MINUTES
CANS Board of Directors Meeting
Dr. Florin has been
representing CANS at recent CMA meetings that were held to develop a viable
alternative to the current Official Medical Fee Schedule (OMFS). He presented
his model that illustrated 100 top surgical codes for 2001 provided by CWCI
(California Workers Compensation Institute).
This model has been proposed to the CMA and to Dick Gannon, the
Administrative Director of the Division of Workers’ Compensation (DWC) who has
been charged with converting the current OMFS; however, it has been difficult to
get a consensus at the CMA level. A new complication is the Alarcon bill, which
proposes Workers’ Comp fees to be set at 120% of Medicare; this bill has great
appeal to many groups because of its simplicity.
Passage of the Alarcon bill would be good for DWC because it would
require minimal work in: (1) defining the transition from the OMFS; (2)
maintaining the fee schedule; and (3) updating it on a regular basis.
These are three of Mr. Gannon’s requirements for a new fee schedule.
CMA has been trying to organize the specialties but the timetable is not
realistic because the legislature expects it to be completed by the first of
July. If the Alarcon bill passes,
surgical codes that will be impacted include spinal arthrodeses, laminectomy
decompression, all arthroscopy, neuroplasty and several other groups with high
frequency. The Board agreed that a letter will be sent to Mr. Gannon requesting
that Dr. Florin meet with him personally to discuss the proposed model fee
schedule.
2.
DiskCure
DiskCure, the treatment that uses Enbrel to reduce disk-related inflammatory
pain, has been reported to the FDA for review.
CANS does not endorse this procedure because it has not passed scientific
scrutiny for the treatment of disk problems. A complaint letter was originally
sent to the Medical Board who subsequently notified CANS that only complaints
against individual physicians can be investigated.
3. AANS
Nominations
CANS efforts to place Dr. Randall Smith’s name on the AANS ballot as a
write-in candidate for the
office of Vice President of the AANS was successful.
He won the election and will work on CANS’
behalf to urge the CNS/AANS merger. Dr. Smith recommended that because the CNS
nominating
committee is composed of so few neurosurgeons from the western states, CANS
should attempt to add
a candidate by petition to the
ballot. A motion was carried to contact Dr. Edie Zusman to determine if
she is willing to be that candidate.
4.
CSNS Resolutions
The following is a summary of the resolutions discussed at the April meeting of
the Council of State Neurosurgical Societies:
a.
Rescission of AANS Requirement for AANS-Sponsored CME
Dr. Wade reported that this resolution passed after it was slightly amended
to change the word “rescind” to “reconsider” in the
resolve phrase that “the CSNS strongly recommend that the AANS rescind
reconsider the CME rule
change that only AANS sponsored CME credits be acceptable for continuing
membership in the AANS.”
There was a discussion about how AANS can determine what is worthy CME
and why the AANS thinks that is the official purveyor of quality CME.
It appears that the AANS’ main reason for this edict is to meet the
standards for Maintenance of Certification.
Dr. James reported that there are 60 hours of neurosurgical credits
(Category 1) required for a certificate of education, but in 2005, the AANS will
require those credits to be co-sponsored by the AANS or by the CNS.
A resolution should be submitted to CSNS to petition the ABNS to determine how
continuing medical education certification should be maintained in reference to
how it may be valid for the recertification of neurosurgeons.
Because there are 24 boards of the American Board of Medical Specialties
(ABMS), Dr. Lippe suggested that a resolution should be submitted to the AMA
House of Delegates since it impacts all specialties. Dr. Smith suggested that
Janine canvas the other 23 specialty boards of the ABMS to determine what their
specific CME requirements are for recertification. This will be completed prior
to the next Board meeting so that a resolution can be written.
Dr. Smith also suggested that CANS should monitor the AANS to ensure it
follows through with developing guidelines and maintaining a co-sponsor list.
The
ABNS is not a democracy and can do whatever it wants.
Dr. Smith reported that the ABNS will welcome liaison persons from CSNS
to spend a few days before the exams to provide input to the ABNS’ pending
designation of AANS and CNS as the only accepted purveyor of CME. A motion was
carried to write to the chairman of the ABNS indicating that CANS has
considerable interest in this issue and wishes to have a liaison attend the next
meeting to listen, learn and provide input.
b. Comparable
Worth, RBRVS, Workers’ Compensation, OMFS – passed
Dr. Shuer reported that this
resolution was accepted after it was combined with the resolution
on Workers’
Compensation, Negotiations, State Action Exemption.
The
resolution was referred to a
committee to formulate a review paper for presentation at the next session.
c.
Justice, Cost Escalation, Re-Privatizing Healthcare -
failed
d.
Justice, Freedom, Federal Health Reserve Board – failed
e. Global Surgical Fees -
failed
f.
CSNS Liaison to ABNS
This resolution was amended to direct the ABNS to allocate one of their
member positions to be filled by a CSNS voting member.
5.
Medicare Fee Schedule
Dr. Rich updated the Board
about the effect of the government’s errors in calculating Medicare payments
and that this year’s 4.4 % cut was rescinded by Medicare and would result in a
1.6% increase. But now it seems there will be 12% decrease over the next three
years beginning in 2004 with a 4.2% cut in Medicare. Dr. Rich reviewed his fee
schedule with the 1.6 % increase, but there were no increases for the most
frequently billed surgical procedures. Spine codes decreased 2-4 % and
craniotomies increased 1-2 %.
6.
Secretary’s Report/Membership Report
Dr. Bonner reported that
recruitment material will be sent to the approximately 200
7.
Treasurer's Report
The CANS monthly operating income and expenses are stable.
All the Annual Meeting incomes and
expenses have been accounted for and have resulted in a negative net of
approximately $2300. The loss
reflects the penalty owed the hotel for CANS’ failure to meet contracted room
block. Dr. James suggested that the room block for 2004 be re-negotiated
to a lower amount with the understanding that the hotel will accommodate rooms
sold over block.
8.
2003 Annual Meeting
Dr. James presented a summary of the Annual Meeting evaluations which were
generally favorable. The QME course on Friday was not well attended which was
most likely due to the day of the week (Friday). The Pain Management course made
money and will be repeated in 2004. There
were several physicians who attended only the QME or only the Pain Management
course and not the general session.
9.
2004 Annual Meeting
The program for the 2004 Annual Meeting was discussed and the following
suggestions will be explored by Dr. Rich and by Dr. James (Program Director):
Socio-economic session
Medical malpractice on the federal level (Dr. Wade will contact Senator
Feinstein;
other possible speakers are Tom Campbell or Richard Anderson of TDC)
(*note: the website hcla.org
has excellent information about malpractice.)
Asset protection/Risk
Management (specific to
Medicare Update (Dr. Rich will formulate program)
Practice Management by NERVES (Dr. Florin will make the initial contact)
AANS Update by AANS Vice President, Dr. Smith
Workers’ Comp Fee Schedule Update
CME/Recertification (by Dr. James or Dr. Smith)
Scientific session
Medtronics van
Fluoroscopy CME (possibly Saturday afternoon for 5 hours)
Neurosurgical procedures for various neurodiseases
Pain (6 CME hours on Sunday to focus on pharmacology/practical applications
An
alternative is to present the Pain Management course on Saturday afternoon but
many felt that would make the day spent in meetings too long.
It was further decided that a QME course will not be offered in 2004. It
was agreed that sponsors would be pursued for grants to help defray the costs of
the meeting. It was suggested that
exhibitors with office management software would be a good addition to the
meeting.
10. 2005
Annual Meeting
The Claremont Resort in
availability in January 2005. Even
though the
from the airport. It was decided
that the
space fees can be reduced. If the
may be pursued.
11. Membership
survey
Dr.
Rodriguez reported that his colleague, Dr. Scott Lederhaus, has volunteered to
assist in surveying the CANS membership to follow up Dr. Hoyt’s ER survey of
1997. Dr. Lederhaus wants feedback
from the neurosurgical population to obtain data on issues such as malpractice,
ER coverage, reimbursements, etc. The Board provided feedback and will review
the survey again once the proposed modifications are made.
12
Blue Shield/IDET
Blue Shield of California has requested that CANS review its 1999 position
statement on Intradiscal Radiofrequency Thermocoagulation (IDET) and that CANS
send a representative to its June 11 Technology Assessment Forum.
The Board agreed that it is not convinced that patients are helped by
this procedure. It is more likely that patient selection is the key and that
this very conservative procedure is probably done on patients who do not need
surgery. The Board reviewed the studies available from Blue Shield and has not
changed its position.
13. NHIC
Carrier Advisory Committee
Dr. Lippe attended the last meeting of the NHIC Medicare Carrier Advisory
Committee (CAC) and has endorsed the draft local Medical Review Policy on Lumbar
MRI. Endorsement of this policy was
also received from radiology and neurology.
14. Next Board Meeting
The next Board of Directors meeting will be held
JMT