Whether we as neurosurgeons remain economically solvent (let alone thrive) in a foreseeable future of ever increasing regulatory obligations, shrinking reimbursements, and rising medical liability and regulatory compliance overhead costs, is largely a matter of effective practice management. Until recently, efforts to study practice management issues and promote an agenda to improve the economic environment for us all were limited to Herculean volunteer efforts of a few neurosurgeons, among them Byron C. Pevehouse, MD, Ben W. Blackett, MD, John A. Kusske, MD, and Robert E. Florin, MD.
More recently, the Council of State Neurosurgical Societies (CSNS) has led organized neurosurgery in a concerted effort to address the improvement of neurosurgical practice management. These important efforts came to fruition with the Sept. 20, 2002, organizational meeting of the new neurosurgery practice managers’ society called NERVES (Neurosurgery Executive’s Resource, Value, and Education Society).
The 28 neurosurgery practice managers at the Philadelphia meeting represented a cross section of types of neurosurgery practices, including private practice, academics, small groups, large groups, and multispecialty groups. The only practice type not represented was solo practice. Twenty-eight visionary neurosurgery groups in 17 states — representing approximately 7.2 percent of practicing U.S. neurosurgeons — supported the formation of NERVES by sponsoring the attendance of their practice manager at the organizational meeting.
At the initial NERVES meeting preliminary bylaws were approved, and members of the Interim Executive Committee were elected, including:
- Interim President Mark Mason, Nashville, Tenn.
- Interim Vice President Cheryl Harris, Arlington, Texas
- Interim Secretary Barbara Hurlbert, Jacksonville, Fla.
- Interim Treasurer Johanna Hartigan, New Haven, Conn.
- Interim “President Emeritus” Robert Rosso, Columbus, Ga.
- Interim Western Regional Director Tammy Marr, Omaha, Neb.
Interim Northeastern Regional Director Nicholas Green, Southfield, Mich.
- Interim Southeastern Regional Director Mary Cloninger, Charlotte, N.C.
A timeline for further society development and evolution was established, and the first annual meeting of NERVES, along with the new society’s first business meeting — at which new officers and the bylaws will be ratified — is scheduled for April 2003 in San Diego. The group’s major initiative is to lay the groundwork for the first neurosurgery practice management survey in 2004.
NERVES Matters
The proposed 2004 survey will provide the AANS/CNS Coding and Reimbursement Committee, AANS/CNS Washington Committee, and individual neurosurgeons struggling to manage their own practices with crucial data for making informed decisions and intelligent future plans regarding a host of practice management issues. All need current and accurate practice management data, as well as knowledge of trends over time.
It is important to recognize that while socioeconomic and practice management issues obviously are of concern to every neurosurgeon, they are the actual “bread and butter,” day-to-day fare of our own practice managers. Their knowledge of staffing needs, customary salary ranges, overhead costs, productivity ranges, coding details, third party and governmental agency regulatory constraints and processes, and fee and reimbursement rates renders them a critical, and until now, untapped and unorganized resource for neurosurgery.
History of a Historic Venture
The first NERVES meeting was an important and historic event that grew out of a CSNS feasibility study exploring different strategies for investigating reimbursement methodologies. The study, performed between September 2001 and April 2002, revealed that the key to obtaining reliable and relevant practice management data on which individual neurosurgeons, the Coding and Reimbursement Committee, and the Washington Committee could base decisions would be the organization of neurosurgery practice managers into their own society. The new society would provide needed services for its members, but would also serve as a critical practice management research “data mine” for the neurosurgery specialty as a whole.
Two different strategies for addressing the needs identified in the CSNS survey were carefully explored. The first involved strengthening neurosurgery participation in the Medical Group Management Association by encouraging neurosurgeons to enroll their practice managers in the MGMA’s Neuroscience Assembly. It was quickly recognized that this approach would be not meet neurosurgery’s objectives, in part because of the low numbers of neurosurgery practice managers involved in the Neuroscience Assembly. Of greater concern was the fact that the MGMA survey provides data specifically for physician compensation, administrator and employee compensation, practice costs, productivity and staffing. No coding, billing, third party billing process, or actual reimbursement data is collected. The MGMA data is generalized because it must apply equally to all types of medical practice, and year-to-year longitudinal trends in data results are not analyzed.
The CSNS decided instead to support a second strategy of establishing a brand new, independent, but closely affiliated neurosurgery practice manager society. The idea was not unprecedented for specialty societies, as exemplified by the American Academy of Orthopaedic Surgeons (BONES Society, Inc.) and the American Academy of Otolaryngology-Head and Neck Surgeons (Association of Otolaryngology Administrators), among others. This approach was undertaken to provide greater flexibility and autonomy for potential members, allow for more concentrated focus on issues of greatest importance to neurosurgery, and encourage stronger and more effective affiliation and cooperation between the new society and the CSNS.
To further the creation of a new society, the Ad Hoc Neurosurgery Practice Manager and Administrator Organization Committee (PMAOC) was established at the April 2002 CSNS meeting in Toronto. The committee was charged with: 1) initiating, guiding, advising and mentoring the establishment of the envisioned new society, 2) supervising the funding of the new organization for three years, or until it becomes financially solvent for routine non-research-related operations based on its own dues and meeting fees, 3) dissolving once the new organization becomes firmly established and self-sustaining.
The PMAOC members — James R. Bean, MD, Samuel Hassenbusch, MD, Cheryl Muszynski, MD, John A. Wilson Jr., MD, and co-chairs Mark E. Linskey, MD, and Gregory J. Przybylski, MD — together with committee consultants representing the AANS Education and Practice Management Department, the AANS/CNS Washington Office, KarenZupko and Associates, and NeuroSource, Inc., identified a nucleus of motivated and enthusiastic neurosurgery practice managers to serve as an initial “critical mass” for the society’s organizational efforts.
New Beginnings
Now that NERVES has launched, neurosurgeons are asked to consider the new society’s importance to neurosurgery as a whole as well as the potential benefit to their own practices. That 28 people from 28 neurosurgical groups in 17 states participated in the initial meeting is very encouraging. Now focus turns to the states which are not yet represented, including populous states such as California, Massachusetts, New Jersey, and Ohio and large urban centers such as New York City, Chicago, Los Angeles, the San Francisco Bay area, Boston, Baltimore, Cleveland, Philadelphia, Pittsburgh, St. Louis, and Washington, D.C.
The active support of all U.S. neurosurgeons will be absolutely critical to the success of NERVES. Support can take the form of encouraging your practice manager to join the new society, agreeing to pay their membership dues and/or meeting travel and fees as a practice expense, or even just granting them the time away from the practice for organization-related activities.
We are asking you to actively support and encourage membership and participation of your own practice managers and administrators in the new organization. Ultimately, we need to see every neurosurgery practice in the United States represented in NERVES.
Mark E. Linskey, MD, University of Arkansas-Little Rock, and Gregory J. Przybylski, MD, JFK Medical Center Neuroscience Institute in New Jersey, are co-chairs of the CSNS Ad Hoc Neurosurgery Practice Manager and Administrator Organization Committee.
Benefits of NERVES Membership
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