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	April 2004 Meeting
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·	Medical Practices Committee Meeting
·	Neurotrauma Committee Meeting
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Medical Practices Committee Meeting

APRIL 30, 2004
Orlando, Florida

Attendees at the meeting were Drs. Tom Francavilla from Alabama, Greg Lanford from Tennessee, Paul Wagnespask from Louisiana, John
Davis from Mississippi, Gary Bloomgarden from Connecticut, Cheryl Muszynski from Wisconsin, Mark Linskey from California, Chris Kent from Nebraska, Julius Goodman from Indiana, Ronnie Mimran from Florida, Ross Jenkins from New Hampshire, and Roger Smith from Louisiana (12).

The meeting was called to order at 12:20pm. Introductions of all new members were made and an attendance sheet was circulated.

Attention turned to old business. The minutes from the October 17, 2003, in Denver, Colorado, Medical Practices Committee Meeting were reviewed. There being no changes or amendments were accepted and approved.

Next status reports were given on the ongoing activities of the Committee. Greg Lanford from Tennessee gave an update on the NERVES Annual Survey Working Group. Since our last meeting in Denver, according to Dr. Lanford, NERVES has been moving ahead with survey design and implementation, but had not been working in a structure, including our representatives or the representatives from the Coding and Reimbursement Committee. According to Dr. Lanford in January NERVES received an opinion from the McGuire-Woods Law Firm stating that no business pre-FTC business review letter would necessarily be required for the activities that are anticipated and furthermore they had sufficient funding solely from NERVES to no longer really require collective contribution through corporate sponsorship. Therefore, they decided to move unilaterally to expedite the process and move it forward more quickly. This was reviewed in a NERVES Executive Committee conference call in February and the NERVES Executive Committee voted 5 to 2 to proceed despite the recommendations of the two liaisons from CSNS suggesting additional time for the originally conceived research partners to review the legal opinion and buy-in to this decision to change course. As the result of their decision NERVES entered into a five-year commitment with Eaton & Edie, an accounting firm who will be performing the actual mechanics for this survey process. NERVES e-mailed notification of their intentions to move ahead to the CSNS, CNS and AANS Chairman and Presidents. One month later NERVES representatives had a meeting with Eaton & Edie and devised a rough draft of a survey data collection instrument. This was circulated to all NERVES members and they anticipate having feedback from that circulation shortly with redesign of the instrument to occur after the NERVES meeting this week and possible circulation for first survey responses in June. The potential consequences for the national organized neurosurgery NERVES practice management data survey efforts of possible withdrawal of support from the Congress of Neurological Surgeons and their requirement that the CSNS also withdrawal financial and participatory survey support for the NERVES survey effort were discussed. It was mentioned that these issues were to be taken up further in CSNS Executive Committee meeting tomorrow.

Next a written report from Clarence Watridge from his Sub-Committee on Unified Practice Management Outcomes Analysis CME/Competency Tracking Database Software was received and reviewed. According to Dr. Watridge’s report there was perception among the neurosurgeons that he polled, as well as the practice management consultant firms that he polled, that the idea of a unified software product for this purpose was of questionable value and potentially not logistically feasible. The point was continually and repetitively made to him that each practice is quite different and therefore requires different approaches to data management and this would be hard to satisfy what a one size fits all type product. At this point Dr. Watridge has asked for additional time for his Committee to further develop for his committee to further develop the idea of exactly what areas of neurosurgical data are in common among all practices and would like to make further report at the fall meeting in San Francisco prior to the CNS Meeting. This committee report was accepted as written by an unanimous vote.

Attention now turned to new business. The first order of business was discussion of Resolution I, Proposed Changes to CSNS Rules and Regulations Allowing Appointees to be Officers. This was presented by John Davis from Mississippi who had done an extensive amount of pre-meeting research. Lengthy discussion of about ½ hour then ensued discussing the multiple issues potentially involved, as well as reviewing currently CSNS Rules and Regulations requirements. There was majority support for the concept of allowing appointees to be nominated and voted into officer positions of the CSNS in order not to lose leadership expertise and experience within the CSNS organization. However, this support was not unanimous and the vote after the end of the discussion was 9 to 3 in favor of supporting the resolution so long as an amendment was made to require delegates who are voted into officer positions give up their delegate status so that additional state delegates would always be appointed from the state of origin of that officer and should mirror the proposed requirement for the appointees.

The next discussion was about Resolution VI, Statement on the Ethics of Non-Participation of Medicare. This was discussed by Dr. Chris Kent from Nebraska. He had also researched this resolution quite well with discussion of the author himself, as well as polling referring physicians in Nebraska and other neurosurgical colleagues. It was the unanimous opinion of the Committee whether or not one participated in Medicare or any other third party payer program was not an issue of ethics and therefore that a statement that the practice was either ethical or non-ethical was inappropriate. Furthermore, there was concern about the potential precedent setting nature of having national neurosurgery organizations make such statements which are really individual practice decisions and non-ethical issues. It was also noted procedurally that the CSNS does not make position statements, but can only request their parent organizations consider making such a position statement at their respective Executive Committee and Board Meetings. Unanimous decision was to come out against this resolution for the reasons stated above.

At this point a call was made for additional new business and no other business being forthcoming the meeting was adjourned at 1:35pm.

Respectfully submitted: