March, 2011
Clinical Neurophysiology News Newsletter of the American Clinical Neurophysiology Society Message from the President Dear Fellow Members of the ACNS,
Volume 3, Issue 2
Like many of you I came away from this year's meeting rejuvenated and excited about the future of clinical neurophysiology. Special thanks go to the organizers of the courses and scientific program: William O. Tatum IV Aatif M. Husain, and Noor A. Pirzada.
Future Meetings 2012 Annual Meeting and Courses February 2-7, 2012 Marriott Rivercenter San Antonio, TX Program Co-Chairs: Cecil Hahn, M.D. & Francis Walker, M.D. Call for Proposals for Symposia, Clinical Workshops, and Other Didactic and Interactive Sessions. Visit www.ACNS.org for details. Submission deadline April 1, 2011 Editor Jonathan C. Edwards, M.D
In typical American fashion our discipline has re-invented itself. Clinical neurophysiology can no longer be lumped with those terrible stereotypes of 20th century neurology as a field with limited therapeutic potential. How long have we had to bear the brunt of jokes like those citing us as purveyors of "perfectly accurate and totally useless information"? Now, we can hold our heads up high Douglas R. Nordli Jr., M.D because we have become do-ers. We are using our techniques in ways previously unimaginable to dramatically enhance therapies and to avoid neurologic injury. In effect we have shifted from static to dynamic mode: performing continuous monitoring to protect the nervous system from harm, measuring nerve conduction in the OR to aid in surgical decisions, and reading intraoperative electrocorticigraphy, We are intervening in all sorts of ways: from injecting Botox to treating non-convulsive status epilepticus. All of this has come about in the span of a decade or so. These are very exciting times! So much so that Francis Walker mentioned "intervention" as one of the themes for next year's meeting and I think it is a great idea. By the way, as co-chairs of the scientific program Francis and Cecil Hahn are eager to hear from you about your suggestions to enhance our annual meeting. Please put San Antonio on your schedule! I have a few specific goals for this year. I'd like to see us continue the efforts started by my predecessors to make our society younger and even more diverse. We should set a modest and achievable goal for growth in membership as we establish our society as The Home for people interested in clinical neurophysiology. How about 50 new members? We can all start on both of these by reaching out to our fellows shortly after the start their training this July. Let's try to attract members that will be active in the society I would like to enhance the quality of our educational materials by converting to greener technology with a goal to convert to digital files for next year's handouts. We should speed up the process of our guideline production, materials that our members highly value, and set specific goals for delivery, maybe 3 guideline enhancements per year. We'll have to revamp our committee structure and procedures a bit to do this. Jonathan Edwards wants to increase the frequency of our newsletter to quarterly, and use the newsletter to help stay in regular communication with members and improve awareness of important issues as they arise. Finally, a personal interest is to work on increasing the involvement of pediatric clinical neurophysiologists. We are very fortunate to have experienced and very capable administrators to help us work hand in hand to meet our goals, but it will take a (Continued on page 2)
American Clinical Neurophysiology Society 2009-2010 Council Members PRESIDENT Douglas R. Nordli, Jr., M.D. Children's Epilepsy Center Chicago, IL 1ST VICE PRESIDENT Susan T. Herman, M.D. Beth Israel Deaconess Medical Center Boston, MA 2ND VICE PRESIDENT Frank W. Drislane, M.D. Beth Israel Deaconess Medical Center Newton, MA
Message from the President (continued) (Continued from page 1)
little effort from all of us to make this happen. Please, if you know of young, dynamic, energetic folks who might want to contribute to these projects, point them our way. Reach out to Tobias Loddenkemper and Stephan Schuele for any suggestions you have about bolstering membership. Thanks to those of you who were able to visit with us in New Orleans and please spread the word about the exciting developments within our society so that even more of our colleagues join us in San Antonio. In the meantime, here's hoping your impedances are low, your tracings are clean, and the signal to noise ratio of all of your professional endeavors is high! Doug President American Clinical Neurophysiology Society
SECRETARY Aatif M. Husain, M.D. Duke University Medical Center Durham, NC TREASURER Stephan Schuele, M.D., M.Ph. Northwestern University Neurology Chicago, IL IMMEDIATE PAST PRESIDENT Peter W. Kaplan, MB, FRCP Johns Hopkins Medical Center Baltimore, MD PAST PRESIDENT Gareth J. Parry, M.D. University Minneapolis Minneapolis, MN COUNCIL MEMBERS Jonathan C. Edwards, M.D. Medical University of South Carolina Charleston, SC Terrence D. Lagerlund, M.D. Mayo Clinic Rochester, MN
Incoming President, Dr. Doug Nordli (left), presents a plaque to ACNS President Dr. Peter Kaplan (right) in honor of his leadership over the past year.
Suzette LaRoche, M.D. Emory University Medical Center Atlanta, GA Suraj Ashok Muley, M.D. St. Joseph's Hospital and Medical Center Phoenix, AZ Piotr W. Olejniczak, M.D. Louisiana State University Health Sciences Center New Orleans, LA William O. Tatum IV, D.O. Mayo College of Medicine Jacksonville, FL Francis O. Walker, M.D. Department of Neurology Winston-Salem, NC Elizabeth J. Waterhouse, M.D. Medical College of Virginia Medical Center Richmond, VA
Highlights of the Annual Meeting This year’s Annual Meeting, which took place in New Orleans under the direction of CoChairs Dr. Aatif Husain and Noor Pirzada, was a huge success despite severe weather conditions throughout the USA all week. With only a handful of meeting and course registrants canceling due to the weather, there were a total of 269 attendees. Individuals traveled to New Orleans from 39 states, including Puerto Rico, and also Canada, England, Italy, Japan, Nepal, Netherlands, Qatar, Saudi Arabia, Thailand and West Indies. In addition, there were 16 exhibitors and representation from the ABCN, ABRET, ASET and the ASNM. Attendees learned about the exciting research in clinical neurophysiology, networked with colleagues, reunited with friends, and enjoyed an ever joyous, though cold, New Orleans! The ACNS remains the only place where all aspects of clinical neurophysiology are discussed and debated. This year the Jasper award was presented to a most deserving pioneer of clinical neurophysiology, Dr. C. William Erwin. The Gloor awardee was Dr. Paul
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Highlights of the Annual Meeting (continued) Nunez, who in his lecture challenged the audience to think about consciousness in terms new to most neurophysiologists. The Schwab award was presented in absentia to Dr. Andrew Eisen, who could not attend due to unavoidable circumstances. The plenary sessions were very well received as well, and the special session on Human Adaptation to Spaceflight by Dr. Story Musgrave, surgeon and NASA astronaut, was a truly unique and wonderful experience. Dr. Musgrave graciously signed autographs and shared experiences with attendees before and after his program. The President of the ACNS, Dr. Peter Kaplan, kicked off the Presidential Symposium with a discussion about nonconvulsive status epilepticus (NCSE). Drs. Bryan Young and Frank Drislane discussed the important issues of neuronal injury and treatment of NCSE. Other central neurophysiology topics presented included neonatal ICU EEG monitoring and neurophysiology of hypothermia. A debate about the utility of invasive EEG monitoring in temporal lobe epilepsy drew a large audience, as did the workshop on quantitative ICU EEG analysis. A discussion on “How Not to Read an EEG,” generated passionate discussion about “over reading” of EEGs. In addition to the course on neurophysiologic intraoperative monitoring (NIOM), a symposium on localization of eloquent cortex further enhanced the NIOM education. A wide range of EMG/Neuromuscular topics were presented at the 2011 meeting in New Orleans. These included comprehensive symposia on Clinical and Electrophysiologic features of Neuromuscular Junction disease, State of the art Quantitative studies of Autonomic function and a discussion on all aspects of primary Muscle disease, which were very well received by the participants. Workshops on Focal Neuropathies and EMG waveform recognition provided an excellent review for trainees, practitioners as well as academic faculty. The Special Interest Group (SIG) meeting provided an appropriate forum for attendees with specialized interests to interact and an interesting topic discussed at this year’s Neuromuscular SIG meeting was identification of Neuromuscular diseases by quantification of decomposed needle EMG. The EMG section is continuing to grow and we hope that in the future, with increasing awareness of the EMG/Neuromuscular programs provided at our annual meetings we will attract a sizable number of participants. Based on feedback from our membership we hope to provide more “hands on” EMG sessions next year. New this year was special interest group (SIG) meetings for NIOM, ICU EEG, EMG, and sleep. All SIGs were well attended and received very favorable evaluations. The ACNS annual meeting continues to be an excellent opportunity for residents/fellows to submit posters, and a record number of travel fellowships were awarded this year to trainees whose abstracts were accepted. The Program Committee for the 2012 meeting, chaired by Drs. Cecil Hahn and Francis Walker, is already planning for next year’s meeting. Proposals are being sought now for symposia, discussion groups, debates, and workshops. We hope to see you again in San Antonio in 2012!
Summary of the Annual Courses by: William O. Tatum IV, D.O., Annual Course Chair This year the ACNS met in the heart of Dixie in the wake of unfavorable weather conditions in the north. The roster of courses included notable contributions in several areas of clinical neurophysiology provided by eminent leaders in the field of EMG, sleep physiology, and provided the latest developments in the emerging fields of ICU and neurophysiologic intraoperative monitoring. Brand new features this year took the ACNS to a higher level of course direction by implementing co-moderators that were able to co-direct the well-rounded faculty of extremely dedicated professionals. The breakfast seminars included the ever-popular evoked potential reading session, the limited-entry nerve conduction workshop, and the new quantitative EEG primer as an early morning complement to the didactic courses to successfully complement this years’ outstanding program. In the up and coming year, the ACNS will further evolve the Annual Courses segment to pilot an AM-PM graded degree of difficulty in addition to highlighting the return of the hottest topics in EEG. Addressing the gaps in the field of clinical neurophysiology and new emerging areas of interest promises will be the directives to make the 2012 annual meeting one you don’t want to miss to learn about the latest developments in clinical neurophysiology.
Congratulations to the winners of the highest awards bestowed by the ACNS! The Herbert H. Jasper Award is given to an individual for a lifetime of outstanding contributions to the field of clinical neurophysiology; the Pierre Gloor Award is given to an individual for outstanding contributions to clinical neurophysiology research; and the Robert S. Schwab Award is given to an individual for outstanding achievement in the field of Clinical Neurophysiology.
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ACNS Newsletter
Awards
ACNS President, Dr. Peter Kaplan, presents Dr. C. William Erwin with the 2011 Herbert H. Jasper Award.
ACNS President, Dr. Peter Kaplan, and Dr. Mark Hallett, Councilor, present Dr. Paul Nunez with the 2011 Pierre Gloor Award.
Dr. Andrew Eisen, Professor Emeritus of Neurology at the University of British Columbia, Canada, was awarded the 2011 Robert S. Schwab award but was unable to attend the meeting. Congratulations Dr. Eisen!
ACNS Newsletter
Neurophys Bowl - 2011 The 2011 ACNS Neurophys Bowl, with Co-Chairs Larry Hirsch and Mark Ross, was a huge success and enjoyed by participants and attendees alike. Four teams competed – two in the “Up and Coming” category (including a Travel Fellows team) and two in the “Old and Wise” category. In the end, after a dramatic comeback, the Up and Coming “Fast Ripples” (Drs. Mike McGarvey, Cecil Hahn, Sarah Schmitt and Shafeeq Ladha) defended their title in a nailbiter, once again defeating the Old and Wise runner-ups, the “Left Temporal Slow Waves” (Drs. Francis Walker, Susan Herman, Mark Hallett and Marc Nuwer).
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Thanks also to the “Normal Variants” (Drs. Madeleine Grigg-Damberger, Bruce Fisch, Bill Tatum and Francis Walker) for competing, and to The Honorable Peter Kaplan, President and Neurophys Bowl Judge. If anyone is interested in contributing a few questions for next year’s Bowl, please contact the Co-Chairs … and start getting your team together for the 2012 Neurophys Bowl in San Antonio! The registration form can be found on the ACNS website (www.ACNS.org) or by contacting the ACNS Executive Office by phone (860-243-3977) or email (ACNS@ssmgt.com).
Thank You 2011 Annual Meeting Exhibitors! Blackrock Microsystems Cadwell Laboratories, Inc. CareFusion Compumedics USA Electrical Geodesics, Inc Elekta, Inc Grass Technologies Ideal Health Careers, Inc. IOM Solutions Ives EEG Solutions, Inc. Lippincott, Williams & Wilkins Max Neuro Supply, Inc. Natus Medical Incorporated Nihon Kohden America PMT Corporation Rochester Electro-Medical, Inc. Thank you also to CareFusion for loan of EEG Equipment for the Nerve Conduction Workshop!
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Focus on Fellows
ACNS President, Dr. Peter Kaplan, and 2011 Travel Fellows. Twelve neurophysiology fellows from around the world won travel scholarships to this year’s ACNS annual meeting in New Orleans. They presented posters on a wide range of topics, and the projects were of exceptionally high quality. Over the next few issues of Clinical Neurophysiology News, we will shine the spotlight on these fellows. This group of new colleagues includes some rising stars in our field. Please keep an eye out for them as we discuss their background, their projects and their upcoming plans. American Clinical Neurophysiology Society 2011 Travel Fellows Allan Azarion, M.D. University of Pennsylvania, Philadelphia, Pennsylvania Mackenzie Cervenka, M.D. Johns Hopkins University, Baltimore, Maryland Leo L.K. Chen, M.D. UCLA Medical Center, Los Angeles, California Brandon Foreman, M.D. Columbia University, New York, New York Koichi Hagiwara, M.D. Kyushu University, Fukuoka, Japan Ram Mani, M.D. University of Pennsylvania, Philadelphia, Pennsylvania John J. Millichap, M.D. Children's Memorial Hospital, Chicago, Illinois Wei Ping Kay Ng, M.D. National University Health System, Singapore Rajdeep Singh, MBBS, MS Duke University Medical Center, Durham, North Carolina Fleny S. Thomas, M.D. University of New Mexico, Albuquerque, New Mexico Wang Xinning, M.D. Peking Union Medical College, Beijing, China Wang Yue, M.D. Tianjin Medical University, Beijing, China
ACNS Newsletter
Focus on Fellows (continued) Wang Yue, MD . Dr. Wang Yue is currently a trainee at the Department of Neurology at Tianjin Medical University General Hospital. Her primary mentor is Professor Cui Li-ying, and she is also mentored by Dr. Liu Ming-sheng.
In describing the project that she presented, she told Clinical Neurophysiology News:
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“The rationale of the project was to recognize different pattern of GBS by serial electrophysiological studies, as well as their prognosis. In this study, eighteen patients with GBS were studied by clinical and electrophysiological methods”. As she explains further, she and her colleagues found that “electrodiagnostic results showed that 55.6% of the patents had acute inflammatory demyelinating polyneuropathy (AIDP), 11.1% had AMAN, and 33.3% were unclassified. The type of GBS in two patients was verified as AIDP by serial electrodiagnostic studies instead of AMAN.” In terms of the essential take-home point of this study, she indicates that: “it is important to follow up patients with GBS by sequential eletrophysiological studies in discriminating between demyelination and axonal degeneration”. In terms of her future, she plans to continue her fellowship training, and pursue a career in Academic Medicine, either as an academic clinician or physician scientist. She especially acknowledges Professor Cui Li ying as a role model that has influenced her interest in clinical neurophysiology and her career plans.
Wang Xinning, MD As we all know, great mentors have a tremendous influence on the careers of the next generation of academic physicians. Dr Wang Xinning presented an excellent project, and also names Professor Cui Li-ying as a mentor who aroused her interest in electromyography and NCS. Wang Xinning attended the ACNS meeting as a travel scholarship winner from the Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College. Her presentation was titled "A Clinical Neurophysiological Study of Hirayama Disease". About her project, she told Clinical Neurophysiology News: “Neurophysiological studies, including electromyography(EMG), motor conduction velocity (MCV), sensory conduction velocity(SCV) and F-wave, were performed in 27 patients with the diagnosis of Hirayama Disease. EMG was selectively performed on upper and lower extremities, sternocleidomast and thoracic paraspinal muscle according to the clinical features of the patient”. She and her colleagues reported that “decreased compound muscle action potentials (CMAP) were found in nerve conduction velocity examinations. The abnormality rate of median F-wave persistence was 22.2%. The study of EMG demonstrated the neurogenic lesion in all patients with spontaneous potentials, prolonged latency or augment of amplitude in motor unit potentials (MUPs), or abnormal pattern of MUPs recruitment. 33.3% of patients showed EMG abnormalities only in upper extremities, whereas 66.7% of patients have abnormalities in lower extremities, sternocleidomast and thoracic paraspinal muscle. Changes of EMG showed that the right side
ACNS Newsletter
Focus on Fellows (continued) were more affected than the left side. As a result, EMG can detect neurogenic lesion in one or more segments in patients with Hirayama disease”. She plans to pursue this topic further, by indicating that neurophysiological methods will be used to evaluate disease activity in a follow-up study. She has also planned study of amyotrophic lateral sclerosis. She will be completing her fellowship in 2012, and hopes for a career in academic medicine.
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Kay Wei Ping N g, MB.BS, MRCP (UK), M.Med (Singapore) Dr. Kay Wei Ping Ng presented a poster from a very interesting project titled " Evolving Axonal Neuropathy: A Rare Complication of Colchicine". She is currently in her final year of a threeyear specialist Neurology training program in Singapore at the University Medicine Cluster, National University Health System. Her primary mentor on this project was Dr Rahul Rathakrishnan, and other colleagues who participated in the study included Dr. Yee Cheun Chan and Prof. Einar Wilder-Smith. When asked to describe her project for Clinical Neurophysiology News, she told us: “We aimed to highlight acute evolving neuromyopathy as a possible complication of colchicine, and how its recognition can avoid redundant and invasive further investigations or treatments. We featured 2 patients with serial clinical examinations, nerve conduction studies (NCS) and needle electromyogram (EMG) studies. Both had chronic kidney disease, taking customary doses of colchicine, presenting with subacute proximal, then distal, limb weakness and sensory loss. The first patient had an initially normal NCS 3 days following the onset of her symptoms. Repeat NCS was suggestive of an evolving sensorimotor axonal polyneuropathy. The NCS for the second patient performed 2 weeks after symptom onset showed a moderate sensorimotor axonal polyneuropathy, and EMG showed myotonic discharges. Both patients made a full clinical recovery weeks after colchicine cessation, but while EMG abnormalities resolved, the NCS abnormalities remained. These cases illustrate how NCS changes may lag behind clinical onset and recovery in colchicine neuromyopathy. We therefore propose that patients with neuromyopathy on colchicine should be observed for at least a few weeks following drug cessation before unnecessary investigations or treatments are performed”. She will be completing her Neurology training this year, and has great enthusiasm for a career in academic Neurology. She plans to obtain board accreditation in Neurology this year, and intends to pursue a fellowship in the United States, “to expand my horizons in both clinical medicine and research. I am excited with the prospect of being able to bring new insights and techniques back to my hospital practice to further improve patient care”. She cites several mentors who have guided her interest in academic Neurology. “Dr. Rahul Rathakrishnan, who trained in epileptology at the Montreal Neurological Institute, has always been very supportive of my interest in research, and has also helped deepen my interest in EEG reading. In addition, Dr Yee Cheun Chan and Prof Einar-Wilder Smith have both brought me through multiple nerve conduction studies and electromyograms, and were the ones to encourage me to submit an abstract for the ACNS meeting. I am also very grateful to my head of division, Prof Benjamin Ong, and the rest of my department for allowing me the training opportunities”. The opportunity to present her work at the ACNS meeting has been a great experience for her. She informed us that: “The ACNS meeting had also given me the chance to exchange experiences with fellow neurology residents and fellows, and I was thrilled to attend presentations given by the authors of the journals and texts that we study from! I would say that this meeting itself has intensified my interest in the subject, where, having seen my mentors' obvious enthusiasm for clinical neurophysiology being mirrored in people from all over the world, I am encouraged to be a part of that community as well”.
ACNS Newsletter
Focus on Fellows (continued) Koichi Hagiw ara, M.D ., Ph.D . Dr. Koichi Hagiwara attended the ACNS annual meeting as a traveling scholar from the Department of Clinical Neurophysiology, Kyushu University, Fukuoka, Japan. His primary mentor for this project was Dr Shozo Tobimatsu. His co-investigators included Drs Katsuya Ogata, Tsuyoshi Okamoto, Hiroshi Shigeto, and Yuko Somehara.
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In describing his project, Dr. Hagiwara told Clinical Neurophysiology News: “Age-related electrophysiological changes in the primary somatosensory cortex (SI) are well established: the amplitude of the N20 component of median nerve somatosensory evoked potentials typically increases with age, probably because of cor125ical disinhibition. The secondary somatosensory cortex (SII) receives direct input from the SI and the thalamus. In our study, we quantified age-related changes in the SII using magnetoencephalography (MEG). We recorded somatosensory evoked magnetic fields (SEFs) in response to right median nerve stimulation in 72 healthy volunteers (36 females, 22-69 years of age)”. In terms of the key findings, he informed us that “The latency, amplitude and dipole moment of the N20m correlated positively with age. In contrast, the latency of the SII response (80-120 ms) correlated inversely with age. There were no significant age-related correlations for the amplitude and dipole strength of the SII response. We also analyzed time-frequency domain to evaluate two indexes for neural synchrony. One is a phase-locking factor (PLF), which is an index of phase synchronization with respect to the stimuli. The other is a phase-locking value (PLV), which is an index of phase synchronization between the two cortical areas (i.e., SI and SII). The PLF analysis revealed increased phase-locked oscillations both in the SI and SII. The PLV analysis showed enhanced phase synchrony between the SI and SII, particularly in the gamma-frequency band. The incresed PLFs and PLVs indicate age-associated increase in cortical excitability in the two cortical areas. As in the SI, the increase in the PLFs in the SII began from the early post-stimulus period, probably because of the direct thalamocortical pathway to the SII”. Dr. Hagiwara tells us that significance of the study was in demonstrating that: “Age-related plastic change of the SII was suggested by the shortening of the latency in the SEF analysis. Increased PLFs and PLVs may reflect cortical disinhibition in the SI as well as the SII. Our results suggest that the age-related plastic changes of the SII may result from enhanced short-latency inputs to the SII, which is mediated by the direct thalamocortical pathway”. Dr. Hagiwara plans to continue to work as a Neurologist a Neurophysiologist, and hopes to develop his career with further training. He cites Dr. Yoriaki Yamashita as an important role model who has influenced his interest in neurophysiology and his career plans. Please check upcoming issues of Clinical Neurophysiology News where we will focus on additional 2011 Travel Fellows.
Journal of Clinical Neurophysiology Dr. John Ebersole, Journal Editor, welcomes suggestions and guest editors for special issues of the Journal. Potential authors may now submit their manuscript online at www.EditorialManager.com/JCNP.
ACNS Newsletter
Case of the Month Each issue of Clinical Neurophysiology News will feature a clinical case submitted by an ACNS member. The answer to the case will be available in the Members Only section of the ACNS website (www.ACNS.org). This issue’s case is submitted by William O. Tatum IV, D.O.. For the answer, sign in to the Member’s Only section of the ACNS website: www.ACNS.org. Case Study:
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A 63 year old right-handed female had a recent quintuple bypass for coronary artery disease with comorbid hypertension, diabetes, and chronic renal insufficiency. She was at home and suddenly collapsed, though was “immediately” resuscitated after her husband called 911. She was asystolic on arrival and in the ED had a witnessed “grand mal” seizure during intubation and was administered Levitiracetam (LEV) 1000 mg IV. A CT brain was normal. Neurology evaluation on arrival to the NICU demonstrated a comatose patient despite a transient reduction of neuromuscular blocking medication. What is featured on the EEG in (A), and what actions were taken to result in (B)?
A
B
For the answer and references, please sign in to the Members-Only section of the ACNS website: www.ACNS.org If you do not know your login and/or password, please call the ACNS Executive Office at 860-243-3977 or email ACNS@ssmgt.com
The Board and Commissioners of CAAHEP want to thank
American Clinical Neurophysiology Society For joining us as a partner in the important process of accrediting ENT educational programs. The quality assurance that accreditation of these programs promotes protects patients and students as well as enhancing the profession.
ACNS Newsletter
ACNS Membership If you are not presently a member of the ACNS, please consider joining. Membership benefits include reduced fees for CME-accredited meetings and courses, reduced dues for members in training and early practice physicians, subscription to the Journal of Clinical Neurophysiology, and MORE! For additional information on ACNS and the benefits of membership, please visit the ACNS website: www.ACNS.org.
Medicare Physician Fee Schedule Changes for 2011
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by: Dr. Marc Nuwer
Relative Value (RVU) changes for Neurodiagnostic procedures were mixed for the calendar year 2011. The overall Conversion factor declined, which affected all codes for all fields. The combined effect of the RVU changes and Conversion factor changes on technical components improved moderately. In contrast, most professional fees were unchanged or declined. The improvements in most Neurodiagnostics were the result of AMA action by ACNS along with AAN and other societies. Specifically, your society lobbied AMA and the Center for Medicare and Medicaid Services (CMS) to audit the actual practice costs for physician’s practices. The societies believed that CMS was not crediting neurologists as having as high of practice costs as actually occurred in real practice. A neutral outside firm conducted the audit. Practice expenses were measured by reviewing the portions of practices’ income tax statements’ pertaining to practice costs. As was expected by ACNS and AAN, the actual costs of neurologists’ practices was higher than previously considered by CMS. Over the past year and the next several years, CMS is adjusting neurologists’ practice expenses upward. This applies most directly to services provided in office by neurologists such as EEG. Services provided most by other specialties, e.g. Sleep testing, was affected much less. Whereas neurologists’ practice expenses had been too low, some other specialties practice expenses had been too high. The latter specialties are seeing a drop in their services’ RVUs. A second effect also occurred. The Sleep Testing RVUs were reassessed. In the old way of assessing RVUs, each service was assessed as a single stand-alone test. More recently it came to CMS’s attention that polysomnography often was performed by one technologist for two patients. That was an economy of scale not accounted for in the previous RVU system. That was factored into the RVUs for Sleep Studies recently, resulting in a drop in RVUs for polysomnography. Technical Component
Professional Component
EEG
+ 26-28%
+ 0%
PSG
- 27-29%
- 4-6%
MSLT
+ 16%
- 33%
EPs
+ 17-26%
- 1-2%
Video-EEG
N/A
+0
EMG
+ 19- 24%
+0
NCV
+ 16
- 0-2%
At the same time, outpatient visits saw modest gains. Levels 4 and 5 new and established office patients increased by 2%.
ACNS Newsletter
ACNS 2012 Annual Meeting and Courses February 2-7, 2012 Marriott Rivercenter San Antonio, TX Program Co-Chairs: Cecil Hahn, M.D. & Francis Walker, M.D.
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Call for Proposals for Symposia, Clinical Workshops, and Other Didactic and Interactive Sessions Proposals are being sought for Symposia, Clinical Workshops and other didactic and interactive sessions for the 2012 American Clinical Neurophysiology Society (ACNS) Annual Meeting which will take place at the Marriott Rivercenter in San Antonio, Texas. This call for proposals is to enhance the opportunities for clinicians and investigators to introduce advanced scientific or clinical topics for those interested in the field of clinical neurophysiology. All details and submission forms are on the ACNS website: www.ACNS.org. Please note: Submission deadline is April 1, 2011.
2013 Annual Meeting and Courses February 5 - February 10, 2013 Miami Marriott Biscayne Bay Miami, Fl Watch the ACNS website for details: www.ACNS.org
American Clinical Neurophysiology Society One Regency Drive P.O. Box 30 Bloomfield, CT 06002 Phone: 860-243-3977 Fax: 860-286-0787 E-mail: ACNS@ssmgt.com Website: www.ACNS.org