Minnesota Neurosurgical Society

All sessions are at The St. Paul Hotel

 

Friday, September 18, 2015

MNNS Opening Reception and Poster Session

7:00 pm – 10:00 pm

James J. Hill South Room

Saturday, September 19, 2015

Breakfast

8:00 am – 9:00 am

Summit Room

Welcome

Matthew Hunt, MD

9:00 am – 9:10 am

Scientific Session I:  Functional / Spine

9:10 am –10:30 am

Moderator:  Ann Parr, MD, University of Minnesota, Neurosurgery

9:10 – 9:30 am  Paola Testini, MD – “Thalamic Deep Brain Stimulation for Tourette Syndrome: Clinical Outcomes and Neural Network Modulation”

9:30 – 9:50 am Christopher Graffeo, MD – “Type II Odontoid Process Fracture in Octogenarians: Surgical Versus Nonoperative Management”

9:50 – 10:10 am Patrick Maloney, MD – “Radiographic Analysis of Postoperative Delayed Cervical Palsies”

10:10 – 10:30 am David Darrow, MD – “Magnetic Resonance Imaging for Trigeminal Neuralgia: Meta-analysis”

Break

10:30 am – 10:50 am

Scientific Session II:  Peripheral Nerve

10:50 am – 11:50 am

Moderator:  Matthew Hunt, MD, University of Minnesota, Neurosurgery

10:50 – 11:10 am Stepan Capek, MD – “Tumefactive Appearance of Peripheral Nerve Involvement in Hematologic Malignancies: A New Imaging Association”

11:10 – 11:30 am Nikhil Prasad – “The Sub-paraneurial Compartment: A New Concept in the Anatomic Classification of Peripheral Nerve Lesions”

11:30 – 11:50 am Robert Spinner, MD – “Recurrent Intraneural Ganglion Cysts: Pathoanatomic Patterns and Treatment Implications”

Lunch

11:50 am – 1:00 pm

James J. Hill South Room

Distinguished Lecturer

Stephen J. Haines, MD

“The Making of a Neurosurgeon”

1:00 pm – 1:45 pm

Summit Room

Scientific Session III:  Tumor 

1:45 pm – 3:05 pm

Moderator:  Michelle Clarke, MD, Mayo Clinic, Neurosurgery

1:45 – 2:05 pm Catherine Miller, MD – “MAPK Pathway Inhibitor Therapy for Progressive Pediatric Astrocytomas”

2:05 – 2:25 pm Joshua Hughes, MD – “Magnetic Resopnance Elastography and Slip Interface Imaging of Meningiomas, Pituitary Adenomas, and Vestibular Schwannomas”

2:25 – 2:45 pm Paramita Das – “An Oncogene in Medulloblastoma”

2:45 – 3:05 pm Lydia Wheeler – “Clinicopathologic Features of MEN1 Neoplasms”

Break

3:05 pm – 3:25 pm

Scientific Session IV:  General

3:25 pm – 4:25 pm

Moderator:  Anthony Bottini, MD, Park Nicollet Clinic

3:25 – 3:45 pm Ramachandra Tummala, MD  – “Teaching Brain Surgery – Observations of a Young Neurosurgeon”

3:45 – 4:05 pm Avital Perry, MD – “Clinical Correlation of Magnetic Resonance Elastography in Idiopathic Normal Pressure Hydrocephalus”

4:05 – 4:25 pm Anthony Burrows, MD – “Outcomes from Staphylococcus Aureus Colonization Screening and in Patients Undergoing Elective Neurologic Surgery“

Outgoing President Remarks

4:25 pm

Matthew Hunt, MD

Evening Reception, Dinner and Piepgras Awards

6:00 pm – 9:00 pm

Pazzaluna Restaurant

360 St. Peter St., St. Paul

Sunday, September 20, 2015

MNNS Business Meeting

9:00 am – 10:30 am

Hotel Restaurant

Minnesota Twins Game

1:00 pm

Target Field, Downtown Minneapolis

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RESOLUTION I-2015F

Title: INCLUSION OF A PATIENT IMPACT ASSESSMENT ON CSNS RESOLUTIONS

Submitted by: Gary Simonds (Ad Hoc Committee on Patient Safety)

WHEREAS, the principle charge of the CSNS is to act as a forum for the State Neurosurgical Societies to air and discuss socioeconomic issues and concerns; and

WHEREAS, language regarding the centrality of the patient in CSNS activities permeates the official language of the body, for example:

I. PURPOSE, MISSION & VISION 

1. The purpose of the Council of State Neurosurgical Societies is to provide a national forum for the State Neurosurgical Societies of the United States. This forum is primarily for discussion, consideration, and proposals of action regarding socioeconomic issues concerning Neurological Surgery. 
2. The Mission Statement for the Council of State Neurosurgical Societies is as follows: 

The CSNS is a representative, deliberative and collaborative organization of delegate neurosurgeons in training and practice that exists to: 

1. positively influence and affect the socioeconomic policy of organized Neurosurgery for the benefit of Neurosurgical patients and our profession, 
2. serve as a resource for socioeconomic knowledge and education for our Neurosurgical colleagues, regulatory and health care officials as well as legislative representatives, 
3. provide a conduit for new initiatives, concerns and issues to be brought to the AANS and CNS for response and action, and 
4. provide an environment for developing future leaders in healthcare policy and advocacy for Neurosurgery. 

We believe that the specialty of Neurosurgery stands for the highest quality of care and that neurosurgeons are their patient’s strongest advocates. ; and

WHEREAS, the welfare of the neurosurgical patient should be integral in the discourse surrounding socio-economic issues in neurosurgery (for the patient may be directly impacted by any such issues and/or action taken with respect to them); therefore

BE IT RESOLVED, that all resolutions submitted to the CSNS carry a “Patient Impact Assessment”; and

BE IT FURTHER RESOLVED,  that the Patient Impact Assessment of a CSNS resolution comments upon the anticipated effect the resolution will have on neurosurgical patients if its requested action is seen to fruition; and

BE IT FURTHER RESOLVED, that a CSNS resolution author(s) is prepared to discuss the patient impact of the resolution in open testimony at the CSNS plenary session.

Conflicts of Interest: None

Fiscal Note: None

Prior Similar resolutions: None

Committee(s) Assigned:

“This content represents the business of the CSNS meeting and does not represent CSNS, AANS, or CNS policy unless adopted by this body and approved by the parent organizations”

RESOLUTION II- 2015F

Title: Making connections between graduating residents and state societies 

Submitted By: Cara Sedney and Jeffrey Mullin on behalf of the Medical Practices Committee

WHEREAS, graduating neurosurgical residents often relocate upon residency graduation and may not be aware of existing state neurosurgical society infrastructure; and

WHEREAS, state neurosurgical societies and the CSNS have been working to reinvigorate the membership and involvement for these societies and involve young neurosurgeons; and

WHEREAS, a knowledge of the state society and local/state neurosurgeons may be beneficial to the new graduates; and

WHEREAS, the ABNS currently collects new contact information for graduating residents from their program coordinators as part of the board certification process; therefore

BE IT RESOLVED, that the CSNS petition the ABNS for access to this contact information; and

BE IT FURTHER RESOLVED, that this information be utilized to contact the newly graduated residents to connect them to their new state societies and CSNS quadrants.

Fiscal Note: none

Conflicts of Interest: none

Notes:  This resolution was approved for submission by the Medical Practices Committee by email vote on August 12, 2015.

RESOLUTION III-2015F

Title:  “Integrated care pathways” for Neurosurgeons in the Era of the Affordable Care Act

Submitted by: Michelle Smith, Darlene Lobel, and Clemens Schirmer, on behalf of the Medical Practices Committee

WHEREAS, current health care reform places emphasis on care delivery across the continuum of care and utilizes alternative payment models to promote this; and,

WHEREAS, these alternative payment models include concepts such as bundling for disease based practices, value based care, and accountable care organizations for which hospitals and physicians will incur financial penalties for events such as readmissions, patient dissatisfaction, extended length of stay, or hospital acquired infections; and.

WHEREAS, as a response to these alternative payment models, many hospitals are requesting their physicians participate in the creation of “Disease Group Care Pathways”, also known as “Clinical pathways”, “care pathways”, “critical pathways”, “integrated care pathways”, or “care maps” to attempt to standardize a patient’s experience and eliminate variations of care, even when there is no evidence based medicine, in order to cut costs and improve quality; and,

WHEREAS, it is unclear what impact these “Care Pathways” will have on the practice of Neurosurgery; and

WHEREAS, there are few sources of practical knowledge and tools for neurosurgeons to effectively participate in such efforts; and

WHEREAS, there should be a means to share these pathways among Neurosurgeons; therefore,

BE IT RESOLVED, that the CSNS will investigate the extent to which “Integrated Care Pathways” are being implemented in neurosurgical practices, including the impact of these pathways on practice, and will report the findings in a white paper; and,

BE IT FURTHER RESOLVED, that the CSNS create content that describes and explains the practical creation, validation and acceptance of an “Integrated Care Pathway” with relevance to clinical neurosurgery geared towards the busy practicing neurosurgeon and make available such content to both the CSNS membership and neurosurgeon members of the AANS and CNS.

 

FISCAL NOTE:  none

Notes: This resolution was approved for submission by the Medical Practices Committee by email vote on August 12, 2015.

References:

Aston, G. “Service Line Management: Now It’s Critical,” www.HHNmag.com January, 2015, p. 34-37.

Burwell S.M., “Setting Value-Based Payment Goals — HHS Efforts to Improve U.S. Health Care,” NEJM January, 2015, p. 1-3.

RESOLUTION IV-2015F

Title: CSNS resource to access and dispute Physician Payments Sunshine Act Data

Submitted By: Christine Hammer, Darlene Lobel, and Brad Zacharia, on behalf of the Medical Practices Committee.

WHEREAS, the Physician Payments Sunshine Act requires companies participating in United States Federal Health Care Programs to report certain financial relationships with individual physicians and teaching hospitals, including, but not limited to, speakers’ fees and honoraria, travel, meals, research funding, educational items; and

WHEREAS, the Centers for Medicare and Medicaid Services (CMS) implements this reporting through the Open Payments Program; and

WHEREAS, neurosurgeons’ financial data is available to the public through an open-access website; and

WHEREAS, CMS is not required to alert neurosurgeons about newly reported financial relationships, unless they sign up on the Open Payments website to receive alerts; and

WHEREAS, there exists potential for damage to physician and hospital reputations from inaccuracy in reporting, from misinterpretation of reports by patients or those unfamiliar with the reporting format; and,

WHEREAS, neurosurgeons may not know how to access their data, sign up for alerts, or properly dispute or correct a report; therefore

BE IT RESOLVED, that the CSNS will post a link to the Open Payments website on the CSNS website providing neurosurgeons access to their data in order to encourage and accommodate early review and timely disputing; and

BE IT FURTHER RESOLVED, the CSNS will develop and post an informative document on the CSNS website describing how physicians can sign up to receive alerts when new reports are made and learn how to dispute or correct questionable reports.

Fiscal Note:  None

Conflicts of Interest: none

Notes: This resolution was approved for submission by the Medical Practices Committee by email vote on August 12, 2015.

RESOLUTION V-2015F

Title: Assessing the impact of ICD-10 on neurosurgical practices and patient access to neurosurgical care

Submitted by: Luis M. Tumialán MD, Darlene Lobel MD, Todd Barnes MBA, and  Derek Cantrell

WHEREAS, the effects of the coding change from ICD-9 to ICD-10 are likely to have an impact on physicians and medical practices; and

WHEREAS, many of the changes may affect the productivity of physicians and the operation of their offices; and

WHEREAS, these changes may have a negative impact on the work flow of clinical operations and outpatient volumes; and

WHEREAS, the collective effect of the implementation of ICD-10-CM may result in decreasing patient access to neurosurgical care; therefore,

BE IT RESOLVED, that the CSNS will measure the impact of ICD-10 implementation by conducting a survey in collaboration with NERVES, that will be administered to the AANS, CNS, and NERVES membership, and that this survey will measure such factors as outpatient clinical volumes, surgical volumes, number of days of account receivables, charge lag, collections, denials, and cash flow ; and

BE IT FURTHER RESOLVED, that this survey will be sent out in two phases: the first survey will collect data from three months prior to until three months after ICD-10 implementation, and a second survey will be distributed six months after ICD-10 implementation to measure any changes from the initial survey; and

BE IT FURTHER RESOLVED, that a white paper summarizing the finding of the surveys will be drafted and distributed to AANS and CNS members.

Fiscal note: None

Conflicts of Interest: None

RESOLUTION VI-2015F

September 2015 CSNS Proposed Resolution

Title: Evaluating the impact of the medical review panel process on neurosurgical malpractice litigation

Submitted by: Bharat Guthikonda, MD; Richard Menger, MD; Cathy Mazzola, MD on behalf of the CSNS Medicolegal Committee

WHEREAS, The Medical Review Panel Process is in place in 17-20 states to evaluate medical malpractice litigation claims prior to proceeding to a trial and

WHEREAS, The Purpose of the Medical Review Panel is to provide, with the assistance of a judge, a consensus opinion as to whether the physician plaintiff acted within or outside the acceptable standard of care and

WHEREAS, the CSNS in invested in providing support for organized neurosurgery and protecting the neurosurgical community against frivolous litigation therefore

BE IT RESOLVED that, by the 2016 Spring CSNS meeting, the CSNS will assess the effectiveness of the medical review panel process in preventing frivolous litigation pertaining to neurosurgery only , and

BE IT FURTHER RESOLVED that, if the medical review panel process is found to be helpful in protecting neurosurgeons against frivolous litigation, then the CSNS will formulate a statement of support / recommendation that the medical review panel process should be adopted in all 50 states

RESOLUTION VII-2015F

Title: Expansion of Non-delegate, non-appointee participation in CSNS activities

Submitted By: Clemens M. Schirmer and Scott Simon, on behalf Young Neurosurgons Representative Section (YNRS) and Website Committee.

WHEREAS, a recent change of the CSNS rules and regulations in Spring 2015 (see summary of changes referenced below) has created the category of Non-delegate, non-appointee individuals (NDNA); and

WHEREAS, there exist a current mandate from the chair and EC to expand membership and participation within the Young Neurosurgeons Representative Section (YNRS) from the larger body of eligible neurosurgeons to; and

WHEREAS, the use of the double negative in the NDNA designation could be considered repudiative and a disincentive for engagement of the target group of young neurosurgeons

WHEREAS, there is an ongoing lack of recognition of status and academic standing of the CSNS from the perspective of program directors and department chairs when ask to grant leave to attend the CSNS meeting due to the lack of a formal membership that signifies ongoing scholarly interest and engagement in organized neurosurgery; and

WHEREAS, currently there does not exist a membership class or coherent treatment of such individuals that allows access to protected portions of the CSNS website and ongoing participation in committee work that may require such access; therefore

BE IT RESOLVED, that the CSNS move to amend the rules and regulations to modify the description of the NDNA category to the positive descriptor “Affiliate”; and

BE IT FURTHER RESOLVED, that the new class of affiliates (NDNA members) of the CSNS are granted appropriate website access to foster collaboration and work on the committee level; and

BE IT FURTHER RESOLVED, that the CSNS further define and clarify the interpretation of the rules and regulations changes from Spring 2015, which created the status and privileges of Non-delegate, non-appointee individuals (NDNA) pertaining to the internal work of the CSNS with consideration of creation of a “Affiliate” membership class and a administrative framework to apply for and be granted membership similar to other Joint AANS/CNS Sections in order to further attract lasting interest and participation of neurosurgeons in the CSNS.

Fiscal Note: none

Prior Similar Resolutions: none

Conflicts of Interest: none

References:

1. Summary of Spring 2015 CSNS Rules and Regulation changes pertaining to the above

1. …
2. Followup on resolution XIII-2013F – Non delegate, non-appointee (NDNA) participation
   1. R/R committee worked on language for proposed change to allow participation by these individuals (see attached R/R version)
   2. Proposal outline
      1. NDNA individuals may serve on standing committees and help participate in committee work
      2. NDNDA individuals may provide testimony at plenary sessions if recognized to do so by the Chair of the CSNS  but must identify themselves as such
      3. NDNA individuals hold no right to vote, either in committees or at the plenary session
      4. NDNA individuals may not serve as committee chairs
      5. NDNA individuals who participate in CSNS functions are welcome at CSNS functions (lunch, reception)
   3. If we accept the wording for this, Appendix A also requires modifications (see attached proposed R/R)
3. …

2. Definition of Young Neurosurgeons as part of YNRS

Representative Section of the CSNS whose members are within 10 years of completion of training and are interested in advancing socioeconomic issues of particular interest to neurosurgeons, including job search, practice initiation, Board certification and recertification, training conditions, practice economics, and other related topics.  The mission of the Young Neurosurgeons Section is to educate, interest, and involve recently graduated and resident neurosurgeons in current CSNS and AANS/CNS organizational activities related to socioeconomic issues of neurosurgery practice. This committee undertakes research and report or educational projects on issues of particular interest to young neurosurgeons, including job search, practice initiation, Board certification and recertification, training conditions, practice economics, and other related topics.

RESOLUTION VIII-2015F

TITLE: Development of new quality reporting measures

Submitted by: Cory Hartman, Darlene Lobel, Clemens Schirmer, and Brad Zacharia

WHEREAS, the Physician Quality Reporting System (PQRS) is a quality reporting system established by the Center for Medicare and Medicaid Services (CMS) for reporting quality of services provided to Medicare; and,

WHEREAS, CMS requires individual eligible professionals (EPs) and group practices to report a set of  Clinical Quality Measures (CQM) as stipulated in the criteria for meaningful use stage I-III and CMS final rule 77; and,

WHEREAS, quality measures were intended to be indicators of the quality of care provided by a specific practitioner or practice; and,

WHEREAS, the many of the quality measures established by the CMS are the result of coming up with a lowest common denominator for all physicians and may not be appropriate measures to represent the care provided by neurological surgeons; and,

WHEREAS, individual EPs and group practices who do not satisfy report data on quality measures for Medicare Part B Physician Fee Schedule (MPFS) in 2015 will face the 2017 PQRS negative payment adjustment; and,

WHEREAS, the importance of satisfactorily reporting on quality measures through PQRS is critical due to CMS making performance data available to the public in 2016; therefore,

BE IT RESOVLED, that the CSNS develop a white paper which describes the process of creating a reportable quality measure that is relevant to neurosurgical practice; and,

BE IT FURTHER RESOLVED, that the CSNS establish a web base tool accessible to all neurologic surgeons that will aid in the identification of PQRS quality measures applicable to neurologic surgeons; and,

BE IT FURTHER RESOLVED, that the CSNS offer to work with the AANS and CNS, and work, in particular, with the Quality Improvement Council to establish a Potential Neurological Surgery Preferred Specialty Measure Set specific to the care of neurosurgical patients.

Fiscal Note: none

Conflicts of Interest: none

References:

2015 Physician Quality Reporting System (PQRS): Implementation Guide, accessed at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_PQRS_ImplementationGuide.pdf

RESOLUTION IX-2015F

Title:

Assessment of the Impact of Mobile Technology in the Neurosurgical Operating Room

Submitted by:

Debraj Mukherjee, MD, MPH and Clemens M. Schirmer, MD, PhD

WHEREAS, the use of mobile technologies have dramatically increased among healthcare providers over the past decade; and

WHEREAS, use of mobile devices, particularly in the operating room, has been of increasing interest to patients and the general public; and

WHEREAS, such interest has primarily revolved around the balance between mobile technology’s ability to improve communication and enhance productivity for surgeons, in contrast to concerns over it’s potential role in causing distraction or contamination in the operating room; and

WHEREAS, formal position statements focusing on the use of mobile technologies in the operating room have been issued by the American College of Surgeons (ACS)¹, American Academy of Orthopaedic Surgeons (AAOS)², and the Association of periOperative Registered Nurses (AORN)³; and

WHEREAS, organized neurosurgery has yet to formally address the role of mobile technology within the operating suite; therefore

BE IT RESOLVED, that the CSNS develop a white paper to study the issue of mobile technology use in the neurosurgical operating room; and

BE IT FURTHER RESOLVED, that the CSNS request that the parent organizations develop a position statement on the use of mobile technologies in the neurosurgical operating room.

Fiscal Note: None

Conflicts of Interest: None

References:

1. College’s Committee on Perioperative Care. Statement on use of cell phones in the operating room. Bull Am Coll Surg. 2008 Sep;93(9):33-4.

2. American Association of Orthopaedic Surgeons. (December 2014). “Information Statement: Surgeon and Surgical Team Concentration”. http://www.aaos.org/about/papers/advistmt/1041.asp

3. Association of periOperative Registered Nurses. (January 2014). “AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care”. http://dx.doi.org/10.1016/j.aorn.2013.10.010

RESOLUTION X-2015F

Draft Resolution for Fall 2015 CSNS Meeting

Title: Development of recommendations for appropriate use of personal electronic devices and social media by neurosurgeons

Submitted By: Kristopher T. Kimmell, Jordan Amadio, G. Edward Vates

WHEREAS, neurosurgeons, like other healthcare providers, are increasingly dependent on personal electronic devices (PEDs) to carry out their workflow in caring for patients,

WHEREAS, PED use also carries significant risk secondary to potential security breach of personal health information (PHI) and distraction during patient care,

WHEREAS, these risks are a focus in the media and have resulted in medicolegal action in some instances,

WHEREAS, both PEDs and social media use (such as Facebook, Twitter, Doximity, and LinkedIn) engender both risks and positive opportunities for practicing neurosurgeons,

WHEREAS, several other specialty organizations have developed guidelines for clinicians in use of these devices in patient care areas (such as the operating room) as well as use of social media technologies,

WHEREAS, the CSNS has recently developed educational material to neurosurgeons regarding appropriate use of PEDs (RESOLUTION VII-2013F),

BE IT RESOLVED that the CSNS petition its parent organizations to develop formal recommendations on the appropriate use of PEDs and social media in healthcare delivery and patient care, and

BE IT FURTHER RESOLVED that the CSNS provide our parent organizations with three work products that can be distributed to members:

1. How can neurosurgeons protect PHI when they use PEDs?
2. Benefits and pitfalls of PEDs in the OR and clinic: what every neurosurgeon should know.
3. Social media guidelines: best practices for neurosurgeons.

Previous resolutions: RESOLUTION VII-2013F

References

“Do Cell Phones Belong in the Operating Room?” http://www.washingtonpost.com/national/health-science/do-cellphones-belong-in-the-operating-room/2015/07/13/f524e908-1e9e-11e5-aeb9-a411a84c9d55_story.html

McGirt MJ. mHealth: The emerging role of mobile technology in healthcare delivery re-engineering. CNS Quarterly, Winter 2014

“ACS, as a Member of CSPS, Endorses Noise Reduction Resource”  https://www.facs.org/publications/newsscope/noise0515#sthash.m44Za9U2.dpuf

“Information Statement: Surgeon and Surgical Team Concentration”

http://www.aaos.org/about/papers/advistmt/1041.asp

‘Communication Devices: Personal cell phones, computers, tablets and other communication devices have become indispensable and critical tools for timely communication and acquisition of important information. Effective use of these devices is important to fulfill clinical responsibilities. Removal of these devices is impractical and may be dangerous in some critical care environments. However, inappropriate and unnecessary use in OR settings may introduce distractions and prevent focus on the important clinical task at hand. It is important for OR policies and procedures to assure appropriate use of such devices in the OR setting to promote optimal surgical and emergency care.’

“Technology: An Uninvited Guest in the O.R.?” http://www.asahq.org/resources/publications/newsletter-articles/2015/april-2015/technology-an-uninvited-guest-in-the-or

“Professional Use of Digital and Social Media” http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Professional-Liability/Professional-Use-of-Digital-and-Social-Media

“Surgeons and social media: Threat to professionalism or an essential part of contemporary surgical practice?” http://bulletin.facs.org/2015/08/surgeons-and-social-media-threat-to-professionalism-or-an-essential-part-of-contemporary-surgical-practice/

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