AANS and CNS oppose the “Patient Protection and Affordable Care Act”

Nov 21 2009

The American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) announced their opposition to the “Patient Protection and Affordable Care Act,” released this week by Senate Majority Leader Harry Reid. Additionally, while Senator Reid pushes ahead to finalize sweeping healthcare legislation in order to extend coverage to the uninsured and control increasing healthcare costs, the AANS and CNS cannot ignore several key issues which are vital to any overhaul plan and are missing from this bill including: concrete options for proven medical liability reform and protections to ensure patient choice of physician, including the right of patients to privately contract with their physicians.

“Despite some positive aspects of this bill, including the expansion of health insurance coverage, improvements in access to emergency neurosurgical care, and loan forgiveness for pediatric subspecialists, this bill still seriously misses the mark. It’s missing vital solutions to fix some of the most crucial broken aspects of our current system,” states Troy M. Tippett, MD, President of the AANS. “The Senate will vote on a procedure motion to begin debate this weekend and as it is now drafted, the bill is extremely detrimental for physicians and our patients.”

Gerald E. Rodts, MD, President of the CNS, comments, “We remain concerned that despite the state opt-out provision, the community health insurance option will ultimately limit patient choice; will put the government between the doctor and the patient, interfering with patient care decisions; and because of its tremendous cost – immediately and in the future – will be a burden to all Americans.”

The AANS and CNS find the following provisions to be particularly alarming:

• Ultimately, the community health insurance option will lead to a single-payer, government run healthcare system;
• The bill fails to recognize the looming workforce shortages in surgery by requiring that all unused medical residency training slots be allocated to primary care and by providing primary care physicians bonus payments that are financed on the backs of other physicians;
• The bill is devoid of proven medical liability reforms and merely includes a “Sense of the Senate” encouraging states to develop and test alternatives to the current civil litigation system as a way of addressing the medical liability problem. The Congressional Budget Office recently confirmed that a comprehensive set of tort reforms will reduce the nation’s deficit by $54 billion over 10 years, which would help finance expanded health coverage and contain costs.
• Largely unchecked by Congress or the courts, the Secretary of the Department of Health and Human Services would have unprecedented authority through, among other things, the new Center for Medicare & Medicaid Innovation and the new Independent Medicare Advisory Board, to make significant changes to the Medicare program, which permits the government to arbitrarily reduce reimbursement for valuable, life-saving specialty care for elderly patients, thereby threatening treatment options.
• The bill inappropriately expands the government’s involvement in determining the quality of medical care. Doctors are mandated to participate in the flawed Physician Quality Reporting Initiative (PQRI) -- which does not effectively measure quality – or face penalties for non-participation.
• The temporary one-year SGR “patch” to replace the 21.2 percent payment cut in 2010 with a 0.5 percent payment increase does little to address the serious underlying problems with the current Medicare physician payment system and compounds the accumulated SGR debt, causing a payment cut of approximately 28 percent in 2011. The Congressional Budget Office (CBO) has confirmed that a “significant reduction in physicians’ participation in Medicare would reduce beneficiaries’ access to services.”
• Patient-centered healthcare is threatened by provisions curtailing the development of physician-owned specialty hospitals.

Dr. Rodts concludes, “While we support healthcare reform measures, unfortunately, this bill fails patients and doctors because it imposes new agencies and more bureaucracy and government than currently exists, which will ultimately interfere with the doctor-patient relationship. The AANS and CNS stand firm that dismantling our current structure or creating a huge government bureaucracy is not necessary to achieve meaningful healthcare reform.”

Furthermore, AANS and CNS leaders are disappointed in the process leading to the development of this bill. “We, along with other medical professional organizations, have provided a strong voice from the ‘front lines’ in recent months to help shape the future face of healthcare in America, at the invitation of Senate leaders,” explains Dr. Tippett. “And while we’re thankful for this open dialogue during such a critical time, we are disappointed that virtually none of our recommended changes are reflected in this bill, calling into question the value of this process.”