AANS Neurosurgeon | Volume 26, Number 2, 2017

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Council of State Neurosurgical Societies: Evolving and Maintaining Relevance

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The Council of State Neurosurgical Societies (CSNS) is the designated neurosurgical organization focused on socioeconomic issues, socioeconomic effects on neurosurgical practice and access of patients to neurosurgical care. It is a joint committee parented by the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS). Since its inception 40 years ago, the CSNS has continually evolved to maintain relevance and meet this charge. The work output of the CSNS is enormous, and several highlights include:

  • Development and delivery of innovative and important socioeconomic education during both the AANS and CNS annual meetings;
  • Creation of numerous white papers on key topics such as narrow networks, neurotrauma regionalization, Closed Neuro-ICUs and Quality Improvement initiatives;
  • Major contributions to Washington Committee programs and projects;
  • Significant player in the Rapid Response efforts related to insurance denials of neurosurgical procedures; and
  • Establishment of organized neurosurgery’s only Patient Safety Committee.

Figure 1

Along the way, the CSNS has impactbeyond the policy realm through the development of a large number of leaders who have had significant influence on all of organized neurosurgery through the AANS, CNS, Society of Neurological Surgeons (SNS) and the American Board of Neurological Surgery (ABNS) (See Figure 1).

The Mission Statement for the Council of State Neurosurgical Societies is as follows:
The CSNS is a representative, deliberative and collaborative organization of delegate neurosurgeons in training and practice that exists to:

  1. 1. Positively influence and affect the socioeconomic policy of organized Neurosurgery for the benefit of Neurosurgical patients and our profession,

  2. 2. Serve as a resource for socioeconomic knowledge and education for our Neurosurgical colleagues, regulatory and health care officials as well as legislative representatives,

  3. 3. Provide a conduit for new initiatives, concerns and issues to be brought to the AANS and CNS for response and action, and

  4. 4. Provide an environment for developing future leaders in healthcare policy and advocacy for Neurosurgery.


We believe that the specialty of Neurosurgery stands for the highest quality of care and that neurosurgeons are their patients’ strongest advocates (2).”

There is much to know about the CSNS. Important resources about it, its history and function can be found on the CSNS website at https://csnsonline.org. The content includes pages on the history of the CSNS, committee structure and function, current and past activities, awards, resident socioeconomic fellows, medical student fellowships and more. Another source is a recently published paper in Neurosurgery (5).

A critical event in the life of the CSNS enabling it to remain vital and effective occurred during the years 2005–2009: a comprehensive re-design. The “new” CSNS had increased capacity to have significant positive influence on neurosurgical practice and patient access today and into the future. The project involved a strategic planning retreat with a committee of 50 individuals equipped with a knowledge of CSNS history, purpose, challenges and opportunities. They locked themselves in a room for two days to get the job done. The result of this effort was brought forward to the CSNS body, and members engaged in spirited debate to craft a new and invigorated organization. The culmination of the committee’s work and the CSNS body’s actions is memorialized and available on the CSNS website as both a power-point presentation and a white paper (Mark E. Linskey, MD, FAANS). These papers provide the names of the numerous committee members who worked to bring the product to fruition and who deserve considerable thanks from all neurosurgeons (2,3).   

Strategic Planning Committee Members & Attendees – 3/24/2007 
Attendees (n=16+4) (8)
Deborah L. Benzil, MD, FAANS; William E. Bingaman Jr., MD, FAANS; Gary M. Bloomgarden, MD, FAANS; Frederick A. Boop, MD, FAANS; Fernando G. Diaz, MD, PhD, FAANS; Jeffrey W. Cozzens, MD, FAANS; Thomas L. Francavilla, MD, FAANS; R. Patrick Jacob, MD; Mark E. Linskey, MD, FAANS; Mick J. Perez-Cruet, MD, FAANS; Michael Patrick Steinmetz, MD, FAANS; Edward von der Schmidt III, DVM, MD, FAANS; Kevin A. Walter, MD, FAANS; Monica C. Wehby, MD, FAANS; Richard N. Wohns, MD, JD, MBA, FAANS; Edie Zussman, MD; Katie O. Orrico, JD; A. John Popp, MD, FAANS(L); Melany Thomas

Strategic Planning Committee Members & Attendees – 7/28/2007
Attendees (n=17+4) (8)
Deborah L. Benzil, MD, FAANS; William E. Bingaman Jr., MD, FAANS; Gary M. Bloomgarden, MD, FAANS; Joseph S. Cheng, MD, MS, FAANS; Fernando G. Diaz, MD, PhD, FAANS; Domenic P. Esposito, MD, FAANS; Satish Krishnamurthy, MD, FAANS; Mark E. Linskey, MD, FAANS; Catherine Anne Mazzola, MD, FAANS; Mick J. Perez-Cruet, MD, FAANS; J. Adair Prall, MD, FAANS; Gregory J. Pryzbylski, MD, FAANS; Randall W. Smith, MD, FAANS(L); Alan M. Scarrow, MD, JD, FAANS; Michael Patrick Steinmetz, MD, FAANS; Ann R. Stroink, MD, FAANS; Edward von der Schmidt III, DVM, MD, FAANS; James R. Bean, MD, FAANS; A. John Popp, MD, FAANS(L); Margaret Popp; Melany Thomas

The re-design project seems to have arisen from the observations of Fernando G. Diaz, MD, PhD, FAANS, CSNS chair 2005-2007. He noted some concerns in his chair comments to the plenary session. The minutes of the Oct. 7, 2005, plenary session reflect:

Delegate and Appointee Participation – Dr. Diaz requested greater participation of the delegates. It has been noted that there has been a gradual decrease in the attendance and commitment of delegates and appointees. It was noted that there are a great number of issues, including reimbursement, coding, and education that need full support (1).”

Apparently, his comments struck a nerve with the Executive Committee as the appointment of the Strategic Planning Committee materialized shortly after, under the leadership of Gary M. Bloomgarden, MD, FAANS, who served as chair of the CSNS after Dr. Diaz.

The Strategic Planning Committee process was driven by A. John Popp, MD, FAANS(L), and James R. Bean, MD, FAANS. Dr. Popp had experience as a past president of the AANS (2003-2004), and Dr. Bean was a past CSNS chair (1997-1999) and was incoming president of the AANS (2008-2009). Dr. Bean had been a critical contributor of the CSNS conversion to a delegate representative assembly in 1995 (6,7). Drs. Popp and Bean highlighted the fact that the CSNS had a history of complaining about issues like going to “the wailing wall,” disorganization with work failing to carry through to next phases, unrealistic expectations of what could be done, poor resolutions and a lack of understanding of the CSNS sphere of influence.

The committee got the message and decided to pursue significant opportunities for improvement in the CSNS. R. Patrick Jacob, MD, presented the need for improvement in the Resolution process, Deborah L. Benzil, MD, FAANS, presented the need and vision for the CSNS to lead the socioeconomic education mission and Drs. Diaz and Linskey laid the groundwork for committee structure, purpose and work product (8). The overall impact of the changes addressed CSNS inefficiencies and converted it into an organization with a 12 month work cycle, accountability of committee function, an effective resolution process and a more professional approach to engagement with the parent bodies and other associated agencies.

As CSNS leadership keeps a finger on the pulse of the organization’s place in organized neurosurgery, the 2005-2009 redesign is an example of evolving with the times to stay current, vital, engaged and effective. Because of CSNS’ structure and dedicated leadership, as well as the respect the organization has earned, the CSNS may well be the most direct place to bring issues and actions for the betterment of neurosurgical practice. 

References
1. https://csnsonline.org/meeting_documents.php?document_id=22 – accessed May 23, 2017.

2. https://csnsonline.org/index.php – accessed May 24, 2017.

3. https://csnsonline.org/meeting_documents.php?document_id=293 – accessed May 23, 2017.

4. https://csnsonline.org/meeting_documents.php?document_id=240 – accessed May 23, 2017.

5. Zaidi, H. A., Tumialan, L. M., Rosenow, J. M., Colen, C. B., Stroink, A. R., Linskey, M.,…& Watridge, C. B. (2017). A History of the Council of State Neurosurgical Societies. Neurosurgery, 80(1), 146-157. 

6. https://csnsonline.org/meeting_documents.php?document_id=138 – accessed May 24, 2017.

7. https://csnsonline.org/resolutions.php?id=58 – accessed May 24, 2017.

8. https://csnsonline.org/meeting_documents.php?flv_id=57 – accessed May 24, 2017.

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