Summary of Minutes
CANS Board of Directors Meeting
Saturday, September 17, 2005 , The Resort at Squaw Creek, Lake Tahoe

1.         Lobbyist
The Board voted to have Dr. Edwards write to CANS’ lobbyist (Norwood & Mattoch) for a summary report of activities to show value of work products to the CANS membership. 

2.         LA County Trauma/State Action Exemption
Dr. Caton and Dr. Prolo continue to work with various legislators about initiating a bill regarding the Los Angeles County trauma surgeons where the number of neurosurgeons covering the 8 private practice hospitals in LA County is down to 18.  Dr. Caton asked for CANS support when he is dealing with the politicians.  He is working with legislative analysts to determine how to proceed regarding either a bill with a “good Samaritan” clause which would state that the existing 18 neurosurgeons covering LA would be immune from malpractice litigation; or a state action exemption to collectively bargain with hospitals.  It is hoped that the legislative analysts will recommend on how to proceed to a successful resolution.

3.         Secretary and Treasurer's Report
CANS’ Secretary Dr. Caton reported that CANS continues to lose members, possibly due to dues increase. There is only one new applicant  (Dr. Alan Edelman of Santa Maria was approved for membership) and 14 dropouts.  Neurosurgeons continue to leave practice and to leave California . It is difficult to obtain an accurate count of actively practicing neurosurgeons.  It is hoped that once the Medical Board of California begins tracking specialties in its database, this will assist the executive secretary in identifying potential new neurosurgeons each year.  CANS delegates to the Council of State Neurosurgical Societies (CSNS) will request data from other state societies are doing regarding membership and dues. Treasurer Dr. Robbins reported that although the current budget is on track, there is a $39,000 shortage due to the members who have not paid dues. CANS financial situation is still strong enough to operate based on current income.   

A retired CANS member who currently only assists in surgery requested Senior status. According to CANS bylaws, “An active member in good standing, upon retiring from the practice of neurosurgery, may become a Senior member upon written notification to the Secretary and by approval of the Board.”  The Board voted to define “retired” in the “Policies and Procedures” manual as retired from “active practice as the primary surgeon if the member is 60 years of age or older.”   This definition will be a policy rather than a change to bylaws. Members younger than 60 years of age must have ceased all surgical activity to qualify.

4.         Annual Meeting
Dr. Edwards outlined the draft socio-economic program he would like to present and is still in the process of obtaining commitment from speakers:
EMTALA Update – Dr. John Kusske
Workers’ Comp Update – Andrea Hoch, Admin. Director, Division of Workers’Comp
Political Views – Governor Schwarzenegger
Lobbying Update – Mike Mattoch
Relevance of Neurosurgeons in Hospitals - Martha Marsh, CEO, Stanford

Auxiliary programs for the 2006 meeting were finalized to include a 6-hour CME session on Sunday, January 15, 2006 on Pain Management, sponsored by the American Academy of Pain Medicine and planned by Dr. Lippe.  An AMA Guides to Impairment Ratings course will be presented on Saturday afternoon, January 14, 2006 for 4 hours.  This course should focus on spine and will be coordinated for QME hours by Dana Livingstone-Lopez.

The hotel site was changed from the U.S. Grant to the Sheraton Suites because the renovation of the U. S.  Grant will not be completed on time.

5.         2007 Annual Meeting
President-Elect, Dr. Bonner, and Ms. Tash visited 3 sites in Sacramento for the January 2007 Annual  Meeting: Embassy Suites, Hyatt Regency and the Grand Sheraton.  After reviewing the three hotel  proposals, Dr.Bonner has decided to choose the Hyatt whose sales department offered a $125 room rate on the weekend of January 12-14, 2007 .  The hotel agreed to hold the banquet on the top floor of the hotel overlooking the state capitol at no charge except for food and beverage.

6.         ER Reimbursement for Non-Contracted Physicians
Dr. Edwards received a call from a member in San Jose , who was not getting full reimbursement for ER call and wanted to know what CANS was going to do about balance billing. He had billed for a procedure during ER call and because he had no contract with the patient he was not receiving full payment.  The Board agreed that this is not a CANS issue but an individual practice issue. Dr. Caton suggested that he and Dr. Abou-Samra publish an article about: what neurosurgeons can and cannot do about this issue; guidelines about how to proceed using various mechanisms; who to call to air grievances regarding billing for non-contracted patients (i.e., the insurance company, county medical society, CANS members in area to find out what is usual and customary, etc.)  A. information sheet that can be distributed to assist CANS members who have similar problems. What cannot be published are fees of other neurosurgeons because this would violate anti-trust laws. Because it was felt the neurosurgeons should be able to balance bill and need a way to determine fairness of billing, it was discussed whether CANS should have a position statement.  The Board reaffirmed CANS support for the principle of balance billing for contracted and non-contracted physicians. An ad hoc committee will be formed to develop a mechanism to adjudicate these complaints. 

7.         CTAF/Blue Shield
Dr. Robbins has agreed to attend the October 19 Blue Shield Technical Advsiroy Committee meeting to represent CANS on issues such as artificial disc for the treatment of degenerative disc disease and kyphoplasty.  Blue Shield has posted on its website that artificial disc does not meet their criteria

8.         Council of State Neurosurgical Societies (CSNS)
The delegates representing CANS at the October 7-8 CSNS meeting in Boston will be Drs. Caton, Hoyt,  Linskey and Wade. Proposed resolutions were reviewed and the Board agreed to support Resolution II - Endorsement of NPs/PAs Position Statement and Resolution V - Evidence Based Guidelines.

9.         NHIC Carrier Advisory Committee (CAC)
Dr. Lippe attended the Medicare CAC meeting on July 20, 2005 in Oakland . He suggested that the Board  periodically review the NHIC website (medicarenhic.com)which contains a wealth of important information about Medicare. There appears to be many practice abuses, especially related to pain medicine. Dr. Lippe things the biggest problem is undertreatment of pain. 80 % of cancer patients die in pain and half of those 80% are inadequately treated.  Dr. Edwards reported that nurses are not allowed to receive a range of pain medicine which makes it very difficult to control pain, especially for children.

10.       PPAC – Practicing Physicians Advisory Council
Dr. Lippe attended this meeting of 15 physicians appointed to advise the Secretary of HHS on effects of  Medicare and Medicaid regulations on the practice of medicine.  This item is informational only.

11.        Utilization Review/CMA
Dr. Lippe asked the Board to review a letter from CMA regarding their objection to Utilization Review  Standards filed by the Division of Workers’ Compensation. No action required.

12.        Board Meeting Schedule
The next Board of Directors meeting will be held from 1:00-5:00 p.m. , Friday, January 13, 2006 at the Sheraton Suites in San Diego in conjunction with the Annual Meeting.                                                                                   

  CANS members may contact janinetash@sbcglobal.net for full text of meeting minutes.

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