MINUTES
                                    CANS Board of Directors Meeting
                                          Saturday, September 25, 2004
                                           Hilton Hotel, Oakland Airport

 1.         Formal Call to Order
            The meeting was called to order at 9:00 a.m. by Alan Hunstock, M.D., President. The following individuals were also present:  Drs. Abou-Samra, Caton, Edwards, Kaczmar, Rich, Robbins, Rodriguez, Shuer, Vanefsky, Wade, Florin , Kusske, Lippe, Prolo and guest: Laurence W. Kessenick (attorney).  The minutes of the May 15, 2004 Board Meeting were approved.

2.         CME/AANS
            The AANS will discuss CANS’ request for clarification of their policy about acceptable CME credit at the AANS Executive Committee in San Francisco in October. 

3.         Membership/New Members
Kern Guppy, MD of Sacramento ; Mark Linskey, MD of Orange ; and Javed Siddiqi, MD of  Highland were approved for CANS membership.

             4.         Treasurer's Report
CANS income to date is approximately $12,000 below estimated budget because approximately 60 members have yet to pay dues. Another delinquent notice will need to be sent.

5.         2005 Annual
Dr. Hunstock reviewed the proposed program which will highlight three main topics: Workers’  Comp, MICRA and Neurotrauma. Mayor Jerry Brown will be the keynote speaker and will provide comments about California ’s political scene related to healthcare as well as MICRA. Story Musgrave, MD is an astronaut who will speak and present a slide show at the CANS banquet. The Santa Clara County Medical Society may participate and share expenses for Dr. Musgrave’s travel and honorarium.  There will be another 6-hour Pain Management course on Sunday.

6.        Workers’ Compensation  
a.         Fee Schedule  
Dr. Florin presented a well-developed summary of his version of “How to Convert the OMFS to an Updateable Relative Value Scale.” This was done because of the transition to the 2006 requirement for an updateable fee schedule. Dr. Florin’s model takes the existing system and incorporates the 5% discount.   
Updating the existing system can now be done because it relies on relativity established in Medicare for the value of a particular code relative to other codes in same family of services.  Dr. Florin received CANS support for the proposal.  He is hopeful that the California Orthopedic Association (COA) as well as the Association of California Neurologists (ACN), the California Society of Industrial Medicine and Surgery (CSIMS), Physical Medicine and Rehabilitation (PM&R) and the California Society of Anesthesiology (CSA) will ultimately support this proposal.  Although DWC does not view the fee schedule as a high priority, the agency has already accepted significant changes/corrections previously provided by Dr. Florin so he feels that DWC is willing to listen further.  
b.         Second Opinions  
Dr. Lippe reported that the second opinion program for spinal surgery has been
implemented. Several members of the Board mentioned that there has been a slight decrease in neurosurgical cases and it has been difficult to get authorizations. Referrals from primary care doctors has decreased and seem to be coming more 
from occupational medicine clinics.  Dr. Vanefsky reported that Kaiser has seen no change in number of cases being done.  
c.         Treatment Guidelines  
Dr. Lippe reported that there are 3 tiers of guidelines; treatment/utilization and the evaluation guidelines which must follow AMA guidelines. ACOEM treatment and utilization guidelines must be followed by law until November 1 unless they are replaced by something else which most likely will be determined by the Rand Corporation.  Rand will probably propose general rather than specialty specific guidelines.  
d.         Provider Networks  
Effective January 1, 2005 , SB899 mandates compulsory medical provider networks for the employer and the Workers’ Comp carries. Regulations are currently out for public comment. The Board discussed the concept of a network for neurosurgeons which may be beneficial even though no other specialties have done it yet.Dr. Prolo introduced Laurence W. Kessenick, a healthcare attorney with Hanson Bridgett, who presented the pros and cons of forming an IPA.  A regional or statewide network may have appeal but it is important to recognize challenges and legal problems as well as the intricacies of antitrust laws.

7.         LA County Trauma  
Dr. Caton presented a summary of the crisis in LA County regarding trauma and manpower where there are112 hospitals (86 have emergency rooms and 12 are trauma centers). The trauma care of the 12 million people in LA County is currently handled by 12 centers and 22 trauma surgeons. He recently met with most of these 22 trauma surgeons to brainstorm about ideas on what can proactively improve the trauma system.  The following common problems were identified: (1) all were overworked; (2) no amount of money would be enough; and (3) it is very difficult to attract younger physicians to cover trauma.  Three motions were  approved by the Board:  
(1) form an ad-hoc CANS committee on trauma care in California;  
(2) encourage Los Angeles County Board of Supervisors to keep King Drew Hospital open, including its emergency room;  (3) encourage Los Angeles County Board of Supervisors to add more hospitals to its trauma system, in particularly, California Hospital . Letters will be routed to the Board for   approval before they are mailed.

8.         CMA Committee Nominations  
A request was sent to the CANS membership for candidates to serve on various CMA committees.  Robert Meredith, MD was reappointed to the Council on Ethical Affairs; Patrick Wade, MD was reappointed to the Committee on Professional Liability; George Locke, MD for Committee on Medical Services and Committee on Quality Care; Richard Kim, MD to Council on Legislation and Deborah Henry, MD to Committee on Ethical Affairs.

9.         NHIC- Chiropractic Services  
Dr. Lippe reported on the draft LCD for chiropractic services where CANS submitted a response striking many of the codes that were felt to be inappropriate.  CANS felt that the
draft contradicts existing CMS guidelines.  

10.       CIGNA Settlement  
Dr. Prolo reported that the recent RICO settlement resulted in two foundations with big pots of money and there are 8 additional companies that have not yet settled. CMA issued information about how physicians can apply for grants as long as independent studies in patient care are done.  It is important that physicians know how to recoup money owed by CIGNA/Aetna.

11.       Legislation  
a.         Stem Cell Research
The Board agreed that California, in its current state of deficit, is in no position to support this expensive proposition.
Although the Board supports stem cell research in general, research should be done at federal level.
 b.         SB1325 Medical Staff Self-Governance  
 CANS sent a letter of support for this bill which was just signed by the Governor.  

12.       Washington Committee  
a.         EMTALA Revisions  
Dr. Kusske discussed a paper he presented to the Washington Committee about final  
EMTALA regulations. There are several things that everyone should be aware of:  
* a neurosurgeon can be on call at more than one hospital at same time;  
*  regularly scheduled surgery can be done while on call;  
*  hospital must specify exact time frames that neurosurgeons are available; if not available in 30 minutes, this may be cause for litigation;  
*  response times will be stated in minutes.  
*  EMTALA dictates that a neurosurgeon must come in when the ER physician asks; 
* once a patient is admitted, EMTALA no longer applies.  

b.         “Where We are after Managed Care”  
This paper is in regard to Health Insurance in the Consumer Era and what private payors are doing since managed care has bottomed out.  Premiums and cost per  patient has increased while services are less than they were with HMOs.  

13.        Blue Shield Technology Assessment Forum  
Blue Shield has requested CANS’ position on “Recombinant Human Bone
Morphogenetic Protein-2 for Spinal Surgery.”  The Board of Directors agreed that this
procedure is effective for selective spinal fusion surgery.  

14.        Next Board Meeting 
The next Board of Directors meeting will be held on Friday, January 21, 2005 from 1:00-5:00p.m. at the Fairmont Hotel in San Jose in conjunction with the Annual Meeting.

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