AANS and CNS Reshape National Healthcare Reform Debate By Advocating for Basic Patient Protections

Access to Specialists A Key in Proposed Act

The American Association of Neurological Surgeons and Congress of Neurological Surgeons have been active in the battle on Capitol Hill to provide patients with basic protections in their health plans. As a member of the Patient Access to Specialty Care Coalition (PASCC), the AANS and CNS have helped to redefine the current national debate. The PASCC brings together more than 130 national organizations representing consumers and providers of medical services. These groups are advocating that any managed care reform bill must include six principles as minimum standards for managed care. The GAP (Guaranteed Access for Patients) bill, officially known as the Patient Choice and Access to Quality Health Care Act of 1998 (H.R. 3547), includes the six principles in one package. The principles are:

• Healthcare plans must allow providers to give patients full information regarding their conditions and treatment options, i.e., no “gag” clauses.
• All health plans must allow patients access to specialists.
• Patients must have the right to an expedited appeal when a plan denies benefits for a coverage or service.
• A complete list of benefits and costs must be provided to patients prior to their signing up for a plan.
• All health plans must allow patients to seek treatment outside their HMO, with the HMO covering part of the cost.
• Health plans are prohibited from paying doctors more money for offering less treatment or refusing referrals.

Managed Care Poll

Earlier this year, the PASCC commissioned Frank Luntz, a GOP pollster, to conduct a national poll on managed care. The poll tested the principles outlined in the GAP bill and found that they were overwhelmingly popular with the American people. Frank Luntz indicated that in all his years of polling, he had not seen anything with the universal numbers that managed care reform has. It cuts across party lines, across age lines, across income lines. The random sample of more than 1000 people confirmed that Americans expect quality from their healthcare plan, and they are willing to pay a reasonable amount more to ensure access to the specialists, procedures, and information they need to make sound judgements about their health. (See Figure 1 for summary of poll results)

The AANS and CNS strongly support H.R. 3547 and urge you to contact your representatives in Washington to support this and similar initiatives. You may contact your representative by using the PASCC toll free hotline (1-800-756-1100) to generate a faxed letter to your members of Congress. You may also send an electronic message to your member from the PASCC web site at https://www.patientaccess.com.

There is not much time remaining in this year’s congressional session, so it is imperative that neurosurgeons and their patients tell Congress that basic managed care reforms must be enacted this year.

For more information, please call Katie Orrico or Lori Shoaf in the Washington Office, (202) 628-2072.

Practice Expense Changes in the Medicare Fee Schedule; Neurosurgical Practice Expense Data Needed

On June 1 st , the Health Care Financing Administration (HCFA) released data on the proposed plan to reduce payment for practice expenses beginning in 1999. Initial analysis has revealed significant decreases in payment for many services, although the details are still unclear. HCFA indicated that the annual impact for neurosurgery over the next four years would be about 3 percent per year, with a total negative impact of about 10 percent. Other opinion suggests that it might be greater despite a staged implementation over the 4-year period.

The Washington Committee has been collecting actual data on neurosurgical practice expenses since last fall to use in judging what changes HCFA has proposed. We have had a major problem because of insufficient numbers of practices responding to the survey. We need a large number of practices to help with this effort because there is so much variation in practice expenses that a reasonable average will not be achieved without a broad sample. This must include the various demographic strata in our specialty, including academic settings, in order to achieve statistical significance. Without your help and participation, we will not be able to complete this project.

Some members have indicated a high level of interest in receiving an analysis of their own practice expenses, especially as compared to benchmark values for various categories of expense in other similar practices. This can be provided as long as we are able to collect sufficient numbers of responses to develop the benchmark databases, and have adequate funding to manage the survey process and the data collection and analysis.

Despite the politics of this move by HCFA to create a set of practice expense relative values based on resources consumed, this is still a data driven game. We have seen that specialties with even small amounts of credible data can prevail in this arena. The responses from the practice expense survey to date have shown that this can be done to useful effect, but the base of data needs to be much broader. This depends on the practicing neurosurgeons and their staffs to provide the information. If you receive a request for this data from your practice please cooperate and help, since this is only the end of the second round. The process of “refinement” of the HCFA data will continue over the next several years until fully implemented in 2002. Good data that contradicts HCFA’s data will still be useful in improving the accuracy and fairness of our payment system, especially since over 80 percent of non-Medicare payers are using the Medicare Fee Schedule as a basis for their reimbursement policies.

NIH NAMES NEW NINDS DIRECTOR

Harold Varmus, MD, Director of the National Institutes of Health (NIH), announced the appointment of Gerald D. Fischbach, MD, as Director of the National Institute of Neurological Disorders and Stroke (NINDS), the leading federal agency supporting research on the brain and nervous system. Dr. Fischbach is the Nathan Marsh Pusey Professor of Neurobiology at the Harvard University Medical School. He is Chairman of the Departments of Neurobiology at Harvard Medical School and the Massachusetts General Hospital. He was also the founding Director of the Harvard University Initiative on Mind, Brain, and Behavior.

As the new Director of the NINDS, Dr. Fischbach will oversee a staff of more than 700 scientists, physician-scientists, and administrators, and an annual budget close to $800 million. The Institute supports research by investigators in public and private institutions across the country, as well as by scientists working in 23 intramural laboratories and branches at the NINDS.

“This is a remarkable time in the field of neuroscience. Exciting discoveries at all levels of analysis from molecules to mind have led to a more profound understanding of the normal and diseased brain,” Dr. Fischback said. “It is an honor to be asked to serve as Director of NINDS at this time, and it is a welcome obligation to help the NIH remain the world’s most important force promoting biomedical research.”

Dr. Fischbach is an internationally renowned neuroscientist who throughout his career has studied the formation and the maintenance of connections between nerve cells and their targets. He developed methods for growing nerve and muscle cells outside of the body, and he has used such tissue cultures to study small molecules and proteins that alter synaptic efficacy.

Among his many awards and honors, Dr. Fischbach is a member of the National Academy of Sciences, the Institute of Medicine, and the American Academy of Arts and Sciences. He has served on numerous editorial and advisory boards including the Howard Hughes Medical Institute, the Helen Hay Whitney Foundation and the McKnight Foundation. He is a past-president of the 28,000-member Society for Neuroscience and he has been a trustee of the Marine Biological Laboratory in Woods Hole, Massachusetts. He is currently a non-Resident Fellow of the Salk Institute. Dr. Fischbach received his undergraduate degree in Mathematics and Chemistry from Colgate University in 1960 and his M.D. from Cornell University Medical School in 1965. After interning in medicine at the University of Washington, he worked at the National Institutes of Health for eight years, first as a senior surgeon with the NINDS, and later as a staff fellow at the (then) National Institute of Child Health. Between 1973 and 1981, he served as an Associate Professor and later as a full Professor of Pharmacology at Harvard Medical School. In 1981, he accepted the position as Chairman of the Department of Anatomy and Neurobiology at Washington University School of Medicine. Before leaving St. Louis to return to Boston and his current positions, Dr. Fischbach became Director of Washington University’s’ Jacob Javits Center for Excellence in Neuroscience, and the John S. McDonnell Center for Cellular and Molecular Neurobiology.

Dr. Fischbach will join the NINDS staff on July 30, 1998.