I have been asked to communicate to the members of our neurosurgical community my thoughts and ideas since stepping down as Chairman of the Council of State Neurosurgical Societies (CSNS). I have traveled to some practices around the country as a senior member of the Council and found these experiences to be very enlightening and useful.
Traveling to Tallahassee
I recently traveled to Tallahassee, Fla., to give a talk on head injury and was able to meet with members of a young, motivated, aggressive neurosurgery staff at the Tallahassee Memorial Hospital. These neurosurgeons, Drs. Romano, Crawford, and Cuffe, allowed me the opportunity to ascertain what issues were important to them and what they were trying to accomplish in neurosurgery in the panhandle of Florida compared to issues we face in my state, Nebraska. I found there are local interests specific to a geographic area. However, there are many collective areas of interest that involve neurosurgery as an entire community.
Linac vs. Gamma Knife
One of the topics we discussed was what to do when making a decision about the productivity and usefulness of Gamma Knife versus Linac radiosurgery considering the cost of the two and how the hospitals and physicians can afford to use it. We had an interesting discussion about this, with no conclusion being reached other than the fact that one is certainly much more expensive than the other. In addition, hospitals can use the Linac in so many other ways if they are not using it specifically for stereotactic radiosurgery.
Onerous Malpractice Premiums
We also discussed an issue that is currently common among neurosurgeons and the medical community as a whole: elevated malpractice premiums. This issue, at crisis point 30 years ago, has simmered over the years, and now its spector has risen again in many states, including Florida and Nebraska. I also have friends in Philadelphia telling me their malpractice premiums are approaching $125,000 to $150,000 per year, onerous sums for anyone in any profession. The national organizations for neurosurgery and the AANS/CNS Washington Committee are going to have to take a very aggressive posture in bringing the issue to the attention of federal and state legislators. A multifaceted approach is required to resolve this issue. Neurosurgeons need to be involved in their local state societies, state neurosurgical organizations, and the CSNS because resolution of these issues is best handled at the local level. Nationally, issues in relationship to tort reform need to be worked on again and again until some sense is brought to the area of malpractice. Educating neurosurgeons in the methods of influencing state and national legislators is vital to prevailing in the malpractice battle. The organizing committee of next year’s National Leadership Development Conference in Washington, D.C., is investigating ways to accomplish this.
Neurosurgeons: Take Action!
Neurosurgeons also are aware that the government is going to lower reimbursement to physicians, particularly in the area of Medicare, at a time when malpractice premiums are rapidly increasing. How Congress could possibly think this is a good idea in relation to access to medical care for patients is beyond my comprehension. I have written and communicated with my local congressmen and senators to convey to them my angst at how these changes could be considered at this particular moment in time. I welcome feedback from anyone regarding this issue and how we can address it. Certainly it needs to be aggressively addressed through the American College of Surgeons, the American Medical Association, and physicians, or there are going to be some dramatic changes to healthcare access for people who need it the most-those in their senior years of life and the uninsured population-if the reimbursement reductions are carried forward by CMS. I reiterate the sentiments of the AANS/CNS Washington Committee and call neurosurgeons to action: Every neurosurgeon needs to support the Physician Payment Fairness Act of 2001, introduced Nov. 8, 2001, by Senators James Jeffords (R-Vt.) and John Breaux (D-La.).
I continue to plan trips to other areas around the country and will provide thoughts in the future regarding these visits.
Lyal G. Leibrock, MD, FACS, is immediate past chairman of the Council of State Neurosurgical Societies.
Editor’s Note: For more information on the Physician Payment Fairness Act of 2001 and tips on contacting your representatives, go to the AANS Web site at https://www.neurosurgery.org/socioeconomic/2002feeschedulealert-2.pdf.