Mueller, Jeffrey T.

In 1995, Medicare reduced payments by 50% for anesthesiologists teaching two residents concurrently. By 2004, anesthesiology residency programs were losing, on average, $400,000 per year, causing many institutions to close their anesthesiology training programs. American Society of Anesthesiologists leaders tried unsuccessfully for several years to address this situation through appeals to Medicare. They then organized an advocacy effort to pass the Medicare Anesthesiology Teaching Funding Restoration Act of 2007, which in 2010 restored full payments for teaching anesthetics. From 2010 through 2024, anesthesiologists received $1.262 billion from Medicare for 2.8 million cases involving residents, which is between $442 million and $568 million more than if the legislation had not been enacted. Anesthesiology residency programs increased from 131 to 167 after the enactment. This historic legislation taught anesthesiologists that changing Medicare policies may require congressional action and that persistent and broad-based advocacy can make a legislative campaign successful.

Significant knowledge gaps exist in the perioperative pain management of patients with a history of chronic pain, substance use disorder, and/or opioid tolerance as highlighted in the US Health and Human Services Pain Management Best Practices Inter-Agency Task Force 2019 report. The report emphasized the challenges of caring for these populations and the need for multidisciplinary care and a comprehensive approach. Such care requires stakeholder alignment across multiple specialties and care settings. With the intention of codifying this alignment into a reliable and efficient processes, a consortium of 15 professional healthcare societies was convened in a year-long modified Delphi consensus process and summit. This process produced seven guiding principles for the perioperative care of patients with chronic pain, substance use disorder, and/or preoperative opioid tolerance. These principles provide a framework and direction for future improvement in the optimization and care of ‘complex’ patients as they undergo surgical procedures.