April Meeting Lays Course for 2005-2006 – Liability Reform and Reimbursement Lead List of Concerns

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    Resolutions and additional CSNS information are available at www.csnsonline.org.
    The Council of State Neurosurgical Societies met during the 2005 Annual Meeting of the American Association of Neurological Surgeons in New Orleans. During the CSNS meeting it was noted that the successful completion of the 2004 Leibrock Leadership Development Conference raised significant funds that will be used, with the consent of CSNS parent organizations the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, to support medical liability reform efforts. This initiative is a continuation of the efforts made by the AANS/CNS Washington Committee as well as the American Medical Association, which has recently noted that the liability crisis is still its number one concern: A medical liability crisis continues in 20 states, the average cost of a lawsuit is $90,000 even if the doctor wins, and only 20 cents of every dollar awarded goes to the victim.

    Medical Liability Reform and DMLR: Your Support Is Needed
    Doctors for Medical Liability Reform, a coalition of specialty societies which includes Neurosurgeons to Preserve Health Care Access, was discussed. Fifty-five Republicans have been elected to the U.S. Senate, and 53 of them are favorable to tort reform. Only Richard Shelby of Alabama and Lindsey Graham of South Carolina are Republican senators who have not been supportive, and it is felt that they never will be as they are trial attorneys. So far the Democratic side of the Senate has been cool toward tort reform.

    Even though DMLR was successful with the 2004 Protect Patients Now campaign, much work still remains and the CSNS needs to continue to fund further tort reform efforts this year. For the effort to be successful, it is recommended that every neurosurgeon contributes a minimum of $1,000 annually for the next three to five years in order to fund a campaign effective in achieving permanent medical liability reform. As a point of reference, plaintiff attorneys in Florida contributed over $50 million dollars this year, with individual contributions starting at $1,000. There has been some success in tort reform in Georgia and South Carolina, where there now is a $350,000 “stacked cap.”

    NERVES: A Remedy for Reduced Reimbursement
    A critical issue in the next few months will be the participation of all neurosurgical groups in a sister organization known as NERVES (Neurosurgery Executives’ Resource Value and Education Society). NERVES is the organization composed of the business managers of various neurosurgical practices including private groups, employed groups, and academic groups. Its main purpose is to develop a comprehensive understanding of the needs of neurosurgeons and to integrate those needs into their individual practice settings. A major area of concern for NERVES is to optimize neurosurgical finances by improving reimbursement and minimizing costs which affect various neurosurgical practice groups. A 2004 survey conducted by NERVES identified the diversity of reimbursement schemes currently in existence in the United States. Gaining a full understanding of practice patterns and reimbursement structures will assist neurosurgeons in the negotiations required to receive appropriate payment for their efforts.

    One important impending change in reimbursement for neurosurgeons’ work is pay for performance, an initiative recently adopted by the Centers for Medicare and Medicaid Services. Pay for performance is intended to reimburse optimal practice performance at the currently nominal rate. Those neurosurgeons who perform “best” as determined by the CMS will receive full reimbursement, and others will be reimbursed at a lower level. The total available dollars for reimbursement will not increase, and it is likely that the actual total debit to CMS will be less since only the top 5 percent to 10 percent of neurosurgeons will be paid at the peak of pay-for-performance rates.

    The AANS/CNS Washington Committee and the American Medical Association are working together to prevent significant drops in the reimbursement available to neurosurgeons. Participation in NERVES will assist all practice groups with gaining a better understanding of the changes in reimbursement planned by various third party payers and will assist the participants in learning how to respond to them appropriately. The CSNS greatly encourages all practicing neurosurgeons to support their practice managers and administrators in becoming members of NERVES.

    Fernando G. Diaz, MD, PhD, is chair of the Council of State Neurosurgical Societies.

    For Further Information
    • Bertagna, M, and Gliklich, R. “P4P for Specialists Gains Velocity,” AANS Bulletin Spring 2005. www.AANS.org, Article ID 27723.
    • Mason, M. “The P4P Initiative: How NERVES Can Help, AANS Bulletin Spring 2005. www.AANS.org, Article ID 27725.
    • Orrico, KO, and Popp, AJ. 2004 DMLR Campaign Posts Huge Successes: Through NPHCA, Neurosurgery Presses On for Liability Reform,” AANS Bulletin Spring 2005. www.AANS.org, Article ID 27710.
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