2018 Annual Report by American Academy of Neurology

ANNUAL REPORT

Our Vision

Our Core Values

To be indispensable to our members.

Core values answer the question: “How do we want to act as we move toward achieving our vision?”

Our Mission To promote the highest quality patient-centered neurologic care and enhance member career satisfaction.

Our Goals • Demonstrate and assert the value of neurology to policymakers and other major stakeholders. • Expand the neurology workforce to meet future needs for patient care. • Ensure the health of the organization by enhancing member satisfaction, well-being, and engagement. • Provide resources to support the financial well-being of the practice of neurology. • Expand neuroscience training and research funding. • Educate and assist members in providing highvalue clinical care. • Strengthen advocacy on behalf of members and their patients.

Leadership We provide guidance and inspiration through education, information, policy development, and advocacy for our members and their patients.

Integrity We set and maintain the highest ethical and professional standards for ourselves, our staff, and our programs.

Professionalism We work with expertise, commitment, and diligence to provide high-quality neurologic care.

Commitment We are dedicated to upholding the integrity and mission of the American Academy of Neurology.

Diversity and Equality We commit to building and sustaining an inclusive organization that respects and values the diversity of our membership and the communities we serve, and promotes equality in professional advancement and compensation.

Respect We embrace the dignity and uniqueness of every human being and in all we do keep the interests of the patients first.

Compassion We are sensitive and empathetic to the needs of others.

LETTER FROM LEADERSHIP Would A.B. Baker, the AAN’s founder and first president, recognize what has become of the organization he launched in 1948 with 50 charter fellows and 326 active members? Would he be astounded that our membership has grown to 36,000 and includes not only neurologists and neuroscience professionals, but business managers and advanced practice providers as well? Could Doris McKinley, the Academy’s first executive secretary who worked from her small home and stored membership cards in a box in her oven, fathom leading a staff of 200 dedicated professionals who go the extra mile to ensure that our members benefit from the highest quality events, products, and services that enable them to succeed? How would Stanley Nelson, our first executive director who managed a staff of three in 1966, react to seeing it now takes scores of staff and member volunteers to deliver an innovative week-long Annual Meeting that attracts 14,000 attendees? As the AAN celebrated its 70th anniversary in 2018, it continued a path of strategic growth and broke records as we: • Demonstrated the value of the AAN by achieving several membership records: • 96-percent retention of US neurologist members • 91-percent retention of US neurologists early in their career (five years or fewer) • Record number of medical student members • Record number of advanced practice provider members • Record number of international members

• Achieved one of our largest regulatory advocacy wins by successfully lobbying to delay proposed cuts to the E/M codes—we hope you read our plea in the Washington Post! • Achieved record attendance at our Annual Meeting in Los Angeles and the Sports Concussion Conference in Indianapolis • Welcomed 70 percent of US neurologist members visiting the redesigned and personalized AAN.com • Redefined the look and feel of Continuum® with a bright, modern design and complementary website to appeal to its record 13,700 subscribers • Made it easier for members to digest the superlative content in Neurology® with a sleek new look, format, and digital experience • Secured actress Sharon Stone to grace the inaugural cover of Brain & Life® magazine for patients and caregivers and the new BrainandLife.org website • Published a fourth study on neurologist burnout through the Wellness Task Force • Expanded the Axon Registry® to nearly 1,150 members • Implemented task force recommendations to address health care disparities • Grew participation in the AAN’s 56 SynapseSM online communities to more than 20,000 members • Created a new learning management system to help members learn from anywhere in the world • Addressed the high costs of neurologic drugs through the Drug Pricing Task Force • Hosted more than 100 neurology department chairs at the first Neurology Chair Summit to discuss issues facing academic medicine

• Launched an academic year membership so Junior members can receive publications immediately in July • Applied 87 cents of every dollar to member benefits Only a handful of these efforts, like the Annual Meeting, the journal, and member recruitment, would have been on our predecessors’ radars. The Academy evolves and grows as your needs change. What remains constant is the AAN’s desire to be an invaluable part of your professional life, your personal success, and your expert care for your patients. We hope you enjoy reading about our many accomplishments in 2018, and that we see you at the 2019 Annual Meeting in Philadelphia!

Ralph L. Sacco, MD, MS, FAHA, FAAN President

Catherine M. Rydell, CAE Executive Director/CEO

TOOLS & RESOURCES Practicing Neurologists & Administrators Axon Registry In 2018, the AAN’s Axon Registry completed a firstof-its-kind database validation effort. The results confirmed the ability to extract data directly from the electronic medical records and identified opportunities to improve the precision of the registry. In addition, the Axon Registry continued to grow. By the end of the year, participation included 234 practices and more than 1,477,000 patients representing over 4,763,000 patient visits. The Centers for Medicare & Medicaid Services (CMS) continued to approve the Axon Registry as a qualified clinical data registry (QCDR). This designation opens the door for AAN members looking for an easy way to submit quality data to CMS for the Meritbased Incentive Payment System (MIPS). The Axon Registry also is approved by the American Board of Psychiatry and Neurology (ABPN) as a maintenance of certification Part IV Improvement in Medical Practice Clinical Module activity and participation in Axon Registry waives eight hours of Self-assessment in a three-year CMOC block. These changes make our registry an even greater benefit to our US members. The Axon Registry now has over 50 neurology-relevant quality measures, including several patient-reported outcome measures. The Registry Committee works

234 practices 1,477,000 patients 4,763,000 patient visits

in collaboration with the AAN’s Quality and Safety Subcommittee to integrate the measures into the Axon Registry.

MACRA/QPP/MIPS For three years, the AAN has been advocating on behalf of its members regarding the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA) and informing members about changes in how clinicians are reimbursed through the Quality Payment Program (QPP). This program rewards the delivery of highquality patient care through Advanced Alternative Payment Models (Advanced APMs) and the Meritbased Incentive Payment System (MIPS). The changes issued by the CMS for the 2019 QPP reflected a great deal of AAN input. The AAN lobbied successfully for CMS to change the time requirements for reporting of MIPS measures. Due to this change, in 2019 and 2020, neurologists will now only be required to report 90 days of activity for all but the quality components of MIPS. The Academy also successfully advocated for the continuation of reduced reporting requirements and an increased bonus for small and solo practices. CMS is reducing burden on neurologists by excluding Medicare Part B drug costs from MIPS payment adjustments and will only apply payment adjustments to covered professional services. Additionally, CMS recognized the value delivered by clinicians caring for complex patients and continued the complex patient bonus. The AAN continues to provide resources to help neurology practices be successful in MIPS.

Quality Measures The AAN is the leader in developing quality measures for neurology. In 2018, the AAN released three new quality measurement sets to improve the care of patients with epilepsy, neuro-otology, and neurooncology. The AAN released quality improvement toolkits to add in implementation of falls and epilepsy measures. The AAN also reaffirmed the dementia management measurement set.

Payer Relations The AAN continued to advocate with commercial payers for appropriate coverage of neurologic therapies. This resulted in successes such as two major commercial payers expanding coverage of IONM procedures in response to AAN activity and select local carriers amending policies to improve coverage of migraine therapies. The Academy also continued to work with payers to decrease the burden on providers, participating in discussions on utilization management techniques and submitting comments to major carriers with suggestions for improvements.

Practice Management Webinars The AAN enhanced its practice management webinars by offering more presenters in a panel format, making them more conversational and engaging. This resulted in higher registration and more positive evaluations from members. The AAN produced 11 webinars in 2018, including a free webinar to prepare members for changes to E/M coding and QPP changes outlined in the 2019 Medicare Physician Fee Schedule rule released by CMS.

Academic Neurologists and Researchers Neurology Department Chair Summit

Academic Medicine Initiative

Academic neurology departments, like many other constituents of the AAN, are facing many challenges today to support the under-funded missions of clinical care, education, and research. As the birthplace for many neurologists, neurology departments are the place where students get their first exposure in the field, residents begin their training, fellows differentiate into subspecialties, and faculty careers develop. Given the challenges facing neurologists, including the ever-changing health care reforms, research funding cuts, neurology work force issues, graduate medical education funding cuts, reduced reimbursement for services, and increasing regulatory burden, the AAN felt the time was right to come together to discuss the state of neurology and academic medicine. For these reasons, the AAN hosted the first-ever Neurology Department Chair Summit in 2018. The goals of this summit were to identify the current gaps, share best practices, and create a roadmap for moving forward. Attendees included more than 100 neurology department chairs from across the country. The AAN is continuing to work to implement the outcome of the 2018 summit and making plans for a summit, including business managers, to be offered in 2019.

Neurology academic departments deliver clinical care to neurology patients, lead transformative cutting-edge research, and train the leaders of tomorrow in both neurology and neuroscience. The vision of this initiative is to be indispensable to academic neurologists by supporting them across their professional lifetimes. The AAN has long been the home for both the academic neurologists and practicing neurologists, and it will continue to be. However, the AAN has primarily focused on medical students, residents, program directors, clerkship directors, and fellowship directors within neurology academic departments rather than taking a holistic approach to identify and address the needs of all constituents with the academic neurology department. The AAN continued its work on this initiative in 2018 and the primary goals of the AAN neurology academic department initiative include: 1. Identify and understand the needs and gaps within neurology academic departments 2. Provide outstanding and innovative programs, tools, and resources for all constituents within neurology academic departments 3. Ensure the AAN is indispensable to all levels of neurology academic departments 4. Achieve a diversified and sustainable portfolio of offerings for neurology academic departments

Advanced Practice Providers and Care Team

During 2018, groups across the AAN continued to develop education and resources for advanced practice registered nurses and physician assistants in neurology. The Advanced Practice Provider (APP) Work Group developed an online toolkit of resources, including handouts for patients, examples of care models, billing and coding considerations, and onboarding recommendations. The Consortium of Neurology APPs continues to grow its presence on its Synapse online community, as AAN leadership works to appoint APPs to AAN committees. The Education APP Work Group surveyed APP members to better understand their educational needs and plans on sharing this data in the future.

Residents & Fellows

Medical Students

The AAN continues to grow and evolve its programs and resources to help augment the neurology residents’ education and experience during neurology residency.

Medical Student Pipeline Initiatives

Residency In-service Training Examination In 2018, the AAN, through the leadership of its Residency In-service Training Panel, Graduate Education Subcommittee, and Education Committee, made the decision to transition the Residency Inservice Training Examination (RITE) from a paper/ pencil-based examination to an online examination. Although the full implementation will take effect with the 2019 RITE being offered online, the 2018 year marked a year of strategic planning and preparation for onboarding to the new format.

Regional Conference Scholarships for Residents The AAN added Regional Conference Scholarships for Residents to its residents’ portfolio of offerings. The 2018 scholarships allowed 10 recipients to attend the 2018 Fall Conference in Las Vegas, NV, and attend a variety of programs including Plenary Sessions, Neurology Updates Program, Practice Management Programs, and Leadership Programs as well as the opportunity to connect with AAN leaders and network with colleagues across the neurology field.

Chief Resident Synapse Community A new Synapse Online Community was created for the chief resident community to enable members to discuss topics relevant to neurology training, residency, and serving in the role as chief.

With support from the Conrad N. Hilton Foundation three-year grant awarded in 2016 and matching AAN funds, the Academy tackled a number of exciting medical student initiatives this year including:

DATA COLLECTION The AAN completed its data collection—both quantitative and qualitative—to understand why medical students do or do not choose neurology. The data is informing the deliverables and also is being used for manuscript purposes. The second manuscript—based on the qualitative data—started development.

Student Interest Group in Neurology (SIGN) 2018 marked the 20th anniversary for the Student Interest Group in Neurology (SIGN). Although SIGN has progressed and expanded over its 20 years, it was time to give it a strategic overhaul given the AAN’s commitment to attracting more medical students into neurology. SIGN was revamped to further engage chapters in the exploration of the field of neurology and participation in the AAN. The new framework includes a core content lecture series, featured SIGN chapters, new funding structure, new logo and assets, updated webpage on AAN.com, and updated registration/tracking requirements.

MEDICAL STUDENT SYMPOSIUM The AAN hosted the first Medical Student Symposium at the 2018 AAN Annual Meeting in Los Angeles, CA. This half-day program provided information to medical students about neurology as a career choice. Specifically, the symposium exposed them to the diverse neurologic subspecialties, broad spectrum of career pathways, and the many new therapeutic advances in the field.

MEDICAL STUDENT EXPERIENCE AT THE ANNUAL MEETING SCHOLARSHIP The AAN provided 45 Medical Student Experience scholarships at the Annual Meeting for the first time in 2018. These scholarships afforded first- and second-year medical students the opportunity to attend the 2018 Annual Meeting and learn more about the field of neurology by attending tailored medical student programming, education courses, scientific presentations, and networking opportunities.

Medical Student Annual Meeting Scholarships The AAN expanded the number of Medical Student Annual Meeting Scholarships from 40 to 60 in 2018. This support is designed to help stimulate students’ interest in pursuing the field of neurology by offering them the opportunity to attend the Annual Meeting. The recipients attended a variety of education and scientific programming, met leaders in neurology, and

networked with other medical students, residents, and neurologists. Preference for the scholarships is given to SIGN chapter presidents or a designated SIGN representative.

Medical Student Synapse Online Community The Medical Student Member Group currently has 4,704 members, an increase of nearly 200 from 2017. This online venue provides students a forum for sharing topics of interest and learning about opportunities offered by the AAN and has been actively discussing the recent SIGN revamp.

4,704 Visiting Medical Student Scholarship In an effort to address the pipeline shortage, the Undergraduate Education Subcommittee in consort with the Education Committee continues to develop appropriate resources for medical students. This scholarship is intended to attract high-quality medical students enrolled in an MD or DO program to US MD or DO training programs. This exposure is designed to make neurology a more attractive career option. Recipients are provided the opportunity to augment their education and training by participating in a

visiting student program to network with neurologists. The intent is to support any away rotation within the field of neurology, including consultation and outpatient electives. For 2018, 48 applications were received and 20 scholarships were awarded.

Medical Student Diversity Program The Medical Student Diversity Program provides opportunity and access to neurology to students from traditionally underrepresented groups in medicine, including African American/Black, American Indian, Native Hawaiian, Alaska Native, and Hispanic/Latino. This program is overseen by the Medical Student Diversity Subcommittee and reports to the Leadership Development Committee. There are three components of the program.

MEDICAL STUDENT DIVERSITY SCHOLARSHIP This scholarship provides 10 medical students the opportunity to attend educational and scientific programming at the AAN Annual Meeting and network with neurologists and neuroscientists. A total of 35 applications were received for 2018 compared to 22 in 2017. The 2019 program will be enhanced to incorporate specific leadership elements.

VISITING MEDICAL STUDENT DIVERSITY SCHOLARSHIP Designed for third- or fourth-year AAN member medical students, this scholarship enables them to participate in a visiting student program to network with neurologists and neuroscientists. The intent is to support any away rotation within the field of neurology, including consultation and outpatient electives. Nine applications were received, only eight were eligible candidates. Rotations took place between August and December 2018.

VISITING PROFESSOR DIVERSITY PROGRAM The objective of this program is to attract high-quality medical students from underrepresented racial and ethnic backgrounds to US neurology residency programs and make neurology a more attractive career option. A neurology professor is selected to visit an interested underrepresented medical school for two days. The visiting professor will give neurology Grand Rounds and observe neurology patient rounds and clinic, as well as provide an additional lecture to medical students and lead a discussion regarding careers in neurology and the neurosciences.

medical student scholarships

for the 2018 AAN Annual Meeting 7

EDUCATION & RESEARCH Education Education Research Program

ABPN and MOC

Neuro Products

The AAN Education Research Work Group provides grants and fellowships to improve the quality of educational programs for all neuroscience professionals by promoting career development. In 2018, the Education Research Program awarded three Education Research Grants and one Medical Education Research Training Fellowship totaling $91,600. The purpose of these opportunities is to promote education research.

The AAN continued its commitment to monitoring the maintenance of certification (MOC) landscape and advocating for flexibility regarding the MOC requirements set by the American Board of Psychiatry and Neurology (ABPN). In addition to its ongoing advocacy, the AAN continues to provide members with a free suite of online learning products to help them understand and prepare for MOC. The Academy is pleased that the ABPN approved the Axon Registry to meet both non-CME selfassessment as well as practice improvement clinical requirements.

NeuroSAE®: Four new editions of NeuroSAE debuted this year: NeuroSAE® Medical Student Third Edition, NeuroSAE® Eleventh Edition, NeuroSAE® Annual Meeting Edition (free with Annual Meeting registration), as well as the NeuroSAE® Vascular Third Edition. All NeuroSAE exams are accessible through the Online Learning Center. NeuroLearnSM: Three new courses were developed and produced in 2018: Psychiatric Comorbidities Associated with Migraine; Introduction to Teleneurology; Interpretation of the Normal Adult EEG: Normal Patterns and Common Artifacts (Second Edition). All NeuroLearn courses are accessible through the Online Learning Center and are offered free to AAN members. NeuroPISM: Thirteen modules are currently available. All NeuroPI modules are offered free to AAN members.

$91,000 awarded in research grants and training fellowships

To further the goal of providing mentorship to education researchers, the work group coordinated two sessions in the Research Experiential Learning Area at the 2018 Annual Meeting in Los Angeles. These opportunities were marketed to all recent AAN Education Research Grant and fellowship applicants in addition to the general Annual Meeting attendees via the Annual Meeting app. The Research Corner offered two formats for the sessions including a presentation stage and a room for small group “Office Hour” sessions.

Customized Education The new Online Learning Center launched in spring 2018 and currently hosts six Academy online learning programs. Future enhancements will focus on ways to personalize and tailor content to users through the system. The eLearning Subcommittee continued to explore the option of transitioning additional programs to the Online Learning Center and focused on new program development with microlearning opportunities for members.

ONLINE LEARNING CENTER

NeuroTracker NeuroTracker, an AAN member-only benefit, continues to be the AAN’s one-stop shop for tracking members’ CME, self-assessment, and performance in practice. This tool is extremely helpful to members when needing to provide documentation to various regulatory bodies including state licensing boards, ABPN, academic institutions, practices, etc. NeuroTracker also helps members in updating their CVs by providing information on the various AAN activities for which they have been involved. There were a variety of additional enhancements in 2018 to help members in providing their information to the ABPN, viewing screens, report generation, and links to helpful AAN resources.

Research Annual Meeting Research A total of 3,063 abstracts were accepted for presentation at the AAN Annual Meeting in Los Angeles. The Research Corner Experiential Learning Area continued to be a vibrant area for meeting attendees to learn about AAN efforts in supporting research and attend select scientific platform sessions. For the first time, plenary session content was sourced through attendees, as two Controversies in Neurology Plenary Session debate topics were selected from member feedback. The use of audience response technology was expanded to multiple plenary sessions to enhance audience interaction. The poster hall was further refined to incorporate an Overflow Viewing Area with a giant LED screen within the 2014 neighborhoods. 2,818 poster

Abstracts 2015 2,678accepted the last 3 years 2016 2,783 2017 2,756 2018 3,063

partnerships has grown every year, up from 13 in 2018 and 10 in 2017. In addition, the AAN continues the Career Development Award, Clinical Research Training Scholarship, Practice Research Training Scholarships, and Neuroscience Research Training Scholarships. After finishing their AAN grant, most recipients receive additional major funding and bring hope to the future of research.

Research program applications

2016 139 2017 151 2018 166 Neuroscience Is… Neuroscience Is…™ is a sweeping initiative of the AAN to build public awareness and demonstrate the importance of neuroscience research in care of neurology patients and cures for brain diseases. Four physician work groups direct the initiative, which demonstrates how Neuroscience Is….

AAN Research and Awards The AAN applauds the 2019 Research Program recipients who were determined in 2018. There were a record-breaking number of 166 applications for the 2019 program, well above the 151 applications for 2018 and 139 applications for 2017. With the help of the American Brain Foundation, 15 voluntary health associations and industry partners are represented in the 2019 funding portfolio. The number of

• Cool: The AAN used 2018 to develop cost-free “neuroscience lessons in a box” called the Neuroscience Is… coolkits. Each coolkit contains a complete lesson plan and all the required tools tying the core components of the neurologic exam back to basic brain anatomy and neuroscience. The lesson plans are appropriate for students

ranging from kindergarten through sixth grade. The coolkits will be available to teachers via a needs/interests-based application. The AAN hosts a web clearinghouse of neuroscience lesson plans for all ages, as well as other free neuroscience resources (storybooks, brain models, posters) for classrooms that demonstrate a need. Further, the AAN’s Brain Health Fair and social media outreach are used to engage young people in their curiosity of neuroscience. • Rewarding: The AAN is focused on creating the next generation of neuroscientists with the Neuroscience Is… Rewarding College Internship. This opportunity pairs an AAN member with an undergraduate level college student in a skillsbased internship that includes both a clinical and research component in neurology. The first class of interns completed their internships in December and we look forward to sharing their successes with you. The AAN engaged first- and second-year medical students by using innovative social media events to celebrate the second annual “Neuroscience Is… Rewarding Day” to grow its SIGN chapters and strengthen the pipeline of medical students choosing neurology and neuroscience as a career. The day was held on November 30 in celebration of Dr. Wilhelm Erb, the neurologist who popularized the use of the reflex hammer. • Essential: The AAN strives to use the most effective methods to explain the importance of research to patients with neurologic disease through various forms of public outreach, including education for patients and providers

alike regarding the value of engaging in clinical trials and community-based research when appropriate. Further, the AAN continues to inspire our members with interesting stories of research discoveries, some with discoveries occurring hundreds to thousands of years ago, which have resulted in modern practices, therapies, and cures in neurology today. The AAN’s 2018 Neuro Film Festival received 36 videos from patients and caregivers who shared their story on why they think neuroscience is essential. • Critical: The AAN continues to link stories of success in patient care to the importance of research funding, creating education materials in 2017 and 2018 that tied basic science research at the National Institutes of Health (NIH) to positive outcomes in neurologic disease management through the personal stories of patients. These materials were used in visits with neurology advocates and lawmakers to support strong federal research funding.

Diversity in Research The AAN has partnered with the University of California San Francisco (UCSF) and the National Institute of Neurological Disorders and Stroke (NINDS) to implement a diversity in research grant named TRANSCENDS (Training in Research for Academic Neurologists to Sustain Careers and Enhance the Number of Diverse Scholars). The grant is for a five-year period and provides research training, AAN membership opportunities, and professional development to early-career academic neurologists from underrepresented racial and ethnic groups in the field of neurology, or with disabilities. Up to six individuals per year are selected for the grant, and six scholars each were selected in 2017 and 2018. The

Cohort 1 Scholars recently completed their Master of Science in Clinical Research program, and the Cohort 2 scholars are halfway through their Master’s program. Each scholar also is pursuing individual clinical research, and each receives coaching on the development of their K Award applications and personal mentoring from AAN leadership. The 2019 class (Cohort 3) of TRANSCENDS Scholars was selected in November 2018 and will be formally welcomed and oriented to the program at the 2019 Annual Meeting.

Rapid Response Teams The AAN is committed to supporting careers in research by staying in touch with everyday issues that may affect your career. To that end, four Rapid Response Teams comprised of your colleagues have been established to prioritize issues of research in the media (Media Rapid Response Team); the protection of the use of animals in research and public communication strategies regarding animals in research (Animal Rapid Response Team); addressing regulatory concerns regarding research (Regulatory Rapid Response Team); and most recently, a team appointed to quickly provide organizational letters of support to our researchers applying for grants (Grant Rapid Response Team). These teams are dedicated to providing fast and comprehensive clarity, positions, and support to our members regarding topics in research. Notably, the Grant Rapid Response Team approved a dozen organizational letters of support to AAN members applying for PCORI and other federal grants in 2018.

Growing the Next Generation of Neurology Researchers The Academy is proud to support robust and tailored programming that encourages medical students, residents, and junior fellows to attend research training opportunities at the AAN Annual Meeting: • Young Investigator Programming: In 2018, the AAN piloted this popular program to residents and medical students with scholarships to attend the Annual Meeting, a symposium that featured “speed dating” mentoring concepts in specific topics in research, and a three-day track of training and courses focused in growing a research career. • Futures in Research Programming: The Academy was pleased to offer this perennial favorite in 2018 to medical students, residents, and junior fellows with travel reimbursement scholarships to the Annual Meeting, a six-day track of training and courses focused on growing a research career, subspecialty research mentoring sessions, and the Futures in Research Luncheon, which allows trainees to network with leadership from the NINDS and AAN Research Programs, and offers face-to-face mentoring with career researchers.

Publications Neurology®

Neurology® Clinical Practice

Neurology.org/N

Neurology® Clinical Practice

Neurology® 1–47

The year 2018 saw short versions of all research articles published in print, with expanded articles online on the newly redesigned website. Submissions grew to 5,350 in 2017 with an increase to 5,500 expected in 2018; Resident & Fellow submissions increased to 665. The journal collaborated with the Center for Biomedical Research Transparency to plan a special Neurology Null Hypothesis issue early in 2019, integrated reporting of peer reviewers to acknowledge their efforts in Publons, expanded authorship criteria, and created a policy for consideration of articles published on preprint servers. Neurology Podcasts awarded more than 17,500 CME credits since inception of the podcasts through summer of 2018. International editions of the publication include those in Argentina, Japan, and India. Volume 90, Number 1, January 2, 2018

The most widely read and highly cited peer-reviewed neurology journal

Neurology.org/CP

A peer-reviewed clinical neurology journal for the practicing neurologist

Volume 8, Number 2, April 2018

Volume 90, Number 1, January 2, 2018

COMMENTARY

Diet quality is associated with disability and symptom severity in multiple sclerosis 18

Achieving high value care for all and the perverse incentives of 340B price agreements 148

ARTICLE

Increased midlife triglycerides predict brain β-amyloid and tau pathology 20 years later 26 ARTICLE

Apathy is associated with incident dementia in community-dwelling older people 27

17,500

An Oﬃcial Journal of the American Academy of Neurology

The Oﬃcial Journal of the American Academy of Neurology

ARTICLE

Sex disparities in access to caregiving in Parkinson disease 23

The full texts of all papers except those less than a year old are now available in PubMed. The latest completed Practice Current survey featuring a hot topic for all practicing neurologists worldwide garnered 1,163 survey respondents from 96 countries.

Volume 8, Number 2, April 2018

RESEARCH

Neurologist–patient communication about epilepsy in the United States, Spain, and Germany 93 RESEARCH

Apathy and functional disability in behavioral variant frontotemporal dementia 120 REVIEW

Multiple sclerosis management and reproductive changes 142

Neurology® Neuroimmunology and Neuroinflammation This free open access journal continued to publish new papers, which are searchable in PubMed. The journal has been approved to receive its first impact factor in 2019. A new journal section, Diagnostic & Treatment Challenges, was added for publishing papers from educational conferences. Volume 5, Number 1, January 2018

Neurology.org/NN

A peer-reviewed neurology open access journal

ARTICLE

Immune response to vaccines is maintained in patients treated with dimethyl fumarate e409 ARTICLE

Decreased occipital lobe metabolism by FDG-PET/CT: An anti-NMDA receptor encephalitis biomarker e413

ARTICLE

Phenotypic and functional complexity of brain-infiltrating T Cells in Rasmussen encephalitis e419

ARTICLE

Progressive inner nuclear layer dysfunction in non-optic neuritis eyes in multiple sclerosis e427

Neurology Genetics ®

Volume 4, Number 1, February 2018

Neurology.org/NG

A peer-reviewed clinical and translational neurology open access journal

ARTICLE

Biallelic CHP1 mutation causes human autosomal recessive ataxia by impairing NHE1 function e209 ARTICLE

Familial monophasic acute transverse myelitis due to pathogenic variant in VPS37A e213 ARTICLE

Alzheimer risk loci and associated neuropathology in a population-based study (Vantaa 85+) e211 ARTICLE

CYP2C19 variant mitigates Alzheimer disease pathophysiology in vivo & postmortem e216

This open access journal, free to everyone, continued to publish new papers, which are searchable in PubMed. For the second year, the journal published the abstracts for the Proceedings of the International Stroke Genetics Consortium Workshops.

Continuum® Continuum, which now includes Continuum® Audio, received a complete facelift in 2018 with a new design in both print and online. Continuum’s circulation grew to 13,665—an increase of 7.8 percent over 2017. The publication’s presence on social media grew to 5,862 followers. Continuum LIFELONG LEARNING IN NEUROLOGY®

FEBRUARY 2018

VOL. 24

NO. 1

Child Neurology

EDITOR-IN-CHIEF: STEVEN L. LEWIS, MD, FA AN GUEST EDITORS: JAMES W. M. OWENS JR, MD, PHD; SHAFALI JESTE, MD

CONTINUUMJOURNAL.COM

CME credits

circulation grew to

13,665

% 7.8 increase

over 2017 11

Neurology Today®

Brain & Life®

AANnews®

Neurology Today implemented several new editorial features, including Off the Clock, Explaining the Science, and By the Numbers, as well as an information box on the inside front cover to improve reader experience. Website changes were also implemented, including refining the homepage to better feature current content and trending articles and streamlining content collections. Website visits increased 35 percent over 2017. Neurology Today won a Clarion Award in the category Newspaper Feature Series for a series of six articles on physician burnout. Scientific meeting highlights from the AAN’s Annual Meeting and eight additional subspecialty meetings were covered by the e-news service Conference Reporter.

The AAN’s award-winning patient and caregiver magazine, Neurology Now, was renamed and redesigned in 2018. Now Brain & Life, the publication has a refreshed consumer-friendly look and a new website, BrainandLife.org, that centralizes all AAN patient education content in one location. A Spanish version, Brain & Life® en Español, began publishing quarterly in April 2018. Brain & Life won a Clarion Award in the category Magazine Feature Article, External Publication— Circulation between 100,000 and 500,000—Lifestyle for the article “Parkinson’s on the Ropes.”

The official monthly member magazine of the Academy, AANnews is mailed to 29,000+ US members and is posted online in the “About the AAN” area of AAN.com for international and US members to easily access. Along with keeping members up-to-date on Academy events and resources in 2018, the magazine celebrated the Academy’s 70th anniversary with interviews of former AAN presidents, explained continuing changes in the Quality Payment Program, and shared the success stories of neurology advocates and AAN Leadership Program graduates.

JANUARY 11, 2018 | VOLUME 18 | ISSUE 1

Neurology Today

THE OFFICIAL NEWS SOURCE OF THE AMERICAN ACADEMY OF NEUROLOGY

NeuroTodayOnline.com

Eculizumab Found Safe and Effective for Myasthenia Gravis

1/11/18

BY J A M I E TA L A N

BY K U RT S A M S O N

Tasman W, et al. Wills Eye Hospital Atlas of Clinical Ophthalmology, LWW 2001.

PRACTICE MATTERS: Delay on Medicare Acceptable Use for Diagnostic Imaging . . . . 8

istockphoto

AMONG MyASTHENIA GRAVIS

MULTIPLE SCLEROSIS: The study that closes the book on use of venous angioplasty . . . . . . 21

Look for more highlights from the issue on page 6.

PUblIsheD by:

symptoms is slight right ptosis on initial upward gaze.

culizumab, a drug that blocks the complement cascade, is safe and effective in reducing symptoms in patients with generalized myasthenia gravis (gMG) who have not responded to the standard treatments used in the autoimmune disease, according to the results of a clinical trial published in December in Lancet Neurology. In October, the U.S. Food and Drug Administration (FDA) approved eculizumab (Soliris), even though the primary endpoint in the phase 3 study narrowly missed statistical significance. About 10 to 15 percent of patients with gMG continue to have severe disabling muscle weakness and repeated hospitalizations despite multiple therapies. Sometimes, the side effects from these medicines are just too daunting

to continue taking them, said the lead author of the new study, said James F. Howard, Jr, MD, professor of neurology, medicine and allied health and chief of the neuromuscular disorders section at the University of North Carolina School of Medicine. “This is a breakthrough treatment,” Dr. Howard said. “There is no question that the drug works in many of the refractory patients in the phase 3 study.” Still, he said, 30 to 40 percent of the patients on the drug did not seem to have a significant benefit, and the researchers are still trying to figure out why. For now, eculizumab can be prescribed when other medications used to treat gMG have failed or patients are dependent on chronic plasma exchange or IV immunoglobulin G (IVIG), he said. For more on the drug’s development, see “The Back Story of Eculizumab: A New Treatment Strategy.”

STUDy METHODOLOGy, FINDINGS The REGAIN (Safety and Efficacy of Eculizumab in Refractory Generalized Myasthenia Gravis) study recruited 125 patients with refractory gMG at almost 80 centers throughout the world. Patients had to test positive for

HOw wOULD yOU SUMMARIZE THE NEw GUIDELINE? In general, it maintains the recommendations from the 2001 AAN practice guideline. However, we now have much better evidence to support the earlier conclusions. Continued on page 19

Continued on page 27

nly days after the US Food and Drug Administration approved a new vaccine, Shingrix, for herpes zoster in October, the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) narrowly voted to recommend its use over an older vaccine (Zostavax) approved in 2006 for people aged 60 and older. In an eight-to-seven vote, the ACIP recommended that adults aged 50 and older receive Shingrix to prevent shingles and related complications, and that those who have received the Zostavax vaccine should receive the new vaccine as well.

LWW_NTY_January 11_18_Layout.indd 1

lmost two decades of research on mild cognitive impairment (MCI) diagnosis and treatment reinforces rather than replaces recommendations made by the AAN in 2001, but with much better evidence. The new AAN practice guideline describes the current state of MCI research and makes recommendations on how clinicians should integrate the findings into practice. The full text is available in the December 27 online issue of Neurology. We asked Oscar L. Lopez, MD, FAAN, professor of neurology and director of the University of Pittsburgh Alzheimer’s Disease Research Center, who helped draft the guideline, to discuss what has been learned since 2001.

Why a New Vaccine for Preventing Shingles Received FDA Approval and a CDC Recommendation BY E V E B E N D E R

PERIODICALS

NEw AAN GUIDELINE: CLINICAL TAKEAwAyS ON MCI

Continued on page 25

istockphoto

INSIdE

CREUTZFELD-JAKOB DISEASE: Infectivity in skin cells . . . . . . . . . 7

SOME ACIP members expressed

concerns about whether serious events could occur on a larger scale among people receiving Shingrix.

21/12/17 12:25 AM

A P R I L/M AY 2 0 1 8

Exercise Find the Right Type and Amount for Your Condition Nerve Pain Smart Ways to Manage Neuropathy

After My Stroke In 2001, I Feel So Blessed and I’ve Learned So Much.”

Rebound Headaches How to Break the Cycle

— AC T R E S S S H A R O N S TO N E

Neurology Now® Books Navigating Life with Migraine and Other Headaches by William B. Young, MD, FAHS, FAAN, and Stephen D. Silberstein, MD, FACP, FAHS, FAAN, was the latest volume to publish in the Neurology Now® Books patient and caregiver series. This book focuses on the myths that exist around headaches and dispels common misperceptions on how headaches occur and how to treat them.

VOLUME 32 · ISSUE 1 · JanUary 2018

PLAN YOUR ANNUAL MEETING EXPERIENCE

New Mobile App

Annual Meeting Deadlines

Download the new aan Conferences Mobile app at AAN.com/view/MobileApp to put all the information you need to make the most of your 2018 annual Meeting experience conveniently on your iPhone, iPad, or android.

Hotel Deadline: March 2 Early registration Savings Deadline: March 29

Visit AAN.com/view/AM18 today!

Browse program details, speakers, and social/networking events access program slides and syllabi Search scientific abstracts Create an itinerary and customize your schedule View room locations and hotel map Submit your program evaluations to earn CME Explore the Los angeles City Guide

The aan Conference Mobile app is sponsored by Sunovion Pharmaceuticals Inc. 

AANConferences

AAN SCORES VICTORIES IN FINAL MEDICARE PHYSICIAN FEE SCHEDULE

2018 PRACTICE MANAGEMENT WEBINAR SERIES KICKS OFF ON JANUARY 23

Each year, the Centers for Medicare & Medicaid Services (CMS) issues regulations that impact how physicians are paid. On november 2, 2017, CMS issued its final rule updating payment policies and rates for physicians paid under the Medicare Physician Fee Schedule (MPFS) in 2018. Last august, the aan submitted comments to the agency advocating on behalf of our members

Continued on page 12

Through Their Eyes: recollections of Past aan Presidents

›

The aan’s series of practice management webinars for 2018 begins this month with helpful tips and insights for neurologists in small and solo practice.

No Small Feat: Personally and Professionally Succeeding in Small and Solo Practice January 23, 2018 12:00 p.m.–1:00 p.m. ET

Deadline to register: January 22 Faculty: Teryn Clarke, MD, and Gurdesh Bedi, MD

MIPS reporting: Out with the Old year, in with the new

Continued on page 15

16 Take your Career to the

next Level with Leadership University Offerings

›

POLICY & GUIDELINES Public Policy Medicare Physician Fee Schedule

Following a CMS proposal to collapse payments for levels 2-5 office evaluation and management (E/M) visits in July, the AAN sprang into action, mounting one of its biggest campaigns against the devastating cuts. The AAN rallied its members, engaged with medical societies and patient advocacy groups, and leveraged its strong congressional relationships to fight the misguided proposals. The results of these efforts were reflected in the Medicare Final Fee Schedule, published in November, which retained level 5 E/M, delayed changes to levels 2-4 until 2021, and offered immediate relief of administrative burden. The AAN was recognized as a national leader in multiple media outlets. The AAN will work to develop a modified E/M structure that meets the needs of patients and neurologists.

2018 Legislative Wins The AAN had a strong year advancing its legislative priorities in Washington, DC. Some accomplishments include: • Furthering Access to Stroke Telemedicine (FAST) Act: Due in large part to AAN’s substantial advocacy efforts, along with the American Stroke Association, Congress passed the FAST Act in February as part of the Bipartisan Budget Act of 2018. This new law expands Medicare access to telestroke starting in 2019. Under this legislation, Medicare will soon reimburse for telestroke consultations regardless of the location of the hospital where the patient presents with stroke symptoms. • Bipartisan Budget Act of 2018: In addition to the FAST Act, other AAN priorities were included: • Elimination of the Independent Payment Advisory Board (IPAB), a provision of the Affordable Care Act that threatened physician Medicare payments • Extension of the Children’s Health Insurance Plan (CHIP) through 2028 • Permanent repeal of Medicare therapy caps for rehabilitation services • $6 billion over two years to combat the opioid crisis • Allowing Medicare Advantage plans to include additional telehealth services in their bids, and giving certain ACOs more flexibility to provide telehealth services

• Changes to MACRA to increase the flexibility of the MIPS Cost component and excluding Part B drug reimbursement from MIPS payment adjustment • NIH and BRAIN Initiative Funding: All the AAN’s research priorities were included in the FY2018 appropriations, including the biggest increase for the NIH in 15 years, bringing total funding to over $37 billion. Additionally, the final package included $140 million in new funding for the BRAIN Initiative (bringing total funding up 53.9 percent to $400 million), $414 million increase for Alzheimer’s disease research, and $500 million for NIH research on opioid addiction and new nonaddictive pain therapies.

$414 increase

million Alzheimer’s Disease research

$500 million

Opioid addiction

BILLION

$400 BRAIN

million Initiative

53.9% increase

NIH Funding

and new non-addiction pain therapies

• Administrative Burden: Another AAN priority to streamline the electronic prior authorization process in Medicare Advantage and Medicare Part D plans will also become law due to the Academy’s strong advocacy in support of simplification.

Guidelines • Drug Pricing: New laws supported by the AAN will end the prohibition on pharmacists from telling patients if paying in cash is cheaper than using their insurance benefit.

recess, where 70 AAN members participated in 53 local events including clinic tours, district meetings, and fundraisers. Follow #AANAdvocacy to see AAN members in action on the Hill and back home.

Neurology on the Hill

BrainPAC

Once more, “Academy green” was the signature color in Washington, DC, on February 27, as the AAN’s 16th annual Neurology on the Hill had 211 AAN members from 49 states meeting their members of Congress, generating a record 3 million social media impressions on Twitter using #NOH18. Advocates visited 298 congressional offices to educate senators and representatives on three crucial priority issues including increasing funding for the NIH, reforming drug pricing, and reducing regulatory hassles.

The American Academy of Neurology’s federal political action committee, BrainPAC, gives the AAN an essential tool to represent US neurologists and their patients on critical issues such as health care reform. BrainPAC is the only political action committee that specifically supports advocacy for neurology. The AAN competes with many special interest groups both inside and outside the medical community to ensure neurologists and their patients are at the table when federal health care policy is debated. BrainPAC helps the AAN increase the influence and profile of neurology on Capitol Hill and on the campaign trail. BrainPAC supported over 150 congressional candidates in the 2018 election cycle, most of them currently members of Congress. BrainPAC is funded solely by AAN members who are US citizens or permanent residents, and in the 2018 election cycle raised more than $800,000 in contributions from over 1,600 AAN members.

211 49

member attendees from states

Neurology on the Hill Congressional Visits More AAN members are meeting with members of Congress in both Washington, DC, and back in their own local congressional districts. This effort was followed by Neurology off the Hill over the August

800,000 in

more $ than

donations from over

1,600

AAN members

The Academy published eight evidence-based products in 2018. This includes a new product that summarizes the evidence for newer therapies and treatments (Evidence in Focus), three systematic reviews, and four guidelines. • Evidence in Focus: Nusinersen Use in Spinal Muscular Atrophy • Practice Guideline Update Recommendations Summary: Disorders of Consciousness • Practice Guideline Update Systematic Review Summary: Disorders of Consciousness • Practice Guideline Update Summary: Efficacy and Tolerability of the New Antiepileptic Drugs I: Treatment of New-onset Epilepsy • Practice Guideline Update Summary: Efficacy and Tolerability of the New Antiepileptic Drugs II: Treatment-resistant Epilepsy • Practice Guideline Recommendations Summary: Disease-modifying Therapies for Adults with Multiple Sclerosis • Comprehensive Systematic Review Summary: Disease-modifying Therapies for Adults with Multiple Sclerosis • Comprehensive Systematic Review Summary: Treatment of Cerebellar Motor Dysfunction and Ataxia

CONFERENCES & COMMUNITY Conferences 2018 Annual Meeting

The 2018 Annual Meeting took place in Los Angeles, which hosted a record of more than 14,000 people from over 100 countries who experienced a meeting featuring more than 240 education programs, 3,200 scientific presentations, seven plenary sessions, and more than 300 lively and interactive experiential learning area presentations. The energetic buzz for the meeting was established by a night celebrating the 70th anniversary of the AAN at Universal Studios. The AAN gave back to the local Los Angeles community in the form of the Brain Health Fair, which had more than 2,500 attendees. In addition to connecting to over 270 exhibitors, attendees engaged in more than 10,300 Twitter, Instagram, and Facebook posts resulting in more than 62.5 million impressions across the platforms.

2018 Breakthroughs in Neurology Conference and Career Essentials Conference

The fourth annual Breakthroughs in Neurology Conference was paired with the first-ever Career Essentials Conference and took place in January in Orlando, FL. The conferences were attended by 250 people. The Breakthroughs in Neurology Conference

offered a year-in-review of the best neurology science and education, networking opportunities, and the chance to earn up to 28.5 CME while the Career Essentials Conference provided strategies for individuals starting out their career in neurology and offered up to 8.5 CME.

2018 Sports Concussion Conference

programs, a track of six Practice Management programs, three skills workshops, two Continuum®: Test Your Knowledge: A Multiple-choice Question Review courses, a Maintenance of Certification Informational Session, and a course on Leadership Challenges in Practice, the 2018 Fall Conference featured the addition of some of the most popular offerings from the 2018 Annual Meeting, including two plenary sessions.

2018 Brain Health Fair The Sports Concussion Conference took place in Indianapolis, IN, and was attended by a record audience of 512 neurologists, athletic trainers, nonneurologist physicians, and others involved in the management of concussion in sports. They came together to learn about and share expertise on the latest concussion prevention, diagnosis, and treatment developments via a mix of lectures and a hands-on “boot camp.” A record number of 85 abstracts were presented at the conference, and the AAN partnered with the NCAA to host a portion of the conference in the NCAA Hall of Champions.

2018 Fall Conference

The AAN Fall Conference, held in Las Vegas in October, had over 625 neurology professionals seeking the year-end opportunity to learn the latest clinical advances in neurology and earn up to 16.0 CME. In addition to a series of eight Neurology Update

The Brain Health Fair is a free public event presented by the AAN during the Annual Meeting to connect neurology patients, caregivers, students, and anyone interested in brain health. This year’s fair drew over 2,500 people to the LA Convention Center. There were 25 presentations, 55 exhibitors, 400 bike helmets given away, and several disease-specific areas for attendees to speak one-on-one with a neurologist. The program offered opportunities for attendees to tour the UCLA mobile stroke unit, interact with trained service dogs, walk through a 20-foot inflatable brain, learn about home modifications, gather resources as well as other opportunities such as the MS Experience Room. Over 80 high school students participated in a daylong specialized neurology experience to learn about the wonders of the brain. A Spanish component was added this year, which included materials, presentations, and neurologists available to speak with attendees.

Community

Leadership

Bike Helmet Giveaway

Leadership University

The AAN held its seventh annual bike helmet giveaway in June, distributing 1,000 helmets to the public outside AAN headquarters. The public began lining up 45 minutes before the 8:00 a.m. start, and the line was soon around the block. In acknowledgment of the day, Minneapolis Mayor Jacob Frey proclaimed it Brain Health Awareness Day in the city. The event received media coverage from five local TV stations, along with extensive social media exposure. To extend its impact on Minnesotan’s brain health, the AAN also donated an additional 1,000 helmets to various non-profits around the Twin Cities.

For individuals who are unable to give the time commitment to more intensive leadership programs but would still like to build their leadership skills, Leadership University is available at Annual Meetings and Fall Conferences. World-renowned consultants and physician leaders in the field of neurology collaborated to create an expanded complement of Leadership University programs at the 2018 Annual Meeting to meet the professional development goals of neurologist in every stage of their career.

2,000 16

Leaders. BuildingTraining Neurology’s Future. IntensiveCultivating Leadership Programs From personal development opportunities to transformational career pathways, the AAN is here With the current demands physicians to guide your leadership growth. Applyfacing for one of 10 unique opportunities coveringin the full spectrum of career stages. neurology, AAN.com/view/lead it is imperative to identify future physician leaders and to create developmental programs to close the gap between current skillsets and those needed for higher level positions within health organizations and leadership positions at the AAN. It is important to equip current and future physician leaders with the skills, experiences, insights, and connections required to effectively manage and lead to promote the highest quality patient-centered care and enhance our members’ career satisfaction. The following leadership programs address these needs: • Emerging Leaders Program • Diversity Leadership Program • Enhanced Resident Leadership Program • Transforming Leaders Program • Women Leading in Neurology • Practice Leadership Program • Palatucci Advocacy Leadership Program • Medical Student Diversity Leadership Program

Continued Member Engagement with the AAN The Leadership Engagement Subcommittee was created to work on developing opportunities and resources for sustained engagement and ongoing leadership development of leadership program graduates. • Leadership Alumni Newsletter • Alumni Networking Opportunities • Leadership Alumni Synapse Community

Leadership Program Successes Developing key leadership skills so that everyone can reach their own leadership potential is a goal for all leadership programs. Highlighting the successes of program graduates continues to be a priority. These success stories are shared each month in AANnews and available on AAN.com.

Membership 2018 Recruitment and Retention

Business Administrators

New AAN.com

This was another record year for AAN membership recruitment and retention. Neurologists and neuroscience professionals from around the world now make up 36,000 AAN members and contribute to the 91.5 percent market share of US neurologists. Successful year-over-year recruitment and retention of members is attributed to the AANâ&#x20AC;&#x2122;s commitment to continuing to grow the available resources for neurologists as well as the various members of a neurology care team no matter their practice setting, career stage, or geographic location.

2018 was spent assessing the needs of the AANâ&#x20AC;&#x2122;s business administrators to increase membership as there were 245 business administrative members at the end of 2018. Additionally, a focus group was held at the Annual Meeting and deep dive phone interviews of current and former members were conducted in the fall. Initial insights have already influenced 2019 Annual Meeting programming to meet our administrator needs and increase their meeting attendance.

Since the redesign of AAN.com weâ&#x20AC;&#x2122;ve seen an increase in visitors with 69 percent of US neurologist members having logged into the site, compared to 41 percent reported in 2017. Annual Meeting, Online Learning, and Guidelines continue to be the most popular areas of the site, and increasingly (36 percent), members are visiting via mobile devices. In 2018, the website went through multiple optimizations, improving dynamic content and search engine capabilities to deliver more relevant, personalized experiences to Academy members.

Synapse

The AAN had another strong year with approved applications for Fellow status in 2018, at 263. The photos of those chosen as fellows will be included in a display of new FAAN members at the 2019 Annual Meeting. Those who were present at the meeting were celebrated at a special breakfast honoring this accomplishment. Fellow status acknowledges exemplary work and achievements in the neurosciences, the clinical practice of neurology or academic/administrative neurology, in the AAN, and in the community.

The strength of Synapse Online Communities continues to grow. Wrapping up 2018, there were a total of 20,208 AAN members belonging to one or more Synapse open or private communities. Synapse continues to provide a platform for AAN section members to openly share special interest and subspecialty-related information and resources with colleagues.

Advanced Practice Providers and Care Team This membership option saw increased growth and interest, with more than 1,100 members in 2018. This membership category has grown significantly in recent years; in 2014, there were just 228 Advanced Practice Provider members.

1,100+

New FAAN Members

Advance Practice Providers and Care Team members

Career Services Member engagement with the Neurology Career Center continues to increase with strong growth for both applications and job seeker profiles. Trackable applications are estimated to reach 6,670 in 2018, representing a 36 percent increase over 2017 (when there were 4,892 applications). Similar increases were also seen in job seeker profiles. New profiles reached 880 in 2018, an increase of 37 percent when compared to 2017 (646 job seeker profiles).

MEMBERSHIP SUMMARY Membership Growth

34,000 32,000

36,000

Breakdown of US Members Neurologist/Physician Junior Student Senior/Honorary Researcher Advanced Practice Provider Business Administrator

24,000

17.7% 15.3% 51% 6.3% 3.5% 5.1% 1.1%

19,500 17,000 14,000 1995

2000

2005

2010

2016

2017

2018

Based on 2018 year-end data. Includes members in arrears.

Membership Demographics US Members:

2018 18

91.5%

More than of current market share

28,000

US Neurologists:

14,500

International Members:

8,000

FINANCIAL SUMMARY 2018 Revenue $54.1M

38%

Royalties & Publications

19%

Conference & Education

17% Grants & Gifts

16%

11%

10%

Membership Dues

Exhibit Sales

1% Other

2018 Expenses $53.4M

36% Education

15%

Membership

13%

General & Administrative

Publications

Advocacy

Grants & Awards

Clinical Practice

87Â¢ of every dollar directly applied to member benefits!

2018–2019 STRATEGIC PLAN The Academy is a leader among national medical specialties in recognizing the importance of foresight in serving as the basis for executing leadership in the form of strategic planning. Through foresight, we discern, analyze, and act on potential futures. Foresight is a critical component of leadership—an essential part of the fiduciary responsibility of the Boards of Directors. Foresight practice can add value and strategic insight to all levels and functional areas of Academy management. The Academy’s strategic planning efforts are continuous and data-driven. The Academy engages in future-focused research, including environmental scanning by staff led by the Academy’s Insights Team to provide a continual stream of research and resources about anticipated trends. The components of the Academy’s strategic plan include the Academy’s vision, mission, core values, board goals, and committee objectives. The board measures progress on its goals through a compelling Board Scorecard, which includes measurable outcomes that drive action that is meaningful to AAN members.

The Academy’s goals describe how we will accomplish our mission to promote the highest quality patientcentered neurologic care and enhance member career satisfaction. The 2019 goals are: 1. Demonstrate and assert the value of neurology to policymakers and other major stakeholders 2. Expand the neurology workforce to meet future needs for patient care 3. Ensure the health of the organization by enhancing member satisfaction, well-being, and engagement 4. Provide resources to support the financial wellbeing of the practice of neurology 5. Expand neuroscience training and research funding 6. Educate and assist members in providing highvalue clinical care 7. Strengthen advocacy on behalf of members and their patients These goals envision a preferred future to which we aspire for the American Academy of Neurology—a future in which we achieve our vision to be indispensable to all our members. The Boards of Directors, in consultation with the chairs and staff liaisons of each major Academy committee, identified objectives for 2019 around each goal and major tactics in an annual operational plan. The committee objectives serve as shared priorities. By creating shared priorities, the Academy is better able to focus energy and resources; strengthen operations; ensure that committees, staff, and

other stakeholders collaborate and work towards common goals; establish agreement around intended outcomes; and assess and adjust the Academy’s direction in response to a changing environment. Today’s challenges are unprecedented; yet there is no shortage of new ideas and great passion among our members and staff for strengthening our growing community of neurology and neuroscience professionals. The Academy continually prioritizes new ideas and existing Academy programs, products, and services using common criteria established for use across the organization. As a result, initiatives abound in many emerging areas of Academy focus, including current efforts to address health care disparities among neurologic patients, wellness and the resiliency of the neurology patient care team, neurology drug pricing, the environment for diversity and inclusion, professional equity, patient education and engagement in our advocacy efforts, and economic challenges common to all our practice settings from academic to solo practice. At the same time, we continually improve our core strengths—including the Annual Meeting and educational conferences, our array of publications, and our capacity to advocate successfully on behalf of our members and their patients. The process of continual, data-driven strategic planning and decision-making will continue as the Academy strives to demonstrate the value of neurology and be indispensable to you!

AAN BY THE NUMBERS

36,000 members

Neurology Today member circulation

25,596 Members represent

international scholarship recipients

141 countries

grants awarded

Members who participated in the 16th annual

NOH

211

90 first-time member advocates 49 states and DC represented 298 US congressional offices visited

$3,100,000

unique visits to AAN.com

grant recipients

Facebook Fans

3 million impressions with #NOH18

all accounts

digests read

badges awarded

526,247 unique logins

9,592

3,538 communities

2,195,735

new threads

1,535

210,645 AAN account only

28,553

LinkedIn Followers

7,819

Twitter Followers all accounts

138,000 AAN account only

15,554 21

2017–2019 AAN BOARD OF DIRECTORS 2017-2019 AAN Board of Directors Officers President: Ralph L. Sacco, MD, MS, FAHA, FAAN President Elect: James C. Stevens, MD, FAAN Vice President: Ann H. Tilton, MD, FAAN Secretary: Carlayne E. Jackson, MD, FAAN Treasurer: Janis M. Miyasaki, MD, MEd, FRCPC, FAAN Immediate Past President: Terrence L. Cascino, MD, FAAN

Directors

Front L to R: Flippen, T. Cascino, Rydell, Stevens, Sacco, Tilton, Jackson, Miyasaki Back L to R: Gross, Morris, Banwell, Schwartz, Goldenberg, Benish, Jones, Gamaldo, Rost, Avitzur, Kissela, G. Cascino, Smith, Hosey, Johnson, Vidic

Brenda Banwell, MD, FAAN* Sarah M. Benish, MD, FAAN Charlene Gamaldo, MD, FAAN* James N. Goldenberg, MD, FAAN* Jonathan P. Hosey, MD, FAAN* Elaine C. Jones, MD, FAAN Brett M. Kissela, MD, MS, FAAN* John C. Morris, MD, FAAN Thomas R. Vidic, MD, FAAN *First-term members

Ex Officio (voting) Orly Avitzur, MD, MBA, FAAN, Chair, Medical Economics and Management Committee Gregory D. Cascino, MD, FAAN, Chair, Member Engagement Committee Robert A. Gross, MD, PhD, FAAN, Editor-in-Chief, Neurology® Nicholas E. Johnson, MD, FAAN, Chair, Government Relations Committee

Ex Officio (non-voting) Catherine M. Rydell, CAE, Executive Director/CEO

2017-2019 AAN Institute Board of Directors

2017-2019 Academy Committee Chairs

Officers

Board Planning Committee Carlayne E. Jackson, MD, FAAN

Joint Audit Committee George K. York III, MD, FAAN

BrainPAC Executive Committee Glen R. Finney, MD

Joint Investment Committee Ralph F. Józefowicz, MD, FAAN

Bylaws Committee Ralph L. Sacco, MD, MS, FAHA, FAAN

Leadership Development Committee Terrence L. Cascino, MD, FAAN

Education Committee A. Gordon Smith, MD, FAAN

Medical Economics and Management Committee Orly Avitzur, MD, MBA, FAAN

Chair: Ralph L. Sacco, MD, MS, FAHA, FAAN Chair Elect: James C. Stevens, MD, FAAN Vice Chair: Ann H. Tilton, MD, FAAN Secretary-Treasurer: Charles C. Flippen, MD, FAAN Immediate Past Chair: Terrence L. Cascino, MD, FAAN

Directors Brenda Banwell, MD, FAAN* Sarah M. Benish, MD, FAAN Charlene Gamaldo, MD, FAAN* James N. Goldenberg, MD, FAAN* Jonathan P. Hosey, MD, FAAN* Elaine C. Jones, MD, FAAN Brett M. Kissela, MD, MS, FAAN* John C. Morris, MD, FAAN Thomas R. Vidic, MD, FAAN *First-term members

Ethics, Law, and Humanities Committee James A. Russell, DO, FAAN Executive Committee No chair—led by Ralph L. Sacco, MD, MS, FAHA, FAAN

Ex Officio (voting) Robert A. Gross, MD, PhD, FAAN, Editor-in-Chief, Neurology Carlayne E. Jackson, MD, FAAN, AAN Secretary Janis M. Miyasaki, MD, MEd, FRCPC, FAAN, AAN Treasurer Natalia S. Rost, MD, MPH, FAAN, FAHA, Chair, Science Committee Heidi B. Schwarz, MD, FAAN, Chair, Practice Committee A. Gordon Smith, MD, FAAN, Chair, Education Committee ®

Meeting Management Committee Stefan M. Pulst, MD, FAAN Member Engagement Committee Gregory D. Cascino, MD, FAAN

Fair Hearing Panel Committee Glenn A. Mackin, MD, FAAN, FACP

Nominations Committee Timothy A. Pedley, MD, FAAN

Finance Committee Janis M. Miyasaki, MD, MEd, FRCPC, FAAN

Practice Committee Heidi B. Schwarz, MD, FAAN

Government Relations Committee Nicholas E. Johnson, MD, FAAN

Publications Committee Robert A. Gross, MD, PhD, FAAN

Grievance Committee William P. Cheshire, Jr., MD, FAAN

Registry Committee Lyell K. Jones, MD, FAAN

History and Archives Committee Douglas J. Lanska, MD, FAAN

Science Committee Natalia S. Rost, MD, MPH, FAAN, FAHA

Ex Officio (non-voting) Catherine M. Rydell, CAE, Executive Director/CEO

American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415 AAN.com Member Services (800) 879-1960 (US/Canada) (612) 928-6000 (International) Members featured throughout this book represent new Fellow members of the AAN and members currently holding section leader positions. ÂŠ American Academy of Neurology