Author: Steven N. Kalkanis
As the business of medicine has evolved, so too has the neurosurgeon’s role in the hospital system. Decisions about patient care, once the eminent domain of the operating surgeon, are increasingly driven by health system policies set by hospital administration, as well as administrative requirements set forth by Congress and other regulatory agencies. Today more than ever, it is essential for neurosurgeons to step into broader organizational leadership roles, to ensure that these decisions take into account the latest evidence-based practices and patient outcomes.
The essential need for neurosurgical leadership has become ever more apparent this year, as the SARS-CoV-2 pandemic has forced hospitals to reevaluate which surgeries are considered essential, and triage and operating procedures have been revamped to ensure patient and surgeon safety. Leaders throughout our specialty have risen to this challenge to develop and implement practices and workflows that ensure the timely and safe delivery of care to critical neurosurgical patients.
Since our founding, the CNS has been uniquely focused on developing young neurosurgical leaders and helping our members build the skills and knowledge necessary to rise to such leadership positions. I personally credit much of my career success to the leadership lessons and invaluable relationships I have developed in the trenches of CNS committees and programs over the last decade. In addition, the role of mentorship cannot be overstated in our profession. The early lessons and critical guidance – and encouragement – I received over many years from Dr. Bob Carter, my chief resident during training and now the Chair of Neurosurgery at MGH, and Dr. Mark Rosenblum, the founding chair of the Tumor Section and the Chair Emeritus at Henry Ford who gave me my first job, made all the difference in my professional life. I am so thrilled to welcome them as our 2020 CNS Honored Guests and look forward to their presentations and involvement in our 2021 Annual Meeting in Austin.
The CNS has also demonstrated tremendous leadership in medicine, partnering with other societies, including the SNS and the Joint Sections, to advance our specialty and foster the development of evidence-based guidelines.
Perhaps nowhere is the impact of our collaborative leadership greater than in Washington, where the Washington Committee works tirelessly to represent our members and patients on Capital Hill, under the guidance of our fearless and indefatigable advocate Katie Orrico. As a small specialty, the CNS must collaborate with other organizations to promote neurosurgery’s advocacy agenda. By forming and leading coalitions, we are successfully making progress on several top issues affecting the specialty. Consider the following:
- The CNS is one of the founding members of the Regulatory Relief Coalition (RRC), a group of national physician specialty organizations advocating for regulatory burden reduction in Medicare so that physicians can spend more time treating patients. Working to remove barriers that hinder patients’ timely access to care, the RRC is championing legislation to reform prior authorization in Medicare Advantage — H.R. 3107, the Improving Seniors’ Timely Access to Care Act. This bipartisan legislation has more than 225 bipartisan cosponsors in the House of Representatives.
- Medicare is poised to cut neurosurgical payments by 6% in 2021, and additional cuts of 15 – 25% may be on the horizon. Recognizing that reductions of this magnitude would be devastating to neurosurgical practices and would harm patients’ timely access to care, the CNS joined forces with 11 other surgical societies in establishing the Surgical Care Coalition (SCC). Working together, the SCC — which has launched a major public affairs campaign — is seeking passage of federal legislation and regulatory changes to prevent Medicare from implementing these cuts.
- Neurosurgeons face substantial medical-legal risks every day, and the CNS continues to lead the charge for medical liability reform. As leaders of the Health Coalition on Liability and Access (HCLA) — a national advocacy coalition of physicians, hospitals and liability insurers dedicated to passing comprehensive medical liability reform at the federal level — the CNS has successfully advocated for the introduction of H.R. 3656, the Accessible Care by Curbing Excessive lawSuitS (ACCESS) Act. This bill is modeled after successful laws adopted by states such as California and Texas. With neurosurgeons facing even more risks associated with COVID-19, through HCLA, the CNS is working closely with Congress to pass legislation that will protect physicians from unwarranted COVID-19-related lawsuits.
To increase our voice, members of the CNS are reaching beyond our specialty to serve in leadership roles across organized medicine.
- Ann R. Stroink, MD, chair of the Joint Washington Committee and Washington Office, was recently appointed to the American Medical Association’s Council on Legislation, which advises the AMA Board of Trustees on state and federal legislative matters. Dr. Stroink also serves as the vice-chair of the AMA’s Mobility Caucus, which promotes policies related to the care of patients with neurological or musculoskeletal problems that affect function, well-being and quality of life.
- CNS Executive Committee members, Alexander A. Khalessi, MD and Clemens M. Schirmer, MD, PhD, represent the CNS on the American College of Surgeons’ Summit on Surgical Training.
- Joint Washington Office Director, Katie O. Orrico, Esq., is the vice-chair of HCLA and was recently appointed as a public member on the American Board of Medical Specialties.
These are but a few examples of how the CNS is leading the charge. Punching above our weight and as the tip of the spear of medicine, we will continue to advocate on our members’ behalf to improve neurosurgical practice and to protect patient access to neurosurgical care.
As we move ahead into 2021 and beyond, the CNS remains committed to supporting neurosurgical leaders. Our Leadership Institute continues to grow each year, providing essential leadership training and networking opportunities to surgeons in early to mid-career. We continue to expand our standing committees and workgroups as we grow our portfolio, offering essential opportunities to lead projects, influence the development of CNS products and services, and collaborate with other leaders in the field. If you have not already, I encourage you to get involved in one of our CNS committees. I promise the relationships you build will fundamentally shape your neurosurgical career, and enrich your life in immeasurable ways.