1236756_10201843651315115_1054821300_nToday, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) released its 2015 legislative agenda, which includes action items such as abolishing the Independent Payment Advisory Board (IPAB), expanding support for graduate medical education, championing an improved Medicare reimbursement system, and alleviating the medical liability crisis. A few of our top priorities are detailed below and readers can view the full legislative agenda by clicking here.

  • ABOLISH THE INDEPENDENT PAYMENT ADVISORY BOARD (IPAB). Established by the Affordable Care Act (ACA), the IPAB is a 15-member government board whose members are appointed by the president. 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.
  • EXPAND SUPPORT FOR QUALITY RESIDENT TRAINING & EDUCATION. An appropriate supply of well-educated and trained physicians—both in specialty and primary care—is essential to ensure access to quality healthcare services for all Americans. Unfortunately, the nation is facing a serious shortage of physicians, due to an aging population and the expansion of health insurance coverage through the ACA. And while medical schools in the U.S. have increased their enrollments, and additional medical and osteopathic schools have been established, the number of Medicare funded resident positions has been capped by law at 1996 levels. To ensure an adequate supply of physicians, Congress should (1) eliminate the current graduate medical education (GME) funding caps and increase the number of funded residency positions; (2) expand funding to fully cover the entire length of training required for initial board certification; channel a larger percentage of GME funds directly to the academic departments responsible for resident education; (3) allow resident and fellows to bill for the services they render after achieving verified competence in particular skills; (4) provide the profession with the tools, including antitrust relief, to ensure a well-trained physician workforce; (5) maintain current financial support for children’s hospital GME; (6) encourage all other payers to contribute to GME programs; and (7) ensure that the Accreditation Council for Graduate Medical Education (ACGME), American Board of Medical Specialties (ABMS) and Association of American Medical Colleges (AAMC) retain their preeminent roles in overseeing resident training and education.
  • CHAMPION AN IMPROVED MEDICARE PHYSICIAN PAYMENT 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. 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. Finally, to ensure access to vital surgical services, Congress must rescind the Centers for Medicare & Medicaid Services’ (CMS) plan to eliminate the 10- and 90-day global surgery payment package.

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