As we come to the end of a decade and head into 2020, it is fitting to reflect on the progress that the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have made in advancing organized neurosurgery’s legislative and regulatory agenda to ensure that neurosurgical patients have timely access to quality care. At the beginning of 2019, we set forth an ambitious agenda, and throughout the year, the AANS and CNS continued to make progress on achieving our health policy goals.

Some highlights:

• Protect Patients’ Timely Access to Care. Prior authorization is a cumbersome process that requires physicians to obtain pre-approval for medical treatments or tests before rendering care to their patients. To protect patients’ timely access to care, as leaders of the Regulatory Relief Coalition, the AANS and the CNS collaborated with key champions in Congress — Reps. Suzan DelBene (D-WA); Mike Kelly (R-PA); Roger Marshall, MD, (R-KS); and Ami Bera, MD, (D-CA) — to introduce H.R. 3107, the Improving Seniors’ Timely Access to Care Act. With 156 sponsors at year’s end, this bill would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program.
• Improve the Health Care Delivery System. Narrow insurance networks restrict patient access to the physician of their choice and leave patients vulnerable to unanticipated medical bills. Working to improve the health care delivery system, the AANS and the CNS successfully advocated for the introduction of legislation to protect patients from unanticipated medical bills. The Protecting People from Surprise Medical Bills Act (H.R. 3502), and the Stopping The Outrageous Practice (STOP) of Surprise Medical Bills Act (S. 1531), would hold patients harmless and ensure that they would only be responsible for in-network cost-sharing amounts when out-of-network providers take care of them. Patients would also be kept out of the middle of payment disputes between health plans and providers, and a process for fairly reimbursing providers for their services would be established.
• Support 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 health care services for all Americans. Looming physicians shortages — by 2032, the nation faces a physician shortfall of between 46,900 to 121,900 — threaten this access to care. To help ease this shortage and to support quality resident training and education, the AANS and the CNS successfully advocated for legislation to increase the number of Medicare-sponsored residency training positions. The Resident Physician Shortage Reduction Act ( 348 / H.R. 1763), with a total of 185 cosponsors, would increase the number of available medical residency positions by 15,000 over five years.
• Continue Progress with Medical Innovations. America has a long tradition of excellence and innovation in patient care, and neurosurgeons have been on the cutting edge of these advancements. However, due to the medical device excise tax, American medical innovation and patient care have been at risk. Working with our partners in the medical technology industry for the past decade, the AANS and the CNS have been advocating for Congress to repeal this tax. This year, with the passage of H.R.1865, the Further Consolidated Appropriations Act, 2020, Congress demonstrated its commitment to continuing progress with medical innovation by repealing this tax. President Trump signed the legislation into law (P.L. 116-94). This bill also included increased funding for biomedical research in the neurosciences. Finally, Reps. Diana DeGette (D-Colo.) and Fred Upton (R-Mich.) released their initial vision for their Cures 2.0 initiative, which aims to modernize insurance coverage policies and improve access to life-saving cures. Cures 2.0 would build on the original 21^st Century Cures Act (P.L. 114-255), which aspires to advance medical research and foster a new era of medical innovations.
• Fix the Broken Medical Liability System. Medical lawsuit abuse is driving up health care costs, and driving good doctors out of the practice of medicine, leaving patients without the care they need when they need it. Many doctors — particularly in high-risk specialties like neurosurgery — are cutting back on high-risk and life-saving services, relocating to states with more patient-friendly liability laws, retiring early or leaving the practice of medicine altogether. To help fix the broken medical liability system, as a leader of the Health Coalition on Liability and Access, the AANS and the CNS worked with leaders in Congress to introduce H.R. 3656, the Accessible Care by Curbing Excessive LawSuitS (ACCESS) Act, which is modeled after proven reforms that are in place in California and Texas. In addition, legislation to help ensure that physicians are available to take care of patients with medical emergencies is pending before the House and Senate — the Good Samaritan Health Professionals Act (S. 1350) and the Health Care Safety Net Enhancement Act (H.R.3984).

We still have our work cut out for us to continue advocating for sound health policy that improves patient care, but 2019 will go down as a year in which the AANS and the CNS made significant positive strides.