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1. CANS Board takes pivotal actions
2. EMTALA wars
3. Lobbyist interview

1. CANS Board meeting notes
At the CANS Board meeting on April 30th the decision was made to continue to exist. The Board interpreted the 131 members who by that time (it’s up to 146 now) had paid the new increased dues of $500 as sufficient evidence of a mandate to stay alive and become more proactive in pursuing the interests of member neurosurgeons.
That decision was closely followed by another to engage a lobbyist and Michael Mattoch, Esq., of the firm of Norwood & Mattoch was chosen and has signed a contract to represent us for $2000/month plus certain expenses. We have asked for an initial focus on the Vargas bill, AB681, which proposes to maintain work comp treatment fees at the current level until 2009 and forestall the rumored 1/1/2006 imposition of an RBRVS at something approximating Medicare rates (a 50% reduction). This would appear prudent since 75% of CANS members treat work comp patients. Mr. Mattoch was interviewed by this reporter—see item 3.
Since readers of this newsletter know how to do math, you can determine the current dues income creates 23K to pay Mr. Mattoch’s $24K+/yr since in the past we have needed 50K to run the organization. Noting the potential shortfall, the Board decided to reduce routine annual costs by discontinuing reimbursement to Board members and consultants for travel/lodging related to attending Board meetings. This saves about 5K a year which added to saving 2K a year by publishing an electronic rather than a printed newsletter, effectively makes another 7K available. Toss in the 4K we made on the last annual meeting (kudos to Dr. Hunstock) and our lobbying costs have been more than covered by the increased dues without dipping into our 30K reserve. That strikes me as what Boards of Directors are supposed to do, namely pursue the goals of the organization in a responsible manner.
The Board heard a report from Bill Caton about the deteriorating trauma emergency call system in Los Angeles . Eight trauma hospitals only have 18 neurosurgeons to cover them with no help in sight as their trauma burden increases with the closure of the King-Drew hospital and recruiting new, young neurosurgeons to the California/LA area proves elusive in light of reimbursement levels and life style costs. His hospital has offered to double his daily trauma coverage stipend of $1200 but he does not feel that will entice new blood into the system. His report was limited by his early departure to attend an acute subdural patient. The Board decided to pursue, along with the CMA, a state application for exemption from the Taft-Hartley law for trauma coverage which, if successful, would allow trauma surgeons and neurosurgeons, among others, to collectively bargain for fees. The question arises as with whom to bargain but is a beginning maneuver to try to help in this troubled area. Stay tuned.

2. EMTALA—it gets better, it gets worse
As you know, the Feds recently lightened up on docs when they allowed us to be on call at more than one institution and to be practicing neurosurgery on our daily patients while on ER call without incurring EMTALA violation law suits. They did indicate that when we are not available for these reasons, the hospitals have to make a good effort to handle the emergency patient who needs us by finding other docs to treat or have good and quick transfer protocols in place. Of course, what constitutes “good effort” is in the eyes of the beholder and plaintiff attorneys are bring suits against the hospitals when “harm” has come to their clients because of failure to make the good effort. This institutional pain is accentuated by fewer and fewer neurosurgeons willing to take ER call at all and those that do expecting some significant compensation.
Little wonder that the hospitals are looking for some relief. John Kusske, past CANS president and present Board consultant, and who is the neurosurgical representative on the CMS EMTALA TAG (Technical Advisory Group) and the chair of its “On-Call” subcommittee, reported to the CANS Board that the hospital association members on the TAG have recommended that the CMS require docs to take ER call as a condition of participation in Medicare. These TAG’s were formed as part of the Medicare Modernization Act and recommendations, once approved by a TAG majority vote, go to CMS for potential implementation either as an administrative rule imposition or as a suggestion for legislation to Congress.
John is plenty savvy and smart and can represent us well in this debate but calls upon all neurosurgeons to contact him with their ideas as to why this idea will result in a worse rather than better situation for the patient needing emergency treatment. He can be reached at jkusske@uci.edu.
As a footnote to this issue, academic neurosurgeons who are longtime colleagues, allies and fellow CANS members, are chaffing at fast becoming where the buck stops in emergent care. Our President, Dr. Edwards, who in his spare time is Chief of Pediatric Neurosurgery at Stanford, reports that he has to turn away elective neurosurgical referrals because the hospital has no beds due to having to admit many true emergencies from other institutions who claim to have no specialists available to provide care. He notes the general under or non-funding these transfer patients have and also indicated the same problem exists in the adult service as well as at USC and UCLA.
If the private sector doesn’t perform better, I wonder if our academic friends may consider calling John and supporting the hospital idea of mandatory coverage. I don’t think the private sector can not do ED coverage or only do so after a hospital hold-up for excessive coverage fees and not at some point pay the piper, said piper playing the “ED coverage as a condition of program participation or medical licensure” tune.

3. Michael Mattoch—CANS Lobbyist
Mr. Mattoch was kind enough to spend some phone time with this reporter to flesh out what he does and how he does it. He is well spoken as one might expect and is able to put his answers across clearly. He is providing CANS with his expertise in gaining access to the staff of legislators and government officials to present his take on proposed legislation and/or government rule-making and in the process be sure to present the view of his clients on said actions. Mattoch, an attorney, has a long history of this kind of advocacy having been counsel to the Assembly Insurance Committee; he has advised various state departments and organizations and has worked for the California Healthcare Association and the CMA. He currently is an independent lobbyist and principal in the Norwood &Mattoch lobbying firm which has a client list of 31 organizations, CANS being the most recent addition.
He monitors and analyzes all pending legislation and rule making to determine how it may effect his clients and alerts same when something is afoot that could effect his client’s fortunes. He knows just about every staff person of every official in Sacramento and trades on his reputation of presenting clear, even analyses of pending actions/legislation as well as the views of his clients. Every two years he has the daunting task of establishing himself with the new crop of legislators that come to Sacramento, said crowd being 25% of the 40 Senators and 80 Assemblymen these days what with term limits.
For CANS, his attention will initially be focused on the work comp medical fee schedule which is under review by Andrea Hoch, the Administrative Director of the Department of Industrial Relations (who is rumored to be considering a major pay cut for docs) and AB681 which, if passed and signed by the governor (two big if’s), would prevent those pay cuts. He will alert us if our President needs to give testimony at a hearing in that regard. He notes that he also represents Liberty Mutual Group, a prominent work comp insurance carrier, but feels they will not lobby for a doc pay cut or against AB681 so any conflict can be avoided.
He also provides a weekly legislative update which this reporter will review and summarize in the monthly newsletter. Also, he is happy to attend CANS Board meetings but only if requested since his travel/housing expenses would be in addition to the monthly retainer. We welcome him to our CANS playing field as a significant team member. I think he should play middle linebacker.

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.