CSNS Update

1. CSNS Update Fall 2013 www.csnsonline.org Prepared by Darlene A Lobel, MD, Julie G. Pilitsis MD,PhD

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. Welcome from the New Chair: Dr. Mark Linskey • Accomplishments • Creation of State and Regional Advocacy platforms for assistance and community advocacy. • Expansion of the Communication and Education Committee • Expansion of socioeconomic content for SANS, CNS university, public relations and communications. • Reinstatement of Young Physicians Representative Section • Development of the Neurosurgical Patent Safety Ad Hoc Committee • Goals • Expansion of representative sections of the CSNS • Reinvigoration of the relationship between CSNS with NERVES, AANN and the ANSPA.

4. Passed Fall 2013 Resolutions • An emergency resolution was unanimously supported for the AANS and CNS to respond to and oppose the recent implementation by the CMS of the “two midnight” rule that would drasticallychange Medicare reimbursement (and charges to the patient) for hospital admissions that do not continue through at least two midnights. • A resolution to study the degree of radiation exposure sustained by neurosurgery residents in training was overwhelmingly supported. • The CSNS will evaluate the potential problems and hazards presented by the widespread health care provider use of personal electronic devices. • A surveywillbedevelopedto study of the various types of neurosurgical practices, their contribution to the advancement of the field, and ways of integrating the disparate groups giving all “a place at the table” of organized neurosurgery. • A resolution to createa way of cataloguing and accessing various socioeconomic surveys produced by the CSNS • CSNS materials will be securely collected and disposed of after each meeting • CSNS meeting information will be placed on the AANS and CNS Annual Meeting websites • Socioeconomic AANS/CNS Seminars will no longer be scheduled during the CSNS Biannual Meeting

5. 2013 Meeting Highlights: State and Regional Advocacy Initiative • Goal: Expand the role of the CSNS to advocate at state and regional levels, to complement the role of the Washington Committee’s national advocacy efforts • Initial steps • Survey sent out to analyze current state neurosurgical society member composition, political contributions, and interest in national advocacy efforts • Median membership of State Societies: 50-100 • 50% donate to a PAC • 34% interested in furthering State Advocacy efforts

6. Washington Committee Highlights:John Wilson, MD and Katie Orrico, JD • Affordable Care Act update Administration added a voluntary delay of the corporate mandate for one year (on companies exceeding 50 employees) HR 2775added a new rule requiring income verification for individuals applying for “premium tax credits.” • Medicare Payments 24.4% reduction in physician payment will begin January 1, 2014 if Congress does not act Additionally, 2% reimbursement cuts for the next 9 years are slated to take effect as part of the sequestration related SGR reductions.

7. Washington Committee HighlightsJohn Wilson, MD and Katie Orrico, JD • Medical Liability Reform: The HEALTH Act to be introduced this year which caps non- economic damages at $250,000 H.R. 36 seeks to protect physicians who provide EMTALA related care by bringing them under the Federal Tort Claims Act. Similar Senate bill S961 has been introduced. H.R. 1473 seeks to prevent the language of laws regarding federal healthcare programs from being used as new standards of care for medical liability lawsuits. • Quality Improvement: The N2QOD maintained by Neuropoint Alliance (NPA) is a registry in which physicians may participate to fulfill the CMS requirement for participation in the Physician’s Quality Reporting System (PQRS). Membership in this database, will prevent penalties and even can create payment incentives for neurosurgeons who participate.

8. Coding and Reimbursement • Cervico-cerebral angiography codes 36221-36227 were reduced by 10% this year • In response, organized neurosurgery joined seven other physician societies in sending a joint to letter to CMS asking for clarification in the ruling on the 10 % reduction of cervico-cerebral codes. • A new method of RVU validation has been begun by the CMS • Changes for complex chronic care management service reimbursement currently favor primary care • AANS/CNS are pushing to provide equal payment to any physician providing the appropriate service. • New “two midnight rule” sparks confusion regarding its implementation • Process for CPT changes has been changed to no longer require society support, however the AMA will now review members of specialty society advisory committees extensively regarding their conflicts of interest.

9. Rapid Response Committee Highlights Payor policy initiatives are being challenged regarding: • Denial of coverage for cervical cages in fusion surgery • Consideration of EMG monitoring during cranial or spine surgery experimental and therefore not reimbursable • Consideration of mechanical embolectomy to be investigational and not medically necessary in the treatment of acute stroke

10. Upcoming Meetings