Spring 2014
www.csnsonline.org
Prepared by Michael S. Park, MD
CSNS mission:
to provide a national forum for the State Neurosurgical
Societies of the United States, for the discussion,
consideration, and proposals of action regarding
socioeconomic issues concerning Neurological
Surgery.
Chairman’s Report:
Dr. Mark Linskey
• Update on goals presented at Fall 2013 CSNS
Meeting
• Success of Winter 2014 Washington
Committee meeting
• Legislative and payer policy monitoring
• Formal links between CSNS and state
societies; attendance at state society meetings
by CSNS officers
• Reestablishment of CSNS associations with
NERVES, AANN, & ANSPA
• Additional CSNS representative section
New Initiatives
 CSNS to participate in NREF review of socioeconomic grants, including TBI
grant
 Affordable Care Act and proactive monitoring; Medical Practices and YNRS to
proactively anticipate implications and process with evaluations to CEC for
review by CNS/AANS
 Development of a medical business training simulator; CEC to form a working
group to submit a feasibility study
 Neurosurgical Medical Directors Ad Hoc Committee to address needs and
issues of Neurosurgeons as leaders
 Patient Advocacy Ad Hoc committee and Long-Range Planning Committee
processes
Passed Spring 2013 Resolutions
 Resolution to support ongoing study of insurance denials in MN in order to
promote transparency in denial practices and to ascertain denial rationale(s)
 Collation of data on anticoagulant and antiplatelet agents, particularly with
regard to emergent reversal, and online distribution of this data
 Regarding CSNS Processes:
 Resolution-writing tutorials and previously submitted resolutions are to be reviewed
before submitting new resolutions
 Scholarly works pertaining to socioeconomics by CSNS members and resident fellos
in particular will be displayed at future CSNS plenary sessions
 Transparency of Conflicts of Interest of CSNS members
Referred Spring 2013 Resolutions
 Creation of resident safety protocol
 Creation of a pilot program of organized neurosurgery engaging insurance
companies in open dialogue and bidirectional education on approval and
denial practices and rationale.
Rejected Spring 2013 Resolutions
 Broad CSNS evaluation and review of neurosurgical Conflicts of Interest
 Resolution calling for removal of CME requirements for maintaining membership
in CNS and AANS
 Development of educational materials and efforts to minimize wrong-side,
wrong-level surgeries
2013 Meeting Highlights:
“New Frontiers for Neurosurgeons in the Era of the Affordable Care
Act: The Geisinger Experience”
Steven A. Toms, MD, MPH, FAANS, FACS
Washington Committee Highlights:
John Wilson, MD and Katie Orrico, JD
 Sustainable Growth Rate (SGR) Update
One-year “doc fix” (HR 4302) implemented to avoid 24% cut in Medicare payments
Increased Medicare pay by 0.5%
Delays ICD-10 implementation to October 1, 2015
Delays implementation of “2-midnight rule” 6 months
Provides improved Medicare payments to rural hospitals and ambulance services
Reduces payments to SNFs by $2B over 10 years
Authorizes “mis-valued code analysis” to decrease spending by 0.5%/yr
Washington Committee Highlights
John Wilson, MD and Katie Orrico, JD
 Quality Improvement:
Physician Quality Improvement System (PQRS): physicians eligible for 0.5%
incentive bonus payment; 2% penalty starting in 2016 for not satisfying
reporting requirements
Increased public reporting for Group Practice Reporting Option and
Accountable Care Organization participants on the Physician Compare website
EHR: 2014 is the last year eligible professionals can qualify for payment
incentives for meaningful EHR use. 1% penalty starts in 2015. EHRs must meet
2014 Edition criteria (encouraging information exchange and improved
interoperability)
Accountable Care Organizations (ACOs): data on first 2 rounds of ACO
payments released by CMS. 54/114 ACOs saved money (net $128M), 29 to
receive bonus payments.
Washington Committee Highlights:
John Wilson, MD and Katie Orrico, JD
 Affordable Care Act
Enrollment started slowly in Fall/Winter 2013
1-year delay in small business marketplace announced in November 2013
Individual mandate dropped for those with cancelled health plans in December 2013
Employers with 50-100 employees given to 2016 to offer coverage in February
7M enrollment goal met on 31 March 2014
- lower than hoped for “first time enrollees”
- only 1M “young adults”
Member Activities:
Resident fellows:
 13 fellows were selected for 2014-2015. Applications for the fellowships are
available at csnsonline.org
 The outgoing 2013-2014 fellows were afforded a unique meeting with the
editors-in-chief of Neurosurgery, Journal of Neurosurgery, and AANS
Neurosurgeon
HIPAA, PEDs, and you: Look before you tweet!
 Kimmel KT, Srinivasan V, Colen CB
How CSNS Can Help Achieve Milestones
 Park MS, Gard AP, Rosenbaum B, Pilitsis JG
Updates on Prior Resolutions:
• Medical Student Fellowship: Travis Ladner, Vanderbilt, Quality of Life
Instrument of Chiari Malformation
• Needle-stick injuries during the 80-hour work week, Dr. Chaim Colen
• Resolution V – 2011 F: Neurosurgical Practice Disparities
Dr. David Connor presented data on neurosurgical coverage in
Louisiana, and found coverage to be lacking outside the major academic
centers in New Orleans and Shreveport
• Resolution XIV – 2013S: Establishing neurosurgical coverage between
academic and non-academic neurosurgical practices, Dr. Abou-Samra
Special Reports
 Milestones, Status, and Timeline for Amalgamation of MD
and DO Neurosurgery Training Programs, Dr. Batjer
 The Leibrock Lifetime Achievement Award was presented
to Russel H. Patterson, Jr., MD
Upcoming Meetings