The semiannual assembly of the Council of State Neurosurgical Societies (CSNS) took place in April in Toronto. The CSNS discussed and acted upon a number of issues referred by grassroots neurosurgeons. Delegates heard a summary of a recent survey on neurosurgical professional associations and acted upon four resolutions advanced by several state societies and their members.
Survey Results
The CSNS reported the results of its organizational survey on a merger between the AANS and CNS. Sixty-two percent of respondents favored a merger of the two parent organizations, 26 percent favored some type of joint venture between the two groups and 12 percent wanted to leave things as they are. The response rate to the survey was 31 percent. A more detailed report will be published in an upcoming issue of the Bulletin.
Three Resolutions Passed
In terms of action items, the CSNS passed three substitute resolutions, rejected a resolution and referred another to the Washington Committee. Accepting the recommendation of its Reference Committee, the CSNS rejected a resolution asking the AANS/CNS to change its annual meeting requirements. The rejected resolution encouraged the AANS to revise its bylaws requiring members to attend an annual meeting at least once every three years. The resolution also asked the AANS to allow attendance at AANS/CNS Joint Section meetings to count in fulfillment of the bylaws requirement.
The CSNS passed a substitute resolution concerning recertification. The approved resolution asks the AANS Board of Directors and CNS Executive Committee to petition the American Board of Neurological Surgery (ABNS) to consider appointing a liaison to the ABNS who received board certification after May 1999 and will be required to be recertified. The original resolution called for the CSNS to survey neurosurgeons eligible for Board recertification to determine a fair and convenient testing methodology and process.
The CSNS passed a substitute resolution encouraging U.S. neurosurgeons to ask their county medical societies to survey members on their career plans over the next three years and to analyze future human resource requirements in each community. The original resolution called for such a survey and also asked for county medical associations to form Coalitions for Healthcare Workforce Survival to make recommendations to counteract critical shortages of healthcare workers and services.
The third substitute resolution passed by the CSNS encourages physicians to determine yearly overhead costs for each service (CPT) and to use the overhead costs to negotiate equitable reimbursement fee schedules from third party payers. The assembly accepted the Reference Committee’s substitute resolution with intent to refer to the CSNS Health System Cost Control Committee for submission of articles to disseminate this information.
The CSNS voted to refer a resolution on the Campbell Bill (which allows coalitions of independent physicians to bargain collectively with insurers) to the Washington Committee. The resolution requests the CNS and AANS to contribute to a fund that allows the Law and Economics Consulting Group to analyze the cost of passage of the Campbell Bill to consumers and employers and to present its findings to the Senate.
Other Activities
The CSNS delegates discussed a number of other timely issues impacting neurosurgeons, including:
- The Medical Practices Committee discussed surveying membership about various aspects of the rules and regulations of the Health Care Financing Administration and its handling of Medicare. The committee will work on the survey with the intent of distributing it to a statistically valid subset of neurosurgeons annually and getting initial results before the Congress meeting in San Diego this fall.
- The Health System Cost Control Committee discussed the resolution concerning practice expense costs and noted how rising practice expenses have led many physicians to leave their practices. In Santa Clara County in California, for example, 62 percent of physicians over the age of 50 reportedly are planning to leave their practice, which will result in loss of access to medical care.
- The Medico Legal Committee discussed the rising number of lawsuits and the increased cost of malpractice insurance. National tort reform is needed. Part of the problem is malpractice testimony by physicians who are not members of neurosurgical groups and thus cannot be disciplined by organized neurosurgery. Some redress can be accomplished through state boards of medicine or in the military through the chain of command.
- The Neurotrauma Committee discussed a position statement from the AANS/CNS Section on Neurotrauma and Critical Care for approving ancillary and emergency neurosurgical services. The committee decided that a position statement is necessary and that the position statement in question was sufficiently general but needs to be worded more strongly. The recommendations were forwarded to the section’s Executive Meeting. (Note: A position statement was later drafted. See Position Statement.) The committee also decided that a liaison to Think First was not needed.
- The Reimbursement Committee discussed the current status of coding development for this year. A series of six new surgical endoscopy codes was developed as well as a revision for editorial change of an existing code. New codes that will be presented at the CPT Editorial Panel in August include ventricular catheter placement with an endoscope; dissection for adhesions or fenestration of cysts; removal of cysts, foreign bodies, brain tumors or pituitary tumors; and third ventriculoscopy.
- The Workforce Committee is undertaking a survey of practicing neurosurgeons to determine their intent to retire and at what age. This survey will be analyzed to determine the impact of workforce requirements especially in relation to spine, trauma and pediatric services.
- The Young Physicians Committee is working on a project to gain access to medical student and primary core curriculum in order to provide information on the total scope of the practice of neurosurgery.