One of the most critical functions that the AANS performs on behalf of its members is representing the interests of neurosurgeons before the federal government. The principle mechanisms for carrying out this function are through the Washington Committee for Neurological Surgery and the Washington Office. Under the current AANS Bylaws, the committee, which is jointly funded with the Congress of Neurological Surgeons (CNS), is officially charged with: 1) Monitoring the activities of the government affecting neurological surgery; 2) Notifying neurosurgical leadership of these activities; 3) Recommending actions to be taken on behalf of the AANS and CNS; and 4) Making comments or taking action as directed by the parent organizations.
The activities of the committee, however, are not limited to its interface with the federal government. The committee also serves as the principle mechanism to address health policy and practice issues that may not directly involve the federal government. In addition, the committee frequently serves as the sounding board for new ideas and programs for the benefit of the neurosurgical community and its patients. For example, program ideas, such as “Think First,” “Decade of the Brain” and the “Cost Containment Project” were first generated by the Washington Committee.
A Brief History
In 1975, the AANS and CNS decided to become actively involved in the federal government’s rapidly expanding role in formulating, legislating, implementing and regulating health care policy. Dissatisfied with the representation on a number of issues by the American Medical Association and the American College of Surgeons, the neurosurgical leadership of the AANS and CNS felt that more direct involvement in Washington would give neurosurgery more influence on important issues impacting the specialty. The pioneer committee consisted of Louis A. Finney, MD; Donald H. Stewart, Jr., MD; Russel H. Patterson, Jr., MD; and Charles A. Fager, MD, who, after an extensive search, contracted with Charles L. Plante, a former Senate aide, to provide part-time Washington representation services. One of Mr. Plante’s requirements in accepting the job was that the AANS and CNS establish a small committee that would consist of senior members of the parent organizations who had an interest and expertise in health policy and federal affairs. Hence, the Washington Committee for Neurological Surgery was officially formed in 1976.
In its early years, the committee limited its activities to specialty-specific issues, such as federal funding for neuroscience research, professional liability reform and neurosurgical manpower. Over the past 20 years, however, the committee’s agenda has expanded to include nearly all health policy issues that either directly or indirectly have an impact on neurosurgeons.
Continued pressures by the federal government and private health insurers on the practice of medicine, particularly in the areas of reimbursement and managed care, heightened the need for a proactive presence in Washington, D.C. In 1996, the AANS and CNS decided to establish a full-time presence. Since 1997, organized neurosurgery has had a permanent, full-time Washington, D.C. office with a staff of four. At present, they include: Katie O. Orrico, JD, Director; Cherie L. McNett, Senior Manager of Regulatory Affairs; Lori Shoaf, Senior Washington Associate; and Cynthia Spriggs, Administrative Assistant.
Washington Committee Members
The Committee is composed of six members, three appointed by the AANS Board of Directors and three appointed by the CNS Executive Committee. In addition, the President and President-Elect of the AANS and CNS serve as Ex-Officio members and the Committee includes Liaison representatives from Sections and committees.
The current Washington Committee volunteers include: A. John Popp, MD, Chair, James R. Bean, MD, Robert E. Harbaugh, MD, L. N. Hopkins, III, MD, John A. Kusske, MD, Troy M. Tippett, MD, Stewart B. Dunsker, MD, Stan Pelofsky, MD, Daniel L. Barrow, MD, Issam A. Awad, MD, Robert E. Florin, MD, Lyal G. Leibrock, MD, M. Ross Bullock, MD, Kim J. Burchiel, MD, Lawrence S. Chin, MD, Richard G. Fessler, MD, Steven L. Giannotta, MD, Julian T. Hoff, MD, and Marion L. Walker, MD.
Decision-making Process
The committee meets four times each year in Washington, D.C. At these meetings, the committee considers a wide range of issues and recommends what action, if any, should be taken by the AANS and CNS. Final decisions on these recommendations are made by the leadership of the parent organizations and are then implemented by the committee members and/or staff. Before any action is carried out on a specific piece of legislation or federal regulation, the committee consults with representatives from the Sections, state societies and other experts within neurosurgery. Because the federal process timetable is unpredictable and sometimes requires rapid decision-making, the Washington Committee and staff have some latitude to act as necessary.
Expanding Role
The ever increasing involvement of federal and state governments, health insurers and employers in the practice of medicine has created increased pressure on the AANS and CNS to expand their role in socioeconomic matters. The Washington Committee is currently undergoing some structural change to ensure the AANS and CNS remain influential in the formulation of health care policy affecting neurosurgeons and their patients. At the committee’s recommendation, the AANS and CNS leadership recently approved the creation of several new activities that will be facilitated by the Washington Committee.
First, is the creation of the new AANS/CNS Coding and Reimbursement Committee. This new committee, Chaired by James R. Bean, MD, has consolidated and reorganized the former AANS Reimbursement Committee and the AANS/CNS CPT Coding Task Force into a single functioning entity. It is critical that all of our efforts in the reimbursement arena are conducted in a coordinated fashion. This new structure will allow the AANS to ensure that neurosurgical services are valued and reimbursed in a fair manner.
Second, is the creation of the Neurosurgical Devices Forum. Chaired by Richard G. Fessler, MD, the Forum will provide a mechanism for improving communication between neurosurgery, the Food and Drug Administration and other governmental agencies, the device industry and the public on issues related to neurological devices. The purpose of the Forum is to improve access to, and make more efficacious use of, neurological medical devices, diagnostic technology and other related products. Finally, the Washington Committee has established a new process for enhancing its representation of Section specific issues. Several Sections — Spine, Tumor, Cerebrovascular and Trauma- – have made direct financial contributions and have appointed a Liaison, who is invited to attend all Washington Committee meetings. A regular reporting and information sharing process is now in place, enhancing the ability of the AANS to represent the Sections before the federal government.
Keeping Members Informed
In an effort to keep membership informed about the Washington Committee’s activities, its members and staff make frequent reports to the leadership, Sections, state neurosurgical societies and the membership at large. The Chairman and Washington Office Director attend and make reports at the meetings of the AANS Board of Directors, the CNS Executive Committee, the AANS/CNS Joint Officers, the Sections and the Council of State Neurosurgical Societies. The committee also provides a Washington Update at special symposia held at the AANS and CNS Annual Meetings. Throughout the year committee members and staff are frequently invited to speak at state neurosurgical society meetings. Finally, the committee communicates its activities through the AANS Bulletin, the AANS/CNS Changing Times in Neurosurgery fax broadcast newsletter, and through periodic “e-blasts.”
Into the Future
Neurosurgery clearly has both a present and future role in the establishment and implementation of health care policy. The Washington Committee will continue to evolve so that the AANS will remain an effective advocate.
Katie O. Orrico, JD, is Director of the Washington Office.
Working For You…
The Washington Committee’s agenda is extensive, covering nearly all health policy issues facing neurosurgeons today. Our continued vigilance and presence in Washington, D.C. has helped the neurosurgery attain numerous legislative and regulatory “victories” that otherwise would not have been possible had we not had a “seat at the table.” The following outlines the many issues that the Committee addresses on an ongoing basis.
REIMBURSEMENT
- Medicare Physician Fee Schedule
- HCFA Regulations
- Legislative Initiatives
- Relative Value Updates
- Litigation
- CPT Coding
- Medicare Conversion Factor
- Medicare Coverage Policy
- Medicare Reform
- Chiropractic Payment
- CRNA Supervision
- Hospital In-Patient and Out-patient Payment
ACADEMIC CENTERS/TRAINING
- Graduate Medical Education
- GME Reform and other payment Legislation
- Physician Workforce, including manpower studies and legislative initiatives
- Physician certification/recertification
- PATH Audits
- Collective Bargaining of Residents
- Biomedical Research Funding, Programs and Policies
NEUROSURGICAL PRACTICE
- Patient Protection Legislation
- Health Plan Consolidation
- Antitrust Relief (i.e. Campbell Bill)
- Medical Records Confidentiality
- Emergency Medical Services Including EMTALA Regulations and Legislation and On-Call Physician Reimbursement
- Fraud and Abuse, Including HCFA and Inspector General Regulations/Enforcement Policies
- ยจ E&M Documentation Guidelines
- Tort Reform
- National Practitioner Data Bank Regulations
- Agency for Healthcare Research and Quality (AHRQ) Outcomes and Guidelines projects
- Physician Accreditation Initiatives
- Food and Drug Administration Issues
PUBLIC HEALTH
- Organ Donation Initiatives
- Injury Prevention Initiatives
- Medical Error Prevention
- Trauma Systems Development, Including Federal Grant Program Funding