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1. State Comp goes Blue
2. President’s Message
3. Report from Executive Secretary
4. An Apology and a Goodbye

1. SCIF dumps its preferred providers; MPN now Blue Cross PPN
The State Compensation Insurance Fund has deep sixed its own Preferred Provider Network (PPN) and will, as of May 1st, force physicians presently in the PPN, if they want to stay on board, to join its new Medical Provider Network operated by Blue Cross of California. Since SCIF writes 52% of the comp insurance in California , this is no minor shift in provider affiliation. It does not take a brain surgeon to figure out that Blue Cross will want to take a cut from the Official Medical Fee Schedule (OMFS) which is what SCIF will give to Blue Cross (and which is due to be reduced some time this year to a rumored 120% of Medicare). I would guess that Blue Cross is enamored of their present fee schedule for general commercial patients which is some fraction of Medicare rates and will try to impose those rates for allowing you to care for SCIF’s insured workers, taking the difference between the OMFS and what they pay you for their trouble. This could be a first class morass for doctors.

We all know that Medicare rates are not great (and we finally got a slight increase this year instead of the satanic 4+% cut) but at least there is minimal hassle in scheduling a free roaming Medicare patient (read no HMO) for an operation. Pre-certification is not necessary and your surgery proceeds apace in the best interests of the patient. Even the commercial patient, for whom you care at something less than Medicare rates, has the advantage of probably being younger and with fewer co-morbidities to complicate an operation. Every work comp patient comes with a major co-morbidity—the work comp rules and regulations. To think we can navigate the work comp rules and paper swamp and make an honest buck for less than Medicare rates is like thinking that your stock broker works for nothing except your gratitude.

If you are already a participant in the Blue Cross Preferred Provider Network, the potential vehicle for the SCIF patients, then you should not be required by the terms of your present contract to extend those PPN rates to work comp patients. Rest assured you will be asked to do so. I suggest you use considerable caution because it may not pencil out on a sound business basis. Look at it this way—if your costs for providing care are “X” and you just make a little profit on commercial patients for which you are paid “X+Y”, the thrash of dealing with work comp rules, regulations and adjusters in a “Mother, may I” scenario may well tip you into the negative as your “X” rises to greater than “Y”. Volume, the mantra of the “pay you less but you get more because you do so much” crowd doesn’t work if each case is done at a loss. Multiply a negative by any number and you still get a negative.

If you are not already a Blue Cross PPN participant, you will need to contact them to try to get on the PPN list. If work comp is not your big income source, maybe you should get a second job rather than bed down with corporate medicine.

There is a rumored state initiative circulating that would allow comp patients to choose their own treating physicians. Where do I sign?

2. President’s message for February: Transitions in Neurosurgery–II
In many of our California communities, we find that neurosurgical services are less because of some surgeons reducing their practice parameters (i.e., confining practice to spinal surgery only), but more notably by the aging of the neurosurgical population, leading to retirements and decrease in practice and availability. Recruitment of new neurological surgeons has been difficult in California , with average neurosurgical incomes here often ⅓ to ½ of other regions of the nation, even though MICRA has served to control our malpractice costs better than many other regions.

In my community, over the last two and one-half years, two neurosurgeons have closed their offices to retire, another retired this month (February) and one other practices approximately half time, with no replacement neurosurgeons in sight, and this in an area that needed additional practitioners prior to this occurring. Two candidates who had agreed to come have subsequently decided to settle elsewhere. This has led to only part-time emergency room coverage in our largest private hospital (eight days per month currently), leading to compromise of early acute care and frequent transfers of patients to other centers, also a great inconvenience to families.

This situation, another manifestation of the ER crisis, is not unique to our community, not even our state, as illustrated by an April 18, 2004 Chicago Tribune editorial. The Tribune noted a flight of neurosurgeons from Illinois , especially southern Illinois , with three counties having no coverage at all, with the malpractice rates being the major factor in Illinois .

Unfortunately it appears that the situation will get worse with time. Other contributing factors will be discussed in the future.

CANS exists to benefit its members and I request that our members let me know how we can better benefit them, with new programs or modification or expansion of existing services. This is your opportunity to contribute to the benefit of all.
John T. Bonner, M.D., F.A.C.S., President

3. Report from the Executive Office
a. Membership:
To date, 25% of the CANS membership have paid dues for 2006. This is good news and CANS thanks you for your continued support. The dues statements sent out last month asked that members check if address information should be published to the CANS website. In case you missed that box, please review the website (www.cans1.org) to make sure your name and address appears as you would like it.

Welcome to Roland Torres, M.D. of Stanford who is CANS’ most recent new member.

CANS has several ways in which it identifies new neurosurgeons to California ; however, the best way is for members to encourage new colleagues to join. If you know someone who is interested, please contact me and I will follow up with an application package.

b. Board Meeting input:
The next Board meeting will be held in Los Angeles on April 8, 2006 ; if you have anything you would like to submit to the Board of Directors for discussion, please send it to me by March 31.

c. Physician Employment Opportunities:
The California Medical Board is looking for physicians to participate either in their Expert Reviewer Program or to be a consultant for the Central Complaint Unit. If you are interested, contact Susan Goetzinger at 818 551-2129 (sgoetzinger@medbd.ca.gov) for Expert Reviewer; contact Susan Cady at 916 263-2644 (scady@medbd.ca.gov) for Central Complaint Unit.

d. 2007 Annual Meeting:
The next Annual Meeting will be the weekend of January 12-14, 2007 at the Hyatt Regency Hotel in Sacramento . Program planning will be discussed at the April Board of Directors meeting. Your suggestions for topics or workshops are welcome.

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

4. Sorry about these two things
In addition to apologizing to the readers of this newsletter for rather badly disguising the SCIF item above as a news item instead of the editorial it really is, a great loss has occurred at CANS for which we should all be sorry. Bob Florin, long a stalwart CANS supporter and former CANS President and recipient of the Pevehouse Award, has asked to be replaced as a consultant to the Board of Directors, a position he has held for a long, long time. Bob’s health has not been stellar recently but I think he retired from the CANS Board for perhaps a more cogent reason. As the list of Board consultants reflects, age is their long suit, perhaps as it should be. But as this group approaches, reaches or passes their 8th decade of life, they may be more a source of what has been rather than what should be (this consultant not excepted). Ron Rich has been appointed to replace Bob and will be a valuable sexagenarian asset. Our best wishes and thanks to Dr. Florin, truly one of the giants among neurosurgeons.

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.