Curiosity, Politics, and the Endgame: The Best Way to Lead and Practice

Curiosity

That is the word on my mind for this edition of the Chairman’s Corner. Recently, I was asked by a colleague in the world of industry: “Why would we want to publish best practices about any topic until all research questions had been answered?” And the opinion was purely based on high-level prospective evidence.

I smiled as I replied, telling him our main reason was to provide guidance based on what we know but, even more importantly, to stimulate new questions for us to explore, fueling our curiosity.

You see, having led consensus statements for over two decades, I have learned that the most important trait is to be curious about whether our opinions and evidence grading represent the best practice. Many times, I have debated with other physicians who were so certain they were correct about an issue that they dampened the natural curiosity of many younger and more skeptical colleagues. Certainty can be a significant impediment when coupled with a closed mind.

This leads me to the reason I established NEURON and why I believe it will set the standard for future consensus in the fields of interventional spine, neuromodulation, physician education, and regenerative medicine.

Not only does NEURON strive to provide the best answers based on the current level of evidence and expert opinion, but our collaboration with Michael Schatman, PhD, and the editorial team of the Journal of Pain Research allows us to make real-time updates as new peer-reviewed literature becomes available. This will also offer our young innovators the opportunity to showcase their talents as authors of these crucial updates.

Politics

Another important goal of NEURON is to focus on science, evidence, and patient access. In my experience, many previous consensus guides have been bogged down by the politics of authorship, excessive editorial involvement, the need to support predetermined goals, a desire to satisfy third parties, and favoritism that often results in authors who contribute little work or effort to produce true best practices. We are fortunate at ASPN to have many dedicated members who serve as selfless volunteers, enabling us to avoid many of these pitfalls. Our aim is to have a committed and well-educated group of healthcare professionals working together to create the most researched, evidence-based opinions possible.

The diverse writing teams for each project bring a central goal of enhancing the field in terms of both patient safety and efficacy. The first NEURON paper on resident and fellow education is now published, and in the coming months, we will see new NEURON expert guidance on Diabetic Neuropathy (SWEET), Closed Loop in Spine and Nerve, Neuromodulation for Non-Surgical Back Pain, Spinal Stenosis, and Regenerative Medicine.

In addition, teams are currently being organized to write on topics like Endoscopic Surgery, SI Joint Fusion, Peripheral Nerve Stimulation, Advanced Practice Provider Best Practices, and Artificial Intelligence in Spine and Nerve Care. Additional larger projects are scheduled for launch in 2024.

Endgame

The goal of NEURON is to bring together a group of experts to establish best practices and consensus guidelines on critical topics to improve patient care, safety, and efficacy.

Working together, I believe we can achieve this important goal. In that spirit, the ability to combine the efforts of Interventional Spine, Interventional Radiology, Ortho Spine, and Neurosurgery creates a unique opportunity to elevate all of these fields while advancing healthcare in the United States and throughout the world.

In the latest issue of the American Society of Pain and Neuroscience (ASPN) newsletter, significant changes in the descriptors for neurostimulation codes, particularly in spinal cord stimulation (SCS) codes 63685 and 63688, were discussed for the fiscal year 2024.

Of particular concern is the revision to code 63688, which involves the removal of an implanted spinal neurostimulator pulse generator or receiver with a detachable connection to the electrode array. The Centers for Medicare & Medicaid Services (CMS) is considering reducing the work relative value units (RVUs) for this code from its current value of 5.30 to 4.35.

This potential reduction has raised substantial objections within the medical community as it could significantly impact reimbursement for revisions, potentially making the procedure financially unviable.

In parallel, the 116th Congress introduced HR 2474 in April 2023, aimed at updating the Medicare physician fee schedule to provide a single conversion factor based on the Medicare Economic Index.

Sponsored by Representative Raul Ruiz of California’s 36th district, the bill seeks to address payment uncertainties affecting Medicare participating physicians and prevent potential opt-outs by physicians from Medicare, ultimately safeguarding Medicare beneficiaries’ access to care.

Although the bill has gained support from both Democrats and Republicans, it currently awaits action in the health subcommittee of the Energy and Commerce Committee, with its fate uncertain amidst other legislative priorities and ongoing political developments.

ASPN Young Innovators Committee had an incredibly successful CME webinar on Continuing Education and Board Preparation and additionally webinar A on Surgical Skills and Wound Care.

On November 29, we are planning to host a CME webinar on Sacrolliac Joint PainDiagnostic Workup, Management and Surgical Intervention.

We are excited to launch the Poster to Podium Young Innovators track this year and are closely working with the participants to work on quality research presentations for the 2024 Annual Conference!! As always, please reach out to get more involved!

As a professor of neurosurgery, I see autumn as a time of transitions. New fellows are settling into their training, new graduates are getting well into the swing of things in their practices.

The Pain Fellowship Match is behind us, and I am deep into the process for residency interviews and our own Match. As we take stock of these changes, many of us recognize the need to supplement our professional development, and the programs at ASPN can offer support.

Dr. Tim Lubenow coordinates a masterful webinar series for fellows on the basics of practicing pain medicine. The Young Innovators kicked off their webinar series with practice tips and tricks for boards and CME last month.

I would encourage you to check out these offerings and all the archived webinars. which are available to you as a member. ASPN takes pride in the resources, evidence, and information about therapies that we create for our society.

If you have ideas for topics, please share your suggestions and help us to expand our collection! This is your society, and we will make it even better with your energy and enthusiasm.

Thank you for your membership.