AANS Bulletin A quarterly publication of The American Association of Neurological Surgeons Michael L.J. Apuzzo, MD, Editor Susan A. Nowicki, APR, Staff Editor Tony Loster, CGCM, Production Manager Jennifer Lazzara, Graphic Designer Volume 6 • Number 2 Spring 1997 1996–1997 Officers and Directors J. Charles Rich, Jr., MD, President Edward R. Laws, Jr., MD, President-Elect Articles Russell L. Travis, MD, Vice-President Martin H. Weiss, MD, Secretary 15 AANS and CNS Launch New Joint Communications Stewart B. Dunsker, MD, Treasurer Program Sidney Tolchin, MD, Past-President Arthur L. Day, MD, Director-At-Large 21 NEUROSURGERY ON-CALL™ Continues to Expand Roberto C. Heros, MD, Director-At-Large Services A. John Popp, MD, Director-At-Large R. Michael Scott, MD, Director-At-Large William Shucart, MD, Director-At-Large 23 ACS Board of Regents Holds Winter Meeting John A. Kusske, MD, SW Regional Director P. Robert Schwetschenau, MD, NW Regional Director Herbert M. Oestreich, MD, NE Regional Director Donald D. Sheffel, MD, SE Regional Director Stanley Pelofsky, MD, JCSNS Liaison Karin M. Muraszko, MD, Young Neurosurgeons Liaison Departments AANS National Office 2 President’s Message—AANS Takes the Lead in Defending 22 South Washington Street Against Pedicle Screw Litigation Park Ridge, Illinois 60068-4287 Telephone: (847) 692-9500 3 Washington Report—Proposed Changes in Practice Telefax: (847) 692-2589 E-mail: [email protected] Expense Reimbursement Threaten Neurosurgery Web site: http://www.neurosurgery.org Robert E. Draba, PhD, Executive Director 14 Managed Care Update Nancy S. Bashook, Dir. of Professional Development Laurie L. Behncke, CMP, Dir. of Meetings 22 Section News Robert T. Cowan, CPA, Controller Susan A. Nowicki, APR, Dir. of Communications 24 Professional Development David W. Reid, Dir. of Information Systems Steven L. Serfling, Dir. of Marketing & Membership Services 26 Research Foundation Tony Loster, CGCM, Production Manager 33 Membership Send change of address to: AANS 34 Positions 22 South Washington Street Park Ridge, Illinois 60068-4287 35 Announcements ©1997 by The American Association of Neurological Surgeons, all rights reserved. Contents may not be reproduced, stored in a retrieval system, or transmitted 36 In Memoriam in any form by any means without prior written permission of the publisher. 36 Calendar of Events The AANS Bulletin is published quarterly by The American Association of Neurological Surgeons, 22 South Washington Street, Park Ridge, Illinois 60068-4287, (847) 692-9500, and is distributed without charge to the neurosurgical community. Unless specifically stated otherwise, the opinions Editor’s Note: expressed and statements made in this publication You may notice some changes in this issue of the AANS Bulletin. We’ve altered the reflect the authors’ personal observations and do design a bit to improve readability. We’ve added a new ongoing column on managed not imply endorsement by nor official policy of care. And, we’ve eliminated the mailing envelope to cut postage and handling costs. The American Association of Neurological More changes are due in coming issues and we hope they make the Bulletin a more Surgeons. valuable source of information for members. President’s message Litigation Background also a wider range of defendants with AANS Takes the Lead in The AANS has long supported the similar interests. That has resulted in a Defending Against efficacy of pedicle screw fixation in close coordination of defense efforts and appropriate cases. That support remains the elimination of duplication of efforts by Pedicle Screw Litigation strong today. In 1993, we cooperated the law firms representing the associations. with the Food and Drug Administration Another important step we took to n many ways, (FDA) and several prominent medical ensure that the resources of the AANS were I the past year associations in conducting the retrospec- appropriately marshaled behind the defense has been one of tive Cohort Study. That study, involving was to appoint a blue-ribbon task force of ambiguity for the more than 300 surgeons and 3,000 prominent neurosurgeons, chaired by field of neurosur- patients, was the most comprehensive David Cahill, MD, to prepare an analysis of gery. Socioeco- study of the use of pedicle fixation ever the scientific and medical issues involved. nomic issues have conducted. While its methodology may That report has been completed, and, I created both not have been perfect, its conclusion that understand, has been extremely useful to controversy and pedicle screw systems are efficacious in our attorneys in responding to the issues opportunity for the reconstruction of certain types of raised in the litigation. neurosurgeons diseased and damaged spines was an like never before important contribution to the literature. Motion to Dismiss and research and Following the broadcast of the 20/20 Our attorneys, working in conjunction J. Charles Rich, Jr., MD development are television show that severely criticized (in with counsel for the other associations, bringing forth medical technologies and our view, unfairly) pedicle screws and the filed a comprehensive motion to dismiss treatments that were unimaginable even resulting explosion of litigation, Judge the “Omni” complaints last year. In 15 years ago. As President of the AANS, Louis Bechtle in Philadelphia was August, Judge Bechtle granted that motion I am frequently asked, “What is the designated as the multi-district judge to dismiss, but gave the plaintiffs leave to AANS doing for neurosurgeons to help who would coordinate all pedicle screw refile with amended complaints. Many them cope with the forces now threaten- cases filed in the federal courts. Because (although not all) chose to do so, which ing the future of neurosurgery?” the results of the FDA-sponsored led to renewed motions to dismiss filed by I can assure you that your professional Cohort Study so undermined the counsel for the associations. Those society has become a true leader and plaintiffs’ basic contention that pedicle motions were based on deficiencies of the advocate for the field of neurosurgery. screws are inherently dangerous and amended complaints in the allegations of Over the past year, the AANS has risen unsafe, the Plaintiffs’ Legal Committee the alleged conspiracy and in asserting to face some of our biggest challenges (PLC) attempted to attack that study some causation between the associations’ yet—the proposed changes in practice and its participants in an effort to activities and the injuries to each particular expense reimbursement by the Health discredit its results. plaintiff. In addition, First Amendment Care Finance Administration (HCFA), The AANS’s first involvement in that protections were asserted with respect to the pedicle screw litigation, and litigation was to take the lead in blocking anything taught or discussed at associa- increased competition from other Judge Bechtle’s imminent disclosure of tion-sponsored meetings. specialties—to name just a few. What the names of the participant surgeons The renewed motion to dismiss was the future holds for neurosurgery, we and perhaps their patients. That data had argued before Judge Bechtle on February cannot be sure, but through the work of been submitted by participating surgeons 7,1997, and he is expected to rule soon. such organizations like the AANS, we under an assurance of confidentiality by Counsel for the AANS is optimistic that can certainly try to manage influences the FDA. It was not until the interven- we will be dismissed from the litigation at over different facets and prepare for tion of the medical associations, led by some stage prior to remand of the cases whatever changes lie ahead. the AANS, that Judge Bechtle appreci- for trial, whether through this motion or Elsewhere in this issue of the Bulletin, ated the sensitivity of the confidentiality a subsequent one. you’ll be reading about our efforts in of those medical records. responding to the practice expense issue In due course, the AANS and many The Future for Pedicle Screws and the marketing communications other additional parties were drawn into You may have heard that one of the initiative we developed to increase the the litigation as defendants in complaints manufacturers, AcroMed, entered into a visibility of neurosurgeons in the public alleging a broad-ranging conspiracy to settlement agreement with the PLC. That arena. In this, my last President’s promote the products of the manufactur- settlement is being implemented by the Message, I wish to focus on the work ers. Our attorney was selected as the creation of a class of patients who received that the AANS has done in area of the liaison counsel for all of the medical AcroMed devices. The AANS and the pedicle screw litigation. associations in that litigation and has other medical associations were not parties taken the lead role in coordinating the to that agreement and had no voice in its efforts of not only those associations but (continued on page 13) 2 AANS Bulletin • Spring 1997 Proposed Changes in Practice Expense Reimbursement Threaten Neurosurgery Cover Story By Katie O. Orrico, JD Director AANS/CNS Washington Office he Health Care Financing Adminis- reduction in total income if HCFA Overview of HCFA Practice Ttration (HCFA) is in the process of implements its current proposal on Expense Project and Implica- developing new relative value units for January 1, 1998, as now planned. tions for Neurosurgery the practice expense component of the This situation has galvanized much of Up until 1992, Medicare reimbursed resource based relative value scale organized medicine, prodding many physicians under the usual customary (RBRVS). The RBRVS is used by groups to initiate counter measures and reasonable (UCR) charge system. Medicare and many other private aimed at preventing the implementation There were many critics of this system insurers to determine reimbursement of this plan. Neurosurgery is at the and in the mid-1980’s, Congress levels. These changes threaten the long- forefront of this effort and has taken a decided to explore new ways to term viability of many specialty prac- very aggressive stance on the issue.