Earlier this year, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) released its 2014 legislative agenda, which includes action items such as abolishing the Independent Payment Advisory Board (IPAB), alleviating the medical liability crisis, expanding support of quality resident training and education, and championing an improved Medicare reimbursement system. A few of our top priorities are detailed below:
ABOLISH THE INDEPENDENT PAYMENT ADVISORY BOARD (IPAB). Established by the Patient Protection and Affordable Care Act (ACA), the IPAB is a 15-member government board whose members are appointed by the president and which essentially has no meaningful Congressional oversight protections. The principal responsibility of this board is to cut Medicare spending. Proposed spending cuts automatically go into effect if Congress does not replace the recommendations with cuts of equal magnitude. Congress only has a very short time in which to pass its own proposal — making it a virtual certainty that the board’s recommendations would be adopted. The AANS and CNS strongly urge repeal of the IPAB because leaving Medicare payment decisions in the hands of an unelected, unaccountable governmental body with minimal congressional oversight will negatively affect timely access to quality neurosurgical care for our nation’s senior citizens and those with disabilities.
ALLEVIATE THE MEDICAL LIABILITY CRISIS. The AANS and CNS support legislation to provide common sense, proven, comprehensive medical liability reform. Federal legislation modeled after the laws in California or Texas, which includes reasonable limits on non-economic damages, represents the “gold standard.” The Congressional Budget Office has shown that comprehensive medical liability reform would save the federal government over $50 billion over ten years. Other solutions should be adopted including: (1) applying the Federal Tort Claims Act to services mandated by the Emergency Medical Treatment and Labor Act; (2) liability protections for physicians who volunteer their services; (3) liability protections for physicians who follow practice guidelines set by their specialties; and (4) clarifying that the ACA did not create any new causes of action.
CHAMPION AN IMPROVED MEDICARE PHYSICIAN REIMBURSEMENT SYSTEM. Year after year, because of Medicare’s flawed sustainable growth rate (SGR) formula, physicians face significant cuts in Medicare reimbursement. And time and time again, Congress intervenes with a short-term “fix” to prevent these steep cuts. Congress needs avoid band-aid solutions for fixing the physician payment system and once and for all replace the Medicare SGR formula with a stable mechanism for reimbursing physicians – particularly during any transition period to a modernized Medicare program. Any new payment system must also allow patients and physicians to privately contract without penalty to either patient or physician, and must maintain a viable fee-for-service option in Medicare. Preserving this option for Medicare beneficiaries is especially critical for those patients seeking specialty care – particularly neurosurgical services.
Other priorities include:
- Expanding support for quality resident training and education
- Fostering continued progress for medical innovation
- Funding to preserve and enhance access to trauma and emergency care
- Moving Medicare to a defined contribution system
- Restructuring and streamlining quality improvement programs