A M E R I C A N A SSOCIATION OF N EUROLOGICAL S URGEONS The Socioeconomic and Professional Magazine for AANS Members • Volume 15 Number 2 • 2006 COMPLETING THE PICTURE Assessing Neurosurgical ER Coverage Whom Does Credentialing Protect? 30 Texas Teaches That Tort Reform Works, 34 AANS Board Approves Professional Conduct Recommendations, 36 AANS NON-PROFIT ORG 5550 MEADOWBROOK DRIVE U.S. POSTAGE PAID ROLLING MEADOWS, IL 60008 AMERICAN ASSOCIATION OF NEUROLOGICAL SURGEONS C ONTENTS VOLUME 15 NO. 2 Egyptian, Coptic, “Portion of a Hanging Showing a Figure of a Warrior,” 5th/6th century, linen and wool, plain weave with weft pile and embroidered linen pile in back and stem stitches, 136.5 x 88.3 cm, Grace R. Smith Textile Endowment, FEATURES 1982.1578, The Art Institute of Chicago. 16 | Sweet Success in San Francisco Photography © The Art The 74th Annual Meeting initiates the AANS’ diamond Institute of Chicago. jubilee year. Manda J. Seaver 22 | Inspirations and Epiphanies Juan Cardenas, Stephen Mahaley, Edgar Kahn, Keasley Welch, and the Mona Lisa are among neurosurgeons’ inspirations. NEWS AND EVENTS 5 | Newsline ON THE COVER The AANS, CNS and ASTRO define stereotactic radiosurgery. 8 | Completing the Picture: AANS 2006 Workforce 42 | News.org Survey Assesses Neurosurgical ER Coverage NERVES releases 2005 practice survey results. A new survey finds that the vast majority of neuro- surgeons are participating in the emergency care 44 | Calendar of Neurosurgical Events system, but most also report problems with call AANS/CNS Section on Pediatric Neurological Surgery coverage in their practice areas. annual meeting will be held Nov. 29–Dec. 1. Manda J. Seaver OPINION 12 | What Will Improve Neurosurgical Emergency Coverage? 35 | Letters In the wake of the IOM report on emergency care, A reader questions the motivations of defense attorneys. surgery’s views on the proposed specialty of acute care surgery and regionalization are explored. 7 | Personal Perspective The case for regionalization of neurosurgical emergency Manda J. Seaver services grows stronger. PRESIDENT’S MESSAGE William T. Couldwell, MD 3 | Professional Conduct: Witness Testimony Continued on page 2 Obligations of membership include adherence to the AANS Code of Ethics. Donald O. Quest, MD Vol. 15, No. 2 • 2006 • AANS Bulletin 1 C ONTENTS DEPARTMENTS 34 | Medicolegal Update Texas teaches that tort reform works. 38 | Advancing Neuroresearch David F. Jimenez, MD Two NREF milestones give reason to cheer. 30 | Patient Safety Michele S. Gregory Whom does credentialing protect? 40 | Bookshelf Patrick W. McCormick, MD Character is at the core of two new books by neurosurgeons. 21 | Practice Management When insurers share savings, you don’t have to suffer. Gary Vander Ark, MD Nick Green 28 | Coding Corner Coding for concurrent spinal procedures 24 | Residents’ Forum is explored. You can clip an aneurysm, but can you compute cost per RVU? Gregory J. Przybylski, MD Lawrence S. Chin, MD 33 | Education A new endovascular course for residents illustrates 32 | Timeline how collaboration benefits education. Two world wars had an “acute” impact on neurosurgi- cal training. Joni L. Shulman Michael Schulder, MD 36 | Governance AANS Board of Directors approves four Professional 26 | Washington Update Conduct Committee recommendations. Tort reform falls short in the Senate, but the DMLR campaign presses forward. W. Ben Blackett, MD, JD, and Russell M. Pelton, JD Katie O. Orrico, JD AANS MISSION Forum; Monica Wehby, MD, and Michael Chabraja, JD, in a future issue edited for length, clarity and style. The American Association of Neurological Surgeons Risk Management Correspondence is assumed to be for publication unless (AANS) is the organization that speaks for all of neurosurgery. otherwise specified. The AANS is dedicated to advancing the specialty of WRITING GUIDELINES neurological surgery in order to promote the highest www.aans.org/bulletin Bulletin Online quality of patient care. The current issue and searchable archives since 1995 are avail- ARTICLE SUBMISSIONS AND IDEAS able at www.aans.org/bulletin. AANS BULLETIN Articles or article ideas concerning socioeconomic topics The official publication of the American Association of related to neurosurgery can be submitted to the Bulletin, PUBLICATION INFORMATION Neurological Surgeons, the Bulletin features news about the [email protected]. Objective, nonpromotional articles that The AANS Bulletin, ISSN 1072-0456, is published four times AANS and the field of neurosurgery, with a special emphasis on are in accordance with the writing guidelines, are original, a year by the AANS, 5550 Meadowbrook Drive, Rolling socioeconomic topics. and have not been published previously may be considered Meadows, Ill., 60008, and distributed without charge to the for publication. neurosurgical community. Unless specifically stated other- William T. Couldwell, MD, editor wise, the opinions expressed and statements made in this Patrick W. McCormick, MD, associate editor The AANS reserves the right to edit articles for compliance publication are the authors’ and do not imply endorsement with publication standards and available space and to Manda J. Seaver, staff editor by the AANS. publish them in the vehicle it deems most appropriate. Articles accepted for publication become the property of the BULLETIN ADVISORY BOARD © 2006 by the American Association of Neurological Surgeons, AANS unless another written arrangement has been agreed a 501(c)(6) organization, all rights reserved. Contents may not Gregory J. Przybylski, MD Deborah L. Benzil, MD upon between the author(s) and the AANS. be reproduced, stored in a retrieval system, or transmitted in Frederick A. Boop, MD Gail Rosseau, MD any form by any means without prior written permission of Lawrence S. Chin, MD Michael Schulder, MD PEER-REVIEWED RESEARCH the publisher. The Bulletin seeks submissions of rigorously researched, Fernando G. Diaz, MD, PhD Gary D. Vander Ark, MD hypothesis-driven articles concerning socioeconomic topics ADVERTISING SALES David F. Jimenez, MD K. Michael Webb, MD related to neurosurgery. Selected articles are reviewed by peer- Richard Devanna, Cunningham Associates, (201) 767-4170, Monica C. Wehby, MD Katie O. Orrico, JD review panelists. Papers must comport with the writing guide- or [email protected]. Mick J. Perez-Cruet, MD Richard N. Wohns, MD lines at www.aans.org/bulletin. Rate card, www.aans.org/bulletin. A. John Popp, MD Peer-Review Panel led by Deborah L. Benzil, MD William E. Bingaman Jr., MD; Frederick A. Boop, MD; Fernan- DEPARTMENT EDITORS AND CORRESPONDENTS do G. Diaz, MD; Domenic Esposito, MD; David F. Jimenez, MD; Mark E. Linskey, MD; Mick Perez-Cruet, MD; Richard N. Frederick Boop, Newsline; Lawrence Chin, MD, Education; Wohns, MD Fernando Diaz, MD, PhD, CSNS Report; David Jimenez, Patient Safety; Katie O. Orrico, JD, Washington Update; Mick LETTERS Perez-Cruet, MD, NS Innovations; Gregory J. Przybylski, MD, Send your comments on articles you’ve read in these Coding Corner; Michael Schulder, MD, Timeline; pages or on a topic related to the practice of neurosurgery Gary Vander Ark, Bookshelf; K.Michael Webb, MD, Residents’ to [email protected]. Correspondence may be published 2 Vol. 15, No. 2 • 2006 • AANS Bulletin P RESIDENT’ S M ESSAGE D ONALD O .QUEST, MD Professional Conduct: Witness Testimony embership in the AANS is volun- evidence in court, the general qualifica- tary and not a prerequisite to the tions necessary for those who testify, and When the Professional practice of neurosurgery. Never- the importance of honest testimony. This Conduct Program was initi- M theless there are obligations of report states that “expert witnesses should membership, and one of these is adherence avoid inflammatory accusations…and ated, guidelines for expert to the AANS Code of Ethics. must not merely offer speculations but The AANS Code of Ethics addresses, in rather be able to substantiate claims on witness testimony were part, expert witness testimony. Such testi- the basis of experience, published re- developed to ensure a mony as part of the practice of medicine is search, consensus statements or evidence- indeed an obligation of members of the based guidelines….” standard of quality and medical profession. The AANS is joined in The AMA report also stresses that testi- this view by many prominent medical soci- mony is to be impartial and has a higher impartiality on both sides of eties, among them the American Medical goal than that of supporting the claims of professional liability cases. Association and the American College of Surgeons. The AANS, the AMA and the ACS all provide their members with guid- Donald O. Quest, MD, The AANS Code of Ethics states in part ance on how to act professionally and is the 2006–2007 that “expert testimony should reflect not ethically in the legal arena. While documen- AANS president. only the opinions of the individual but also tation of this guidance is readily available describe where such opinions vary from from each of these organizations, a brief common practice; the expert should be review of salient points follows. engaged in active practice of surgery or be The ACS Statements of Principles, most able to demonstrate enough familiarity recently updated in 2004, avers that “expert with present practice to warrant designa- witnesses are expected to be impartial and either prosecution or defense: “Although tion as an expert, and should champion the should not adopt a position as an advocate the testifying physicians’ services