The Health Care Finance Administration’s (HCFA) recent Medicare Resource-Based Practice Expense legislation and the negative effects it poses to neurosurgery was the primary focus of the Joint Council of State Neurosurgical Societies (JCSNS) April meeting held in Denver. The Council also passed five resolutions; discussed subspecialty certification issues; and addressed Federal EMTALA regulations and the Kassebaum-Kennedy Act during John Kusske’s luncheon presentation.
HCFA Medicare Resource-Based Practice Expense Legislation
The Washington Committee’s action plan was outlined and includes legislative, administrative, and judicial strategies to help fight against the proposed 30 percent cuts in revenue that neurosurgeons face if HCFA’s plan goes into effect on January 1, 1998. A State Action Network Plan, which extends to all Congressional districts, was introduced at the meeting. The plan is ambitious, but with active participation by motivated neurosurgeons, can be accomplished.
The JCSNS is prepared to do all it can to help implement the Washington Committee’s plan. Rapid communication and grassroots political activity, two strengths of the JCSNS, will play a vital role in preventing the HCFA legislation from being implemented.
Additional prevention efforts discussed at the meeting include the formation of the American Neurological Surgery Political Action Committee (ANSPAC). The ANSPAC works directly with Washington by lobbying against the HCFA legislation. All AANS members are urged to join the ANSPAC and to encourage their colleagues to do the same.
New Communications Program
Getting SMART About Neurosurgery, the new marketing communications campaign, which focuses on lumbar spinal stenosis, was also introduced at the April meeting. The acronym SMART describes the components of the new marketing focus: specific, measurable, attainable, relevant, and time-framed goals. A comprehensive information package about the campaign was distributed to those in attendance.
For the new campaign plan to be effective, neurosurgeons need to take an active role by participating in local communications efforts. The purpose of the program is to attract public attention to the benefits of neurosurgery and raise awareness that neurosurgeons are specialists in care of the spine . Anyone interested in participating in the program should request an enrollment form from the AANS National Office.
Resolutions
The Council reaffirmed its opposition to subspecialty neurosurgery board certificates by passing a resolution to that effect. It also passed a resolution requesting the Joint Officers of the AANS and CNS to establish a mechanism for tracking CME credits according to their relevance to major areas of specialty interest, as defined by the Joint Sections of the AANS/CNS in addition to their general neurosurgical CME value. This approach would serve as an alternative to subspecialty fellowship training and certification and would be available to practicing neurosurgeons by demonstrating continued education credits in special interest areas for those needing documentation for credentialing purposes.
The assembly adopted a resolution requesting the AANS Board of Directors and CNS Executive Committee jointly to examine the issues surrounding minimum standards for maintaining the quality of fellowship training programs and asked that such a task force include a JCSNS representative. Among the issues suggested for consideration by the Task Force were the need to look both at fellowship training standards as well as related concerns raised by fellowships — such as fellowship effects on residency training and adequacy of residency training standards. A Task Force on Fellowship Training was appointed by Council Officers to examine the issues surrounding minimum standards for maintaining the quality of fellowship training programs.
Neurotrauma Recommendations
The Ad Hoc Committee on Neurotrauma of the JCSNS reported its findings on the socioeconomic issues in neurotrauma, including recommendations for action. The report examined the following: neurosurgeon participation in organized trauma systems, neurosurgical coverage by one neurosurgeon of several hospitals, compensation for ER trauma call, compensation by HMOs for emergency treatment of covered enrollees by neurosurgeons outside the HMO panel, compensation for emergency treatment of indigent patients, EMTALA (Emergency Medical Transfer and Active Labor Act) regulations, and several other related issues.
Several resolutions regarding the Ad Hoc Committee’s recommended actions were adopted and passed on to several Joint Sections for review and further recommendations. The resolutions urged the following:
- To support the development of organized regional trauma systems which incorporate designated neurotrauma centers in which manpower, expertise, and infrastructure can be concentrated, and to encourage regional neurosurgical participation in their design and governance.
- To urge the Washington Committee to actively participate in ongoing discussions with the Health Care Finance Administration (HCFA) to clarify that agency’s interpretations of EMTALA and to facilitate appropriate and practical solutions. Of particular concern are those rules which do not clearly distinguish between trauma care capabilities of different institutions and may not allow appropriate transfers meeting predefined criteria within the framework of an organized trauma system to be exempted from EMTALA and initiated without the risk of penalty.
- To encourage neurosurgical participation in trauma care by supporting the concept of voluntary contractual relationships between neurotrauma centers providing emergency neurosurgical services and the participating neurosurgeon — including reimbursement (called stipends) for guaranteed availability. In regions with significant indigent populations the use of tax credits and and/or other economic incentives should be encouraged.
- To support state and regional efforts to address trauma system funding by recognizing the special responsibility of particular groups — particularly managed care organizations — for emergency point-of-service care for their own contractually-covered populations and for a reasonable proportion of the infrastructure costs of providing that emergency care.
- To maintain a neurotrauma committee to promote interaction between the JCSNS, Joint Section on Neurotrauma, Washington Committee, AANS and CNS, outside organizations such as the American College of Emergency Physicians, and the American College of Surgeons, to stimulate interaction, disseminate information, and promote education in the socioeconomics of neurotrauma at the state, regional, and local levels.
New Officers Elected
After three years of service, Stan Pelofsky completed his tenure as JCSNS Chairman and new officers were elected at the April meeting and are as follows: Council Chairman, Jim Bean (KY); Vice Chairman, Lyal Leibrock (NE); Recording Secretary, David Jiminez (MO); and Treasurer, Randall Smith (CA).