Council of State Neurosurgical Societies (CSNS)
Of the American Association of Neurological Surgeons
And
Congress of Neurological Surgeons
Washington, DC
April 13-14, 2007

The CSNS office staff again did a fantastic job with the organization and arrangements for the 2007 spring meeting. Ms. Melany J. Thomas and her staff were wonderful. With fifteen resolutions submitted through the online abstract center and via email, there was a significant amount of planning that went into the preparation for this meeting. Despite the large number of resolutions, the presentation and debate of the resolutions and their proposed amendments went smoothly. Special gratitude was given to Medtronic Sofamor Danek for its’ continued support of the education of the resident delegates.

The current organizational chart of the Council of State Neurosurgical Societies as of March 2007 was included in the registration packet of all attendees. The list of State Officers, Delegates and Alternates is also available online at www.csnsonline.org.

CNS Appointees Meeting

The CNS Appointees meeting was conducted by its' Chair, Dr. Kevin Walter. There were several neurosurgeons from across the country in attendance. Dr. Walter discussed the topics of importance at the recent strategic planning meeting. The CNS executive committee would support the CSNS in the implementation and execution of its' own resolutions. The CSNS as the socioeconomic body of the CNS and AANS has the ability to form task forces and ad-hoc committees to carry out research and other projects generated by the bi-annual resolutions, once accepted. Although the CSNS cannot execute its own guidelines without the approval of CNS-AANS, the CSNS does have the authority to assign the project to teams of neurosurgeons for the purpose of resolution action.

Communications & Education Committee Meeting

Communications & Education Committee meeting was chaired by Dr. Satish Krishnamurthy, who did an excellent job organizing the committee. Discussed were such topics as: CME credits, website updates, award presentations, SANS MOC questions, and 2007 CNS socioeconomic sessions plans.

• CME Credits: Dr. Krishnamurthy is attempting to obtain the necessary documentation for CME credits for the Washington Committee report, Quality Improvement Workgroup (QIW) report and RUC report for the next CSNS meeting in the fall of 2007. To this end, there was a survey submitted to all CSNS attendees with questions inre the number of sessions attended and the attributed educational value.
• www.CSNSonlline.org: Quarterly updates are available at www.csnsonline.org: Dr. Krishnamurthy spoke about the quarterly updates on the www.csnsonline.org website. These updates provide a quick and easy way to preview the upcoming meeting or review the most recent CSNS meeting. Dr. Michael Steinmetz spoke about sending an e-blast type summary out to all AANS/ CNS members with the CSNS meeting summary. The resident section of the website is up and running. Alan Scarrow, MD has been working to put together the Wikipedia format "white paper" about the business of neurosurgery: how are groups formed, contracts negotiated, and how do you look for/ hire a partner. These are just some of the planned topics for discussion in this section of the website. There was a consensus that this apge of the website should be password protected. A few people have been selected to test password protection of the website.
• Cone Pevehouse Award Presentation: was given to John A. Cowan, Jr., MD et al for the paper "Who is Getting Spinal Fusions?"
• Robert Florin Award Presentation: was given to John P. Miller, MD et al for "Improving Resident Work Hour Compliance through a Novel Computerized Patient Information Management System".
• SANS-MOC Socioeconomic Questions: 12 questions were submitted directly through the CEC.
• CNS 2007 San Diego Meeting Plans: Sunday's practical course topics were discussed. Monday afternoon there will be presentation of abstracts. This year there were 32 abstracts submitted to the socioeconomic section. Tuesday there will be a mini-symposium with topic presentation about quality and outcomes in neurosurgery. Paul Curtain, MD who is from the San Diego area will speak on these topics. Coding talks and Guidelines discussions may be included in the Sunday practical course. The implementation of telemedicine and how telemedicine applies to the practice of neurosurgery may be included in the program on Sunday.
• CSNS Socioeconomic Journal articles: Articles can now be submitted online. Deborah Benzil, MD is the editor. Anyone interested in becoming a reviewer for the journal may contact Dr. Benzil.
• Improved awareness of the actions and accomplishments of the CSNS: At a recent strategic planning retreat of the CSNS, there was a strong effort to define the CSNS as an independent group within and under the authority of AANS-CNS. As the socioeconomic body of both organizations, the CSNS provides neurosurgeons a remarkable opportunity to submit ideas as resolutions for presentation at a national meeting of CNS-AANS and state appointed neurosurgeons. Resolutions, if passed, can be acted upon by the CSNS, AANS or CNS, if they agree to do so. Through their respective executive committees, the AANS and CNS can support or reject a proposal, or send the resolution back to CSNS with questions etc. To a certain extent, the CSNS can carry out tasks through its' own committees and form taskforces to investigate proposals or ideas. The CSNS through it's own website and socioeconomic sessions can enact various programs with the permission of the CNS-AANS.
• Resolutions: There were eight resolutions assigned for discussion at the CEC meeting.

Executive Committee Meeting

The Executive Committee Meeting was chaired by Dr. Fernando Diaz.

New Delegates, Alternate Delegates, Guests & New Residents

This informational conference was organize and directed by Dr. P. Robert Schwetschenau, the Historian for the CSNS. An introduction of the organization and history of the CSNS was presented. 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: csnsonline.org.

Young Physicians Committee

Young Physicians Committee of the CSNS is the committee focused on addressing the interests and issues involved in neurosurgeons in-training and recently in practice. YPC is concerned with issues involving residency training, the 80 hour work week, residency rotations, and boards certification. YPC is also involved in maintenance of certification and the factors involved in career development and job procurement. Dr. Josh Rosenow, the Chair of YPC, discussed the planned CSNS Fellowship Meeting for later that evening. The planned creation of a CSNS Fellowship would also interested residents to continue and develop their interest in organized neurosurgery, especially in the socioeconomic section. There were several resolutions discussed at YPC including resolutions I, II, IV, V, VII, X, XI, XII, XIII, XIV, and XV.

Neurotrauma Committee

The Neurotrauma Committee was chaired by Dr. Dom Esposito.

Reimbursement Committee

The Reimbursement Committee was chaired by Dr. Greg Przybylski.

Workforce Committee

The Workforce Committee was chaired by Dr. Deborah Benzil. Minutes from the fall 2006 CNS-CSNS meeting as submitted were approved. Resolutions I, II, IV, V, XI, XII, and XIII were discussed. Changes in Workforce Committee leadership were discussed since Dr. Benzil will be taking on a more active role in CSNS Executive Committee. Workforce Committee was instrumental in the writing of Resolution IV that recommended a thorough re-evaluation of residency training to meet the criteria and challenges of the ever-changing workforce and socioeconomic environment. Workforce was also primarily responsible for Resolution V that requested an evaluation and assessment of the websites which refer patients to physicians based on various search criteria.

Medical-Legal

Medical Legal Committee was chaired by Dr. Alan Scarrow.

Medical Practices

Medical Practices was chaired by Dr. Mark Linskey.

CSNS Chairperson Report

The CSNS Chairman, Dr. Fernando Diaz, spoke about the nomination and election process for officers. He commended Dr. Benzil for her dedicated efforts with the Bulletin, the socioeconomic journal of CSNS. Dr. Diaz also discussed the focus of the strategic planning meeting.

CSNS Vice-Chair Report

Dr. Gary Bloomgarden, the CSNS Vice-Chairperson, spoke about the NERVES annual report. Dr. Bloomgarden also invited participation in the upcoming Lyle Leibrock Leadership Development conference. The Vice-Chair spoke about the importance of participation in and support of the Neurosurgery PAC.

CSNS Recording Secretary's Report

Dr. Monica Wehby gave the Recording Secretary Report. Minutes from the 2006 meeting are available on the www.csnsonline.org website. Minutes were accepted as submitted.

CSNS Treasurer's Report

Dr. William E. Bingaman, Jr. was the CSNS Treasurer. The CSNS Treasurer's report was included in the registration packet.

NERVES Report

Ms. Barbara Hurlbert gave a brief summary about the data collected from the 253 members of NERVES. 130 members attended the annual conference. The 253 members represented 343 physicans and 130 non-physician providers of neurosurgical service. Their website is www.nervesadmin.com. Please encourage your office managers and support staff to join NERVES. Data will be presented at the Thursday socioeconomic session of the AANS meeting. National practice data is available to the members of NERVES. Online chat rooms and email support are available to all members of NERVES. Billing advice, questions and support are offered to all participants.

Resolution Testimony -- Reference Committee Hearings

• Resolution I: Gary Simonds, MD gave passionate testimony about the neurosurgical coverage crisis in his area. He felt that too many neurosurgeons were opting out of covering emergency rooms. Since board certified neurosurgeons are credentialed to perform all aspects of neurosurgery by the ABNS, he believed that all board certified neurosurgeons should be able then to provide ER coverage for basic neurosurgery trauma, and other neurosurgery emergencies. However, some neurosurgeons felt that it is their right to select what "type" of neurosurgery they practice. Some "spine" neurosurgeons felt uncomfortable covering head trauma, shunt emergencies, aneurysms / hemorrhage, and pediatric neurosurgery.

• Resolution II: Gary Simonds, MD recommended that negative discussion centering around resident training with the 80 hour work week restrictions should be limited. There was some debate as to the significance of such a resolution.

• Resolution III: Gregory Bennett, MD wrote Res. III to resolve that the AANS Professional Conduct Committee forward all disciplinary actions inre neurosurgeons to their respective state boards of professional conduct.

• Resolution IV: Workforce Committee wrote Res. IV to recommend the complete re-evaluation of residency training. The ever-changing demands of the neurosurgery workforce should be reflected by changes in residency training. Their suggestion was to involve residents, young neurosurgeons in private and academic practice in the development and assessment of neurosurgery residencies. The discussion centered around changes already in progress through AANS-CNS and Senior Society.

• Resolution V: Also written by members of the Workforce Committee, requested the evaluation and investigation of those websites selling information about neurosurgeons to prospective patients. Websites such as www.HealthGrades.com, www.webmd.com and others sell practice profiles to patients about neurosurgeons in their geographic area, usually for a nominal fee. However, often the information is incorrect, and therefore may interefere with the neurosurgeons ability to practice.

• Resolution VI: At issue was the right of neurosurgeons to become involved in collective bargaining. Anti-trust immunity will be proposed later in 2007. Debate followed since the AMA is already taking a stand on this issue.

• Resolution VII: Donald Prolo, MD from CA recommended that the AANS and CNS educate people on the pro's and con's of the Pay-for-Performance initiatives.

• Resolution VIII: Catherine Mazzola, MD wrote Res. VIII to suggest the creation of AANS-CNS Guidelines for the Pronouncement of Brain Death. Dr. Mazzola pointed out that there are often different state and regional criteria for the pronouncement of brain death, and there are different hospital forms and guidelines as well. These differences often create unnecessary confusion. With the advent of MR and CT angiograms, there is no consensus as to the validity of these studies as "confirmatory" tests.

• Resolution IX: Written by Jeffrey Cozzens, MD to support the education of those neurosurgeons found guilty of unprofessional conduct via mandatory CME accredited ethics courses. Neurosurgeons receiving sanctions of membership suspension for unprofessional conduct should be required to take 2 hours or 2 AMA Category 1 CME credits of ethics training.

• Resolution X: David McKalip, MD wrote a resolution recommending the termination of support for PFP and public reporting programs.

• Resolution XI: Dr. Mc Kalip also wrote Res. XI asking for CSNS and state societies to recommend non-participation in Physician Quality Reporting Initiative (PQRI).

• Resolution XII: David Mc Kalip, MD also wrote Res. XII which suggested the creation of a private, neurosurgical outcomes database.

• Resolution XIII: CSNS Medical Practices wrote this resolution, to recommend description and certification of neurosurgical critical care for neurosurgeons. Their feeling was that critical care privileges are unfairly, often being taken away from neurosurgeons.

• Resolution XIV: CSNS Medical Practices wrote Res. XIV to recommend that the AANS and CNS consider state CME requirements when forming the scientific programs at the yearly meetings.

• Resolution XV: CSNS Medical Practics wrote Res. XV which advocated the standardization of DICOMM image distribution.

Reference Committee Meeting

The Reference Committee was again directed by Dr. Gary M. Bloomgarden. The committee members at this meeting were: Drs. Cheng, Stroink, Hassenbusch, Jenkins, Vates, and an AANS appointee.

Northeast Quadrant Meeting

The Northeast Quadrant meeting was held under the direction of Dr. Ed Von Der Schmidt

Southeast Quadrant Meeting

The Southeast Quadrant meeting was directed by Dr. Thomas Francavilla.

Northwest Quadrant Meeting

The Northwest Quadrant meeting was held under the direction of Dr. Richard N. Wohns.

Southwest Quadrant Meeting

The Southwest Quadrant meeting was held under direction of Dr. Thomas Hoyt.

CSNS Reception

CSNS Fellowship Meeting

At the CSNS Fellowship meeting, directed by Dr. Bill Bingaman, plans to introduce CSNS Fellowships were discussed. Currently, there are 3 resident delegates from each quadrant. The possibility of increasing the appointment to two years was discussed, with one year supported by CSNS and one year supported by the respective residency program. Fellows could be solicited via e-blast to the various states, delegates, or perhaps directly to the residents, through AANS. There would be a fellowship committee for the oversight of mentorships, program requirements, evaluations and funding. This committee should be comprised of representatives from Young Physicians, and Committee for Communication and Education.

AANS Caucus Meeting

CNS Caucus Meeting

Quadrant Caucus Meetings

Nominating Committee Report

AANS President Report

Dr. Quest spoke about the AANS Workforce Taskforce and the Professional Conduct Committee work. The AANS is very interested in developing outcomes databases and registries. The AANS is very proud to be celebrating its’ 75^th year Diamond Jubilee. Dr. Quest also mentioned the AANS Summer Medical Student Fellowships available. The medical student summer scholarships provide stipends of $2500 for summer research.

CNS President Report

Dr. Doug Kondziolka spoke about the recent "think tank" with 30 neurosurgeons each with over 20 years experience in the CNS. The CNS is interested in procative changes, educational and professional development. SANS, CNS University of Neurosurgery, Neuro-wiki are current examples of the ways the CNS is actively involved in educational and career development for neurosurgeons. Current projects include the re-negotiation of the journal contract, research and development funds, member needs assessments, CSNS-SANS partnership, and core competencies development. Dr. Kondziolka thanked and mentioned Dr. Alan Scarrow for his continued dedication and hard work. Dr. Scarrow has done a tremendous job with the SANS socioeconomic questions.

Debate and Voting on Resolutions as edited by the Reference Committee

The debate and voting on the 15 resolutions submitted for consideration by the CSNS went surprisingly well. There were concise and well presented arguments made by the supporters of the various proposals. Those members concerned with respective reprocussions also spoke their minds. The FINAL resolutions as they were accepted and passed are available online at www.csnsonline.org.

Washington Committee Update

The Washington Committee provided a very detailed and comprehensive update that was published and circulated to all attendees in the registration packet. Drs. Troy Tippett and Ms. Katie Orrico gave summary updates on the current topics of interest from the Washington Committee.

Quality Improvement Workgroup Report

The Quality Improvement Workgroup report was submitted and presented by Dr. Harbaugh.

Coding & Reimbursement Committee Report

Dr. Przybylski gave a fantastic and very detailed review of important topics.

Luncheon with CNS-AANS Boards: "Politics, Power and You" as presented by Mr. Michael E. Dunn.

The lunch presentation that was done by Mr. Dunn highlighted the importance of political advocacy and involvement. Through support of the Neurosurgery PAC a direct impact on policies made in Washington, can be achieved.

CSNS Executive Committee Meeting

CSNS Website Subcommittee Meeting

The www.csnsonline.org website currently has FREE state webpages available for use. These state webpages can be used to post relevant information about the state meetings, events, and contact information. The "members only" beta site is currently being tested. Once the "members only" site has cleared initial evaluations, this part of the website will contain wikipedia -- format white papers about neurosurgery contracts, job application and evaluation, career selection and medicolegal information. The Subcommittee meeting, under the direction of Dr. Michael Steinmetz, was well organized. We discussed the current format of the website, and future directions. Currently there are CME credited presentations available online through the website. Ways that the website could pay for itself included: fee based CME credits, a "handbook" of current socioeconomic topics for studying for the socioeconomic section of the MOC/ boards. We discussed plans to solicit socioeconomic abstracts on the website.

Doctors for Medical Liability Reform (DMLR)

The DMLR 2006 Annual Report was presented to all attendees in the registration packet. The DMLR activities continue to educate the public about the need for medical liability reform. An option presented by the AMA includes : Health Courts. Health Courts are composed of judges trained in medical standards that could render more accurate decisions regarding whether medical malpractice has actually occurred and, if so, render a judgment as to the amount of monetary damages to be awarded.