There are numerous connections in this world. Some are obvious and others are subtle; some are planned and others are accidental; some are physical and others are metaphysical; and some are inherent, while others must be developed. The connection between this editorial and the cover story on the Emergency Medical Treatment and Active Labor Act (EMTALA) in this issue is no accident. It is intended to demonstrate how organized neurosurgery can address the many aspects of an important health policy such as EMTALA.
As neurosurgeons we pride ourselves on service, round-the-clock availability and rigorous commitment to patient care. However, we are only human. At some point, we need to decide when we’ve reached the limit of our ability to provide safe and effective care for our patients and then we need to let Washington know when legislation exacts obligations beyond our limits. EMTALA represents a dangerous intersection between our commitment to service and our ability to physically deliver that service.
EMTALA was enacted to prohibit patient “dumping” based on inability to pay. That reprehensible practice deserved to be prohibited. But the EMTALA requirements are broad enough and the penalties steep enough that the law has an effect on physicians far greater than the lawmakers could have envisioned.
Committee Powers “Neural Network”
The Washington Committee for neurosurgery, made up of the AANS and CNS presidents, presidents-elect, and six appointees, is charged with responding to the external political environment as it affects the delivery of neurosurgical care. As such, the committee interacts with the White House, Congress, federal agencies, the court system, the American Medical Association (AMA) and other organizations.
To meet its charge, the Washington Committee serves as a nexus for other neurosurgical entities, such as the AANS/CNS Coding and Reimbursement Committee, the various AANS/CNS joint sections, the Council of State Neurosurgical Societies, and the individual state neurosurgical societies. All of these organizations have been pivotal in the Washington Committee’s strategy concerning EMTALA.
Here is one example of how the Washington Committee has addressed EMTALA through this virtual “neural network”: Codes that determine how neurosurgeons are paid for services, such as emergency care services mandated by EMTALA, are established through the AMA’s RVS (Relative Values for Physician Services) Update Committee and Current Procedural Technology (CPT) processes. The AANS/CNS Coding and Reimbursement Committee (CRC), chaired by Jim Bean, MD, reports through the Washington Committee. Through the CRC, the AANS and CNS worked with the AMA to establish an “on-call” CPT code that aids neurosurgeons in gaining reimbursement for on-call services.
Another example of a connection that achieved a positive result for neurosurgeons: Representatives from various AANS/CNS sections attend Washington Committee meetings, keeping the committee connected to specialty-specific concerns on the socioeconomic and political fronts and providing the committee with each section’s expertise. Recently Don Marion, MD, from the trauma section brought the section’s concern about EMTALA’s effect on reimbursement for neurosurgical emergency room care to the committee’s attention. In response, the committee drafted and facilitated the adoption of an AANS/CNS position statement on reimbursement for on-call services. This statement now is being used by neurosurgeons around the country to negotiate on-call stipends from their respective hospitals.
The Washington Committee also is plugged into the socioeconomic activities of the Council of State Neurosurgical Societies (CSNS). Committee members attended the July 2001 leadership development conference in Washington sponsored by the CSNS, which was then under the chairmanship of Lyal Leibrock, MD, a liaison to the Washington Committee. Concluding the conference was a trip to Congress. Approximately 80 neurosurgeoons trekked to the ÒhillÓ and met with their congressmen and senators to discuss concerns about health care delivery, EMTALA in particular. Their effort ultimately has led to the inclusion of EMTALA reforms in several bills now pending before Congress.
Committee’s Efforts Continue
Many other important strands can be woven into this skein of activities. Currently the Washington Committee leads the effort to prevent additional onerous EMTALA regulations from being implemented, and it is responsible, in part, for Health and Human Services Secretary Thompson’s directive to the Centers for Medicare and Medicaid Services to reevaluate EMTALA.
While these connections might seem “too political,” the fact is, organization and mobilization of our activities in a coordinated way enhances our small specialty’s ability to bring our message to the right constituency at the right time. It seems that now may be the right time for EMTALA.
A. John Popp, MD, is editor of the AANS Bulletin, chair of the Washington Committee, and Henry and Sally Schaffer Chair of Surgery at Albany Medical College.