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President's Message - April 2020

Posted By Rich Vogel, Monday, April 6, 2020

Dear Members,

 

As I look back on my year as ASNM President, I am reminded of Shakespeare's Henry IV who once remarked, "Uneasy lies the head that wears a crown". To King Henry I say, “Indeed”.

 

The President of the ASNM volunteers his or her time to work nights and weekends for the benefit of this profession and everyone who works in it. Set aside for the year are hobbies, goals, dreams and time with family and friends. There are nights of lost sleep amid persistent feelings of stress and worry. There are thousands of emails to read and respond to. There are hundreds of decisions to make; each, it seems, with lobbying from different points of view. The President of the ASNM experiences admiration and disregard, support and opposition, loyalty and betrayal. Amid all of this, one comes to recognize that the dominant feeling about this profession, coming from those who work in the profession, is one of indifference. That, I believe, takes the greatest toll... indifference. Heavy lies the crown indeed.

 

Despite all of these feelings, my presidency has proven to be ephemeral in hindsight. It seems like only yesterday when I gave my Incoming President’s Address at the ASNM Annual Meeting in May of 2019. And, here we are a year later, ready to transition to a new President. Despite the emergence of the COVID-19 virus, which has put the whole world on hold and caused us to cancel our much-anticipated Annual Meeting, this past year has been a successful one for me, and for the ASNM.

 

A lot of people have asked if my final President’s Message was going to be another big speech, similar to the long, passionate address that I delivered last year. The answer to that question is no. My feeling is that a speech of such magnitude should probably be reserved for exactly what I used it for... to unleash a scathing indictment of an entire profession and reveal a strategic vision for how it can be improved over both the short and long term. So, no big exit speech. Today, my final message to the ASNM Membership will simply consist of a few important things I want to say before I pass the torch.

 

As I look back on my presidency, I can honestly say that I’m proud of every decision I made and every action I took. As President, I experienced both success and failure. In hindsight, I am left only with peace of mind knowing that I led the ASNM with integrity, I persevered through difficult times, and I learned some important lessons that I’ll take with me to the next stage of life. At the end of the day, I’m proud of what we’ve accomplished in the ASNM and happy to see us moving in the right direction.

 

I would like to take a moment and extend my sincere thank you to every single person who stepped up over the last year and offered to help. In fact, so many people answered my call to assist, we weren’t even able to use everyone’s help. Having too much help is always an asset in a volunteer society. So, thank you to everyone who offered to volunteer their time to the ASNM.

 

I’d also like to thank the people who supported me over the last year, both personally and professionally. My supporters are too numerous to name, but you know who you are, and I want you to know that I’m deeply appreciative of you.

 

Over the next few weeks, I’ll be working with Faisal to make sure we have a smooth transition of leadership on May 4th, 2020. I am confident in Faisal’s leadership and I certainly hope everyone will give him the help, support and encouragement he needs to have a successful year.

 

So, what’s next for me? Well, I will remain on the Executive Committee for one year in the position of “Immediate Past President”. After that, I will cycle off of the ASNM Board entirely. We’re moving in the right direction. Now, it’s time for new leaders to emerge and take us to the next level. Personally, I’m going to take a step back and focus on me. It’s about time for that.

 

It has been an honor and a privilege serving as ASNM President.

 

Sincerely,

 

Rich Vogel, PhD, DABNM, FASNM

ASNM President 2019-2020

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President's Message - March 2020

Posted By Rich Vogel, Friday, March 6, 2020
Updated: Wednesday, March 4, 2020

Dear Members,

 

We just finished our 2020 Winter Virtual Symposium and it was a resounding success!! We had more than 90 attendees logged in, and over 120 total attendees if you include faculty and Board members. The exhibitors who submitted video commercials got lots of air time, benefiting from the individual attention of all attendees. We got so much positive feedback on all fronts. This is definitely something that we’ll consider doing again. 

 

As we begin to look toward our big 2020 Annual Meeting, I want you to know that award nominations close March 15th. We have two awards that you can nominate someone for right now. Click the link below to learn about these award, and please take the time to nominate someone!

 

Founders Award.

ASNM Fellow.

 

Winners of these awards, and others, will be recognized at the Saturday Luncheon at the 2020 Annual Meeting.

 

Speaking of the Annual Meeting, registration is open. We're starting to get lots of questions about whether or not the annual meeting will happen as concerns over COVID-19 escalate. As of now, we have no plans to cancel or alter the meeting, but we are preparing, as should you. My recommendation is to book your travel now, rather than wait; here's why: many airlines are presently offering indefinite waiving of change fees if you book travel in the next couple of weeks. So, under these circumstances, booking travel is of little risk. I also recommend buying travel insurance as an added precaution. In the meantime, we're full speed ahead with planning for this meeting!

 

Last year, in my inauguration speech, I asked an audience of over 200 people to raise their hand if they would pledge to go home, tell two people about the ASNM and bring them back to the meeting in 2020. Every...single...person in that room raised his/her hand high! If everyone in that room keeps their promise, we will have over 600 people at this meeting. What about you? Did you raise your hand? Time to dig deep again and look within. Are you the type of person who makes a pledge and keeps it? Now is the time to make that decision. Register for the 2020 Annual Meeting and bring someone along! The meeting will be held May 15-17, 2020 in St. Louis, Missouri.

 

In case you missed my previous announcement, I’ve invited someone very special to be my Presidential Speaker, Dr. Marty Makary. His work is known the world over, he’s published 2 NYT best-selling books, he’s frequently interviewed on national and international news outlets, and he fills venues of thousands every time he speaks, so we’re very lucky to have him in such an intimate setting. 

 

The last thing I want to let you know is that the ASNM Board is presently working on a major overhaul of the Bylaws. The Bylaws are essentially our constitution. They describe how we govern ourselves. This update is long overdue because the Bylaws are written for a smaller organization, and they are outdated. I’m telling you all of this because you need to be part of the process. Once we have a draft done, we will send an announcement to the entire membership, opening a 30 day window for you to submit comments. Look for an email from the ASNM around March 25th. We’ll need to close the comment period by April 24th in order have the Bylaws done in time for the Annual Meeting in May. That's the plan, anyway. 

 

Thank you all for taking the time to read. I hope you'll take time to nominate someone for one of our awards. I hope you all can enjoy the waning days of the winter season. I’ll be back in April with another update from the front lines. Thanks for being a valued member!

 

Disclaimer:

The views, thoughts, and opinions expressed in this blog post are solely those of the author(s). Blog posts do not represent the thoughts, intentions, strategies or policies of the author’s employer or any organization, committee or other group or individual, including the ASNM. The ASNM, along with the author(s) of this post, makes no representations as to the completeness, accuracy, suitability, validity, usefulness or timeliness of any information in this blog and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. All information is provided on an as-is basis. Any action you may take based upon the information on this website is strictly at your own risk.

 

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President's Message - February 2020

Posted By Richard W. Vogel, Monday, February 3, 2020
Updated: Wednesday, January 29, 2020

Dear Members,

 

A lot has happened in the couple months since I’ve communicated to you, so let’s jump right in. 

 

Many people have contacted the ASNM over the last few months asking what’s happening with the 2020 Winter Symposium. We’ve also been dealing with lots of questions over the past few weeks about what’s going on with the leadership of the ASNM. I want to spend some time today talking to you about both of these things. 

 

The first thing that I want you all to know is that the leadership of this society is strong, our vision is clear, our direction is unwavering, and our Board is united. I can tell you all that achieving and maintaining this high level of organizational grit and chemistry is not easy, and doesn’t come without experiencing some bumps in the road, but our collective passion, perseverance and dedication to promoting the highest quality of patient care in IONM is what keeps us going. 

 

The second thing I want you to know, because it’s relevant, is that one of our Board Members, Dr. Gene Balzer, resigned from the BOD in late December, and the Executive Committee accepted his resignation. Dr. Balzer was a founding member of this Society, indeed a founding “father” in this profession, and he has a long-standing record of dedication to the ASNM and accomplishment as a leader within the Society. So, it goes without saying that his contributions will be missed. On a personal note, I can say that I consider Gene to be a friend and mentor, and I wish him well. 

 

I will also note that, in a Society of volunteers leading a profession notoriously plagued by apathy and disengagement, Gene was always one of those people who raised his hand to help. Gene was not just a member of the BOD, but he was also Chair of 2 of our Standing Committees, he was the sole Program Chair of the 2020 Winter Symposium, and Program Co-Chair of the 2020 Annual Meeting. We thank Gene for the work he did in all of these roles. The ASNM BOD will work together to back fill all of these roles with minimal disruption to our organization. 

 

Regarding the Winter Symposium, I can tell you that the symposium is full speed ahead. It will take place February 22-23, and it will be 100% virtual (no onsite presence). Attendees who sign up will experience a world-wide broadcast of educational content (some live and some pre-recorded, along with live Q&A from a panel of experts) and they can experience this content, including getting CME and CEUs from the comfort of their own home. This means we have completely eliminated expenses associated with travel and accommodations. 

 

The meeting is open to everyone, regardless of whether or not you are a member of the ASNM. The cost to view the content live is $300, again, regardless of membership status. If you just want to view the recorded symposium after the fact, the cost will be $400, but this option is open to members only. If you want to view the content live and get all the benefits of 2020 ASNM membership, you can purchase a package for $450 (for a total savings of $35). 

 

We have more-and-more people registering for this Symposium by the day. We also have exhibitors that have produced videos which will air during commercial breaks. Despite whatever setbacks we experienced, I have no doubt this grand experiment, this virtual symposium, will be a resounding success. 

 

Turning to our 2020 Annual Meeting, This meeting will be held May 15-17 in St. Louis, MO. I’ve taken over for Gene as one of the Program Co-Chairs, and I’m working with two rock stars to make this one of the best meetings ever: Rebecca Clark-Bash and Clare Gale. Together, we are developing an outstanding Program, which you can expect to see on our website by March 1 at the latest. 

 

The final meeting this year will be our Fall Symposium, and I’m very happy to announce that we have partnered with the Canadian Association of Neurophysiological Monitoring ht to develop a joint ASNM-CANM Symposium September 18-20, 2020 in Vancouver, BC. We’re very thankful to the leadership of CANM for joining forces with us in a shared venture, and shared vision, to build bridges in the IONM community. 

 

While I have you, just a couple other quick announcements. 

 

First, on January 15th, we sent an email to membership informing you that nominations for ASNM office are now open. This is your opportunity to choose who gets to be on the election ballot for ASNM office later this year. Please look for that email from Jan 15th. Think about who you’d like to see run for ASNM office, and submit their name. The deadline for submission is April 15th, but don’t wait that long or you’ll forget. Take action today!

 

Second, on February 1st, we send out an email to membership informing you that nominations for ASNM Fellowship are now open. If you know someone who meets the criteria, please do submit their name for consideration to receive this prestigious title. I can tell you that you will need to collect and submit a lot of information to nominate a candidate, so you need to start that process ASAP. Nominations close March 15th. Again, take action today!

 

Finally, I made due on my promise to roll out new awards to recognize members of the ASNM who make outstanding contributions in various ways. You can read about our awards on the website, but I want to give you a heads up that you can expect to see another call for award nominations in the weeks ahead. There is one award in particular that comes from nomination by general membership of the society, and we’ll be asking you to nominate someone special. 

 

I’m heading off to the ACNS meeting in NOLA. It reminds me of how important it is to participate in our profession, to be engaged and support the folks who are out here working to advance this profession. I encourage our members to also support our sister societies, like ACNS and ASET.

 

I’ll be back in March with another update from the front lines. Thanks for being a valued member!

 

Disclaimer:

 

The views, thoughts, and opinions expressed in this blog post are solely those of the author(s). Blog posts do not represent the thoughts, intentions, strategies or policies of the author’s employer or any organization, committee or other group or individual, including the ASNM. The ASNM, along with the author(s) of this post, makes no representations as to the completeness, accuracy, suitability, validity, usefulness or timeliness of any information in this blog and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. All information is provided on an as-is basis. Any action you may take based upon the information on this website is strictly at your own risk.

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President's Message - November 2019

Posted By Rich Vogel, Thursday, October 31, 2019

Dear Members,

 

Just a few announcements this month:

 

ASNM elections open this coming Monday (November 4th). Please look for an email from the ASNM with a link to access information about the candidates, and a link to access the ballot. We have 2 people running for one open position as ASNM President, and 9 running for 4 open positions on the ASNM Board of Directors. Once ballots open, you will have 2 weeks to vote. We’ll announce the winning candidates in December. Winning candidates will take office at the ASNM Annual Meeting in May of 2021.

 

Our new industry prospectus is out, on time, as promised. I’d like to thank our Exhibitor Taskforce, Executive Committee and the team at Affinity for all the hard work that went into developing this prospectus. As our society grows and experiments with new educational platforms, we’ve elected to offer our industry partners a variety of new options to tailor their support of the ASNM to their individual needs.

 

We finally have a date for the ASNM 2020 Winter Symposium. It will be held Feb 22-23. As I said previously, this will be a (mostly) virtual meeting, consisting of a live, interactive, world-wide internet broadcast. We’ll plan to air commercials from our sponsors between talks. 

 

Symposium attendees will be able to attend via an internet portal without the expenses associated with travel. Virtual attendees will be able to purchase individual sessions or the entire symposium. The fee structure will significantly reduce member’s cost unit of CME and CEU. Limited in-person audience attendance is available.

 

Why are we doing this? Because you asked for it! Last year, we conducted a membership survey which indicated that members wanted, 1) more innovative speakers and formats, 2) effective utilization of their time, and 3) lower cost CME/CEU options. Ask and you shall receive! This is a big experiment for us, and I certainly hope you will join us in February. I’d like to thank the Representation and Advocacy Committee for coordinating the membership survey, and many thanks to Dr. Gene Balzer for his vision and hard work in developing this virtual meeting program.

            

Finally, I have a very big and exciting announcement to make. I’m bringing in a very special guest as my Presidential Speaker at the 2020 ASNM Annual Meeting. This meeting will be held May 15-17, 2020 in St. Louis, Missouri. If you want to know who it is and why I’m bringing this person in, you’ll have to watch my November President’s video

 

If you want to go back and watch my previous monthly video messages, just search for “ASNM President” on youtube.

 

I hope you all have a very happy Thanksgiving. I’ll be back in December with another update from the front lines. Thanks for being a valued member!

 

Disclaimer:

The views, thoughts, and opinions expressed in this blog post are solely those of the author(s). Blog posts do not represent the thoughts, intentions, strategies or policies of the author’s employer or any organization, committee or other group or individual, including the ASNM. The ASNM, along with the author(s) of this post, makes no representations as to the completeness, accuracy, suitability, validity, usefulness or timeliness of any information in this blog and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. All information is provided on an as-is basis. Any action you may take based upon the information on this website is strictly at your own risk.

 

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President's Message - October 2019

Posted By Rich Vogel, Thursday, October 10, 2019

Dear Members,

 

We just finished our 2019 Fall Symposium in Boston. I was excited to hear from attendees and exhibitors alike that this was one of the best meetings they ever attended. Attendees liked the variety of speakers/topics and the practical advice for all levels of practitioner. Exhibitors liked the attendance, room setup, foot traffic and engagement. I’d like to extend my congratulations to our Program Chairs, Drs. Joe Moreira and Faisal Jahangiri, who developed the educational content. I’d like to thank all of our speakers, and a very special thank you to our industry partners for sponsoring the event. We couldn’t have done it without you!!

 

I think the success of our 2019 Fall Symposium foreshadows what is to come from future ASNM meetings. In taking office as ASNM President, I promised to double down on education, experiment with new technologies, expand our annual meeting and make the ASNM the best place in the world to learn about IONM. At this moment, today, there is no question in my mind that the ASNM has emerged as the nation’s premier resource for IONM education, we’re just getting started.

 

I’m happy to announce that the 2020 ASNM Winter Symposium will be a (mostly) virtual meeting to be held in early 2020. In a major departure from our traditional symposia, we will be offering a live, interactive, world-wide broadcast of the meeting. This allows attendees to get the same premier education they’ve come to expect from the ASNM, and without having to pay additional cost of travel and hotel. So, you can get your CMEs/CEUs in your pajamas! Of course, we still expect to offer in-person attendance to a limited number of participants. We’re still working out the specifics/logistics and finalizing the dates, but we expect to make formal announcements very soon. So, stay tuned. 

 

This leads me to the 2020 ASNM Annual Meeting. This will be our biggest and best meeting that we’ve ever hosted. We’re incorporating new formats, new technologies, new topics and new speakers. I won’t say any more right now, but I will say this: if you’re going to travel to one meeting in 2020, you will definitely want to make sure it is the ASNM Annual Meeting May 15-17 in St. Louis, MO.

 

Finally, if you have been a speaker at a recent ASNM meeting, or are a frequent audience attendee, you may have noticed that we’ve been changing our requirements for what speakers need to disclose, as well as what can/can’t appear on slides. We do this for two reasons, 1) because some of it is required by our CME provider, and 2) so the audience can readily detect any bias in a presentation.

 

When I say “bias”, I’m talking about bias driven by economic influence, not individual opinions about how to practice. So, someone saying that you should do BCR on all spine cases is certainly free to present evidence to support that argument; however, someone whose company sells the latest “BCR electrode” stands to make financial gain from that statement, and the audience has the right to know that. Also, we’re learning new things from our CME provider. For example, if you work for an academic institution, you can put your institution name and symbol on you slides, but you cannot do that if you work for a private company. So, we’re making changes to our rules over time to maintain transparency for the audience, as well as compliance to rules set forth by our CME and CEU providers. We hope you will understand and bear with us while we hone our technique.

 

Happy Halloween everyone. No matter where you live, I hope you get to enjoy some of the beautiful fall foliage that we see in the north. It’s a wonderful time to travel. I’ll be back in November with another update from the front lines. Thanks for being a valued member!

 

Disclaimer:

The views, thoughts, and opinions expressed in this blog post  are solely those of the author(s). Blog posts do not represent the thoughts, intentions, strategies or policies of the author’s employer or any organization, committee or other group or individual, including the ASNM. The ASNM, along with the author(s) of this post, makes no representations as to the completeness, accuracy, suitability, validity, usefulness or timeliness of any information in this blog and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. All information is provided on an as-is basis. Any action you may take based upon the information on this website is strictly at your own risk.

 

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President's Message - September 2019

Posted By Administration, Thursday, September 5, 2019

Dear Members,

 

Summer is winding down and the cool winds of fall are beginning to make their way to my home state of Pennsylvania. This is my favorite time of year, but right now my thoughts are with the people affected by hurricane Dorian. I hope all of our members, as well as their loved ones, in affected areas are somewhere safe.

 

Over the past month, we’ve been busy getting ready for the upcoming Board Meeting, which will be held on Friday September 13th, just before our Fall Symposium in Boston, Massachusetts. More on the symposium in a few minutes. 

 

If you’ve ever wondered what goes on at our Board Meetings, you can always attend one as they are open to all members. In general, we discuss the business of running a society and shaping a profession. Each Committee gives reports to update us on their projects. We discuss various topics and takes votes on proposals that will shape the direction of the ASNM. I think it is excellent experience to serve on a board, and I’d encourage everyone to run for office at some point in their career. If you’re looking for a good entry point to get some experience, I’d strongly encourage you to start by serving on one of our Standing Committees. Feel free to contact me if you’d like to get involved. 

 

One big project we’ve been working on in August is a major update to our 2019 Industry Prospectus for 2020. You may remember from my Incoming President’s Addressthat I wanted to work more closely with our industry partners. In doing so, I created an Industry Partner Taskforceto advise us on certain topics that impact our partners. In developing our 2020 Industry Prospectus, we’ve worked closely with this Taskforce to ensure it works well for the ASNM and our partners who support our Society. The Board still needs to vote on the 2020 Prospectus, so it won’t be available for a few weeks. Stay tuned!

 

In the middle of August, I traveled to Kansas City to attend ASET’s Annual Meeting. The Neurodiagnostic Society celebrated its 60thyear. I had the opportunity to meet with ASET leadership to continue our close collaboration. As usual, I had a wonderful and productive conversation with ASET Immediate Past President Susan Agostini and the new ASET President, Connie Kubiac. I look forward to our continued collaboration. 

 

In late August, neuromonitoring was again in the national spotlightand, sadly, not in a positive light. I think we are on the verge of seeing more national news stories related to out of network (OON) billing for neuromonitoring. While the OON status of many companies is mostly the fault of the insurance industry refusing to allow us to be in-network, the news stories will sensationalize this and blame the IONM profession as a whole. Those of you who are engaged in business practices of questionable ethics (you know who you are), you’re not helping matters because stories that break about you will only make the rest of us look bad. 

 

Anyway, I’m sure you’re all aware of the NPR story about IONM that broke on June 17th. Well, a different version of this story also aired on NBC Nightly News with Lester Holton August 18th. In this segment, Ms. Cannon’s story was reported by Catie Beck in the Your Money Your Lifesegment. This particular story did not use quotes or comments from me, but it did talk about surprise bills and paint IONM in a negative light. 

 

On a more positive note, there was also a recent story about IONM published in Neurosurgery Market Watch. Among those interviewed for the story include myself, Dr. Faisal Jahangiri (ASNM President-Elect), Dr. Jay Shils (ASNM Secretary) and Dr. Marc Nuwer (longtime ASNM member and Fellow).

 

Turning to the future, the ASNM Fall Symposium will be held September 13-15at the Hyatt Regency Boston. You can view the program online and register here . There will be three pre-conference workshops covering the 10-20 system, TCD and electrode safety. As usual, the main conference will feature a variety of new speakers covering a variety of new topics. If you’re one of those people who continues to think of that ASNM as presenting stale topics with the same old speakers, I’d encourage you to set aside your prejudice and check out our program. Also, if you can’t make the fall symposium, I’d strongly encourage you to plan to attend our 2020 Annual Meeting in St. Louis, MO. We’re planning a bunch of new activities that will transform your meeting experience.

 

So, that’s my President’s Message for September 2019. In my October President’s Message, I’ll tell you about how our Fall Symposium went, and give you important updates from our Board Meeting. I hope you’re all enjoying the closing days of summer. I’ll be back in October with another update from the front lines. Thanks for being a valued member!

 

Rich Vogel, PhD

ASNM President

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President's Message - August 2019

Posted By Rich Vogel, Wednesday, July 31, 2019

Members,

My last President’s Message was in June. This has been a busy month. On the personal front, I moved to a new home and took a week’s vacation to unplug and recharge. Now, I’m back to work for you.

I want to give you an update on some of the things we’re working on, as well as make some comments related to the NPR storyabout IONM that broke on June 17th.

Here’s a bullet point list of some projects we’re working on presently.

  • Reviewing contracts for upcoming meetings. Our management partner, Affinity Strategies, is working hard trying to secure locations and hotels. In that process, our Executive Committee is working to select the best locations and review potential contracts with hotels.
    • As you know, a primary goal of mine is to get our hotel prices down and make them affordable for all.
    • Our 2020 Annual Meeting has been moved from Chicago to St. Louis. It will be held May 15-17, 2020. 
  • Collaborating with other societies, like ASET, to coordinate various projects that we’re collaborating on. One example is patient awareness and advocacy.
  • Our Taskforce on Diversity is off the ground and presently being coordinated by Dr. Tara Stewart
  • We also launched a “Sponsor Taskforce” to seek input from our industry partners. This taskforce is being led by Leah Hanson. They are presently working on our 2020 prospectus.
  • I’ve been working with Affinity Strategies to update our branding and communications.
    • We’ll no longer bombard you with emails. You can expect to see e-blasts from us approximately every 2 weeks. The President’s Message will come in the first e-blast of the month.
    • You’ll get a reminder to register on the day of a webinar.
    • Everything that comes from the ASNM will be branded the same and look clean and consistent.
  • We’ve made a few changes to the membership application:
    • Removed CV requirement for membership application. Students must still upload proof of student status in a relevant program.
    • I am personally reviewing every question on the membership application and we will update/alter them as needed to ensure we are attracting a diverse membership. Remember, the ASNM is open to anyone with an interest in IONM, regardless of background, education, training, experience or role in IONM.
  • We’ve made a few changes to the website:
    • We included headshots on leadership page so you can see who represents you.
    • While it is in the very early stages, we are working to develop a section of the website dedicated to educating patients about IONM. We have some awesome volunteers working on this project. I expect it to take the better part of a year to complete. 

Now, I’d like to spend the rest of my message commenting on the NPR Story:

Unless you’ve lived in a cave for the last two months, I’m sure you are aware of the story that NPR broke about a patient in Texas receiving an Explanation of Benefits for IONM to the tune of $94K.

The first thing I want to say is my heart goes out to the patient, Liv Cannon, and her fiancé, Cole Chiumento. It’s bad enough having a complex spine disorder and a complex spine surgery, but to receive a large EOB is certainly scary for anyone. The anxiety Liv and Cole must have felt wondering if they would ever receive a bill, well, I can only imagine.

The second thing I want to say is that I spoke to NPR for about 30 minutes, but they only used 2 quotes from me. Both of them were used out of context. I want to give you a couple of examples taken directly from the article. What you see below in italicsis what NPR reported in print. Anything in [brackets]is my comment on that particular statement.

There is an ongoing debate about whether neuromonitoring is needed for all spinal surgery. But it is standard for a complicated operation like the one Cannon had, says Richard Vogel, president of the American Society of Neurophysiological Monitoring[There are no quotation marks here. So, this is not a quote. This is a summary of a conversation I had with the reporter in which I talked about regional differences in the use or nonuse of IONM by surgeons, and how some surgeons feel that lower risk cases do not require IONM. Regardless, I stand behind the accuracy of this statement as it is printed.].

On the other hand, a $94,000 charge for the service can't be justified, Vogel says. [Again, no quotation marks, not a quote. This is the reporter’s interpretation of the quote below].

"You're not going to meet anybody who believes that a hundred thousand dollars or more is reasonable for neuromonitoring," Vogel says. [This statement is surrounded by quotation marks. This is a direct quote, and the context of this quote was related to the cases in Colorado which the reported asked me about. As an independent individual, I stand behind this statement. The ASNM, however, is not in a position to determine what one can or cannot charge for IONM. If you want to read why, you’ll have to read my statement that I gave to NPR in the paragraphs that follow below].

Most neuromonitoring companies charge reasonable fees for a valuable service and are upfront about their ownership and financial arrangements, he says. But some companies are greedy and submit huge bills to an insurance company, hoping they won't be challenged, he adds. [Again, no quotation marks, not a quote. This is a summary. I stand behind the accuracy of this comment].

Even worse, "some neuromonitoring groups charge excessive fees in order to gain business by paying the money back to surgeons," Vogel says. [This statement is surrounded by quotation marks. You can review my written statement for context. I stand behind the accuracy of this statement, too.].

Last year, Vogel's group published a position statement condemning these "kickback arrangements" and other unethical business practices. [Again, the primary context was the Colorado story.].

 

Now that I’ve given you some info about my quotes, I thought it might be helpful to our members to read some of what I actually said to NPR, so you can see the context for some of my comments, AND so you can see all the good stuff they never even used: What you see in bold below are the questions I was asked, and then you can see below each how I responded.

What is the evidence that neuromonitoring (IONM) is beneficial for patients?

In general, the evidence is quite good in support of neuromonitoring’s benefits across the wide range of surgical procedures in which it is used. Aside from any risk to the nervous system coming directly from the surgical procedure, studies also show that IONM can detect and prevent positioning related injuries that may result from a patient laying in the same position for a long time during surgery. So, the utility of neuromonitoring is greater than what many people initially consider.

Recently, a number of studies have been published in prestigious journals questioning the utility and value of neuromonitoring, but those studies are so fundamentally flawed, the very fact that they were even published is a testament to how broken our peer review system is in the scientific and medical literature. At the end of the day, these studies have little merit, but their publication brings to light some important considerations regarding evidence for neuromonitoring. Specifically, evaluating the neuromonitoring literature is challenging because there’s tremendous variability in how surgeons use it. This heterogeneity confounds many comparative studies. Also, critics argue that there are no class I studies evaluating neuromonitoring, but the same is true for many medical interventions, including spinal decompression and fusion surgery. In order to develop class I studies, patients would have to be randomized to groups receiving IONM or no IONM in high risk surgery, and the ethics of withholding a treatment which is largely considered standard is questionable. 

Which patients need neuromonitoring?

Neuromonitoring is performed in a wide variety of surgeries, including brain, spine, cardiothoracic and ear/nose/throat, just to name a few. All of these procedure pose some risk to the patient’s nervous system, which can result in weakness, paralysis, loss of sensation, loss of hearing, loss of sight, loss of bowel/bladder control, etcetera. So, it may be indicated for any surgical procedure in which the patient’s nervous system is at risk. 

What has led to the rapid expansion of neuromonitoring?

Many people have argued that use of neuromonitoring expanded secondary to the availability of personnel created when we introduced the telemedicine model of one physician remotely supervising many technologists, but there’s no evidence to support this. Indeed, a highly qualified and educated workforce was available long before this model was introduced.

The real drivers of the expansion are education and liability. Regarding education, many surgeons now understand the utility and value of neuromonitoring for protecting their patients. Whereas neuromonitoring started in spine surgery, it has now expanded to include surgery on other parts of the body. The number of surgeries performed in the US continues to grow, and the types of surgeries that neuromonitoring benefits continues to expand as well.

Regarding liability, there’s tremendous pressure on surgeons and hospitals from the medicolegal community. There’s always a fear of being sued. Using neuromonitoring is thought to reduce a surgeon’s liability, so they use it for their own protection.

How much does neuromonitoring typically cost?

I think we need to break this down two different ways, so I going to rephrase your question both ways and answer each independently:

How much does it cost to perform the service?

We can start by asking how much does it cost a neuromonitoring company (or hospital) to perform the service on a single patient. Neuromonitoring is like any other business where you have salaries, equipment, supplies, travel and overhead. The break-even amount can vary significantly from one group to another. Hospitals and insurance companies often want to pay as little as possible, but they’re just bargaining for lower quality patient care. The unfortunate consequence of driving down prices is a less educated and competent work force using lower quality equipment. So, neuromonitoring can be done inexpensively at the risk of lower quality patient care, or it can be more expensive to get expert neurophysiologists working in the operating room with the most advanced monitoring equipment. 

How much is the average cost to consumer (payor)?

The next question is, how much should it cost the insurance company, or the patient. I have to start by saying that I’m not an expert in medical billing, which is extremely complex, and neuromonitoring is no exception. The cost to consumer (payor) can vary simply depending on the type of monitoring performed and the length of surgery, but these factors alone do not account for the exorbitant charges that are billed for neuromonitoring. Those charges come from a fee schedule that each neuromonitoring group generates to determine what they will charge insurance companies for performing the service. This is based on CPT codes (current procedural terminology) that identify which neuromonitoring tests were used. The usual, customary and reasonable fees associated with these codes are updated annually in a medical fee manual published by Practice Management Information Corporation. For each code, PMIC publishes rates in the 50th, 75thand 90thpercentile based on national averages. In developing a fee schedule, neuromonitoring groups use these numbers, and adjust them by their geographic location. So, there is a basis for developing specific fees for specific neuromonitoring tests. The problem is that some groups are greedy, and they can just double or triple the end product to get more money, and insurance companies are simply unaware or don’t care. The other method that some companies use to develop their fee schedule is to see what Medicare recommends from their fee schedule, then charge a multiple. The basis for determining the multiple is beyond the range of my expertise. 

There have been news reports of some patients receiving very high bills for neuromonitoring. Is that a problem in the field?

The first thing we have to do is differentiate between what is a bill, and what is not a bill. Most frequently, patients receive something in the mail from their insurance company called an Explanation of Benefits. It’s a summary of charges and coverages, and it always says somewhere “this is not a bill”, but patients often get scared and come to expect an impending bill when they see some amount of money listed under a section entitled “your responsibility” or “provider may bill you”. The amount listed is just the difference between what the doctor charged the insurance company and what the insurance company is contracted to pay. Attempting to collect that difference from the patient is called “balance billing”, which is prohibited in some states, but not all. So, patients may or may not be responsible for some portion of the balance. How much the patient actually owes depends mostly on the patient’s co-insurance, deductible and co-pay. It’s all related to the patient’s individual insurance plan. So, if the patient owes anything, it may be far less than expected.

In rare circumstances, patients do actually get very large bills. Unfortunately, many patients these days have high deductible plans with no OON benefits. So, they’re going in to have what is often a very expensive procedure with little in the way of financial protection.  The best thing a patient can do is contact the doctor and the insurance company and ask them to advocate for you. There are ways to reduce costs. Even then, most neuromonitoring groups don’t put patients into collection unless they received a check from the insurance company and failed to turn it over to the rendering provider.

The biggest concern for our field is the fact that some groups charge excessive fees in order to gain business by paying the money back to surgeons. It’s a big enough problem that the ASNM took the bold step last year of publishing a position statement on business practices in neuromonitoring. We’re not in a position to tell providers how much they can charge insurance companies, but we are in a position to express concern over why they charge such high fees and what they do with the money. A growing problem in the US right now is groups paying surgeons a kickback to use neuromonitoring. So, some percentage of that patient’s large bill is funneled back to the surgeon as an incentive to use a specific neuromonitoring group. While the practice is technically legal in a few states, the AMA is clear in their view that the practice is unethical, and we feel the same way. 

How and when should patients be informed that neuromonitoring services will be an out-of network service?

Best case scenario, the patient should be informed by the surgeon or hospital at the time when the surgery is booked. Unfortunately, 99% of IONM is considered elective. So, surgeons and hospitals may fear that, if they tell the patient IONM is OON, the patient will choose not to have their surgery at that location. Hospitals/surgeons are afraid of losing the business. So, the patient is often informed in the minutes just before surgery when they sign the consent for neuromonitoring.

The most unfortunate part of all this is that the OON status of most neuromonitoring companies is actually the fault of the insurance companies who are supposed to be advocating for their patients. Many IONM groups actually try to go in network, but the insurance companies only accept a limited number of neurologists in their network, most of whom don’t do neuromonitoring. So, a neuromonitoring group attempting to bring their neurologists in network is often denied.

On top of that, the fees are driven up by insurance companies’ refusal to negotiate with neuromonitoring groups, which would only make charges more reasonable for all. That alone could save the insurance industry tens of millions of dollars per year.

Neuromonitoring’s pervasive OON statues is mostly the result of the fact that insurance companies don’t understand IONM, and they’re not willing to listen.

How can consumers avoid a surprise bill for neuromonitoring?

If the patient actually receives a bill in the mail, the best thing to do is to call the provider. They can usually help to reduce the cost by working with the patient to appeal to the insurance company to reprocess the claim at in-network prices. This could save hundreds or thousands of dollars.

In terms of actually avoiding a surprise bill, some states have laws against surprise bills, while others do not. So, it’s difficult to know if you are protected. The best thing a patient can do is ask his/her surgeon which ancillary services will be used during surgery. Neuromonitoring is just one type of ancillary service. From there, the patient can find out of the provider is in-network, or ask their insurance company what they can do to process the claim at in-network prices. 

 

So, that’s my President’s Message for August 2019. I hope you’re all enjoying your summer. I’ll be back in September with another update from the front lines.

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President's Message - May 2018

Posted By Joseph J. Moreira, M.D., Monday, May 14, 2018

Dear Membership,

The time has come to pass the gavel, officially, to Jeff Gertsch. I will make this brief but just wanted to thank the membership for making this past year possible. The commitment you all made to this society year after year keeps us moving forward and flourishing as a profession. We have excellent educational offerings and make progress in the field due mainly to your support and participation. Your ongoing interest and support is what drives us on the ASNM board. To that end I ask that all of you consider serving in any capacity possible. The new year comes quickly, and many hands are needed. Please consider running for office, joining a committee, speaking at a meeting, running a webinar, searching for and recruiting new members etc.

I want to thank our amazing board of directors and members of the executive committee as well as Apex Management for all their efforts and support. We accomplished a great many things this year but there is a tremendous amount of uphill work to be done. I will give all my efforts and support to the new President and board members and will do my best to keep things moving forward in our field. I ask you all to do the same.

Thank you again for this humbling experience and I am always available to help in any way. All the best to our new leadership, we are in excellent hands.

Best, Joe

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President's Message - December 2017

Posted By Joseph J. Moreira, M.D., Thursday, November 30, 2017

Greetings,

I hope this message finds you all well and that you had a wonderful Thanksgiving.  It is now a family tradition that when things are either not going well, or we are complaining about life in general, that we force ourselves to think of 5 positive things. Yes, my partner is a psychotherapist! I am proud to update you on a number of items that I hope will brighten your day a bit.

The first order of business is to congratulate everyone on a well-run and successful election. I am very grateful to all the candidates that had the courage and spent the time to throw their hats in the ring and run for an office. It is a wonderful process to undertake as it gets you thinking about our field and what needs to be done to keep it moving in the right direction. It also gives each candidate a bit of exposure and helps them to network some and be recognized for their accomplishments. I urge all our members to consider being a part of this process and get involved in an election, a committee, a meeting, or whatever you have time for.

Our new President-Elect is Rich Vogel. He will become president after the Annual Meeting in 2019.

We also have 4 new Directors who will take office in 2019: 

I am excited about our new board members and am looking forward to working with all of them. This society is in excellent hands and we owe the entire group that participated in this election a thank you for getting involved.

 

The second item I am grateful for is the recent board approval of our new Practice Guidelines for the Supervising Professional: Intraoperative Neurophysiologic Monitoring. This was over a year and a half in the making with the great efforts of an ad hoc committee comprised of original authors, board members, executive Committee members and general members. Great pains were undertaken to assure that the new document was properly updated. We strove to have the document reflect current practices while maintaining the highest quality of patient care. We will now submit the revision to other societies for their review and accept comments from them if any. The document will then be published after a final run through and consideration of any comments generated during the review period.

 

Item number three. We had one of our most successful Fall meetings ever in Baltimore. The main thrust was IONM and Medical-legal issues. Our Mock trial was a tremendous success and is the start of an all new type of creative format for our future meetings playing off a theme and using a more practical method of delivering the message.

 

That brings me to number four. Our Annual meeting will be held February 23-25 at the Swan and Dolphin in Disney World, Orlando, Florida. This will be held during President’s week off so please consider bringing the family. The meeting will be a new format of 2 tracks on day 1. Each session will have its own lectures, panel discussions and E poster presentations. The topics are cutting edge and all promise to be excellent. Please check out the agenda on our website.

 

Finally, number five. In keeping our promise to collaborate with other societies, May 1-6, 2018 we will be contributing to the 31st International Congress of Clinical Neurophysiology (ICCN) in Washington, DC. This is a great opportunity to hear from international neurophysiology experts and attend workshops and lectures. Note that this meeting is taking place during our usual Annual Meeting and that our Winter Meeting in Orlando is our Annual Meeting.

 

I look forward to seeing you all at the meetings and wish everyone a Happy, Joyous and Healthy Holiday Season.

 

Best Wishes, Joe

 

Joseph J. Moreira, MD

President, American Association of Neurophysiologic Monitoring

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President's Message - September 2017

Posted By Joseph J. Moreira, M.D., Thursday, August 31, 2017

Greetings to all in the IOM community. If you are reading this address then you are looking to the ASNM for information of some kind, or just curious to see what we have to offer. If you have visited us previously or are a member then you will notice that we just launched our new website. I want to extend a thank you to our two board members that orchestrated the new web design from the start, Dr. Richard Vogel and Dr. Bryan Wilent. Great job! Here is a brief message from Rich and Bryan:  

“We're very excited to announce that our website has been redesigned to enhance your experience as a member of the ASNM. The new website features a modern, responsive design with a new menu system that simplifies navigation on any device. The website now contains a blog, which replaces the old Monitor Newsletter. From the blog, you can expect frequent posts from the ASNM to keep you up-to-date on news and announcements from the ASNM, including upcoming meetings and webinars, interesting case studies, clinical commentary, recently-published literature, and other news from around the neuromonitoring community. Finally, the website will include a member community, like a social network, that provides a new way to connect with fellow colleagues, share information across the ASNM network and manage your membership preferences. We encourage you to explore the new website and all of its features, and don’t forget to subscribe to our blog!”

 

I had the honor of taking the reigns over during our Annual Meeting in Cleveland. We celebrated the 40th anniversary since the first IOM meeting was held there. I was humbled by the experience of meeting the pioneers of our field. It was an amazing sight to see our youngest and brightest at the meeting mingling with the likes of Dr. Tamaki, Schramm, Nuwer, Nash, Kartush, Moller, Sloan and Koht. Drs. Koht and Eccher and the rest of the planning committee did an outstanding job of coordinating and creating this event. Thanks to all involved.

One of this year’s themes is about growth as a field and as a society. We are considering a corporate membership plan that would give IOM companies and institutions a discounted rate for a group membership. The larger we grow as a society the more presence and influence we will have. Our offerings will also grow with a larger membership base. I encourage our current members to recruit others in the field to join and perhaps participate on a committee or in any way possible.

Another main theme is about improving communication. One of the messages I have taken away from my few months as President is that we all aspire to improve the ground operations of the IOM field. It all comes back to a common theme of excellent communication with the patient as the central focus. We have recently heard many different messages and ideas of how our field can improve, but the common theme is communication. The link between the personnel in the OR and the supervising professional, the surgeon/anesthesiologist and the IOM team, and so on, are critical to the benefit of the patient. As there is always room for improvement, I urge all of us to step back and examine how we communicate daily before, during and after our surgeries and enhance the process in any way possible.

Our third theme this year is about collaborating with other societies. I had the opportunity to attend the annual ASET meeting this month along with the ASNM’s Executive Director Carol Ingmanson. We participated as a vendor and promoted the ASNM. Carol did a great job of setting up and coordinating the trip and we added several members and potentially a few more corporate sponsors. We are also planning a joint meeting May 1-6, In Washington DC, just before the International Congress of Clinical Neurophysiology (ICCN). More details to follow.

If you have not already made plans to attend please look at our upcoming Fall Meeting in Baltimore on September 9-10. We have a very interesting and practical agenda. “What to do When Something Goes Wrong and Hot Topics” We are featuring a Mock Trial and several talks on managing and avoiding potential legal issues. Drs. Eva Ritzl, Trey Lee and Robert Minahan and the rest of the planning team have done an excellent job of creating a very new and innovative meeting. Thanks to all!

Our Annual 2018 Meeting will be held early this year on February 23-25 at Disney’s Swan and Dolphin Resort in Orlando. Great family destination!

Last but certainly not least please check out our Webinar schedule. Our next webinar is on 10/11 with Dr. Charles Yingling, “A Comprehensive Guide to Corticospinal Tract Mapping and Monitoring”

Thank you all for logging in, I look forward to seeing you all in Baltimore and at future meetings.

Best,

Joseph J. Moreira, M.D.

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