Capitol Hill Report: The Reality in Washington
FEBRUARY 24, 2014
By Bruce Sigsbee, MD, FAAN, AAN Past President
The Deal Won't Get Any Better
I hope you got a chance to respond to the AAN's Action Alert asking all members to urge Congress to support legislation (HR 4015/S 755) that would permanently eliminate the flawed Sustainable Growth Rate (SGR) formula.
If you didn't because you were concerned about the details, I have just one thought to share: The deal for physicians will not get any better than this.
After a long career in patient care, I now spend substantial time in Washington advocating on behalf of neurologists and their patients. It is clear to me that members of Congress believe that the cost of federal programs is too high and that substantial reforms are needed to ensure that federal health expenditures pay for quality and value.
As physicians, we have to deal with this reality. It is not going away. The legislation before us is the proof.
Under current law, physicians face a 24-percent cut in reimbursement on April 1. Some say Congress will never let the cut take effect. Maybe not, but what about letting a 2- to 5-percent cut go through? I think that is a real concern.
In addition, under current law physicians face reporting requirements that can lead to significant reductions in payments due to non-performance. As a physician, I saw firsthand how difficult it can be to adapt to assessments that have yet to prove their effectiveness in improving patient care.
The bills the AAN supports offer a better deal than current law. Not only does it permanently eliminate the SGR, it also ensures a 0.5-percent increase in payments each of the next five years. In comparison, the grand total of increases over the last decade has been 1.9 percent. It also institutes a Merit-based Incentive Payment System (MIPS) that replaces PQRS, meaningful use, and the value-based payment modifier. MIPS includes penalties for low performance, those penalties will be about the same as called for under current law. MIPS will also provide the opportunity for significant bonuses for those who do participate where none currently exist. Lastly, it provides a four-year transition period for the AAN to work on the details to ensure that neurology can take part in every opportunity to promote high quality, effective care to patients.
The bill faces a substantial hurdle: How to pay for the $150 billion cost over 10 years. It may well not pass. But the alternative is another temporary fix that will certainly not increase payments and will maintain current quality programs that are in need of improvement.
I know that many of you find this entire process frustrating, I know that I do. Neurologists work hard and provide outstanding care to difficult patient populations. The future of improvements in the care of our patients will depend on the care, education, and research provided by neurologists. We continue to work on Capitol Hill to educate policy makers about that reality. The AAN and I are dedicated to supporting the specialty at every opportunity and this bill gives all of us four years to continue this effort. Given the reality today in Washington, this bill is as good as it's going to get.
I hope you will join the AAN in supporting this important legislation. Contact your members of Congress and let them know that physicians back the deal.
By Michael J. Amery, Esq., Legislative Counsel
2014 Palatucci Advocacy Leadership Forum Recap
I recently returned from the 12th Annual Palatucci Advocacy Leadership Forum, one of the AAN's award- winning training programs. This year's Forum took place in San Diego, CA, where 29 neurologists took part in an intensive media and advocacy training program.
Year after year, we find the best and brightest Academy members at the Palatucci Forum. This year's class was no different with everyone eager to learn, plan, and change the world. Each advocate left with a year-long action plan on an issue important to them and their community.
We had a special guest at the forum this year. US Rep. Scott Peters (D-CA), who represents part of San Diego in the Congress, stopped by to supplement the training by describing the factors that influence his decisions as a member of Congress and urged the class to step up as physician advocates.
If you have never been to the Palatucci Forum, learn more about it online and consider applying for the 2015 program when the application cycle opens this summer.
AAN Member Neurologist Helps Lead Olympic Health Team
Jeffrey Kutcher, MD, of the University of Michigan, has been a leader for the AAN on the issue of concussion and sports medicine. Now he has taken those skills to the Olympics as the head neurologist for Team USA.
I got a chance to talk via email with Kutcher while he was in Sochi and asked what it was like. "It's an incredible honor to care for our athletes and to see the dedication and effort each of them gives every single day," said Kutcher. "I work with an inspiring, world-class, team of clinicians and staff, in unpredictable and challenging settings, all day long. It's very tiring! No two days are the same. I'm also very proud to be a neurologist in this environment. We have a huge role to play in sports medicine, and I see my involvement with the US Olympic Team as another step in the evolution of the field of sports neurology."
It is inspiring to see AAN members doing such meaningful things around the world. Take an in-depth look at Dr. Kutcher's service.
By Tim Miller, Sr. Program Manager, Communications and State Advocacy
State Legislative Issues in the 2014 Session
Along with federal issues, your AAN also advocates for neurologists and their patients at the local level. Many states have kicked off their 2014 legislative sessions, with several more doing the same in the coming weeks. Depending on the issue, we address concerns by collaborating with your state medical societies, state neurological societies, patient organizations, and other physician organizations when necessary.
As always, your AAN will continue to monitor legislation pertaining to issues such as scope-of-practice, stroke issues, and medical liability reform. States already have introduced legislation on other emerging issues such as telemedicine, restrictions on opioid dispensing, and prescription drug tiering. And the governor of Mississippi has recently signed a youth sports concussion bill into law, making them the 50 th state to implement new regulations.
AAN members can see what staff is monitoring by selecting "AAN Legislative Hotsheet" on the legislative issues page. Have a legislative issue going on your state you think the AAN should be made aware of? Contact Tim Miller.