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Medical Liability Reform and DMLR: Your Support Is Needed
Doctors for Medical Liability Reform, a coalition of specialty societies which includes Neurosurgeons to Preserve Health Care Access, was discussed. Fifty-five Republicans have been elected to the U.S. Senate, and 53 of them are favorable to tort reform. Only Richard Shelby of Alabama and Lindsey Graham of South Carolina are Republican senators who have not been supportive, and it is felt that they never will be as they are trial attorneys. So far the Democratic side of the Senate has been cool toward tort reform.
Even though DMLR was successful with the 2004 Protect Patients Now campaign, much work still remains and the CSNS needs to continue to fund further tort reform efforts this year. For the effort to be successful, it is recommended that every neurosurgeon contributes a minimum of $1,000 annually for the next three to five years in order to fund a campaign effective in achieving permanent medical liability reform. As a point of reference, plaintiff attorneys in Florida contributed over $50 million dollars this year, with individual contributions starting at $1,000. There has been some success in tort reform in Georgia and South Carolina, where there now is a $350,000 “stacked cap.”
NERVES: A Remedy for Reduced Reimbursement
A critical issue in the next few months will be the participation of all neurosurgical groups in a sister organization known as NERVES (Neurosurgery Executives’ Resource Value and Education Society). NERVES is the organization composed of the business managers of various neurosurgical practices including private groups, employed groups, and academic groups. Its main purpose is to develop a comprehensive understanding of the needs of neurosurgeons and to integrate those needs into their individual practice settings. A major area of concern for NERVES is to optimize neurosurgical finances by improving reimbursement and minimizing costs which affect various neurosurgical practice groups. A 2004 survey conducted by NERVES identified the diversity of reimbursement schemes currently in existence in the United States. Gaining a full understanding of practice patterns and reimbursement structures will assist neurosurgeons in the negotiations required to receive appropriate payment for their efforts.
One important impending change in reimbursement for neurosurgeons’ work is pay for performance, an initiative recently adopted by the Centers for Medicare and Medicaid Services. Pay for performance is intended to reimburse optimal practice performance at the currently nominal rate. Those neurosurgeons who perform “best” as determined by the CMS will receive full reimbursement, and others will be reimbursed at a lower level. The total available dollars for reimbursement will not increase, and it is likely that the actual total debit to CMS will be less since only the top 5 percent to 10 percent of neurosurgeons will be paid at the peak of pay-for-performance rates.
The AANS/CNS Washington Committee and the American Medical Association are working together to prevent significant drops in the reimbursement available to neurosurgeons. Participation in NERVES will assist all practice groups with gaining a better understanding of the changes in reimbursement planned by various third party payers and will assist the participants in learning how to respond to them appropriately. The CSNS greatly encourages all practicing neurosurgeons to support their practice managers and administrators in becoming members of NERVES.
Fernando G. Diaz, MD, PhD, is chair of the Council of State Neurosurgical Societies.
For Further Information
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