·	Organizational Chart
·	Roster of State Delegates and Alternates
·	Past Meeting Archives
	April 2004 Meeting
·	Plenary Session Minutes
·	Resolutions Submitted
·	Resolutions Results
·	Communications and Education Committee
·	Medical Practices Committee Meeting
·	Neurotrauma Committee Meeting
·	Reimbursement Committee
·	Workforce Committee
·	Young Physicians Committee
	Quadrant Reports:
·	Northwest
·	Northeast
·	Southwest
·	Southeast

CSNS PLENARY SESSION ORLANDO 4/30/04

I.  Call to Order/Dr. Boop-
Dr. Boop called the plenary session to order at 12:00 p.m.. Dr. Boop reviewed the resolutions from last year. Dr. Deborah Benzil will give a report on nurse practitioners and PA's. Also, Dr. Perez-Cruet will report progress on the resolution calling for the creation of a socioeconomic peer review journal. Reports on the resolution calling on the American Board of Neurological Surgeons to allow representation from CSNS will be made by both Dr. Jiminez and Dr. Ralph Dacey. A resolution calling for the AANS and CNS to publish a list of all sanctioned neurosurgeons was passed and the congress has decided that from this time forward they will publish all names. The AANS will address this at this meeting and will announce their decision.

II.  Vice-Chairman's Report/Dr. Diaz
Dr. Diaz introduced the resident members and thanked Sofamor Danek for their continued financial support of the resident delegate program.

III.  Recording Secretary Report/Dr. Rigsby
Dr. Rigsby presented the minutes from the Denver meeting. They have been posted on Neurosurgery.org and have been available online for review. A request for approval of the minutes was made, seconded and no changes or additions were made.

IV.  Corresponding Secretary Report/Dr. Zusman
Dr. Zusman reminded the quadrants that the Northwest and Southwest quadrants will elect quadrant chairpersons and vice chairpersons. In addition, the Southwest and Northwest quadrant will obtain names for regional director for the AANS. These names will then be forwarded as a mail ballot for a vote by the membership.

New residents will be picked from the Northeast and Southwest quadrants and the Northwest and Southeast quadrants will ask for the names of new residents to be elected at the fall meeting. In addition, the quadrants should select a list of names for nominations for all the AANS posts and this will be due by September.

V.  Treasurer's Report/Dr. Bloomgarden

Dr. Bloomgarden - "We have money - not a lot, but we have money". Dr. Bloomgarden reported that the state voluntary fund has a balance of $50,129.47 secondary to contributions and return of money from other projects. However, liabilities include a $10,000 contribution to Neurosurgeons to Protect Healthcare Access, $5,000 to the Neurosurgical Research and Education Fund and various awards. This leaves a balance of approximately $33,000. The resident fund has approximately $5,000 and it was noted that Medtronic will give $12,000 per year to support this endeavor. Dr. Bloomgarden discussed the proposed budget for the year 2004-2005 and noted that the total budget of $105,800 was up $200 from the previous year.

There had been some concern that food and beverage costs had been out of line, but on further evaluation this had taken in account money that was going to be given to NERVES. However, this money is being recouped, as NERVES would not need it and thus the expenses are in line with previous years.

VI.  Special Presentation

Dr. Zusman called Melany Thomas to the podium and gave her special thanks for her years of service to the council, but especially the help that Ms. Thomas had given Dr. Zuzman during her tenure as corresponding secretary. A bouquet of roses was presented and a standing ovation was given to Ms. Thomas

VII.  Lifetime Achievement Award/Dr. Schwetschenau

Historian of the CNS, Dr. Robert Schwetschenau, announced that account number 48040 with the Neurosurgery Research and Education Fund had been set up to be 100% tax deductible. The money from this would go to fund the lifetime achievement award and members of the CSNS were encouraged to support this. This account can be accessed through neurosurgery.org.

VIII.  Liaison and Committee Reports

A.  Nominating Committee/ Dr. David Jiminez - Dr. Jiminez reported that he, as past chairman, and the four quadrant chairs had nominated Dr. Mick Perez-Cruet as corresponding secretary. It was also noted that nominations could be made from the floor and the vote would take place on Saturday.

B.  AMA Report/Dr. Phil Tally-Dr. Tally gave out an extensive handout which was a compendium containing facts on the issues of medical liability and reform. In addition, he explained the AMA's new strategy to allow "practical to tactical" ideas. The professional liability insurance issue has been fragmented to allow the senate to vote on various aspects of it and thus divide the issue into smaller and possibly more palatable issues. By doing this, the plan would be to make the senators vote on the issue more than once and thus increase their chances of exposing themselves to their constituents as being anti-patient care. OB, trauma and rural issues are the next vote to be taken by the senate.

In addition, the AMA has pushed for tax credits for the uninsured. Also, alien indigent care has been addressed and money has been allocated by the congress for this. However, Dr. Talley noted that this may be difficult to collect at this time, but members may want to look into this, especially in states that have a high number of illegal aliens.

The SGR formula, which ties the conversion factor for Medicare reimbursement to the economy, is being reviewed and hopefully will be addressed soon.

A warning was given that Physician Assistant and Nurse Practitioner reimbursement may be shifted into hospital DRG's payments, thus instead of PA's billing Medicare independently and directly, they would be paid by the hospital, as the money for this would be assumed to be included in the DRG. This would save CMS approximately15% of surgical assistant fees and this is being strongly opposed by the AMA.

C.  American College of Surgeons /Dr. Fernando Diaz - Dr. Diaz reported that the American College of Surgeons met in October 2003 in Chicago and he attended. This would be his last meeting, as Dr. Dom Esposito will be the new CSNS representative to the American College of Surgeons.

D.  WINS/Dr Deborah Benzil - Dr. Deborah Benzil discussed activities of the Women in Neurosurgery group. She noted that there are 175 board certified female neurosurgeons in the U.S. and 10% of the graduating class will be female. The WINS will present the Ruth Kerr Jacoby lecture o Tuesday, 5/4/04 from 5:30-7:00p.m. The speaker will be Greg Mortenson and his topic will be "Fighting Terrorism with Books" At the Advanced Leadership Seminar on 5/2/04 the Lois Eisenhardt Scholarship Award will be presented for the best resident paper.

E.  By-Laws Committee/Dr. Edie Zusman - - Dr. Zusman presented the new bylaws book and this has been distributed t the membership prior to the meeting in their packets. Comments from the floor congratulated Dr. Zusman for an excellent job in reviewing and compiling the Rules and Regulations for the new CSNS book.

F.  CSNS Appointees/ Dr. William Bingaman - Dr. Bingaman reported that 16 appointees from the CNS are present and they will be contributing in committee meetings. New appointees were presented, including Aaron Cole Gadol and Holly Gilmore-Hill.

G.  AANS Appointees /Dr. Boop- These were presented by Dr. Boop, as Dr. Cozzens was unable to attend at the time of the report. Dr. Boop reported that Dr. Harold Portnoy had given up his AANS appointeeship to allow Dr. Jamie Metcalf to become a AANS appointee. Dr. Phil Carter gave up his appointeeship. This allowed Dr. Mark Linskey to become a AANS appointee.

H.  Socioeconomic Fellowship/Dr. Boop - Dr. Scarrow was unable to attend. Dr. Boop reported the Charles Plant Public Policy Fellowship, which is sponsored by the Congress of Neurological Surgeons, provides $80,000 to study public policy. Dr. Alan Scarrow was the first fellow and spent time with Senator Hillary Clinton. It was noted that the CNS may do away with this fellowship if it is unused and members of the audience or members of their respective State Society,were encouraged to apply for the scholarship.

IX.  Reference Committee Testimony

Vice Chairman Fernando Diaz chaired the Reference committee. Members of the committee included Dr. Ross Jenkins, Dr. Steve Natelson, Dr. Holly Gilmore-Hill, Dr. Deepak Awasthi, Dr. Satish Krishnamurthy and Dr. Joshua Rosenow. Testimony was then taken on each of the 7 resolutions. The meeting adjourned at 4:30 and the members were encouraged to report to their quadrant caucus meetings and the meeting was set to resume at 8:00 a.m. on 5/1/04.

IX.  Reference Committee Testimony

Vice Chairman Fernando Diaz chaired the Reference committee. Members of the committee included Dr. Ross Jenkins, Dr. Steve Natelson, Dr. Holly Gilmore-Hill, Dr. Deepak Awasthi, Dr. Satish Krishnamurthy and Dr. Joshua Rosenow. Testimony was then taken on each of the 7 resolutions. The meeting adjourned at 4:30 and the members were encouraged to report to their quadrant caucus meetings and the meeting was set to resume at 8:00 a.m. on 5/1/04.

CSNS PLENARY SESSION ORLANDO 05/01/04

I.  Call to Order/ Dr. Boop

Vice Chairman Fernando Diaz chaired the Reference committee. Members of the committee included Dr. Ross Jenkins, Dr. Steve Natelson, Dr. Holly Gilmore-Hill, Dr. Deepak Awasthi, Dr. Satish Krishnamurthy and Dr. Joshua Rosenow. Testimony was then taken on each of the 7 resolutions. The meeting adjourned at 4:30 and the members were encouraged to report to their quadrant caucus meetings and the meeting was set to resume at 8:00 a.m. on 5/1/04.

Dr. Boop then conducted election for Corresponding Secretary. He called for nominations from the floor and none were made. Dr. Perez-Cruet was then elected by unanimous affirmation.

II.  Debate and Voting of Resolutions

Resolution I - The Reference Committee recommended an amendment: BE IT RESOLVED that the current Rules and Regulations be amended to allow CNS and/or AANS appointees who are members in good standing of their state society be elected to officer positions within the CSNS; and BE IT RESOLVED that the changes required in the CSNS Rules and Regulations needed for the implementation of those elections be referred to the Executive Committee of the CSNS for development. Testimony was heard for and against this from the floor. A vote was taken and the measure passed.

Resolution II - Referred to the Medical Legal Committee for report to the Washington Committee. BE IT RESOLVED that AANS, CNS and the CSNS present a physicians statement to hospitals encouraging them to provide medical professional liability insurance coverage in exchange for neurosurgical ER coverage.

Resolution III - Was not adopted

Resolution IV - Was rejected

Resolution V - A substitute resolution was proposed and a vote accepted the amendment. BE IT RESOLVED that the CSNS recommends that the AANS, CNS and state societies reaffirm the importance of injury prevention programs, including the support of mandatory helmet laws for motorcycle riders throughout the United States.

Resolution VI - Was rejected

Resolution VII - Was amended to read:
BE IT RESOLVED that the CSNS recommend that the AANS E-blast shall include a link to the calendar of events on the AANS website and that the calendar of events will include submissions by state and regional neurosurgical societies, regardless of whether or not the events are AANS co-sponsored. This was accepted..

III.  General Reports and Presentations

A.  Coding and Reimbursement Committee - Dr. John Wilson substituted for Dr. Hassenbusch who was unavailable. Dr. Wilson reported new codes have been brought up and valued by the RUC, including deep brain stimulator and re-programming, and laminoplasty, which will include three different codes. A category III code for carotid stenting has been moved to category I and will be valued by the RUC. It was noted that carotid stenting is a non-coverage procedure by CMS and this is being worked on. A tracking code for artificial disk placement will be presented at the next CPT coding panel. This will give an idea of the frequency of the procedure so it can be valued.

B.  Washington Committee Update/Dr. Bean and Ms. Orrico - Dr. Bean reported on the Medicare Reform Legislation that had passed. He noted that physician payment had increased 1.5% for 2004 and 2005, but would drastically change in the years following this. He also noted that the issue of whether ICD-9 versus ICD-10 would take the place of CPT coding for physician services had been addressed and CPT was left alone. He also reported there had been regulatory reform which balanced audit criteria, E&M documentation guidelines and also addressed EMTALA rules. Furthermore, electronic prescribing would be voluntary. Medical savings accounts would now be called Health Savings Accounts and would have no restrictions. It was also reported that there would be an 18 month moratorium on new physician owned hospital ventures while Medpac performs a study to judge the impact of specialty hospitals.

Dr. Bean reported under Medicare physicians fee schedule that the conversion factor had increased 1.5% for 2004 and 2005, but PLI expenses only increased 1% for neurosurgery. Practice expenses increased for clinical staff time. The overall reimbursement of neurosurgeons increased 2.5% to 3%. The graph comparing projections of physician payment update with no legislation, versus the Medicare bill as passed, showed that after 2005 there will be a steep decline and by mid 2007 the reimbursement would go lower than it would have been had there been no legislation. The Washington Committee is addressing this vigorously. It was noted that the Sustainable Growth Rate (SGR) is the rule for changing the conversion factor and since the economy is in decline the growth rate has declined as well. The Medicare Reform Act will be reconsidered in the next couple of years and will hopefully stop this decline.

C.  EMTALA - The EMTALA reform has been addressed and it is now noted that there is no "rule of three" and working 24 hours per day, 7 days per week, 365 days per year is not required. In addition, simultaneous call and elective surgery while on call is now approved. In addition, it is acceptable to transfer a patient to a hospital where the on call physician is located, if the benefits of transfer outweigh the risks. EMTALA regulations now stop when the patient is admitted to the hospital and EMTALA applies only to hospital owned entities with dedicated emergency departments.

D.  Neurosurgical Campaign for Medical Liability Reform - Dr. Bean discussed medical liability reform and explained that the goal is to pass a federal medical liability reform. In the short term we need to change votes in the senate and in the long term the goal is to change the Senate to be more favorable towards medicine. Dr. Bean reported the facts that medical liability awards are increasing and that the national average jury award in medical liability cases topped six million dollars in 2002. In addition, these awards are driving up premiums. The average PLI premium was $44,900 in 2000 and in 2004 had grown to $91,848 which represents a 100% increase in premiums. These figures are based on a survey that had been sent out to neurosurgeons with over 800 neurological offices reporting. As a result, it was noted that 56% of neurosurgeons have limited their services and no longer treat brain tumors or aneurysms, no longer operate on children and no longer perform complex spine procedures. In addition, 44% of neurosurgeons no longer treat Medicare, Medicaid and uninsured patients. 35% of neurosurgeons have altered emergency call coverage by limiting certain ER services and reducing their hours and days on call or stopping ER call altogether.

Thus, the patient access to neurosurgical care is in jeopardy. As a result of increased premiums and the risk of lawsuit, 19% of neurosurgeons will likely move to another state where premiums are stable. 1/3 of neurosurgeons will likely retire from practice. 8% of neurosurgeons will likely sell their practice and become salary-based physicians and 22% of neurosurgeons will make no change. This also limits patient access to care. For this reason, a MICRA type reform is necessary on a national level to control the crisis. It is noted that in those states where MICRA style reforms have taken place that the premiums had risen only a small amount compared to other states, such as Illinois where premiums had risen from $70,000 in 2000 to over $200,000 in 2004. The House of Representatives passed HR-5, the Health Act on 3/13/03. President Bush wanted to sign the Health Act into law, but this reform was stalled in the U.S. Senate, which needs 60 votes to overcome any democratic led filibuster. It is interesting to note that the first act failed 49 to 48 on 7/9/03. Senate bill 2061, Healthy Mothers and Healthy Babies Access to Care failed 48 to 45 on 2/24/04 and senate bill 2207, Pregnancy and Trauma Care Access Protection Act failed 49 to 48 on 4/7/04. There are continued votes planned to include rural and voluntary services. To achieve reform we need to change Senators' votes and thus an educational program to put constituent pressure on Senators to change their votes is needed. When the Senators perceive their will be political consequences for their continued opposition, they will perceive that they will lose their election and they will change their vote. Thus, the vehicle for change was the Doctors for Medical Liability Reform "DMLR", which is composed of 11 national medical specialty societies. The leading institution was Neurosurgeons to Preserve Healthcare Access, which had been created by the AANS and CNS. With the leadership of those two organizations, ten other medical specialties joined, including American Association of Orthopedic Surgeons, American College of Emergency Physicians, American College of Surgeons Professional Association, Society of Thoracic Surgeons, The American College of Obstetricians and Gynecologists, American College of Cariologists, American Academy of Dermatology Association, The National Association for Spine Specialists, American Urological Association and the American Society of Plastic Surgeons. The strategy is to select key battleground states based on political vulnerability and market affordability analysis. States such as Florida, Georgia, Illinois, North Carolina, Pennsylvania, South Carolina and Washington meet these criteria. In these states we will create hard-hitting state specific messages involving real people with real stories. We will deploy campaigns to coincide with key political events such as Senate floor votes, national presidential conventions, primaries and general elections. In addition, we will create the perception that this is a national campaign by earning media coverage on national television programs such as The Today Show, Crossfire, Meet the Press, etc. The tactics will include press coverage, 30 minute new magazine television programs, printed advertisements and grass roots and local coalition voting with physicians, patients and citizens through the use of a dynamic interactive website protectpatientsnow.org. This was officially kicked off 2/10/04 with simultaneous press events, including the National Press Club in Washington D.C. with Dr. Gail Rosseau and Dr. Stewart Dunsker in Seattle WA with print advertisements in Raleigh NC by Dr. Jim Bean and in Charlotte NC with Craig Van Der Veer and John Wilson. In addition, we plan to stir controversy in areas so to encourage discussion among constituents and we will deploy two synchronized messages using two funding sources. One, a soft money educational source with DMLR and two, a hard money source through Political Action Committees. The goal is for each member society of DMLR to contribute one million dollars each year for three years or as long as it takes to pass reform. It is suggested that individuals contribute $1,000 per year for three years, preferably to the PAC, which can then make contributions to continue the fight. In summary, it was noted that reform is within our reach, if we only reach for it.

Dr. Gail Rosseau gave an update on her local campaign in Chicago for medical liability reform and noted that the Chicago Tribune had written an editorial calling for this and Dr. Rosseau is now giving copies of this to her patients. It was suggested that the members could obtain a copy of the editorial from the Chicago Tribune and do the same in their local markets.

Dr. Stewart Dunsker then discussed successes that have been made thus far, including apparent concerns by the Trial Lawyers Association about our activities. He called for further support and continued vigilance.

E.  NERVES - - Mr. Mark Mason announced that NERVES is financially solvent and will no longer need financial support from the CSNS. Mr. Mason noted that three meetings of NERVES had taken place since their creation and there had been over 100 persons at each meeting. They have well over 200 members representing over 800 neurosurgeons in this country.

The NERVES board had decided to move forward with the survey process without FTC review. This decision had been made because the legal council for NERVES said FTC review was unnecessary if NERVES followed strict guidelines. In addition, separate legal opinions were obtained from other sources and they all supported the idea that the FTC review was unnecessary if the guidelines were followed. The legal council for NERVES supplied these guidelines. In addition, the cost of FTC approval was prohibitive, being in the $10,000 to $15,000 per approval range. In addition, it would not be timely to seek approval as it takes over two years for the approval process to occur.

Thus, in February a firm to collect data was selected (Heaton and Eady). This month a draft of the first survey was presented to the NERVES membership and this will be forwarded to the CNS and AANS and the lawyers to make sure that it is acceptable. It will then be reviewed and in September and possibly will be ready for publication in October.

F.  Update on Ad Hoc Committee for PA's and NP's/Dr. Benzil -

A template for the white paper and procedures for treating guidelines have been discussed. A validating committee made up of NP's, PA's and three neurosurgeons will review this and then a final report will be promulgated. This is expected to be ready by the Fall CSNS meeting.

G.  NLDC/Dr. Bloomgarden

The NLDC has been renamed The Leibrock Leadership Development Conference in recognition for the work that Dr. Leibrock has performed in creating this conference. Dr. Bloomgarden encouraged members to sign up for the meeting that will take place on July 18 through July 20, 2004. It is critical that we have at least three people from every state, though it is recognized that some states should have more, depending on the size of their neurosurgical population.

H.  Socio-Economic Publication/Dr. Mick Perez-Cruet

Dr. Perez-Cruet reviewed that the resolution that had been passed in Denver suggesting a socio-economic journal in Neurosurgery. This would be a peer review journal with an editorial board made up of neurosurgeons, mostly from the CSNS. It would come out quarterly and would cover a wide variety of topics. It was noted that present publications are not peer reviewed and it would encourage investigation into topics affecting neurosurgical practice. It would also encourage discussion and encourage solutions to problems. Possible topics for papers were presented and included resident work hours and use of physician extenders. It was noted that this should cost about $120,000 per year. Funding is the key for this and hopefully it will be able to fund itself, but other sources would include organized neurosurgery, individuals and industry. Paper submission could be made through solicitations, mail outs and through private practice and it is felt that this journal could represent the CSNS as it's official journal, or could be the official journal of NERVES. Dr. Nelson Oyesiku suggested that this could possibly be a portion of Neurosurgery and he will talk to the editors.

I.  ABNS/Update on guidelines for recertification

Dr. Jiminez reported that he had been a guest examiner with the ABNS and that the ABNS was making good faith effort to address our concerns.

Dr. Ralph Dacey then presented an extensive talk on ABNS and the reasons for it's present course. It was noted that the ABNS is a member of the ABMS (American Board of Medical Specialties) which has 24 member boards. Two years ago the ABMS agreed to evolve from recertification to a maintenance of competency format. Maintenance of competency has four elements, including evidence of professional standing, evidence of commitment, evidence of cognitive expertise and evidence of evaluation of performance. Evidence of professional standing requires full unrestricted license and hospital privileges and a recommendation from the Chief of Staff from the hospital. Evidence of professional commitment requires 150 hours of CME over three years and assessment open book exam every three years. Evidence of cognitive expertise requires that once every ten years a member needs to pass a secure computer based exam which would involve three different modules, including general neurosurgery, spinal neurosurgery and/or pediatric neurosurgery. These will be 200 questions based on a pool of questions from the open book exam and need to be taken within three years of the ten year deadline. Every three years a diplomat will supply a log of key cases. Ten operative procedures are proposed. Once every ten years six months of data in a standardized internet based program will be obtained. These three year and ten year cycles will then be repetitive and ongoing. It is noted that 1999 was the first year that time limited board certification was given, but it is highly likely that states will require that maintenance of competency exams will be required for re-licensure.

J.  AANS Report/Dr. Popp

Dr. Popp welcomed the CSNS delegates to Orlando and reported that the CSNS is a proving ground for the leaders of neurosurgery. Dr. Popp briefly reviewed his goals as president of AANS of which PLI reform is the number one goal. He noted that the AANS has donated $100,000 to the Neurosurgeons to Protect Healthcare Access campaign. Every attending member of the AANS meeting will be provided with 100 copies of a medical liability reform brochure. He also reminded that the AANS has a strong professional conduct committee.

K.  CSNS President, Dr. Vince Traynelis

Dr. Traynelis reported that the congress is strong, healthy and a vibrant organization. He encouraged members of the CSNS to review programs that are outlined on the CNS website.

Dr. Boop concluded the meeting at 12:30 p.m. and invited the delegates to lunch with the AANS and CNS boards. Dr. Peter Carmel was the invited speaker.

Respectfully submitted:
Thomas W. Rigsby, M.D.