Newsletter

Volume 49, Number 12

Inside This Issue

Mark Linskey, MD

Mark Linskey, MD

CANS President

President's Message

We are now only two weeks away from our January 14-16 CANS Annual Session. I know that many CANS members and their families are concerned about the recent emergence of the Covid-19 Omicron variant and the surge of new cases brought on by this new variant, the annual winter virus season and recent holiday gatherings. Please rest assured that your CANS leadership shares this concern. We have been following events very closely, and will continue to do so. We held a special 2022 CANS Annual Planning Committee meeting 12/28/21 to thouroughly discuss and debate these issues. Please refer to a special message from the CANS 2022 Annual Meeting Committee published later in this newsletter communicating the committee’s unanimous decision to proceed with our first in person CANS Board meeting in two years January 14, and our first CANS Annual Session in two years Janaury 14-16.

As we have been discussing monthly since our September CANS newsletter, our upcoming annual session January 14-16, 2022, will be a very special CANS Annual Session as we 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”. In the September and October newsletters we focused on two sessions (Sessions 3 and 5) 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. In this newsletter we will focus on our Washington legislator participation and the role of neurosurgery residents in training in our meeting.    

At 3:45 Saturday afternoon, we will be joined by California Congressman Raul Ruiz. Congressman Ruiz is joining us to receive the CANS George Ablin Distinguished Public Service Award. He will also address CANS for 15 minutes on US Federal Healthcare issues and initiatives. This will be followed by an audience question and answer session, so between now and then, write down any healthcare-related questions that you would like our California Congressman to address and answer. Unfortunately, our guest California Senator Alex Padilla, has had to pull out from the meeting due to another conflicting, pressing, engagement, but he has offered to send a video address that we will review when we receive it, and might consider playing it at this afternoon session as well.

As many of you know, CANS is firmly dedicated to supporting our California neurosurgery residency training programs, contributiong the the socio-economic and healthcare policy trainign of our California residents, and engaging neurosurgery residents in the structure and leadership of our organization. Many of you may not be aware that each year we elect a neurosurgery resident from Northern CA and another from Southern CA to our CANS Board and they participate and contribute at all CANS Board mettings throughout the year. For the very fiirst time this year we will be providing them with a CANS Annual Meeting Plenary Session forum for presenting issues that the choose that they consider important to all California neurosurgery residents. These presentations will occur late Saturday afternoon after Congressman Ruiz’s session.

Dr. Jennifer Quon is a neurosurgery resident at Stanford and currently serves as our Northern CA Resident Liaison to the CANS Board of Directors. She will be addressing us on the “Transition to practice: resources for understanding the evolving practice landscape”. Dr. Arvin Wali is a neurosurgery resident at UCSD and currently serves as our Southern CA Resident Liaison to the CANS Board of Directors. He will be addressing us on “Optimizing Neurosurgical Residency Training – Inspiring the Surgical Leaders of Tomorrow”. We hope that this new CANS meeting session will become a permanent CANS meeting feature going forward, allowing our residents to have even greater influence in the direction and initiatives of CANS as we expand the Resident Board Liaison positions to four residents beginning July 1, 2022.

Two thirds of our half-day Sunday morning program will be dedicated to our California residency training programs and our California neurosurgery residents. Session 9 will feature one chosen resident from each of our eleven trainign programs presenting ten minute abstracts related to their socio-economic, clinical care, or basic science research projects. Cash awards will be given for the best socio-economic, best clinical, and best basic science abstracts presented. This will be followed by a Rapid Fire abstract program as Session 10 which will feature residents presenting 2minute abstracts outlining their research projects.

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. Randy Smith, MD, In Memoriam – Moustapha Abousamra, MD
  6. Randre Grace – Mark Linskey, MD
  7. 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, we will get a chance to honor two of our very well deserved members with CANS awards, we will be able to celebrate the life of one of our greatest members, Randy Smith with his family joining us, and 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.

Please remember that Proof of Covid-19 vaccination or a pre-entry negative test result within 72 hours of registration, will be required for members, guests and vendors to attend our 2022 Annual Session. Proof of vaccination either in the form of a completed HHS/CDC Covid-19 Vaccination Record Card or a California Digital Covid-19 Vaccine Record (https://myvaccinerecord.cdph.ca.gov/), or a copy of the negative test result, will be needed at registration in order to obtain a colored sticker indicating your vaccination status which will be placed on your meeting badge and allow access to all venues. Masking and social distancing requirements will conform to those officially in effect for the San Diego County Department of Public Health at the time of the meeting. Currently for indoor events in SD County, masking is required through January 15, and social distancing is recommended, but not required.

There is still time to register for the CANS Annual Session January 14-16, 2022 in La Jolla, CA

REGISTRATION at the Hilton La Jolla Torrey Pines hotel https://www.hilton.com/en/hotels/santphh-hilton-la-jolla-torrey-pines/ . When you register, it would also be a terrific time to update your CANS membership dues so that they are current https://cans1.org/membership-renew/ 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 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.

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 (based on arbitrated fairness, not on which was the lowest). 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 not the arbitrator-determined fairer of proposals, but the lesser of either (a) the billed charge, or (b) “the median payment amount for the same or similar service in the geographic area”. This Administration final rule is in direct conflict with the letter of the law passed by Congress. In November, 152 bipartisan members of Congress sent a letter called on the administration to revise the new rules before they take effect on Jan. 1. In the absence of action on this request, legal action became necessary. On Dec. 9, the American Medical Association (AMA) and American Hospital Association (AHA) filed suit against the Biden Administration in an effort to stop part of the surprise billing regulations from going into effect in January. The AANS and CNS will be leading an amicus brief effort supporting the AMA/AHA lawsuit. Other state medical and national specialty societies will join this initiative.

On December 7, 2021 by a close vote of 222 to 212, the House of Representatives passed S. 610, the Protecting Medicare & American Farmers from Sequester Cuts Act. It then went on to reconcile with the Senate where it originated and was subsequently signed by the White House December 10, 2021. The bill will mitigate steep Medicare payment cuts in 2022. Specifically, the legislation (which prevents approximately 7.75% of the anticipated 9.75% payment cuts):

  • Delays the 4% Pay-as-You-Go cuts for through 2022
  • Provides a one-year 3.0% payment adjustment to the Medicare Physician Fee Schedule conversion factor (CF) to help offset next year’s 3.75% CF reduction; and
  • Extends the moratorium on the 2% Medicare sequestration cuts for Q1 and suspends 1% of the sequestration cut for Q2. The 2% sequester cut would resume in Q3 and Q4 of 2022.

While this is good news, it is not the Medicare Fee Schedule reform that is so desperately needed as a long-term solution. It merely temporarily delays the next fiscal “cliff” and allows this recurring ongoing threat to the viability of physician practice to continue to be used as a leveraging bargaining chip going forward. Our Washington Office and NeurosurgeryPAC working through the Surgical Care Coalition worked hard and are to be thanked and congratulated for at least achieving this temporary, partial victory.

I would once again like to take this opportunity to ask all CANS members to please consider getting involved. We need your thoughts, ideas and input. Please do not hesitate to contact me 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.

This message will be my last CANS newsletter “President Message”. I would like to take this opportunity to thank each and every CANS member, and especially my fellow CANS Board members, for the chance to serve during these difficult two pandemic years. It has truly been an honor.

All the best!

Moustapha Abou-Samra, MD

Moustapha Abou-Samra, MD

CANS Past President

Acting Editor's Corner Optimism … Disappointments … Heartaches … Optimism Moustapha Abou-Samra, MD  

What a year?

 As I write this note, my son who lives in Washington, DC, andhis family are fighting a Covid infection, presumed to be Omicron. He is fully vaccinated and boosted. His wife, a DC public school teacher, also fully vaccinated, suffered with it for three days and luckily seems to be recovering. She brought the infection home from school…Their two children are sick.
First Omicron case was documented in the US on December 1. Since this date, this variant has spread like wildfire and in exactly three weeks 73% of all new COVID cases in the US are of the Omicron variety; this number was just revised downward on December 28 to 59%, please read tidbits. Luckily, this strain does not seem to be as virulent, and vaccination seems to lessen the severity and length of the illness but does not prevent one from catching it.

We started 2021 with optimism: we had three miraculous new vaccines and hoped that the majority of our citizens would take advantage of the fact that these vaccines were made available, and for free. Vaccines were eventually made available for kids 12 and up, and later children ages 5-12. However, as of now the percentage of our population that is vaccinated in barely over 60%. Ignorance, misinformation propagated by certain segments of the media and a misguided political stand led more than a third of our citizens to refuse the vaccines, even though they must realize the harm they maybe inflicting on their fellow citizens.

Yes, a lot of harm. We now lost more that 800,000 of our family members, neighbors and friends to this pandemic and the end is not in sight. Incredibly, one in every 100 Americans over the age of 65 died as a result.

The Omicron variant is wreaking havoc with Holidays plans of most Americans. Thousands of flights were canceled, disrupting Holidays travel. Elective surgeries are being canceled; ICUs are full in some segments of our Country; testing lines for COVID are hours long with many of the people getting positive results being totally asymptomatic but who can infect others. In New York City, even Broadway shows were suspended; the Metropolitan Museum of Art is limiting admissions. In my own family we decided that each of us and our guests must get a rapid antigen test before getting together. We were lucky to get enough test kits. However, these are now scarce …

But we must move forward!

Over the last two years, we learned a lot about safety. And we are learning how to behave during this pandemic. We also learned and continue to learn that being isolated causes more harm than the intended good.

This applies to and is very relevant to our Annual Meeting. We have been and are looking forward to meeting in person, seeing colleagues we haven’t seen in two years, and learning about the state of our profession in California and our Nation. I think the in-person CANS Annual Meeting should be safe since everyone in attendance must show proof of vaccination, and since everyone will be wearing masks.

This year started with optimism, an optimism personified by a young poet in a bright yellow coat and a red headband telling us and our 46th President at his inauguration about the fact that “there is always light if we are brave enough to see it.” And despite all the disaters, this year is ending with some optimism: Amanda Gorman Just published her first collection of poems “Call Us What We Carry,” and The F.D.A. cleared Pfizer’s Covid pill, the first of its kind, for high-risk patients 12 and over. It was found to defend against severe illness. So now we have the vaccines and the treatment. Let’s hope for the best!Happy New Year and see you in La Jolla!

Special Reminder:

The editorial team of this newsletter and I would like to remind you that we published a commemorative edition on December 15, in the memory and in celebration of our departed colleague and founding editor of this newsletter Randy Smith. Here is the link to the online version of this special edition. Special Newsletter

Annual Meeting Planning Committee

IMPORTANT CANS ANNUAL MEETING PLANNING COMMITTEE 2022 MESSAGE

 

T

The new Omicron Covid 19 variant currently has everyone understandably concerned. This variant is proving to be more infectious and more easily spread than the Delta variant or the original Covid 19 virus. Fortunately, it is also turning out to be less virulent than prior variants and the existing Covid-19 vaccines appear to be highly effective in preventing most infections and more importantly, preventing serious illness if a vaccinated person becomes infected despite vaccination. As a result, the Omicron surge we are experiencing in the US is more a surge in new cases detected, rather than in hospitalizations, ICU cases or deaths. Indeed, almost all hospitalizations, ICU cases and rare deaths have been among unvaccinated individuals who usually have pre-existing co-morbidities. As President Biden has said, “the Omicron variant is a cause for concern – but not panic”.

As of the time of the publication of this newsletter, California (https://covid19.ca.gov/) currently has no travel restrictions in place. In addition, there are currently no county tiers, capacity limits, or physical distancing requirements in place. There is an indoor mask mandate effective through January 15, 2022. Neither the US, nor CA are returning to a lock down or US travel restrictions.

Our duty and responsibility as CANS leadership is first, and foremost, the safety of our CANS members, guests and allied vendor support teams. As such we have established that all meeting attendees (members, guests, staff and vendors) must be vaccinated, and must show proof of vaccination at the time of registration. In addition, we will be in full compliance with the CA Governor and State and County Health Department indoor mask mandates throughout our meeting.

Our Annual Meeting 2022 Committee met 12/28/21 in special session, and thoroughly discussed and debated all potential issues surrounding our planned in person meetings. At the end of this discussion the whole committee unanimously agreed to move forward with our January 14-16, in-person 2022 CANS Board Meeting and 2022 CANS Annual Session. We will certainly keep abreast of any developments that occur between now and January 14, 2022, and will certainly comply with any new mandates and/or restrictions.

We look forward to seeing everyone at a safe and successful 2022 CANS Annual Meeting.

Mark Linskey, Committee Chair John Ratliff, Immediate Past President

Ciara Harraher, Treasurer Praveen Mummaneni, Committee Appointee

Ken Blumenfeld, Committee Appointee Anthony Di Giorgio, Subcommittee Appointee

Brian Gantwerker, Subcommittee Appointee

Moustapha Abou-Samra, MD

Moustapha Abou-Samra, MD

CANS Acting Editor

Changing Times Wildfires and Tornadoes … Climate Change Or bad luck?

On December 5, 2017, four years ago, we lost our home to the Thomas Fire. It was then the largest wildfire in the history of the State of California. Our City of San Buenaventura-Ventura lost 575 homes. It looked like a war zone … The Golden State has since suffered many devastating fires; several of the wildfires we endured this year were much larger than the Thomas Fire and they have caused massive devastation.

On December 10, 2021, the so-called Quad-State Tornado hit the heartland causing major devastation everywhere but particularly in Mansfield, as well as several other cities in Kentucky. Once again, in the aftermath of this tornado the area looked like a war zone.

I confess that I don’t understand the science behind tornadoes, but an editorial by James B. Elsner, a Tornado Climatologist who is Professor at Florida State University in Tallahassee, shed some light on the matter. “A tornado is a rapidly rotating column of air inside a thunderstorm. A thunderstorm that lasts more than 20 minutes and is energized by continuously rising air is called a supercell. The rising air is fueled by warm, moist conditions and changes in wind speed or direction associated with the approach of a frontal system where warm and cool air collide. The warm, moist air and that wind shear can generate a series of supercells, some of which produce tornadoes.” … I think I understand.

He also discussed “outbreak” of tornadoes when the supercells and moisture are such that several tornadoes- six to ten- team up to cause a wide area of devastation. This is what happened in our heartland recently. I think of such tornadoes as “super-tornadoes.” Tornadoes seem to be hitting areas previously immune to such disasters, such as Nashville, while areas used to them, such as Oklahoma City, are witnessing them less frequently; a recent tornado in the southeastern portion of Minnesota was the first ever reported in the state in the month of December. And Wildfires are striking areas previously not prone to them, not only in California but throughout the Western US.

Why the change?

It is impossible to say with certainty whether any particular tornado or wildfire is caused by climate change, but what is clear is that the severity of the tornadoes and the wildfires have increased tremendously.

Is this just a coincidence? Cyclical change? Bad weather? Or simply bad luck?

Not likely.

Dr. Elsner indicated that studying these trends leads us to believe that climate change or “global warming,” a term used less and less frequently, has a significant role to play.

It is interesting that most people tend to view images of devastation with some detachment, so long as they are not affected. However, as my wife, my family and I view the photos of hundreds and hundreds of destroyed homes, we can’t help it but feel the loss that the thousands of people affected are feeling. Their lives, much like ours will never be the same. May God help them.

They, absolutely, need our thoughts and prayers, but they also need a lot more from their devastated communities, their states and yes, the Federal Government.

What can we do? In addition to contributing to various relief organizations such as the American Red Cross, I invite each of you to pay closer attention to climate change. Although any action by one individual may not make a difference, if we all change our planet damaging habits, we may start making a difference; I am learning from my adult children the need and urgency to do this. So, let us pledge to start paying attention.

I know this is a politically charged issue but let me say it: Climate Change is for real. It is not bad weather and let us not blame it on bad luck!

Jennifer Quon, MD

Jennifer Quon, MD

CANS Resident Consultant North

Neurosurgery Residency

Neurosurgery residency – leading a culture of safety

As we move through each stage of our education, we’re asked to demonstrate leadership. But very little formal training is required before being asked to take charge of a busy clinical service, under high pressure settings. In medical school, I had to take one business psychology class. I distinctly remember the professor telling us that, as residents, we were about to become middle managers. Our job would be to resolve conflict between those above, below and around us, while resisting the tendency to pick a side. You can imagine how excited we all were to hear our hopes and dreams distilled into one term – “middle manager”. But he was right. During residency, in addition to learning how to do surgery and take care of neurosurgery patients, we’re also learning how to manage people in high pressure settings. The team includes not only other residents but mid-level providers and healthcare staff. We are teaching even as we’re learning. We are holding things together even as stress and conflict try to tear them apart. How do we lead a successful, motivated team?

 

The answer is multifaceted, and not completely dependent on one person or group of people. The challenge has been even greater during the COVID-19 pandemic. Without the same strategies for bonding, we’ve had to make a more conscientious effort to show our team that they’re supported. Sometimes cues for showing connectedness are small, or virtual. In Daniel Coyle’s “The Culture Code,” he discusses how groups create a sense of belonging. Belonging, in turn, is foundational for high-performing groups, and is reinforced by a culture of safety. In neurosurgery, what does creating a culture of psychological safety really mean? A safe culture is one in which people trust those around them, enough to admit mistakes and ask for help. Safety also means being able show vulnerability, and not equating vulnerability with weakness. In some ways we are naturally bound by our grueling schedules, and shared compulsion to master our craft. But neurosurgery can also be highly unpredictable. How do we foster safety in this environment while also addressing other important objectives, like optimizing training for multiple levels of residents and facilitating good neurosurgical outcomes?

 

Even during my training, I have seen a shift in the culture– I think, overall, for the betterment of patient care and resident wellness. To those who would argue that residents aren’t as strong or skilled as they used to be because of these changes, I would say that healthcare, technology and the field of neurosurgery are also constantly evolving. And so too are the demands and expectations of neurosurgeons and neurosurgical residents. We are all expected to have a widening skillset that goes beyond our skills in the operating room. Appropriately, leadership and other training is more widely available to those who seek it. We put a higher value on our leaders’ abilities to demonstrate empathy and prioritize diverse viewpoints.

 

As chief residents at Stanford, we meet regularly with our chairman, Dr. Lim, to discuss challenges and triumphs, both big and small. This has, of course, given us a direct lifeline to escalate any concerns. But really the greatest privilege has been the ability to establish rapport with someone who has become a great mentor to all of us. As he reminds us, “challenges are leadership opportunities”. Without his guidance and the opportunity to step back, and reflect, we wouldn’t be able to reframe them that way. We’d put them under the category of things that are simply a “rite of passage”. With the goal of fostering the next generation of leaders, residency training has become something more thoughtful and nuanced.

Kenneth Blumenfeld, MD

Kenneth Blumenfeld, MD

CANS Resident Consultant North

AMA Update

The AMA House of Delegates convened another virtual Special Meeting in November. That constituted the 4th virtual meeting since the SARS-CoV-2 pandemic. Representing neurosurgery were Ann R. Stroink, MD, CNS Delegate, Delegation Chair; Nitin Agarwal, MD, AANS-CNS Resident and Fellow Section Delegate; Maya A. Babu, MD, CNS Alternate Delegate/Young Physicians Section; Kenneth S. Blumenfeld, MD, AANS Delegate; Joshua M. Rosenow, MD, AANS Delegate; Jason M. Schwalb, MD, CNS Delegate; and Krystal L. Tomei, MD, AANS Alternate.

 

Reports and resolutions of note to neurosurgery included “Standardized coding for Telehealth Services”; “Traumatic brain injury and firearm/motor vehicle use”; “Medicare physician payment”; “Improved access to non-opioid modalities to address pain”; “Assessing physician competency”; and “Procedural issues involving AMA election rules”.

 

Neurosurgery co-authored a resolution asking for the modification or repeal of Medicare’s Appropriate Use Criteria (AUC) program for Advanced Imaging but failed to meet the Resolutions Committee criteria for consideration at the Special Meeting. The resolution was extracted for inclusion but lost by a narrow margin on the floor. More will be needed to address AUC implementation.

While organized neurosurgery is actively working through the CSNS to adopt telehealth policy our delegates provide testimony surrounding coding and billing issues as it related to Resolution 101 – Standardized Coding for Telehealth Services.

The HOD adopted the relevant policy:

RESOLVED, That our American Medical Association support legislation, regulation and/or outreach, whichever is relevant, to ensure that public and private payors utilize one consistent set of reporting and coding rules to identify telehealth services in claims. (Directive to Take Action)

In a fairly comprehensive report from the Council On Science and Public Health – Physician Involvement in State Regulations on Motor Vehicle Operation and/or Firearm Use by Individuals with Cognitive Deficits Due to Traumatic Brain Injury (TBI) our delegation debated that TBI is only one of among many potential reasons for cognitive impairment and raised concern over creating liability for those physicians treating patients with TBI. Neurosurgery offered significant amendments with the house ultimately adopting the following amended report:

  1. Our AMA encourages the National Institutes of Health and other funders to expand research on cognitive impairment, including traumatic brain injury (TBI), as a risk factor for harm to self or others that may impact driving and/or firearm ownership, and the role of the physician in policy advocacy and counseling patients so as to decrease the risk of morbidity and mortality (New HOD Policy).
  2. That Policy H-15.995, “Medical Advisory Boards in Driver Licensing,” advocating for state governments to create and maintain medical advisory boards to oversee driver licensing, be reaffirmed. (Reaffirm Current HOD Policy)
  3. That Policy H-145.972, “Firearms and High-Risk Individuals,” which advocates for ERPO laws and protocols for removing firearms from those deemed to be high-risk in the wake of a petition from concerned parties, be reaffirmed. (Reaffirm Current HOD Policy)
  4. That Policy H-145.970, “Violence Prevention,” calling upon state and federal government entities to strengthen and promote the use of the NICS background check system, be reaffirmed. (Reaffirm Current HOD Policy)

Although there were many reports and resolutions germane to Medicare payment cuts it was Resolution 212- Sequestration that drew the most debate from our team. After extended debate the following substitute alternate resolution was adopted:

RESOLVED, That our AMA: continue to prioritize and actively pursue vigorous and strategic advocacy to prevent sequester and other cuts in Medicare payments due to take effect on January 1, 2022; seek positive inflation-adjusted annual physician payment updates that keep pace with rising practice costs; ensure Medicare physician payments are sufficient to safeguard beneficiary access to care; work towards the elimination of budget neutrality requirements within Medicare Part B; eliminate, replace, or supplement budget neutrality in MIPS with positive incentive payments; advocate strongly to the current administration and Congress that additional funds must be put into the Medicare physician payment system to address increasing costs of physician practices, and that continued budget neutrality is not an option; advocate for payment policies that allow the Centers for Medicare & Medicaid Services to retroactively adjust overestimates of volume of services.

That the following HOD policies be reaffirmed: D-165.941—Sequestration Budget Cuts, H- 330.932—Cuts in Medicare and Medicaid Reimbursement, H-31 400.972—Physician Payment Reform, H-330.888—Exempt Physician-Administered Drugs from Medicare Sequestration, H- 400.990—Refinement of Medicare Physician Payment System, H-400.991—Guidelines for the Resource-Based Relative Value Scale, H-385.905—Merit-based Incentive Payment System (MIPS) Update, H-390.838—MIPS and MACRA Exemption, D-390.963—Improving the Medicare Economic Index, D-390.988—Patient Access Jeopardized By Senate Failure to Correct Medicare Payment Error, H-390.849—Physician Payment Reform.

Our delegation led by Joshua Rosenow and Jason Schwalb gave impassioned testimony on Board of Trustees Report 8 – Improved Access and Coverage to Non-opioid Modalities to Address Pain. The debate revolved around inadequate access and lack of coverage of evidence-based pain procedures such as spinal and peripheral nerve stimulators. Unfortunately, our amendments were rejected by the house.

With CME Report 1 – Guiding Principles and Appropriate Criteria for Assessing the Competency of Physicians Across the Professional Continuum the focus was on late career physician performance and fitness. Neurosurgery raised concerns about due-process, offering an amendment accepted by the reference committee. After final debate on the floor the more extensive policy which include our amendment was adopted:

  1. That our American Medical Association (AMA) support the following Guiding Principles on the Assessment Physicians Across the Professional Continuum:
  2. a) Evidence-based: Guidelines for assessing and screening and assessing physicians across the professional continuum should be based on evidence of the importance of cognitive changes associated with aging and other factors that may impact physician performance. Some physicians may suffer from declines in practice performance with advancing age, acquired disability, or other influences. Research suggests that the effect of age on an individual physician’s competency can be highly variable. Since wide variations are seen in cognitive performance with aging, age alone should not be a precipitating factor.
  3. b)  Ethical: Guidelines should be based on the principles of medical ethics. Self-regulation is an important aspect of medical professionalism. Physicians should be involved in the development of guidelines and standards for monitoring and assessing both their own and their colleagues’ competency.
  4. c)  Relevant: Guidelines, procedures, or methods of assessment should be relevant to physician practices to inform judgments and provide feedback regarding physicians’ ability to perform the tasks specifically required in their practice environment.
  5. d)  Accountable: The ethical obligation of the profession to the health of the public and patient safety should be the primary drivers for establishing guidelines and informing decision making about physician screening and assessment results.
  6. e)  Fair and equitable: The goal of screening and assessment is to optimize physician competence and performance through education, remediation, and modifications to a physician’s practice environment or scope. Unless public health or patient safety is directly threatened, physicians should retain the right to modify their practice environment to allow them to continue to provide safe and effective care.
  7. f)  Transparent: Guidelines, procedures, or methods of screening and assessment should be transparent to all parties, including the public. Physicians should be aware of the specific methods used, performance expectations, and standards against which performance will be judged and the possible outcomes of screening and assessment.
  8. g)  Supportive: Education and/or remediation practices that result from screening and /or assessment procedures should be proactive, ongoing, and supportive of physician well- being.
  9. h)  Nonburdensome: Procedures and screening mechanisms that are distinctly different from “for cause” assessments should not result in undue cost or burden to physicians. Hospitals and health care systems should provide easily accessible screening assessments for their employed physicians. Similar procedures and screening mechanisms should be available to physicians who are not employed by hospitals and health care systems.
  10. i)  Due Process: Physicians subjected to screening and assessment must be afforded due process protections, including a fair and objective hearing, before any action may be taken against the physician. (Directive to Take Action)
  11. That our AMA encourage the Council of Medical Specialty Societies and other interested organizations to develop educational materials regarding decline of cognitive and psychomotor performance throughout a physician’s career and the resulting impact on the quality and safety of physician practice. (Directive to Take Action)
  12. That Policy D-275.956, “Assuring Safe and Effective Care for Patients by Senior/Late Career Physicians,” be rescinded, as having been fulfilled by this report. (Rescind HOD Policy)

Our delegation provided considerable testimony and recommendations on Speakers’ Report 2 – Report of the Election Task Force Establishing an Election Committee. This was particularly important in our new virtual world and a critical issue for neurosurgeons who engage and participate in elected leadership.

In the end the Special Meeting was indeed “special”, being limited in scope and debate due to a virtual format. Nonetheless it was productive, and neurosurgery was well represented. Our delegation’s testimony was recognized and quoted by online publication MedPage Today as it related to TBI and firearms as well as physician competency and due process.

Many thanks to our staff leadership, Katie Orrico. I can be contacted with any questions @ kennethblumenfeld@mac.com. Lastly, please attend out annual meeting for a more comprehensive update.

Communication from a CANS member Proposal: A Grass Roots Effort to help remedy Disparities in Neurosurgery Richard B. Williams, MD

Neurological Surgery is a noble profession that has made major contributions to all aspects of our society. At a time when we have witnessed a widening educational and financial/economic gap, studies, and data show that neurosurgery lags behind other medical specialties in the representation of certain racial groups, such as Hispanic or African American and those with economically disadvantaged roots. This diminishes diversity in our workforce and those willing to embrace careers in non-urban environments, disadvantaged neighborhoods, and academic research/teaching careers. The spectrum of reasons for this is wide, but one possibly remediable obstacle to choosing neurosurgery is certainly economic.

Over the last thirty years, neurosurgery compensation has decreased, and the residency has lengthened. It has been shown repeatedly that medical students particularly minorities now carry significantly higher levels of educational debt. This debt is often made more formidable by the lack of family resources for financial support. The median net worth of all American families with the heads of household over 55 is $212,500.00. In contrast, the median net worth of an African American family is $24,100.00 and that of Hispanic families $38,000.00. The lack of resources to cope with debt may influence the decisions of well qualified medical students who are considering neurosurgical training. For example, a three-year residency in emergency medicine may offer high salary, limited hours, and a shorter period of crippling debt to repay when compared to neurosurgery.

The Future Neurosurgeons Foundation (a fully accredited 501 (c) nonprofit) was formed to address this problem in part by granting tax-free stipends to deserving financially disadvantaged underrepresented medical students who have matched in Neurosurgery. Existence of these grants is publicized to medical students considering neurosurgery in hopes that knowing some financial help is available will encourage them to choose our specialty. Last year six awards, typically $10,000.00 each, were granted to matched students to assist in relocation expenses from medical school to residency. Please visit our website at bogganaward.com to learn more and consider donating. With your help, we hope the Foundation will grow and greater impact on the lives of our future colleagues.     The foundation named the award in honor Dr. James E. Boggan, Emeritus Julian Youmans Chair and Professor of Neurosurgery at the University of California, Davis. Major donors or their designees can be recognized as co-sponsors of the wards granted…The Foundation is completely volunteer; there are no salaries or administrative expenses. Every cent of every donation is directed to students who have bravely chosen neurosurgery despite the long and challenging training in the face of onerous debt. We are in the process of applying for some corporate funding, but at this time our efforts are dependent on the generosity of individuals, particularly neurosurgeons. Thank you very much for your consideration.

Acting Editor’s Note: Although the above seems very worthwhile, it is not endorsed by CANS, as it has not yet been presented to the Board of Directors for discussion.

Tidbits

  •  

    • TheAP (12/2, Tanner) reports, “In an analysis of 2018 data from nearly a dozen states, researchers at the Centers for Disease Control and Prevention found that among 8-year-olds, 1 in 44 had been diagnosed with autism,” compared to “1 in 54 identified with autism in 2016.”

     

    • According to theNew York Times (12/7, Richtel ), on Dec. 7, in a “rare public advisory,” U.S. Surgeon General Vivek H. Murthy, MD, MBA, “warned that young people are facing ‘devastating’ mental health effects as a result of the challenges experienced by their generation, including the coronavirus pandemic.”

     

    • The Food and Drug Administration on Friday, December 3, 2021, authorized Eli Lilly’s monoclonal antibody treatment for infants and children under age 12 with Covid-19 who are at high risk of becoming severely ill from the virus because they have a condition such as obesity or diabetes.

     

    • According to theNew York Times (12/6, Rabin ), researchers “reported that blood pressure measurements of nearly a half-million adults showed a significant rise last year, compared with the previous year.” The study, published in Circulation, “found that blood pressure readings changed little from 2019 to the first three months of 2020, but increased significantly from April 2020 through December 2020, compared with the same period in 2019.”

    • USA Today(12/11, Hassanein) reported, “The U.S. infant mortality rate continued its downward trend in 2019, according to a Centers for Disease Control and Preventionreport.” But health disparities continue. USA Today added, “Nationally, white babies died at a rate of 4.49 compared to Black babies, who died at a rate of 10.6 deaths per 1,000 births. The infant mortality rate for Native Hawaiian and Pacific Islanders was 8.19; American Indian and Alaska Native, 7.87; and Asians, 3.38.”

     

    • TheNew York Times (12/9, Sanger-Katz) reports, “Three weeks before a new ban on surprise medical billing is set to start, hospital and doctor groups have filed suit to block part of it.” The lawsuit, “from the American Medical Association, the American Hospital Association and a handful of individual hospitals and providers, argues that regulators in the Biden administration have misread the law’s language – and that their faulty interpretation will harm medical providers.”

     

    • TheAP (12/15, Alonso-Zaldivar) reports total S. health care spending “rocketed to $4.1 trillion last year as Congress opened the spigot of federal dollars to battle the coronavirus pandemic across multiple fronts,” according to CMS data published Wednesday in Health Affairs. The report “said national health spending jumped by 9.7%” compared to 2020, “more than double the usual growth rate, with health care accounting for nearly $1 of every $5 in the economy.”

     

    • Before adjourning, Congress passed, and President Bidensigned into law the Protecting Medicare and American Farmers from Sequester Cuts Act— legislation that would avert steep Medicare payment cuts scheduled to take effect on January 1. Neurosurgeons had anticipated cuts of 9% or more.
    • JAMA Netw Open.2021;4(12):e2136405. doi:10.1001/jamanetworkopen.2021.36405, published the results of a survey of patients’ preferences when it comes to telehealth. In this survey study of 2080 adults, most respondents were willing to use video visits in the future but, when presented with the choice between an in-person or a video visit for nonemergency care, most preferred in-person care. Willingness to pay for preferred visit modality was higher for those who preferred in-person care, and those who preferred video visits were more sensitive to out-of-pocket cost.
    • Beginning on January 1, 2022, almost all prescriptions written in California must be transmitted electronically. Physicians who have not yet implemented electronic prescribing in their practices should begin the process now.The electronic prescribing mandate was contained in a law passed by the California State Legislature in 2018.
    • The Department of Consumer Affairs (DCA) has extended a temporary license waiver designed to make it easier for retired, inactive or canceled licenses to return to an active status to assist the state during the State of Emergency.
    • Fee Increases:In recent years, the Medical Board of California’s expenditures have exceeded its revenue. Therefore, SB 806 increases all application, initial licensure, and renewal fees.

     

    • Email Addresses Required: All applicants and licensees must obtain an email address (if they do not currently possess one) and provide it to the Board no later than July 1, 2022.

     

    • Minimum wage increase:Starting Jan. 1, California’s hourly minimum wage will increase to $15 for large employers and $14 for smaller employers
    • TheAP (12/20, Alonso-Zaldivar) reports, “People in crisis and those trying to help them will have a new phone number – 988 – to reach the national suicide prevention network starting in July,” now that “federal health officials” from the Department of Health and Human Services on Dec. 20 “announced more than $280 million to smooth the transition from the current 10-digit number to three digits.” In addition to voice calls, the 988 number will “handle text and chat.” People using 988 “will be able to reach trained counselors who belong to the National Suicide Prevention Lifeline network.”

     

    • As daily coronavirus cases in the United States soared to near record levels, The CDC on Monday, December 27, shortened by half the recommended isolation period for many infected Americans, hoping to minimize rising disruptions to the economy and everyday life.

    • On December 28, the CDC estimated that the Omicron variant now accounts for roughly 59 percent of all Covid cases in the United States, a significant decrease from the agency’s previous estimate. The update shows how hard it is to track the fast-spreading variant in real time and how poorly the agency has communicated its uncertainty, experts said.

     

    • The US hit a seven-day average of 265,427 new Covid-19 cases on December 28, blowing past the country’s previous record of about 252,000 daily cases, reported nearly a year ago on January 11.

     

    Brain surgeons and rocket scientists are not necessarily smarter than the general public, researchers reported early December, as they tried to settle the argument of whether the phrase “it’s not brain surgery” or “it’s not rocket science” is most deserved. The study, published in the BMJ Christmas issue, was professionally conducted and peer reviewed but this special issue of the British Medical Journal is generally dedicated to light-hearted studies. This writer has many reservations about the validity of this study and is not prepared to come down from his pedestal!

Emily Schile

Executive Secretary

Annual Meeting Schedule

Emily Schile, Executive Secretary 916-806-7463 emily@cans1.org

Must wear masks in ALL Indoor areas & Proof of Vaccination are Required!

  • Friday NuVasive Lab Off site Event:
  • Friday Reception: 6:30-830pm (Exhibit Hall Salon D & E)
    Light bites, no host bar and mingle with our vendors!

  • Saturday Breakfast: 6:30am-7:35am (Exhibit Hall Salon D & E)
  • Saturday Meeting 7:40 am (Scripps I)
  • Saturday Break: 9:45-10:15am (Exhibit Hall Salon D & E)
  • Saturday Lunch with Exhibitors 12pm-1pm (Salon D & E)
  • Saturday Break 3:15-3:45pm (Exhibit Hall Salon D & E)
  • Saturday Resident/Med Student Session 4:15-6pm(Sponsered by Medtronic-non CME event)
    Salon D&E

  • Saturday Banquet 6:30- 9:30pm(Must have purchased ticket prior to event-contact Emily for space availability) Fairway Ballroom

 

  • Sunday Breakfast: 6:30am-7:30am (Exhibit Hall Salon D & E)
  • Sunday Meeting: 7:30am (Scripps I)
  • Sunday Break: 9am – 9:30am (Exhibit Hall Salon D & E)
  • Adjournment: ~12:10pm

Emily Schile

Executive Secretary

Thank you Sponsors & Exhibitors

THANK YOU EXHIBITORS & Welcome back!

NuVasive – Platinum Sponser
Medtronic – Gold Sponser
Atec Spine – Silver Sponser
DePuy – Silver Sponser
Integra LifeSciences – Silver Sponser
Metadynamics, Inc – Silver Sponser
Surgical West – Silver Sponser

Exhibitors
Acumed
Barricaid
BK Medical
Brainlab
Carbo-Fix
Fidelis Medical
Fujifilm
GEOEC Imaging
Globus
GT Med Tech
SCM (Surgeon Capital Management)
Spinal Elements
Spineart
Synaptive
Zap Surgical Systems


 

Quote of the Month

 

As long as we live, they too will live; for they are now a part of us as we remember them.

Jewish Prayer, usually said at funerals

Calendar

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,

Positions Available & Classifieds

Looking for a new partner or position?

Position(s) Available

NEUROLOGICAL SURGERY / School of Medicine / UC San Diego

APPLICATION WINDOW

Open date: December 7th, 2021

Next review date: Sunday, Jan 9, 2022 at 11:59pm (Pacific Time)
Apply by this date to ensure full consideration by the committee.

Final date: Wednesday, Dec 7, 2022 at 11:59pm (Pacific Time)
Applications will continue to be accepted until this date, but those received after the review date will only be considered if the position has not yet been filled.

https://apol-recruit.ucsd.edu/JPF03007

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 – December 2021

Newsletter December 2021 Issue Volume 49, Number 12 Inside This Issue President’s Message We are now only two weeks away from our January 14-16 CANS Annual Session. I know that many CANS members and their families are concerned about the recent emergence of the Covid-19 Omicron variant and the surge of new cases brought on

Read More »

CANS NEWSLETTER – November 2021

Newsletter November 2021 Issue Volume 49, Number 11 Inside This Issue President’s Message This will be my penultimate newsletter message as President of CANS. The January 15, 2022 limit for the terms for President, President Elect, and Vice Presdient is fast approaching. I am really excited to hear from Dr Javed Siddiqi as he outlines

Read More »

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CANS 2021 Special Session Corporate Sponsors