August 8, 2016

By Mike Amery, Esq., Senior Legislative Counsel, Federal Affairs

Behind the Scenes: How the AAN's Proactive Regulatory Advocacy Efforts Secure Victories for Neurologists 

With Congress out of town and the presidential candidates anointed, we at the AAN Center for Health Policy want to step back from federal politics and give Capitol Hill Report readers an update of our progress on regulatory issues.

Passing legislation through Congress is a big deal. For instance, we worked tirelessly for years to eliminate the SGR formula. But what happens afterwards can be even more important as a lot of the real policy action on the federal level happens after Congress acts. For physicians, it is often the impact of how laws are implemented by the Centers for Medicare & Medicaid Services (CMS), a regulatory agency that enacts health care policy “behind the scenes.” 

The AAN's regulatory advocacy efforts are directed by the Medical Economics and Management (MEM) Committee chaired by Orly Avitzur, MD, MBA, FAAN, of New York. The Academy has several staff members who work daily to influence federal agencies, including the AAN's Senior Director of Policy and Practice Innovation Amanda Becker and Regulatory Counsel Daniel Spirn, JD, MA, who is a frequent contributor to Capitol Hill Report.

The AAN has dedicated itself to developing a proactive regulatory advocacy strategy on behalf of our members. Recent actions by CMS show this effort is making significant progress. In the past, CMS sometimes seemed indifferent to the regulatory and practice burdens facing neurologists. In response, the AAN strategically emphasized the value of cognitive services and patient care in regulatory comment letters and meetings with CMS leadership. Whereas previous CMS rules discussed the importance of primary care, this year's proposed physician payment rule repeatedly refers to “primary care, care management and coordination, and cognitive services.” Many in Congress have changed their statements to include cognitive care, and now our regulatory efforts have helped broaden CMS' recognition that payment inequality applies not only to primary care, but also to neurologists and other cognitive specialists. 

These results have come from our constant presence involving several meetings with CMS leadership in Baltimore and Washington over the last year. These meetings have included many of the AAN's top leadership including President Terrence L. Cascino, MD, FAAN, and several MEM Committee members. 

Other results can be seen in the proposed Physician Fee Schedule for 2017, where AAN recommendations have been significantly endorsed by CMS to:

  • Recognize and reimburse existing CPT codes for non-face-to-face services including chronic care management
  • Recognize and reimburse a new G-code for evaluation of patients with cognitive impairment
  • Simplify requirements to provide chronic care management services

The AAN also has successfully advocated to shorten the meaningful use program's reporting period to 90 days, while also securing expanded hardship exceptions that benefit our members.

What is interesting to me about the regulatory sphere is that it never stops. Congress is often slow to act, but there is an old saying that "no man's life, liberty, or property are safe while the Legislature is in session.” With Congress out of session we know nothing is going to happen. But CMS continues to put out new rules all year round. AAN members should be reassured that the MEM Committee and AAN staff are on top of each and every one, securing significant victories for neurologists in the process.

Former Presidential Assistant Reassesses Obamacare Impact on Practices 

An interesting article was published last week in the Wall Street Journal that I would encourage all AAN members to read. “How I was Wrong About Obamacare” was written by Dr. Bob Kocher, who served as special assistant to President Obama for health care and economic policy from 2009 to 2010 while the Affordable Care Act was written and passed into law.

Kocher still believes in the law and its efforts to extend insurance coverage, but is troubled by the impact on the physician-patient relationship due to practice consolidation. 

Kocher writes, “What I got wrong about Obamacare was how the change in the delivery of health care would, and should, happen. I believed then that the consolidation of doctors into larger physician groups was inevitable and desirable under the ACA.” Kocher goes on to say, “Well, the consolidation we predicted has happened: Last year saw 112 hospital mergers (up 18% from 2014). Now I think we were wrong to favor it.”

Kocher indicates that it is small practices that have the ability to improve quality and improve patient care. “What I know now, though, is that having every provider in health care “owned” by a single organization is more likely to be a barrier to better care. Small, independent practices know their patients better than any large health system ever can. They are going up against the incumbent and thus are driven to innovate.”

The AAN's Solo and Small Group Practice Task Force understands the concerns of Dr. Kocher and is hard at work making recommendations to support AAN members who choose to remain in small practices. The AAN is committed to maintain a wide range of practice alternatives for AAN members at every stage in their careers.