Council of State Neurosurgical Societies
Quarterly Update
April 26 – May 1, 2008
Chicago, IL
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 HYATT REGENCY CHICAGO
this year. The Sheraton Chicago Hotel & Towers was the Headquarter Hotel
for the AANS 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.
Perhaps the most important item on the agenda
includes the finalized resolutions:
1. RESOLUTION I—Referred to
Medical Practices Committee to study
Title: A Neurosurgical Code of Ethics for the
Practice of Spinal Surgery
Submitted by: Gary R. Simonds, M.D.
BE IT RESOLVED, that the CSNS
produces a series of ethical guidelines for the practice of spinal surgery to
be endorsed by the AANS and CNS and, to be disseminated to all neurosurgeons;
and
BE IT FURTHER RESOLVED, that these
guidelines should be collated into a publishable “Code of Ethical
Behavior” that can be readily displayed by neurosurgeons in their
offices. Such a publication could be produced in paper form or, at less expense,
could be made downloadable from the CSNS website; and
BE IT FURTHER RESOLVED, that the
Medical Practices Committee develops said guidelines- to be approved by the
CSNS body; and
BE IT FURTHER RESOLVED, that said
ethical guidelines are offered to the representative bodies of Orthopedic
Surgery in order to include Orthopedic “Spine Surgeons,” and
General Orthopedic Surgeons who practice spinal surgery, in their
dissemination.
2. RESOLUTION II—Adopted and sent to
Rules and Regulations Committee
Title: Armed Forces Delegates to the CSNS
Submitted by: CSNS Membership Ad Hoc Committee
BE IT RESOLVED, that the CSNS
establish membership for delegates from the Armed Forces as follows:
1. There will be 3 delegates
representing the Armed Forces to be chosen by the Joint Committee of Military
Neurosurgeons by whatever method they choose. Alternate delegates may be
selected. The delegates must be active members of the AANS or CNS. The Chairman
of the Joint Committee shall submit the names of the delegates annually to the
Recording Secretary of the CSNS.
2. The delegates shall be voting
members of the Quadrant in which they are primarily stationed. They shall vote
in all matters pertaining to both the Council and in deliberations of their own
Quadrant.
3. RESOLUTION III regarding establishing a
CSNS Military Committee was withdrawn by author
4. RESOLUTION IV—Adopted. Letter to be sent to AANS/CNS
Title: Re-Authorizing Balance Billing
Submitted by: David McKalip, M.D.
BE IT RESOLVED, that our CSNS asks
the Boards of the CNS and the AANS to continue to work via the Washington
Committee to advocate for national legislation to implement Medicare balance
billing and the restructuring of the current Medicare Physician Payment formula;
and
BE IT FURTHER RESOLVED, that this national
legislation be designed to pre-empt state laws that prohibit balance billing and
prohibit inappropriate inclusion of balance billing bans in insurance-physician
contracts.
5. RESOLUTION V—Rejected as not
reasonably attainable
Title: Ending the Global Period and the RBRVS
System for Medicare
Submitted by: David McKalip, M.D.
BE IT RESOLVED, that our CSNS asks
the Board of our AANS and CNS to take all necessary action within its means to
end the global period for surgery in Medicare and work with allies within and
outside organized medicine to do so; and
BE IT FURTHER RESOLVED, that our
CSNS asks the Board of our AANS and CNS to take all necessary action within its
means to and end the RBRVS payment system and to return free market principles
to the health care economy; and
BE IT FURTHER RESOLVED, that our
CSNS asks the Board of the AANS and CNS to direct its delegates to the AMA and
all other representatives of the AANS and CNS to various groups in the private
and public sector to support such action.
6.
RESOLUTION VI—Referred to Communication and Education Committee
for study
Title: Neurosurgery Employment and Contracting
Educational Campaign
Submitted by: David McKalip, M.D.
BE IT RESOLVED, that our CSNS
develop an educational campaign designed to ensure that neurosurgeons are able
to form contractual relationships that provide them the most benefit to their
practice; and
BE IT FURTHER RESOLVED, that our
CSNS work with partners, such as the AANS, CNS and state neurosurgical
societies, and consultants to enable them to develop such a campaign; and
BE IT FURTHER RESOLVED, that the
campaign emphasize clinical autonomy for the benefit of patients and the best
possible economic value for neurosurgeons.
7. RESOLUTION VII—Referred to
Reimbursement Committee for study
Title: Opposition to Med PAC Bundled Payment
Proposal
Submitted by: Illinois State
Neurosurgical Society
BE IT RESOLVED, that the CSNS ask
the AANS Board of Directors and the CNS Executive Committee to instruct the Washington Committee to
vigorously oppose this idea of bundled payments to be shared between physicians
and hospitals. The Washington Committee
should actively use its influence at Med PAC, AMA, ACS, CMS and Congress to
oppose this idea.
Now for a few of the reports/events
of interest:
1.
The Neurosurgery
Executives’ Resource Value and Education Society (NERVES) reported they
now have over 200 members, adding 88 this last year and held their 7th
meeting during which they reported on their 4th annual survey which
documents just how hard their members work, how they are paid and how much,
their specific overhead costs and the range of costs of providing an RVU. Their report can be obtained by
non-NERVES members at a cost of $1000 (nervesadmin.com).
2.
The ACS report by
Dom Esposito included an update on the acute care surgeon concept being
considered for implementation by the general surgeons who continue to
experience trouble reaching a consensus on the issue. The amount of additional training in
orthopedics and neurosurgery that would be necessary for acute care surgeons to
operate as they propose has been a discouraging eye opener for them. Dr. Esposito along with Drs. Shelly
Timmons maintain a strong CSNS neurosurgical monitoring presence at the ACS on
this issue.
3.
The Workforce
Committee reported that in the near future, neurosurgery training programs will
take control of the PGY1 (internship) year as part of their residency training
program. The neurosurgical
residency match will include this year which will be filled with rotations each
program director deems best for the resident rather than rotations that satisfy
the manpower needs of the various other specialties.
4.
The Determination of Brain Death in Adults and
Children report is still a work in progress by Katherine Mazzola and her
CSNS Young Physicians/Resident Committee.
She reports there is no national or real state mandated standards and
that most protocols are generated by hospitals, many using a protocol published
by the neurologists some years ago.
She feels the neurology protocol could be improved and will invite
neurologists, pediatricians and transplant surgeons to work on a new document
that could function as a national resource.
5.
Dr. Peter Carmel,
the only neurosurgical AMA trustee (and recipient of the 2008 AANS
Distinguished Service Award) reports that neurosurgeons are viewed by others as
the biggest problem in the delivery of ED services. He encouraged organized neurosurgery to
develop a solution before outside forces do it for us. He felt that regionalization of acute
neurosurgical care would be the best and most immediate solution to the
mismatch of ED numbers (4K), trauma centers (1.5K) to neurosurgeons (<3K). He also reported that the Baucus
suggestion of increasing primary care payments at the expense of specialty
payments has probably been stifled.
6.
The CSNS
Reimbursement Committee, which works hand in glove with the AANS/CNS Coding and
Reimbursement Committee, has been sorting out the codes for stereotaxic
radiosurgery and has sent to CMS a set of sensible codes that allow treatment
of up to 5 lesions at one setting in the brain and spine plus a separate code
for placement of head holder. If
accepted, the codes will go into effect 1/1/09.
7.
The Washington Committee reported that the Institute of Medicine
is actively considering making a recommendation to reduce the resident work
week hours to 56 from the current 80.
They anticipate that the ACGME will follow their recommendations so if
the 56 hour week is mandated by the ACGME, neurosurgery will strongly consider
resigning as a member of the National Board of Medical Specialties and the
ACGME it embraces. The Committee
also will work toward getting CMS to moderate its position on not paying for
“never” events such as a complicating wound infection since the
incidence of the latter is never zero even under the best of protocols.
8.
The Quality
Improvement Workgroup of the Washington
Committee continues to feel that the costs involved in partaking in the Medicare
PQRI process will not be covered by the bonuses to be paid.
9.
The AANS/CNS Joint
Guidelines Committee continues to monitor all published or in progress
guidelines and will not approve any that don’t adhere to our
recommendations. The committee is
also starting to write a few guidelines of its own for consideration of
adoption by the AANS/CNS.
10.
The Leibrock
Lifetime Achievement Award was presented to Edwin Amyes of Los Angeles for his herculean efforts on
behalf of neurosurgery in the 1960s and 70s. Ed was a long term co-chairman of the
Joint Section on Socio-Economics of the AANS/CNS, a recipient of the CNS
Distinguished Service Award and was a driving force behind the formation of our
grass roots organization, the Council of State Neurosurgical Societies, and
served as its first chairman from 1977 to 1980.
11.
The CSNS Robert
Florin Young Neurosurgeon Award was won by Zachary Litvak from the University
of Oregon who presented a study of what neurosurgeons in tort stressed states
actually did following completing a CSNS survey in 2004 in which 30% said they
would retire early, 19% said they would leave the state and over 40% said they
would limit their practices. They
noted that about 30% did retire but instead of an exodus of neurosurgeons there
was a net increase in the state neurosurgical numbers in many states that were
stressed in 2004 and remained so in 2007 which they felt was due to
neurosurgeons filling the void created by those who limited their practices or
retired. Of note
was that the paper was part of the prime Monday morning AANS Plenary Session
program and not relegated to the Socioeconomic program on Thursday (at which
the CSNS Cone Pevehouse Resident Award paper by Shearwood McClelland from the
University of Minnesota on Postoperative Intracranial Infection Rates in North
America Versus Europe was presented).
Jon Robertson, AANS President, gave an address about
ethics in our dealings with the medical device community. The AANS has had a very strict policy in
place since 2004 governing their relationship with industry sponsors and our
educational programs which should withstand major scrutiny. A recent set of guidelines governing the
ethics of relations between the practicing neurosurgeon and medical device
companies has been adopted by the Board of Directors and is now on the AANS Web
site (aans.org; About AANS; Governance and Leadership).
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
