Washington Committee Report

Andrew D. Parent, MD

The AANS/CNS Washington Committee met July 7, 2006, in Arlington, Va., A summary of the topics discussed follows.

Transition to ICD-10. As the 2010 deadline for implementing the ICD-10 approaches, the AANS, the CNS, and the ACS have petitioned to delay implementing the ICD-10 until the end of 2012. Collectively, they are concerned about several issues, of which one is a transition from the ICD-9 to the ICD-10. They question whether this transition from the ICD-9 (composed of 24,000 codes) to the ICD-10 (composed of more than 200,000 codes) will require an electronic medical record. At the present time, the Health Information Technology Bill has not been reconciled thoroughly enough to entail the level of financial support or the mechanisms that would effectuate implementation of the 200,000 codes required for the ICD-10.

Pay for Performance. Apparently, progress continues with respect to the programs governing payment for reporting and payment for performance. Unfortunately, because very few performance indicators have been developed and, because surgery tends to function as a team effort rather than as a series of separate, independent performances, the proposed incentive program would reimburse surgeons inadequately and inequitably.

IOM Emergency Care Report. In June 2006, the Institute of Medicine released its report, “The Future of Emergency Care” (Executive Summary). Of special interest to pediatric neurosurgeons was the attention paid by the IOM committee to tailoring and customizing facilities, technology, and policy in emergency care to pediatric patients. Included in these findings were recommendations for the availability of child-appropriate equipment when training personnel in the emergency department and for developing an explicit disaster plan that addresses issues faced by the pediatric population. The committee also recommended increasing funding for the children’s program to $37.5 million per year over five years.

To FDA: Exempt Cranial Orthosis From Patent. In early February 2006, the committee sent a formal letter to the FDA recommending that cranial orthosis be exempted from patent. The presidents of both the AANS and the CNS signed and endorsed this letter. Katie Orrico, director of the AANS/CNS Washington Office, informed us of a rumored early favorable response to this recommendation.

Neurosurgeons/Neurointensivists? Recently, neurosurgeons have become aware that they are not recognized as neurointensivists because they are not certified in intensive care. Vigorous discussion has ensued about the definition of neurosurgery and whether neurosurgery billing should include intensive care services. However, neither the CMS nor the JCAHO recognize intensive care services rendered by non-certified intensivists.