CANS NEWSLETTER—September 2006

1.  The Board Meeting
2.  President’s Message
3.  Report from Executive Secretary
4.  Other News

1.  Prop. 86 dominates Board Meeting.
The Board of Directors met last Saturday the 23^rd in Oakland .  The most glaring absentee was Janine Tash, our Executive Secretary, who was occupied with the funeral for her mother who died suddenly and unexpectedly the week previous.  The Board expressed its sincerest condolences to Janine for the loss of her Mom.  It was noteworthy that the discussion of many issues was hampered by not having Janine’s input and access to her corporate memory.  Every organization should be able to tolerate the absence of one team leader but CANS is crucially reliant on Ms. Tash.  Her anticipated retirement in the next few years will place a major strain on CANS. 

The Board devoted considerable time to the Proposition 86 issue.  As you know, the proposition includes language that would result in specialist ED coverage stipends being determined by an independent health care specialist who will assay the going rates for ED coverage in a local area/region and determine what a hospital should offer you to provide emergency neurosurgical services.  CANS, in addition to opposing the proposition which we feel limits your ability to negotiate and exempts hospitals from any price fixing violations, feels you might be well served if the proposition passes by having some good data on what is already being paid in your region and in the state if you come to loggerheads with your hospital and the hired health care specialist.  Our Board has good regional representation so getting this data from our members is very doable.  The information we gather will not include reference to specific surgeons or specific hospitals but rather be regional and state ranges for compensation as well as a median/average.  We have pretty good info regarding the LA basin, San Diego area and the Sacramento area but could dearly use figures for the Bay area and less populated regions of the state.  Bill Caton is our point man on this issue and we really need you who cover EDs to let him know what your local arrangements are (including how many days per week of coverage, number of times you have to go to hospital, hospital support such as supplying PAs to help in responses and care, number of times consults and management are on ICU patients).  His E-mail address is wlciiimd@aol.com. And all information will be treated in confidence and results will not include information about specific docs or hospitals.  If you decide to sit on the sidelines on this one, you could reap exactly what you sow.

Of some collateral interest is the result of the AANS Workforce Survey recently published in their Bulletin.  The survey (770 surveys returned; 30% response rate) indicated that 94% or responders take ED call, 50% get stipends and that 36% of those get between $750 and $1500 per diem, 20% get less and 17% get more (26% have “other” arrangements).  One could say that the 94% coverage rate is skewed because those who don’t cover EDs heavily populate the 70% who didn’t respond, but the stipend info should be pretty solid.  We have asked if they can break out California figures.

It is to be recalled that NERVES (Neurosurgery Executives' Resource Value and Education Society) which counts 65 USA neurosurgical practices encompassing 365 neurosurgeons as members, previously found that 42% of its members get on-call coverage pay which averaged $1476/24 hours.

2.  President’s message for September
Prop 86
As Randy Smith has pointed out, much of the Saturday 9/23/06 board meeting was occupied by discussion of our opposition to Proposition 86, the Tobacco Tax.  This is important enough to repeat some of the basis for opposition. 

CANS in no way supports an unhealthy lifestyle, like the use of tobacco, but we are very concerned about portions of the proposition:  it is too hospital friendly and it would exempt the hospitals from anti-trust laws and other anti-competition laws in the implementation of emergency services.  It would allow hospitals in a region to collude in setting compensation levels for physicians and other medical service providers, perhaps allowing hospitals to establish the corporate practice of medicine.  Hospitals could exclude specialists from hospital service and divide up areas for providing service, allocating certain types of patients to specific hospitals without concern for some patient and physician issues.  Indeed, the nature of emergency service is to provide patients with professional care as soon as possible.  Should Prop. 86 pass, it may endanger patients in critical condition when the patient is in transit to the hospital ‘designated’ to treat that patient’s ailment, rather than taking the patient to an otherwise qualified closer emergency room.  The majority of the CANS Board felt that the issues were important enough to neurological surgeons and other physicians to join the “No on 86 coalition” despite allying ourselves with some interests, such as tobacco, that we would otherwise prefer to avoid.

 Cost of Health Care
There has been an increase in news articles on the rising costs of health care, leaving some impression that we physicians are profiting from it, despite evidence to the contrary.  We all realize that much of the increased costs, over 12% of the GNP, is due to the rapid development and use, often overuse, of technology.  Ordering an additional x-ray for defensive medicine was bad enough, but consider the impact of studies such as MRI and PET scans, both indicated or perhaps marginally needed, or not needed, such as in defensive medicine.  In our specialty, instrumentation use and overuse is certainly a factor.

History of Neurosurgery
At the Board meeting, it was suggested that CANS should help in preserving our specialty history, an excellent idea.  I would encourage our membership to contribute historical information and vignettes, especially concentrating on our deceased and retired members, but not excluding the general membership.  I do hope that this project will excite much interest and contribution.

CANS exists to serve our membership.  I look forward to letters to our editor and board.

John T. Bonner, M.D., F.A.C.S.

3.  Report from the Executive Office
Annual Meeting
The keynote speaker at the next CANS Annual Meeting will be Dan Walters, political columnist and journalist, who will speak about California and its politics. Some of the other topics planned for the agenda include electronic medical records, risk management, and trauma.  Reserve the weekend of January 13-14, 2007 for this timely and informative meeting at the Hyatt Regency Hotel in Sacramento .  Registration material will be sent in mid-October.

Officers
A request for 2007 officer nominations and awards will be sent next week by mail. Please give careful consideration to this item as it is an opportunity for you to assist in determining the future leadership of CANS as well as a way to recognize a neurosurgeon or public figure for their distinguished service.

Please contact me at janinetash@sbcglobal.net with your input on any of the above items.

4.  Exhibitors needed; CSNS Resolution Positions; Office Drug Crackdown;
2008 Meeting

You Can Help
The Board noted we lost $3000 on last year’s annual meeting in no small part due to limited exhibitor attendance.  A recent regional neurosurgical society meeting in a far corner of the USA with doc attendance numbers similar to ours garnered about 38K in exhibitor fees.  Last year we did 21K.  It would really help CANS if you tweak your local reps to come to Sacramento January 12-14 or at least make an educational grant.  The rep will want to know number of doc attendees and price.  We usually get about 75; price $ 1500 per exhibition table.

State Council Resolutions 
The Board noted the following resolutions to be debated at the forthcoming Council of State Neurosurgical Societies (CSNS) meeting in Chicago and took the indicated positions on each.

Resolution I:  That CSNS create working papers on new partner recruitment, practice compensation models and investing in ancillary service facilities.  The Board thought that NERVES (Neurosurgery Executives' Resource Value and Education Society) would be a better group to pursue this.

Resolution II:  That the AANS/CNS create online resources for medical students to peruse and learn about what it takes to become a neurosurgeon as well as providing a list of mentors for them to talk to.  The Board felt this info is already available.

Resolution III:  That the CSNS request the Neurosurgery Board and the Residency Review Committee among other things reduce the length of  neurosurgical residencies to one year of internship plus 4 years of residency.  The Board did not view this as an appropriate activity for the CSNS.  It was noted that some residency programs make the internship year 6 months of general surgical training followed by 6 months of neurology.

Resolution IV:  That the CSNS be provided a page in each monthly edition of the two major neurosurgical journals to present the actions and accomplishments of the CSNS.  The Board agreed.

Resolution V:  That the CSNS establish and fund two summer fellowship programs for medical students to do neurosurgical socioeconomic research.  The Board questioned the ability of medical students to identify appropriate topics.

Resolution VI:  That the CSNS oppose economic profiling and credentialing of neurosurgeons.  The Board concurred.

Work Comp Meds
The Division of Workers’ Compensation will as of 12/1/06 install lower limits on what you can charge for drugs dispensed by your office to Comp patients.  This practice has been a real moneymaker for some practitioners.  The amendment to the regulation would close a loop hole created from legislation passed in 2003. Currently, Labor Code section 5307.1 requires that reimbursement rates for medical services, except physician fees, be in accordance with the relevant Medicare and Medi-Cal payment systems. However, those systems do not allow drugs to be dispensed by doctors in their offices. This exception allows doctors to be reimbursed for drugs dispensed during office visits at much higher rates than those paid to pharmacies for the same drugs, thereby creating a loophole in the reimbursement structure. The DWC regulation closes that loophole.

Annual Meeting Location for 2008
Pat Wade, our President-elect, announced that the CANS 2008 annual meeting will be held at the Grand Californian Hotel at Disneyland over the Martin Luther King Day weekend in January.  He negotiated a room rate near $200/night.  We don’t know how he managed to get such a good room rate but he did wear a Mickey Mouse hat to the Board meeting.

Randy Smith, M.D., Editor

The newsletter is a mix of fact, rumor and opinion.  The facts are hopefully clearly stated.  The rest is open to interpretation.  The opinion is mine.  R.S.

The assistance of Janine Tash and Jack Bonner in the preparation of this newsletter is acknowledged and appreciated.If you do not wish to receive this newsletter in the future, please E-mail or fax Janine Tash ( janinetash@sbcglobal.net, 916-457-8202) with the word “unsubscribe” in the subject line.