All of us recognize that there are systematic problems with the funding and delivery of health care services in this country. There is substantial competition for state and federal resources. For more than a decade, the AAN has trained members as advocates for neurology and our patients to ensure our concerns are heard.
The Palatucci Advocacy Leadership Forum (PALF) is two–and–a–half days of intensive advocacy training. Participants are asked to develop an idea or policy for which they would like to advocate and implement. Mentors work with the participants in small groups to refine the advocates' messages, the message delivery, and establish an effective plan of action. Media training and coaching on effective advocacy to legislators is a key part of the program. More than 300 neurologists over the past decade have participated in the program.
Since 2003, Neurology on the Hill (NOH) has trained over 500 neurologists to advocate for neurology on Capitol Hill in Washington, DC. (See page 4 for pictures from this year's visit.) Each year, a cross section of AAN members representing almost every state floods the Halls of Congress, delivering messages that are key to the specialty and to the patients we care for. This year, two key messages to Congress were to fix the flawed Sustainable Growth Rate (SGR) formula and recognize that some specialties such as neurology, in addition to primary care, principally deliver face–to–face patient care.
Graduates of PALF are active participants of our advocacy efforts, including serving on the Governmental Relations Committee and the Medical Economics and Management Committee. PALFers were key in establishing neurologists and the AAN as an authority on concussion, establishing model policies for anticonvulsant coverage in particular by Medicaid, and developing position papers on topics including telemedicine, among many other accomplishments.
NOH has been key to a number of legislative successes including preventing SGR cuts, authorization of MS and Parkinson's Disease Centers of Excellence within the VA, pushing Congress to pass TBI screening for service members, and creating the VA Centers of Excellence for Epilepsy, among others.
One of my personal frustrations is the lack of action by Congress on recognition that the work of evaluation and management services performed by non–procedural specialties such as neurology should have the same recognition as primary care. Our contribution to the quality of life and improved outcomes in patients with complex chronic diseases is demonstrated in numerous studies. The burden of these diseases and the need for adequate numbers of neurologists going forward as the population ages emphasizes the need for this recognition.
However, things are not as bleak as they seem. In recent trips to Washington, I found that the congressional staff and members on committees of jurisdiction are well aware of this issue. Just a few years ago, there was no recognition that some specialties performed the same amount of evaluation and management care as primary care and were experiencing the same problems. Increasingly, there is appreciation that if the payment differential to primary care versus non–procedural specialties continues to increase, there will be substantial unintended consequences. The fact that the problem has not been effectively addressed to date in part is due to the budgetary and deficit problem the federal government is facing and the increasing political divide between the parties in Washington, resulting in the inability to get just about anything done. It is my view that ultimately the problem will be effectively addressed.
I would encourage all of you to consider applying for either PALF or NOH. Neurology needs effective advocates at both the local and national level. Whether or not we like it, decisions on health care payment policy and delivery system reform are driven by the state and federal governments. Legislators need to hear about the importance of neurology to their constituents. They need to hear from all AAN members.
Bruce Sigsbee, MD, FAAN