Fall 2012 www.csnsonline.org Prepared by Hooman Azmi MD, Julie Pilitsis MD,PhD
CSNS mission: to provide a national forum for the State Neurosurgical Societies of the United States, for the discussion, consideration, and proposals of action regarding socioeconomic issues concerning Neurological Surgery.
Passed Fall 2012 Resolutions Re: Healthcare economics RES II: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT: The Washington Committee will report salient features of the PPACA which effect neurosurgeons RES XII: UNDERSTANDING COST EFFECTIVENESS IN NEUROSURGERY: This resolution seeks insight into and education on the cost effectiveness discourse in neurosurgery. RES IX: MA HEALTH CARE LAW 2.0 IMPACT ON NEUROSURGICAL CARE: This resolution calls for an evaluation of a new Massachusetts Law that will tie restriction of health care costs to the Gross State Product.
Passed Fall 2012 Resolutions Re: Outcomes RES VII: NEUROSURGERY STRUCTURAL HEAD INJURY IN SPORTS REGISTRY: The call for the establishment of a registry for such patients will be evaluated by appropriate CSNS committees. RES X: ADMINISTRATIVE METRICS IN NEUROSURGICAL PATIENT OUTCOMES: This resolution calls for an evaluation of metrics employed by health care systems and the government to measure outcomes and quality of care. RES XI: UNDERSTANDING COVERAGE OF NEUROLOGIC EMERGENCIES: This resolution, referred to committee, seeks to look at emergency neurosurgery coverage issues-particularly the role and involvement of non- academic and community neurosurgeons in its delivery
Passed Fall 2012 Resolutions: re: CSNS RESI: FORMATION OF A CSNS PUBLIC RELATIONS COMMITTEE: for better integration of PR efforts in related Neurosurgical organizations, including the AANS, CNS, and Washington Committee. RES VITI: THE RANDALL W. SMITH AWARD FOR MERITORIOUS SERVICE TO CSNS: This resolution recognizes the life-long contributions to the CSNS first of Dr. Smith, and then those of other highly dedicated members.
2012 Meeting Highlights: Doctor Envy: The Curious Co-Evolution of Medical and Legal Education Mr. Gregory Mark, Dean of Depaul University College of Law Accountable Care Organization, How ACOs Change Neurosurgical Practice Patrick Elwood, MD. Prof Emeritus of Neurological Surgery, University of Illinois, Peoria; CEO OSF Neuroscience clinical service line
2012 Meeting Highlights: Geisingers Approach to Sustainable Facility Operations Robert Davies, CSO Geisinger Health System Green and Lean Healthcare Architecture Robert Pratt, CEO Pratt Design Studio
2012 Meeting Highlights: First Randall Smith Distinguished Service Award Recipient Dr. Randall Smith, Presented by Dr. Benzil and Kusske
Coding and Reimbursement: Ed Vates MD BAD NEWS: as much as an 85% decrease in Medicare reimbursements over the next few years could take place. CPT code 63047 (lumbar laminectomy) will get re-evaluated and a negative re-evaluation may have an impact on other spine codes GOOD NEWS: Several CPT codes were deferred in revaluation thus maintaining their current valuation because of efforts of members of the CSNS Dr. Joe Cheng and his rapid response team were successfully in protecting the approval and valuation of multiple neurosurgical procedures.
Social Media to expand our mission Health reform Neurosurgery Blog: More Than Just Brain Surgery (www.neurosurgeryblog.org) Neurosurgerys Twitter Feed: @Neurosurgery (https://twitter.com/neurosurgery) Neurosurgerys Facebook Page (http://bit.Iy/NeuroFacebook) Neurosurgerys LinkedIn Group (http://bit.Iy/NeuroLinkedIn)
CSNS and Education Despite the identified need for more socioeconomic and medicolegal courses, attendance of these courses at the CNS and AANS has left room for improvement. To address this, CSNS has designed specialty specific courses and has offered it directly at the specialty sections: Vascular and Spine and Peripheral Nerve. CSNS is planning courses for the Pediatric, Tumor and Functional sections.
Washington Committee Highlights: Alex Valadka, MD and Katie Orrico Patient Protection and Affordability HealthCare Act Upheld by Supreme Court on 6/28/2012, expansion of Medicaid coverage by states was struck down. ACA Medical Device Tax HR436 passed by House repealing the medical device tax, bill has moved to the Senate. SGR Neurosurgeons face a 27% cut in reimbursement. Several alternatives fixes to the SGR pit specialists versus primary care providers for an ever decreasing pot of funds. PQRS 0.5% bonus pay to participants in 2012-2014. Under PPACA bonus will be phased out and a progressive 2% penalty will be assessed for 2016 and beyond.
Washington Committee Highlights: Alex Valadka, MD and Katie Orrico Electronic Health Records Beginning in 2015 non users of EHRs will begin facing penalties. Up to 5% in later years. CMS proposed rule Overall neurosurgical reimbursement is expected to drop by 1%, as PCP payments are increased for care coordination. CPT coding issues Code 37201 non coronary thrombolysis code used by endovascular neurosurgeons for stroke was eliminated by bundling with a renal angio code and the neurosurgical use was overlooked. For 2013 an unlisted code will be used. Dr. Henry Woo has drafted a proposal change submitted to CPT.
Washington Committee Highlights: Dr. Alex Valadka and Katie Orrico Graduate Medical Education Congress asked IOM to aid in modification of the GME to produce the 21 st century physician workforce. CRNAs and pain management AANS and CNS opposed a new proposal allowing CRNAs to provide chronic pain management services without the supervision of a physician. Emergency Medical Services and other Appropriations Trauma EMS was provided no funding in Congressional appropriations for FY 2013. CDC saw an increase of $55 million
Member Activities: Resident fellows 13 fellows were selected from 47 well qualified applicants. Applications for the fellowships are available at csnsonline.org. Douglas Brinkley in the Big Easy Douglas Brinkley a noted author and historian will be the Luncheon Speaker for the Spring 2013 meeting. Medical Student Handbook for Neurosurgery An online tool now available to medical students on the CSNS website for forming and maintaining neurosurgical interest groups in medical schools.
Updates on Prior Resolutions: Resolution X-11F Hospital Employment Survey of 221 hospital employed neurosurgeons by Colen et al detailed in the Fall 2012 newsletter Resolution VI-2012S Burning the Candle at both ends Klimo et al examining burnout in neurosurgeons with pilot survey being shortened and prepared for national distribution. Resolution I-10F meeting duration Based on Jenkins et al, CSNS has a later starting time to allow for travel.
Update on the Resolutions: Resolution III 20102S Regarding the stewardship of the CSNS resolutions is being incorporated into the SOP committee. Resolution X 2012S Being incorporated into a larger project regarding the effect of closed ICUs on neurosurgical residency training. Letters sent to AANS/CNS For Resolution I 2012S (importance of patient comprehension of online spinal cord injury education material). For Resolution XIII 2012S (impact of global cost of spine care). For Resolution XIV 2012S (promoting international health opportunities in neurosurgery). For Resolution XVIII 2012S (response to intraoperative monitoring guidelines from the American Society of Neurophysiological Monitoring). Resolution IX 2012S (improve recognition of and participation in the N2QOD project).
Leibrock State Leadership Award The state with the highest total contributions and percentage of donations to the Neurosurgery Political Action Committee will win the annual Leibrock State Leadership award. https://www.aans.org/Legislative%20Activities/NeurosurgeryPAC.aspx Or call the Washington Office at 202-628-2072