SUMMARY of MINUTES
CANS Board of Directors Meeting
Saturday, September 8,
2001, Hilton Hotel, Oakland Airport
I. AANS/CNS Merger
CANS President, Dr. Hoyt, has spoken with the presidents of the American
Association of
Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS)
regarding a potential merger. Each organization’s leaders indicated that a
merger is being considered; however, each has different view of how that merger
should occur. This issue may be discussed at greater length next January at the
CANS Annual Meeting where the presidents of both organizations have been invited
to attend. The Board agreed that it is still important that there is a single
voice for neurosurgery.
2. ABSS
CANS had written a letter of opposition
to the application of the American Board of Spinal
Surgery. No further action is required at this time because the Medical Board
hearing is not
scheduled until February 2002.
3. ER Call
Dr. Hoyt has received several inquiries about problems between neurosurgeons
and hospitals in negotiating ER compensation. Earlier this year, the position
statements of CANS, CSNS and AANS were distributed to all CANS members to assist
them with these negotiations. Dr. Kusske said the Washington Committee has made
one minor correction to the AANS position statement: "… hospitals may
should provide neurosurgeons with reasonable compensation for serving on
the on-call panel."
Dr. Kusske recommended that everyone should purchase copy of a book titled EMTALA, Providing Emergency Care Under Federal Law, authored by Dr. Robert Bitterman. It is available from the American College of Emergency Physicians (ACEP) website. This is a comprehensive book covering all the problems that may be encountered with EMTALA
Dr. Rodriguez suggested that CANS back
legislation to help neurosurgeons with this problem.
Dr. Kusske said there are two levels of law: federal law and state law which is
more onerous because it mandates criminal penalties. The Board has agreed to the
following action items:
a. A motion was made and seconded to form a committee to study EMTALA and
all the problems it has created with a goal to work with CMA to introduce legislation. Motion carried. . Committee members will be Dr. Kusske (to focus on federal law) and Drs. Hoyt, Rodriguez and Prolo (to focus on state law).b. Dr. Prolo will draft a resolution for the CMA House of Delegates meeting.
c. Dr. Kusske has asked the Board to send him personal anecdotes about how EMTALA has affected them here in California. These stories could be used as testimony in hearings with Senator Kyle in Washington.
d. Dr. Robbins will speak with CMA lobbyist, Steve Thompson, about ER compensation.
4. Membership Report
Membership applications were approved for five new neurosurgeon members:
Drs. S. Chang, G. Kaptain, F. Castro-Moure, B. Curtis and F. Massoudi and three
physicians assistants: John Castle (Naval Medical Center, San Diego), Kavita
Chabra (UCI) and Stephan Morey (Modesto).
5. Nevada Neurosurgery
Dr. Hoyt extended Annual Meeting invitations to the Nevada neurosurgeons and
reported that several may attend. The Board also agreed that neurosurgeons in
Oregon and Arizona should be invited.
6. Treasurer's
Report
Dr. Abou-Samra reviewed the income and expenses to date and reported that
dues collection remains a problem with the same people late each year. It was
noted that there is still approximately $5700 in the CAPP (Californians Allied
for Patient Protection) fund.
The Board will send an inquiry to the
Council of State Neurosurgical Societies requesting a summary of the projects
financed by the contributions made by the individual state societies.
7. Annual Meeting 2002
The Board reviewed and approved the Annual Meeting program. Friday will be
the Coding and Reimbursement course by Karen Zupko and Associates. Saturday will
begin with separate business meetings for CANS and ACN with a joint session on
The Criminalization of Medicine. This session will be lead by Dr. Kusske,
followed by Mindel Spiegel, MD, Department of Health Services, and Ruth
Patience-Midcap, Nurse Consultant for CMA. Dr. John McVicker, of Colorado, will
discuss ER contracting. After lunch, there will be a session on compliance by
Conomikes, Inc. and the ACN will hold a parallel scientific session on therapies
for various neurological disorders. A QME course will be held on Sunday to
conclude the 3-day event.
8. Workers Compensation
The IMC has contracted with the Lewin Group to change to the RB/RVS system
for E& M codes. The Lewin Group has recruited Dr. Lippe and Dr. Meredith to
serve on a Technical Advisory Panel (TAP). The OMFS will be changed from
a charge database to a resource-based system, which determines what a procedure
is worth. One advantage is that the fee schedule will be updated at least every
2 years, hopefully every year. It is difficult to predict, at this time, what
the benefit for physicians will be other than a current fee schedule.
9. Communication Committee/Website
Dr. Hoyt presented Dr. Randall
Smith’s Communication Committee Report. Completed
sections on the CANS website include membership listings, member services
section and
Board information. The patient information section languishes for lack of
authors. Dr. Hoyt
asked the Board to please consider assisting Dr. Smith with this project and to
contact him
directly.
10. Bylaws
Dr. Shuer presented extensive bylaws changes which were reviewed, edited and
finally
approved by the Board. These changes were done to clarify and simplify the
bylaws as was
recently done by the AANS. These amendments will be reviewed by the CANS
attorney to
ensure that they conform with current corporate law.
11.
Ad Space/Newsletter
The Board agreed that CANS should
consider selling ad space in newsletter. The editor will
be responsible to set ad prices, accept advertisements and review for content.
12. Legislation//AB487 (Aroner)
Several letters have been sent to the
legislature in opposition of this bill, where physicians would be sanctioned for
undermedicating for pain. There have been many amendments to this bill. It
currently states that physicians must have 12 CME hours in pain management
(original bill stated 20 hours) and that the Medical Board will develop
standards (original bill said protocol). Objectionable to most doctors is the
fact that the state is mandating specific topics and hours of CME and also that
standards allow no room for deviation and are too rigid. CMA has been in a
support position from the start. This bill will most likely pass. Board members
were encouraged to contact Bob McElderry, the CMA lobbyist. A letter will
subsequently be sent to Governor Davis requesting his veto.
13 CMA
A.
House of Delegates
The CMA House of Delegates will convene February 23-26,
2002 in Anaheim; resolutions are
due January 4, 2002.
B. Council on Scientific Affairs
CMA is resurrecting this committee and has asked for
representatives. Drs. Bonner, Meredith,
Smith and Wade have volunteered to serve and Drs. Kusske and
Shuer were recommended to
represent CANS from the academic point of view.
C. Committee
CMA has also requested names for various
other committees. Dr. Meredith agreed to continue on the Committee on Ethical
Affairs and Dr. Prolo will continue to represents CANS on the Council on
Legislation (COL) with Dr. Lippe representing pain management on the COL.
14. Procedures and Carriers
A. Laser Discectomy
The Executive Office has received several inquiries from patients and also from Blue Cross about laser discectomies. Ms. Tash asked whether or not CANS should have a position statement about this procedure. Blue Shield is also discussing this topic at their October 24 meeting and would like a CANS representative to attend; they too have requested a position statement. Dr. Shuer explained that this is not a new procedure but just a different way to perform the procedure. CANS cannot say it is substandard; it is just not widely done and the efficacy of using this particular device to remove discs has not been studied scientifically. Its efficacy at this time, to the best of CANS’ knowledge, is unproven. Drs. Robbins, Shuer, and Prolo have agreed to review the material provided by Blue Shield on this subject.
B. Deep Brain Stimulation
Dr. Kusske reported that National
Heritage Insurance Company (NHIC) has a current policy on deep brain
stimulation/pallidotomies for Parkinson’s Disease stating that they will
consider covering this procedure only after it has been performed. Dr. Kusske
recommended that we address this issue and asked for the best way to do so. Dr.
Meredith, the Carrier Advisory Committee (CAC) representative, suggested a
letter be sent to the Medical Director of NHIC, Dr. Rogan, from CANS, strongly
stating that this is a proven therapy. Dr. Robbins further suggested that
everyone write to Blue Shield to complain about their low payment schedules;
many doctors have been leaving Blue Shield.
15. Next Board Meeting
The next meeting will be held on Friday, January 18, 2002 from 1:00 pm to
5:00 followed by
a joint meeting with the ACN from 5:00-6:00 p.m. in San Francisco at the Parc 55
Hotel. Input from the CANS
membership is always welcome. If you have a specific problem or question, please
submit it to jt4ns@aol.com.
file/minSep2001web
JMT