, opportunities to join AAPMs than anesthesiologists. These issues are not unique to anesthesiologists or pain medicine physicians. Instead, these challenges reflect both legislative and regulatory shortcomings in encouraging best practices for delivering quality care and protecting patient safety.

Regardless of whether you participate in the QPP, quality improvement and patient safety are shared interests between the ASA and ASRA Pain Medicine. Anesthesiologists and pain medicine physicians continually strive to improve the care they deliver and protect patient safety. We expect to share common goals and interests in future measure development, implementing value-based care.

As you can see, our two organizations are symbiotic and intertwined, and together we are working to ensure our patients continue receiving the highest quality of care, while continuing the fight to ensure that our members are fairly paid for the services they provide.

Ronald L. Harter, MD, FASA, is the president of the American Society of Anesthesiologists and a professor of anesthesiology in the department of anesthesiology at Ohio State University Wexner Medical Center in Columbus.
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