Archive for May, 2009

Council of State Neurosurgical Societies Plenary Session:

Nerves: what is it, who belongs.

Neurosurgery Executives Resource Value & Education Society (NERVES) provides assistance in the art of neurosurgery practice management and is an initiative of the CSNS )Council of State Neurosurgical Societies). From the organization’s website:

What can NERVES provide to a neurosurgical practice?  First, NERVES establishes  a strong networking connection to other practices all over the United States.  Secondly, NERVES holds an annual education meeting adjacent to the AANS conference each year.  Informative speakers, breakout sessions, round table discussions, and vendor exhibits help administrators and managers further develop and enhance their practices. Thirdly, NERVES provides current benchmarking data.  In 2003 a NERVES data survey was distributed and collected from NERVES members.  This data addresses a wide variety of valuable information such as physician compensation & benefits, benchmarking data, total and work RVUS, and average CPT allowables by code.  In the first two years of the survey, data was compiled and became an important resource for neurosurgery practices to take steps to significantly increase their bottom line. Lastly, NERVES has developed and implemented a NERVESGOOGLE list serve for its membership. Practice managers can email questions out on the list serve and receive answers from other NERVES members.  This process has become a valuable tool to capture reliable practice management information in a quick fashion.

For more information, go to nervesadmin.com.

CSNS Resolutions, 2009:

Resolution to develop guidelines for peer to peer  utilization review process that addresses the need for specialty specific review, accountability and transparency

Asks for a white paper to address these issues. Appears that the AMA has recognized the problem with peer review issues for at least the past 20 years. Policy statements appear to exist in spades and tis will likely duplicate those efforts already expended over the past several decades which may not have effectively impacted the problem.

Resolution to reassess the use of methylprednisolone in acute spinal cord injury, resolution.

Asking for an interim update on these guidelines

CSNS and NERVES develop a list of resources regarding acceptable methods for determining usual and customary fees. Further resolution that the Washington Committee support pt access to neurosurgical care by preserving fair compensation for care provided out of network.

No debate

Trauma Surgeon management of traumatic brain injuries. Resolution: AANS and CNS to work with ABSN to issue a joint position statement to the AAST asserting that training required to fully understand and care for both acute surgical and non-surgical traumatic brain injuries requires the completion of a neurosurgical residency.

Discussion: Any barrier which prevents a neurosurgeon from participating in the care of TBI patients impedes patient care. Radical elements of Trauma Surgeons have backed down slightly in their push to perform emergency craniotomies. Another joint position statement may be duplicative and unnecessary. Maybe a better move would be to put out a position paper on neurosurgeon’s responsibilty in managing trauma. Do neurosurgeons shirk trauma responsibilities and create a practice opportunity for trauma surgeons to perform necessary services?

Resolution: CSNS investigate currently avail skills competency training and virtual reality training tools could efficiently contribute to neurosurgery resident training and potentially improve quality of care.

No debate.

Resolution: AANS/CNS through Washington Committee work to make any federal legislation that provides for transparency in the relationship between physicians and industry acceptable to neurosurgeons.

No meaningful debate.

Resolution: AANS/CNS through Washington Committee work to make any federal legislation that provides for transparency in the relationship between physicians and industry acceptable to neurosurgeons. The CSNS should create an educational module to inform our membership and the public about existing AANS and CNS Guidelines and Policies regarding management of conflict of interest pertaining to neurosurgeons and industry.

No meaningful debate.

Resolution: CSNS urges the AANS and CNS through the Washington Committee to support the general principle of a national medical device registry based on the concept of a unique device identification number (UDI).

Referred back to committee for more study before accepting this resolution. Concern regarding physician responsibilities about device recall, level of detail and documentation required.

Washington Committee Report:

Gail Rosseau possible candidate for Surgeon General

Proposals for Healthcare Reform:

Baucus and Daschle proposals

Cost containment will be paramount. Mo=re interest among employers in healthcare reform  because employer health benefit costs have more than doubled since Hillary care first proposed.

Most stakeholders agree on core principles; breaking points center on financing issues.

Daschle Plan:

Medicare outcome measures linked to pay. All Americans required to have health care. Federal Health Board insulated from “politics” would oversee Fed health Care programs, set terms for private insurers who participate in Fed employees insurance pool. Assess effectiveness and costs of treatment.

Sustainable Growth Rate formula for Medicare: Reform costs keep escalating. 318 billion more next 10 years if reimbursement remains flat.

Obama Plan: 329 billion to wipe out SGR debt now reduced to 38 bill.

Our proposal: Replace SGR with Service Category Growth Rate (SCGR): Imaging and testing, minor procedures are leading increases in volume; major procedure have declined in volume. SCGR keeps funding reform focussed on separate “buckets” of resource allocation.

operationpatientaccess.facs.org Surgery’s message regarding need for health are reform and patient access issues. Focus is unduly on primary care problems.


CMS Chronic Care Management, Medical “Home”

Hospital Readmissions and Bundling

Penalties for MD’s who exceed imaging ordering volumes of 5%.

Senate Finance Committee:

Best case: 6% increase for surgeons, 16% increase for primary care and rural surgeons.

Worst case: 35% decrease for surgeons, 30% decrease for primary care and rural surgeons.


Only Medicare reform may survive budget reconciliation process, if Dems can’t get 60 votes in the seante.

temporary Medicare physician payment fix to prevent 22% cut but with “poison pills” (budget neutral primary care bonus)

Neurosurgical training restrictions (“neurosurgery’s finest hour?”) Not favorable but better than anticipated. Max shift of 16 hours without sleep. Max in hospital call every third night. Neurosurgery program rules may be different than those accepted for other specialties.

Emergency Neurosurgical Care

Regionailzation demonstration programs;

better reimbursement for ER care

Summary: Hope not warranted at this point. See Despair.com

Coding and Reimbursement Committee

21% cut in 2010

61793 Stereotactic radiosurgery  17.75 wRVU, 32.05 total RVU

Issues was multiple mets Rx with -51 modifier

New Codes for Stereotactic radiosurgery 2009

10.79 wRVU, complex lesion wRVU same

Refinement panel to meet this all regarding neurosurgery’s appeal. Some additional RVU’s but not likely parity with pre-2009 codes.

Scrutiny for lowering code RVU’s based upon increasing volume and codes which often combine.

63655 laminectomy is undervalued

Issue to bundle codes 63075/22554 together for ACDF (occur together 95% of the time). New code due in 2011. Plate 22845 may also be bundled (70% concurrent submission)

Quality Improvement Update

Comparative Effectiveness Research CER: Topics submitted for investigation:


Cervical myelopathy

Vertebral augmentation

Health Information Technology Program (HIT)

Progresses from trivial bonuses to large financial penalties by 2015.

2009 PQRI measurement appropriate to Neurosurgery (Google)

CMS questions worth of these procedures: lumbar fusion, vertebroplasty, BMP, Axiallif, Xstop.


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