Lessons Learned at the NERVES Annual Meeting
The Neurosurgery Executives’ Resource Value & Education Society (NERVES) is a vibrant organization that has evolved to support the critical work of neurosurgeons across the nation. NERVES recently held its annual meeting April 20-22, in Hollywood, Calif., that coordinated with the 2017 AANS Annual Scientific Meeting. The topics covered, the spectrum of sessions, and the networking interactions proved extremely beneficial to the 99 attendees.
The meeting kicked off with roundtable discussions, splitting the attendees into groups representing academic practice, hospital-based practice, small to medium private practice (1-10 surgeons) and large private practice (10+ surgeons). One prevalent discussion topic was the utilization of Advanced Practice Providers (APPs). There is considerable traffic on this topic on NERVES’ listserv. More and more neurosurgical practices are utilizing APPs to:
- Triage new office patients;
- See patients with the neurosurgeon or independently;
- Order diagnostic tests; and
- Perform other clinical treatments for the patients.
These help ensure patients meet conservative care criteria before scheduling for surgical treatment. They are also taking first call for the neurosurgeon for trauma and practice call. In one of the discussion groups, we were fortunate enough to hear directly from a neurosurgeon who could not conceive of meeting the demands of his practice without his APP.
In the academic session, concerns were raised about resident duty hour restrictions, which reduce the time spent in critical care and clinic rotations. The potential result is that residents achieve good surgical skills but have less exposure to evaluation of patients and judging whether patients are good surgical candidates. This potential shortcoming will impact the neurosurgeon’s ability to practice effectively and successfully participate in bundled payments and other alternative payment models.
There were 25 first-time attendees at the conference. The feedback received about the roundtable discussion indicates this is a highly successful start to the conference. It provides a casual, relaxed setting in which administrators can raise hot topics of concern in the daily running of their practices. Attendees gain a sense that they are not alone in dealing with issues and can identify people in their practice size and type to engage in further networking discussions throughout the meeting. This first contact with the members sets the tone for the whole meeting, which is designed to be a resource in this complicated health care world.
2016 NERVES Survey
NERVES was established in large part to provide neurosurgery practices the ability to measure and benchmark key practice metrics. The goal was and remains to enhance the quality of the practice of neurosurgery. To that end, we had a general session and breakout session with Mike Heaton, CPA, Katz Sapper & Miller (KSM). KSM is responsible for overseeing the independent and confidential practice data gathering, preparation and distribution of the annual NERVES socio-economic survey. During his presentation, Mr. Heaton provided key data points and insight regarding neurosurgery practice trends. Practice administrators will be able to utilize the data presented to facilitate the financial wellbeing of their practice. The 2016 NERVES survey received information from 794 full-time neurosurgeons, an increase of 15 percent from 2015. The importance of the NERVES survey is that the response rate is significantly above the Medical Group Management Association (MGMA), Sullivan Cotter and the American Medical Group Association (AMGA) surveys. The NERVES Board strongly advocates for the membership to complete the survey each year so that we can provide useful and meaningful data to neurosurgeons and neurosurgery at large. As the practice of neurosurgery changes, it is critical to continue gathering data from all practice types including private, hospital-owned and academic. The following chart from the survey indicates the shift in ownership while demonstrating that our ability to still reach all practice types has not waned:
Payment Models Update
Alternative payment models, including MACRA (MIPS/AAPM) and private and government bundling efforts, was another hot topic that was addressed by several speakers.. There was a very good comparison drawn between what Medicare is looking for in savings and what the commercial plans are focusing on doing. Medicare is trying to reduce utilization of Post Acute Care (PAC) resources and asking specialists and PCPs to prevent ED visits and readmissions. In contrast, commercial payors are trying to:
- Consolidate volume with trusted partners;
- Move volume to providers where their contract terms are more favorable;
- Ask facilities and providers to help reduce costs that are carved out (implants); and
- Motivate patients to use certain providers.
What Medicare is NOT trying to do is create winners/losers based on hospital add-on payments, push more volume between hospitals or physicians or worry about the cost structures of hospitals. What the Commercial payors are NOT trying to do is to be indifferent to where doctors take their cases. The site of service is more important to commercial payors than Medicare. (Information presented by Judy Eustace and Marian Lowe of United Surgical Partners International at the 2017 NERVES Annual Meeting.)
The meeting was rounded out with multiple general and breakout sessions focusing on marketing a practice, patient financing, utilization of RVUs in the management of the practice, a review of the neurosurgical coding changes for 2017, HIPAA and cyber protection, a Washington, D.C. update and spine and neurology trends for the future.
What trip to Hollywood would be complete without entertainment? Our keynote speaker was Dr. Zubin Damania, aka ZDoggMD. Dr. Damania provided his practice perspective on the journey to value-based medicine while his ZDoggMD alter ego mixed in his well-known entertainment for the group.
The meeting is also an opportunity to learn from exhibit vendors. We are very appreciative of the 22 vendors that supported the meeting and allowed our membership to review potential new partnership opportunities. Companies that exhibited provide solutions with everything from collections, credentialing, recruitment, coding, medical malpractice, electronic health records, expense reduction, quality registries, transcription, locums, marketing, patient intake products, electronic and secure messaging, financial resources and surgical companies, among others.
One first time attendee said,
“This meeting was extremely beneficial especially being able to talk with other administrators
that are living through the same monumental changes in health care.”
The NERVES Annual Meeting allows administrators and managers the opportunity to gather information, meet and support one another in the many endeavors that neurosurgery practice
demands of its leaders. Even though a practice in a hospital or academic setting may not have a full-time practice administrator, they still have someone within the practice or department that is charged with overseeing the practice to ensure that they are providing high quality care, developing strategies for growth of the practice and achieving efficiency and financial rewards for the neurosurgeons. Whether full-time or part-time in neurosurgery, administrators benefit greatly from NERVES membership and Annual Meeting attendance.
We encourage neurosurgeons to support their practice managers and administrators in joining NERVES, becoming involved in its governance, participating in the annual survey, contributing on the listserv and attending the meetings including next year’s in New Orleans, April 26-28, 2018.
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