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4/2/2012AANA UpdateAANA BOARD OF DIRECTORSFY 2012April 20, 2012North DakotaBernadette Henrichs, PhD, CRNA, CCRNRegion 4 DirectorThe New AANA WebsiteAANA Membership StatisticsTotalMembership 2001-2011FY 2011 AANA Practice Profile andDemographic Surveys and Database35,00025,00015,000200120032005200720091

4/2/2012Highest Level of Education CompletedMembership Renewals as ofFebruary 20 (2010 – 2012)Renewal FY# CRNAs(AANAMembers)Total 8,03843,40987.6(n 6,666)Diploma / Certificate inAnesthesiaMembershipPercentage11%Baccalaureate (inNursing, and/or OtherField)18%Masters (in Nursing,Anesthesia, and/orOther Field)DNP, other Doctorate,JD69%3%2011-20809Employment statusDegree Currently Pursued(n 7,470)(n 319)Part time (lessthan 35 hoursper week onaverage)13%Master's inNursing5% Master's inAnesthesia4%Retired3%Unemployed1%Master's inother field15%Doctorate other31%Full time (35hours or moreper week onaverage)83%Doctorate DNP45%2011-208092011-208092011 Median Base Salary & OtherCompensation For Full-time EmployeesCompensation Trends in Thousands(n 3,680)20012011Median Base Salary21518716625thpercentile108Mean105 18,000 22,500 135,000 137,500Median122 145,00075thpercentile 155,000 150,00090thpercentile20110809 12,546Other Compensation14414092 17,000162 15,688201108092

4/2/2012In your primary practice setting, please indicate thepercentage of cases MEDICALLY DIRECTED by ananesthesiologist.Primary EmploymentArrangement/Source of Income2009 Results (n 5,099)(n 5,228)2010 Results (n 5,626)38%33%34% 35%Never 30%Always,48%15%13%7% 8%5% 4%4% 4% Always,22%1% 1%2010-208092010-20809Of the anesthetics you personally administer, how often isan anesthesiologist involved in the following activities?Years practicing as a CRNA(n 5,690)23%AlwaysPre-anesthetic assessment(n 5,175)38%Prescribe anesthetic plan(n 5,164)15%21%28%Present at induction (n 5,172)7%24%10%Perform post-anestheticassessment (n 5,008)Periodically Monitor AnestheticCourse (n 5,169)15%25%40%5%20%20%23%23%Present for emergencies or urgentsituations (n 5,165)Present for emergence fromanesthesia (n 5,169)Most of the time27%11%17%Less than 2years18%2-5 years6-10 years 11-20 years 21-30 years More than30 years2010-208092011-20809Age Trends 2001 vs. 2011Nurse Anesthesia Programs,Graduates & Clinical %13%12%11%15008%6%5%10005002% 2%1%0Under3030-3435-3940-4445-4950-5455-5960-6465 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011* 2012*ProgramsGraduatesClinical Sites* Projected2010-208093

4/2/2012Manpower Needs & ConcernsMajor Revisions to Standards Vacancy rate above 10% COA undertaking revision of standards with ALLmember input requested– AANA J. 2009 Apr;77(2):121-9 AANA Meeting with COA to discuss concernswe have heard Open sessions at upcoming COA Meetings on May21-23 & October 10-12, 2012 COA requires data on: Let them know your concerns by calling847-655-1160 or emailing at Pauline McKenna @pmckenna@coa.us.com– Adequacy of clinical site experiences– Employment rates of graduates– Certification pass ratesNBCRNA’s CPC ProposalAANA BODs & NBCRNA As BODs, we represent & advocate for AANA members andfelt there was a need for revision to the current decades-oldrecertification process for CRNAs The AANA & the NBCRNA are separate entities.The two organizations function autonomously & noAANA dues money is used to support theNBCRNA or the recertification process. Committed to a recertification process that best meets theneeds of all interested parties, particularly AANA members. The NBCRNA proposed the ContinuousProfessional Certification (CPC) program. Met with NBCRNA on Nov. 11-13, 2011– 168 pages of member comments; 7000 surveys; 1200 emails This is not an AANA initiative; exclusively thework of the NBCRNA. We can communicate withbut we do not control the NBCRNA.Revised CPC Program Implementation: Starting date: January 1, 2016. Certification Period: The certification period will be 4 years. Continuing Education Requirement: 3 BOD Members part of the Delphi Task Force– Wanted to make sure we are able to represent AANA membersRevised CPC ProgramFeb 2012 Examination:––––– 15 assessed CE units per yearCompetency examination to be phased into program over next 20 yrsRequired at 8-year intervals; first exam available beginning in 2020During the first 8-yr interval, exam used for diagnostic/developmental purposesFailing to meet performance standard in any major content area will requireadditional continuing education credits in that category Prior approval required– 10 professional activity units per year (developmental activities which donot require an assessment) By 2032, all CRNAs will be required to meet a passing standard on therecertification exam at 8-yr intervals. Four attempts to pass within a 4 yearrecertification cycle will be allowed. Work Requirement: NBCRNA will no longer monitor practice hours. Re-Entry: Criteria for re-entry to practice following lapsed certification to beestablished at a later date Self monitored by the certificant, but subject to audit by the NBCRNA. Competency Modules:– 4 self-study modules every 4 years on 4 core competencies (airwaymanagement techniques, applied clinical pharmacology, applied physiologyand pathophysiology, and anesthesia technology).– Continuing education credit awarded when modules completed.4

4/2/2012Thank You for YourAANA Membership!Value of AANA Membership Advocacy at State and National LevelsDues Allocations: Scope of Practice SupportActive Members: 645.00 Allocated to State Association: 232.50 Allocated to OHA/SRF: 62.50 350 comes back to the AANA: Communication– Members– Regulators– Legislators– Insurers 350 comes back to the AANA: Maintain our ‘place at the table’ regardingreimbursement for our work Maintain member CE records Provide active, permanent presence in Wash. DC Support research on the cost-effectiveness & safetyof nurse anesthesia Support state associations Fight for non-discrimination in existing and futurereimbursement policies Publish our Journal and NewsBulletin Obtain malpractice ins from AANA insurance services Develop practice standards & policies for ourpractice (so no one else does) Conduct researchAANA DuesAANA General Fund% of Median Salaries% x 1,0000.51651400.4Membership Renewals as ofFebruary 20 (2010 – 2012)AANA General FundAANA Operating RevenuesAANA Operating ExpensesFY’11 (Unaudited)Operating Revenues 19,571,968 19,147,65490Operating Expenses 18,477,396 18,232,27365Net Operating Income 1,094,572 915,381 625,000 610,717 1,719,572 1,526,098115400.3151975 1980 1985 1990 1995 2000 2005 2010Annual Dues as % of Median SalaryFY’12 (Projected)Investment IncomeNet IncomeMedian Salary5

4/2/2012AANA Operating RevenuesConsolidated Total Revenue Trend(by type)FY’12 (Projected)FY’11 (Unaudited) 13,460,000 00Rents and 62,251,9015,000,000Total 19,571,968 19,147,654030,000,000Dues25,000,000Meetings &WorkshopsLabels and ad sales20,000,000DuesNon DuesGrossAANA Operating ExpensesFY’12 (Projected)FY’11 (Unaudited) 12,561,467 12,165,016Printing & Publishing1,535,8201,168,220Meetings & 2,649,411 18,477,396 18,232,273Infrastructure &Member Support20072008200920102011Affiliate Subsidies (by anceNBCRNACPIAFoundation600,000PACGrants & Projects400,000200,000TotalState Government Affairs (SGA) DivisionContact: sga@aana.com – (847) 655-1130 Anna Polyak, RN, JDSenior Director of State Government Affairs Sarah Chacko, JDAssistant Director of State Government Affairs Jana Conover, BAAssistant Director of State Government Affairs Bruce Allain, JDState Government Affairs Analyst020072008200920102011Colorado Opt-Out LitigationLawsuit requests: Declaratory judgment that anesthesia provided by CRNAsis a “delegated medical function” and that state lawrequires physician supervision. Opt-out creates “danger of real, immediate, and irreparableinjury.” The CSA and CMS have filed an appeal 5/12/2011 of thelower court ruling with the Colorado Court of Appeals.www. aana.com/GovernmentRelations.aspx The opt-out remains in effect during the appeal.6

4/2/2012Colorado Opt-Out Litigation12/22/11-AHA Submits Brief in Support of CO Opt-Out . “[t]he opt out will improve access to health care for ruralColoradans,” and argues that “health care providers are wellpositioned to determine what anesthesia delivery arrangementswill best serve the local population.” . “[w]here a governor, in consultation with the Boards ofMedicine and Nursing, determines that allowing CRNAs toadminister anesthesia without requiring physician supervision isin the best interests of the State and consistent with State law,that exercise of the governor’s discretion should be upheld.”Missouri Issues Anesthesiologists have had bills filed (HB 1399 andSB 682) that would basically give physiciansownership of all image guided spinal injections. CRNAs have written letters to legislators asking forthem not to support these bills; the Board of Nursingoversees nurse practice and there are alreadynurses practicing with x-ray, fluoroscopy, andultrasoundFTC Issues Comments on Tennessee Bill Active pain management battle in TN. Tennessee Medical Association proposed a bill that wouldrequire on-site supervision of CRNAs performing certaininterventional pain management procedures in unlicensedfacilities. AANA staff worked closely with outside counsel and theFTC to communicate AANA’s and TANA’s concerns aboutthe restrictions that would be imposed if the bill is enacted.Iowa 01/23Bill establishes training & certification standards for a personwho wishes to practice chronic interventional pain medicine. Theperson must either complete advanced specialty training ininterventional pain medicine or be certified by a national board.Bill exempts the following from these training requirements incertain circumstances within the scope of their training:anesthesiologists who are medical or osteopathic physicians,medical or osteopathic physicians, podiatrists, anddentists. The various licensing boards are empowered to adoptrules detailing standards of care for the professions.Bill did not make it out of committee and is likely deadMissouri SB 682 “The injection of therapeutic substancesaround the spine or spinal cord for thetreatment of acute or chronic painsyndromes under fluoroscopic,computerized axial tomography (CAT)scan, magnetic resonance imaging (MRI),or ultrasound guidance shall only beperformed by a physician licensed underthis chapter.”FTC Issues Comments on Tennessee Bill FTC voiced concerns that bill may result in:– Increased prices– Reduced access to care, especially for elderly, rural,and low-income patients– Reduced choice by consumers of health care inTennessee, especially rural or underservedpopulations On 9/28/11, FTC commented there is no evidence that thebill’s restrictions “are necessary to protect the public”and that “statutory limits should be no more strict thanpatient protection requires.”7