The following summary of issues constitutes the 2008 legislative agenda of the AANS and the Congress of Neurological Surgeons. Additional information is available from Adrienne Roberts, [email protected], in the AANS/CNS Washington office and from the Legislative Activities area of www.aans.org.
Improve trauma systems and access to neurosurgical emergency care. With only approximately 3,100 board-certified practicing neurosurgeons in the U.S., the AANS and CNS want to work with Congress to develop and implement a system for the regionalization of emergency neurosurgical care. As recommended by the Institute of Medicine, “the objective of regionalization is to improve patient outcomes by directing patients to facilities with optimal capabilities of any given type of illness or injury.” Neurosurgery also actively supports increased funding for the HRSA Trauma-EMS Program, which provides grants to states to improve critically needed statewide trauma care systems.
Champion improvements to the Medicare physician reimbursement system. Congress stopped the 10.1 percent cut that was scheduled to go into effect on Jan. 1, but physicians face a 10.6 percent cut in Medicare reimbursement on July 1 and payment cuts totaling 40 percent over the next eight years, beginning in 2009. The AANS and CNS are committed to working with Congress to pass both short- and long-term solutions to the Medicare reimbursement system crisis.
Preserve quality resident training and safe patient care. The AANS and CNS believe that further reductions in resident work hours will have a negative impact on resident training and education and will produce a generation of neurosurgeons who will not be as skilled or committed as their predecessors and will fall short of public expectations. In addition, adherence to strict work hours can lead to medical errors attributable to more frequent patient handoffs, fragmentation and loss of continuity of care. The Accreditation Council for Graduate Medical Education is effectively addressing these issues, and legislation on this matter is therefore unnecessary.
Alleviate the medical liability crisis. The AANS and CNS support legislation to provide commonsense, proven, comprehensive medical liability reform. Federal legislation that is modeled after the laws in California or Texas and includes reasonable limits on noneconomic damages represents the “gold standard.” Other solutions also should be explored, such as applying the Federal Tort Claims Act to EMTALA-mandated services and replacing the current system with specialized health courts.
Enhance Medicare and other quality improvement programs. The AANS and CNS support a pay-for-participation system in which clinical data collection occurs in a nonpunitive environment; data is appropriately risk adjusted; physicians continually receive performance feedback; and individual data is not publicly reported.
Increase funding for healthcare and research. Institutions such as the National Institutes of Health, Centers for Disease Control and Prevention) and the Agency for Healthcare Research and Quality are leading the way to help improve our nation-s health and save lives. The AANS and CNS urge Congress to increase funding for these vital public health programs.
Safeguard patient access to specialty care in healthcare reform. Healthcare reform must ensure that every patient has access to appropriate quality care, by the appropriate doctor, at the appropriate time. The AANS and CNS believe it is imperative that all healthcare reform proposals ensure that patients are provided adequate details about health plan options and physician specialist networks, and patients have adequate access to timely, affordable specialty care, including the doctor of their choice.
Advance measures to improve the neurosurgical workforce. While neurosurgery continues to fill its residency slots across the nation, the number of slots has not kept pace with growth in the U.S. population. As baby boomer enrollment in Medicare continues to climb, the future supply of all surgical specialists will be inadequate to provide the healthcare that these seniors will require. The AANS and CNS support reevaluating the residency-funding caps that were established by the Balanced Budget Act of 1997.
Protect patient-centered healthcare. Diagnostic imaging is an integral component of neurosurgical care, and the ability of neurosurgeons to provide in-office diagnostic imaging services to their patients ensures they get the best possible and timely care available. Ambulatory surgery centers and physician-owned specialty hospitals provide cost-effective care; have low infection, complication and mortality rates; and produce a marked increase in patient satisfaction. The AANS and CNS urge Congress to protect patient access to these services.