CSNS Quarterly Update
May 2009
Untitled Document
May 2009
Council of State Neurosurgical Societies
Quarterly Update
May 1-2, 2009
Orlando, FL
Tom L. Yao, MD
The Council of State Neurosurgical Societies (CSNS) is an organization with representatives from all states. Neurosurgeons are elected or designated at the state level. Appointees to the CSNS from other organizations, such as the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS), the parent organizations, also participate in CSNS and its committees. Representative liaisons of the CSNS report on the activities and interests of other groups, and share with them, the actions and interests of the CSNS. The CSNS meets twice yearly, two days before the AANS and CNS meetings. Upcoming meeting dates and locations can be found through the CSNS website: www.csnsonline.org.
The CSNS meeting was held at the PEABODY ORLANDO HOTEL this year. The Orange County Convention Center was the Headquarters for the CNS meeting. The venue was great and weather excellent. The meeting was well attended by delegates representing nearly every state of the country and the AANS and CNS. We continue to have strong interest/presence in the resident delegates.
As always the registration and coordination of the CSNS committee meetings were skillfully handled by Ms. Melany Thomas and her staff. There was a big push to have all the organization chart of the CSNS and individual state society officer, delegates and alternates updated. The website through the “contact us” will also serve as a method of updating state changes as the state societies meet throughout the year.
Many thanks to the hard work of historian Dr. Randall Smith, who had graciously compiled the key points/events of the weekends proceedings.
Attendance: 43 delegates from state societies, 23 delegates appointed by the AANS and CNS, 12 resident delegates and 11 guests
Perhaps the most important item on the agenda includes the finalized resolutions. There were a number of items of pertinent business on the resolutions agenda:
RESOLUTION I
Title: Definitive Direction on the Use of High Dose Methylprednisolone in the Care of Spinal Cord Injured Patients.
BE IT RESOLVED, that the CSNS asks the Joint Guidelines Committee to prioritize the update of the spinal cord injury guidelines, and work in conjunction with the Joint Sections on Neurotrauma and Spine.
BE IT FURTHER RESOLVED, that the CSNS calls upon the Joint Guidelines Committee to put forth an interim update on the use of methylprednisolone in the treatment of acute spinal cord injury.
Action: Letter to Guidelines Committee
RESOLUTION II
Title: Responsibilities of Medical Directors and “PEER” Reviewers For Insurance Companies and Worker Compensation in Adjudication of Prescribed Tests and Procedures for Neurosurgical Patients
BE IT RESOLVED; that the CSNS Medical Practice Committee (MPC) develop a white paper for report back to the CSNS body supporting a peer-to-peer utilization review process that addresses the need for specialty specific review, accountability, and transparency.
Action: Assigned to MPC for report in October
RESOLUTION III
Title: Protecting Out-of-Network Benefits for our Patients
BE IT RESOLVED, that the CSNS Reimbursement Committee in collaboration with NERVES develop a list of resources regarding acceptable methods for determining usual and customary fees.
BE IT FURTHER RESOLVED, that the CSNS ask the AANS and CNS through the Washington Committee to support patient access to neurosurgical care by preserving fair compensation for care provided out-of-network.
Action: Referred to Reimbursement Committee for report in October; Letter to AANS/CNS
RESOLUTION IV
Title: Trauma Surgeon Management of Traumatic Brain Injuries
BE IT RESOLVED, that the CSNS ask AANS and CNS to work with ABNS to issue a joint position statement to the AAST asserting that the training required to fully understand and care for both acute surgical and non-surgical traumatic brain injuries requires several years of dedicated study and practice: and
BE IT FURTHER RESOLVED, that the position statement includes the assertion that a neurosurgeon should be involved in the management of acute traumatic brain injuries.
Action: Not Adopted. Reason: AANS/CNS and ABNS have already done this
RESOLUTION V
Title: Defining the Role of Simulators in Neurosurgical Training
BE IT RESOLVED, that the CSNS investigate whether currently available skills competency training and virtual reality training tools could efficiently contribute to neurosurgery resident training and potentially improve quality of patient care
Action: Referred to CEC Committee for October Report
RESOLUTION VI
Title: CSNS Website Tool Box Resource
BE IT RESOLVED, that the CSNS encourage the utilization of a password-protected “Tool Box” to allow for an active repository of categorically organized information storing topical financial, legal and economic documents affecting neurosurgical practice; and
BE IT FURTHER RESOLVED, that this “Tool Box” be used as a complete reference library including policies, protocols, procedures, rules and regulations, government compliance documents (Medicare, Joint Commission), care maps, standard orders, continuing medical education accreditation compliance resources, informed consent forms, research tools (protocol development, grant application guidelines and opportunities), and other resources related to neurosurgical healthcare delivery which can be modified as needed for individual or institutional use under the direction of a neurosurgeon; and
BE IT FURTHER RESOLVED, that the CSNS remind its members on a quarterly basis, through e-mail blasts, requesting submission to this “Tool Box” to encourage and enhance the research capabilities of neurosurgeons seeking expedient information and exemplary resources for their own individual or institutional use.
Action: Referred to Medical Practices Committee
RESOLUTION VII
Title: Neurosurgeons and the Physician Payments Sunshine Act
BE IT RESOLVED, that the CSNS create an educational module to inform our membership and the public about existing AANS and CNS Guidelines and Policies regarding management of conflict of interest pertaining to neurosurgeons and industry.
BE IT FURTHER RESOLVED, that AANS/CNS through the Washington Committee work to make any federal legislation that provides for transparency in the relationship between physicians and industry acceptable to neurosurgeons.
Action: Referred to Communications and Education Committee for creation of module and letter to AANS/CNS.
RESOLUTION VIII
Title: National Medical Device Registry
BE IT RESOLVED, that the CSNS urges the AANS and CNS, through the Washington Committee, to support the general principle of a national medical device registry based on the concept of a unique device identification (UDI) number.
Action: Referred to Medical Practice Committee to research and prepare report addressing feasibility (does every pedicle screw need a UDI?)
Now for a few of the reports/events of interest::
1. Dr. Peter Carmel, New Jersey neurosurgeon and member of the Board of Trustees of the AMA, reported that the AMA has decided to reduce its primary advocacy issues to two: Care for the Uninsured and Adequate Compensation for Physicians. He noted that the Medicare pay cut scheduled for this year has been revoked and a small increase allowed with that congressional action coming about because of AMA lobbying. He also felt that AMA lobbying resulted in the three month delay in docs having to have an identity theft policy (red flag rules) and that the AMA will continue to push for excluding docs from having to satisfy the requirement.
He also noted that the AMA was lead plaintiff in the successful suit against United Healthcare for using the faulty Ingenix database to determine out of network charges. The $350 judgment will almost totally go to docs as the AMA legal fees were less than $2 million (unlike to large legal costs most class action suits generate for lawyers).
Finally, he acknowledged the pivotal role played by Charles Rosen, West Virginia neurosurgeon, in spearheading (at the request of the CSNS) the AMA effort to get industry to accept a universal software viewing program for digital diagnostic studies.
2. The report of the Committee on Socioeconomics of Neurosurgical Research, formed in response to a previous CSNS resolution, was given by Chairwomen Edie Zusman from California. She noted that a national database indicates academic neurosurgeons make 30-40% less than their private practice counterparts and that those academicians spend a fair amount of time in clinical practice in order to generate those lesser salaries. She outlined some methods for attracting and keeping academic faculty including equal pay for clinical and research positions, assistance programs for academic faculty to apply for NIH and NINDS grants, encourage academic faculty to spend time applying for grants from philanthropic organizations and for organized neurosurgery to encourage industry to make unrestricted and ethical grants to the Neurosurgical Research and Education Foundation who then awards grants for basic research to neurosurgical academic faculty on subject matter of the researcher’s choice. Five such industry/NREF grants were awarded this year on behalf of Biomet Microfixation, Codman, DePuy Spine, Medtronic and Porex Surgical.
3. The Coding and Reimbursement Committee report by John Wilson included no good news for docs. He noted that CMS has ACD&F on the front burner and plans to bundle 63075 and 22554 into one code which probably will be assigned 45% fewer RVUs over our vigorous objections. It was also noted that the Obama budget included $300 billion to permanently fix the Medicare Sustainable Growth Rate formula but the Senate cut that to $40 billion which is not enough to fix the problem beyond a couple of years.
4. The Workforce Committee arranged for a presentation by Osteopathic Neurosurgeons as to their history, training, certification and practice. It was noted that DO and MD medical school curricula was quite similar with DOs getting additional instruction in manipulation. There are 30 DO medical schools and 40% of graduates go on to ACGME (MD) residencies. Eleven osteopathic neurosurgical residencies turn out 17 new neurosurgeons a year while the 97 allopathic neurosurgical residencies graduate 160+ neurosurgeons annually. The DO neurosurgical residency is of very similar length and breadth as MD programs and each DO program is accredited by the American Osteopathic Association. Graduates of DO neurosurgical residencies take a written and oral exam to become certified by the American Osteopathic Board of Surgery which is not neurosurgery specific as is the ABNS. Recertification is required every 10 years. Most mid-aged and younger osteopathic neurosurgeons do not manipulate but rather send selected patients to osteopaths who do manipulations; they use the technique like physical therapy or chiropractic. It was the opinion of the presenters that older osteopathic neurosurgeons are happy where they are in the national neurosurgery fabric but the younger DO neurosurgeons, many of whom took MD fellowships, are interested in becoming part of national neurosurgery and having a role in the AANS and/or CNS. The AANS is currently considering the issue although a recent AANS by-laws change rewrote the criteria for Associate Members which specifically excluded DOs.
5. AANS President Jim Bean addressed the CSNS and gave credit to the late Lyal Leibrock for introducing him to the Council and during his years in the CSNS, culminating in his Chairmanship in 1997-99, he learned the skills necessary for his career at the AANS Board and eventual presidency. He pointed out that his grass roots perspective played a significant role in the recent equalization in the standing of and responsibilities assigned to Regional AANS Board Directors (positions determined by the CSNS quadrants) and the inclusion of CSNS generated socioeconomic articles in the AANS Neurosurgeon (formerly the AANS Bulletin). He cited the CSNS, through its resolutions, for bringing thoughtful ideas to the AANS/CNS leadership (he modestly failed to mention he was primarily responsible for the adoption of that resolution process in 1995 while CSNS Vice-Chairman).
6. The Lyal Leibrock Lifetime Achievement Award was presented to Robert Florin, M.D., from California for his many years spending very many hours representing neurosurgery in coding and reimbursement act ivies which resulted in making our neurosurgical practices successful.
7. The Robert Florin, M.D. Young Neurosurgeon Award for best socioeconomic paper was presented to Brian L. Hoh, M.D. for his study “The Effect of Coiling versus Clipping on Length of Stay, Hospital Cost and Reimbursement and Surgeon Reimbursement”. The Byron C. Pevehouse Award for best socioeconomic paper by a resident went to Jayant Jagannathan, M.D. for his paper “Effects of ACGME Work Hour Rules on Neurosurgical Resident Education and Productivity”.
8. From among 41 very good applicants, 12 new resident fellows were selected by their appropriate quadrants to serve as CSNS delegates for the next two CSNS meetings.
Northeast Quadrant
Peter Campbell, M.D. Thomas Jefferson
Maxwell Laurens, M.D. Yale
Clemens Schirmer, M.D. Tufts
Southeast Quadrant
Wesley Hsu, M.D. John Hopkins
Matthew Lawson, M.D. University of Florida
Carrie Muh, M.D. Emory
Northwest Quadrant
Andrew Bauer, M.D. University of Wisconsin
Joseph Hsiah, M.D. University of Chicago
Fahd Khan, M.D. Case Western
Southwest Quadrant
Namath Hussain, M.D. University of Arizona
Paul Kalanithi, M.D. Stanford
Vincent Wang, M.D. UCSF
SPECIAL GRATITUDE TO MEDTRONIC SOFAMOR DANEK FOR THEIR RESIDENT DELEGATE EDUCATIONAL SUPPORT
Please notify Melany Thomas of any changes (859) 260-2721 or mthomas@kyneurosurgeons.com
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