Board of Directors Holds Interim Meeting

The AANS Board of Directors convened in Chicago November 19-22 for their 1997 Interim Meeting. Although the meeting focused on several substantive financial issues, a number of other key discussions took place as well. The highlights of the major actions taken are summarized here.

Finance Committee

Stewart Dunsker, MD, Treasurer and Chairman of the Finance Committee, reported that the AANS had an outstanding year financially, projecting 1997 revenues at $13.4 million against expenses of $11.99 million, leaving a net revenue of $1,425,205. He stated the revenue represented across the board improvements in all program areas, along with larger than anticipated investment revenue, resulting from the growth in value of AANS investments in mutual funds.

Dr. Dunsker recommended, and the Board approved, a proposed fund allocation for 1997 net revenues as follows:

Overall, the Association is in good financial health, with diversified sources of revenue.

It should be noted that dues represent only 13 percent of overall revenues for the AANS. This compares favorably with other medical associations, which obtain 40 percent of their revenue from dues. Development of new programs, such as the Professional Development Program (PDP) courses and publication of various textbooks, have allowed the AANS to maintain very diversified revenue sources. This not only helps the Association to bring advances in surgical techniques to members in a timely way, but also helps to fund new educational activities.

In April 1997, at the recommendation of the Finance Committee, the Board of Directors approved a change in fiscal year from a calendar year (January through December) to July 1 through June 30. This change was made for several reasons:

• Shift the annual audit from the busiest time of the year, thus reducing staff overtime and lowering the cost paid to the outside auditing firm.
• Coordinate the AANS fiscal year with that of the Congress of Neurological Surgeons, thus improving financial reporting for joint projects.

To bring the budget process into compliance with the new fiscal year, two budgets were presented to the Board for review – a six month budget covering the period January 1, 1998 through June 30, 1998 and a one-year budget covering July 1, 1998 through June 30, 1999. The Finance Committee projects modest growth for the AANS during the 18-month period covered by the two budgets and recommended a conservative plan for both revenues and expenses.

Several years ago, the AANS began the process of upgrading the Association’s computing systems. The Association’s hardware and software were at that time more than six years old and beginning to show their limitations. The AANS now stands midway through the conversion process. The hardware upgrade was principally accomplished in February and March of 1996, although an occasional small expenditure occurs, as technology continues to evolve and improve.

The software conversion is now underway and occurring in two segments: Association management software (management of the membership database) and Accounting/Finance. At the recommendation of the Finance Committee, the Board approved immediate purchase of new financial software. It is anticipated the system will be tested and ready for implementation at the beginning of the new fiscal year on July 1, 1998. A proposal for new association management software is being prepared for a decision at the beginning of 1998 and implementation by year’s end.

Nominating Committee

J. Charles Rich, Jr., MD, Immediate Past President and Chairman of the Nominating Committee, announced the recommended slate of Officers, Directors and Nominating Committee members for 1998. The Board of Directors approved the following slate of nominees, which will be presented for consideration by the voting members:

President-Elect: Martin H. Weiss, MD

Vice President: Stewart B. Dunsker, MD

Treasurer: Roberto C. Heros, MD

Directors-at-Large:

William F. Chandler, MD, Volker K.H. Sonntag, MD, Fremont P. Wirth, MD

Nominating Committee Members:

Richard A. Roski, MD, James R. Bean, MD

In accordance with the Bylaws, the foregoing slate will be mailed to the voting members in late January. If no opposing candidates are proposed, this slate will be voted on at the Annual Business Meeting on Monday, April 27, 1998 in Philadelphia, Pennsylvania. In the event opposing candidates are proposed, written ballots will be distributed as prescribed in the Bylaws.

Membership Committee

The Board of Directors approved the membership applications of 96 Active Members, 57 Candidate Members, 94 Active (Provisional) Members, and 11 Associate Members. In terms of Membership class transfer requests, the Board approved 40 transfers from Active (Provisional) Membership to Active Membership, three transfers from Lifetime to Active, one transfer from Active to Active (Foreign), one transfer from Active (Foreign) to Lifetime (Inactive), two transfers from International Associate to Lifetime (Inactive), and 52 transfers from Active to Lifetime. In addition, the Board accepted two resignations, one from Active Membership and one from Associate Membership, as the individuals are no longer working in the field of neurosurgery.

Total membership for the AANS is now 5,177. Finally, the Board received notice of the deaths of 23 members and observed a moment of silence in their honor.

ABNS

The Board reviewed the report of John C. VanGilder, MD, Chairman of the American Board of Neurological Surgery (ABNS), which described ABNS activities during the 1996-97 academic year. Some of the major issues highlighted in his report were:

• Resident Numbers — There are presently 98 neurological surgery training programs in the United States. There were 130 positions offered in the 1997 Neurological Surgery Matching Program and all positions were filled from the 240 individuals who submitted a ranking list. The number of positions offered was 10 less than 1996.
• Primary Examination — The ABNS administered the 1997 primary (written) examination on Saturday, March 22, 1997 to 567 examinees at 107 test centers. Of these examinees, 263 were candidates for certification and 304 were self-assessment examinees. The pass rate for those taking the examination for credit was 79 percent.
• Oral Examination — Seventy four candidates were examined in November, 1996 and 75 candidates were examined in May, 1997. The pass rate was 81 percent. The Board has certified 4,542 neurological surgeons since its incorporation in 1940, and approximately 3,420 are in active practice.

The ABNS Directors have been unanimously of the opinion that the oral examination should be more standardized. Yet they wish to maintain the flexibility of utilizing personal cases to further probe the candidate’s knowledge. Consequently, a new examination format has been created in which each candidate receives 18 ratings from each examiner in relation to clinical assessment, acute management and complications (long-term management) of tasks selected by the examiner. In addition, based on greater than 45 ratings throughout the examination, a statistical measurement of examiners severity is developed.

This modified grading system was used simultaneously with the standard format during the November 1995 and November 1996 examinations and the pass/fail incidence was similar with both approaches. In addition, the new grading format was tested for the May, 1997 oral examination, with a similar outcome in the pass/fail rate to previous years. The ABNS will likely adopt this new grading system to enhance standardization and add statistical weight to the pass/fail score of the oral examination.

• Time Limited Certificates and Recertification — The ABNS is considering issuing a ten-year, time-limited certificate beginning in 1998 and recertification in 2005. Recertification criteria being discussed includes a current valid medical license, verification of satisfactory clinical performance, completion of 90 hours CME activities in the three-year period immediately preceding the recertification application and successfully passing a written examination.

At the May, 1997 ABNS Board meeting, Robert H. Wilkens, MD, and Burton M. Onofrio, MD, completed their six-year terms on the ABNS and new directors were elected, including R. Michael Scott, MD and David G. Piepgras, MD. New officers elected were John C. VanGilder, MD, Chairman, and Fremont P. Wirth, MD, Vice Chairman. Donald O. Quest, MD, continues as Secretary and Stewart B. Dunsker, MD, Treasurer.

CPT Coding Committee

In light of increasing complexity of physician reimbursement, particularly with regard to CPT coding, the Physician Reimbursement Committee recommended that a separate committee to deal with CPT issues be created. It was further recommended that shared membership be maintained between the new CPT Committee and the Physician Reimbursement Committee.

The nature and scope of activities relating to reimbursement have become more technical and detailed than five years ago and require a major volunteer commitment. The complexity of some of the policies proposed by the Health Care Finance Administration (HCFA) that require a detailed response has escalated steadily, not to mention the growing number of inquiries from members and managed care organizations seeking information.

Agreeing that creation of a separate committee for CPT issues would be a useful step in the specialization of efforts to deal with problems that relate to the relationships between CPT and reimbursement, the Board approved establishment of the committee. It was suggested that the committee be joint with the CNS under the direction of Richard Roski, MD, and, therefore, will require approval of the CNS Executive Council to implement.

Professional Conduct

One case, which involved a member who presented expert witness testimony, was presented by the Professional Conduct Committee for review. The Committee recommended that, on the basis of their findings in the facts of the case, the physician’s membership in the AANS be suspended for six months, and that this information be forwarded to the National Practitioner’s Data Bank. The Board approved the recommended action.

Endovascular Fellowships

The Board agreed to support, in conjunction with the Congress of Neurological Surgeons, two one-year endovascular Fellowships. The Fellowships will be funded for the next two years at a cost of up to $40,000 per year, per organization.

At the urging of AANS President Edward R. Laws, Jr., MD, the AANS logo was updated to include an enhanced image of Harvey Cushing, MD. The new image is based on an original black-and-white crayon portrait drawn by John Singer Sargent. Dated 1924, the drawing was given to the Historical Library at Yale University in 1949 by Mrs. Harvey Cushing. The image is being used with Yale’s permission.

The Board reviewed a number of graphic treatments utilizing the new Cushing image and selected a new logo design, which is depicted to the right.

Next Meeting

The next meeting of the AANS Board of Directors will be held Thursday, April 23, 1998 during the 66th Annual Meeting in Philadelphia.