I would like to take this opportunity to bring you up to date with activities of the AANS with regard to the different areas of education, activities in Washington, DC, and a review of the current initiatives of the Board of Directors of the AANS. At the beginning of August 1997, the Executive Committees of the AANS and the Congress of Neurological Surgeons (CNS) met together with the leadership of all of the AANS/CNS Joint Sections. This “leadership” meeting was highly productive, and focused on a number of areas which should be of interest to all of our membership.
Education
Education continues to be the major role of the AANS and the most consistent way the membership interfaces with the organization as a whole. The Annual Meeting in Denver in April of 1997 was very successful and plans are well underway for the 1998 Annual Meeting in Philadelphia. Almost 750 abstract submissions were received for this Meeting, and L.N. Hopkins, MD, has taken on the role of Scientific Program Chairman.
The various AANS/CNS Sections were organized to enhance subspecialty interests, particularly in the area of education. They do this by subspecialty-specific programs within the framework of the Annual Meeting, by satellite sessions attached to the Annual Meetings of the AANS or the CNS, and in the case of the Spine, Cerebrovascular and Pediatric Sections, with free standing meetings that have been very successful. The Section leadership is committed to expanding these educational activities in the future, and the Sections have matured into powerful vehicles for progress in neurosurgical education.
Another critical educational arm of the AANS is the Journal of Neurosurgery. This is the premier journal in the field world wide, and has maintained its role as the major element of peer review for scientific progress in neurosurgery. The Journal Editorial Board has been responsive and quite innovative; the development of the online journal Neurosurgical Focus has been just one of the elements related to this creative activity.
The expanding use of our Web site on the Internet, NEUROSURGERY://ON-CALL®, is fulfilling the original design of the program when it was founded. N://OC® is extremely important as an educational and communications arm for the AANS, and under the leadership of John Oro, MD, the content and capabilities of the site continue to grow.
The Professional Development Program continues to provide our membership with focused pertinent regional courses. The response to these has been outstanding, and they offer a needed focused experience in a number of different areas. The Oral Board Preparation course was added this year to service our provisional members, and was quickly filled to capacity.
The publications produced by the AANS are the result of a great deal of work by a committee that tries to be responsive to areas within neurosurgery that are not well served by standard texts. It is also a vehicle through which the membership can obtain publications of high quality that compliment other educational efforts.
The AANS and CNS have collaborated to develop the Self Assessment Examination in Neurosurgery (SANS) which will appear as a brand new updated version in time for the Congress Meeting in New Orleans. Our organizations also sponsor the RUNN course held each year in Wood’s Hole, Massachusetts, designed to provide neurosurgical residents and young neurosurgical faculty an opportunity to interface with a variety of experts in neuroscience.
The pre-eminent position of neurosurgery within the surgical specialties is in no small part related to these outstanding educational activities, and the leadership of both the AANS and the CNS are pleased that such a variety of educational experiences is available for the membership.
Washington Committee
Activities in Washington have been dominated by the area of physician reimbursement, specifically the practice expense adjustments by HCFA for Medicare patients. The AANS and CNS maintain a Washington Office with a full time legislative representative and a small staff. These individuals are extremely active and have worked vigorously on our behalf with a superb outcome, measured by the delay in implementation and reappraisal of some particularly damaging changes in HCFA regulations that impact on reimbursement in a highly negative fashion. In the course of achieving these goals, which will be communicated to the membership through other vehicles, our Washington Office has participated in coalitions related to preserving patient access to specialty medical care and the practice expense issues.
We have also worked with the American Tort Reform Association in order to ease the malpractice situation, and have worked with other groups in the hopes of maintaining legitimate animal experimentation for advances in neuroscience.
Our Washington activities include providing liaisons to the Health Care Finance Administration for purposes of coding and classification of neurosurgical procedures. We also provide representatives to the CPT editorial review process. We have liaisons to the National Institutes of Health, the National Cancer Institute, the Veteran’s Administration and the Decade of the Brain Initiatives. We interact on a regular basis with the Food and Drug Administration and the Agency for Health Care Policy and Research. Through the efforts of the Washington Office we have provided testimony before a variety of Congressional Committees and individual neurosurgeons have been facilitated in their efforts to make visits to their own Members of Congress. The Washington Committee, which includes individuals from the leadership of both the AANS and the CNS, meets at least quarterly and receives constant briefings on activities in Washington that may impact upon neurosurgery.
Getting SMART Communications Program
The marketing communications program, initiated by the Joint Council of State Neurosurgical Societies (JCSNS) and carried forward by the National Office in Chicago, is maturing into a very exciting and productive plan centered on lumbar stenosis. The concern is that neurosurgeons are not adequately viewed as spine surgeons, and lumbar stenosis is a very good place to start informing the public and referring physicians about our role in this area. Because a great deal of lumbar stenosis surgery is already done by neurosurgeons, and because this disease impacts elderly patients whose quality of life can be completely turned around by successful neurosurgical procedures, we thought it would be an ideal area in which to begin a marketing initiative. This has been formalized into a series of educational packages designed to interface with the various segments of our constituency.
Neuroendovascular Task Force
A Neuroendovascular Task Force has been developed under the leadership of Marc Mayberg, MD. This Task Force will try to combine the previous initiatives in stroke management, extracranial cerebrovascular surgery, and endovascular neurosurgery. It was strongly felt by the Board of Directors that aggressive action in these areas is necessary if neurosurgeons are to continue to play an appropriate role in cerebrovascular disease. Our hope is that this Task Force can accomplish results similar to those provided by the Spine Task Force.
Fellowship Task Force
Another initiative, under the leadership of Julian Hoff, MD, is a Fellowship Task Force. The actual concept is related to the entire scope of post residency neurosurgical education, but the activities of the Task Force, at least initially, will focus on the area of fellowships. The fellowship experience has become more and more a routine part of a neurosurgical resident’s education, and the reasons behind this and the impact that this trend may have on neurosurgical practice are under active investigation.
Other factors that impinge upon the importance of this Task Force are the move toward recertification by the American Board of Neurological Surgery and the developing accreditation program provided by the AMA, and the AMAP. These areas are under review by various members of our Board of Directors, and we will be reporting to you on them as they develop further.
The complexity of these problems has resulted in a request for periodic meetings of neurosurgical leadership to include the leaders of the AANS and the CNS, the American Board of Neurological Surgery, the Residency Review Committee, the JCSNS, and the Society of Neurological Surgeons, representing the Program Directors. It is hoped that these meetings can coordinate responses and actions that might be appropriate.
Cost Containment
It appears more and more clearly that there is a finite amount of funding available for neurosurgical care in the United States. It is important for the membership to recognize that money from this global budget that is diverted to inappropriate and highly priced medications, devices, or consultative care is simply subtracted from the amount available for neurosurgical reimbursement. If we do face a system where reimbursement for individual procedures will be fixed, then the area of cost containment becomes more and more essential, and also becomes part of our competitive advantage.
For those reasons, and many others, a Cost Control Initiative has been developed under the leadership of John Kusske, MD, utilizing the talents of the JCSNS, other highly informed neurosurgeons, and with the vigorous support of your President and a number of other Members of the Board. We are attempting to obtain outside funding for demonstration projects that will show how neurosurgical costs to the public can be reduced overall without impacting negatively on the quality and outcome of neurosurgical care.
It is hoped that these messages will help inform our membership as to what the AANS is doing on their behalf, and once again we invite suggestions and criticisms and will try to be as responsive as possible. Plans are under way for a very exciting Annual Meeting in Philadelphia in 1998 and we look forward to seeing you there.