AAN President-Elect Bruce Sigsbee, MD, Speaks Out: Is Neurology in for a Challenging Decade?

February 15, 2011


By Bruce Sigsbee, MD, FAAN, AAN President-Elect

The cost of health care continues to rise faster than inflation. Currently, nearly one out of five dollars spent is on health care. Many businesses are retracting their health care insurance benefits. The federal government currently is engaged in substantial deficit spending. Health care as 25 percent of the federal budget (and climbing) is a major contributor to the deficit. As I write this, the Republicans in the House of Representatives announced that they intend to trim $100 billion from the current budget. Health care will not likely escape cutbacks.

This scrutiny is compounded by a public perception that the quality of health care is uneven. Research that backs up that perception—CMS initiatives, PQRS, and many provisions in the recent health care legislation—identifies steps to measure quality with the assumption that quality will be improved. Similarly, the recent maintenance of certification (MOC) initiative is an effort and obligation placed on physician boards, including the American Board of Medical Specialties, in large part in response to this public perception.

Going forward there will be substantial pressure to rein in the cost of health care, and the relative protection of entitlements allotted thus far is not likely to hold. Taking the approach of a turtle is not an option, even if your retirement is within 10 years. Your practice will need to evolve. First of all, it is important to stay informed. Be skeptical of arguments that appeal to emotion rather than to evidence-based facts. The use of electronic health records has been mandated. Increasing requirements for measurement and quality reporting are already law and are bound to increase. Major modification of the payment system is currently under discussion and will inevitably be adopted. Many proposals encompass payment that is contingent on demonstration of quality of care and cost containment.

As neurologists, it is important that we stand together. I can attest that the AAN has worked hard to block or mitigate changes that are deleterious to neurologists and will continue to do so. This is a highly political process. We need you to be involved and periodically we will ask you to help by contacting your legislators. Also, the AAN needs your direct involvement in advocacy efforts. The AAN alone cannot represent your interests. Other specialties and limited-license practitioners have learned this lesson, such as chiropractors and physical therapists.

I strongly encourage every one of you to be involved in advocacy. There are many ways you can do this:

  • Donate to the AAN political action committee BrainPAC. Whether you like it or not, we are not taken seriously in Washington without the PAC.
  • Neurology on the Hill is an opportunity that you should apply for. It provides direct training in effective advocacy and the attendees take neurology issues to Capitol Hill.
  • The Palatucci Advocacy Leadership Forum is an intensive four-day training program that focuses on the details of effective advocacy.
  • The AAN sends out periodic legislative efforts through the VOCUS program. Respond! Legislative offices count the number of messages received on a topic as a measure of the importance of the issue to constituents.
  • Finally, get to know your legislative delegation. To paraphrase Tip O’Neill, all politics is personal.