Capitol Hill Report: Clearing Up SGR Repeal Misconceptions

May 11, 2015

By Mike Amery, Senior Legislative Counsel, Federal Affairs

Setting the Record Straight on the SGR Repeal
It was great to see so many of my neurology friends at the Annual Meeting this year in Washington, DC. I spent most of my time at the BrainPAC booth where 300 AAN members contributed $80,000. There was a lot of excitement about the permanent repeal of the SGR. No more threats of drastic and unrealistic Medicare payment cuts.

I did hear some concern about two issues around the SGR repeal bill that I think are worth addressing.

“The Medicare payment increases are too small!” 

The SGR provision in the bill, HR 2, removed a potential 21-percent cut in physician reimbursement under Medicare. It replaced the cut with a 0.5 percent increase for each of the next five years for a grand total increase of 2.5 percent. 

Some have suggested that the Academy should have opposed the bill because of the small increase. A few believed we should have held out and forced Congress to implement the large 21-percent cut to show them what a mess it would create when Medicare beneficiaries lost access to their care providers.

There are a couple of big problems with both of those positions. If HR 2 had failed, Congress would have again patched the SGR. In a patch, the discussion is not about increases in payments, it is about how much to cut from physicians. My guess is the update would have been zero percent and what was owed for the term of the patch would have to be fully paid for. This is exactly what happened in 2014 when the SGR fix was paid for by the “misvalued code initiative.” Congress simply directed the Center for Medicare & Medicaid Services (CMS) to find savings from the CPT codes, so physicians really paid for the whole cost of the SGR patch. 

On the suggestion that we let Congress go ahead with the 21-percent cut, the reality is that Congress would never let that happen. A drop that big would cause many, if not all physicians to stop taking Medicare patients. Members of Congress understand the implications of that on their constituents and their reelections.

“The SGR bill puts maintenance of certification into law.” 

We at the AAN have heard a lot about maintenance of certification (MOC) in recent months. There is a great deal of discussion among physicians in all specialties about the relative value of Part IV of MOC which is required by the American Board of Medical Specialties and its specialty component boards, such as the American Board of Psychiatry and Neurology.

During negotiations of the HR 2, we were concerned that the bill drafters might make MOC a requirement to participate in quality improvement programs called for by the bill. For that reason, the AAN strongly urged members of Congress and key committee staff to make MOC only one of many options for physicians in future quality payment programs. We were successful in this argument as MOC was not made mandatory in any way in HR 2.

If you hear the same concerns, I hope you will let your AAN colleagues know the details. Learn more from our analysis of HR 2. 

AAN Supports Medical Marijuana Legislation on Capitol Hill 
By Tim Miller, Sr. Program Manager, State Affairs and Grassroots

The AAN is supporting two measures on Capitol Hill that would reschedule marijuana and cannabidiol (CBD) a compound found in cannabis. The Compassionate Access Act, sponsored in the House by Rep. Morgan Griffith (R-VA) and Rep. Earl Blumenauer (D-OR), sets up a process to reschedule marijuana from its current position as a Schedule 1 drug under the Controlled Substances Act, which asserts the drug has no medical use and limits the ability of researchers to study the drug’s safety and effectiveness as a treatment. It also exempts CBD from the federal definition of marijuana.

AAN Past President Timothy A. Pedley, MD, FAAN, was quoted in a press release announcing the legislation, saying “We are encouraged by the potential this bill has to accelerate research on possible medical uses for marijuana. Without rigorous scientific data, however, the true benefits and possible side effects of medical marijuana will remain unknown. Reclassifying medical marijuana from its current Schedule 1 status will give researchers who study its effects on the brain increased opportunities to conduct evidence-based clinical trials that, we hope, will clarify the clinical indications for its use in patients with neurological conditions such as epilepsy and MS.” 

The legislation is also supported by the Epilepsy Foundation and Americans for Safe Access.

The Academy is also supporting S.683/H.R. 1538, the Compassionate Access, Research Expansion, and Respect States Act of 2015. Introduced by Senators Cory Booker (D-NJ), Rand Paul (R-KY) ), and Kristin Gillibrand (D-NY) in the Senate, and Rep. Steve Cohen (D-TN) in the House, this bill would also reschedule marijuana from its current Schedule 1 status.

The AAN released a legislative position statement on this topic in December 2014 advocating for the rescheduling of medical marijuana for research purposes only. The Academy does not advocate for the legalization of medical marijuana at this time, as more research in its effectiveness is needed. 

CMS Releases PQRS Participation Data
CMS recently released its 2013 PQRS Experience Report and Appendix, with interesting data regarding the practice of neurology. The median incentive paid to eligible neurologists was $277 and neurologists received 1.4 percent ($3,011,598) of the national total amount paid out. There were 15,149 neurologists considered eligible professionals in 2013 and 8,706 (57.5 percent) of these eligible providers participated in PQRS. From this group, a large majority, 7,042 (80.9 percent), received an incentive payment. However, there were 4,783 (31.6 percent) eligible neurologists subjected to the 2015 PQRS payment penalty. Learn more about PQRS.


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