Bill Klaproth (Host): This is an AAOMS On the Go Podcast. I'm Bill Klaproth. And with me is Dr. Greg Ness. Dr. Ness is here to discuss the Office Anesthesia Evaluation Program Expansion. Dr. Ness, great to see you.

Dr Gregory Ness: Thanks so much, Bill. It's great to be back with you.

Host: Yeah, I always love talking with you. So, thank you so much for your time. So, first question then is how is the Office Anesthesia Evaluation or OAE program changing?

Dr Gregory Ness: Yeah. So, OAE is a peer review process that goes all the way back to 1975. And the core of this is an in-person office evaluation by a colleague oral and maxillofacial surgeon at least every five years. And these visits review office facilities and equipment, anesthesia team emergency preparedness, and really evaluate the anesthesia practices followed by that office and the requirement for continued membership in the association.

So over the last three years at the AAOMS House of Delegates, we've developed enhancements to the existing OAE process based on advice and recommendations from the Association Committee on Anesthesia. In the end, three new requirements were added to the OAE and this really makes it a program, not just a one-off, once-in-a-while office visit.

Host: Okay. So, three new requirements. Can you share with us what these three new requirements are?

Dr Gregory Ness: Yeah. So, the first is already in place and that is quarterly mock emergency drills involving the entire anesthesia team. And so, this is something that people should already be doing and documenting and ready to show what they're doing at their next OAE visit. And I can tell you in my own practice, this has been terrific. You go through an emergency scenario with your whole team. And when you get them together, you start to discover little details that you might have overlooked if you just talked through things. And the preparedness that comes of this and the competence and confidence that we're seeing in the staff, not to mention the surgeons, has been a real boon. So, this is kind of the low-hanging fruit of these things. You know, it costs us an hour, a quarter. And it's paying benefits already.

Host: Okay.

Dr Gregory Ness: The second requirement starts in 2026. And that will be submitting anesthesia survey data back to AAOMS every five years. So, this survey will gather basic but essential data from our members practices on their anesthesia cases and outcomes. So, we'll have more details on responding to that survey as the date draws nearer. But it will also be connected to the OAE program. Then, the third requirement is probably the most complicated to implement. Members are required to have approved anesthetic airway management simulation training by 2026. And this will be verified through the OAE program. Now, it's important to note all of our anesthesia-providing members will need to meet all three of these requirements for continued membership in AAOMS, that means we need to be sure the required training is accessible and that AAOMS makes it convenient for our members to report compliance.

Host: So, AAOMS will conduct these requirements or they will verify these programs, is that right?

Dr Gregory Ness: Yeah. We'll be looking to members, and we'll come back to this here In a minute, we'll be looking to members to tell us that they're doing the things that we ask.

Host: Right. Okay. And even on these quarterly mock emergency drills, those are at the discretion of the individual practice?

Dr Gregory Ness: Yeah. There are some sort of guidelines on things you want to cover. But yes, when and how you do that, the minimum is once a quarter.

Host: Okay. Got it. So, I'm still interested in the simulation training requirements. Can you tell us more about that?

Dr Gregory Ness: Sure. So, the prototype or the first in class training course is something that AAOMS has developed called the Office-based Emergency airway Management or OBEAM course.

Host: Okay, got it.

Dr Gregory Ness: So, OBEAM is focused on airway management because that is an especially critical skill in our office anesthesia setting. The course uses high-fidelity simulation of intensive and very real life experiences, so oral and maxillofacial surgeons can practice, master established and some innovative techniques to address airway problems. And this is not unlike what you see in aviation where pilots train for adverse events through simulation. So, OBEAM offers four hours of pre-course online learning and then two hours of hands-on training simulating various emergency airway situations with some immediate data-driven feedback to the participants. And some clever educators have made this a state-of-the-art simulation course.

Host: So, how can AAOMS member surgeons take this course?

Dr Gregory Ness: Yeah, and that is an essential question for our members. So, leading up to the 2023 AAOMS Annual Meeting, roughly a thousand surgeons have already taken this course. And at multiple sessions during the meeting, a few hundred more will complete the training. It will be offered again at the 2024 Annual Meeting in Orlando. But in the meantime, it will also be offered on a series of dates at the Laskin Institute in our headquarters building in Rosemont, Illinois, and those will be listed on aaoms.org. Now, in 2023, we also offered it at three regional or state OMS meetings. In 2024, that's going to be available at up to 10 of those meetings. And there are more states and regional groups asking to sign up all the time, so we're really seeing good geographic distribution of course locations across the country.

Host: For AAOMS members, is this a requirement to take the OBEAM course?

Dr Gregory Ness: Well, not exactly. It's a requirement to take a simulation course, but there are other alternatives to OBEAM that would also meet the requirement.

Host: Okay. So, what are those other OBEAM alternatives, if you will?

Dr Gregory Ness: So, AAOMS has a process in place to approve courses offered by other providers who can show that their course meets all the requirements and is substantially similar, and this is already happening. So to date, we've got two courses approved and I believe they're advertising their availability already. A third was just approved and we expect to be adding more options and without sacrificing quality over this next year. And AAOMS is happy to see this. We like to see the growth in state-of-the-art training in this subject and taking any one of these courses that are approved will also meet that membership requirement.

Host: So, earlier, you said you were going to touch base on the compliance of this, because I asked earlier, "Well, how does this get certified?" And you said, "Well, let me touch base on that earlier." So, let's get back to that. How will members demonstrate compliance with these new requirements?

Dr Gregory Ness: So, here's where the rubber meets the road. And we want our members to demonstrate this, but we want them to really focus their time and effort on sharpening their patient care skills, not on bureaucratic paperwork. So, beginning in 2026, AAOMS will ask each individual member to sign an attestation form. Well, they'll affirm they've done each of what are really four overall OAE elements: an OAE office visit, mock emergency drills, simulation training and submitting anesthesia survey data.

So, these forms will get sent out at the beginning of the year when a member is due for re-evaluation. And for most of our members, AAOMS has a record of the most recent OAE visit date. But there are some states where the anesthesia evaluations are administered by the state licensing agency, and AAOMS doesn't have records for individual members. So for those members, the forms will be distributed in 2026, and members can then update their actual due date or due year with AAOMS as needed.

And this is probably important to note, too. I'm talking about forms like we're talking about a physical piece of paper and that will probably be an option. But like everything else, we're really working on options for making this electronic or incorporating it into the rest of the OAE visit documentation. And again, the point is we want people to do these things, be better, safer providers, focus their attention on that, and then just be able to let us know they're doing it.

Host: Right. So, this is incumbent on the individual provider then. Basically, the individual members will be reporting their own compliance to AAOMS?

Dr Gregory Ness: Yes, yes. Now, right now, most states, through their state society, report the OAE visit dates and compliance to AAOMS for all their members. But beginning in 2026, that responsibility will shift to individual members in every state. And this is why we want the process to be clear, quick and easy as possible.

Host: So, what precipitated this? What is the goal of the Expanded OAE Program?

Dr Gregory Ness: The bottom line, the expanded program and other initiatives that parallel it are all designed to enhance patient safety. Now, looking ahead, we're also seeing some incredibly exciting advances in simulation technology. There's promise of a whole new generation of life-like reality and, surprise, substantial drop in cost. So, these things are coming together, and this is going to keep AAOMS and its member oral and maxillofacial surgeons exactly where we want to be, at the forefront as world leaders in delivering safe and efficient office-based anesthesia care to our patients. So, are we asking more of our members in all this? Yes. Is it reasonable and meaningful and impactful? Absolutely. And this is exciting stuff and I think it's something we can all be proud of.

Host: Yeah. So, what has the member feedback been so far for these new requirements?

Dr Gregory Ness: The people I've talked to have been doing a lot of the right things all along, and they want to do the right things. And so, this is not new to them. The drills uncover little surprises, things you thought you might have covered and you didn't quite, and that's been a big boost in confidence.

Host: Yeah, for sure. And, you know, anesthesia is probably one of the biggest questions you get asked the most about being an OMS, is that fair to say?

Dr Gregory Ness: That's fair. A lot of people come to us, and the first thing is, "I want to be asleep."

Host: And people probably ask about the risks of that as well, so this new program will help soothe people's nerves or anxiety about anesthesia?

Dr Gregory Ness: You know, a lot of this just goes into the confidence that you have that you and your office are making good choices and you're well equipped to handle problems if they arise. Obviously, we'd prefer to prevent them in the first place. But I think the take-home message to the public at large is we're preparing for problems as best as we can in a state-of-the-art way.

Host: Absolutely. And I think as you said earlier, this puts AAOMS and its members at the forefront in delivering safe and efficient office-based anesthesia care to the patients.

Dr Gregory Ness: That's our goal.

Host: It's really the bottom line, yeah.

Dr Gregory Ness: Absolutely.

Host: Anything else you want to add, Dr. Ness, before we wrap up on the OAE Program Expansion?

Dr Gregory Ness: You know, I would think I'd let everyone know that there are going to be some more details coming over the next year and a half as we look at deadlines and some of the finer details of the implementation. We've got a little time to work those things out yet, but we're committed to making this a feasible and a positive thing for our membership.

Host: Absolutely. Well, that's a great place to leave it. Dr. Ness, thank you so much for your time. We appreciate it.

Dr Gregory Ness: Thanks so much, Bill. It's good to talk with you.

Host: Yeah, you too. And once again, that is Dr. Gregory Ness. And for more information and the full podcast library, please visit aaoms.org. That's aaoms.org. And if you enjoyed the show, please share it on your social media and be sure to subscribe so you don't miss an episode. Thanks for listening.