June 26, 2017

By Mike Amery, Esq., Senior Legislative Counsel and Daniel Spirn, Regulatory Counsel


Cascino Shares Burnout Insights with Doctor's Caucus

AAN's Immediate Past President Terrence L. Cascino, MD, FAAN, joined us on Capitol Hill last week after receiving an invitation from the House Doctors Caucusto discuss physician burnout.

  • The House Doctors Caucus is made up of 16 Republican health professionals who are often the leaders on policy decisions impacting physicians such as the 2015 elimination of the Sustainable Growth Rate (SGR) formula.
  • Cascino was invited after meeting Rep. Phil Roe, MD, (R-TN), the caucus chair, at the AAN's Neurology on the Hill in February.
  • Cascino focused on recent AAN research that shows:
    • 60 percent of neurologists suffer from burnout.
    • The prevalence of burnout is higher for physicians than in other professions and is especially high for neurologists.
    • Neurology is the only medical specialty that has both one of the highest rates of burnout and the poorest work-life balance.
    • Regulatory burdens are a key driver of physician burnout.
  • Cascino also stressed how the AAN has made it a priority to understand and mitigate burnout among neurologists and to promote wellbeing among neurologists by:
    • Researching burnout prevalence among member neurologists and subgroups of neurologists, including neurology residents
    • Identifying and developing resources for AAN members
  • The AAN thanks seven caucus members for attending: Reps. Roe, Brad Wentrup (R-OH), Bruce Babin (R-TX), Buddy Carter (R-GA), Andy Harris (R-MD), Roger Marshall (R-KS), and Neal Dunn (R-FL).
  • Reps. Roe and Dunn had an extended conversation with Cascino, asked for additional resources on burnout, and indicated they are willing to bring these issues up in search of legislative and regulatory solutions.


AAN Opposes Senate Health Care Bill

  • With guidance from the AAN's Principles for Health Care Delivery, the AAN released a statement opposing the Better Care Reconciliation Act (BCRA) of 2017 introduced in the Senate as it will limit access to care for patients with neurologic disease.
  • The Congressional Budget Office (CBO) is expected to release the score of the bill soon, which will provide a greater understanding of the expected impact.
  • The Senate debate on the health reform bill begins this week, and Senate Majority Leader Mitch McConnell (R-KY) has indicated he would like a vote prior to the beginning of the July 4 recess next week.


AAN Presses CMS to Reduce Administrative Burdens

  • Similar to our April meeting with US Department of Health and Human Services (HHS) Secretary Dr. Tom Price, the AAN joined a small group of partners and offered staff at the Centers for Medicare & Medicaid Services (CMS) guidance on steps to reduce the burdens facing physicians across the country.
  • Areas of focus included reducing penalties in 2018 regarding the value-modifier, offering a broad “hardship exemption” for Meaningful Use penalties, and relief from the required measures under the Physician Quality Reporting System (PQRS).
  • The value modifier, electronic health record Meaningful Use program, and PQRS will soon be legacy programs as HHS implements MACRA, but penalties from the 2016 performance year may still be assessed in 2018.
  • Our meeting with HHS and CMS represents the AAN's ongoing commitment to reducing regulatory hassle on neurologists.


CMS Releases Proposed 2018 Quality Payment Program Rule

  • CMS proposed its new Quality Payment Program rule for physicians on June 20, and the agency promises to move slow, keep it simple, and protect smaller practices. The AAN will be submitting comments by the August deadline.
  • As a participation option for 2018, CMS proposes adding Virtual Groups, which would be composed of solo practitioners and groups of 10 or fewer eligible clinicians who come together “virtually” with at least one other such solo practitioner or group to participate in MIPS for a performance period of a year.
  • CMS aims to raise the low volume threshold so that fewer clinicians in small practices are required to participate in MIPS starting with the 2018 performance period.
  • It also would allow another 134,000 doctors to be exempt from MIPS, on top of the roughly 800,000 clinicians who did not participate this year.
  • The MIPS score totals are proposed to remain the same as the 2017 performance year. Quality is 60% of the total MIPS score, Cost remains 0%, Improvement Activities are 15%, and Advancing Care Information (electronic health records) is 25%.
  • The proposal adds a new significant hardship exception for the Advancing Care Information performance category for clinicians in small practices eligible for MIPS.


News and Notes

  • Congratulations to AAN member Ralph Northam, MD, winner of the Democratic primary for governor in the state of Virginia. Northam currently serves as lieutenant governor and will take on Republican nominee Ed Gillespie in the general election on November 7, 2017.