FEATURE STORY
 
Specialty Docs Release 2017 Health Policy Principles
 
Knowing that health care policy would be front and center with the new Congress and new Administration, The Alliance of Specialty Medicine released its 2017 Health Policy Principles as a guide for policymakers and regulators to reference as they work through their options.

First and foremost for the Alliance is access to specialty care, which means addressing narrow networks and workforce shortages, and providing for comprehensive medical liability reform. The Alliance also believes patients should be allowed a range of coverage options whether they get their health care in the private market, through an exchange plan or through the Medicare or Medicaid programs. This means that Congress and the Administration should maintain a viable fee for service option, particularly since many communities do not have enough health plans from which to choose and may not have an adequate number of specialists in those plans.

Other key themes for specialists are transparency, accountability and oversight. Legislation for which the Alliance is advocating along these lines are repeal of the Independent Payment Advisory Board and reform of the U.S. Preventive Services Task Force, and the Physician Payments Sunshine Act.

Finally, the Alliance is calling for careful review and adoption of thoughtful improvements to the Affordable Care Act (ACA) to address the ongoing shortcomings to the healthcare delivery system. As Congress works to improve the healthcare system, the Alliance believes any changes should ensure access to affordable health insurance and access to specialty care, including: providing adequate access to specialty care through any benefit package, protection against the recession of health coverage and the prohibition of annual lifetime coverage limits. The full set of principles can be found on the Alliance web site: specialtydocs.org

 
IN THIS ISSUE...
UPCOMING EVENTS

Alliance Advocacy Fly In. July 17th-19th, Liason Hotel, Washington, DC

NOTE: Participation in Alliance events is by invitation-only, with some exceptions. To learn more about how you or your organization can participate, please contact your organization's staff liaison to the Alliance or email us at info@specialtydocs.org.

ALLIANCE IN THE NEWS

"IPAB's Medicare Cuts Will Threaten Seniors' Access to Care." The Hill.
- February 22, 2017.

"When Bureaucracy Gets In the Way of Preventative Care." The Hill.
- November 29, 2016.

"National Breast Cancer Awareness Month - What Patients Need to Know." The Hill.
- October 14, 2016.

 
 
 
The Following OpEd Appeared in The Hill on February 22, 2017
 
IPAB's Medicare Cuts Will Threaten Seniors' Access to Care
 
Alex B. Valadka, MD

As Congress begins to debate the future of the Affordable Care Act (ACA), there is no doubt that the American people will hear a lot of rhetoric regarding changes in the ACA affecting Medicare. However, there is one fact that cannot be overlooked even before the first repair or replacement bills are rolled out: significant Medicare cuts loom just around the corner, threatening seniors’ timely access to vital healthcare services. Why? Because for the first time since its inception in 2010, experts anticipate that growth in Medicare spending will exceed annual spending targets, thus triggering mandatory spending cuts by the Independent Payment Advisory Board or IPAB. As a neurosurgeon who treats Medicare patients, I consider the IPAB to be one of the most insidious elements of the ACA, and it needs to go!

Since Medicare’s inception, Congress has led the way in shaping policies to ensure our seniors’ healthcare needs will be taken care of. We saw this in the last Congress with a major overhaul of Medicare’s payment system — now known as MACRA — pass with strong bipartisan majorities and then get signed into law by President Obama. This is how Medicare policy is supposed to work. Now however, with the advent of IPAB, the people’s elected representatives will no longer have power over Medicare payment policy. Instead, these major health policy decisions will rest in the hands of 15 unelected and largely unaccountable bureaucrats, with little or no clinical expertise or the oversight required to protect access to care for our country’s seniors. And they will only have one job: to cut billions of dollars from Medicare. Even worse, if no board is appointed, which is the situation right now, the Secretary of Health and Human Services has the sole authority to make these decisions.

Specialty physicians recognize that we need to control the growth of healthcare spending, but the IPAB is simply the wrong solution for addressing these budgetary challenges. Operating now under MACRA, physicians have plunged into the nascent value-based payment world, which, if implemented correctly, will not only improve healthcare quality but will also drive down Medicare costs. Rather than this thoughtful approach to cost containment and quality improvement to enhance the value of the Medicare program, the IPAB is a merely blunt instrument to reduce what Medicare pays for medical treatments and will bring progress on value-based care to a screeching halt. Having lived through a similarly flawed Medicare payment system — the sustainable growth rate or SGR formula — for more than a decade, the last thing we need is another rigid system that relies solely on payment cuts to control Medicare spending.

So, in the end analysis, arbitrarily ratcheting down provider reimbursement, without sufficient oversight and without care taken to ensure that Medicare beneficiaries receive the quality healthcare that they need and deserve, is thus the wrong medicine for fixing our ailing healthcare system. And Americans agree. According to a recent Morning Consult poll, voters oppose changes that would limit access to care, with the vast majority of adults putting their trust in doctors (84 percent), rather than government officials (4 percent) or members of Congress (3 percent), when it comes to medical treatment decisions. Furthermore, more than half of our seniors (56 percent) say allowing IPAB to make changes to Medicare will hurt the quality of Medicare services.

Fortunately, it looks as if Congress is paying attention. In rare bipartisan fashion, legislation to repeal IPAB has been introduced by Sens. John Cornyn (R-Texas) and Ron Wyden (D-Ore.) in the Senate, and by Reps. Phil Roe (R-Tenn.) and Raul Ruiz (D-Calif.) in the House of Representatives. The Alliance of Specialty Medicine — representing more than 100,000 medical specialists and their patients — is urging lawmakers to expedite action on this issue.

As a nation, we have promised our seniors a Medicare system that offers the best care in the world. Bringing an end to the IPAB once and for all is a vital step to fulfilling that promise.

Alex B. Valadka, MD, is a neurosurgeon from Richmond, VA, and spokesperson for the Alliance of Specialty Medicine

Virginia Commonwealth University.
Professor and Chair, Department of Neurosurgery
P.O. Box 980631
417 North 11th Street, Sixth Floor
Richmond, VA 23298-0631
Cell: 713.899.6177
avaladka@gmail.com


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Narrow Networks and Neurosurgical Care
 
We are neurosurgeons, albeit not rocket scientists, but with our insider knowledge, it should be easy for us to understand "narrow networks." Unfortunately, this is not the case so we can imagine how difficult it is for our patients. Consider the following scenario:

A 52-year-old woman is receiving long-term care for multiple myeloma primarily involving the spine. Well-coordinated neurosurgical and oncological care is provided through a large multispecialty group; however, if she has her weekly blood tests performed in the group, she will pay $200! Thus, her blood tests are done across the street and sent to her doctors. Further, when she regularly needs advanced imaging (MRI or CT), her cost if done within the group is over $500. Instead, she travels 20 miles and must obtain a copy to bring to her physician visits.

This scenario is the result of a narrow network. What is a narrow network, why did they evolve and what is the impact on our patients?

Traditionally, insurance coverage offered both depth and latitude of choice for patients. In an effort to contain costs — cynics might argue control physicians and increase profits) — health insurance companies developed plans that allowed access only to a small group of providers or health care facilities. These are then defined as "in-network" providers. This network is not chosen on the basis of quality or value; rather it is an array of providers with whom a health insurance company has negotiated a steep discount. Within such plans, patients pay less when using an in-network provider, because those networks provide services at lower cost to the insurance companies. Such a network's adequacy is the ability to deliver the benefits promised, with reasonable access to a sufficient number of primary care and specialty physicians, as well as all other health care services included under the terms of the contract.

Unfortunately for patients, adequacy has become an increasing problem as plans have ever narrowed in-network providers. Narrow-network plans have grown in popularity since the inception of the insurance exchanges in the Affordable Care Act (ACA) because their cheaper premiums appeal to price-sensitive consumers. Roughly 70 percent of plans sold on the exchanges in 2014 featured a limited network, with premiums up to 17 percent cheaper than plans with broader networks.

Both providers and the patients have expressed dissatisfaction about these networks. Critics claim that insurers have failed to build or maintain adequate networks, provide up-to-date information about their provider networks and imposed additional travel burdens on insurance subscribers — particularly in rural areas where there is a sparsity of providers that are considered in-network for a given plan.

By limiting access to specialists, some plans perhaps find that they can bend the "cost" curve by manipulating the "care" curve. When looking specifically at neurosurgical care and assessing all available plans in 2015, there seems to be no prevailing approach regarding a network size.




While the current administration has promised repeal of the ACA, narrow-network plans are likely to continue proliferating because of the price advantages, even though the provider panels resemble the most limited found in Medicaid networks.

When providers are excluded from plans, many of our sickest patients suffer. And while the travel burdens may be most acute for those patients in rural areas, patient in urban and suburban locations also face difficulties in gaining access to the specialist of their choice due to network restrictions. While some may argue that Medicaid level access is preferable to no access, for many patients, Medicaid or other insurance coverage that reimburses providers at near Medicaid rates, may, in fact, prevent these patients from access to all but emergency care. The neurosurgical community is, therefore, concerned that this trend means patients are not getting the level of care that they deserve.

Insurance companies seem to have difficulty assessing the risk associated with caring for their subscriber population, as evidenced by double-digit premium rises over the last couple of years and insurance company withdrawals from the ACA-exchange marketplace. Continuing the trend towards narrow networks may be a way that insurance companies are holding down costs, but this cost-containment is resulting in a lack of access to care for many of the sickest patients. Compounding this issue are the mandated, yearly out of pocket maximums making access to expensive care difficult or impractical for most patients.

There may be no easy solution to controlling cost while maintaining coverage and choice. Ever narrow networks are an increasing ploy by insurance companies that are difficult for our patients to understand and too often have no connection to quality or value — the factors that should drive decisions for our patients.

This post originally appeared on Neurosurgery Blog which is a publication of The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS). It was authored by Deborah L. Benzil, MD, a neurosurgeon from Mt Kisco, New York and Clemens M. Schirmer, MD, a neurosurgeon from Wilkes Barre, Pennsylvania.


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ASPS President responds to Senator Bernie Sander's characterization of Plastic Surgeons
 
During an appearance on CNN on February 7th, Senator Bernie Sanders (I-Vt.) made a comment on the future of health care in the United States which some plastic surgeons felt mischaracterized the specialty when he brought up the cost of medical school and the shortage of primary care physicians.

During the debate, Sanders stated: "We need tens of thousands more doctors in this country. We have a major crisis in primary care. There are areas in urban America and in rural America where people literally can't find a doctor to serve their needs. And one of the reasons – there are a number of reasons for that – one of them is, you go to medical school, you can come out hundreds of thousands of dollars in debt. And then you're going to become a plastic surgeon, not doing primary care in an urban area or rural America."

American Society of Plastic Surgeons (ASPS) President Debra Johnson, MD, wrote to Sen. Sanders' office on behalf of all board-certified plastic surgeons, to educate the lawmaker about the true depth and breadth of the specialty – and perhaps open the door to further discussions about plastic surgery's vital role in the health-care system. In her letter, Dr. Johnson thanked Senator Sanders for his focus on healthcare but raised her concerns about his comments furthering the stereotype of plastic surgeons as “nip/tuck" doctors who cater to the wealthy. She noted that while some plastic surgeons do have lucrative cosmetic practices, the vast majority are also providing both aesthetic and reconstructive services to their communities:

"We are the doctors called when a dog bites your child, when your brother-in-law accidently sticks his hand in the lawnmower, when your wife gets breast cancer and wants to consider her reconstructive options. We have been at the forefront of helping our wounded warriors reintegrate into society, by making their damaged limbs more functional, their faces more recognizable, their scars of war less noticeable."

Dr. Johnson noted that plastic surgeons have been and will continue to be incredible innovators in medicine, beginning with kidney transplantation (first performed by Nobel Laureate Plastic Surgeon Joseph Murray) and now moving into face and hand transplantation. She concluded by offering ASPS as a resource to the Senator as the debate and considerations on the future of our nation's healthcare system continue.

"Members of the American Society of Plastic Surgeons are proud to serve as aesthetic and reconstructive surgeons. We are proud of the creativity and innovation we have brought to medical care. We hope to partner with you in the task of improving American medicine, and we would like to start that partnership through a conversation. If you would be willing to sit down and meet with leaders from the American Society of Plastic Surgeons, we will gladly come discuss the best path forward for American health care."

The entire letter can be read here.

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SPECIALTY SPOTLIGHT
Alliance of Specialty Medicine Welcomes its Newest Member, The American College of Osteopathic Surgeons.
 
The American College of Osteopathic Surgeons (ACOS) is the primary organizational home for osteopathic surgeons. They provide valuable resources, continuing medical education, and a united community base that helps its members deliver the highest quality care to their patients.

Its history began at an American Osteopathic Association conference in Louisville, Kentucky when a small group of surgeons joined together with a mission to set high education standards and provide continuing medical education to osteopathic surgeons. ACOS was formally established shortly thereafter on January 26, 1927. The efforts and tireless devotion of their founders and dedicated volunteers have raised training standards, improved the quality of patient care, and given osteopathic physicians a respected voice. Their mission continues to be promoting excellence in osteopathic surgical care through education, advocacy, leadership development, and the fostering of professional and personal relationships. With nearly 5,600 members at present, they look ahead inspired for what they will accomplish together in the future as they continue to lead and advocate for their profession.

ACOS welcomes this opportunity to join together with likeminded organizations through the Alliance of Specialty Medicine to make healthcare better for all physicians and the patients we serve.

For more information about the American College of Osteopathic Surgeons, visit www.facos.org.

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ALLIANCE SPONSORS
 

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Join the most powerful group of specialty physicians!
 
Joining forces with specialty doctors from across the country helps amplify the concerns specialty doctors share. By working together, specialty medical organizations can work more effectively to influence health care policy and ensure our primary goal: to continue to provide our patients the optimal care they need. As a part of the non-partisan umbrella organization representing all of specialty medicine, your organization will:

  • Promote specialty specific issues as part of a larger coalition, increasing visibility and understanding of issues.
  • Help increase exposure for specialty medical care.
  • Gain access to insider information, background materials and research on health policy initiatives and the political landscape.
  • Receive expert analysis on proposed legislation.
  • Caucus with other specialty organizations at the AMA House of Delegates and other forums to promote key issues that are important to specialty physicians.
  • Coordinate physician and patient grassroots efforts through a large and robust network.
  • Participate in future Alliance Fly-In events in Washington, D.C. Past events have included Capitol Hill visits and presentations by health policy experts.
For information on joining the Alliance of Specialty Medicine, visit our website at www.specialtydocs.org or contact Vicki Hart at vhart@hhs.com

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