With reimbursement for medical services declining, the cost of running our practices increasing, and government regulatory activities strangling us, it sometimes is difficult for neurosurgeons to see the value of the large investment in lobbying activities that our national organizations make through the Washington Committee. Yet, small victories have been won and incrementally, they can be important. Unfortunately, some of these “victories” in Washington are typically incremental and take years to fully implement; thus, they go unnoticed. Sometimes, the victories are defined in terms of “minimizing losses,” which makes it difficult to identify the “win.” Let me give you just a couple of recent examples of how we make a difference when we get involved.
Action Prods Change
In 1997 the Health Care Financing Administration (HCFA) announced that it was going to implement a new system for reimbursing physicians for their practice expenses. If implemented, the original proposal would have reduced neurosurgical income in 1998 by nearly 50 percent! Working through the Washington Committee, the AANS and the CNS, along with several other medical societies, immediately launched a comprehensive lobbying strategy to prevent these reductions. As a result, Congress recognized that payment cuts of this magnitude would cause a potential crisis in Medicare patients’ access to surgical services and passed legislation that prevented these dramatic cuts. This effort saved neurosurgeons from losing more than $100 million in Medicare reimbursement in 1998 alone and reduced the proposed cuts to about 13 percent altogether over a four-year period.
More recently, in the wake of the emergency room coverage crisis, the burdens of the Emergency Medical Treatment and Labor Act (EMTALA) caught the attention of federal policy makers. One of the most serious problems for us was the policy of the Centers for Medicare and Medicaid Services (CMS, formerly HCFA) that made it illegal for a neurosurgeon to be simultaneously on call for more than one hospital at a time; violators faced fines of up to $50,000. After CMS articulated this policy during the 2002 AANS Annual Meeting in Chicago, the alarm bells went off, and our Washington Committee immediately began an all-out campaign to reverse this policy. One of the key aspects of this campaign was encouraging our membership to send letters to key legislators. In addition, many telephone calls were made directly by neurosurgeons to their congressional representatives and key staff. A number of meetings were held in Washington and within two months we convinced CMS to reverse this policy. As a result, neurosurgeons now are able to be on call for several hospitals at one time.
Important Work to Be Done: Medicare Reimbursement and Beyond
Neurosurgery is now facing two additional major crises that have bubbled up to the top of the federal healthcare agenda: additional steep reductions in Medicare reimbursement and the professional liability insurance crisis.
Thanks to the effectiveness of our Washington Committee and the hard work of many neurosurgeons, we are optimistic about a probable favorable resolution in the Medicare payment issue. The House of Representatives has passed a bill that would increase Medicare reimbursement to neurosurgeons by six percent over the next three years, preventing the anticipated 18 percent cuts that will take place over this same time period if Congress does not intervene.
We are less optimistic about a favorable resolution of the professional liability insurance crisis, but there may be some light at the end of this long, deep tunnel. It is very significant that the magnitude of the problem has reached the attention of the President of the United States, who recently dedicated a speech in North Carolina to this issue proposing major reforms to address the malpractice insurance crisis. Clearly, this is an issue that deserves our full attention and I know that our involvement can make adifference.
Politics Is Not a Spectator Sport:
Neurosurgery’s Personal Messengers
As effective as our national advocacy efforts are, we cannot achieve much without the active participation of many neurosurgeons at the local level. It is well-known that “all politics are local” and individual legislators need to hear from you-not just from our national lobbyists. This may mean writing a letter, making a telephone call, or if at all feasible, meeting with your representatives. They will hear you; policy makers do, in fact, hold neurosurgeons in high esteem and value their opinion greatly. You must be neurosurgery’s personal messengers.
We are making a difference.
Roberto C. Heros, MD, is the 2002-2003 AANS president. He is professor, co-chairman and program director of the Department of Neurosurgery at the University of Miami