1. Work Comp fees—on the wane
2. Can CANS Do More?
3. Free ED Call—also on the wane

1. CANS members face almost certain fee reductions
Work comp fees are still our payment oyster but the pearl is getting smaller. As I understand it, the bill to freeze work comp physician payments at their present level until 2009 and thus forestall a reduction anticipated to be implemented on 1/1/2006 by the work comp czarina Andrea Hoch (otherwise known as the Administrative Director of the Department of Industrial Relations) apparently failed to come out of the Assembly Insurance Committee and has been declared a 2-year bill. That designation is legislative code for the bill’s author determining he did not have sufficient committee support to get the bill passed out of the committee and has pulled it back until the next legislative session when he might have a better chance of getting a favorable committee vote. This rules out any legislative hope to forestall the Hoch payment plan and limits our maneuvering to lobbying her to not treat us harshly. It must be noted that she has so far implemented the 2004 legislative changes to the work comp system in a manner indicating an adoption of cost reductions in the system as a mantra and since our fees are certainly a cost center in work comp, we can anticipate less than a friendly embrace. We shall see what comes of this lobbying by CANS and many others. Any number above Medicare plus 10% will be declared a victory by some of the lobbying crowd but my opinion is that anything more than an additional 10% cut in our fees (heaped upon the 5% cut in 2004) will be a defeat.

2. Heard from the trenches
As your newsletter editor, I have received two suggestions for additional CANS actions to help our members. The first, suggested by John Cleary from San Diego , is to have CANS help market neurosurgeons to the various Medical Provider Networks presently forming for treatment of injured workers. The orthopods appear well represented in these MPN’s but not so our brethren. Getting the MPN list from some of the big insurers should not be too difficult and writing letters pointing out that a full treatment deck for any MPN must include sufficient neurosurgical cards should be easily accomplished. Food for Board consideration.
The second thought, from a friend east of the Mississippi , is to have CANS get its members to submit their treatment data to a central repository so as to clearly identify what constitutes good and justifiable surgical care. This would be a significant undertaking and require a central repository of data and some sort of CANS assayed outcome measures. That we need something like this is painfully clear considering we are supposed to quote practice guidelines (read solid practice data with sufficient laudable outcomes promulgated by some professional organization that can be considered guidelines) as we request authorization for at least work comp surgeries. As you know, our national neurosurgical organizations have published no such guidelines and all spine surgical guidelines that I know of are found in orthopaedic archives or in the National Guideline Clearinghouse (www.ngc.gov/resources/guideline), the latter based on orthopaedic data.
I would like to see such data/guidelines published by a believable neurosurgical source since I really don’t know if a two level lumbar fusion is appropriate for chronic low back pain in patients with dark, slightly bulging discs and positive discography. Can CANS do this? More food for thought.

3. No Free Lunch
You who cover EDs and particularly trauma centers should be heartened by a recent survey by the American College of Physician Executives in which 46% of hospital administrators who responded to a survey indicated they pay their specialists for emergency call and that of those hospitals who didn’t pay, half were considering doing so. Remember that CANS, the AANS, the CNS and the AMA have official policy supporting such on-call payment and that our last survey two years ago noted about a $1000 per night average level of compensation. If your hospital is resisting, they better reread their tea leaves.

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.

issued June 28, 2005