AANS Neurosurgeon | Volume 28, Number 1, 2019


Looking Back and Moving Forward - NERVES 2018 Annual Meeting

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Summer came early for NERVES this year. Three crucial trends in neurosurgical practices – consumerism, technology and data – were found throughout the NERVES Annual Meeting, April 26-28, in New Orleans. With a backdrop of jazz music and Cajun food for presentations, roundtable discussions and networking, more than 100 administrative leaders gathered. NERVES members work collaboratively with neurosurgeons to optimize all medical practices (private, academic and hospital-employed) to provide the best care for patients – a rapidly changing and ever more complex challenge.

Three presentations brought the trend of consumerism into focus. Nicholas Webb (healthcare strategist, innovator, researcher and author) gave the Tim Roberts Keynote Address, highlighting healthcare’s advance towards consumerism. Webb noted that patients are taking control of decision-making, and the healthcare experience matters more than it did in the past. This change is happening through online engagement, where consumers on the internet can share, rank, find and complain about services. Webb also highlighted organizations, including Amazon and Google, not typically in the healthcare space that are looking to enter the market and disrupt existing access. They will leverage their current infrastructure to deliver healthcare into people’s homes and change the payer landscape.

Kate Zentner, of the influential consulting firm Sg2, encouraged a service line tactic to meet rising consumerism and create a win-win environment. She shared a poignant example of cooperation across a service line that simultaneously served to leverage relationships, meet consumer needs and capture market share. A service line can create a broader geographic coverage area that is not possible without collaboration. NERVES will absorb the lesions of these concepts and work with neurosurgeons to meet the challenges of rising consumerism today and adjust for change in the future.

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Ralph Dacey, MD, FAANS, chairman of the Washington University School of Medicine Department of Neurosurgery, noted the need to focus on the patient perspective. Dr. Dacey stated that personal promotion is less desirable than concentrating on advancing the department and the enterprise through the lens of the consumer.

Turning to the theme of technology, Webb noted consumer reliance on technology for information access and sharing. He said that delivering excellent care depends on real-time communication and customer engagement, using today’s electronic navigation tools. Like with consumerism, Amazon and Google plan to leverage their technology expertise to provide healthcare directly to consumers. Rubin Pillay, PhD, professor of healthcare innovation and entrepreneurship at the University of Alabama, Birmingham, focused on the transformative impact of artificial intelligence (AI) on medicine. AI tools already have the capability to diagnose some patient conditions, perform preliminary reading of imaging and complete detailed physical exams on structures, such as the eye. Certainly, he noted, the impact of AI on medicine has just begun.

Big data is the other trend having an enormous impact on the practice of medicine today. Both collection and analysis of data are critical to neurosurgery practice success. Ahead of the curve, the NERVES Socio-Economic Survey is an essential benchmarking data source for neurosurgery practice management. This survey is the most extensive annual neurosurgery survey in the country, representing almost 100 practices and over 800 neurosurgeons. Michael Heaton of Katz, Sapper & Miller shared current-year survey changes and some unexpected results. The survey will now have greater detail on Advanced Practice Providers. Surprising results in the survey include the compensation costs for hospital-employed neurosurgeons that were exceeding the collections on a per RVU basis. Heaton noted that this trend is not sustainable. 

Another presentation by Anthony Asher, MD, FAANS, Carolina Neurosurgery & Spine Associates, updated the audience on NeuroPoint Alliance and QOD. Through QOD data collection and analysis, neurosurgeons can benchmark critical aspects of care, such as readmission, infection rates and patient-reported outcomes. Dr. Asher shared an example of favorable managed care contracting that had resulted from QOD measurement processes and outcomes data.

In addition, Mac Knight, MD, Coker Group, presented on MACRA quality reporting. He said payers are looking at data to adjust payments and careful data review is needed. For example, identifying patients without a PCP would allow practices to steer patients to a PCP relationship and thus avoid attributed patients and costs. Also, identifying patient co-morbidities will ensure appropriate coding and scoring. Each presenter acknowledged the data collection burden and a need for technology to reduce the data collection cost.

Summer is usually fun and the work of NERVES is to support neurosurgical practices and optimize care of the right patient, at the right time, in the right place. The 2018 NERVES Annual Meeting was a success by all measures and every participant is challenged by the difficult messages presented. As everyone carries back new ideas and information to their practices, the neurosurgery leadership is better prepared for what comes in the next year.


NERVES (Neurosurgery Executives’ Resource Value & Education Society) is the premier national neurosurgery practice administrator society in the US. NERVES was established as an initiative of the CSNS to help neurosurgery practice administrators network, combine resources to gather information, and learn from experts and colleagues about how to build stronger practices.

More information is available online at www.nervesadmin.com.


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