REFORMING THE REFORM
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.
EXPAND SUPPORT FOR QUALITY RESIDENT TRAINING & EDUCATION
An appropriate supply of well-educated and trained physicians – both in specialty and primary care — is an essential
element to ensure access to quality healthcare services for all Americans. Unfortunately, the nation is facing a serious shortage
of physicians, particularly due to the expansion of health insurance coverage in 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. The solution for increasing physician numbers
involves not only increasing medical student class size and the number of medical schools, but also increasing the number of
funded residency positions. All payers of healthcare – including the federal government, the states and private payers –
benefit from graduate medical education. To ensure an adequate supply of physicians, Congress should eliminate the current
GME funding caps, expand funding for the full length of ACGME accredited training, maintain current financial support for
children’s hospital GME and encourage all other payers to contribute to GME programs.
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, American medical innovation is at serious risk. The AANS and CNS support the repeal of
the medical device excise tax included in the ACA. This tax will impose over $30 billion in new excise taxes beginning in 2013
and will adversely affect medical innovation and patient care. In addition to these unfair taxes, Medicare payment and
coverage policy can stifle innovation if it is overly limiting. Approaches such as accountable care organizations, bundling and
not paying for procedures in which new technology is used may seem cost effective in the short run, but if they prohibit the
development of safer and better procedures that get patients back to health, work, and activity faster, they may be much more
costly in the long run. The AANS and CNS urge Congress to be vigilant over any measures that would inappropriately
increase the regulatory burden for medical device innovation, hurt America’s competitive advantage in healthcare
advancements, and delay or deny appropriate care for patients.
PROVIDE FUNDING TO PRESERVE AND ENHANCE ACCESS TO TRAUMA & EMERGENCY CARE
There are significant gaps in our trauma and emergency healthcare delivery systems, and trauma is the leading killer of
Americans under the age of 44. The AANS and CNS strongly urge Congress to provide the full $24 million for trauma and
emergency care regionalization programs, which will support grants to states to improve critically needed state-wide trauma
care systems and pilot projects to develop models for regionalizing emergency care. As recommended by the Institute of
Medicine in its ground-breaking 2006 report, “the objective of regionalization is to improve patient outcomes by directing
patients to facilities with optimal capabilities of any given type of illness or injury.”
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