CSNS Update

1. CSNS Update Spring 2014 www.csnsonline.org Prepared by Michael S. Park, MD

2. 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.

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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.

11. 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”

12. 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

13. 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. ChaimColen • 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

14. 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

15. Upcoming Meetings