CSNS UpdateSpring 2014

www.csnsonline.orgPrepared 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) UpdateOne-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 HighlightsJohn 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 DisparitiesDr. 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 ReportsMilestones, 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