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Capitol Hill Report: AAN Supports SGR Deal

FEBRUARY 11, 2014

By Michael J. Amery, Esq., Legislative Counsel, (202) 506-7468

AAN Supports House and Senate SGR Deal;
Last week, House and Senate negotiators reached a deal to permanently repeal the Medicare Sustainable Growth Rate (SGR) formula. Dr. Bruce Sigsbee, Derek, and I knew something was up because we had a number of meetings with key health staff rescheduled at the last minute. The staffers were holed up crafting the final agreement. 

A number of provisions requested by the AAN have been included in the final legislation and the AAN has indicated our support of the proposal. We are particularly pleased that the legislation would provide a transition to new physician payment systems that includes a 0.5 percent increase on Medicare payments to all physicians for five years and will include bonus payments for quality improvement. This stability is in sharp contrast to the never-ending threat of huge Medicare payment cuts, including one of 27 percent scheduled for the end of March. It also represents an accumulative 2.5 percent increase where the grand total of Medicare payment increases over the last decade had been just 1.9 percent.

We have been pressing Congress for many years to fix the SGR, and this is a significant accomplishment! Granted, the bill is not perfect. We argued for greater increases for non-procedural specialists, but are encouraged by the creation of chronic care management codes that, if implemented correctly, would allow another significant payment avenue for non-procedural specialists. We have been assured by congressional staff that the purpose of these codes is to include specialists like neurologists so we will be working to get statements on the record if the bill moves to the House and Senate floors for debate.

But even though it isn't perfect, the transition period gives us four years to continue working to improve provisions to benefit neurologists before most of the provisions go into effect. This is a lot better than the current situation, which is always a race to avoid huge payment cuts that would surely limit access to care.

Learn more about this proposal.

Take Action! Urge Congress to Support Fixing SGR 
We know that AAN members really would like to see SGR behind us. Now is our big chance! Please respond to the AAN action alert you received Monday in your email inbox and let your members of Congress know that the time to end the SGR is now.

How Will It Be Paid For? TBD 
One important thing to remember is that this is still just a big first step. Dr. Sigsbee and I met with Senate Minority Leader Mitch McConnell (R-KY) and his staff who indicated that the complicated SGR repeal policy was "the easy part." Offsets for the legislation still need to be identified in order to pay for the bill which will be no easy task as it approaches $145 billion. At a meeting the congressional staff held for specialty society representatives, the question was asked about offsets and they said, "Give us a day to celebrate before we move on to that."

The AAN is supportive of the bill, but we will be watching the offsets closely to ensure that the impacts to neurology aren't worse than the solution.


MedPAC Meeting - Inequities in the Fee Schedule
By Bruce Sigsbee, MD, FAAN, AAN Past President

I spent the first week of February in the AAN DC office meeting with members of Congress and key staff. I also attended some fundraising events on behalf of BrainPAC, the AAN's federal political action committee.

I also took some time to discuss the current issues facing neurology with the staff of the Medicare Payment Advisory Commission (MedPAC), a committee that advises Congress on physician payment policy.

MedPAC reports are widely respected on the Hill and many of their policy suggestions are enacted. A recent example is the primary care bonus that passed as part of the Affordable Care Act, which was originally a MedPAC proposal.

We all know that the time and effort inherent in evaluation and management services is not well recognized compared to the work RVUs and practice expense allocated to procedures. A number of studies point out that the disparity has increased over the last 20 years. 

Mike Amery presented data to MedPAC staff that shows how US medical students are choosing procedural specialties and I challenged them on why the commission has not meaningfully addressed this systematic disparity. MedPAC pointed out their efforts to encouraging review of overvalued services, but we know that identifying and correcting overvalued services has been sporadic, arbitrary, and capricious; just consider EMG codes.

But we did make some serious progress when we discussed the cause of this imbalance and they agreed that there are significant inequities in the fee schedule when considering the time allocated to services.  They indicated that a consultant looking at the inequity identified the time imbalance as the major source of this problem. The purported time consumed by a physician in some specialties clearly exceeded any realistic allocation. Going forward, they are trying to identify ways in which Congress could implement a reasonable and accurate assessment of the times allocated to codes and revise the RVUs dependent on the analysis, shifting reimbursement to E&M codes.

If we can get a meaningful SGR fix, there is a chance that MedPAC will have a significant impact on how payment reform moves forward. We will continue to develop relationships here and on the Hill to move the process forward for neurology.

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