Newsletter

Volume 49, Number 10

Inside This Issue

Mark Linskey, MD

Mark Linskey, MD

CANS President

President's Message

Colleagues, and friends, on Monday October 25, 2021, we suddenly and unexpectedly lost Dr Randy Smith. Dr. Abou-Samra’s memorial published in this issue pays tribute to Dr. Smith more eloquently and thoroughly than I could. From my perspective I lost a valued friend and an irreplaceable mentor who has advised and guided me for 26 years through my time with the San Diego Academy of Neurological Surgery when I was on active duty with the U.S. Navy at NMCSD beginning in 1995, the Council of State Neurosurgical Societies, the Western Neurosurgical Society, as well as CANS. I know that we all extend our prayers, support and best wishes to his wife, Flo, and his family. We will be modifying our upcoming CANS Annual Meeting Agenda to include an appropriate memorial honoring Dr Smith and his accomplishments. We are saddened that we will miss his originally planned Saturday night banquet presentation entitled – “50th Anniversary Thoughts & Observations from a CANS Raconteur.” I am sure that it would have been poignant, pithy and meaningful, and would have likely had us all periodically holding our sides with laughter. I also want to thank Dr Abou-Samra for stepping up on very short notice, as the senior member of our CANS Publications Committee to step in and lead, as the Acting Editor for the CANS newsletter through our next CANS Board meeting January 14, 2022.

This month four consecutive, over-lapping in-person neurosurgery meetings were safely and successfully held in Austin, TX, namely the Society of Neurological Surgeons (SNS), the AANS/CNS Tumor Section Satellite meeting, the Council of State Neurosurgical Societies (CSNS), and the Congress of Neurological Surgeons. With the success of these in-person meetings and the dropping Covid 19 case numbers nationally, I think we can pretty much put to rest any fears that we will not be able to move forward with our CANS Annual Session January 14-16, 2022, at the Hilton Torrey Pines in La Jolla. Please mark your calendars, register for the meeting and make your hotel room reservations ASAP. We would really like the best possible CANS member showing to “jump start” our society, its efforts, and initiatives as we emerge from the torpor of this terrible pandemic.

As we began to discuss in last month’s CANS newsletter, our upcoming annual session January 14-16, 2022, will be a very special CANS Annual Session as work our way towards the 50th Anniversary of the largest state neurosurgical society in the United States, and we have a very special program prepared. The theme of this Annual Session is the “Challenges of Corporate Employment”. There will be two Special Sessions on Saturday January 15 that will be unique and new topics of interest to all CANS members that, to my knowledge, have never been put together for any other neurosurgery professional meeting presentation. These sessions are Session 5 – Challenges of Corporate Employment, and Session 3 – The Future of Telemedicine in Neurosurgery.

The third of four topics in Session 5 will be “Evolving Misuse of the ‘Disruptive Physician’ Label”. The “disruptive physician” concept was originally born out of a JCAHO requirement for hospital medical staffs to address the problem of physicians who endanger patient safety within a healthcare institution by intimidating staff from speaking up or speaking out to report problems or issues as a result of “bullying” behavior and anger management issues. Unfortunately, this well-intentioned initiative has more recently morphed into an opportunity to control, suppress the voice of, and/or punish physicians who point out problems with existing hospital policies and procedures and even those that are acting as advocates appropriately advocating for the quality of care and the safety of their patients. The speaker for this session 5 topic will be Dr Cara Rogers. Dr Rogers was the lead author, researching and writing our peer reviewed publication on the matter [Rogers C, Simonds G, Mayo DA, Linskey ME, Phelps, J. Commentary: Addressing concerns regarding the evolving “disruptive physician” label. Neurosurgery 2019; March 84(3): E225-229] and she is in a unique position to authoritatively and exhaustively cover this issue. This article arose from a CSNS Medical Practice Committee resolution that not only passed overwhelmingly in the CSNS but went on to the American Medical Association (AMA) House of Delegates through our AANS/CNS AMA delegates to eventually lead to a change in the AMA Medical Staff Code of Conduct.

The fourth of four topics in Session 5 will be “The Corporate Evolution of Department Chairman”. With the consolidation and union of University Medical Centers and Schools of Medicine into unified University Health Affair systems, academic neurosurgeons have increasingly become salaried employees with their income largely formulaically determined based on clinical productivity centered on RVU generation according to a formula largely set at the institutional, rather than the departmental level. With this evolution, we have seen a transformation of academic department chairs from autonomous leaders with some degree of financial independence and freedom to pursue a collective departmental vision, as well as leaders and mentors developing, advocating for, and protecting, their faculty, into what are now essentially middle management corporate employees often dependent on institutional stipends to augment their formulaic clinical productivity income as Chairs. These stipends often come with conditions and expectations as an institutional middle management representatives. Clearly this has potentially serious implications for neurosurgeons as employed, salaried physicians. The speaker for this session 5 topic will be Brian Miller, M.D., M.B.A., M.P.H. Dr Miller is a Hospitalist and Assistant Professor of Internal Medicine at John Hopkins University School of Medicine. More importantly he is a professional Health Policy Consultant (https://www.brianjmillermd.com/). He has previously worked for the Federal Trade Commission (FTC), the Federal Communications Commission (FCC), the Center for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA). Dr Miller has an interesting perspective on how and why this transformation has come about as well as some ideas as to how we might move forward in a better direction.

The second and third of five topics in Session 3 will be “Neurosurgery Telemedicine Neuro Exam – Spine” and “Neurosurgery Telemedicine Neuro Exam – Spine”. The speaker for the second talk will be Dr Mick Perez-Cruet from Michigan and the speaker for the third talk will be Dr Ezequiel Goldschmidt from UCSF. Dr Perez-Cruet has co-authored a paper on this topic [Yoon JW, Welch RL, Alamin T, et al. Remote virtual spine evaluation in the era of covid-19. Int J Spine Surg 14(3): 433-440, 2020]. Dr Goldschmidt has extensively relied on telemedicine consultations and video examinations in his cranial skull base surgery practice. Both will be focusing on practical strategies for getting the most information and the most reliable information from video-based neurological examinations in each subspecialty area.

The fifth speaker in Session 3 will be Dr Jordan Xu. Dr Xu is a neurosurgery resident at UC Irvine and is currently a CSNS Resident Fellow from the CSNS Southwest Quadrant.   Dr Xu will be presenting the data from the survey on the use of telemedicine in neurosurgery in the U.S. This important survey just went out 10/30/21 by email to all U.S. neurosurgeons through the AANS/CNS Washington Office. Dr Xu will be presenting this important data for the first time publicly at our CANS Annual Session. This will be important new data which will be used by our AANS/CNS AMA delegates at the AMA House of Delegates to try and influence AMA health policy recommendations to congress in a way that will support the needs of neurosurgical practice across the country as the emergency measures for telemedicine instituted during the Covid pandemic are examined for possible transition to permanent new policy going forward.

This Annual Session will also mark the beginning of a one-year run up to the 50th Anniversary of CANS as an organization in 2023, and as such we have a very special Saturday pm banquet planned with its own dinner program as outlined below:

6:30 Cocktails
7:00 Dinner

Program:

  1. CANS Historical Vignette – Austin Colohan, MD
  2. Formal Presentation of New CANS Members – Joseph Chen, MD
  3. Byron Cone Pevehouse Distinguished Service Award
  4. CANS Lifetime Service Award
  5. Randre Grace – Mark Linskey, MD
  6. Avant-Premiere CANS 2022-23 – Javed Siddiqi, MD

As you can see, everyone will get a chance to meet, introduce yourself, and chat with each of our new members and their families in person. There will be interesting reminiscences of our 50 years of existence, and we will get a chance to honor two of our very well deserved members with CANS awards. Dr Javed Siddiqi will have an opportunity to lay out his vision for his presidential term 2022-2023 as the new CANS President and perhaps foreshadow some of his priority initiatives as well as his January 2023 Annual Session. We would ask everyone attending our upcoming CANS meeting to please purchase a banquet ticket so that we can get a proper head count for this special evening event.

The CANS Annual Session will be held the weekend of Martin Luther King’s birthday January 14-16, 2022, in La Jolla, CA. We will be holding our meeting at the Hilton La Jolla Torrey Pines hotel https://www.hilton.com/en/hotels/santphh-hilton-la-jolla-torrey-pines/ . This venue is only 16.3 miles from the San Diego airport and is easily accessed. It is adjacent to the Torrey Pines State Nature Reserve with beautiful hiking trails and views https://torreypine.org/ and is 5 minutes from Torrey Pines State Beach https://www.parks.ca.gov/?page_id=658 . It is only 7 miles from Sea World and is close to La Jolla village and Birch Aquarium. The hotel overlooks the famous Torrey Pines golf course, and all rooms have Pacific Ocean views. The hotel itself has hosted multiple US Open Championships including the 2021 US Open. It provides exclusive access to daily tee times but also has its own spectacular outdoor pool and pool area as well as tennis courts. This venue promises to be a terrific outing for our members as well as our families. Please be sure to book your rooms in the CANS room block as soon as possible to enjoy the whole 3-day holiday weekend BOOK YOUR ROOM HERE. The more people who sign up and book rooms for both evenings as soon as possible, the better the deal that CANS will enjoy on our venue contract. We really would like to see everyone at the meeting. The support of each of our members is really important and certainly needed at this time.

Registration for our meeting is also now open. I would encourage every CANS member to register for this special and historic meeting in this beautiful location ASAP REGISTER HERE! When you register, it would also be a terrific time to update your CANS membership dues so that they are current DUES

As our senior CANS CSNS Delegate and CANS CSNS Delegation Chair Alternate, Dr Wade presents a report of the October CSNS meeting in this CANS Newsletter issue, a service for much of the recent past performed by Dr Smith. We thank him for stepping up to fill this role. Of note at this last CSNS meeting the CSNS Chair Dr Cheng asked for a formal update on the state of CANS as an organization. I was very pleased to bring everyone up-to-date with a presentation Sunday morning which outlined our history, structure, areas of focus and scope of work, as well as the result of our recent initiatives over the last 1.5 years. Please feel free to contact me at mlinskey@hs.uci.edu if you would like a copy of these .ppt slides.

On Saturday 10/30/21, the AANS/CNS Washington Committee and the CSNS jointly emailed all US neurosurgeons a survey regarding neurosurgical use of telemedicine as well as potential neurosurgery needs for any federal policy that might be put into place once the emergency Covid pandemic rules expire. This is a really important survey for addressing our needs which may differ from those of our primary care policies. Please take the time to respond to this survey by December 3. The link is https://www.surveymonkey.com/r/NeurosurgeryTelehealth .

Last week CANS sent out an Urgent Action Needed email to all CANS members requesting immediate action in the form of asking each of us to contact each of our local congress representatives and providing an easy means to do so with a link to a boiler plate letter that simply needed to be selected and signed electronically courtesy of efforts by our colleagues at the CA Medical Association (CMA). In December 2020 congress passed the Surprise Billing Act as part of the year end omnibus spending bill. The law allows an out-of-network provider to invoke arbitration if they are dissatisfied with the amount offered by a third-party payer for their services. The arbiter would then select between the final offer submitted by each party. On September 30, 2021, the Biden Administration via the departments of the Office of Personnel Management (OPM) and Health and Human Services (HHS). issued an interim final rule that essentially changes and violates the original law. Instead of the arbiter choosing one or the other of the best final offers of the two parties concerned, the rule requires the arbiter to choose the lesser of either (a) the billed charge, or (b) “the median payment amount for the same or similar service in the geographic area”. In addition to being in direct conflict with the act of congress and essentially changing the law after the fact without congressional approval, the new administration rule would essentially eliminate all incentive for third party payors to contract with physicians. Why would they, when they can now unilaterally lower payments for services at their whim and then force physicians who refused their contracts to accept these reduced rates under the new final rule for misapplying the Surprise Billing Act. I certainly hope that each of our members stepped up to ask their congress representatives to act and sign the important surprise billing letter to Health and Human Services Secretary Becerra, Labor Secretary Walsh, and Treasury Secretary Yellen before this interim final rule becomes truly final.

The AANS-CNS Washington Committee has also completed its comprehensive update which was prepared for the SNS and CSNS meetings in Austin. TX. Among many other items, it contains recent information from the Washington committee subcommittees including the Coding and Reimbursement Committee, the Communications and Public Relations Committee, the Drugs and Devices Committee, the Joint Guidelines Review Committee, the Neuro surgery Quality Council, and the AANS/CNS AMA delegation The full report can be found at https://www.dropbox.com/s/7s2pwah0c691hpu/October%202021%20Washington%20Update.pdf?dl=0 .

In our April newsletter we alerted you to the California Assembly Bill AB 615, [Higher education Employer – employee relations act: procedures relating to employee termination or discipline] introduced February 12, 2021, by Assembly Member Rodriguez. The bill passed in the Senate 09/02/2021 and passed in the Assembly 09/07/2021. It was “enrolled” 09/09/2021 and then corrected 09/13/2021. Last year Governor Newsome vetoed it but for an apparent technicality. This year it was signed by Governor Newsome and was “Chaptered” on October 6, 2021. (https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220AB615). Presumably, this new law will take effect January 1, 2022. Potential effects of this new law on our California neurosurgery residency training programs remains to be seen, but we will need to watch closely as potentially serious concerns raised by the ABMS, which includes the ABNS, persist.

I would once again like to take this opportunity to ask all CANS members to please consider getting involved. We are always in need of concerned, aware, and engaged neurosurgeons. Please do not hesitate to contact me regarding our upcoming meeting, and/or let me know if you would like to get more involved with CANS at mlinskey@hs.uci.edu. Even if you cannot dedicate your own time and effort, please consider financially supporting CANS, the national Neurosurgery Political Action Committee (Neurosurgery PAC) (https://www.aans.org/en/Advocacy/NeurosurgeryPAC), and the CMA Political Action Committee (CalPAC – https://www.cmadocs.org/calpac/donate ). Please do whatever you can to support CANS, the NeurosurgeryPAC and the CMA, they are fighting for you.

All the best!

Quote of the Month

When an old man dies a library burns to the ground – African Proverb

Randall W. Smith, MD

Randall W. Smith, MD

We Lost a Dear Friend – Neurosurgery Lost an Icon!

The night before he died, as was his custom, he had dinner with his San Diego family after listening to a classical music concert in La Jolla. As usual he was in rare form.n the early hours of October 25, 2021, we lost our dear friend Randy Smith. And, just like that, Neurosurgery lost an icon. Randy was central to how we view ourselves as neurosurgeons.

The next morning, he awoke early, as was his habit, and went downstairs to his study to start his preparations to read his newspapers and the various articles of interest that he always kept handy. He was a voracious reader. Undoubtedly, he was about to check on the scores of various sporting events. He was disappointed that the Dodgers lost the Championship of the National League to the Braves; I know, he told me.

But instead, he collapsed and died. And contrary to his perfect timing when he told jokes, his timing this time was simply awful. He died 5 days before his 83rd birthday. We will miss him dearly.

Randall William Smith was born on October 29, 1938, in Minneapolis Minnesota. He grew up in Seattle Washington where he received his education. After graduating AOA from the University of Washington School of Medicine in 1965, he decided to checkout the East Coast and did an internship at the Boston City Hospital, but since he was a “Westerner” at heart, he went back to Seattle where he completed his training in Neurological Surgery at the University of Washington under the tutelage of Arthur A. Ward Jr., an influential founding member of the Western Neurosurgical Society.

Dr. Smith served our Country in an active-duty capacity and as a USAF reservist from 1965 to 1971 and was stationed at Osan airbase in South Korea after the Pueblo capture activated his medical unit. His service helped fund his training (through the GI Bill) and made it possible for him to purchase his first house with a VA mortgage.

His lucky star was smiling at him when he met and married the love of his life Florence Beale, on December 18, 1962. Flo worked as a nurse and then nursing instructor at the University of Washington, which helped support Randy during his training. She was his partner in every one of his endeavors and accomplishments.

Together, they moved to San Diego where Randy joined the faculty in the Division of Neurosurgery at the University of California San Diego in 1971. He helped start the Neurosurgery program in the new school of medicine with two local colleagues, including Dr. John Alksne, the head of the Division. He was on the active faculty as an Associate Professor until 1981. He then concentrated on building a very successful private practice and covered emergency call until 1993. That year, he celebrated the “retirement” of his beeper by smashing it with a hammer after a celebratory dinner with his family. During this period, he continued to hold a clinical appointment at the University. He loved teaching and mentoring residents. He continued doing surgery until 2004, when he switched to carrying out agreed medical examinations for the next decade.

Although he retired from the “practice” of neurosurgery in 2004, he never retired from “Neurosurgery.” He remained involved and was the founder of several important neurosurgical and neurological societies and served in leadership capacity in many local, state, regional and national organizations. This writer apologizes in advance for missing any of these organizations; it is simply impossible to remember them all.

  • San Diego Neurological Society Founding Member
  • San Diego Academy of Neurological Surgeons President
  • San Diego Neurosciences Society Treasurer-current

formed when the San Diego Neurological and Neurosurgical societies

merged in 2018- his daughter Christine is President

  • Western Neurosurgical Society President
  • Federation of Western Societies of Neurological Sciences President
  • California Association of Neurological Surgeons.               Founder & President
  • American Trauma Society Founding Member
  • Congress of Neurological Surgeons
  • American Association of Neurological Surgeons Vice President

Randy was also a leader in his local medical community and served as Chief of Staff at Sharp Memorial Hospital.

During his amazing career, Randy received many awards. Again, this writer apologizes for missing many:

  • 2006 California Association of Neurological Surgeons

Byron Cone Pevehouse Distinguished Service Award  

  • 2006 Council of State Neurosurgical Societies

Lifetime Achievement Award

  • 2012 Council of State Neurosurgical Societies

Randall Smith Distinguished Service Award, an award created to emphasize the exceptional effort he put in everything he did for the organization-CSNS

  • 2020-California Association of Neurological Surgeons

Lifetime Exceptional Service Award, an award inspired by his service

 

Randy was a renaissance man. His interests were varied and did not only encompass all things neurosurgical.

  • Farmer- he loved working and producing avocados on his farm in San Diego County.
  • Wood worker- his work was not only artistic but also flawless, an example of perfection. He crafted beautiful furniture.
  • Music lover and supporter of various musical groups in San Diego
    • Board of Directors Mainly Mozart Festival, San Diego
    • Board of Directors San Diego Pops Association
    • Summer Pops Advisory Committee, San Diego
    • San Diego Symphony Advisory Committee
  • Sports lover- his encyclopedic memory allowed him to quote what happened exactly in various championship games of baseball and football, going back many years.
  • Comedian- his stand-up routines at the WNS annual banquets rendered the audience members in stitches.
  • Philanthropist
    • Sharp Memorial Foundation in San Diego
    • Committee on Philanthropy, Sharp Health Care
    • La Jolla High School Foundation
  • Editor-many publications including CANS.
  • He founded the CANS newsletter and published more than 200 issues. It is the leading state neurosurgical society newsletter. He was its guiding light.

Randy leaves behind a strong and beautiful family.

  • Florence, his wife of 58 years. “Flo,” to us. Flo managed his office until he retired. Every day, she sets an example of service and excellence. An example of how to work behind the scenes. She is a friend, a mother and grandmother figure to many of us.
  • Stephen, his wife Marina, and children Peyton, 10, Gavin, 8, and Kellen 5. They live in Sacramento.
  • Christine Smith, a neuroscientist who is a member of the Western Neurosurgical Society, and husband Chad Prey. They live in San Diego
  • Michael and girlfriend Athena Garcia. They live in San Diego, three doors down from Flo.
  • A brother Jack “Rod” who lives in Tucson.
  • A sister Jill who lives in Washington State. Jack and Jill are twins.
  • Many nephews and nieces.

Indeed, we lost a friend and Neurosurgery lost an icon. It is difficult to accurately portray the man we lost. Randy was a man of integrity, of scientific curiosity and discipline, a man who at once did not tolerate imperfection but applauded hard work. He was a man who was described more than once as a curmudgeon, but who was often the life of a party. He did not take himself seriously but all of us had a great admiration and respect for him. He was exacting and demanded much of himself. He was a mentor to many of us. And he was a charismatic man whose company everyone enjoyed. He was a man with a vision, a team player, a colleague, a trusted companion, and a caring, loving, and empathetic human being.

Rest in Peace, my friend!

MOUSTAPHA ABOUSAMRA, MD

Please Note: An issue of the CANS newsletter that will be entirely dedicated to commemorating Randall W. Smith, MD, is being planned for mid-December. You are encouraged to submit personal remembrances if you’d like them included in this issue. Please send your remembrances to mabousamra@aol.com or emily@cans1.org. Deadline for submission is November 28, 2021. Thank you.

Ciara Harraher, MD

Ciara Harraher, MD

Contributing Editor

CMA Corner

During the HOD we discussed two major issues and had a legislative update from Janus Norman, Senior VP of Government Relations. Highlights of some of the CMA victories include:he 150th Annual Session of the California Medical Association (CMA) House of Delegates (HOD) convened on Saturday, October 23, 2021, via virtual platform. Dr. Esther Kim and I were representing CANS as part of the Specialty delegation. On Friday, October 22, our delegation met first to discuss our main legislative priorities. Not surprisingly, many of the issues we face as neurosurgeons are common amongst other specialties. Threats to MICRA, scope of practice, ongoing CMS cuts and the burden of prior authorization to name a few. We also held our election, and I was elected President of the delegation after serving as the Secretary for 3 years.

-Extending the telehealth flexibilities and expansions from COVID

-Making permanent the proposition 56 tobacco tax funding to continue with Medi-Cal supplemental payments. This ensures practice stability for Medi-Cal practitioners

-Expanding eligibility for full-scope coverage to individuals >50 y regardless of documentation status

-Extending coverage to all children under 5y

-Securing $50 million one -time in GME funding

-Providing grants of up to $50K to physician practices to incentivize participation in state’s vaccine network

-Fixing the state and local tax deduction cap

SCOPE OF PRACTICE:

SB 890- Board of Registered Nursing has a taskforce that is engaging in how to implement bill, CMA is part of ongoing conversations and has blocked existing NPs from eligibility

-fighting other bills by pharmacists and optometrists to increase their scope.

ADMINISTRATIVE BURDENS:

SB 510 (Pan) – requires health plans to cover all covid tests/vaccines without barriers like patient cost-sharing or prior authorizations.

SB 242 Newman – reimburse physicians for PPE proactively but were unable to get retroactive reimbursement

TELEHEALTH:

AB 457(Santiago) – ensures that insurers don’t steer patients from their providers to 3rd party, direct to consumer companies using the “next doc up” model of care.

MENTAL HEALTH COVERAGE: SB 428 (Hurtado) requiring commercial health plans to provide coverage for adverse childhood experiences (ACES) screenings on par with Medi-cal.

Major Issue #1: Racism and Other Barriers to Health Equity

Three main topics addressed in the report : 1. Health Equity 2. Racism and Medical Education   and 3. Infant and maternal mortality

Report emphasizes that there needs to be a financial commitment to address racism from schools and workplaces. We need to start to allocate resources to this versus just forming committees

Racism is a root cause of health inequities and there is evidence of harmful ignorance and dismissal.

  • core concepts:

  1. Social Construction of Race: System of categorizing people that arises to differentiate groups into hierarchies to advantage some and disadvantage others
  2. Racial essentialism: Inherent biological and genetics by race

naturalness, cross-cultural stability, inductive potential

  1. 4-level conceptualization of racism: structural, institutional, interpersonal, internalized

Four of the top medical journals not writing about racism and health. Although there was a dramatic uptick in 2020, the majority are commentaries and viewpoints not empirical studies.

Evidence of Harm: increased prevalence of disease in black and brown people and a history of blaming and pathologizing historically marginalized groups.

CDPH: California landscape

-California strategic growth council

-plan for when race is no longer a predictor of one’s health outcomes

-Normalize to organizing to operationalizing

-Momnibus act to tackle racial disparities in maternal and infant health

Trying to address root causes upstream

Equity: means that groups have different needs and starting points

For example: Covid vaccination rates are highest in Asian>White>Hispanic>black, higher rates in Non-Medi-Cal >Medi-Cal

Continuum on becoming an antiracist multicultural organization

  1. Talk about racism weekly or daily
  2. Share adopted CMA recommendations with colleagues
  3. Observe your daily thoughts
  4. Ask yourself how did I contribute to help or dismantle racism today?

Major Issue #2: Corporatization of Health Care

-increased control of physician’s practices by lay entities

-many practices face severe financial pressure during COVID

-only 30% of practices are independent in 2021

-rapid pace of mergers and acquisitions

-corporate policies may restrict the practice of medicine

-predatory contracting practices

Medical Practices act does provide some support but not enough, needs to be expanded to protect small and solo practices.

Ray Quintero – National trends on Corporatization

70 % physicians employed

Big increase after COVID

Ex. Optum united healthcare subsidiary – >50 000 physician group

Private equity firms – non tradeable, 25% return on investment, keep practices for < 5 y and then they move on 32% acquisitions from private equity firms:

Why are practices doing this? Financial pressures, risks, incentives, administrative burden, burnout and lifestyle, generational perspectives COVID closed practices, led to early retirements, PPE pressures, advanced and accelerated payments, provider relief fund, stopping elective procedures.

Market consolidation decreases consumer choice and puts physician autonomy in clinical decision making at risk. We will need to balance the shift to value-based care and the associated pressures that go with that transition. Overall, consolidation increases spending and vertical integration impacts other sectors.

 

Regulatory and legislative pressures force physicians to leave private practice

Could legislation be passed to preserve physician autonomy in theses private equity owned firms, foundation models skirt around the corporate bar on medicine

Questions remain: Will a door be left open for CRNA or APPs to take over physician roles as they cost less to these private equity firms?

If the majority of us are now employed, Do we need a union?

Patrick Wade, MD, FACS, FAANS

Contributing Editor

CSNS at the CNS Meeting Report

The CSNS met in Austin TX but the meeting was a hybrid. No resolutions were presented or debated. In general there was an in depth review of what work is being done by the various committees.
Also discussed was the relationship we share with the two parent societies, the AANS and the CNS. We have a dependency on them for financial support. The meetings were held at the JW Marriott Hotel.

Joe Cheng, M.D. is the CSNS Chairperson. For a number of years he has lead a fight against Insurers trying to limit spine reimbursement. And he has had some success in this area. He discussed some of the history of the CSNS especially its commitment to reimbursement and fiscal affairs. I can tell you many moons ago when this type of organization was presented Frank Mayfield, M.D. rallied against it saying it was beneath our professional character to discuss money. I was a Resident and Peter Dyck,M.D. (A past CANS Pres.) and Jack Doyle, M.D. (A CANS Founder)  urged me to attend the AANS Business meeting and vote in favor. Dr Mayfield was not pleased.
This at the height of the Med Mal crisis and many attempts to limit our professional reimbursement.
It is fitting Dr Chen is the Frank Mayfield Chair and Professor of Neurosurgery at Cincinnati.  Oh how the worm turns.

His discussion included of how we are organized, the success of our Resident mentor programs and now we have CSNS papers presented at the afternoon sessions All were covered as our progress as an effective organization. It is notable how many of the CNS and AANS officers have been members of the CSNS.
The various committees discussed works in progress, on manpower, legal issues, various assaults to our practice of Medicine and Neurosurgery, the looming Federal cuts etc.

In Medical legal we are working on surveys to determine if there is bias in approval of new devices. There also is an issue on burnout which will also get a survey.
Go to the AANS and CNS websites for details.

On Sunday the officers reviewed their areas of concern. One is to try and assure all states have someone representing them. Cathy Mazzola our Treasurer gave a very good in depth report.of the finances of CSNS.
Dr. Phelps discussed future funding and the prospect of more industry support.
Dr Mark Linskey our CANS President gave an in depth review of CANS. How we approach problems and our participation over the years in the CSNS. There are awards given by CSNS the Cone Pevehouse young neurosurgeons award. There is the Roberet Florin Resident award. And there is the Randall W. Smith Award for Meritorious Service to the Council of State Neurosurgical Society.  All were  CANS members who contributed very much for us.
May Randy rest in Peace.

The luncheon speaker addressed the disastrous effects of opioid  limitation on the citizens of West Virginia. Because of the rural nature of the state and limited amounts of refills they turn to the streets.
What is found on the street is often laced with fentanyl. We all know what happens next.

Katie Orrico as always reviewed our interests  and problems in Washington DC. And we have many. Especially the proposed 9% shut off of Medicare funds to Neurosurgery.
She lauded 2 Democrat California Congressmen both M.D.s, who have supported us and carried legislation in the interest of our patients and their care. If you can Thank Ami Bera and Raul Ruiz for their help.  Support and contribute to the PAC! Our own John Ratliff is not only the CSNS Vice Chairman.
He also Chairs the Washington Committee which works with both the AANS and the CNS. We are so fortunate to have John on our team.

Next CSNS meeting is in Philadelphia at the AANS Spring meeting.

Tidbit #1- 'Rosa' Recall

The FDA issued on October 29, 2021, a Class I recall for the Zimmer Biomet Rosa One 3.1 Brain Application platform for robot-assisted neurosurgery procedures.

Evidently, Zimmer Biomet sent an urgent medical device correction on September 22, 2021, for the platform as a result of a software error. Affected devices — of which there were 119 total in the U.S. — were distributed between Dec. 1, 2019, and Aug. 31, 2021, according to the FDA.

The recall was due to a software error that could lead to the incorrect placement of instruments during stereotactic neurosurgical procedures.

In total, there have been three complaints about the device issue with zero deaths or injuries reported.

The Rosa Robot has gained popularity over the last two years. It is important for our members to be aware of this.

Tidbit #2- New Faces Appointed to CANS Board

N. Nicole Moayeri, MD was appointed by Mark Linskey, MD, CANS President to finish the Director at Large South position held by Esther Kim, MD. This term ends this year. Dr. Kim is relocating to Oregon and we wish her all the best.

Anthony DiGiorgio, DO was also appointed by Dr. Linskey to finish theDirector at Large North position held by Sanjay Dhall, MD. Dr. Dhall has accepted a position at UCLA.

Tidbit #3 Other Appointments and Accolades  

Ciara Harraher, MD was elected the President of the Specialty Delegation of the CMA.
Moustapha Abou-Samra, MD was elected for his 4th term as Chairperson to the Council of Ethical and Judicial Affairs(CEJLA).
Brian Gantwerker, MD, CANS Director at Large South won NASS Advocacy Award, read about it here: NASS Award

Congratulations to all!

EXHIBITORS!

Calling all exhibitors! Sign up today to secure your company’s table at our Annual Meeting! Please find information here to do so: https://cans1.org/exhibitor-info-2/  

We appreciate and welcome you all!

Calendar

International Society for Pediatric Neurosurgery: Annual Meeting, November 14-18, 2021, Singapore

AANS/CNS Joint Pediatric NS Section: Ann. Meeting, December 7-10, 2021, Salt Lake City, UT

Cervical Spine Research Society: Annual Meeting, December 2-4, 2021, Atlanta, GA

CANS, Annual Meeting, January 15-16, 2022; San Diego, CA

Southern Neurosurgical Society: Annual Meeting, February 17-19, 2022, Hollywood, FL

California Neurology Society: Meeting, November 12-15, 2021, Santa Barbara, CA

AANS/CNS Joint Section on Pain: Annual Meeting, TBA

Neurosurgical Society of America: Annual Meeting, June 12-15, 2022, Maui, HI

Rocky Mountain Neurosurgical Society: Ann. Meet., 2022, TBA

New England Neurosurgical Society: Annual Meeting, 2022, TBA

AANS/CNS Joint Cerebrovascular Section: Annual Meeting, 2022, TBA

AANS/CNS Joint Spine Section: Annual Meeting, February 23-26, 2022, Las Vegas, NV

North American Neuromodulation Society: Annual Meeting, January 13-15, 2022, Orlando, FL

CSNS Meeting, April 28-29, 2022, Philadelphia, PA

AANS: Annual Meeting, April 29-May 2, 2022, Philadelphia, PA

Western Neurosurgical Society: Annual Meeting, September 9-12, 2022, Kona, Hawai’i, HI,

Classifieds

Looking for a new partner or position?

Any CANS member who is looking for a new associate/partner/PA/NP or who is looking for a position (all California neurosurgery residents are CANS members and get this newsletter) is free to submit a 150 word summary of a position available or of one’s qualifications for a two month posting in this newsletter.  Submit your text to the CANS office by E-mail (emily@cans1.org).

To place a newsletter ad, contact the executive office for complete price list and details.

Archives

CANS NEWSLETTER – October 2021

Newsletter October 2021 Issue Volume 49, Number 10 Inside This Issue President’s Message Colleagues, and friends, on Monday October 25, 2021, we suddenly and unexpectedly lost Dr Randy Smith. Dr. Abou-Samra’s memorial published in this issue pays tribute to Dr. Smith more eloquently and thoroughly than I could. From my perspective I lost a valued

Read More »

CANS NEWSLETTER – July 2021

Newsletter July 2021 Issue Volume 49, Number 7 Inside This Issue President’s Message Over the last decade, there has been an inexorable fundamental paradigm shift in how physicians are employed in the United States. As private practice financial pressures and risks including rising medical liability costs, requirements to invest in expensive electronic health records, ever-growing

Read More »

CANS NEWSLETTER – May 2021

Newsletter May 2021 Issue Volume 49, Number 5 Inside This Issue President’s Message Wow! What a change in only four weeks! Whatever happened to the goal of herd immunity??? In my last newsletter message Governor Newsom had only two weeks previously finally allowed hotels to re-open under significant protocol restrictions for counties who had reached

Read More »

CANS NEWSLETTER – April 2021

Newsletter April 2021 Issue Volume 49, Number 4 Inside This Issue President’s Message It has been an eventful month since my last CANS newsletter message. On Saturday April 17th CANS held its Spring Board of Directors meeting. We were once again able to demonstrate that virtual Zoom board meetings are efficient and effective while saving

Read More »

Leave a Reply

A Special Thank You To Our Sponsors

CANS 2021 Special Session Corporate Sponsors