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Capitol Hill Report: Listening to You. Talking to Them.

August 10, 2015

Thinking Outside the Beltway
By Mike Amery, Esq., Senior Legislative Counsel, Federal Affairs

Congress is officially on its summer vacation until September 8. With everyone released from the Capitol, I took some time to work outside DC, attending the Texas Neurological Society (TNS) meeting as well as the annual retreat of the congressional Blue Dog Coalition.

The AAN advocacy staff and I relish the opportunities to attend state society meetings. I enjoy getting out of the beltway and listening to our members share their concerns and challenges. In Fort Worth, the TNS event was well attended as it was joined by the Southern Headache Society. AAN State Society Liaison, Grant Niver, and I heard a story we had never encountered on the issue of “end-of-life planning.” In Texas, physicians are getting pressure from family members to keep patients alive at the end of life so they can continue to collect Social Security benefits. I certainly can't confirm if that story is true, but it sure makes the point that patients ought to have some type of way to let their wishes be known before that type of situation arrives.

Congressional legislation to allow physician reimbursement for time spent with patients on advanced care planning is something the AAN has supported for years. At long last, CMS proposed in July funding these services through the physician fee schedule. AAN Congressional Affairs Representative, Derek Brandt, recently attended an event featuring key health care leaders. Both House Ways and Means Health Subcommittee Chairman, Kevin Brady (R-TX), and Senate Finance Committee Ranking Member, Ron Wyden (D-OR), specifically mentioned the value and importance of having patients be proactive regarding advance care planning. We'll be sure to keep Capitol Hill Report readers in the loop on this issue as it continues to move forward.

I also attended the Maryland weekend retreat of the Blue Dog Coalition, a group of “conservative House Democrats” that came to prominence back in 1995. Over time, the coalition grew to 50 members of Congress as they worked with the Republican majority to pass some high profile bipartisan legislation like welfare reform. They then declined to just 17 Blue Dogs today. The decline began after Democrats regained the House in the 2006 and President Obama was elected in 2008. In subsequent elections Republicans were very successful in defeating conservative Democrats in swing districts in the 2010 and 2012 elections, leaving the ranks of the Blue Dogs decimated.

But I think the Blue Dogs' influence is beginning to grow again for the very same reason they came about in 1995―the need for some Democrats to work with House Republican leadership. A contribution to the coalition from the AAN's political action committee BrainPAC allowed me to attend the retreat, just as I did with House Republicans in early July. The more relaxed, social atmosphere away from Washington is an excellent setting for meaningful conversations with lawmakers about issues facing neurologists. It is clear that these members of Congress want to move issues forward. They proved that earlier this year when each one supported repeal of the SGR physician payment formula.


AAN to Comment on Medicare Physician Fee Schedule
By Daniel Spirn, Regulatory Counsel

We are continuing to review the Centers for Medicare & Medicaid Services' (CMS) proposed rule that updates payment policies and rates for physicians paid under the Medicare Physician Fee Schedule in 2016. Neurologists should be especially excited about CMS's openness to improving payments for evaluation and management (E/M) services. CMS emphasized its interest in receiving comments to better describe and value the time and intensity spent by primary care and other cognitive specialists in the complex care of patients. The AAN has continuously stressed to CMS the need for E/M codes to accurately reflect the relative resources involved with furnishing these services.

Furthermore, we are happy to see CMS specifically referencing “cognitive specialists” in their proposal. In previous years, the agency exclusively limited their focus to primary care physicians. CMS also acknowledged the importance of neurology in the care and management of patients with chronic conditions. The proposal cites a neurologist's unique role in the collaborative care for a patient with Alzheimer's disease and other chronic diseases.

Our comments are due to CMS by September 8. One week later, AAN leadership and staff will meet with CMS leadership to emphasize the value of cognitive care and E/M services. We look forward to a productive meeting advocating on behalf of our members and strengthening our efforts to develop a more proactive relationship with CMS.


Sharing Insights at the AMA State Legislative Roundtable
By Tim Miller, Senior Program Manager, State Affairs and Grassroots

The AMA Advocacy Resource Center State Legislative Roundtable is an opportunity for staff at physician specialty associations and state medical associations to gather and discuss issues and trends taking place in state legislatures across the country. This year's meeting was attended by 120 people in Carlsbad, CA. The following are a few trends that were discussed:

Prescription Drug Abuse, Treatment, and Prevention

The AMA has started the Task Force to Reduce Opioid Abuse, comprised of more than 25 physician organizations, including the AAN, and is focused on five clear actions:

  • Increasing physicians' registration and use of prescription drug monitoring programs
  • Enhancing physician's education on safe, effective, and evidence-based prescribing of opioids
  • Reducing the stigma of pain and promising comprehensive assessment and treatment
  • Reducing the stigma of substance use disorder and enhancing access to treatment
  • Supporting overdose prevention efforts by expanding access to naloxone and providing Good Samaritan protections

Recent activity includes 10 states expanding access to Naloxone, which is a special narcotic drug that reduces the effects of other narcotics. Advocating for the need for comprehensive public health strategies to organizations such as the Federation of State Medical Boards (FSMB) and National Association Boards of Pharmacy also has been a priority. 

Medical societies are encouraged to take action to persuade physicians to register for and use prescription drug monitoring programs, make the case for enhanced education and training related to safe prescribing practices, and continue efforts to enact laws that increase access to naloxone and provide Good Samaritan protections.

Network Adequacy and Out-of-Network Care

State legislatures are anticipating the release of the National Association of Insurance Commissioners' (NAIC) network adequacy model bill, likely making provider issues front and center in state legislatures in 2016. However, according to the AMA, the model bill still won't provide as much meaningful regulation of networks as hoped. This will mean state medical associations will have their work cut out for them. Strategies to address narrow networks, provider directories, and out-of-network billing were discussed. 

Several states also are dealing with what is called “surprise” balance billing, which are unanticipated bills from out-of-network providers at in-network facilities. Medical societies in those states have been working to point to this issue as part of the larger problem. 

Telemedicine

State legislatures have been moving quickly to adopt laws regulating the practice of telemedicine. Adopting telemedicine has been moving even faster. Resistance to telemedicine payment parity laws was discussed, as more than half of the states now have laws enforcing medical care coverage via telemedicine, with ten states passing parity laws in 2015. Some states also passed laws limiting the coverage of telemedicine services to certain geographic areas.

Legislatures also continue to debate about whether establishing a patient-physician relationship via telemedicine is appropriate. Tennessee, Idaho, and Arkansas have enacted laws addressing this issue. Tennessee requires only that the relationship be undertaken with mutual consent between the provider and patient. Idaho requires the relationship be established by use of two-way audio and visual interaction, just as long as the community standard of care is satisfied. 

Other issues on the agenda included Medicaid managed care, strategies for protecting the patient-physician relationship, and a federal update from the AMA government affairs team on Capitol Hill.

Contact Tim Miller at tmiller@aan.com for information on any of these subjects.

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