Thomas Sowell, economist and senior fellow at Stanford University’s Hoover Institution, is 93 years old. He is a staunch conservative. He once stated: “There are no solutions, there are only trade-offs; and you try to get the best trade-off you can get – that’s all you can hope for.”
“Our members feel threatened in terms of both identity and livelihood. They feel our core values – patient safety and physician-led anesthesiology care – are under attack.”
The late Paul Samuelson was a long-time Professor of Economics at MIT and is considered one of the most influential economists of the 20th century. In contrast to Sowell, his positions on fiscal policy generally were more liberal. He once stated: “When somebody gives you an offer that’s too good to be true, almost always it is too good to be true. There are no easy pickings.”
Both men, from opposite sides of the political spectrum, basically are stating the same thing: there are no simple answers around financial planning, but instead ambiguity, hard decisions, and difficult choices. And both statements describe well ASA’s strategic priorities and financial challenges.
ASA’s finances are sound. ASA’s finance team, led by Chief Financial Officer Mark Manka, provides transparent and clear management of our reserves and balance sheet. Guided by responsible investment policies and transparent management, our reserves remain strong. Yet in full transparency, ASA faces a revenue problem: total revenue has been flat since 2017, and the majority still is dependent upon member dues (50%) and educational products sold to members (25%). The sobering reality is that ASA’s operating expenses continue to outpace its operating revenue (Table 1).
As Treasurer, I hear our members loud and clear. Payment, scope of practice, and workforce. Wellness, education, and anesthesiologist autonomy. Our members feel threatened in terms of both identity and livelihood. They feel our core values – patient safety and physician-led anesthesiology care – are under attack. They rightly are asking, “Tell me why ASA matters!”
The volume of work ASA does on behalf of its members is stunning. But faced with finite revenue streams and an increasingly complex and consolidating health care system, how can ASA support its members and achieve its vision to be a world leader improving health through innovation in quality and safety?
What is a rigorous path upward?
Last year in this column (“Financial Stewardship and Securing the Future: One and the Same”), I presented a view that strategic planning and financial strength are interdependent and each informs the other. ASA can neither develop strategic plans without evaluation of financial impact nor be responsible financial stewards without thoughtful consideration of strategic goals. Brian Reilly, ASA Chief Executive Officer, has succinctly summarized this relationship well: Revenue and relevance.
How must ASA leadership build a foundation to evolve into a growth organization? How must ASA leadership think beyond today to sustain our members for not just three, but 30 years?
Revenue
Over the years, ASA’s initiatives and programs have grown as the society’s strategic goals related to quality and patient safety, payment/legislative/regulatory advocacy, education, practice management, and workforce have become more complex. Most of these initiatives are highly valued by many ASA members, yet this growth comes with increased costs.
Since 2022, ASA leaders established two new programs to strengthen our long-term financial foundation:
- Strategic Revenue Growth: The Subcommittee on Strategic Revenue Growth (SRG) reports to the ASA Section on Fiscal Affairs and ASA Board of Directors. Established in late 2022, its primary goal is to identify, develop, and execute upon opportunities for ASA to increase nonmember, non-dues revenue from hospital and health system partners. The SRG is a unique committee comprising both clinician and staff leaders as voting members. Over the past year, ASA has built out staff expertise in product development, marketing, and financial modeling. Using a rigorous and data-driven approach to understanding customer needs and product development, the SRG is developing marketing and financial models for five potential projects, with five more in the pipeline for evaluation. ASA also is developing a broader business development infrastructure to support partnerships not only with hospitals and health care systems, but also group practices and industry.
- Project and Resource Prioritization (PReP): As ASA’s strategic needs grow in size and complexity, ASA leaders will need to have laser-like focus on how they use resources within a challenging revenue environment. Given the wide variety of programs across ASA, it is daunting to consider a change in culture around resource allocation and program evaluation. Yet that is exactly what we must do as responsible stewards of the society. To meet this need, ASA is developing discipline across staff and clinical leadership related to program evaluation and business planning. The goal is to advance ASA’s mission and remain responsive to members’ needs while being diligent around use of our precious resources. When fully implemented, the PReP initiative will ensure ASA is investing in programs that deliver strategic advantage, member value, and/or financial return.
Relevance
ASA and anesthesiologists will always champion patient safety, physician-led anesthesiology care, and scientific discovery. These are our core values. But to support anesthesiologists and remain viable within an increasingly complex health care delivery system, we must be honest about the need to adapt. ASA must consider new approaches that are relevant and meaningful to both members and external stakeholders.
Member value: How will ASA evolve into an organization focused on large-scale, transformational goals yet still maintain responsiveness to its members? Safe Haven, the recently introduced initiative around well-being, is a good example of how to focus on a large-scale problem while meeting individual member needs.
Financial stability: How will ASA prioritize resources, with focus, discipline, and transparency, around member value, strategic goals, and financial strength? This work has started, as described above, with the SRG and PReP initiatives. ASA is building a foundation based upon growth, transparency, and discipline.
Payment advocacy: How will ASA build strategic long-term partnerships and relationships to secure adequate health care funding and fair payment from both commercial and government payers? We will need scope and size to win this fight. Our emerging partnership with the American College of Healthcare Executives is a very good start.
Demonstrate our expertise and leadership as problem solvers: How will ASA leverage anesthesiologists’ expertise (and vice versa) to demonstrate value in the face of growing health care system consolidation? Through our expertise in clinical outcomes, clinical operations, patient experience, and perioperative management, anesthesiologists are uniquely positioned to partner with and lead within health care systems. A recent report from the Ad Hoc Committee on Market Strategy for Anesthesiology, completed earlier this year, but not yet published, is a good roadmap to guide ASA’s strategy in this area.
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