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Capitol Hill Report: AAN Scores Successes in NINDS, Congress, AMA

June 22, 2015

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

AAN Member Walter Koroshetz, MD, FAAN, Appointed NINDS Director
The AAN congratulates Walter Koroshetz, MD, FAAN, on his appointment to director of the National Institute for Neurological Disease and Stroke. Dr. Koroshetz is a longtime member of the Academy and leader in neurology, and we look forward to continuing our work with him and his colleagues at NINDS.

One of the first neurologists to help me out when I joined the AAN 15 years ago was Dr. Koroshetz, who was then at Massachusetts General.

The AAN Government Relations Committee chair in 2000 was Linda Buchwald, MD, FAAN, who told me that her senator, Ted Kennedy (D-MA), wanted to introduce legislation on stroke care. She asked me to contact Dr. Koroshetz to put it together and meet with Kennedy's staff in Washington. A few weeks later we did just that and presented the first version of the Stop Stroke Act. 

The effort was a great introduction to me about how a few connections and someone who really knows what is needed can lead to some truly substantive public policy. The Stop Stroke Act became one of the top issues for the AAN in the early 2000's. But federal budget issues got in the way and like many new ideas, no matter how good, it never moved forward.

Dr. Koroshetz did move forward, however. Several years ago, he moved from Massachusetts down to the DC area to become the assistant director of NINDS at the National Institutes of Health. Last week, he became the director, putting him in charge of the preeminent neurological research entity in the world backed by 500 staff and a budget of $1.5 billion.

AAN-sponsored Telestroke Bills Introduced
Although the Stop Stroke Act is a bill from the past, we are still working to improve access to the best care possible for victims of stroke. The AAN and the American Heart/Stroke Association have secured the introduction of telestroke legislation in both the House and Senate.

The “Furthering Access to Stroke Telemedicine (FAST) Act” will allow the Center for Medicare & Medicaid Services to expand payment for telestroke services to urban and suburban areas. Current law restricts payment to stroke patients originating in rural areas only.

We anticipate that this change in policy could save more than $1 billion over a ten year period through reductions in Medicare payments for rehabilitation and skilled nursing. The bills have been authored by stroke survivor, Sen. Mark Kirk (R-IL) in the Senate and by Reps. Morgan Griffith (R-VA), Gregg Harper (R-MS), Jim Sensenbrenner (R-WI), David Scott (D-GA), Mike Thompson (D-CA), and Joyce Beatty (D-OH)― who is also a stroke survivor―in the House.

Extension of Medicare Cut Averted!
The physician lobbying community had a big win two weeks ago that most people probably never heard about―and in the Trade Promotion Authority, bill of all things.

The Pacific trade bill contained an adjustment program designed to support American workers who lose jobs due to trade agreements with foreign countries. When trade bill passed the Senate, the cost of adjustment program was paid for by an extension of the two-percent cut in Medicare physician payments instituted as part of the “sequester” in 2013. It would extend sequester through 2024.

It makes no sense to pay for the consequences of a trade bill by cutting physician payments.

With very little time to prevent the House from enacting the same provision, the entire physician community on Capitol Hill let members of Congress know that this was not acceptable.

Prior to a final vote, House leadership stripped the Medicare cuts from the bill in a big victory for physicians and Medicare beneficiaries.


AAN Call for AMA Support of BRAIN Initiative Accepted
By Amber Stock, Program Manager, Advocacy

The 2015 Annual Meeting of the American Medical Association (AMA) House of Delegates concluded on June 9. It was a successful meeting for the AAN delegation and for neuroscience research. The AAN delegation introduced a proposal in support of Congressional funding for the BRAIN Initiative, which accelerates the development of technologies to improve the understanding of the human brain. The proposal was passed in the House of Delegates without opposition and will become official AMA policy.

We need your help to continue to grow the AAN delegation and the voice of neurology in the House of Delegates. Learn more about the importance of our representation in the AMA in the February issue of AANnews® and select the AAN to represent you at AMA-ASSN.org.


Final Shared Savings Rule Issued
By Daniel Spirn, Regulatory Counsel

On June 4, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates the policies governing the Medicare Shared Savings Program (MSSP). CMS is simplifying rules for Accountable Care Organizations (ACOs) and plans to reduce administrative burdens. Existing ACOs that participate in the one-sided model will now be allowed to continue in the program after the end of their first three-year agreement. They also can keep the same sharing rate of 50 percent. The rule also modifies its two-sided performance-based risk track and creates an alternative model known as Track 3. This alternative model incorporates a higher sharing rate of 75 percent for taking on more risk.

CMS also finalized its decision to expand the range of primary care providers that participate in the first step of the attribution process. The agency now includes primary care services (E/M) delivered by nurse practitioners, physician assistants, and clinical nurse specialists in step one of the attribution process. Additionally, the rule includes codes for transitional care management (TCM) and chronic care management (CCM) services as E/M for beneficiary assignment. CMS also is removing certain specialists-such as surgeons, dermatologists, and radiologists-from step two of the attribution process. However, neurology remains in step two of the attribution process as was published in the proposed rule. You can learn more about ACOs on the AAN website.

State Neurosociety Meetings
Below are the upcoming state neurosociety meetings. Contact Grant Niver, Program Manager, State Society Relations, with any questions.

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