The Health Care Business

The Health Care Business

by Bruce Sigsbee, MD, FAAN, AAN Past President 

The Health Care “Business” 
I spent last week in Washington, DC, advocating for neurology and the AAN. As I met with congressional offices and with some key members of Congress, it was apparent that many think of health care as a business or, more importantly, that market forces could be used to lower costs and improve access.

I have wondered if this is true and heard both sides from AAN members at the recent Annual Meeting in Philadelphia. Forces-both market and government-are at work. Recently, many neurologists have been left out of Medicare Advantage or Affordable Care Act (ACA) exchange networks. The reasons are not provided but presumably the decisions are based on the cost of care. In some areas, MS specialists have been removed from networks, presumably because of the cost of care of MS patients yet the medications and monitoring such as periodic imaging are entirely appropriate. But is the Affordable Care Act at all to blame?

New York Times article on the differential in payments between physicians and health executives reflected the evolution of health care into a business. The May 17, 2014, piece by Elisabeth Rosenthal pointed out the disparities: “$584,000 on average for an insurance chief executive officer, $386,000 for a hospital CEO and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor.” This was an interesting article coming on the heels of the data dump from CMS on payments showing a few individual physicians making millions, while the average physician was making much less.

Of course, hospitals and insurance companies increasingly apply business principles to health care. As physicians, we see this all of the time while trying to provide appropriate care to our patients. But government regulations are also certainly in play.

Questions continue about health care delivery, escalating costs, and uneven quality. If business/market forces are not the solution, is a federal program such as a single payer a solution? I'm really not sure. Government actions impacting neurology in recent years have seemed arbitrary and capricious, consider the recent EMG cuts. There is certainly no consensus on Capitol Hill, or for that matter among AAN members or its leadership.

These are issues that AAN leadership and committees such as the Government Relations Committee and the Medical Economics and Management Committee are debating. Going forward, we will continue to represent the interests of neurology and patients with neurological conditions as AAN membership examine all of the possibilities. If you have any thoughts I hope you will contact me

AAN Endorses Bills to Support Alzheimer's Research, Sports Neurologists
The AAN threw its support behind two pieces of federal legislation recently that would improve patient care for individuals suffering from neurologic conditions. 

The first is S 1091/HR 1508 by Sen. Barbara Mikulski (D-MD) and Rep. Maxine Waters (D-CA) that would issue a stamp to help fund Alzheimer's research. The United States Post Office would issue a stamp costing slightly more than normal and difference would be used to fund Alzheimer's research at the National Institutes of Health. A similar Breast Cancer Research Stamp first issued in 1998 has proven to be an effective fundraising tool, generating $78.7 million for research.

The second is  S 2220 /HR 3722 by Sens. John Thune (R-SD) and Amy Klobuchar (D-MN) and Reps. Tom Latham (R-IA) and Cedric Richmond (D-LA) that would provide much needed liability protections for neurologists and other sport medicine professionals who provide critical medical services outside their primary state while traveling with their athletic teams. Team physicians travel all over the country for short periods of time, making state‐based solutions impractical for this gap in liability. This bill would provide a limited common sense solution that will help ensure that athletes receive the care they deserve from a medical professional they can trust.

Odds and Ends 
by Tim Miller, Sr. Program Manager, Communications and State Advocacy

The White House has invited the AAN to the “White House Healthy Kids & Safe Sports Concussion Summit” on Thursday, May 29, which will feature remarks from the president and a panel discussion featuring experts in the field. AAN sports concussion guideline co-author Christopher Giza, MD, will represent the Academy during this event.

The Academy also has lended its support for legislation on Capitol Hill in regard to equestrian helmets. The Christen O'Donnell Equestrian Helmet Safety Act  would require all equestrian helmets to meet basic safety standards, as well as ban the use of unapproved equestrian helmets.

More sports concussion: A bill that would implement stricter youth football regulations has moved forward in the California State Senate. AB 2127 would prohibit full-contact football practices in the off-season. Nineteen other states have taken this step. The AAN was approached by the bill's sponsor and agreed to support it. 


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