SGR Deal This Week?

March 23, 2015

By Mike Amery, Senior Legislative Counsel, Federal Affairs

Was It Because of Neurology on the Hill?
Just after AAN advocates from 43 states went to the Hill to demand a permanent repeal of the flawed Sustainable Growth Rate formula (SGR), House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) announced that they were in negotiations to finally get rid of the SGR once and for all.

Our DC staff met with key members of Congress throughout last week, pushing for a final solution. On Wednesday I spoke personally with Speaker Boehner, House Energy & Commerce Health Subcommittee Chair Joe Pitts (R-PA), and Ways & Means Health Subcommittee Chair Kevin Brady (R-TX), all of whom are part of the negotiations. Derek Brandt focused on Democrats, having conversations with top staff across the caucus including Pelosi's health team and Rep. Gene Green (D-TX), who leads Democrats on the Health Subcommittee.

The bill was introduced last Thursday and we expect the legislation to be on the House floor this week. It is a combination of an SGR repeal with Medicare reforms and an extension of the Children's Health Insurance Program (CHIP). One of AAN's priorities has been to ensure that neurology is included in any extensions of the Medicaid bump or the primary care bonus, but we do not expect either of those provisions to be a part of the final package.

We have heard that part of the House deal will be that each side needs to put up 125 votes to get to 250 in favor (218 is needed for passage). Republicans currently hold a 244-188 advantage with two vacancies. Republicans will be convincing members on the right that the Medicare savings due to structural reforms outweighs the upfront cost that isn't paid for, roughly $130 billion over ten years. Democrats will struggle with the left side of the party who object to increased cost sharing by some Medicare beneficiaries and other potential cuts that will equal approximately $70 billion of the $200 billion total cost.

Senate Democrats have complained that the CHIP extension is only for two years when they would prefer four, but the Senate would be under a lot pressure to pass the bill as the SGR cut takes effect on March 31 with no action. This would mean an across-the-board cut of 21 percent in physician Medicare reimbursement. 

We have been close before, but I truly think we are on the cusp of a final repeal of the SGR. Please contact your member of Congress by responding to AAN action alerts in your inbox and ask for a vote in favor of this package so the next Capitol Hill report can be an announcement that this bill is heading to the president's desk.

CMS Releases Stage 3 Proposed Rule
by Daniel Spirn,  Regulatory Counsel

On Friday, March 20, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule outlining the requirements for Stage 3 of the Meaningful Use incentive program. The proposed rule specifies the Meaningful Use criteria and maintains most payment adjustments and hardship exceptions. The proposed rule would require nearly all providers to report on a full calendar-year cycle beginning in 2017 and would require electronic reporting of clinical quality measures beginning in 2018. The proposal contains eight objectives focused on the advanced use of electronic health record (EHR) systems. Concurrently with CMS' Stage 3 proposed rule, the Office of the National Coordinator for Health IT (ONC) unveiled a new 2015 edition based EHR definition and certification program that is accessible to more types of health information technology.

The AAN is reviewing the potential impact of these proposals on our members and intends to submit comments to CMS regarding the Stage 3 proposed rule. We will continue to advocate for a rule that improves patient care and outcomes while minimizing further burdens on our members. In the past year, the AAN has advocated that CMS allow for greater certified electronic health record technology (CEHRT) requirement flexibility. We also joined other organizations recommending changes to EHR certification that address frustrations physicians have expressed with current requirements. View updated information as we learn more.

CMS Meetings on E/M, Globals, and Advance Care Planning
On March 19, AAN members met with the Centers for Medicare & Medicaid Services (CMS) to discuss the importance of evaluation and management (E/M) services and express support for CMS's proposal to eliminate 10- and 90-day global payments for surgical procedures starting in 2017. During the discussion with CMS, we requested the agency consider revised documentation criteria for E/M codes that emphasize medical decision-making. Improving E/M reimbursement is always a top priority for the AAN and we are pleased to take our members' concerns directly to CMS.

The next day, the AAN participated in a second meeting with CMS to request that the agency pay for new advance care planning codes. These services promote important conversations about end-of-life care.

This week, the AAN will meet with CMS to address our members' questions regarding the Value-based Payment Modifier (VBPM) and Quality Resource and Use Reports (QRURs). The AAN will also be attending a specialty society meeting with Sean Cavanaugh, deputy administrator and director of the Center for Medicare at CMS, to propose redefining and revaluing outpatient E/M service codes.

These efforts are a part of AAN's broader strategic goal to develop a more proactive relationship with federal regulatory agencies.

Momentum to Fund Cure for Alzheimer's Builds
For the last several years, the AAN has taken an active role in advocating for increased funding for Alzheimer's research with appropriators on Capitol Hill. To magnify our voice on this issue, the AAN has partnered with the Leaders Engaged on Alzheimer's Disease (LEAD) Coalition, which includes a wide range of constituencies such as USAgainstAlzheimer's and the Alzheimer's Foundation of America. Our efforts have been fruitful, resulting in an additional $125 million in annual funding, at a time when the NIH budget overall has been severely constrained.

Although this increase is laudable, the gains are widely recognized as only a down payment toward reaching the national goal of effectively preventing or treating Alzheimer's by 2025. With this in mind, the AAN and LEAD once again took to the Capitol Hill on March 12 to advocate for an additional $200 million for the next fiscal year, and a longer term goal of eventually reaching $2 billion annually. Representing the AAN was Board Member John C. Morris, MD, FAAN, who is the director and principal investigator of the Charles F. and Joanne Knight Alzheimer's Disease Research Center in Saint Louis, MO.

Dr. Morris was a keynote speaker at a briefing to educate congressional staff about the basics of Alzheimer's and ways their offices can help find a solution to this devastating disease. He met with key appropriation staff in both the House and Senate, including Sen. Roy Blunt (R-MO), who is the chairman of the Labor-HHS Subcommittee that has jurisdiction over NIH funding. Dr. Morris' research center was a great conversation piece, highlighting the profound impact NIH funds have on labs all over the country.


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