Capitol Hill Report: Hard Fight Ends and More Advocacy Victories
January 11, 2016
By Mike Amery, Esq., Senior Legislative Counsel, Federal Affairs
Medicare Primary Care Bonus Expires
If you attended the AAN's Neurology on the Hill event any year between 2010 and 2014, you discussed adding neurology to the Affordable Care Act's (ACA) Medicare Primary Care Bonus or the Medicaid Bump with your congressional offices. Both programs were time limited by the ACA. The Medicaid bump expired at the beginning of 2015 and with the New Year ringing in 2016 last week the Medicare bonus expired as well.
The ACA's goal for these two bonuses back in 2010 was to improve the practice climate for primary care providers. Of course, that is an honorable goal that the AAN has long supported. But the big problem for neurology and other physician groups that rely primarily on evaluation and management (E/M) codes was that the bonuses increased payments for E/M codes, but only for the selected specialties of family medicine, internal medicine, geriatrics and pediatrics. There was no recognition that many physicians bill the same E/M codes for new and existing patient visits. Once the increases went into effect, some physicians were paid more than others for billing identical codes simply based on their specialty.
To raise awareness of this issue among members of Congress and congressional staff, the AAN led an effort to create the Cognitive Specialty Coalition (CSC). For the last six years, we have been joined by other CSC members such as the American College of Rheumatology, The Endocrine Society, and the American Psychiatric Association in educating Congress about the unfairness of selecting winners and losers based on specialty designation rather than the needs of patients.
We had a lot of support along the way in the form of legislation and amendments and strong pushes with our Neurology on the Hill program, grassroots lobbying, and many meetings with members of Congress and their staffs. Now that the bonuses have expired, we especially want to thank some of our strongest supporters, including Sens. Amy Klobuchar (D-MN), Susan Collins (R-ME), and Martin Heinrich (D-NM); Reps. Frank Pallone (D-NJ) and Steve Stivers (R-OH); and former Reps. Henry Waxman (D-CA) and Jim Moran (D-VA) for their steadfast support of sponsoring efforts to include neurology.
In the end, the provisions expired for many reasons including a change in congressional leadership and the fact that both bonuses were very expensive. Also, the effectiveness of the increases was greatly in question evidenced by fact that 50 percent of primary care doctors weren't even aware that they were getting the bonus. Going forward the AAN and other cognitive specialties have made it clear that future efforts to improve payment for E/M need to include all specialties that primarily rely on E/M. You can find more information about the end of the Medicare bonus program here.
BrainPAC Concludes Record-setting 2015
The AAN's federal political action committee, BrainPAC, again set fundraising records with $342,000 raised from 1,291 AAN members. Even with 60 fewer contributors than the year before, this total was up $20,000 from 2014. Contributions will be used to support Congressional incumbents and candidates who side with neurology and educate them on issues affecting the profession and patients.
AAN Advocacy Secures Coverage for Epilepsy Patients
By Katie Shepard, Associate Director, Medical Economics
As a direct result of AAN advocacy, Cigna has reversed its previous non-coverage of responsive cortical stimulation for the treatment of patients with medically refractory partial onset seizures effective December 15, 2015. Based upon AAN subject expert member input, the payer will now cover this therapy for patients when certain criteria are met.
In addition to advocating on behalf of our members at the Centers for Medicare & Medicaid Services (CMS), AAN staff and volunteer members work just as diligently behind the scenes to develop relationships with the largest commercial payers throughout the country.
We are extremely pleased that Congress passed the Patient Access and Medicare Protection Act, which will help ensure flexibility in applying for the Meaningful Use hardship exemption for the 2015 electronic health record reporting period that will affect 2017 payment adjustments. The bill, S. 2425, includes a provision that automatically grants every physician who applies by March 15, 2016, with a hardship exemption in order to avoid penalties being assessed in 2017. The AAN has called continuously upon the CMS to offer a broad array of hardship exemptions for providers and we are glad to see that Congress is listening to the concerns of our members. Stay informed about the electronic health record incentive program at the AAN's website.