VOLUME 30, ISSUE 1

Thank you for the honor of serving as your President. I am truly humbled and honored to have this privilege. Although this coming year is not a legislative one it has already been a momentous one and I predict that the remainder of the year will be just as exciting and busy. We are a strong and vibrant society and thanks to our members’ commitment we are able to address issues in a prompt and efficient manner.

At this year’s annual meeting our most urgent concern was the welfare of our members impacted by hurricane Harvey. Your House of Delegates approved a resolution to provide support to resident members and to provide an optional dues waiver to members impacted by Harvey. An Ad-Hoc Committee on Resident Disaster Relief Aid was formed. The members were: Drs. Amr Abouleish-Chair, Semhar Ghebremichael, Mark Harbott, Lynn Knox, Mary Dale Peterson, Evan Pivalizza, Tom Swygert and George Williams. I am happy to report that the Anesthesia Foundation agreed to work with us. TSA and ASA members across the nation contributed to the Anesthesia Foundation on behalf of Texas Resident Members to raise $18,200. The Foundation provided grants to 16 of our residents for a total of $20,300. On behalf of our Society I want to recognize and thank Dr. Charles Otto, president of the Foundation, for his support and his tireless efforts.

We have also established a method for members to waive their 2018 dues if they were victims of Harvey and I have appointed the Ad-Hoc Committee to Explore Charitable Efforts for future incidents. The Ad-Hoc Committee members are Drs. Amr E. Abouleish-Chair, Gerald Callas, Kristyn Ingram, Lynn Knox, Joe Naples, Udaya Padakandla, Rosario Parra, Jeremie Perry, Mary Dale Peterson, and LoriJean Reed. The Committee is developing a proposal to present to the Board in January.

Over the course of the last two years the TSA has fought aggressively against Medicaid anesthesia cuts for the physician anesthesiologist payment in a care team model which were implemented in January 2017 to 75% of the anesthesia rate and were set to be further reduced in January 2018 to 25%. Through intense interaction through legislative and administrative channels, a new proposed rate was adopted effective November 1, 2017 that aligns the Medicaid reimbursement percentages in a care team model with those used in Medicare – 50% to the physician anesthesiologist and 50% to the physician extender. With that division the Texas Health and Human Services Commission (HHSC) increased and simplified the anesthesia rates to $25.60 for children and $24.32 for adults, regardless of whether it was obstetric related. Substantial increases were also seen in flat rate reimbursements for epidurals. Rates for dental anesthesia remained the same at $27.276. While this still represents a slight decrease in care team reimbursement from 2016, it represents a huge increase in anesthesia rates overall and reversed a possibly disastrous rate beginning in 2018. It has been a team effort with myself, and Drs. Debbie Plagenhoef-Immediate Past-President, Sherif Zaafran-Governmental Affairs Committee Chair, and David Bryant-Economics Committee Chair, as well as legislative assistance from John Zerwas-House Appropriations Chair. Due to an oversight by the HHSC the Medicaid payment for academic institutions was going to be affected. However, thanks to your TSA leadership and Dr. Amr Abouleish’s quick actions the issue was promptly corrected.

Our Bylaws Committee will be presenting a proposal to the Board in January to amend the TSA Bylaws to allow the appointment of Anesthesiologist Assistants to serve on TSA Committees.

Through the legislative efforts of the TSA beginning as far back as 2015, the legislature passed a law cracking down on the Texas State Board of Dental Examiners (TSBDE) regulation of the dental anesthesia care. As part of the new law, an Anesthesia Advisory Committee was created to review dental anesthesia cases to suggest regulatory changes and enforcement actions. The Committee membership includes a physician anesthesiologist. I was proud to nominate Dr. Carlos “Nick” Lee, a pediatric anesthesiologist in Austin for this position. Selections will be made by the TSBDE before the end of the year. It is our expectation that we can lend our expertise to increase the safety of all anesthesia patients.

Our Patient Safety and Medical Quality Committee is working alongside the Practice Management Committee to finalize the TSA White Paper which will define the difference between providing an anesthetic vs. the medical act of an anesthetic. Upon approval by the TSA Board, the White Paper will be submitted as a Resolution to the ASA to establish a formal definition.

The state is also addressing the dismal maternal mortality rates in Texas, which is the highest in the developed world at 35.8 per 100,000 live births as of 2014. The Texas Medical Association has created a maternal mortality task force and has asked the TSA to participate. Their first meeting was on September 30th and Dr. Michelle Simon from UTMB-Galveston represented anesthesia concerns during the meeting.

At the September Board of Directors meeting an issue regarding the lack of a conflict of interest statement for Board, Committee and House Members as well as our consultants was discussed. The TSA Judicial Committee is currently creating an appropriate document which will also be presented in January for review.

I am happy to report that your Board approved continued funding to three anesthesiology programs to send resident members to the 2018 ASA Practice Management Conference.

We had 5 anesthesiologists accepted into the TMA Leadership College Class of 2018. Congratulations to Drs. Brian Boies, Ifeyinwa Ifeanyi-Pillette, Michael Kim, Shaina Sheppard and January Tsai.

The Ad-Hoc Committee to Bring the TSA and Texas Academy of Anesthesiologist Assistants (TAAA) Together has been appointed. Members are Drs. Sam Gumbert-Chair, Tim Bittenbinder, Stephen Hoang, Jeff Jekot, Debbie Plagenhoef, Crystal Wright and Jeff Zavaleta as well as Anesthesiologist Assistants Tim Goodridge, Brian Haskins and Jana McAlister.

Lieutenant Governor Dan Patrick and Speaker Joe Straus have issued their interim charges to their committees for research over the interim and to prepare for possible legislation for the 2019 session. Both chambers highlighted the need to address the opioid crisis. In response, I have created an Ad Hoc Committee on the Legislative Opioid Charges to formulate a position and recommendations to the committee when they begin their hearings next year.

In closing I want to recognize the members who generously contribute their time and their financial support to the TSA and TSAPAC. You are all invaluable to the future of our Society.