May 23, 2016

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

Elaine C. Jones, MD, FAAN, Named PALF Advocate of the Year

Albuquerque, NM, was the site of the 14th annual Palatucci Advocacy Leadership Forum last week as another 28 AAN members graduated from the prestigious, award-winning leadership program.

More than 400 AAN members have now gone through the intensive media and advocacy training since the inception of the program in 2003. Many attendees have gone on to leadership positions within the AAN and I expect the 2016 class to be no different.

There were some real stars in this year's groups as they spent the weekend in front of a camera creating sound bites about caring for patients and improving the health care system for patients with neurologic conditions. Legislative training consisted of mock congressional office visits to support the Furthering Access to Stroke Telemedicine Act (FAST Act) that the AAN is currently pushing on Capitol Hill. The bill is up to 93 cosponsors and I really wish we could have taken our PALF class straight to DC to meet with their members of Congress. I expect we would pick up 20 or more cosponsors pretty quickly.

A key part of the Forum is the return of previous graduates who serve as advisors and faculty for the new advocates. Each year, one is chosen as the “Advocate of the Year.” The award is given to a Palatucci Advocacy Leadership Forum graduate that has demonstrated passion for patient advocacy, an individual who has risen above their peers, had success or progress on their advocacy goals, and displayed proven confidence with the media.

This year's winner came from the very first class in 2003. Elaine C. Jones, MD, FAAN, a solo practitioner in Rhode Island, was selected in recognition of her outstanding accomplishments in bringing neurologic care to patients in Haiti and her numerous leadership roles in the AAN and her community.

Dr. Jones served six years as chair of the Government Relations Committee and now is a member of the AAN Board of Directors and current chair of the Payment Policy Subcommittee. She has worked tirelessly to organize and grow an effort to bring adequate neurologic care to the poor of Haiti. She provides direct care to patients at the St. Luke Hospital in Port-au-Prince, brings much needed medical education for Haitian physicians, and has established innovative programs to deliver neurologic care to those in need.

If you have never been to the Palatucci Forum, consider applying for the 2017 program when the application cycle opens later this year.

Seeking a Better Approach to Address Medicare Part B Costs

By Daniel Spirn, Regulatory Counsel

Drug pricing remains a hot topic with Congress and the Obama administration as both are looking to find ways to control spending on medication. On March 8, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that it hopes will contribute to this effort. The proposal would test new payment models with the stated goal of improving how Medicare Part B pays for prescription drugs. Currently, Medicare pays for most Part B drugs at a rate of the average sales price (ASP) plus 6 percent. According to CMS, this current payment methodology may encourage providers to select higher-priced Part B medications for their patients. CMS wants to experiment with different versions of the add-on percentage to see the effects it would have on spending and prescribing patterns.

In our response to the government, the AAN stressed its disagreement with CMS' flawed assumption that physicians, including neurologists, practice medicine solely by financial incentives rather than what is in the best interests of their patients. While the AAN shares the goal of encouraging more value-based programs, the current proposal disproportionately places the burden of rising drug costs on physicians and their patients. Physicians should be responsible for only the costs and drug usage that are related to decisions over which they have direct control.

Infusion centers may be especially hard hit. The pressure to provide affordable access to biologics and other specialty medications has increased alongside the rising cost of care and declining reimbursement environment. If Part B reimbursement for these medications is further reduced, providers will no longer be able to sustain their infusion centers for Medicare patients and will have no choice but to refer them to their nearest available hospital, greatly increasing costs and further burdening hospital facilities.

While the AAN does not believe the drugs chosen by neurologists in the course of treating patients are motivated by financial gain, there are actions CMS can take to help limit this possibility from occurring. Such steps include helping societies like the AAN develop episodes of care that include the cost of medications to give the physician an incentive to reduce costs. Additionally, CMS should remove obstacles to forming alternative payment models (APMs), especially those that will be considered qualifying APMs under the final Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) regulations. This further encourages physicians to choose drugs for patient benefit and not profit.

As written, the proposed rule adds too great of an administrative burden on neurology practices that already struggle to comply with complex Medicare regulations and quality programs. Although these are significant challenges, the AAN is confident it can work with CMS to improve the current rule which may be finalized this fall. We hope the agency will work with stakeholders with the understanding that value-based programs are an important tool to help limit rising drug costs, but they cannot be designed such that physicians and their patients carry all of the associated burdens.

Congress Continues Oversight Hearings on Part B, Concussions, MACRA

By Derek Brandt, Senior Congressional Affairs Representative 

With the elections approaching and the window for legislative achievement rapidly closing, the House of Representatives has become increasingly active in conducting oversight and investigative hearings into issues that affect neurology. A hearing last week focused exclusively on evaluating the proposed Part B demonstration discussed above. Members of Congress shared many of the same concerns expressed by the AAN including its size, scope, and potential adverse consequences. Some members of the committee and a witness panel expressed support for the proposal, but their views were in the minority.

This issue has received a lot of attention on Capitol Hill, resulting in numerous letters from Congress to CMS on this issue, including one opposing the proposal from 242 members of the House.

Concussion is another big topic. The Energy & Commerce (E&C) Committee recently began a series of hearings and roundtables focused on this topic. During the first roundtable, a representative from the NFL admitted a link between football and brain disorders for the first time, as reported in Capitol Hill Report. Last week, the E&C Committee held another hearing featuring family members who lost loved ones to CTE and second impact syndrome.

The hearing also featured sports teams and national organizations that discussed altering policies and procedures to limit risks of concussions. One interesting example was the head football coach for Dartmouth College, who explained that they have completely eliminated all player-on-player hits during practice.

Another oversight hearing that took place recently within the House Ways & Means Committee focused on the implementation of MACRA, the current Medicare physician payment system that was established one year ago following the repeal of the sustainable growth rate (SGR) formula.

During this hearing, CMS Acting Administrator Andy Slavitt described agencies work promulgating the 962 page MACRA proposed rule, which was discussed last week in the Capitol Hill Report. While the tone of the hearing was positive overall, during the discussion members of Congress raised two key concerns shared by the AAN about the MACRA rule. The first is that the criteria for what constitutes an Alternative Payment Model (APM) is so strict under the proposed rule that only 30,000 to 90,000 physicians will likely qualify, according to CMS. Second, that the requirements of the rule would be disproportionally burdensome on small practices, though Slavitt said that would not be the case.