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Introduction to Tumor Focus Series: Bringing “Better” to Our Patients in Multiple Ways

By Tumor, Tumor SeriesNo Comments

Neurosurgery has historically been a uniquely wide-ranging and varied specialty. Unlike other specialties that focus on a particular organ system or body region, neurosurgery is quite literally a “head-to-toe” specialty dealing with the brain, spinal cord, peripheral nerves and the other organs intimately related to the nervous system. Neurosurgeons classically had to be experts in a wide variety of surgical procedures and disease processes. As medical knowledge and technology have advanced, neurosurgeons have evolved with medicine to become experts in particular disease processes, leading to a reorganization of neurosurgery into sub-specialty disciplines.

Over the years, the Neurosurgery Blog has partnered with various neurosurgery subspecialty sections to provide an update on the state of the subspecialty, highlight current issues, add to the conversation and portray their concerns to a non-specialized audience. Today’s neurosurgeon must be facile in many different areas — both medical and non-medical. As medical care and health care delivery have grown increasingly complex, neurosurgeons must wear several hats: surgeon, team-member in multi-disciplinary care teams, teacher, scientist and advocate.

We partnered with the AANS/CNS Joint Section on Tumors for the following series of blogs. Under the guidance of Tumor Section chair, Jason P. Sheehan, MD, PhD, FAANS, and AANS/CNS Washington Committee representative, Michael A. Vogelbaum, MD, PhD, FAANS, members of the section came together and produced a sweeping overview of ongoing topics:

  • Arnold B. Etame, MD, FAANS, leads us off with a piece about diversity in neurosurgical oncology. Isabelle M. Germano, MD, FAANS, FACS, then tackles disparities in access to care and outcomes in brain tumor patients.
  • Ricardo J. Komotar, MD, FAANS, FACS, reports on efforts in education and collaboration on an international scale. Edjah E. Nduom, MD, FAANS, speaks to brain tumor advocacy, providing an overview of the outward-looking direction of some of our efforts.
  • Michael Lim, MD, FAANS, and Nader Sanai, MD, FAANS, bring us two pieces highlighting the ability of neurosurgeons to translate discoveries from the lab into patient care and back again and how neurosurgeons contribute to drug development in the increasingly complex fight against brain tumors. These pieces are complemented by an article by Manish K. Aghi, MD, PhD, FAANS, updating the role of neurosurgeons in clinical trials and research in neurosurgical oncology.

Academic publishing, the Journal of Neuro-Oncology, and the dissemination of scientific results, particularly in the era of the COVID-19 pandemic, are at the center of a piece by Dr. Sheehan and Christopher P. Cifarelli, MD, PhD, MMM, FAANS, FACS. Dr. Vogelbaum presents “A Neurosurgical Perspective on Multidisciplinary Care for Patients with Brain Tumors,” emphasizing the team-based nature of neuro-oncology care today.

In the era of a worldwide pandemic and an increasingly complex care delivery environment, neurosurgeons are playing more and more roles in delivering better care to our patients. This is especially true in the field of neurooncology. We hope that these blogs inspire you to join the efforts of this important field. The amount of work that the members of the section and the authors, in particular, put into these issues outside of patient care is astonishing and deserves credit!

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NSTumorSection and using the hashtag #TumorSeries.

Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, Pa.

January 20, 2022
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Neurosurgery Lost a Leader, and I Lost a Dear Friend — Randall W. Smith, MD, FAANS(L)

By Guest Post, Loss of LifeNo Comments

On Oct. 25, neurosurgery lost a leader, and I lost a dear friend. Randy’s accomplishments in organized neurosurgery, especially in California, are too numerous to list and have been chronicled by others in recent days. Today, I want to tell you the main lessons Randy taught me over our decade-long friendship.

  • Your biggest supporters may not be who you think. As a young female neurosurgeon starting in the California Association of Neurological Surgeons (CANS) and the Western Neurosurgical Society (WNS), Randy didn’t care who I was or what I looked like as long as I showed up and worked hard. Once I proved myself, he went to great lengths to support me and promote my career. This is the very definition of sponsorship, which I have found much more helpful than mentorship.
  • Actions speak louder than words. Randy could spot nonsense from a mile away and did not hesitate to call it out. I have met very savvy and politically correct leaders in my time who have done nothing to help foster diversity and inclusion in neurosurgery. When it came to supporting equality, he made the necessary changes in our organizations to make them better.
  • Work-life balance is best when you don’t try to separate them. Randy loved neurosurgery. When he retired from clinical practice in 2004, he was still very engaged in organized neurosurgery. In California, it is no secret that Randy was the backbone of the two influential organizations: CANS and WNS. He attended all the board and executive committee meetings and was part of every critical decision until his death. Randy was constantly curious about the advances in the field of neurosurgery and strived to make the lives of working neurosurgeons better. He involved his whole family — his wife Flo is like a surrogate mom to many of us. Randy taught me that I wouldn’t constantly feel like I had to choose by blending my life and family with my work. He has seen my children grow up and developed an independent friendship with my husband. It well-demonstrated that we are all happier and less likely to develop “burnout” if we feel part of a community.
  • Listen to your instincts. As the COVID-19 Delta variant surge was starting to wane in September, there was still considerable uncertainty about holding an in-person meeting for the WNS. After much planning and consideration, we decided to go for it and held the annual meeting in New Mexico. I do not regret that decision for one minute. It was an engaging, safe and productive meeting and allowed us to connect in person for the first time in nearly two years. This felt even more precious with my older colleagues. I didn’t know at the time that the picture you see here would be the last night I would spend time with Randy. I can just hear him saying: “Just go for it, kid.” Thanks, Randy. I will.

As we get ready to sit down with our families and friends for Thanksgiving, I encourage you all to reflect on how fortunate neurosurgery is to have had such an icon in our field. He will be missed.

Editor’s Note: An issue of the CANS newsletter that will be entirely dedicated to commemorating Randall W. Smith, MD, is planned for mid-December. You are encouraged to submit personal remembrances if you’d like them included in this issue. Please send your memories to mabousamra@aol.com or emily@cans1.org. The deadline for submission is Nov. 28. Additionally, we encourage everyone to follow @Neurosurgery and @CaNeuroSurgeons.

Ciara D. Harraher, MD, MPH FAANS
Stanford Department of Neurosurgery
Dominican Hospital
Santa Cruz, Calif.

November 23, 2021
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Cross-Post: Physician Pay Cuts Are Another Threat to Independent Practices

By Cross Post, Health Reform, MedicareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in The Hill on Nov. 13, 2021. In the op-ed titled “Physician pay cuts are another threat to independent practices,” Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., discusses how the 9% Medicare physician pay cuts for medical services starting Jan. 1, 2022, will have enormous consequences for the entire health care system.

According to Dr. Menger, “Medicare physician pay has increased only 11 percent from 2001-2020. Meanwhile, the cost of running a medical practice increased 39 percent from 2001-2020.  Adjusting for inflation and the cost of running a practice, Medicare physician pay dropped 22 percent over the time period.” He continued, “Medicare payment to hospitals increased nearly 60 percent over the same time period.”

Medicare physician pay cuts place external pressure on physicians and drives them into more hospital-employed practices. Hospitals are merging and consolidating around regional health care markets on an astounding basis. Dr. Menger noted that a collection of the country’s leading surgical societies, the Alliance of Specialty Medicine and the Surgical Care Coalition, recognize this downward pressure as impossible to maintain.

Click here to read the full article in The Hill.

Editor’s Note: We encourage everyone to join the conversation online by following @Neurosurgery, @SpecialtyDocs and @SurgeonsCare and using the hashtag #Neurosurgery.

November 17, 2021
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Giving Thanks to the Neurosurgeons in the Military Who Have Served our Country

By Military Faces of NeurosurgeryNo Comments

Each year on Veterans Day, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) pay tribute to the contributions of the many military neurosurgeons who have made significant contributions and sacrifices. Whether on the battlefield, in the operating room or research lab, neurosurgeons have served our country with distinction and grace throughout history.

ICYMI, Neurosurgery Blog has featured many of these stories. Once again we encourage our readers to take a trip down memory lane. Read how former AANS president Roberto C. Heros, MD, FAANS(L), volunteered for the ill-fated Bay of Pigs invasion. Remember the horrors of the Vietnam War, as seen through the eyes of Patrick J. Kelly, MD, FAANS(L), while he was stationed in Da Nang during the bloodiest year of that conflict. Learn how neurosurgeons, like COL (ret) Rocco A. Armonda, MD, FAANS, have taken their skills from the operating room into the battlefield. Recognize the many women in neurosurgery who have made significant contributions and sacrifice. Recall the recent efforts of the U.S. Comfort and Mercy, and how neurosurgeons came to the aid of Los Angeles and New York City as COVID-19 stressed the hospital ecosystem in the early days of the pandemic.

Thank you to these and all other veterans who have served our nation with selflessness and dignity to protect the freedoms we have all come to take for granted. Your service can never be honored enough. Happy Veterans Day, one and all.

November 11, 2021
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Permanently Funding CHIP is Essential for the Health of Our Children

By Guest Post, Health Reform, PediatricsNo Comments

The Children’s Health Insurance Program (CHIP) is a health insurance program that provides coverage to children from low-income families. CHIP was established in 1997 with strong bipartisan support and is an essential state-federal partnership. As many as 15% of children lacked health insurance coverage at the time. According to the American Academy of Pediatrics (AAP), Medicaid and CHIP provided health insurance to more than 50% of U.S. children in 2012, making both programs combined the nation’s largest insurer. These children and their families depend on federally subsidized state Medicaid for their health insurance.

As a pediatric neurosurgeon in New Jersey, I have seen how these programs help children and allow them to have their well visits, sick visits and hospitalizations covered. The program is not perfect — for example, provider reimbursements are typically well below market rates and fail to cover physician practice costs. Thankfully, however, many physicians in our state — and across the U.S. — accept CHIP-covered patients providing access to care is needed for these children who otherwise would not receive the medical and surgical care that they so desperately need. And as we know, healthy children grow up to become healthy adults.

Unfortunately, since the program’s inception, Congress must reauthorize CHIP every few years, putting this vital coverage in jeopardy. In fact, at one point in 2018, CHIP funding lapsed for an unprecedented 114 days. While Congress extended CHIP funding through 2027, the program remains vulnerable without permanent financing.

Fortunately, Congress is currently considering legislation to fund CHIP permanently. One such effort is being led by Reps. Vern Buchanan (R-Fla.) and Lucy McBath (D-Ga.). Endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons, the Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act (H.R. 66) would ensure that gaps in CHIP coverage would never again happen.

Kids need access to care, and pediatric neurosurgical patients depend on CHIP funding. We need to provide adequate health care for children from low-income households. We have a fiduciary responsibility and an ethical obligation to support permanent funding for the CHIP. This is not just my opinion, but truth and reality. If Congress does not act, federal funding for CHIP will expire.

CHIP has provided access to care that low-income families would not have had otherwise. As a nation, we need to come together to support permanently funding CHIP through the CARING for Kids Act or similar federal legislative efforts so our children will have access to health care that they so desperately need.

Please help make permanent funding a reality by taking a moment to contact Congress and ask your representative to co-sponsor H.R. 66. Click here to go to neurosurgery’s Advocacy Action Center to send an email to your elected officials asking them to co-sponsor H.R. 66. A sample message, which can be personalized, is provided. It takes less than a minute to make a difference in the lives of millions of children and their families, so please act today!

 Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FundCHIP.

Catherine A. Mazzola, MD, FAANS
New Jersey Pediatric Neuroscience Institute
Morristown, N.J.

October 25, 2021
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Faces of Neurosurgery: An Interview with Volker K. H. Sonntag, MD, FAANS (L)

By Career, Faces of NeurosurgeryNo Comments

In Episode 4 of Neurosurgery Blog’s Faces of Neurosurgery interview series, we spoke with Volker K. H. Sonntag, MD, FAANS (L) about his proudest achievements, his favorite surgery to perform and one surgical instrument he couldn’t live without. Dr. Sonntag is an emeritus professor of neurosurgery at Barrow Neurological Institute in Phoenix, Ariz.

Dr. Sonntag is most proud of the nearly 300 residents and fellows he has trained over the years, and the legacy they carry from him. One of his biggest accomplishments was “putting spine on the map” in neurosurgery, and seeing spinal neurosurgery grow over the course of his career. His autobiography, “Backbone: The Life and Game-Changing Career of a Spinal Neurosurgeon,” is available now.

The full interview is available here and on Neurosurgery Blog’s YouTube channel.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FacesOfNeurosurgery.

September 21, 2021
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Cross-Post: A Way Forward For The Imaging Appropriate Use Criteria Program: Aligning Quality Metrics

By Cross Post, Health Reform, MedicareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in Health Affairs on Aug. 26, 2021. The article, “A Way Forward For The Imaging Appropriate Use Criteria Program: Aligning Quality Metrics,” discusses proposed changes to the Centers for Medicare & Medicaid Services (CMS) calendar year 2022 proposed Medicare Physician Fee Schedule (PFS) Rule and implementation of the Appropriate Use Criteria (AUC) program. Mandated by the Protecting Access to Medicare Act (PAMA), the AUC program requires physicians ordering advanced diagnostic imaging to consult with AUC using an approved clinical decision support mechanism before the radiologist can provide the scan.

As the Health Affairs piece points out, following the release of the  PFS, the House Appropriations Health Subcommittee included in its report a provision for CMS to inform Congress about the implementation of the AUC program, including any challenges and successes. The AANS and the CNS have urged Congress to repeal the AUC program, given the additional burdens on physicians and potential delays in imaging services. At the very least, the neurosurgical societies have recommended that Congress adopt legislation that directs CMS to incorporate AUC for diagnostic imaging into the existing Quality Payment Program.

Click here to read the full article in Health Affairs.

Editor’s Note: We encourage everyone to join the conversation online by following @Neurosurgery and using the hashtags #Neurosurgery and #Medicare.

September 13, 2021
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