The 2009 legislative agenda for organized neurosurgery in the U.S. is summarized below. Additional information is available from Adrienne Roberts, [email protected], in the AANS/CNS Washington office.
- 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 the CNS believe it is imperative that all healthcare reform proposals ensure that patients have timely access to the doctor of their choice.
- 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 that 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 the CNS urge Congress to protect patient access to these services.
- Alleviate the Medical Liability Crisis The AANS and the CNS support legislation to provide commonsense, proven, comprehensive medical liability reform. Federal legislation that is modeled after the laws in California or Texas and that includes reasonable limits on noneconomic damages represents the “gold standard,” but other solutions also should be explored. A first step would be to apply the Federal Tort Claims Act to services mandated by the Emergency Medical Treatment and Labor Act, which puts neurosurgeons at an increased liability risk. Congress also should study alternatives to civil litigation, including: early disclosure and compensation offer; the administrative determination of compensation model; and health courts.
- Champion an Improved Medicare Physician Reimbursement System Physicians face a 22 percent cut in Medicare reimbursement on Jan. 1, 2010. The AANS and the CNS are committed to working with Congress to pass a long-term solution to avert this significant cut and identify innovative approaches for reforming the Medicare payment system. Congress needs to replace Medicare’s sustainable growth rate formula with a new system that is fundamentally fair for all physicians, and any additional payments that are made to primary care physicians must not be budget neutral within the physician payment pool.
- Advance Measures to Improve Neurosurgical Workforce While neurosurgery continues to fill its residency slots, the federally funded positions have not kept pace with the growth in the U.S. population, particularly the Medicare population. Training a healthcare workforce to successfully serve the nation’s needs requires stable, long-term, predictable funding. The AANS and the CNS support preserving Medicare funding for graduate medical education and eliminating the residency funding caps that were established by the Balanced Budget Act of 1997. In addition, Medicare should fully fund residency programs through at least the initial board eligibility—in neurosurgery’s case, six years.
- Improve Trauma Systems and Access to Neurosurgical Emergency Care The AANS and the CNS are committed to working with Congress to develop and implement creative approaches that improve the emergency care system, including implementation of a system to regionalize emergency care. As recommended by the Institute of Medicine in its 2006 report, “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.” In addition, the AANS and CNS actively support increased funding for the HRSA Trauma-EMS Program, which provides grants to states to improve critically needed state-wide trauma care systems.
- Enhance Medicare and Other Quality Improvement Programs While Congress has taken the first steps toward implementing informed quality improvement programs, the current Physician Quality Improvement Program needs to be drastically reworked to better incorporate a system for clinical data collection and reporting. The AANS and the CNS support a pay-for-participation system under which data regarding physician quality is collected in a nonpunitive environment and analyzed using accurate risk-adjustment mechanisms; public reporting of data only occurs at the aggregate level and not at the individual level; and physicians receive performance feedback continually and in a timely manner.
- Increase Funding for Healthcare Research Organized neurosurgery embraces the need for well-designed clinical comparative-effectiveness research, which can be a valuable tool to “learn what works in healthcare” and support good clinical decision-making. CER must focus on communicating research results to patients and physicians and must not be used for determining medical necessity or making centralized coverage and payment decisions. The AANS and the CNS urge Congress to provide adequate funding for these vital public health research programs.
- Preserve Quality Resident Training and Safe Patient Care The AANS and the CNS believe that further reductions in resident work hours will have a negative impact on resident training and education. In addition, adherence to strict work hours can lead to medical errors attributable to more frequent patient handoffs 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.