The most recent meeting of the Council of State Neurosurgical Societies in Philadelphia Sept. 20-21 provided an excellent opportunity for neurosurgeons to delve into a variety of issues affecting our specialty. Salient topics included the status of the professional liability insurance crisis, issues in coding and reimbursement, particularly recent changes to the evaluation and management guidelines, and declining Medicare reimbursement.
The results of the 2002 CSNS professional liability insurance survey bear witness that the concerns related anecdotally by neurosurgeons across the country are founded on fact. As reported at the September meeting, the 2002 survey data indicate that fully 50 percent of respondents experienced at least a 20 percent increase in premiums between 2000 and 2002; 25 percent experienced at least a 64 percent increase; and 10 percent, a 141 percent increase. The median percent of increase for neurosurgeons’ premiums was 34 percent for the same two-year period.
Liability Premiums May Affect Patients’ Access to Care
Of even greater concern is how the challenge of neurosurgeons’ rising premiums may affect patients’ access to care. Of all neurosurgeons responding to the survey, 14 percent said they were planning to or are considering moving, while one quarter said they were planning to or are considering retiring. One third said they already are, or are considering restricting their practices. This information documenting neurosurgery’s professional liability insurance crisis already is forming the basis of organized neurosurgery’s plan for resolution of the crisis. The complete summary of survey results, together with liability “hot spots” and “success stories” can be found at https://www.neurosurgery.org/csns.
Reimbursement issues continue at the forefront of the CSNS agenda. Troy Tippett, MD, who served on the American Medical Association’s evaluation and management workgroup, reported on changes to E&M documentation guidelines recommended by the workgroup, including replacing the “bullet” system with a “clinical vignette” system by 2004.
Declining Medicare reimbursement and organized neurosurgery’s response combating the downward trend have been a focus of the AANS/CNS Washington Committee’s recent efforts, as James R. Bean, MD, the committee’s chair, reported. He noted that joining with the Coalition for Fair Medicare Payments has strengthened the committee’s advocacy efforts with respect to this timely topic.
Second NLDC Deemed a Success
Neurosurgery’s advocacy efforts were enhanced by the second Neurosurgical Leadership Development Conference held in July. The successful conference readied neurosurgeons to tackle the socioeconomic issues that affect their livelihoods every day by teaching them how to effect change in both the state and federal legislatures. Updates on critical issues-the Emergency Treatment and Labor Act (EMTALA), the Health Insurance Portability and Accountability Act (HIPAA), declining Medicare reimbursement and more-were followed by advocacy training, a media workshop, and a visit to Capitol Hill. The next NLDC is scheduled for July 2004.
CSNS Launches NERVES
As the complexity of the various issues involved in successful practice management has increased, harnessing the expertise of neurosurgical practice managers has become an essential ingredient in maintaining a thriving practice. Recognizing this reality, the CSNS voted to provide initial support of NERVES, Neurosurgery Executive’s Resource, Value, and Education Society, a new society of neurosurgical practice managers championed by Mark Linskey, MD, and Gregory Przybylski, MD. At the organization’s inaugural meeting held in September, officers were elected and bylaws established, while planning for the first annual meeting in April 2003 was initiated. All neurosurgeons are encouraged to actively support this group by sponsoring their practice managers’ attendance at the upcoming Aprillllll meeting. (See related story, Launching NERVES, in this issue.)
During the Plenary Session on Sept. 21, unification of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons remained a hot topic, with two of the eight resolutions directly addressing that issue. Physician workforce concerns, including resident work hour regulations, were covered by three separate proposed resolutions that were combined into one in Substitute Resolution II. The final resolutions follow. The original proposed resolutions and other information relating to the meeting can be found at www.neuro surgery.org/csns.
David F. Jimenez, MD, is chair of the Council of State Neurosurgical Societies.
| Resolution VII Sparks Debate: AANS Stands for Unification When the CSNS Executive Committee submitted Resolution VII, which called for the American Association of Neurological Surgeons and the Congress of Neurological Surgeons to create “a 501(c)(6) neurosurgical organization,” that “allows for no limitation in the amount of lobbying activity, may operate a PAC as a ‘special segregated fund,’ creates no limitation on socioeconomic business promotion activities while still maintaining an educational and research mission,” it didn’t go far enough, according to the AANS Caucus. The AANS Caucus submitted a substitute resolution that proposed creation of the 501(c)(6) organization “as an integral part of a true merger of the two organizations to meet the critical needs of our profession.” Representing the past, present and future leadership of the AANS, Immediate Past President Stan Pelofsky, MD, President Roberto C. Heros, MD, and President-Elect A. John Popp, MD, urged passage of the substitute resolution. With 38 delegates indicating support, Substitute Resolution VII passed. “When AANS President Stan Pelofsky signed the Proposal for Unification Discussions Between the AANS and CNS in September 2001, he pledged that the AANS would act in the best interest of neurosurgery,” remarked Dr. Heros. “Since that time, further consideration of an AANS/CNS merger has lent credence to the wisdom of complete unification.” He cited the November 2000 CSNS survey to which two-thirds of grassroots neurosurgeons reported their support of complete merger of the AANS and CNS. “Altogether, the evidence supports unification,” he stated. “The AANS stands unwavering in its support of a true merger that will consolidate neurosurgery’s resources and increase our impact in the national arena.” |
| FINAL RESOLUTIONS Resolution I: CMS and Medicare Attitudinal Survey Adopted Substitute Resolution I Be it resolved, that the attached survey, or future modifications thereof, be approved by the general CSNS body for use in periodic attitudinal surveying of the CSNS Membership, and This survey be administered during CSNS registration by the CSNS Meeting Coordinator as part of the registration process at each subsequent CSNS meeting beginning in 2003, or by other means deemed appropriate by the committee with the completed forms turned over to the Medical Practices Committee for formal collection, analysis and generation of a survey report for timely transmission to the Washington Committee, and The biannual survey reports be safely and faithfully kept in a database or spreadsheet by the Chairman of the Medical Practices Committee for ongoing use in longitudinal result trends analysis. Resolution II: Neurosurgery Resident Work Hour Regulations Be it further resolved, that the gathered data from such master plan be reported back at the next CSNS meeting and to the Washington Committee and that a budget of $3,000 be provided from the CSNS State Society Voluntary Contribution plan. Resolution III: Restricted Physician Workforce Resolution IV: Pay Shortfall for Neurosurgeons in the United States Military Resolution V: Reserve Medical Officer Civilian Practice Insurance Resolution VI: Neurological Surgery Resident Hour Survey Resolution VII: Creation of a New 501(c)(6) Tax Exempt Resolution VIII Merger of AANS and CNS |
David F. Jimenez, MD, is chair of the Council of State Neurosurgical Societies.