TopMedTalk

Recorded at ASA Anesthesiology 2026 in San Diego, hosts Andy Cumpstey and Harriet Hopf speak with Patrick Velliky, Chief External Affairs Officer and Senior Vice President for Government Affairs at HaloMD, about misconceptions around the No Surprises Act (NSA) independent dispute resolution (IDR) process and its cost impact.

Velliky argues many studies cite total arbitration awards without a pre-NSA baseline, and his emergency medicine analysis comparing like-for-like out-of-network (OON) claims found OON spending is 13%–50% lower post-NSA, with modeled savings depending on assumptions about payments for the ~90% of eligible claims not going to IDR.

He discusses the qualifying payment amount (QPA), recent litigation finding unlawful QPA manipulation, and concerns about third-party administrators (TPAs), including lack of transparency, shared-savings fees, and a reported ~35% nonpayment rate of binding IDR awards.

The conversation links these issues to anesthesia, subsidies, consolidation, employer oversight, and pending bipartisan legislation to penalize nonpayment and improve accountability.

At the EBPOM World Congress in London, Andy Cumpstey interviews Professor Michael Scott, Chair of the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center (URMC) in Rochester, New York for TopMedTalk's Perioperative Profile series.

Scott, recounts growing up in Bath in the UK, studying medicine at Birmingham, and funding medical school through award-winning travel photography that later informed medical teaching resources and WHO's LifeBox work.

He describes extensive travel, including China, Nepal, Peru, Gaza, and Myanmar, and how experiences shifted him toward medicine and then anesthesia after time in emergency medicine.

Scott outlines his UK training, family moves, and relocation to the US, including work at VCU and Penn during COVID, where he helped build tele-ICU capabilities amid PPE and ventilator shortages. He highlights pride in LifeBox, enhanced recovery/complication reduction, and opioid-sparing initiatives, and advises resilience and supportive partnerships.

ANESTHESIOLOGY® 2026 in San Diego, TopMedTalk hosts Kate Leslie and Andy Cumpstey speak with Bonnie Milas, clinical professor of anesthesiology and critical care medicine at the University of Pennsylvania and American Society of Anesthesiologists (ASA) President Patrick Giam.

The discussion covers addiction, overdose prevention, and pain management. Milas, who lost two adult sons to accidental fentanyl poisonings, advocates putting naloxone and basic response training in the hands of families and communities. She explains overdose signs (unresponsiveness, pinpoint pupils, slow/shallow breathing, cyanosis), calling 911, rescue breathing/CPR, and that naloxone is an easy, safe nasal spray now available over the counter.

Giam discusses anesthesiology's role in opioid-sparing multimodal analgesia, individualized prescribing, education at discharge, and advocacy for reimbursement and fewer prior authorization barriers. Milas highlights ASA's REVIVEme initiative to reduce opioid and drug related mortality, an educational campaign to reduce risks from adulterated drug supplies, and the need to remove stigma, educate youth, and make naloxone as available as AEDs.

More here:

http://reviveme.com/

This edition of TopMedTalk at Anesthesiology 2026 in San Diego, features Kate Leslie and Sol Aronson interviewing Major Zachary Affrin, a pediatric anesthesiologist at Tripler Army Medical Center in Hawaii, and Captain Joy Ferré, a PGY3 anesthesiology resident at Brooke Army Medical Center/SAUHEC.

They discuss paths into military medicine and anesthesiology, including HPSP and Uniformed Services University, and emphasize early leadership opportunities, subspecialty development supported by the Army (including Affrin's fellowship at Children's Hospital of Philadelphia), and work-life balance with unique military experiences. Ferré describes Global Health Engagement mission trips, highlighting a Panama trip that delivered 80 cataract, corneal transplant, and glaucoma surgeries for civilian patients. Affrin also notes military innovation efforts such as renewed use of whole blood for trauma care at geographically isolated facilities.

Disclaimer: "The views expressed in this recording are those of the authors and do not necessarily reflect the official policy or position of the Defense Health Agency, Department of War, nor the U.S. Government."

ANESTHESIOLOGY® 2026 in San Diego, TopMedTalk hosts Andy Cumpstey and Harriet Hopf interview Shahid Ali, Assistant Professor of Anesthesiology and the Director of Cardiac Anesthesia at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, about automated anesthesia technologies.

Ali contrasts automated inhaled delivery via end-tidal control (now available in the US) with target-controlled infusions (common outside the US but not FDA-approved), explains anesthesia goals and workflows, and describes how clinicians set age-adjusted MAC targets while the system adjusts vapor concentration and fresh gas flow, including a "purge" function to hasten wake-up.

He highlights safety features that disengage automation when parameters are unsafe, teaching advantages from real-time visualization of flows, MAC, and cost, and sustainability benefits from low-flow automation, citing large reductions in emissions.

ANESTHESIOLOGY® 2026 in San Diego, TopMedTalk hosts Kate Leslie and Sol Aronson speak with David L. Hepner, MD, MPH. Associate Professor of Anaesthesia at Harvard Medical School and Bradley R. Cohn, MD, Regional Medical Director and the Chair of Perioperative Medicine for Kaiser Permanente Northern California (KPNC) / The Permanente Medical Group about the American Society of anesthesiologists (ASA) Center for Perioperative Medicine (CPMed) and its push to move perioperative care from fragmented episodes to a coordinated continuum.

They describe CPMed's origins in October 2022, its multidisciplinary and international "big tent" approach, and efforts in education and training, including adding perioperative medicine to ABA topic areas and expanding ACGME training. The discussion highlights patient-first risk framing, care coordination and communication, scarce resource stewardship, learning from UK and other international models (e.g., prehab, anemia/frailty treatment), and the TEAM payment model's implications for pre-op optimization. They emphasize measuring outcomes, reducing cancellations, and closing gaps at care transitions.

More on the ASA's CPMed here: https://www.asahq.org/quality-and-practice-management/center-for-perioperative-medicine

TopMedTalk's coverage of ANESTHESIOLOGY® 2026 (the annual meeting of the American Society of Anesthesiologists) in San Diego begins, with Kate Leslie and Andy Cumpstey introducing this year's hosting team.

Hosts including Mike Grocott, Sol Aronson, James Bowness and new team member Harriet Hopf discuss meeting highlights such as the Emery A. Rovenstine Memorial Lecture from Anesthesiology editor-in-chief James Rathmell and the keynote by Will Flannery (Dr. Glaucomflecken).

They emphasize perioperative medicine momentum, networking opportunities, and plans for upcoming TopMedTalk interviews on AI (including Mission Control UCSD and large language models) and perioperative profiles with Carol Peden, Ellen O'Sullivan, James Rathmell and Hugh Hemmings, while thanking the American Society of Anesthesiologists and sponsors BD Advanced Patient Monitoring and GE Healthcare.

Host James Bowness and co-host Andy Cumpstey introduce another TopMedTalk AI series recorded at St Andrews University with Alasdair Taylor, a Consultant Anaesthetist at NHS Tayside who runs an exam-focused anatomy course ("Anatomy for the FRCA") and now leads a two-day regional anaesthesia "Regional Anesthesia: Plan A blocks" course aimed mainly at stage two registrars.

Supported by NHS Education for Scotland and technology funding, the course is oversubscribed, attracts delegates internationally, has expanded to ICU and emergency medicine applications, and has trained nearly 200 delegates—about 10% of Scotland's anaesthetists.

The course combines cadaveric anatomy teaching from in-house anatomists with live ultrasound scanning augmented by AI anatomy overlays (ScanNav) and a Needle Trainer simulator that projects a retractable-needle path, provides objective metrics like percentage time the needle tip is in view, and supports deliberate practice. Faculty are aligned using ESRA-endorsed block guides while allowing time for tips and debate.

At the Evidence Based Perioperative Medicine (EBPOM) World Congress, and the first World Congress of Enhanced Post-Operative Care (EPOC), Andy Cumpstey interviews Deena Harji, Consultant Robotic and Colorectal Surgeon at the Manchester University NHS Foundation Trust (MFT) and the Professor of Robotics and Digital Healthcare Technologies, alongside Cathy Price, Consultant in Pain Medicine at Southampton NHS Foundation Trust.

Harji covers the rapid UK adoption of surgical robotics, noting potential benefits such as lower systemic inflammatory response, less pain, faster recovery, and earlier discharge, while acknowledging implementation has outpaced evidence on clinical and cost effectiveness.

Price argues pain management should be treated as a whole perioperative journey, addressing multiple cancer-surgery pain mechanisms and biopsychosocial factors, using multimodal analgesia, ERAS principles, tailored approaches for chronic pain, psychosocial interventions, and functional outcomes rather than "pain tick" metrics. They emphasize teamwork, patient selection for robotics (frail, elderly, obese, complex cases), anesthetic considerations (lower pneumoperitoneum), and sensible limits including early conversion.

Find out more about www.ebpom.org

At the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists (ANZCA) and Faculty of Pain Medicine (FPM) held in Auckland, New Zealand, Kate Leslie and Andy Cumpstey interview ANZCA president David Story and the ASM New Zealand Visitor Tim Walsh about what inspired them to pursue a career in research and how they support emerging research leaders.

David Story is Professor and Chair, Department of Critical Care, University of Melbourne, Australia, and Consultant Anaesthetist at the Austin Hospital, Australia. Tim Walsh is Professor of Critical Care at the University of Edinburgh and Honorary Consultant in Critical Care at Edinburgh Royal Infirmary, Scotland.

Find out more about ANZCA here: https://www.anzca.edu.au/events-and-courses/2027-anzca-annual-scientific-meeting-(asm)