CSNS UpdateFall 2012

www.csnsonline.orgPrepared 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 ResolutionsRe: 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 ResolutionsRe: 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 ACO’s Change Neurosurgical Practice” Patrick Elwood, MD. Prof Emeritus of Neurological Surgery,

University of Illinois, Peoria; CEO OSF Neuroscience clinical service line

2012 Meeting Highlights:“Geisinger’s 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 AwardRecipient 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 missionHealth reform Neurosurgery Blog: More Than Just Brain

Surgery – (www.neurosurgeryblog.org) Neurosurgery’s Twitter Feed: @Neurosurgery –

(https://twitter.com/neurosurgery) Neurosurgery’s Facebook Page –

(http://bit.Iy/NeuroFacebook) Neurosurgery’s 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 RecordsBeginning in 2015 non users of EHRs will begin facing

penalties. “Up to 5% in later years.”

CMS proposed ruleOverall neurosurgical reimbursement is expected to drop by

1%, as PCP payments are increased for care coordination.

CPT coding issuesCode 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 EducationCongress asked IOM to aid in modification of the GME to

“produce the 21st century physician workforce.”

CRNAs and pain managementAANS 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 AppropriationsTrauma 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 EasyDouglas Brinkley a noted author and historian will be

the Luncheon Speaker for the Spring 2013 meeting.

Medical Student Handbook for NeurosurgeryAn 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).

Upcoming Meetings

Leibrock State Leadership AwardThe 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.aspxOr call the Washington Office at 202-628-2072