2019 ANNUAL REPORT
LETTER FROM LEADERSHIP Your Academy began 2019 with a record-high number of members, more than 36,000. Our successful 2019 membership campaign was able to maintain that record 36,000, including a 95-percent renewal rate of U.S. neurologists that would be the envy of another associations. The AAN represents 92.7 percent of all U.S. neurologists. This points to the inherent value of AAN membership, whether you’re a practicing or academic neurologist, a researcher, an advanced practice provider, or business administrator. the AAN is the home of neurology. The AAN again proved its value when it scored one of its biggest advocacy wins ever in July, when the 2020 Medicare Physician Fee Schedule proposed by the Centers for Medicare & Medicaid Services (CMS) revealed CMS dropped harsh changes to evaluation and management (E/M) codes that we had earnestly fought against. In fact, our comprehensive advocacy efforts were recognized with an award! The final rule issued by CMS in November was a significant victory for neurology, not only confirming that CMS will not collapse the payment levels for E/M visits, but will also, in 2021, implement revised office E/M documentation guidelines and increased payments. We foresee that this could generate an additional $150 million annually in Medicare payments to neurologists for E/M services beginning that year! While we did not negate the proposed reductions to long-term EEG as much as we would have hoped, we did convince CMS that it undervalued EEG services in its original proposal and it will increase the rates for several of the professional component codes, helping to offset the reimbursement cuts. In fact, CMS specifically cited the AAN’s comment letter changes— which Policy & Medicine praised as a “a lengthy tour de force regulatory comment letter”— as the reason they changed their mind, validating our regulatory advocacy efforts. We also kept up our pressure on Congress on legislation. A new Legislative Summit held in Washington, DC, generated additional congressional support for our efforts to tackle the high costs of
neurology drugs. The Annual Meeting in Philadelphia broke all previous attendance records, with 15,150 registrants, and 3,973 abstracts chosen for presentation—another new record! Highlights of the meeting included the Innovation Hub and Innovation Talks, the Brain Dome, and Poster Neighborhoods. The Fall Conference in Las Vegas also hit a new high, with more than 750 attendees. Our inaugural oneday APP Pre-Conference, in conjunction with the Fall Conference, drew more than 170 advanced practice providers, many of whom attended the full weekend of neurology education. The AAN also introduced specially priced memberships to APPs, who comprise our fastest-growing category. In a follow-up to last year’s Neurology Department Chair Summit, the AAN hosted more than 230 attendees at the Neurology Department Chair and Academic Business Administrator Summit. We continued to address key issues and challenges facing academic medicine and raise awareness of tools and resources available from the AAN. Our online education opportunities expanded with the NeuroReady: Board Prep Edition, the second edition of the NeuroLearn Patient Safety Course, and NeuroBytes videos. The format for our popular practice management webinars was adjusted to delve deeper into topics with live and recorded content, just as member feedback requested. Important structural changes were authorized by the Board of Directors, including realignment of our committees and subcommittees to enhance communications and delineation of responsibilities. A presidential General Neurology Task Force was created to understand and address unique issues facing our general neurologists. As the AAN’s Industry Roundtable celebrated 25 years, a new Industry Principles Task Force was created to review the AAN’s principles governing its industry relationships, as recommended by the Neurology Drug Pricing Task Force. Work groups formed as a result of the Neurology Chair and Academic Business
Administrator Summit were established to investigate issues of concern to business administrators and to advance women in neurology academia. The Board also established two joint coordinating councils to improve awareness and communications across the AAN on two issues very important to our organization and members. The Joint Coordinating Council on Wellness is coordinating wellness efforts throughout the Academy and addressing the factors contributing to burnout, including regulatory hassles, excessive workload, loss of autonomy, lack of recognition of professionalism, clerical burden, inadequate support staff, and poor work-life balance. To improve equity, diversity, and inclusion (EDI), the Board created the Joint Coordinating Council on Equity, Diversity, and Inclusion. As envisioned by the 2018 Diversity Leadership Program participants, this group is gathering and will publish data pertinent to neurologic health equity and practitioner workforce diversity; develop and maintain effective guidelines and education programs for departmental leadership regarding EDI issues, initiatives, and standards; foster transparency and monitor progress; coordinate EDI efforts across AAN committees; coordinate with AAN advocacy to support legislation pertinent to neurologic health equity; support departmental EDI officers; and administer EDI-related service awards. At the Neurology® journal, José G. Merino, MD, MPhil, FAHA, FAAN, was selected as the seventh editor-in-chief and will succeed Robert A. Gross, MD, PhD, FAAN, when his ten-year term expires in 2020. After the unfortunate publication in the journal of a humanities essay with racial stereotyping, Dr. Gross swiftly made personnel and editorial process changes and recommitted Neurology to greater diversity and inclusivity. Neurology Today® published “Meet Neurology’s Diversity Leaders,” an illuminating article on how EDID officers work to improve diversity in the academic workplace by President Elect Orly Avitzur, MD, MBA, FAAN, who was one of a record number of four women elected to six officer positions on the Board of
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Directors at the Annual Meeting. Finally, the AAN collaborated with the American Brain Foundation on a new strategic alliance. The Foundation, launched by the AAN in 1992, has been an independent entity the last several years but we continue to be special partners in promoting neurologic research and awarding fellowships to promising young researchers. We’d like to thank Ralph L. Sacco, MD, MS, FAHA, FAAN, whose term ended after the 2019 Annual Meeting, for his two years of remarkable leadership. The Academy is positioned to continue to do great things in 2020 (see page 22 for our new strategic plan) and we look forward to continuing to meet the needs of our members and be an irreplaceable part of your professional lives.
Our Vision To be indispensable to our members.
Our Mission To promote the highest quality patient-centered neurologic care and enhance member career satisfaction.
Our Goals 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 well-being of the practice of neurology 5. Expand neuroscience training and research funding 6. Educate and assist members in providing high-value clinical care 7. Strengthen advocacy on behalf of members and their patients
Our Core Values Core values answer the question: “How do we want to act as we move toward achieving our vision?� James C. Stevens, MD, FAAN AAN President
Community
Professionalism
We work together as neurology professionals and Academy staff to accomplish the mission and vision of the Academy and to share our common experience and expertise in belonging to and serving the neurology community.
We work collaboratively as a committed team, to share our expertise and use informed decisionmaking in service of others to improve the quality of neurologic care.
Leadership Catherine M. Rydell, CAE AAN Chief Executive Officer
We guide, inspire, and empower members, patients, and other stakeholders to make a positive difference in their own lives and the lives of others in the neurology community, and to contribute to the Academy mission.
Integrity We set and maintain the highest ethical standards for ourselves and our programs, products, and services.
Respect We embrace the dignity and uniqueness of every person, being sensitive and empathetic to the needs of others.
Diversity and Equity We commit to building and sustaining an inclusive organization that respects and values the diversity of our membership, our staff, and the communities we serve, and promotes equity in professional advancement and compensation.
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2019–2021 AAN BOARD OF DIRECTORS 2019-2021 AAN Board of Directors Officers President: James C. Stevens, MD, FAAN President Elect: Orly Avitzur, MD, MBA, 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: Ralph L. Sacco, MD, MS, FAHA, FAAN
Directors
Front L to R: Flippen, Sacco, Rydell, Avitzur, Stevens, Tilton, Jackson, Miyasaki Back L to R: Banwell, Kissela, Jones, Goldenberg, Rost, Vidic, Cascino, Smith, Benish, Gross, Gamaldo, Hosey, Kilgore, Klein, Johnson, Jones
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 Shannon M. Kilgore, MD, FAAN* Brett M. Kissela, MD, MS, FAHA, FAAN Thomas R. Vidic, MD, FAAN *First-term member
Ex Officio (voting) 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 Brad C. Klein, MD, MBA, FAAN, Chair, Medical Economics and Practice Committee
Ex Officio (non-voting) Catherine M. Rydell, CAE, Chief Executive Officer
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2019-2021 AAN Institute Board of Directors
2019-2021 Academy Committee Chairs
Officers
Advocacy Committee Nicholas Elwood Johnson, MD, FAAN
Joint Audit Committee George K. York III, MD, FAAN
Board Planning Committee Carlayne E. Jackson, MD, FAAN
Joint Investment Committee Ralph F. Jรณzefowicz, MD, FAAN
BrainPAC Executive Committee Glen R. Finney, MD, FAAN
Leadership Development Committee Terrence L. Cascino, MD, FAAN
Bylaws Committee Janis Miyasaki MD, FAAN
Medical Economics and Practice Committee Brad C. Klein, MD, MBA, FAAN
Chair: James C. Stevens, MD, FAAN Chair Elect: Orly Avitzur, MD, MBA, FAAN Vice Chair: Ann H. Tilton, MD, FAAN Secretary-Treasurer: Charles C. Flippen II, MD, FAAN Immediate Past Chair: Ralph L. Sacco, MD, MS, FAHA, 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 Shannon M. Kilgore, MD, FAAN* Brett M. Kissela, MD, MS, FAHA, FAAN Thomas R. Vidic, MD, FAAN *First-term member
Ex Officio (voting) Lyell K. Jones, Jr., MD, FAAN, Chair, Quality Committee Natalia S. Rost, MD, MPH, FAHA, FAAN, Chair, Science Committee A. Gordon Smith, MD, FAAN, Chair, Education Committee
Ex Officio (non-voting)
Education Committee A. Gordon Smith, MD, FAAN Ethics, Law, and Humanities Committee Leon G. Epstein, MD, FAAN Executive Committee James C. Stevens, MD, FAAN Fair Hearing Panel Committee Daniel G. Larriviere, MD, JD, FAAN Finance Committee Janis M. Miyasaki, MD, MEd, FRCPC, FAAN Grievance Committee William P. Cheshire, Jr., MD, FAAN History and Archives Committee Douglas J. Lanska, MD, FAAN
Meeting Management Committee Carlayne E. Jackson, MD, FAAN Member Engagement Committee Gregory D. Cascino, MD, FAAN Nominations Committee Timothy A. Pedley, MD, FAAN Publications Committee Robert A. Gross, MD, PhD, FAAN Quality Committee Lyell K. Jones, MD, FAAN Science Committee Natalia S. Rost, MD, MPH, FAAN, FAHA
Catherine M. Rydell, CAE, Chief Executive Officer
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TOOLS & RESOURCES Practicing Neurologists & Administrators Axon Registry
MACRA/QPP/MIPS
In 2019, the Axon Registry® continued to grow, increasing participation from solo/small to large academic practices. By yearend, participation included 173 practices and more than 2.3 million patients representing over 11.2 million patient visits. Additionally, the AAN entered into a collaboration with Verana Health to facilitate the development and delivery of de-identified clinical data solutions for use by the AAN, its participants, partners, and the broader neurologic community. These solutions aim to improve treatments and discover cures for neurologic diseases. The Centers for Medicare & Medicaid Services (CMS) continued to approve the Axon Registry as a qualified clinical data registry. This designation opens the door for AAN members looking for a better way to submit quality data to CMS for the Merit-based Incentive Payment System (MIPS). The Axon Registry also is approved by the American Board of Psychiatry and Neurology (ABPN) as a Continuing Certification Part IV Improvement in Medical Practice Clinical Module activity and participation in Axon Registry waives up to eight hours of Part II Self-assessment. The Registry Subcommittee works in collaboration with the AAN’s Quality Measures Subcommittee to integrate the measures into the Axon Registry. The Axon Registry now has more than 50 neurology-relevant quality measures, including several patient-reported outcome measures.
For four 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 how changes to the Quality Payment Program (QPP) affect clinicians’ reimbursement. This program rewards the delivery of high-quality patient care through Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS). The changes issued by the CMS for the 2020 QPP reflect small tweaks to Advanced APMs and gradual increases to MIPS components and payment adjustments. Additionally, the proposed MIPS Value Pathways (MVPs), a framework that aims to reduce reporting burden and centers around a specialty or condition, was finalized to begin in 2021. The AAN provided extensive comments to CMS on QPP and MVPs specifically. The AAN looks forward to working with CMS on MVP development to ensure neurologists can successfully participate in the new framework and appreciates the collaborative opportunity moving forward.
173 practices 2,300,000 patients 11,200,000 patient visits
Quality Measures The AAN is a leader in developing quality measures for neurology. In 2019, the AAN released two new quality measurement sets. The universal neurology measurement set aims to improve the care of all patients that see neurologists. The mild cognitive impairment measurement set helps providers identify and manage patients with mild cognitive impairment. The AAN also reaffirmed the distal symmetric polyneuropathy measurement set. The AAN launched the new Quality Pioneers program, a quality improvement learning collaborative where practices participating in Axon Registry receive support and education on quality improvement methods and implementation. Six AAN members are
participating in this year-long cohort that identifies opportunities to improve and shares best practices in a collaborative and learning environment.
Payer Relations The AAN continued to advocate with commercial payers for appropriate coverage of neurologic therapies. The Academy hosted a Payer Summit at the Annual Meeting to assist in reducing barriers to working with payers. An action resulting from the discussions with payers and members will be the initiation of a payer newsletter informing them of high priority issues for neurologists. The AAN supported payers by reviewing medical polices and submitted 20 reviews from subject matter expert members.
Practice Management Webinars The AAN enhanced its practice management webinars in 2019 by offering a live/recorded hybrid based on evaluations that an hour-long live webinar was not meeting members’ needs. In 2019, the AAN offered six webinars, each worth two CME or CMPE credits, and available in short chapters the learner could watch on-demand on the Online Learning Center. These have been received well by membership, with more than 90 percent of participants evaluating these as good/ excellent.
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Neurology Compensation and Productivity Survey
Academic Neurologist and Researchers
3,200
The Neurology Compensation and Productivity Survey was distributed in 2019. It had a Members record-setting response of more Submitting Data than 3,200 members submitting data, making it the largest and strongest data set dedicated to neurology and its subspecialties. Geographically, 35 percent of neurologist respondents hail from the northeast region, and 29 percent are in the south. More than 60 percent of responding neurologists practice in the academic setting. The largest subspecialties represented in the data are general neurology (19 percent), epilepsy (11 percent), and vascular neurology and stroke (10 percent). For the first time, advanced practice providers (APP) were invited to participate and more than 470 submitted data. The data is available through 2020 with the next survey set for 2021.
Neurology Department Chair Summit The AAN hosted its second Neurology Department Chair Summit in March. New this year, the Academy invited the department chair as well as their respective business administrator. The content was created with both constituent groups in mind, and presentations and breakout topics ranged from funds flow (models, challenges, and opportunities) to academic departments and health systems. Additionally, there was a separate lunch for business administrators to hear about reimbursement hot topics and the value of business administrator membership in the AAN. There were around 230 attendees, including various guest members who gave a presentation on diversity and gender disparities. There were multiple action items generated from the summit, including white papers on funding the education mission, service lines, and funds flow that are currently in the works.
Practice Ambassador Program The AAN met the Board’s scorecard goal of visiting 10 small and solo practices through the Practice Ambassador Program, which grew out of a 2016 Solo and Small Practice Task Force recommendation. The AAN recognizes the unique challenges and barriers that prevent small and solo physicians from volunteering in Academy activities and charged the Practice Ambassador Program with visiting small practices to better understand their challenges, listen to their feedback, and uncover themes to aid in resource development to help them thrive in practice. The feedback and resource ideas, both positive and constructive, are shared with the appropriate AAN teams to ensure the small and solo physician voice is heard.
Academic Neurology Initiative The AAN is committed to supporting both academic neurologists and practicing neurologists. In its dedication to academic neurologists, the Academic Neurology Initiative was established and is committed to providing resources and tools for the many different constituent groups within an academic department. The vision of this initiative is to be indispensable
to academic neurologists by supporting them across their professional lifetimes. Those working in neurology academic departments have unique challenges, and a common goal of this initiative is to provide resources and networking opportunities for those in this-environment to learn from one another and stay up-to-date on all that is going on in the field of neurology. The AAN continued its work on this initiative in 2019 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 In 2019, significant work was accomplished to support the Academic Neurology Initiative including the establishment of new work groups to address various issues, including the Academic Neurology Work Group, Academic Business Administrator Work Group, and Advancing Women in Academics Work Group, as well as a number of project-specific work groups to address funds flow, service lines, and funding the education mission. Additionally, the new Chair/Academic Business Administrator SynapseSM online community was launched to provide chairs and academic business administrators the opportunity to network, share best practices, and discuss challenges facing academic neurology. Also, a new Academic Experiential Learning Area was approved and is under development for launch at the 2020 Annual Meeting.
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Dr Casey Farin 
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Advanced Practice Providers and Care Team Areas across the AAN continued to develop education and resources for advanced practice nurse practitioners and physician assistants in neurology. The Consortium of Neurology Advanced Practice Providers continued to develop its strategy for APP resource development and networking opportunities including growing its presence on its Synapse online community and working with AAN leadership to ensure the APP perspective is included on Academy committees. The Education APP Work Group surveyed APP members to better understand their educational needs and plans on sharing this data in the future. A key initiative was the first stand-alone one-day conference for APPs held just prior to the Fall Conference. With over 175 attendees, the conference focused on basics of neurology and disease updates in three key topics and had ample time for networking.
Stand-alone one-day APP conference
175
attendees
Residents and Fellows Several AAN opportunities provide residents and fellows with resources and leadership skills for their burgeoning careers in neurology.
RITEÂŽ Exam The RITE (Residency In-service Training Examination) had a successful transition to computerized exam with more than 250 US, Canadian, and international programs participating and over 3,000 examinees. Additional innovation is planned for the 2020 exam as the RITE blueprint will shift toward clinical competency to align with the ABPN board exam.
Resident Scholarship to the Annual Meeting This scholarship was awarded to 147 residents to support resident representation at the Annual Meeting in Philadelphia. Recipients participated in scientific programming and network opportunities such as the Early Career Reception, which was attended by more than 800 trainees and faculty, with more than 88 programs presenting posters at the event. As part of their scholarship fulfillment at the 2020 Annual Meeting, residents will assist in mentoring medical students.
Regional Conference Trainee Scholarship for Residents Ten residents were selected to receive this scholarship in conjunction with attending the Fall Conference in Las Vegas. Their experience at the conference included guided programming as well as networking events that connected them with leading faculty in the field of neurology.
The best things about being an @AANMember are opportunities for education and mentorship. I love attending the #AANAM, connecting with neurologists across the country, and learning about conditions I don’t see very often.
Enhanced Resident Leadership Program The Enhanced Resident Leadership Program for adult and child neurologists is designed to identify, train, and nurture a highly selected group of 10 residents in adult neurology and five residents in child neurology who have the motivation, drive, and potential to be future Academy leaders. The 15 participants selected for the 2019 Annual Meeting program were provided with opportunities to network and receive special training by attending educational and scientific CME programming.
Fellow Scholarship to the Annual Meeting Funding received in 2019 allowed 16 fellows to receive this scholarship to the Annual Meeting. These fellows were expected to participate fully in program and networking events. In 2020, fellow scholars will assist in mentoring resident and medical student trainees.
Chief Resident Leadership Program The first Chief Resident Leadership Program took place at the Annual Meeting with over 70 attendees who learned critical leadership skills for their programs.
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Medical Students Medical Student Pipeline Initiatives
Medical Student Experience at the Annual Meeting Scholarship
The new Pipeline Subcommittee continued to explore, develop, and enhance opportunities to expose students to neurology and neurologists, with the goal of increasing the number of students who become neurologists. The Conrad N. Hilton Foundation, which had supported the AAN’s efforts with a three-year grant, provided a one-year, no-cost extension.
In 2019, 55 medical students (primarily M1/M2) from a wide range of institutions received the Medical Student Experience at the Annual Meeting Scholarship. This is an increase from the 45 who attended in 2018. Students attended tailored programming, met with physician ambassadors, and took part in large events like the Medical Student Symposium, Opening Party, Presidential Plenary, and Early Career Reception.
Data Collection
What Is Neurology? Video
The Neurology journal published “Characteristics of Graduating US Allopathic Medical Students Pursuing a Career in Neurology,” which looked at quantitative data from the Association of American Medical Colleges graduation survey. A figure from this manuscript was included on the cover of the issue. A second manuscript, “Attracting Neurology’s Next Generation: A Qualitative Study of Specialty Choice and Perceptions Based on Qualitative Data,” has been reviewed by Neurology and authors are making revisions prior to resubmission.
Medical Student Symposium The second Medical Student Symposium occurred on in May. There were nearly 300 students in attendance and close to 100 physicians contributing to demonstration areas, lunch networking, and subspecialty round robin conversations. Evaluations overall were very positive and will be incorporated to further improve the program for 2020.
Debuting at the Presidential Plenary at the Annual Meeting, this short video was created to explain what neurology is as a career and the importance of the field. The video’s targeted audience is college students and medical students. It received more than 6,000 views on YouTube.
Student Interest Group in Neurology (SIGN) The 2018-2019 academic year saw the new framework for SIGN launched with great success. The Academy registered 122 SIGN chapters and their members. There were 19 international SIGN chapters in 11 countries. Registered chapters could sign up to receive a SIGN swag box to use at events or for promotions. Through the registration efforts, we’ve identified over 3,000 SIGN members. The annual registration and status update allow the AAN to stay in better communication with SIGN chapters longitudinally.
Medical Student Annual Meeting Scholarships
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Medical Student Annual Meeting Scholarships
The AAN again offered 60 Medical Student Annual Meeting Scholarships since the increase in 2018. Preference for the scholarships is given to SIGN chapter presidents or a designated SIGN representative 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.
Medical Student Synapse Online Community The Medical Student Member Group currently has 3,168 members. This online venue provides students a forum for sharing topics of interest and learning about opportunities offered by the AAN.
Visiting Medical Student Scholarship To aid in pipeline efforts, the Academy annually awards visiting student scholarships to 20 third- and fourth-year medical students to support any away rotation within the field of neurology. Between July and December, recipients were provided consultation and outpatient elective experience and an opportunity to network with neurologists across the United States, outside of their own programs that do not offer neurology rotations.
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Medical Student Diversity Program The overall purpose of the Medical Student Diversity Program is to provide opportunity and access to neurology to medical students from underrepresented groups in medicine, with the objective to make neurology a more attractive career option. The program comprises the Medical Student Diversity Scholarship, the Visiting Medical Student Diversity Scholarship, and the Visiting Professor Diversity Program.
Medical Student Diversity Scholarship This scholarship supported 10 medical students who attended the Annual Meeting in Philadelphia. Recipients of this scholarship are required to attend educational and scientific programming and networking events with other trainees and faculty at the Annual Meeting. An important aspect of this scholarship is a mentoring component in which the Medical Student Diversity Program works in partnership with the Enhanced Resident Leadership Program, establishing impactful mentoring relationships between residents and medical students.
Visiting Medical Student Diversity Scholarship
Visiting Professor Diversity Program
To aid in pipeline and diversity efforts, the Academy awarded visiting student scholarships to 10 third- and fourth-year medical students in 2019 to support any away rotation within the field of neurology that took place between July and December. This exposure is intended to provide consultation and outpatient elective experience, widen each scholarship recipient’s network, and make neurology a more attractive career option for medical students who might not otherwise have accessible exposure to neurology.
Jennifer Bickel
The Visiting Professor component provides an opportunity for an AAN-selected neurology professor who identifies as a member of an underrepresented racial or ethnic group in medicine to visit a medical school that does not have a required neurology clerkship. The visiting professor participates in grand rounds, assists with neurology patient rounds and clinic, and the visited program is welcome to arrange other events over two days to facilitate conversations, lectures, or presentations with the visiting professor. The primary goal of the visit is to offer important exposure to neurology and diversity for medical students.
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What’s the best thing about being an AAN member? By: Abhimanyu Mahajan, MD
Being a part of such a large family with members from a large variety of institutions affords me the ability to learn by listening to multiple viewpoints, while presenting my own.
Not sure my nerves could handle it, but I’d love to relive the #AANAM exhilaration of the Zombie Apocalypse with the creative #neurology geniuses @jsirven @BertVargas and Constantine Moschonas @AANMember Lyell Jones MD
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The best things about being an @AANMember: Expanding your impact. You can reach more people, find more audiences, and help more patients through the AAN platform. #AANAM
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EDUCATION & RESEARCH Education
Customized Education
Education Research Program 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 2019, the Education Research Program awarded three Education Research Grants and one Medical Education Research Training Fellowship totaling $94,500. The purpose of these opportunities is to promote education research.
$94,500 awarded in research grants and training fellowships
ABPN and Continuing Certification The AAN continued its commitment to monitoring the continuing certification (formerly maintenance of certification) landscape and advocating for flexibility regarding the 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 continuing certification. The AAN continues to monitor the work being done by the ABPN on the pilot that was launched in 2019.
The eLearning Subcommittee continues to explore, develop, and enhance products to ensure the suite of online education products meets the needs of AAN members. Several enhancements were made to the Online Learning Center to personalize and tailor content to users through the system. Additionally, the Annual Meeting On Demand product was transitioned to the Online Learning Center, expanding the catalog of content available to members in the system. There is a continued focus on development of microlearning opportunities for members, with the new NeuroBytes video-based program launched in 2019, and a new question-based mobile application expected to launch next year.
Neuro Products NeuroSAEÂŽ: Two new editions of NeuroSAE debuted this year: NeuroSAE Medical Student Fourth Edition, and the NeuroSAEÂŽ Twelfth Edition. A total of nine NeuroSAE exams are accessible through the Online Learning Center and are offered free to AAN members. NeuroLearnSM: Two NeuroLearn courses were refreshed. The NeuroLearn: Patient Safety Second Edition and NeuroLearn: Brachial Plexus Third edition are now available. NeuroBytes: The new NeuroBytes program consists of three- to five-minute videos designed to educate members on monthly clinical topics outlined on designed to educate members on monthly clinical topics. Two videos are developed each month based on the assigned topic. To date, 20 videos have been produced and are accessible and are offered free to AAN members through the Online Learning Center. NeuroReady: Board Prep Edition: This new online course is designed to help individuals prepare for the ABPN initial certification exam. Materials for the course are based on the content outline used by the ABPN for the Board exam. The course is accessible through the Online Learning Center.
NeuroTracker NeuroTracker is an AAN member-only benefit in which users can track their CME, self-assessment, and performance in practice. It can be used to provide documentation to various regulatory bodies such as the ABPN, academic institutions, state licensing boards, etc. Users also can track their AAN involvements such as committee appointments, which is very useful for when members are updating their CV or documentation of involvements. Improvements continue to be made to NeuroTracker as the Academy receives more feedback from users on improving functionality and usability.
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Research Annual Meeting Research A total of 3,063 abstracts were accepted for presentation at the Annual Meeting. 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 poster neighborhoods.
AAN Research and Awards The AAN applauds the 2020 Research Program recipients who were determined in 2019. There were 147 applications for the 2020 program. The AAN is proud to fund and offer the Career Development Award, Clinical Research Training Scholarship, Practice Research Training Scholarships, and Neuroscience Research Training Scholarships. Through partnership with the American Brain Foundation, 11 voluntary health associations provide funding to research in the 2020 funding portfolio. After finishing their AAN grant, most recipients receive additional major funding and bring hope to the future of research.
Neuroscience Is… Neuroscience Is…™ is a sweeping initiative of the AAN to build public awareness and demonstrate the importance of neuroscience research in the care of neurology patients and cures for brain diseases. Four physician work groups direct the initiative, which demonstrates how Neuroscience Is… • Cool: The Coolkits, which are meant to teach several dynamic lessons about neuroscience, are adaptable for any age level within K-12. Each kit contains age-appropriate visuals and equipment for students’ exploration of this fascinating subject. Ten Coolkits were taken to the 2019 Brain Health Fair, where work group members taught lessons from the kits to groups of 10 students (30 total) in grades 3, 4, and 5. Teachers who attended the Brain Health Fair with their students also received a Coolkit to take back to their classroom. Additional Coolkits were sent to teachers and parent-educators for use during the 2019-2020 academic year. • Rewarding: The AAN celebrated its third annual “Neuroscience Is Rewarding Day” on November 30. Students who received a reflex hammer were asked to post a picture of themselves on social media with the hammer and the hashtags: #FutureNeurologist and #NeuroscienceIs. After a successful inaugural program in 2018, the Neuroscience Is Rewarding Internship increased to 20 opportunities. College interns were mentored by AAN members and exposed to both clinical and research components of neurology. This program meets three goals: developing interest in neuroscience in college students, providing outlets for college students to learn and be exposed to neuroscience research projects, and supporting career development opportunities for academic and practicing AAN members. In an effort to expand college student engagement, there is now a Neuroscience Is Rewarding Intern Scholarship to the Annual Meeting that is available to five students. They will have their
attendance costs covered as they attend meeting programming. • Essential: The Neuroscience Is Essential Work Group continues work on outreach to the public, physicians, and patients to encourage increased participation in clinical trials. This work occurs through the development of discovery timelines for the Annual Meeting as well as identifying strategies needed to elevate the visibility and use of clinicaltrials.gov to AAN members as well as patients and caregivers. • Critical: The goal of Neuroscience Is Critical is to broadly ensure the understanding of neuroscience and the role that research plays in development of therapies is “in the muscle” of national lawmakers, ensuring funding for the National Institutes of Health and other scientific initiatives. In 2019, a new document, “The Urgent Need for Neurological Disease Research,” was developed and distributed within advocacy efforts.
Diversity in Research The AAN has partnered with the Medical University of South Carolina 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 were selected in 2017 and 2018. The 2019 class (Cohort 3) of TRANSCENDS Scholars was selected in November 2018 and was formally welcomed and oriented to the program at the 2019 Annual Meeting. The Cohort 4 Scholars were identified in the fall of 2019.
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Rapid Response Teams The Rapid Response Teams were reviewed to confirm that needs are being met relating to everyday issues which may affect neurologists throughout the year. Moving forward, there are three Rapid Response Teams composed of member experts: Media, Animal Science, and Regulatory. The purpose of the Media Rapid Response Team is to review and select abstracts accepted to the Annual Meeting that are newsworthy and will be highlighted in the AAN Annual Meeting press release promotion process. This group is also available for media questions from the AAN public relations team. The Animal Science Rapid Response Team responds to concerns and issues that come up regarding the ethical use of animals in research. Finally, the Regulatory Rapid Response Team addresses regulatory issues. These teams are in place to provide timely, comprehensive responses to issues as they arise.
Growing the Next Generation of Neurology Researchers The Academy continues to support and encourage medical students, residents, and junior fellows to participate in research training programming at the AAN Annual Meeting as well as participate in neurologic research overall: • At the 2019 Annual Meeting, the Futures in Neurological Research Programs included a bootcamp designed to refine and advance research skills as well as a luncheon to motivate, encourage and connect early-career researchers. The Futures in Neurological Research Scholarship was offered and awarded to 34 recipients. These scholarships supported travel expenses and attendance at the meeting. • The inaugural Resident Research Scholarship was offered to neurology residents who are interested in a career in neuroscience research. Three awards will be given, intended to be a springboard into the AAN’s Research Program or other programs focused on early-career investigators.
Publications Neurology® José Merino, MD, MPhil, FAHA, FAAN, was selected to become editor-in-chief in April 2020. Major accomplishments this year include the launch of an infographics program with an infographic in each issue and launch of a special website “Equity, Diversity, and Inclusion.” Submissions grew to 5,400 in 2018 and are expected to increase in 2019; Resident & Fellow submissions increased from 665 in 2017 to 773 in 2018. The journal collaborated with the Center for Biomedical Research Transparency to publish a special Neurology® Null Hypothesis issue. Neurology® Podcasts moved to a new robust platform and pioneered daily newscasts for voice-activated devices. The Impact Factor increased from 8.055 to 8.689. International editions of the publication include those in Argentina, Japan, and India. Volume 93, Number 23, December 3, 2019
Neurology.org/N
The most widely read and highly cited peer-reviewed neurology journal
ARTICLE
Insomnia symptoms and risk of cardiovascular diseases among 0.5 million adults: A 10-year cohort 994
ARTICLE
Cognition at age 70: Life course predictors and associations with brain pathologies 997
ARTICLE
Physical activity and prodromal features of Parkinson disease 998 CONTEMPORARY ISSUES
Burnout and attrition: Expanding the gender gap in neurology? 1002
Neurology® Clinical Practice The full texts of all papers except those under a year old are now available free in PubMed. The feature ‘Practice Current―An Interactive Exchange on Controversial Topics’ continues to be popular, garnering responses from more than 100 countries. The journal posts an infographic in each issue and published an interactive infographic featuring Practice Current. A special issue, Spotlight on Headache, was published in June. Volume 9, Number 6, December 2019
Neurology.org/CP
A peer-reviewed clinical neurology journal for the practicing neurologist
Special Cases Issue
CASE
Technique for lumbar puncture through a tattoo 535 CASE
Direct tumor embolism presenting as an acute ischemic stroke 490 CASE
Clinical manifestations of episodic ataxia type 5 503 CASE
Therapeutic benefits of early electrophysiological testing in a functional neurology case 532
Neurology® Genetics This open access journal, free to everyone, continued to publish new papers, which are searchable in PubMed. The journal regularly publishes the abstracts for the Proceedings of the International Stroke Genetics Consortium Workshops. The journal has been accepted for inclusion in Science Citation Index Expanded (SCIE) and will receive an impact factor in 2020. Volume 5, Number 1, February 2019
Neurology.org/NG
A peer-reviewed clinical and translational neurology open access journal
THE HELIX
2018: Year in Review and Message from the Editors to Our Reviewers e309
ARTICLE
Gene variants of adhesion molecules predispose to MS: A case-control study e304 ARTICLE
Genomic deletions upstream of lamin B1 lead to atypical autosomal dominant leukodystrophy e305 CLINICAL/SCIENTIFIC NOTE
Variable reporting of C9orf72 and high rate of uncertain results in ALS genetic testing e301
Neurology® Neuroimmunology and Neuroinflammation This free open access journal continued to publish new papers, which are searchable in PubMed. The journal received its first impact factor, 7.353, in June 2019. It was accepted for inclusion in MEDLINE, the National Library of Medicine indexing service, in July. MEDLINE citations are indexed with NLM Medical Subject Headings (MeSH) within a few weeks of publication. Volume 6, Number 2, March 2019
Neurology.org/NN
A peer-reviewed clinical and translational neurology open access journal
CLINICAL/SCIENTIFIC NOTE
Balint syndrome in anti-NMDA receptor encephalitis e532
ARTICLE
Real-world validation of the 2017 McDonald criteria for pediatric MS e528
ARTICLE
HIV is associated with endothelial activation despite ART, in a sub-Saharan African setting e531
ARTICLE
Mouse model of anti-NMDA receptor post–herpes simplex encephalitis e529
Continuum® Continuum’s paid member circulation grew to 7,980—an increase of 4.4 percent over 2018. The publication’s presence on social media grew to 9,131 followers. Continuum received three FOLIO Ozzie Awards in the categories of Cover Design, Overall Design Excellence, and Redesign. The FOLIO Ozzie Awards “recognize excellence in gorgeous design across all sectors of the publishing industry.” Continuum LIFELONG LEARNING IN NEUROLOGY®
FEBRUARY 2019
VOL. 25
NO. 1
Dementia
EDITOR-IN-CHIEF: STEVEN L. LEWIS, MD, FA AN GUEST EDITOR: JONATHAN GRAFF-RADFORD, MD
CONTINUUMJOURNAL.COM
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bertvargas
Neurology Today®
AANnews®
Neurology Today launched a redesigned website, featuring article comments and easier access to articles based on topics and sections. S Website visits increased 8.6 percent over 2018, with unique visitors increasing 13.3 percent over 2018. 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 Annual Meeting and eight additional subspecialty meetings were covered by the e-news service At the Meetings.
The official monthly member magazine of the Academy, AANnews is mailed to 28,000+ US members and is posted online in the “About the AAN” area of AAN.com for international and US members to easily access. While promoting Academy events and resources in 2019, the magazine kept members informed of regulatory changes, federal legislation and advocacy opportunities, election of the new Board of Directors, and success stories of neurology advocates and AAN Leadership Program graduates.
Gene Therapy Reverses MS Symptoms
Therapy Stops Seizures in NORSe
paGe 4
paGe 9
The Global Burden of Motor Neuron Disease paGe 16
The Official NewS SOuRce Of The a MeRicaN acaDeMy Of NeuROlOGy | NeuROlOGy TODay.cOM
jaNuaRy 10, 2019 | VOluMe 19 | iSSue 1
The cGRp antagonists are here. Now how Do you use Them? christine lehmann
ince the US Food and Drug Administration (FDA) approved three calcitonin gene-related peptide (CGRP) antagonists in 2018 — erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) — neurologists have begun integrating them into their practice. More CGRP drugs that can prevent and
treat acute headaches are in the pipeline, with FDA approval expected within two years. Designed to prevent chronic and episodic migraines, the CGRPs showed rapid, significant, and long-lasting relief of migraines with minimal adverse effects in clinical trials. Neurology Today interviewed several neurologists specializing in migraines about their recent clinical experience with the drugs, and any concerns that arose. Their experience to date has been
mostly positive, they said, but they did offer several caveats, as well as noteworthy observations from early experiences prescribing them. “This is the first time we have a preventive class of drugs that was created and designed just for the treatment of migraines based on what we now know about migraine pathophysiology,” said Rebecca Erwin Wells, MD, MPH, associate professor of neurology and founder and director of the comprehensive headContinued on page 24 ache program
ISTOCKPHOTO
The Real-World Experience of Migraine Experts
Migraine specialists agreed that more clinical practice data is needed to better understand the long-term effects and implications of prescribing CGRPs.
passive eeG Detects covert awareness in Severely Brain-injured patients dan hurley
A
new screening test using electroencephalography (EEG) accurately detected covert consciousness in severely brain-damaged patients who appear clinically unresponsive at the bedside, according to a December 3, 2018, paper published in Current Biology.
Coming 12 years after the first such patients were identified with the use of a functional MRI (fMRI) technique, the new EEG test may eventually make it practical for general neurologists to identify those in nursing homes who are covertly conscious but are currently considered to be unaware of their surroundings, according to an accompanying commentary. At present, only a handful of centers in North America and Europe
have neurologists trained in conducting the costly fMRI exams. Those fMRI exams involve asking patients with disorders of consciousness to follow spoken instructions by imagining that they are playing tennis or walking through their homes, and then seeing if the resulting pattern of brain activity is consistent with the requested imaginary tasks. The new test protocol does not require patients to follow such commands, making
it among the first reports of a purely passive measure of awareness that is correlated with an fMRI-based motor imagery task. Instead, patients simply listen on earphones to spoken language — such as stories and memories about their lives prior to their injury shared by family members — and the pattern of their EEG response is compared to that of normal controls. In the study of 21 severely brainContinued on page 20 injured patients,
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Meet Neurology’s Diversity and inclusion “champions”
PerIODICAlS
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NeurologyToday (ISSN 1533-7006), an official publication of the American Academy of Neurology, is published twice a month for the Academy by Wolters Kluwer, at 14700 Citicorp Drive, Bldg. 3, Hagerstown, MD 21742. POSTMASTER: Send address changes to Neurology Today, PO Box 1610, Hagerstown, MD 21740. Periodicals Postage Paid at Hagerstown, MD and at additional mailing offices.
LWW_NTY_January 10_19_Layout.indd 1
24/12/18 11:17 AM
Brain & Life® The AAN’s award-winning patient and caregiver magazine, Brain & Life and companion website, BrainandLife.org, centralizes all AAN patdient education content in Just because you can’t one location. A Spanish version, see migraine doesn’t mean it doesn’t Brain & Life® en Español, published exist.” quarterly in 2019. Brain & Life won an Award of Excellence in the 2019 APEX editorial awards competition in the Feature Writing category for its June/July 2018 cover feature on actor Courtney Vance, “Supporting Role.” The magazine also received a FOLIO Eddie Award for the article “The Long Reach of Grief.” F E B R UA RY/M A R C H 2 0 2 0
D E C E M B E R 2 0 1 9/JA N UA RY 2 0 2 0
Alzheimer’s How to Keep People Safe in the Kitchen
Work Disclosure Should You Tell Your Employer About Your Condition?
bertvargas The one @aanbrain moment I would relive? Watching outstanding educators like @jsirven, #JenBickel & #AnnTilton take risks finding new/creative ways to teach #neurology @ #AANAM 2018 #HeadTalks
Nutrition The Real Deal on Supplements
— B R AO D WAY S TA R K R I S T I N C H E N O W E T H
Brain & Life® Books Nav i g a t i ng L i fe w it h
N av i g a t i ng L i fe w ith
C h r on ic Pa i n
Pa r k i n s on’s D i se a se
RO B E R T A . L A V I N , M D, M S
S O T I R I O S PA R A S H O S , M D, P h D
SARA E. CLAYTON, PhD
ROSE WICHMANN, PT
LINDSAY A. ZILLIOX, MD
SECOND EDITION
The AAN’s patient and caregiver book series, Neurology Now™ Books was rebranded Brain & Life® Books.
Anup Patel, M.D.
Follow
@PedsEpilepsyDoc
three words that best describe what my AAN membership @AANMember means: 1. Access 2. Advocacy 3. Opportunities #AANAM
Natalia S. Rost, MD
Follow
@nsanar
My top 3 words to describe what #AAN membership means to me? LEADERSHIP x COMMUNITY = PURPOSE @AANMember @AANPublic #AAN2019 #AANAM 14
POLICY & GUIDELINES Public Policy Medicare Physician Fee Schedule In response to the proposed 2020 Medicare Physician Fee Schedule, the AAN submitted comments to the Centers for Medicare & Medicaid Services (CMS). The comments strongly opposed proposed payment cuts for long-term EEG monitoring services, supported substantial positive changes to evaluation and management (E/M) coding, and provided feedback on a number of proposals that would significantly impact the Merit-based Incentive Payment System (MIPS) program. The AAN’s 41-page comment letter is one of the longest it has ever sent to CMS and it also received coverage in national media outlets. This letter complemented the AAN’s direct efforts with CMS, which included a September meeting at CMS headquarters to discuss the proposed rule’s impact on neurologists and their patients.
long-term EEG monitoring services. Our advocacy worked: CMS recognized its original proposal devalued the services and increased the rates for several of the professional component (physician work) codes. While pleased that we were able to slightly offset the cuts, we still are disappointed with the overall decreased reimbursement. These payment rates will be finalized for 2020, and the AAN is transitioning from fighting the cuts to ensuring members are educated on the coding changes and understand the financial impact for accurate budgeting. In a major victory for neurology, CMS will not collapse the payment levels for evaluation and management (E/M) visits and will instead implement revised office E/M documentation guidelines in 2021, as recommended by the AMA CPT Editorial Panel. The AAN estimates that the combined impact of the changes will result in an increase of approximately $150 million annually in Medicare payments to neurologists for E/M services starting in 2021, as compared to what was proposed in the 2019 Physician Fee Schedule. The revised guidelines maintain the existing five levels of coding for established patients and reduces the number of levels for new patients to four, by eliminating 99201. The AAN received a national award in recognition of the highly coordinated advocacy efforts that resulted in this significant win to preserve access to neurologic care.
2019 Advocacy Wins The AAN had a strong year advancing its legislative and regulatory priorities in Washington, DC. Along with its major E/M victory, other accomplishments include: • FY 2020 Appropriations • Drug Pricing
5% ANNUAL INCREASE in NIH funding 2016–2019
2016 2017 2018 2019
Neurology on the Hill Once more, “Academy green” was the signature color in Washington, DC, on February 26 at the AAN’s 17th annual Neurology on the Hill. Representing 48 states, 214 members participated in nearly 300 congressional visits. Advocates focused on FY20 research funding and Patient-Centered Outcomes Research Institute (PCORI) reauthorization, reforms to step therapy, and the importance of maintaining access to neurologists. More than 3 million social media impressions were generated on Twitter using #NOH19.
Regulatory Advocacy On November 1, CMS issued a final rule for the 2020 Medicare Physician Fee Schedule which included changes to EEG reimbursement. The AAN, along with the National Association of Epilepsy Centers, American Clinical Neurophysiology Society, and American Epilepsy Society, spent several months actively advocating to maintain maximum reimbursement for these critical services. We pursued all means of objecting directly to CMS and to members of Congress, in person and through comment letters, regarding payment reductions to
The AAN has a robust, year-round, regulatory advocacy program. The AAN’s 2019 regulatory advocacy efforts focused on improving cognitive reimbursement, lowering the high cost of neurologic drugs, addressing administrative burdens including step therapy and prior authorization, improving electronic health record interoperability, and protecting access to neurologic care. The AAN met with CMS and other relevant agencies, submitted neurology-specific comment letters, and collaborated with stakeholders across the health care landscape on numerous sign-on letters to ensure that neurologists have a seat at the table throughout the rulemaking process.
214 48
member attendees from states Neurology on the Hill
dcpottsmd
Congressional Visits Neurology off the Hill takes place over the August recess. This year, nearly 40 members participated in local events including clinic tours, district meetings, and fundraisers. Advocates discussed drug pricing challenges in neurology, research funding including the NIH and BRAIN Initiative, PCORI reauthorization, and the Safe Step Act, a bill to establish commonsense exceptions to step therapy in group health plans. Follow #AANAdvocacy to see AAN members in action on the Hill and back home.
Inaugural AAN Legislative Summit
dcpottsmd If I could relive one moment of my @aanbrain experience, it would be my recognition as 2008 Donald M. Palatucci Advocate of the Year for advocating use of #ExpressiveArts to improve quality of life in persons w/#Alzheimers #dementia #AANAM #AANPALF #AANAdvocacy #LestersLegacy #BringingArtToLife #CultureOfCompassion
What’s the best thing about being an AAN member? By: Shaheen Lakhan, MD, PhD, MEd, FAAN
The Academy facilitates personalized experiences of engagement, education, and advocacy, in addition to larger learning communities for its diverse members.
On September 24, 33 AAN members visited Capitol Hill as part of the inaugural AAN Legislative Summit. This new event is an additional opportunity for the Academy to influence members of Congress on current issues important to neurology, strengthening relationships that have been built at other advocacy events throughout the year. AAN members discussed the We PAID (Protect American Investment in Drugs) Act of 2019, a bipartisan bill to prohibit pharmaceutical companies from charging unreasonable prices for drugs when companies develop prescription drugs using federally funded research, such as NIH or CDC grants. They also urged their representatives to sign a congressional letter led by Reps. Blumenauer (DOR), McMorris Rodgers (R-WA), Sewell (D-AL), and Wenstrup (R-OH) expressing concerns over the CMS proposal on reduced values of the new long-term video EEG monitoring codes. The final letter was sent to CMS with 68 signatures—including 18 as a direct result of AAN member congressional visits.
BrainPAC 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 health policy issues. BrainPAC is the only political action committee representing 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. Despite representing about two percent of the physician community, BrainPAC became a top-10 medical specialty PAC in the 2018 election cycle. BrainPAC is funded solely by AAN members who are US citizens or permanent residents and supports candidates who back Academy priorities. Since its inception in 2007, BrainPAC has raised more than $3 million from over 4,600 members.
Guidelines The AAN continues to address areas of controversy and importance in its evidence-based guidelines program. There are currently 24 active projects at various stages of development and the AAN is participating in several collaborations with our neurology partners for subspecialty related guidelines. The AAN’s rigorous and nationally recognized process resulted in the Academy publishing five evidencebased products in 2019: • Comprehensive Systematic Review Summary: Treatment of Tics in People with Tourette Syndrome and Chronic Tic Disorders • Practice Guideline Recommendations Summary: Treatment of Tics in People with Tourette Syndrome and Chronic Tic Disorders • Practice Guideline Update: Pharmacologic Treatment for Pediatric Migraine Prevention • Practice Guideline Update: Acute Treatment of Migraine in Children and Adolescents • Practice Guideline Update Summary: Vaccinepreventable Infections and Immunization in Multiple Sclerosis
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CONFERENCES & COMMUNITY Conferences 2019 Annual Meeting
The 2019 Annual Meeting took place in Philadelphia, which hosted a record of more than 15,000 people from more than 100 countries who experienced a meeting featuring more than 250 education programs, 3,000 scientific presentations, seven plenary sessions, and over 250 lively and interactive Experiential Learning Area presentations. The energetic buzz for the meeting was established by a night celebrating at the Opening Party at the Reading Terminal Market. The AAN gave back to the local Philadelphia community in the form of the Brain Health Fair, which had more than 3,000 attendees. In addition to connecting with nearly 300 exhibitors, attendees engaged in more than 16,000 Twitter, Instagram, and Facebook posts resulting in 85.5 million impressions across the platforms.
2019 Sports Concussion Conference
The Sports Concussion Conference was held in Indianapolis, IN, and was attended by nearly 450 neurologists, athletic trainers, non-neurologist 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 86 abstracts were presented at the conference, and the AAN partnered with the NCAA to host an attendee reception in the NCAA Hall of Champions.
Community 2019 Fall Conference and Advanced Practice Provider Pre-conference
The AAN Fall Conference, offered in Las Vegas in October, had more than 750 neurology professionals seeking the yearend opportunity to learn the latest clinical advances in neurology and earn up to 15.25 CME. In addition to a series of Neurology Update programs, practice management programs, and popular scientific sessions and clinical courses programming from the 2019 Annual Meeting, a new one-day APP Pre-conference focused on clinical topics geared toward APPs new to neurology, those transitioning to neurology, and those in need of the latest clinical updates. More than 170 people attended the inaugural APP Pre-Conference.
Bike Helmet Giveaway Over the past eight years, the AAN has donated 16,000 bike helmets to the local Minneapolis community through its bike helmet giveaway program, which is designed to raise awareness of and help prevent head injuries in Minnesota. The Academy held its eighth annual bike helmet giveaway event in June, distributing 1,000 helmets to the public outside the AAN headquarters. Attendees lined up around the block to receive free helmets for adults and children. In acknowledgment of the day, Minneapolis Mayor Jacob Frey proclaimed Brain Health Awareness Day in the city. The event received media coverage from 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.
2019 Brain Health Fair The Brain Health Fair is a free public event presented by the AAN during the Annual May 9, 2019 • Philadelphia Meeting to connect neurology patients, caregivers, students, and anyone interested in brain health. This year’s fair drew over 3,000 people to the Philadelphia Convention Center. There were 25 presentations (both in Spanish and English), 50 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 a mobile stroke unit, interact with trained service dogs, experience a one-of-a-kind BrainDome, learn about home modifications, hold a human brain, view animal brains, and gather resources. More than 90 high school students participated in a daylong specialized neurology experience to learn about the wonders of the brain.
16,000 Total bike helmets donated over the past 8 years
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Leadership
Membership 2019 Leadership Programs:
Cultivating Leaders. Building Neurology’s Future. Commitment to Leadership Development From personal development opportunities to transformational career pathways, the AAN is here
to guide your leadership growth. Apply for one of 10 unique opportunities covering the full spectrum Large shifts in stages. the landscape of the health care of career AAN.com/view/lead industry have led to a gap between the skills that health care leaders possess and the skills their organizations need. This gap is largely felt by physician leaders whose medical education has traditionally focused on developing excellent clinical skills, but not the fundamental leadership skills needed to advance their organizations in this changing industry. To meet these challenges, the AAN makes member leadership development an organizational priority. The Academy strives to train members through varying leadership development programs, to support and prepare them for desired leadership roles, and assist them in achieving their desired level of leadership potential throughout their careers, to ultimately increase patient and physician satisfaction and improved clinical outcomes. Since 2014, the AAN has expanded its leadership offerings by developing customized programs to address specific priority areas such as advocacy, diversity, and physician wellness, as well as to support members throughout their career.
• Director Mentorship • Diversity Leadership • Emerging Leaders • Practice Leadership • Transforming Leaders • Women Leading in Neurology • Enhanced Resident Leadership • Live Well, Lead Well • Medical Student Diversity • Palatucci Advocacy Leadership
Continued Member Engagement with the AAN The most promising leaders are those who have experience, a compelling vision, exemplify the core values of an organization and can engage and inspire others to rally around a shared vision. The AAN continues to develop opportunities and resources for sustained engagement and ongoing leadership development of leadership program graduates. Some of those opportunities include: • Leadership Alumni Newsletter • Alumni Networking Opportunities • Leadership Alumni Synapse Community
Recruitment and Retention 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 the Academy can claim to be home to 92.7 percent of US neurologists. Successful year-over-year recruitment and retention of members is attributed to the AAN’s ongoing commitment 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.
New FAAN Members The AAN had another strong year with approved applications for Fellow of the AAN status in 2019, at 274. The photos of those chosen as fellows will be included in a display of new FAAN members at the 2020 Annual Meeting. Those who were present at the 2019 Philadelphia 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.
Synapse The strength of SynapseSM Online Communities continues to grow. Wrapping up 2019, there were a total of 21,181 AAN members belonging to one or more of the 56 Synapse open or private communities. Synapse provides a platform for AAN section members to openly share special interest and subspecialtyrelated information and resources with colleagues.
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Advanced Practice Providers and Care Team
Neurology History Museum
Member engagement with the Neurology Career Center remains strong for both applications and job seeker profiles. Trackable applications are estimated to reach 5,830 in 2019, representing a 12-percent decrease over 2018 (when there were 6,670 applications). A smaller decrease was also seen in job seeker profiles. New profiles are projected to reach 845 in 2019, a slight dip from 2018 when there were 880 new job seeker profiles.
This membership saw continued record growth and interest, with more than 1,400 members in 2019. The category has grown significantly in recent years; in 2014, there were just 228 advanced practice provider members.
2018: 1,100 APP Members 2019: 1,400 APP Members Academic Year Memberships Recognizing the needs of our members in training, in June 2018, membership moved all Student, Intern, and Junior members to an academic year membership, running July 1 through June 30. This included the launch of a new online system to allow residency programs a seamless and streamlined way to add and renew Junior members’ memberships. Following the inaugural year, the 2019-2020 academic year launched in May, and as of 2019 year-end, 81-percent of programs contacted by AAN have utilized the online system. Additionally, as of year-end 2019, we are trending 4.6 percent ahead in total Junior memberships over 2018 year-end.
Career Services
AAN.com The fifth floor of the AAN headquarters added a “Neurology Through the Years” display in September. Led by the History and Archives Committee, and with input from AAN section members and staff, the museum features neurologic images and quotations from neurology notables, as well as artifacts and books belonging to the AAN founders. Visitors to the AAN are encouraged to spend some time perusing the display.
International Membership The AAN remains dedicated to serving the needs of our members around the globe. Members outside of the United States make up 21 percent of total membership and represent 141 countries. Included in the AAN’s international strategy is the dedication from the AAN International Subcommittee, charged with promoting and developing strategies focusing on outreach and education for neurology in resourcelimited countries or regions of the world to facilitate better care for patients with neurologic disease. The subcommittee continues to focus on meeting the needs of our global members, including improved access to membership benefits in low and lowmiddle income countries and supporting a record 35 scholarships dedicated to young neurologists and neurology professionals to attend the 2020 Annual Meeting in Toronto.
In 2019, AAN.com saw an 18-percent growth in new visitors. During May 2019, we reached an all-time high in traffic with 205,175 visitors. Mobile use of AAN.com has risen significantly in the past year to 45 percent, and Online Learning, Conferences, and Guidelines continue to be the most popular areas of the site. In 2019, the website went through several updates focused on improving the findability of content and the relevancy of personalized experiences for our members.
May 2019
205,175
visitors to AAN.com
Business Administrators Based on feedback gathered in 2018, the Academy engaged business administrators in different ways in 2019. Academic administrators were invited to participate in the Academic Chair Summit held in Chicago in March. There was an administrator networking event at the Annual Meeting. A segment of the Fall Conference curriculum was designed to be “For BAs, By BAs” to speak to their unique needs and challenges of practice operations. The Academy’s investment in content resulted in an increase of business administrator members from 245 in 2018 to 314 in 2019.
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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 19,500 17,000
53.4%
15.7%
13.2% 6.9% 3.5% 6.1% 1.3%
14,000 1995
2000
2005
2010
2016
2017
2019
Based on 2019 year-end data. Includes members in arrears.
Membership Demographics
2019
92.5%
More than of current market share
US Members:
28,000
US Neurologists:
International Members:
8,000
14,500
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FINANCIAL SUMMARY 2019 Revenue $63.4M
37%
Royalties & Publications
17%
Conference & Education
17% Grants & Gifts
14%
9%
6%
10%
10%
8%
Membership Dues
Exhibit Sales
Other
2019 Expenses $57.8M
37% Education
15%
General & Administrative
13%
Membership
Publications
Grants & Awards
Advocacy
7%
Clinical Practice
85¢ of every dollar directly applied to member benefits!
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2019–2020 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 patient centered neurologic care and enhance member career satisfaction. The 2020 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 and enhance member and staff 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 high value, team-based, patient-centered, clinical care 7. Strengthen advocacy on behalf of and in collaboration with members and patients 8. Increase the reach of AAN resources to enhance patient-centered neurologic care 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 2020 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 toward 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!
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AAN BY THE NUMBERS
36,000 members
Neurology Today member circulation
23,226 Members represent
30
international scholarship recipients
140 countries
Education Research Grants Awarded
Members who participated in the 17th annual
NOH
214
$94,500
2.51 M
unique visits to AAN.com
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grant recipients
48 states and DC represented 300 US congressional offices visited
Facebook Fans
3 million impressions with #NOH19
238,652
all accounts
LinkedIn Followers
10,502
AAN account only
digests read
badges awarded
549,017 thread reply percentage
92.3%
3,977 communities
56
new threads
1,525
41,281
Twitter Followers
Instagram Followers
all accounts
AAN account
AAN account only
Brain & Life account
148,452 20,471
9,042 3,123
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Robert W. Baloh, MD, FAAN / Los Angeles, CA Faculty, Neuro-otology courses “How has the meeting changed over the years?” “It’s gotten so big. There are so many things that it’s impossible to go to everything. Certainly, the plenary sessions are always very good and it’s still the best clinical neurology meeting there is.”
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Angelique Manasseh / Garden City, MI Fourth-year medical student “What have you experienced so far?” “I went to two sessions for medical students this morning about what to look for in a residency and what they are looking for. Those two alone were worth the trip! They really gave me the most valuable advice I’ve gotten to date on career issues in medical school!”
Claudia Gambrah Sampaney / Philadelphia, PA Fourth-year medical student, abstract presenter, third time attending AAN meeting “What do you enjoy about the AAN Annual Meeting?” “With the AAN meeting, you can pick whatever topic you are interested in and there will be posters on it and people speaking about it and people interested in it. You can really explore your interests, no matter what your niche is.”
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American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415 AAN.com Member Services (800) 879-1960 (US/Canada) (612) 928-6000 (International) Š American Academy of Neurology