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AANS Neurosurgeon : AANS President's Perspective

Volume 24, Number 2, 2015

Objectives for the Coming Year

H. Hunt Batjer, MD, FAANS

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I am honored and humbled at the enormous opportunity of serving you, our patients and our specialty as president of the American Association of Neurological Surgeons. Over the past year, I have been extremely impressed with the vision and commitment of our AANS Executive Committee, Board of Directors, liaisons from societies across the world, and remarkable AANS executive staff. Tom Marshall and his leadership team are extraordinary in their knowledge base, sense of history and willingness to respond to urgent challenges from a variety of sources. They serve as a rich institutional memory for our current and future leadership. The theme of the 2016 AANS Annual Scientific Meeting will be “Neurosurgery – Leading the Way.” The AANS will use this theme to enhance our activities across the breadth of our specialty’s challenges in our health-care system, our advocacy, our international responsibilities and our commitment to leading new innovations to transform the way neurological health care is provided in the coming decades. We have unprecedented opportunities and need to move forward quickly to accomplish our goals. In my first President’s Perspective, I would like to make a few comments about several thematically interrelated topics.

Neurosurgical Alignment
Having served in a variety of roles in organized neurosurgery for more than 25 years, I have never experienced the degree of inter-societal collegiality, collaboration and sense of collectivism that we are seeing today. The most obvious example is the Neurosurgical Summit. This summit is convened by the Society of Neurological Surgeons (SNS) and chaired by the SNS president. The member societies include the AANS, the Congress of Neurological Surgeons (CNS), the American Board of Neurological Surgery (ABNS), the RRC for neurosurgery, the Washington Committee, joint sections and other stakeholders as needed per individual agendas. Over the years, it has proven to be an essential meeting venue at both the AANS and CNS annual meetings; it has served to keep each of our separate societies organized and informed as to priorities across the spectrum of our specialty’s needs. Kim Burchiel, MD, FAANS, as SNS president last year, strengthened this effort by leading an offsite retreat last summer, and as a result, numerous projects have been moved forward quickly. The summit construct allows us to testify effectively before the Institute of Medicine, Congress and other regulatory bodies as an educational and research society that is not viewed as an advocacy. Our response to the most recent Institute of Medicine report with recommendations on the future of graduate medical education funding and structure was done through exactly this mechanism.

Subspecialty Recognition
The concept of sub-specialization has been intrinsic to our specialty from its genesis. Most neurosurgeons over the course of their careers become increasingly focused in certain areas of expertise. This is not a bad thing; in fact, it is a very good thing for our patients. Internally, each of us would be able to put a patient in need in touch with the right neurosurgeon for their problem in any city or town in America. Unfortunately, the public does not always have access to one of us and needs a better means of identifying the neurosurgical resources in their region of the country.

We have resisted allowing this form of public recognition of subspecialty expertise as we have had appropriate concerns about disenfranchising our members who perform services broadly across the neurosurgical domain. We have attempted to use the Maintenance of Certification (MOC) process through the ABNS as a means to identify focused practice in various subspecialty areas, but it proved problematic. The American Board of Medical Specialties has not been particularly engaging in our attempts working through that organization over the years. That is changing. The Committee on Advanced Subspecialty Training (CAST), which has historically accredited postgraduate training in our subspecialties, has been completely transformed over the past year under the leadership of Art Day, MD, FAANS; and Steven Giannotta, MD, FAANS. CAST will be integrated with the Accreditation Council for Graduate Medical Education (ACGME) and the ABNS to produce a robust and bullet-proof accreditation and certification process for our practitioners. There are numerous moving parts in this initiative that look extremely favorable at this moment, and I will keep you closely updated as we go forward.

Military Neurosurgeons
Our incredible colleagues serving in active-duty roles in and outside the continental United States deserve our admiration and support. Member neurosurgeons serving active-duty roles both at home and abroad are subject to disruptions without warning and have very short notice regarding deployment to the Middle East and elsewhere. Over the past several years, our military training programs have had major disruptions where large portions of their faculty were suddenly deployed away from their trainees. The AANS is working aggressively to assure seamless access to ongoing CME activity at reduced or no cost to our active-duty service members. In addition, the AANS is underwriting a good deal of their costs in attending the AANS Annual Scientific Meetings and other important educational opportunities.

International Partnerships
The AANS is actively partnering with other continental societies to further its educational and research objectives. The synergy that has been developed during the past year and will continue through the leadership of Chris Loftus, MD, FAANS, and will be beneficial to both the AANS and international partners. During the 2016 AANS Annual Scientific Meeting in Chicago, we would be partnering with our Latin American colleagues and their national society, Federacion Lationoamericana de Sociedades de Neurocirugia (FLANC). International colleagues will have liaison positions on the AANS Board of Directors, which will provide a good opportunity for exchange of ideas, and our industry partners are extremely interested in these collaborations. We already have plans for key AANS leadership to travel to Mexico and to Colombia during their national meetings during the ceremony.

Neurosurgery Research and Education Foundation
During the past year, Jon Robertson, MD, FAANS, working in lockstep with Reg Haid Jr., MD, FAANS, has transformed the Neurosurgery Research and Education Foundation (NREF). The creation of opportunities for institutions and practices to become Cushing Circle-level sponsors has been very beneficial. In addition, a novel idea of creating donation opportunities to specific mentors has proven very popular as well. These resources will be deployed very efficiently (less than 10% administrative overhead) to fund student and resident research and educational opportunities, postgraduate fellowships and mid-career reeducation needs. During my term as president, we will look toward broadening the base of NREF sponsors into previously non-participating stakeholders.

NeuroPoint Alliance
NeuroPoint Alliance (NPA) is a not-for-profit 501(c6) corporation that was specifically created to coordinate a variety of national projects involving the acquisition, the analysis, and reporting of clinical data from neurosurgical practice using online technologies. Such projects include outcomes research, universal data reporting requirements including MOC, maintenance of licensure, and the Physician Reporting Quality System (PQRS), in addition to local and national quality improvement efforts. NPA is currently involved in a stereotactic radiosurgical registry with the American Society for Radiation Oncology, which has received support from Brainlab, Elekta and potentially others.

Other projects include an extracranial/intracranial (EC/IC) bypass study, led by Carlos David, MD, FAANS, in which NPA has partnered with Acesis Inc., for data collection. The Wallace Foundation has also committed funds for the development of a follow-up project, assessing mechanisms to facilitate data transfer from electronic medical records to the National Neurosurgery Quality and Outcomes Database (N2QOD). The AANS is collaborating with the American Academy of Physical Medicine and Rehabilitation in pursuit of a clinical data registry serving patients requiring comprehensive spine care. Both organizations have solidified their commitment and are working on plans for a scalable, sustainable registry, satisfying quality reporting requirements and providing robust and risk-adjusted data analysis. A business plan is being developed that could be approved in early FY2016.

The N2QOD has been active for more than 36 months. The lumbar spine module currently has 66 active sites and has recruited more than 15,000 patients. The cervical module was formally activated in 22 clinical sites and now 33 sites are participating. More than 4,000 patients have been enrolled in the cervical module. N2QOD is the largest national spine registry yet created in North America. The N2QOD spine registry has joined with the AANS, CNS, AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves and the Scoliosis Research Society to create a spinal deformity registry. This project was launched in 2014 and is actively recruiting patients.

The timber module will be designed in 2015, with pilot testing later this year. It is extremely important that NPA has received the final acceptance required from the Centers for Medicare and Medicaid Services (CMS) to officially identify N2QOD as a qualified clinical data registry (QCDR) for 2015. The NPA submitted its application Jan. 31, 2015, and on April 3, 2015, obtained final approval on 21 novel, non-existing PQRS measures developed by leading quality experts in our specialty. These measures are the first specialty-specific measures for neurosurgery approved for public reporting and will provide a meaningful method for neurosurgeons to use in programs, such as PQRS. The effort of Tony Asher, MD, FAANS, in these activities has been extraordinary.

Advocacy
John Wilson, MD, FAANS; and Katie Orrico were extremely instrumental in the repeal of the Sustainable Growth Rate (SGR) over the last few weeks. In addition this legislation prevents CMS from eliminating the 10- and 90-day global payments. Kudos to Katie and John!

I look forward to this year with a keen sense responsibility to you as members of the most demanding field in our health-care system. Our efforts are critical to assuring that the American public has access to high-level subspecialty care in the surgical disciplines as our health-care environment changes rapidly in the coming years. Please feel free to reach out to me and let me know of areas where we can be of help. I will keep you closely updated with all of the initiatives that are on the table at this time.

H. Hunt Batjer, MD, FAANS, is the 2015-2016 president of the American Association of Neurological Surgeons. He is the chair of the department of neurological surgery at UT Southwestern, Dallas. The author reported no conflicts for disclosure.


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