2023 December AANnews

VOLUME 35 · ISSUE 12 · DECEMBER 2023

This is the final print issue of AANnews. Keep reading the same great articles on AAN.com!

WHAT’S CHANGING FOR NEUROLOGY IN 2024?

Medicare Physician Fee Schedule Final Rule Released Each year, the Centers for Medicare & Medicaid Services (CMS) issues regulations that impact the reimbursement of physicians. On November 2, 2023, CMS issued a final rule updating payment policies and rates for physicians paid under the Medicare Physician Fee Schedule in 2024. The final rule illustrates the importance of the AAN’s regulatory advocacy efforts on behalf of neurologists and their patients. The AAN previously submitted 48 pages of detailed comments in response to the various proposals made by CMS. CMS is projecting that the overall impact of changes contained in the rule will result in a one percent increase in payments to neurology as a specialty broadly. Due to the phase-out of temporary relief measures contained in the Consolidated Appropriations Act of 2023 and statutory budget neutrality requirements, CMS finalized a reduction in the Fee Schedule conversion factor of approximately 3.4 percent to 32.74. The AAN will continue to work with legislators to offset the impacts of statutorily required cuts. The AAN is committed to payment reform efforts to promote a sustainable payment system, such as ensuring physicians receive an inflationary adjustment tied to the Medical Economic Index, and to working with regulators and legislators to ensure that CMS appropriately values the work done by neurologists.

Evaluation and Management (E/M) Visits In a major win for AAN advocacy, CMS is modifying previously finalized policies impacting split (or shared) E/M visits. The agency is finalizing a revised definition of “substantive portion” for Medicare billing purposes. Under the new definition, the substantive portion is more than half of the total time spent by the physician and NPP performing the Continued on page 18

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Storms and Space Flight: As AANnews Goes Digital, a Look at Its History

Unconventional Learning Is Back with the Return of Annual Meeting Hubs

Longtime AAN members may recall receiving NeuroNews.

This short, soon-renamed newsletter came out every two months—and its first issue, which rolled off the presses in February 1988, made some big promises. Along with news from within the AAN and updates on the organization’s programs, NeuroNews planned to deliver timely, accurate information on the biggest issues facing the field of neurology.

Hubs for interactive learning are back! Step outside of a traditional classroom during the 2024 Annual Meeting and into the world of hubs— Annual Meeting an out-of-the-box learning format offering unique Denver and Online • April 13–18 education and networking.

More than conventional lectures, hubs are creative programs that leave participants with take-home skills and resources that can easily be transferred to their patients and careers. Be sure to check out all eight of these unique areas at the upcoming Annual Meeting in Denver and online and see a full lineup of programming at AAN.com/AMHubs.

“In the past, neurologists have been reluctant to exercise their political influence,” said the AAN’s president at the time, Theodore L. Munsat, MD, FAAN, in that first issue’s cover story. “Today’s rapidly changing health care legislation requires direct action from our members. If we don’t speak up now, neurologists will have very little control over their profession in the near future.

This is why the Academy is publishing NeuroNews.”

Continued on page 4

8 Inclusivity Evolves to Meet Member Needs, Reflect Societal Changes

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16 Renew Your Membership

by December 31—Keep Your Valuable Benefits!

Continued on page 6

17 Neuro-oncology

Explored in Continuum

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AANnews · December 2023

December Highlights The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction.

The Vision of the AAN is to be indispensable to our members.

Contact Information American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415 Phone: (800) 879-1960 (toll free) (612) 928-6000 (international) Email:

memberservices@aan.com

Website: AAN.com For advertising rates, contact: Sharon Ames Sr. Account/Relationship Executive Wolters Kluwer Phone:

(516) 993-7800

Email:

sharon.ames @wolterskluwer.com

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Transforming Leaders Graduate Reimagines Approaches to Education, Care Access

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Researchers Investigate Striking Health Disparities with AAN Award

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New Online Learning Center Offers Improved Member Experience

Scott M. Friedenberg, MD, FAAN, explains how skills learned in the AAN’s Transforming Leaders Program helped him treat a hospital system’s “headache.”

Two recipients of the Clinical Research Training Scholarship in Neurodisparities work toward better brain health for everyone.

Online learning just got a major upgrade. Enjoy better video capabilities, new ways to explore courses, and a unified experience across devices at Learning.AAN.com.

News Briefs AAN Chief Executive Officer: Mary E. Post, MBA, CAE

Editor-in-Chief: Melissa W. Ko, MD, MBA, CPE, FAAN Managing Editor: Angela M. Babb, MS, CAE, APR Editor: Val Lick Writers: Ryan Knoke, Sarah Parsons, and Tim Streeter Designer: Siu Lee Email: aannews@aan.com AANnews® is published monthly by the American Academy of Neurology for its 40,000 members worldwide. Access this magazine and other AAN publications online at AAN.com.

The American Academy of Neurology ’s registered trademarks and service marks are registered in the United States and various other countries around the world.

“American Brain Foundation” is a registered service mark of the American Brain Foundation and is registered in the United States.

The inclusion of advertisements and/or promotions of Sponsors and other Internet sites or resources that offer content, goods, or services on the Website does not imply endorsement of the advertised/promoted products or services by AAN.

“With a record-breaking Fall Conference in the books, we’re already looking forward to the 2024 AAN Annual Meeting in Denver and online April 13 to 18!

Registration and housing are open now—make your plans today!”

—Chief Executive Officer Mary E. Post, MBA, CAE

Leadership Programs In their post-program assessment, graduates of the 2023 AAN Leadership Programs indicated that the programs showed positive influences on their leadership skills (28 percent increase in confidence), well-being and resiliency (7 percent less burned out), connection with the AAN (27 percent stronger) and their awareness of opportunities to engage with the AAN (14 percent increase).

Question of the Day In 2023, a select number of RITE questions were included in the Neurology Question of the Day app. This year, 40 questions from the 2024 RITE will appear in Question of the Day interspersed with other questions through early February. Of course, users will not know which questions are from the RITE. Residents are encouraged to log in daily to Question of the Day to help them prepare for the 2024 exam.

Teleneurology Webinar A new, free webinar is available on pediatric neurology. It covers topics such as how to avoid common obstacles to a successful pediatric exam via telehealth and considerations for virtual pediatric headache visits. To browse the AAN’s catalog of webinars, go to Learning.AAN.com and click “Webinars.”

Brain & Life Editor-in-Chief It’s not too late to apply for the editor-in-chief position at Brain & Life®, the AAN’s magazine for neurology patients and caregivers. Applications are due January 2, 2024, for the term starting January 2025. Learn more at AAN.com/BrainandLifeEIC. 

PRESIDENT'S COLUMN Sacco’s Legacy Expands Academy’s Commitment to Research

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Support for research is a cornerstone of the AAN. As we wrap up our celebration of our 75th anniversary, I want to pay tribute to our leaders who had the vision to develop a mechanism to support young investigators to launch their research careers. In 1989, Drs. Roger Rosenberg, Lewis Rowland, and Francis Kittredge had the first discussions that led to what is now the American Brain Foundation.

Now, more than 30 years later, there’s been millions of dollars raised and so many young investigators whose careers have been successfully launched. As a new chair of a department, I have a clear understanding of how critical it is to get young investigators engaged and Jackson excited about research and give them an opportunity to test their hypotheses and provide them some initial data to make them successful in applying for larger grants.

We recently announced a new scholarship program supporting early career trainees focused on how to help people maintain a healthy brain over their lifetime. Offered by the AAN and the American Heart Association, these scholarships were made possible by a bequest by our former president Ralph L. Sacco, MD, MS, FAAN, FAHA, who passed away in January from a glioblastoma.

It was fitting that we announced this new program during our 2023 Brain Health Summit, where we shared our vision to improve the nation’s brain health by 2050 and brought together nearly 150 cross-disciplinary leaders with expertise in brain health to collaborate on optimizing brain health for all.

Dr. Sacco’s generosity comes as no surprise to anyone who worked with him, volunteered alongside him, or was mentored by him. He gave freely of his time, ideas, knowledge, and attention. And, of course, his dedication to research was unmatched. An international expert in stroke epidemiology and health disparities, Dr. Sacco was the founding principal investigator of the Northern Manhattan Study, the Florida Puerto Rico Collaboration to Reduce Stroke Disparities, and the Miami Clinical Translational Science Institute.

In 2024, the Ralph L. Sacco Scholarships in Brain Health, which we are calling the Sacco Scholars program, will award two $150,000 scholarships to early career trainees pursuing a two-year research or public health service project focused on prevention of brain disease and/or maintenance of brain health.

Applications for the inaugural scholarships will open early 2024.

Please channel Dr. Sacco’s mentorship skills and encourage any early career members who may be promising researchers to apply.

Naturally, Dr. Sacco championed the AAN Research Program during his tenure as an AAN leader. Our call for applications for the awards for 2024 garnered 145 applications from talented and hopeful investigators. Since the American Brain Foundation was founded in 1993, we have granted nearly $45 million to over 300 researchers. As a testament to the quality of our applicants and research funded, more than 85 percent of our researchers

have gone on to secure funding from the National Institutes of Health and other national funders.

It's not too late for applications for another research opportunity offered by the AAN in collaboration with the National Institutes of Health and the Medical University of South Carolina. The TRANSCENDS (Training in Research for Academic Neurologists to Sustain Careers and Enhance the Number of Diverse Scholars) program is designed to train early career neurologists to conduct high-quality research.

The program is open to US citizens or permanent US residents who are disabled and/or belong to an underrepresented in medicine group. Through a mainly online program, up to six participants will complete a Master of Science degree in clinical research, receive mentoring and support in developing their current research portfolio, and opportunities to present research and network with AAN leaders at the Annual Meeting, among other benefits. You can learn more at AAN.com/ research/transcends-program.

While the AAN supports all of these programs, we rely especially on your support of the American Brain Foundation to fund our Research Program, which last year provided grants to 23 investigators. Have you made your year-end donation to the American Brain Foundation to support our Research Program? If not, I invite you to do so today by visiting AmericanBrainFoundation. org/donate Our donations directly benefit these young researchers—many of whom would not be able to pursue their research aims without this bridge funding. If you haven’t yet renewed your AAN membership, you can also make a donation to the American Brain Foundation when you renew.

Let’s join together, honor Dr. Sacco’s legacy, and work toward our vision for improving brain health for everyone by 2050!  As I announced last month, this will be our last print issue of AANnews, but we will continue to deliver the latest news from the AAN to you twice a month in your AANe-newsTM email newsletter, or you can find it on AAN.com. There you can also find this column in its new format—60-second videos with the latest Academy updates. Please scan the QR code to see the latest President’s Spotlight video!

Carlayne E. Jackson, MD, FAAN President, AAN cjackson@aan.com @CarlayneJackson on Twitter AANnews • December 2023

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PUBLICATIONS Storms and Space Flight: As AANnews Goes Digital, a Look at Its History continued from cover

Past AANnews editors-in-chief include, from left, Stephen M. Sergay, MB BCh, FAAN; Walter J. Koroshetz, MD, FAAN; Austin J. Sumner, MD, FAAN; and John D. Hixson, MD. Melissa W. Ko, MD, MBA, CPE, FAAN, right, is the current editor-in-chief.

The four-page first issue provided a lengthy article on budget reductions, predicting that physicians would “feel the pinch” of an omnibus budget bill that tightened federal and Medicare spending. It also covered Harvard University’s work developing a resource-based relative value scale and the AAN’s recent victories in Congress.

At first glance, NeuroNews seems completely different to its current iteration—the glossy, colorful AANnews®—but a closer look yields more similarities than differences. AANnews still covers key issues facing neurology professionals and their patients, alerts members to organizational news, and focuses on the news that matters to AAN members. And, much like its precursor, it’s going to change.

“It’s all about evolution,” said AANnews Editor-in-Chief Melissa W. Ko, MD, MBA, CPE, FAAN. “AANnews has been growing and changing with the AAN for decades, and now— as we prioritize becoming a digital-first organization—our member news is going online.”

The December issue of AANnews is the final print version of the 35-year-old newsletter. The AAN plans to continue delivering its latest highlights to members twice a month in its AANe-newsTM email newsletter. Meanwhile, the feature stories, Q&As, and organizational updates of AANnews are headed to AAN.com— check out the new “Latest News” column on the homepage or go to AAN.com/LatestNews.

“AANnews is an extension of our vision—to be indispensable to our members,” Ko said. “It’s become increasingly clear that taking these stories online is the best way to do that. No matter where you are, you’ll be able to access the news that matters for you as a member.”

Covers from 1988 and 1996.

AANnews • December 2023

The 80s were a heady period of change for the Academy—and as the end of the decade neared, leaders wanted a new way to communicate with members. Stephen M. Sergay, MB BCh, FAAN, was tasked with spearheading the effort and leading the new Public and Professional Information Committee.

The committee would brainstorm ways to link members with the Academy and with other neurologists. Meetings began in the afternoon and stretched into the evening, but another setting was just as important.

“We would have dinner afterwards, and that’s where things truly took shape,” Sergay said. “We could speak about our dreams in our work, about what we thought Academy members needed, about what the Academy was about. We just played with ideas, and it was wonderful.”

While the Academy had published newsletters before, these were short, simple affairs. The publication the committee envisioned— which Sergay would go on to lead as its first editor-in-chief— would offer far more. Along with delivering relevant, neurologyspecific news, it would open a crucial dialogue between the AAN and its members. Early issues of the newsletter printed letters to the editor, answered questions about coding dilemmas, and ran a member-sourced series of historical vignettes. It was a public conversation in the not-so-long-ago days before social media, online comment sections, and the Academy’s own Synapse platform.

“We thought it was a wonderful thing, that creative back-andforth between the Academy and the members, that relationship beyond the pages of a scientific journal,” Sergay said. “The staff was smaller then, but it was the beginning of a major growth phase for the Academy. That back-and-forth was important.”

With change around the corner, issues from the AANnews archives and recollections from past editors provide a colorful, human look at the publication’s history.

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AANnews Takes Shape

The “World Wide Web” One notable 1996 issue provides a nostalgic window at the beginning of the Academy’s presence online. “Surf’s up!” an excited headline began. “The American Academy of Neurology’s site on the World Wide Web is now ready for surfing.”

As the Academy grew and its newsletters got longer, a major change for that dialogue was around the corner.

Flipping Through the AANnews Archives Every issue of AANnews and its precursors provides a snapshot of a moment in neurology, whether large or small. “Congress to declare ‘Decade of the Brain,’” one 1989 headline proclaimed. “Congress passes Medicare reform package,” said another. “Neurologists Play Key Role in Organ Donation,” a 1996 story noted.

Other headlines were lighter—a spring 1992 cover story profiled Roberta L. Bondar, MD, PhD, a Canadian member of the AAN who became the first neurologist in space.

The story informed members that the site, billed as a “one-stop shopping center for neurologists,” could be accessed with a personal computer, internet access (“your phone company is often a good place to start”), and a World Wide Web browser (“We recommend the Netscape Navigator ™ 2.0 or higher browser”). It explained that members could sign up for a username and password, which would reach them the oldfashioned way—the US Postal Service.

“Your way of messaging always changes with the technologies,” said Walter J. Koroshetz, MD, FAAN, the newsletter’s editorin-chief at the time, who now serves as director of the National Institute of Neurological Disorders and Stroke. “Everything’s a lot quicker now—hit the link, take a look. The newsletter was founded before I got there, but the purpose was always to get information to neurologists—what the Academy was doing, what issues were affecting neurology. There weren’t too many places where you could get that.”

“The neurosciences have much to gain from microgravity research, and I am pleased to have taken ‘the one small step’ that could start a giant leap forward for our specialty,” Bondar said.

The article detailed Bondar’s work testing her fellow astronauts for the physiological effects of space travel, especially with regard to the vestibular system. She quipped that astronauts were “perfect subjects” during a space flight, partially because “they will never miss a test appointment.”

Sometimes, stories from the newsletter collided with topics of national interest. A 1992 story featured remarks from members who, amid the deadly chaos of Hurricane Andrew, “found themselves without telephones, offices and homes, [but] still found time to help those in need.”

“People really don’t realize the scope of the devastation until they have seen it. It looked like an atomic bomb had done the damage,” said Walter G. Bradley, DM, FRCP, FAAN, speaking to the newsletter about traveling to the epicenter of the storm’s desolation to help establish a Red Cross emergency shelter.

Initially, Bradley and his fellow physicians fell back on their primary care backgrounds to provide triage and emergency care.

Neurologists were needed, however, when neurologic patients found themselves without medication and medical records.

“We solicited free pharmaceuticals from various companies, contacted the patients that needed them, and distributed them,” Bradley told the newsletter.

The article concluded with Bradley’s description of a community that pulled together amidst disaster: “It was phenomenal. You would expect such an event to produce disruption, but actually there was great community spirit and unification. Everyone did whatever they could to help.”

The AAN.com homepage as seen in December 1996.

The AAN’s online presence, much like its newsletters, has seen plenty of change over the years. The organization’s website started out simple and text-heavy in 1996, with a beige background and a large illustration of synapses firing. The modern website—which, to be fair, may also look dated nearly 30 years from now—has a slick design and far more information for neurologists and members of the public alike. A vast array of resources from the Academy are available on the “World Wide Web,” from guidelines and online journals to podcasts and videos.

“Change can be bittersweet as well as energizing,” Ko said.

“The Academy will continue to grow with our members— the people who make the AAN the incredible organization it is today.” 

AANnews • December 2023

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EVENTS Unconventional Learning Is Back with the Return of Annual Meeting Hubs continued from cover Academic Hub

Research Hub

This dynamic area is geared specifically toward academic neurology departments. Whether you’re a department chair, professor, or medical student, it’s the place to connect with fellow participants at networking tables, celebrate the AAN Changemaker Award, and more. Topics and themes include: How a department can grow its neurology residency Handling difficult conversations with leaders or staff Issues facing international medical graduates

This area highlights the moment of discovery, the beauty of science, and encourages researchers to dream big. Gain inspiration for starting—or continuing—your research and make critical connections to help you along your research journey through: Fireside chats to discuss the daily plenary topics and Q&A with plenary speakers Morning Coffee Connects Talks about moving your lab mid-career and advancing diversity in neurologic research National Institutes of Health Day on April 16 to get the latest updates from the National Institute of Neurological Disorders and Stroke

HeadTalks Originally inspired by TED Talks, this highly popular hub isn’t tied to a specific theme, so participants can expect unconventional programming on a wide range of topics served up in bite-sized time frames and gamified formats that include: Talks about the neurology of illusions and comics The neurology of becoming an influencer Neurology-themed game shows, like Neuro-Jeopardy

Innovation Hub If you’re looking for innovative ways to think about the brain, neurology practice, and patient care, then this hub’s array of lively talks, activities, and themes are for you with its: Daily paint and wine sessions Presentations about board games, artificial intelligence, and more Activities on virtual reality systems and vintage video game consoles

Leadership University This is the only area that will be solely dedicated to leadership development—and not to be confused with the AAN’s intensive leadership cohort programs. This hub offers accessible, interactive, and engaging programming designed for anyone to network, grow, and learn strong take-home leadership skills, including: Leadership fundamentals Leadership through Diversity, Equity, and Inclusion (DEI) Leadership throughout your career Leading in the business of neurology

Practice and Policy Hub Visit a one-stop-shop for a robust lineup of tools and resources to help you manage a successful practice, improve quality of care, and learn about—and get involved in—the latest advocacy efforts to make an impact on the future of neurology. Look for dynamic sessions on: Practice management support and sustainability Coding and reimbursement Telehealth practices

AAN.com/AM

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AANnews • December 2023

Trainee Hub Medical students, residents, and fellows will find a whole host of tools and resources to help them excel at every stage of their career. Activities and talks include: How to negotiate contracts How to successfully navigate interviews Interactive discussion and networking opportunities Neurology games, like Codenames and Mad Libs

Wellness Hub Your destination for all things wellness at the Annual Meeting.

Learn how to practice wellness both in your career and personal life, and take part in activities to rest, relax, and rejuvenate the body, mind, and soul during the busy week with: Sessions on moral injury and burnout Bollywood dance Stress puppies from local shelters Yoga and guided meditation 

Annual Meeting

Denver and Online • April 13–18

Early Annual Meeting Registration Discounts End January 18!

Secure your deepest discounts to 2024’s biggest opportunity to come together with your global neurology community in Denver and online April 13 to April 18.

Whether you join us in person or from the comfort of your home, the largest neurology gathering of the year is not to be missed! Top-tier education, the latest breaking science, serendipitous connections, and exciting discussions with neurology’s brightest minds await you. Visit AAN.com/AM before January 18 to learn more and to take advantage of the greatest registration savings. 

MEMBERSHIP Inclusivity Evolves to Meet Member Needs, Reflect Societal Changes The AAN was launched in 1948 because a neurology resident at the University of Minnesota, Joseph Resch, wanted to be included in an organization that would help further his professional growth when he went into practice, and the highly exclusive American Neurological Association was not open to him with its membership limited to 250 and emphasis on academic achievements.

According to the 1973 account of the AAN’s early years by Joe Brown, MD, FAAN, “Certain ruling principles were developed to ensure that the Academy always would be open to any qualified individual. Active membership was to be automatic for all persons who had board qualifications in neurology, and junior membership was to be open to all residents in training in neurology. Associate membership was established for those in related basic sciences and also for qualified clinicians who were not certified by the American Board of Neurology.” Dues were set at a reasonable $5 a year.

However welcoming the new AAN would be to neurosurgeons and psychiatrists, “to ensure continuing neurologic direction of the new organization, the category of fellowship was established,” Brown recalled. “Fellows would be elected only from among known clinical neurologists. Although active members were entitled to vote, only fellows could hold office.”

Membership categories have fluctuated from time to time. International neurologists were once designated as “corresponding members.” Senior memberships were added in 1961. In 2008, business administrators were invited to join the AAN. Further embracing the neurology care team, entry was offered to advanced practice providers and the first 228 joined in 2014. That number has grown to more than 1,900.

The Academy has since diversified its criteria and seen significant growth in the number of Fellows of the AAN, which recognizes members’ professional accomplishments and enables them to be nominated to leadership positions on the Board of Directors. Today, some 15 percent of members have the FAAN designation.

“An ecumenical approach to many problems” While the founders were white, middle-aged males, Francis M. Forster, MD, FAAN, found nuance in the unique backgrounds of his fellow “Four Horsemen” A.B. “Abe” Baker, MD, FAAN; Russell N. DeJong, MD, FAAN; Adolph “Ady” Sahs, MD, FAAN. “We were really an unusual combination. Abe was of a big city practicing Jewish family of the merchant class. Ady Sahs was from a small town in western Iowa and a Congregationalist. Russ was of Michigan Dutch derivation. His family included distinguished state Supreme Court judges. I was from a blue collar, Roman Catholic background on the edge of Cincinnati but had

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AANnews • December 2023

trained and remained teaching in the East. The differences in our backgrounds gave us an ecumenical approach to many problems.”

Mid-century America was exclusionary in many ways, from segregated drinking fountains for White and Black people to quotas limiting the numbers of Jewish people attending medical school. Knowing that their son wanted to be a doctor, the parents of former AAN President and AAN Foundation Chair Lewis P. “Bud” Rowland, MD, FAAN, changed the family name from “Rosenthal” so he would be accepted at Yale University.

“His father changed it when Bud was a senior in high school,” Rowland’s wife, Esther, who has witnessed and participated in the Academy’s history for 65 years, told AANnews in November 2022. “They knew about the Jewish quota in all the Ivy League schools. Bud’s father also wanted to change the name because he was being discriminated against by an antisemitic fabric company that was very popular at the time and was not recognizing him as a salesman. So, they changed it and then it became a problem with his high school records. Bud’s father had to go to the school and saw the transcripts they were sending to the colleges and it originally had ‘Rosenthal’ crossed out and ‘Rowland’ on the top and he made a fuss and said, ‘You can’t do that’ and it became an issue. But Bud got into Yale and his brother got into Harvard. We do know that those schools really did have, at the most, 10 percent…. It’s frightening to see how openly antisemitic some of these schools and colleges were and had a very strict quota. At Yale they had a very small quota for Jews, women, and practically no minorities.”

Joseph M. Foley, MD, FAAN, another former Academy president, shared how founder A.B. Baker “was told to get out of Minneapolis because, despite his superior talents, the University of Minnesota was not going to make a Jew a professor of anything. They already had one, and two would be out of the question. The attitude was not unusual in many parts of the United States in those days. World War II, for all the misery it produced, had the effect of leading most of the American people out of the self-destructive morass of bigotry, that vice in which a man is judged by other men’s misperceptions of him. He endured and survived this insult, and he never compromised the nobility and integrity of his Jewishness in his future career. He stayed in Minnesota, and Minnesota and the world of neurological medicine are better for it.”

Esther and Lewis P. “Bud” Rowland, MD, FAAN, 2008 Annual Meeting.

“It went back to the schools” Contrary to the prejudices of the time in some parts of academia, the Academy was a welcoming organization. But there were relatively few women or non-White physicians, let alone neurologists, in 1948. “It went back to the schools,” said Esther Rowland. “If women were not professors, if Black people were not professors in the medical schools, they were not going to be members of the Academy. It all went back to that. It was not that the Academy purposely discriminated. There were very few women in the beginning, and many, many more men.”

Among the 52 neurologists Baker initially invited to join the new organization as fellows, there was but one woman, Winifred Bayard Stewart, MD, FAAN, who was a professor at the Women’s Medical College in Philadelphia. There were two women presenters at the first Annual Meeting in 1949: Alexandra Adler, MD, a 1948 member whose application for Fellow was turned down because her interests were “devoted largely to Psychiatry” per the membership report in 1949, and Kate Constable, MD, who became an associate member in 1952. Mabel G. Masten, MD, a professor and later chair of the neurology department at the University of Wisconsin, served on the AAN’s first Public Relations Committee in 1948 and was appointed associate editor of Neurology ® in 1954.

Along with Adler, two other women were cited as 50-year members in the March 1998 AANnews®: Elinor R. Ives, MD, and Esther Somerfeld, MD. Adler maintained her membership until she passed away in 2001 at age 99; Ives until her death in 2001 at age 96; and Somerfeld until she died in 2002 at the age of 101!

Mabel G. Masten, MD, 1950 Annual Meeting.

The most visible representation of women during the Academy’s early years was to be found in the AAN Women’s Auxiliary, established at the first Annual Meeting in 1949 for the spouses of male members. It served as both a social and educational network for wives to learn more about neurology and their husbands’ work, particularly during Annual Meetings. Its fundraising activities helped support the AAN’s first award in 1955, the S. Weir Mitchell Award, which recognizes an individual for basic research in neuroscience by physicians in clinical neurology training programs.

As more women entered neurology and joined the Academy—and with their spouses or partners focused on their own careers—the word “Women” was dropped from the name, but the Auxiliary was disbanded in 2011 as a quaint relic of a bygone era.

“The right place at the right time” By that time, women comprised more than 29 percent of membership (up to 43 percent by 2022), and the Academy had selected its first woman president, Sandra F. Olson, MD, FAAN, AAN Women’s Auxiliary, 1974 who served from 2003 to 2005. “I’m aware that other women had been approached before me to see if they would be interested in being president of the AAN,” Olson said in her 2005 Presidential Address at the Annual Meeting, “but they turned down the honor because of other commitments or were not interested in taking on additional work. So, I think it was just luck that I was in the right place at the right time and unable to say ‘No, thank you.’ It has been a distinct honor and privilege, for which I will be eternally grateful.”

When Orly Avitzur, MD, MBA, FAAN, became president in 2021, she was one of four women holding officer positions on the Board of Directors: president, president elect, vice president, and secretary.

She was succeeded Rose Baker and Kay Noran welcomed speaker Rep. Walter Judd (R-MN) to a in April 2023 luncheon of the AAN Women’s Auxiliary

by Carlayne E. at the 1954 Annual Meeting.

Jackson, MD, FAAN, who will be followed by Natalia S. Rost, MD, MPH, FAAN, FAHA, in 2025.

AAN Vice President Janis Miyasaki, MD, MEd, FRCPC, FAAN, who was first elected to the board in 2011, acknowledged the powerful effects of Rowland’s leadership. “I have volunteered for the AAN for 25 years. In the beginning, I was often the only woman on a subcommittee or committee and the only person of color. It was the vision of Dr. Rowland to be more inclusive for women. His advocacy led to specific efforts to mentor women leaders in neurology. Over time, this vision enlarged to the present time. We hope to have leadership that represents our membership. I admit we have far to go.

I was the first elected officer of color as treasurer in 2017. The AAN is collecting better demographic data so we can track our progress to be fully inclusive.

Previously, I often would leave my ethnicity section empty since I worried that this would be used against my application. This is a different time. Now, I indicate my ethnicity and hope that members will trust us and complete this information.”

Sandra F. Olson, MD, FAAN, at 2005 Annual Meeting.

Continued on page 10

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MEMBERSHIP Inclusivity Evolves to Meet Member Needs, Reflect Societal Changes continued from page 9

“Opened up a vista for everybody” The Academy has become more racially diverse, as well, bolstered by a longstanding commitment to encourage more minorities to enter the neurology pipeline. The first Black neurologist member was Ernest Y. Williams, MD, from 1948 to until his passing in 1990. Williams was a psychiatrist who founded the department of psychiatry Janis Miyasaki, MD, MEd, and neurology at Howard University FRCPC, FAAN Medical School. One of his students was Patrick A. Griffith, MD, FAAN, who was invited by then-president of the AAN Education and Research Foundation Sandra Olson, to be the first Black neurologist to join the Board of Trustees in 1999.

“I was so grateful to Sandra Olson to ask me to serve, to support public education and young people who were not neurologists yet,” Griffith said recently. Before joining the Foundation Board, he had been involved in selecting recipients for two industry-supported scholarships offered by the Foundation to bring young medical students to the AAN Annual Meeting from Sanofi-Aventis Minority Scholarships and Marion Merrell Dow (later Hoechst Marion Roussel, Inc.).

“Dr. Annapurni Jayam-Trouth and I pushed students to get scholarships to come to the Annual Meeting,” said Griffith. “She and I would collect applications and do interviews and try to decide who the scholarships should be awarded to. Not only did the scholarships bring young people to the Academy meeting to take courses for free but they got to meet all the other winners, and all the other minority neurologists at a luncheon with the sitting AAN president. The scholarships from Marion Merrell Dow enabled some distinguished neurologists to make a two-day visit to the school of the awardee. It was important for scholars to meet, rub shoulders with prominent faculty, whether Black or White. These programs for minority scholars opened up a vista for everybody, not just the scholars. There used to be a concept they would talk about neurologists considering other fields.

A lot of students had ‘neurophobia.’ The Education Subcommittee took that on as a challenge to attract firstor second-year students when neuroanatomy could be so challenging.”

Edgar J. Kenton III, MD, FAAN, at the 2005 Annual Meeting.

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AANnews • December 2023

Calvin L. Calhoun, MD, FAAN (center) was honored at the 2004 Annual Meeting

by Thomas R. Swift, MD, FAAN (left) and Patrick A. Griffith, MD, FAAN (right).

Griffith also worked closely with Calvin L. Calhoun, MD, FAAN, who had joined the AAN in 1963. Calhoun was the founding chair of the Department of Neurology at Meharry Medical College, a post he held for 25 years. He began his neurology residency at age 37 at the University of Minnesota, where he studied under A.B. Baker. He also was a friend of Rev. Dr. Martin Luther King, Jr. Calhoun was active in the AAN’s Sanofi-Aventis Minority Scholars program. Former AAN President Thomas A. Swift, MD, FAAN, said of Calhoun, “I was so fortunate to have a chance to sit with him and listen to stories of how he overcame adversity, growing up poor in the segregated South and working on tobacco farms. Yet he had the courage and determination to achieve and overcome, paying for an undergraduate degree at Morehouse College with help from the Veterans Administration, and eventually earning his medical degree at Meharry.”

Griffith pointed to the AAN’s initial catalyst of inclusivity and how it enabled actions to speak louder than words. “The significance of the AAN was that you could join, versus the American Neurology Association, where you had to be nominated by someone who was a member. It created a kind of nurturing environment for minorities supported by people like Swift and Calhoun and that was how we got around talking about the issue of racism. We never talked about that.”

Griffith recounted a pivotal action by Edgar J. Kenton III, MD, FAAN, an AAN Board member and longtime chair of the Practice Committee in the 2000s. “Edgar Kenton did something unusual.

When you passed your written board exam you then had your oral exams with faculty. There weren’t any minority examiners except for Edgar Kenton. The only way you are going to make minority neurologists at ease is the examiner was minority. He petitioned ABPN with his concept. Kenton gathered all the minority neurologists he could find and made them examiners!”

One recipient of the Hoechst “Rolling with the times” Marion Roussel [HMR] While the AAN had long promoted Scholarship was Richard greater diversity among neurologists, T. Benson, MD, PhD, these efforts were accelerated in FAAN, who was enabled to the 2000s, even before the tragic attend the 1994 meeting in deaths of George Floyd and others Washington, DC. “This was in 2020 sparked a wave of social the last semester of my unrest and racial reckoning. In 2019, the Academy published “Guiding medical school training. As Policy on Inclusion, Diversity, Equity, an MD/PhD candidate at Anti-racism and Social Justice,” Meharry Medical College, which included value statements and I had completed my PhD guiding principles for members and in neurophysiology. I was staff. In June 2020, the AAN issued definitely ready to graduate. the “Position Statement on Systemic However, I wasn’t quite sure Racism and Inequities in Society” and if I wanted to become a declared to achieve our Vision and cardiologist or a neurologist.

Rowland and AAN Auxiliary Past President Bernadette D’Souza, Mission, we must be an anti-racist 1998 Annual Meeting.

One of my mentors at that organization firmly committed to time, Dr. Calvin Calhoun, embracing the diversity of our members, staff, organization, who was also one of the first African American neurologists in profession, and, ultimately, the patient communities we serve. the US, recommended me for the HMR scholars program. As The Inclusion, Diversity, Equity, Anti-racism, and Social Justice an HMR recipient, I attended the Annual Meeting with him in (IDEAS) Subcommittee was created and this year was elevated Washington, DC, that year. Meeting the other scholars and AAN to the new Diversity, Equity, and Inclusion Committee with the leadership, participating in the courses offered, and listening to chair serving as an ex officio member of the Board of Directors. the scientific sessions really solidified my decision to start a career Among other many subsequent actions are establishing the in neurology. Subsequently, during my last year of neurology Diversity Officers Subcommittee, ensuring the editorial boards residency in the Harvard-Longwood neurology program, I was of the AAN’s journals and speakers at AAN conferences were better reflective of the membership, enhancing awards and able to attend the AAN scholarships, and maintaining resources for members on meeting in Boston in AAN.com, including the on-demand AAN Anti-racism Education 1997. Because of my Program offered to AAN members at no cost. previous experience as an HMR scholar, I was AAN Sections, which first were created in 1955 to connect invited to sit at a table members with common subspecialties or interests, have with the president of expanded to include Adults with Intellectual & Developmental the AAN and Dr. Bud Disabilities, LGBTQI, Underrepresented in Neurology, and Women's Issues in Neurology. In the last decade, inclusion Rowland, who was also has meant providing a prayer room and mothers/family chair of the Columbia room for the convenience and comfort of Annual Meeting and Presbyterian neurology conference attendees. department in New

York City. He told me about Dr. Ralph Sacco and the Northern Manhattan Stroke Richard T. Benson, MD, PhD, FAAN, spoke to Study (NOMASS).

Minority Scholars at the 2006 Annual Meeting.

The rest is history.

The HMR program was responsible for solidifying my interest in neurology and allowing me to get connected with Dr. Sacco, which started my career as a vascular neurologist. The irony of these events highlights the ultimate intelligent design of life.”

Today, Benson is director of the Office of Global Health and Health Disparities in the NINDS Division of Clinical Research and 2016 graduate of the Academy’s Diversity Leadership Program.

Looking back over the many years since her late husband joined the AAN in 1953, Esther Rowland sees the Academy’s inclusivity as mirroring the better nature of society.

“I think they were rolling with the times and not denying progress. It was an open organization and what was happening in the world and happening in the United States and happening in medical schools and the big issues of diversity and affirmative action—I think the people in the Academy absorbed this. It was a movement of the world, of the nation, and they were not separating themselves from public opinion and what was right, what was correct. It was just being open minded.”

Learn more about the AAN's remarkable history at AAN.com/History. 

AANnews • December 2023

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MEMBERSHIP Transforming Leaders Graduate Reimagines Approaches to Education and Care Access Throughout his eight months in the AAN’s Transforming Leaders Program, Scott M. Friedenberg, MD, FAAN, a neurologist with Geisinger Medical Center in Danville, PA, had a clear goal: to figure out how to use education to impact health care access. In particular, Friedenberg saw an immediate need to reimagine Geisinger’s relationship with referring providers so that, given its limited provider population in rural central Pennsylvania, neurologists could lead a change in their referral population to help ensure patients had already tried evidence-based medications.

“Headache became the focal point as it encompassed over 20 percent of our referrals,” said Friedenberg. “A preliminary dive showed that nearly 80 percent were untreated or barely treated patients, most of whom had readily identified primary headache disorders.”

Friedenberg used the skills he learned from his Transforming Leaders experience to explore this problem more completely and create a partnership with primary care. He developed a pilot study in collaboration with Geisinger’s primary care, neurology, informatics, pharmacy, analytics, and administration departments to explore using embedded evidence-based tools in the system’s electronic medical records and launching them at two primary care sites. The new process resulted in a 75 percent reduction in neurology referrals and a 35 percent reduction in MRI ordering. The work was expanded to Geisinger’s entire health system and “while it didn’t initially have an effect, further iterations resulted in a nearly 30-percent reduction in referrals—and is still improving.”

While the new numbers were exciting, a deep dive showed that patients were not actually getting prescribed medicines more often. “Primary care physicians were identifying headaches and not referring, but not clearly changing their treatment habits,” he said. This data led Friedenberg and his teams to apply for, and receive, a $500,000 research grant from Geisinger to develop a virtual headache hospital, which uses a population approach to help identify patients who were not well managed and “admit” them to ensure headache care is initiated. “This ensures they are empowered as patients and that the health system creates a mechanism for getting better care easier and faster,” Friedenberg explained.

Friedenberg’s efforts in creating collaboration across his health system did not go unnoticed by Geisinger’s education team, who invited Friedenberg to take part in their project for the American Medical Association’s Reimaging Residency grant program. “The program aspires to transform how we teach residents health system sciences and system-based practice through practical application, by converting residents from simple learners and observers into active participants in their health system’s improvement process,” he said.

Friedenberg is quick to credit the Transforming Leaders Program for helping him develop the skills needed to pull

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Friedenberg off his notable successes within the Geisinger system. “Key skills that I learned were first recognizing leadership could be captured without a title,” he said. “By leveraging an engaged, strong team and sharing leadership, better work is done quicker because everyone has a voice. This completely parallels the environment of our Transforming Leaders group project, which took advantage of everyone’s abilities rather than one person driving the process. We were taught how to truly see the value in others at many levels, empowering me to be better at collaborating and comfortably delegating rather than managing. It amplified my influence by creating a team with a shared vision rather than me being the fulcrum to every step.”

The program also taught Friedenberg “how to think futuristically, to think about long-term impact rather than local goals,” by learning how to properly reflect on his work, seek mentorship, and maintain an open mind. “Prior to this I had always put my perspective first and ‘stuck to the plan,’ but the Transforming Leaders Program showed me how to be malleable with my ideas, absorb other’s opinions and perspectives, and use the world around me to reflect and modify my direction. I’ve evolved from ‘let’s get this going in the right direction’—where I’m focused on the outcome and how do we get there quickly—to ‘be people focused and outcome-oriented’; meaning, the transforming power comes from figuring out what others can bring, and how I can remove barriers and elevate my partners, and keep each other pointed in a mutually beneficial direction. The speed comes from multiple excited people working together rather than me being the driver.”

Friedenberg also credits the Transforming Leaders Program with instilling an ability to empathize with others and be a better communicator. “Prior to the program, my excitement got people on board, but I was definitely a bull in a china shop.

People followed because I had a direction, I had knowledge, and I spoke up when others waited to see what was going to happen. This led to a lot of agreement, but much less engagement after the fact. Now I work with a group where bidirectional communication is key. Learning to see others’ communication styles, having insight into what they need to feel successful, and actively listening means we’re engaging

each other, not vying for position. One of my primary goals with working with people is to have them feel like they would eagerly work with me again!”

Finally, Friedenberg says that the Transforming Leaders Program helped him recognize that he needed to think beyond his own institution. “I’d spent so long being a modest-size fish in a modest pond that the eye-opening experience of going out into the deep waters with friends to share the experience helped me see I need to think bigger by engaging outside my institution.” While he previously had little experience with the AAN, Friedenberg now serves on the Academy’s Education Committee, which “has opened my eyes to all the opportunities, latest technology, breadth and depth of education that can be leveraged. I learn much more from every opportunity I get to help the AAN and can’t envision getting the same benefits any other place. I’m a lifer!”

To learn more about the AAN Transforming Leaders Program, visit AAN.com/lead. 

The 2023 AAN Transforming Leaders Program was supported in part by: AbbVie argenx Alexion, AstraZeneca Rare Disease Harmony Biosciences Genentech, A Member of the Roche Group Cerevel Therapeutics Supernus Pharmaceuticals, Inc. Alnylam Pharmaceuticals Neurocrine Biosciences, Inc.

MEM: 24 Member Dues Renewal Ad—Half Page Horizontal> AN laced in AANnews 25 x 5.25 +0.125 bleed, 4C

Only AAN membership offers access to the highest quality resources from the world’s largest and most trusted community of neurologists and neurology professionals.

PUBLICATIONS Neurology: Education Seeks Original Art for 2024 Covers Do you have a visual graphic that has a teaching point? Submit to our new cover image section for a chance to be featured as the cover art for an upcoming issue of Neurology ® Education! Cover art submissions, while not indexed or peer-reviewed, appear on the final issue and reach a wide audience through social media and our marketing materials.

Go to ne.neurology.org/cover-art to learn more and submit your original digital image by December 31, 2023. 

Apply Now! Deadline Nears for Neurology Assistant Editor Positions Are you an early to mid-career faculty member with an eye for review and an interest in the editorial process? Now is your chance to apply for two competitive assistant editor positions at Neurology®. The Assistant Editor program is designed for faculty at academic neurology departments anywhere in the world.

The program’s main goals are to cultivate talent and provide a mentored, earlier-than-usual exposure to the editorial process. Participants will play a key role in numerous parts of the review process and work on short-form articles, infographics, and editorials.

The position is open to neurologists who are faculty in an academic department anywhere in the world, regardless of clinical subspecialty, and Neurology encourages applications from those with a background or interest in clinical epidemiology or clinical and translational research.

Neurology expects the assistant editors to commit an average of four to six hours per week to the program, which runs for one year beginning April 1, 2024. To learn more and start your application, visit Neurology.org/assistant-editors. Applications are due December 15, 2023. 

Where the Top Jobs and Top Talent Connect!

From first job to career shift, get access to the latest openings, candidate CVs, and timely resources to seal the deal.

Go right to the top at Careers.AAN.com!

MEMBERSHIP Researchers Investigate Striking Health Disparities with AAN Award Dominique Popescu, PhD, grew up breathing clean air. Her family had easy access to fresh food and high-quality health care, and her town boasted low crime rates—but she would soon discover that children living a few neighborhoods away had a wildly different experience. medical science,” Popescu said. “I’m also looking forward to the next research question, which tends to naturally grow from a project’s completion.”

“I went to a magnet middle school, one that drew kids from multiple towns,” Popescu said. “That’s when I first learned how strikingly different life was from my own not 10 minutes away, just across the town line.”

That childhood experience sparked an interest in disparities—one that caught fire when Popescu went on to study neurology.

A Two-year Journey Popescu

“Despite receiving the same care, Black and Latino adult patients present with more severe intracerebral hemorrhages—commonly called bleeding strokes—and at an earlier age than their White counterparts,” Popescu said. “The more we learn about what’s contributing to these striking health disparities, the better positioned we’ll be to address them.”

Popescu is the 2023 recipient of the Clinical Research Training Scholarship (CRTS) in Neurodisparities, an award funded by the American Brain Foundation in collaboration with the AAN. The award provides a total of $150,000 over two years to a clinicianscientist who has recently completed residency or a PhD.

What Are Neurodisparities?

The term “neurodisparities” refers to neurological health care disparities. Through the CRTS in Neurodisparities, the AAN and the American Brain Foundation plan to foster research on how disparities, social determinants, and bioscience influence brain health; how interventions could address health disparities; and how clinicians can integrate the impact of social determinants in their practice.

Popescu hopes her research will help fellow neurology professionals consider how social determinants could be affecting their local patient population—and which determinants are the most relevant to address. Her goal is to identify geographic regions or other factors correlated with an increased risk of adverse outcomes 90 days after a patient has a bleeding stroke, allowing clinicians to mobilize targeted services to promote the best possible recovery outcomes.

“This research has already expanded my thinking on how we can use information about social determinants of health to improve clinical care by identifying which patients may have an increased risk for worse outcomes after surviving a stroke,” said Popescu, whose funding began in July of this year.

Months before Popescu’s research could begin, the previous year’s recipient was publishing the initial results of her own project. Whitley Aamodt, MD, MPH, who is using the award to investigate end-of-life disparities in Parkinson’s disease patients, published the first part of her project in the May 2023 issue of Neurology® Clinical Practice.

Aamodt

Aamodt’s paper details her retrospective cohort study of more than 50,000 Medicare beneficiaries with the disease who died in 2017.

She and her fellow researchers examined differences like race, sex, and geographic location to determine which variables correlated with poorer outcomes near the end of life, like hospital and ICU admission, in-hospital death, and late referral to hospice care.

“We found that more than 60 percent of all Parkinson’s disease patients are admitted to the hospital in their last six months of life, which is considered a marker of inappropriate end-of-life care quality. That’s a huge number,” Aamodt said.

Among Aamodt’s findings was that, compared to their White counterparts, patients of color were less likely to be discharged to hospice care, more likely to be admitted to the intensive care unit, and more likely to die in the hospital.

“Although these differences are traditionally considered markers of inappropriate care, one important question is ‘Why are there differences?’” Aamodt said. “And could they be based on personal preference or religious or cultural beliefs as opposed to true health care disparities? So part two of the project will investigate why these differences may exist across racial and ethnic groups.”

While the first part of Aamodt’s project was a large retrospective study using Medicare claims data, the second is far more personal. She and her fellow researchers will conduct focus groups in their clinic, which serves Parkinson’s disease patients from different racial and ethnic groups in Philadelphia.

After completing her project, Popescu plans to pursue a K-series Career Development Award with the National Institutes of Health.

Her main goal, however, is to make an important contribution to the study of neurodisparities.

“We’re planning to conduct small focus groups with patients from different racial and ethnic backgrounds to allow them to feel more comfortable when sharing their thoughts and ideas about endof-life care,” Aamodt said. “The goal is to determine whether the differences we found are based on personal or cultural factors or more indicative of inappropriate care practices.”

“I’m particularly looking forward to eventually sharing the project’s results with the field, because I strongly believe that efforts like these benefit greatly from an interdisciplinary team approach to

Aamodt hopes her research will help clinicians take patients’ diverse backgrounds into better consideration during end-of-life care discussions to ensure that care is aligned with patients’ preferences. 

The AAN funds or collaborates on more than a dozen Clinical Research Training Scholarships. Applications for the 2025 awards open in June 2024. To learn more about the CRTS and similar opportunities, visit AAN.com/Research.

AANnews • December 2023

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MEMBERSHIP THIS ARTICLE IS A SPONSORSHIP BENEFIT OF TOP-TIER SUPPORT OF THE AAN LEADERSHIP PROGRAMS

AAN

LEADERSHIP DEVELOPMENT

How argenx Is Advancing Patient-centered Drug Development The AAN and its Leadership Programs have found great partners in companies that share their priorities in neurology. Luc Truyen, MD, PhD, a trained neurologist and Chief Medical Officer at argenx, discusses the company’s leadership in patient-centered research and development, highlighting its innovative clinical trial design in chronic inflammatory demyelinating polyneuropathy (CIDP).

What is your leadership philosophy as a CMO managing clinical trials?

Leaders in our industry have to act as stewards for patients— that means focusing scientific endeavors towards addressing unmet needs. Engaging the patient community in our trial design has been key to addressing what the community needs from us. We have scaled our strategy from one trial in 2016 to over 30 concurrent trials in autoimmune indications by following where patients and the science lead us.

How do the AAN Leadership Programs align with argenx’s mission, values, and initiatives?

One of our cultural pillars is empowerment—we share our singular purpose and our people are our most valuable asset.

Investing in people development is how we enable them to bring innovations to Truyen the patients who need them. We support the AAN’s programs that educate the next generation of neurologists, researchers, and scientists. With the right mindset and tools, we know they can have great impact.

How do you feel the AAN Leadership Programs benefit the field of neurology overall?

The AAN Leadership Programs will contribute to a next generation of neurologists better equipped to identify and navigate the roadways of bringing needed innovation to patients who are waiting for better solutions. For the rare disease community, a neurologist like this in their corner can lead to faster diagnosis and better outcomes. 

Renew Your Membership by December 31—Keep Your Valuable Benefits!

Be sure you renew your AAN membership by December 31, so you can go into 2024 enjoying uninterrupted access to top neurology resources from largest and most trusted community of neurologists and neurology professionals. As a reminder, your AAN membership benefits* are valued at up to $4,000 and provide you with exclusive access to: 350+ online courses, videos, and exams Leading scientific resources, including Neurology® journal 30%+ savings on conferences Trusted AAN clinical practice guidelines, free publications, and patient education Networking with colleagues from 140 countries, spanning all neurologic subspecialties Advocacy efforts representing neurologists at state and federal levels

into

Visit AAN.com/membership to see a full listing of all your valuable membership benefits and resources. For more information, contact AAN Member Services at memberservices@aan.com, (800) 879-1960, or (612) 928-6000 (international).

*AAN member benefits vary by member type. For a full list of benefits, visit AAN.com/membership/member-benefits. 

Don’t Forget About Care Team Memberships!

Did you know that members of your care team can also apply for AAN membership? Ensure your entire team has the resources they need to succeed with an AAN Advanced Practice Provider or Business Administrator membership.

Learn More at AAN.com/CareTeam. 

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AANnews • December 2023

the

EDUCATION New Online Learning Center Offers Improved Member Experience, Capabilities In order to provide members with an improved experience accessing and enjoying the Academy’s robust lineup of online learning opportunities, the AAN has migrated to a new Online Learning Center that is now available at Learning.AAN.com. The enhanced platform is mobile responsive, eliminating the need to install an app to access it from anywhere. A number of site upgrades include: Improved course categorization and search functionality making it easier to find the course(s) you need when you need them Enhanced video capabilities that include auto captioning and the ability to bookmark favorite videos to view later Course progress remembered across all devices, allowing you to start a course on your phone and finish on a laptop, desktop, or tablet Course recommendations on the newest and most popular offerings in the Featured Courses area

Members do not need to create new bookmarks or passwords to access the new platform and should continue using their AAN.com user ID and password to log in. To access the new Online Learning Center and find courses, visit Learning.AAN.com and select “My Courses.”

For questions, email the Online Learning Center at OnlineLearningCenter @aan.com. 

Neuro-oncology Explored in Continuum The latest information on neuro-oncology is presented in the December issue of Continuum: Lifelong Learning in Neurology ®.

Topics in this Continuum® issue include: 2021 World Health Organization Classification of Brain Tumors / David M. Meredith, MD, PhD; David J. Pisapia, MD Adult-type Diffuse Gliomas / Macarena I. de la Fuente, MD Pediatric Neuro-oncology / Fatema Malbari, MD CNS Lymphoma / Lauren Schaff, MD Brain Metastases and Leptomeningeal Disease / Priya Kumthekar, MD; Emilie Le Rhun, MD Skull Base Tumors / Deborah A. Forst, MD; Pamela S. Jones, MD, MS, MPH

Paraneoplastic Neurologic Syndromes / Jerome J. Graber, MD, MPH, FAAN Neurologic Complications of Conventional Chemotherapy and Radiation Therapy / Jennie W. Taylor, MD Neurologic Complications of Cancer Immunotherapy / Nancy Wang, MD, MPH Management of Complications in Neuro-oncology Patients / Mary R. Welch, MD, MS Palliative Care and Care Partner Support in Neuro-oncology / Akanksha Sharma, MD

The issue includes a postreading selfassessment and test with the opportunity to earn up to 20 AMA PRA Category 1 Credits™ toward Self-assessment CME. AAN members pay only $399 per year for a subscription to Continuum. Subscribe now by contacting Wolters Kluwer at (800) 361-0633 or (301) 223-2300 (international), visiting shop.lww.com/ continuum, or checking the Continuum box while paying your 2024 AAN dues.

AAN Junior members who are transitioning to neurologist memberships are eligible to receive a 60 percent discount on the already low member rate for a Continuum subscription. 

March 1 Is Deadline to Apply for 2024 Interventional Neurology Certification Examination Applications are now open for the 2024 UCNS Interventional Neurology Certification Examination, and the deadline to apply is March 1, 2024. The 200 multiple-choice question examination will be scheduled for five hours and take place September 16 through 20, 2024. The online application, eligibility criteria, and examination content outline are available at UCNS.org/INcertification.

Key dates at-a-glance: Application deadline: March 1, 2024 Extended application deadline ($500 fee applies): March 15, 2024

Examination registration opens: May 1, 2024 Examination registration closes: September 2, 2024 Examination week: September 16–20, 2024  AANnews • December 2023

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ADVOCACY What’s Changing for Neurology in 2024? continued from cover split (or shared) visit, or a substantive part of the medical decision making as defined by CPT. The final rule specifically calls out concerns raised by the AAN and other aligned stakeholders and aligns with recommendations that the AAN previously made to ensure that split (or shared visits) can be billed on the basis of both time and medical decision making.

In another significant positive development on a long-standing AAN priority, CMS is heeding the AAN’s recommendations to implement a new add-on code, G2211, effective January 1, 2024, to account for visit complexity for patients whose overall, ongoing care is being managed and monitored by a specialist for a complex condition. The AAN strongly supports implementation of this new code and believes implementation is critical to account for the work associated with serving as the focal point of care for a patient with a complex condition. The AAN has been very active with policymakers with the goal of ensuring that Congress does not take action to delay or eliminate this much needed increase for complex E/M services.

Telehealth Regulations CMS is implementing key provisions of the Consolidated Appropriations Act (CAA) of 2023 that extend certain flexibilities in place during the COVID-19 Public Health Emergency (PHE) through December 31, 2024. These key flexibilities include allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, allowing certain services to be furnished via audio-only communication technology, and continued coverage of services temporarily added to the Medicare Telehealth list through December 31, 2024. Recognizing that many practitioners providing telehealth must functionally maintain their practice expenses, CMS will pay for telehealth services furnished to beneficiaries in their homes at the higher non-facility rate.

Telehealth provided to patients in locations other than a patient’s home, such as physicians’ offices and hospitals, will be reimbursed at the facility rate.

Prior to the PHE, CMS included restrictions on how frequently certain services may be furnished via telehealth. Beyond 2024, CMS is broadly assessing its telehealth

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AANnews • December 2023

regulations considering the ways in which practice patterns may have changed during the PHE. For 2024, CMS is removing the telehealth frequency limitations for the following codes: Subsequent Inpatient Visits: CPT Codes 99231–99233 Subsequent Nursing Facility Visits: CPT Codes 99307–99310 Critical Care Consultation Services: HCPCS Codes G0508 and G0509 Citing concerns that modifying the temporary PHE policy related to direct supervision may disrupt practice patterns and present a barrier to access, consistent with the AAN’s advocacy, CMS will continue to allow for the presence and “immediate availability” of the supervising practitioner through real-time audiovisual telecommunication technology through December 31, 2024. CMS also finalized a policy that allows for virtual direct supervision of services furnished incident to a physician’s professional service, such as Level I office visits. The AAN will continue to work with CMS on permanent policy to further extend these flexibilities as appropriate.

In alignment with the telehealth policies that were extended under the provisions of the CAA through December 31, 2024, CMS is also allowing teaching physicians to have a virtual presence in all teaching settings regardless of geographic location, but only in instances when a service is furnished virtually. This permits teaching physicians to have a virtual presence during the key portion of the Medicare telehealth service for which payment is sought, when the patient, resident, and teaching physician are all in separate locations using audiovisual real-time communications technology. This virtual presence policy will continue to require real-time observation by the teaching physician and excludes audio-only technology. As with direct supervision of auxiliary personnel, CMS will consider other clinical instances in which a teaching physician has a virtual presence in future rulemaking.

CMS declined to add several codes to the permanent Medicare Telehealth Services List, citing a need for further evidence generation. The following codes will remain on the Telehealth Services List on a temporary basis through 2024:

Deep Brain Stimulation: CPT Codes 95970, 95983, and 95984 Inpatient Hospital or Observation Care: CPT Codes 99221–99223, 99234–99236 Inpatient Hospital Observation Discharge Day Management: CPT Codes 99238 and 989239 Emergency Department Evaluation and Management: CPT Codes 99281–99283 During the PHE, CMS granted flexibility in certain reporting requirements whereby practitioners could perform telehealth visits from their homes without having to report their home address on publicly available Medicare enrollment files. This flexibility was due to expire at the end of 2023.

Although CMS did not address this topic in the proposed rule, the agency received significant feedback from stakeholders, including the AAN, citing privacy and safety concerns. In response, CMS will continue to permit distant site practitioners to use their currently enrolled practice locations instead of their home addresses when providing telehealth services from home in 2024 and will consider this issue in future rulemaking.

Health-related Social Needs In alignment with the AAN’s advocacy, CMS finalized new coding and payment (CPT codes 96202–96203 and 97550–97552) for caregiver training services to support patients in carrying out a treatment plan.

Medicare will pay for these services when furnished by a physician, a nonphysician practitioner or therapist to one or more caregivers as part of the patient’s individualized treatment plan or therapy plan of care.

The AAN is pleased that CMS is finalizing the proposal to establish separate coding and payment for community health integration services, which would be performed by certified or trained auxiliary personnel, reported as incident to or under the general supervision of the billing practitioner.

The services can be provided monthly following an initiating E/M visit in which the practitioner identifies the presence of social determinants of health (SDOH) needs that significantly limit the practitioner’s ability to diagnose or treat the problem(s) addressed in the visit. G0019 will be reported for services of 60 minutes per calendar

month and G0022 will be reported for each additional 30 minutes per calendar month.

CMS will also finalize code G0136 for the administration of a standardized, evidencebased SDOH risk assessment tool to review an individual’s social risk factors that may influence the diagnosis and treatment of medical conditions.

A final set of health-related social need services that CMS will cover for 2024 are for principal illness navigation (PIN) services. G0023 and G0024 will be reported for the time spent with patients requiring assistance navigating the healthcare system and coordinating care for their complex or high-risk conditions.

Appropriate Use Criteria CMS has been working since 2014 to implement the Appropriate Use Criteria (AUC) Program, which requires practitioners to consult a qualified clinical decision support mechanism at the time the practitioner orders an advanced diagnostic imaging service for a Medicare beneficiary. The AAN has repeatedly expressed concerns about the feasibility of this program, the subsequent increase in administrative burden, and the unintended consequences it would have on practice patterns. CMS has continually delayed implementation of the penalty phase of this program in recent years. Now, in a significant win for AAN advocacy, CMS is rescinding the AUC program and all implementing regulations to allow for reevaluation. CMS states that in doing this, in alignment with the AAN’s long-standing advocacy on this topic, the goals of appropriate, evidence-based, coordinated care can be achieved more effectively, efficiently, and comprehensively through other CMS quality initiatives.

Medicare Economic Index CMS had previously finalized a policy to update the Medicare Economic Index (MEI) to reflect current market conditions faced by physicians in furnishing services.

Although the agency finalized this policy, CMS chose to delay implementation, citing a need for further comment.

Based on stakeholder feedback, CMS is not incorporating the updated MEI methodology for PFS rate-setting in 2024.

CMS will continue to solicit feedback on how to update this index, including data collected through a forthcoming American Medical Association-led effort.

Quality Payment Program MIPS The weights for MIPS performance categories remain the same as in 2023: 30 percent for Quality, 30 percent for Cost, 15 percent for Improvement Activities, and 25 percent for Promoting Interoperability.

In alignment with the AAN’s comments, the performance threshold will remain at 75 points for the Calendar Year (CY) 2024 performance period.

Neurology will not see major modifications to the Quality, Cost, and Improvement Activity categories. CMS has finalized policy modifications to the Promoting Interoperability category aimed at alleviating administrative burden. The revisions would: 1. Lengthen the performance period for this category from 90 days to 180 days.

2. Modify one of the exclusions for the Query of Prescription Drug Monitoring Program (PDMP) measure.

3. Provide a technical update to the e-Prescribing measure’s description to ensure it clearly reflects the previously finalized policy.

4. Modify the Safety Assurance Factors for Electronic Health Record

Resilience (SAFER) Guide measure to require MIPS eligible clinicians to affirmatively attest to completion of the self-assessment of their implementation of safety practices.

5. Continue to reweigh this performance category at zero percent for clinical social workers for the CY 2024 performance period/2026 MIPS payment year.

MIPS Value Pathways Five new MIPS Value Pathways (MVPs) are being implemented in the rule, including: Focusing on Women’s Health MVP Prevention and Treatment of Infectious Disorders Including Hepatitis C and HIV MVP Quality Care in Mental Health and Substance Use Disorder MVP Quality Care for the Treatment of Ear, Nose, and Throat Disorders MVP Rehabilitative Support for Musculoskeletal Care MVP CMS is modifying the previously finalized Promoting Wellness and Optimize Chronic Disease Management MVPs into a single consolidated MVP titled Value in Primary Care MVP. CMS has already implemented three models which focus on neurologic conditions: Optimal Care for Patients with Episodic Neurological Conditions MVP Supportive Care for Neurodegenerative Conditions MVP Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes MVP To access AAN resources on MVPs and the Quality Payment Program, go to AAN.com/qpp. 

Careers.AAN.com

Visit the AAN’s Neurology Career Center to view hundreds of additional jobs and sign up for customized, confidential notifications when positions of interest are added.

Neurohospitalist and Vascular Neurology Positions Available in Northern California (ref: 23312)—The Medicus Firm—Sacramento, California Multiple positions available at UC Davis School of Medicine in Sacramento, California. UC Davis School of Medicine is recruiting a full-time Neurohospitalist and a full-time Vascular Neurologist to join their growing Department of Neurology. These positions are open to all ranks including Assistant, Associate or Full Professor level. The incoming providers can expect available research opportunities and academic involvement working with medical students, the robust neurology residency

program, and fellows. Neurohospitalist Position: Be the first Neurohospitalist with the opportunity to build and lead a new Neurohospitalist department, be involved in future hires, and potentially add a new fellowship program. Immense potential for leadership growth and development (leadership experience is not required) 24-hour shifts working 7 days on/off for 20 weeks per year, Volumes: 5–15 patients per day, 10-bed dedicated ICU. Vascular Neurology Position: 100% Vascular Neurology case mix with a minimum of 20% academic protected time and 80% clinical, Unique block scheduling rotating between inpatient stroke coverage and tele-stroke coverage, plus academic responsibilities and minimal clinical duties, Potential

leadership positions available include an outpatient stroke vascular neurology clinic leader (experience not required) and a leader in tele-stroke (experience preferred), Vascular Neurology Fellowship is required with the ability to sponsor H1B and O1 visas. Sacramento, California—Ranked as the #1 place to live in California in 2023 by Forbes, Offers year-round temperate weather with vibrant performing arts scene, great neighborhoods and excellent school systems. Easy access to San Francisco, the California coast, Lake Tahoe, the Sierra Mountain range, and several wine regions including Napa and Sonoma, Cost of living that is 22% lower than the California average. Job Reference: NEUR HOSP 23312 