MINUTES Board of Directors Meeting
Saturday, May 5, 2001, Sheraton Gateway Hotel, Los Angeles

1. Attendance
Board of Directors: Drs. Hoyt, Bonner, Edwards, Hoyt, Hunstock, James, Meredith, Rich, Rodriguez, Shuer,Wade; Consultants: Drs. Kusske, Lippe;

2. 2001 Meeting
Overall evaluations of last January’s Annual Meeting in San Diego were positive. Despite the interest in the Coding/Reimbursement course and the QME Seminar, there was some concern about low attendance. It was recognized that exhibitors account for a substantial portion of the meeting income so this interaction needs to be maintained.

3. 2002 Meeting
The Coding/Reimbursement and QME courses will be repeated next year at the Renaissance Parc 55 Hotel in San Francisco the weekend of January 18-20, 2002. The program title, The Criminalization of Medicine, was suggested because this is the reality of what is occurring in medicine today. The Board voted to present only socioeconmic topics at the next Annual Meeting. Economist George Conomikes will be invited to speak on Compliance issues. Speakers on fraud and abuse and EMTALA will also be featured

It was noted again that CAP/MPT had earlier this year offered an incentive to CANS for its endorsement of their company. After further discussion about malpractice insurance and CANS’ previous attempts to form a liaison with other insurance carriers, there was no action taken at this time.

5. Carrier Advisory Committee (CAC)
It was noted that CANS needs to have better representation on the Medicare CAC. Drs. Meredith and Edwards haveagreed to represent CANS at this year’s CAC meetings. It was suggested that contacts will be made to find a CANS
member in the Oakland area who may be interested in serving on this committee.

6. AANS/CNS Merger
The CANS membership voted in favor of supporting a consolidation of the two national organizations (American
Association of Neurological Surgeons and the Congress of Neurological Surgeons) and a letter to this effect was sent from CANS. A motion was made and seconded that CANS should strongly reiterate its position to AANS/CNS and make it very clear that neurosurgery must speak with one voice to be truly effective. Motion carried.

7. AANS Nominations
The AANS has requested nominations for the offices of President-Elect, Vice President, one Member-at-Large and two
members of the Nominating Committee. Motions were made and seconded to nominate Dr. John Kusske to the office of President-Elect and Dr. Randall Smith to the office of Member-at-Large of AANS. Motions carried.

8. Secretary’s Report/Membership
Dr. Edwards noted that membership continues to slowly decrease. Discussion followed about how to recruit new members while retaining current members. Dr. Hoyt asked the Board to consider if it is truly communicating to members what CANS is doing for them. It is important to find new ways to identify neurosurgeons practicing in California.

Seven new applicants were approved for membership: Cary Alberstone, M.D., Igor Fineman, M.D., Tyrone Hardy, M.D., Olusegun Leramo, M.D., Jacques Palmer, M.D., R.L. P. Rhoten, M.D., and Srinath Samudrala, M.D. Four members have retired from practice and have been approved for Senior Status: John Carr, M.D., Mary Mancini, M.D., Robert Mitgang, M.D. and and Steven Tillim, M.D.

9. Allied Health
The CANS bylaws were recently amended to allow a new membership category of Allied Health personnel. Allied Health members will receive all mailings, newsletters, and a reduced Annual Meeting registration. A motion was made and seconded to charge annual dues of $100.00 with the application fee waived. Motion carried. It was felt that PAs would be interested in joining CANS because they now have some liability and reimbursement issues since their fees are tied directly to neurosurgeons’ fees. For future consideration, specific CME courses could be developed for Allied Health CME requirements.

10. Treasurer's Report
CANS income/expenses are straightforward. It was agreed that the previous year’s financial spreadsheet should be included in each Board agenda for comparison with the current year.

11. Bylaws Committee
Dr. Shuer prepared draft descriptions of the three committees (CAC, Workers Comp and Communications) which were to be changed from special committees to standing committees. He asked the Board to review these and the final wording will be presented for approval at the fall Board meeting. The Bylaws Committee will also review the entire bylaws to streamline them where possible to provide the association more flexibility. A report will be prepared for the next Board of Directors meeting.

12. Workers Compensation
Dr. Lippe reported that the Industrial Medical Council (IMC) has finally accepted the term "Neurosurgery, including back" to their list of specialties. Current IMC Neuromusculoskeletal guidelines are acceptable with some minor changes
requested by Dr. Lippe and other members of the CANS Board. Dr. Lippe will forward these comments to the IMC. The Official Medical Fee Schedule (OMFS) for Workers Compensation will be published within the next year (an interim fee schedule will be distributed until the final is completed). The OMFS will be based on the RBRVS system and will link closely to the CPT manual with continuing references to the CPT manual guidelines. It will be published by the Lewin Group. It is hoped that the OMFS will become an annual publication.

13. Communication
   A. Newsletter
It was suggested that CANS dedicate an issue to the Criminalization of Medicine a couple of months prior to the Annual Meeting to encourage attendance. Dr. Hoyt suggested that the membership often has no idea of what CANS does for them. These activities need to be highlighted in the newsletter, especially since what the Board does affects every neurosurgeon in California.

  B. Web Site
Dr. Smith continues to solicit help from the membership with the patient information section of the CANS website. Possible links to Neurosurgery-on-Call (AANS website) and spineuniverse.com.will be pursued.

14. ER Call
Dr. Hoyt received a letter from a member regarding a neurosurgeon who is practicing at a private hospital and has decided not to take ER call. This physician requested to remain on the hospital staff but withdrew cranial surgery privileges. The Board agreed that this is a medical staff issue that needs to be handled by the hospital. Any physician can limit his or her practice in any manner they desire.

15. Omissions Liability Coverage
A member of CANS asked for guidance in purchasing omissions liability insurance. The Board agreed that error and omissions insurance covers costs if a mistake is made in billing practices which could cause a physician to be audited by the Office of Inspector General (OIG) or HCFA. If a physician is found liable, this insurance does not pay the fine and legal costs; some malpractice policies may have a provision for errors and omissions. Each physician must assess his or her own risk.

16. Nevada Neurosurgery
Dr. Hoyt asked the Board for input regarding a possible affiliation with Nevada neurosurgeons because Nevada has
similar socioeconomic issues (coding, compliance, EMTALA). The Board voted to invite the Nevada physicians to register for the CANS Annual Meeting at the member rate; however, they cannot be members because they do not practice in California. They will also be on distribution for the CANS newsletter.

17. Pain Reimbursement
Dr. Lippe reported that the Medicare Carrier Advisory Committee (CAC) took the position that it would not reimburse for filling of pumps used for pain therapies. The American Academy of Pain is working with HCFA and the CMA’s Council of Scientific Affairs to resolve the issue. New orders have been revised and Medicare will now reimburse.

18. Board of Spinal Surgery
The application of the American Board of Spinal Surgery (ABSS) requesting recognition by the Medical Board of California was discussed. The application was rejected, but the ABSS is now resubmitting it for a July hearing. It is not known what the outcome will be. If it is accepted, it will have significant impact on neurosurgery. A motion was made and seconded to oppose the application of the ABSS by writing a letter of opposition to the Medical Board. Motion carried.

19. Council of State Neurosurgical Societies
Dr. Prolo represented CANS at the CSNS April meeting in Toronto where the following resolutions were discussed:
  A. Cost Analysis, Campbell Bill
This resolution requested that CNS and AANS contribute to a fund that will allow the Law and Economics Consulting Group (comprised of professors from Stanford and Berkeley) to analyze the costs of the passage of the Campbell Bill to consumers and employers, and to present its findings to the US Senate. This resolution was defeated. There is no champion in Congress for this measure and the Senate in particular is the weak point. The Republicans are not in favor of this bill because it involves increased cost for insurance companies.

  B. Coalitions for Healthcare Workforce Survival
The resolution requested that CSNS encourage American neurosurgeons to lead their county medical societies to survey membership for career plans over the next three years to determine present and future human resource requirements in each community. Even though the resolution was defeated, CSNS did agree to refer it to its own workforce committee to develop a survey.

  C. Practice Expense Unit Costs; Fee Negotiations
This resolution requested that physicians determine annual overhead costs for each CPT code so that they can negotiate equitable reimbursement fee schedules from third party payors. This resolution was referred to committee.

Dr. Kusske noted that there were a total of only five resolutions presented (and Dr. Prolo presented three of the five). This lack of interest/substance to the CSNS meeting may be an indication that many people may not feel this meeting is worth their time. The other two resolutions presented to CSNS were: (4) The Young Neurosurgeons Committee wanted representation on the ABNS Board so they could have input on how the recertifying exam should be designed; this resolution passed; (5) AANS was asked to recognize that attendance at a Section Meeting should carry the same weight as attendance at the entire AANS meeting. This resolution was also passed.

20. Legislation/AB487 (Aroner) – Conduct
CANS has opposed this Assembly bill which states that a patient who is dissatisfied with his or her pain management is encouraged to complain to the Medical Board of California. The Board will then investigate and take sanctions. Dr. Lippe feels the bill is well intended but misdirected. It was decided that CANS should send a strong message to CMA restating our position and requesting that CMA oppose it as well. Any amendment would be a fallback position in the event that the bill is not withdrawn; it could be that the bill is OK only if it applies to terminally ill cancer patients. A motion was made and seconded to write to CMA requesting them to oppose the bill.

21. Next Board Meeting
The next CANS Board of Directors meeting will be held on Saturday, September 8, 2001 at 9:00 a.m. in Oakland at the Hilton Hotel. Input from the CANS membership is always welcome. If you have a specific problem or question, please submit it to jt4ns@aol.com.


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