July 11, 2016

By Daniel Spirn, Regulatory Counsel

CMS Releases Proposed Medicare Fee Schedule with Major Victories for Neurology

On July 7, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule. We are very pleased to see the proposal contains a number of important victories for neurology. As currently written, neurologists will receive a one percent increase in allowed charges next year. Additionally, neurologists will benefit from a new add-on code that improves payment for visits that initiate chronic care management (CCM) services and increased payment for complex CCM codes. The proposal will also offer payment for the assessment and creation of care plans for beneficiaries with cognitive impairment and payment for critical care consultations furnished via telehealth. Together, these represent a major step forward for the reimbursement of neurologic care.

These victories do not just occur by happenstance. They are hard-earned results coming from months, and sometimes years of proactive regulatory advocacy on behalf of our members. AAN staff are working everyday to develop a proactive relationship with officials at CMS and other federal regulatory agencies. We take your voice directly to CMS and already this year held several meetings and phone calls with Medicare's leaders to discuss the neurologist's perspective on the proposals in this year's Fee Schedule. We have also joined other stakeholder groups to amplify your voice and our past comments submitted on CMS proposed rules have helped shape the agency's latest decision to further reimburse neurologists for CCM services.

It is always rewarding to see positive results from our efforts with CMS officials because regulatory advocacy is a challenging endeavor. CMS and other federal agencies often seem like a maze of red-tape and faceless bureaucracy. But neurologists should take solace in the fact that the AAN's regulatory advocacy efforts are succeeding in having your voice heard by those in power. With so many changes occurring in the regulatory landscape, it has never been more important for the AAN to fight for your interests in this space. This year's proposed Fee Schedule is proof that our proactive efforts are paying off and we have no plans of slowing down anytime soon.

AAN Regulatory Advocacy Secures Success on Meaningful Use Reporting Period

On July 6, the Centers for Medicare & Medicaid Services (CMS) proposalcontained a big success on the regulatory advocacy front for the AAN. In response to our continued pressure, CMS proposed to again shorten the electronic health records (EHR) meaningful use reporting period to 90 days in 2016.

Similar to 2015, CMS is proposing an EHR reporting period of any continuous 90-day period between January 1, and December 31, 2016. This comes after the AAN and other stakeholders continuously stressed the need for a 90-day reporting period. CMS further determined that eligible providers (EPs) that have not successfully demonstrated meaningful use in a prior year may attest to Modified Stage 2 rather than the Stage 3 objectives by October 1, 2017.

CMS is also proposing hardship exceptions for certain EPs that have not successfully demonstrated meaningful use in a prior year, intend to attest to meaningful use for an EHR reporting period in 2017, and intend to transition to MIPS and report on measures specified for the advancing care information performance category under the MIPS as proposed in 2017. These EPs may apply for a significant hardship exception from the 2018 payment adjustment. See the following CMS Fact Sheet for more information on the CMS proposal.

Congress Stalls on Zika Funding

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

Congress has a week to go before it leaves for a seven-week recess for the national conventions and the traditional August break. I encourage everyone to get out in your community and engage your elected officials at every level of government on issues you feel are important. I talked with my congressman, John Delaney (D-MD), at my local July 4th parade about several issues and he was happy to hear from me. Your city council members, state legislators, and maybe even your US senators and governor want to know what's important to you, so take the chance when you can.

This week, a hot topic continues to be funding for the Zika virus outbreak. The House and Senate have passed legislation that would provide funding, but the versions passed by each side are different. A House/Senate conference committee has agreed on a funding figure of $1.1 billion, but the full Senate has been unable to come to an agreement on the final package due to disagreement over how to pay the cost and where the money will actually go.

The AAN has taken proactive steps to prepare the neurology community. Starting with a presentation at the AAN 2016 Annual Meeting titled: “Zika Virus: Neurologic Manifestations of the Latest Emerging Pathogens,” the AAN developed educational materials on Guillain-Barré syndrome, a condition in which a person's own immune system damages the nerve cells, causing muscle weakness and sometimes paralysis.  Guillain-Barré syndrome is likely triggered by Zika in rare cases. In June, the AAN hosted a free webinar to educate health care professionals on the diagnosis, management, and treatment of Guillain-Barré syndrome. We continue to work on programming that will prepare neurologists to deal with the consequences of Zika.

But what could possibly be holding up efforts in the Senate to combat the virus?

Without going into the details on the disagreements, it really comes down to rules. In the House it is easy: there are 435 members, get to 218 votes and you win. The Republicans currently hold 247 seats meaning they can pass anything they want, and they do. The Senate is completely different, a simple majority rarely wins. Controversial legislation almost always needs 60 percent of the vote.

The Senate, sometimes called “the most deliberative body in the world”, operates under unanimous consent agreements. This means that any of the 100 senators can simply object to proceeding on consideration of any issue. The threat behind the objection is that the senator will come down to the Senate floor and filibuster by prolonging debate indefinitely. This rarely happens as senators try to reach agreement on legislation in order to move forward.

When agreement can't be reached the Senate majority leader, currently Sen. Mitch McConnell (R-KY), can “invoke cloture.”  Cloture requires the support of three-fifths of the Senate, which is usually 60 of the 100 potential votes and effectively ends debate and requires a vote after 30 hours.

Right now, the Senate has 55 Republicans, 45 Democrats, and a few votes short of 60 for a final Zika package.

If they leave without a Zika funding package, make sure you find them at your county or state fair and tell them to get this done. 

Partnering with Patient Groups

Partnering with patient communities is a top priority of the AAN. As I look back at many of the successes of AAN advocacy, it is almost always in conjunction with patient groups. Time and time again, we have partnered with epilepsy, Parkinson's, Alzheimer's, MS, and many more patient groups to enact positive health policy goals that benefit both patients and physicians.

Our latest effort has been work with the American Heart/Stroke Association (AHA/ASA) on the Furthering Access to Stroke Telemedicine (FAST) Act, HR 2799, that now has 130 cosponsors. We recently took another step with AHA/ASA.

Congress was out the week before last in advance of July 4th. I took the opportunity to visit the Center for Medicare and Medicaid Innovation (CMMI) alongside AAN members James Grotta, MD, of Houston; Andrei Alexandrov, MD, of Memphis; and Andrew Russman, MD, of Cleveland, as well as Stephanie Mohl of the AHA/ASA.

CMMI is a division of CMS that was created as part of the Affordable Care Act passed in 2010. The purpose of the Innovation Center is to test “innovative payment and service delivery models to reduce program expenditures … while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children's Health Insurance Program (CHIP) benefits.

Drs. Grotta, Alexandrov, and Russman are the pioneers of an innovative care delivery model that provides early interventions for stroke patients using mobile stroke unit (MSU) that are equipped to provide care while in route to an emergency department.

Our visit was put together by AHA/ASA as a collaborative effort to inform CMMI about the projects and pave the way to future coverage of the services by Medicare. That goal is a long way from now but AAN and AHA/ASA will continue our conversation with CMMI.  It was good to get a look at some of the work being done by CMMI and especially to continue our partnerships with the patient communities.