Neurology Wins in Washington!
November 10, 2014
Final Rule Brings
Good News to Neurologists
By Amanda Becker, Senior Director, Medical Economics & Quality
There are two major releases from CMS every year that the AAN’s regulatory staff eagerly awaits. When the proposed and final physician fee schedules come out in the summer and late fall, it becomes our top priority to read the rule and search immediately for any impact on neurology. Some years the specialty is faced with big challenges that require an intensive, coordinated advocacy effort. It was with relief on October 31 (shortly before trick-or-treating) that we saw some very positive news and a noticeable absence of bad news for neurology.
Neurologists who provide chronic care management services can begin charging for that work, those who provide telemedicine can bill more services, and a new ALS measure is available in PQRS.
CMS listened to the AAN’s years of advocacy pushing to eliminate 10- and 90-day global periods. Those procedures will be transitioned to 0-day globals over time, requiring all follow up visits to be separately documented and billed. CMS will no longer pay for visits that are not being performed; in a budget neutral payment system, that’s good news for neurology.
There is little variation in payment for most neurology procedures. Nerve conduction of 1-10 studies show increases of 3 to 7 percent, but 11-13+ studies see decreases of 1 to 3 percent. EEG digital analysis 95957 takes a 28-percent cut due to a shift in how practice expenses are figured. Reimbursement for E/M visits stays relatively flat.
It’s also good news that CMS will implement a new practice of putting payment changes through the proposed rulemaking process, rather than waiting until the final rule to spring cuts on physicians. We remember two years ago when nerve conduction and EMG were cut with no chance to comment or prepare.
Election Results: AAN-supported
Candidates Mostly Successful
By Mike Amery, Legislative Counsel, Federal Affairs
I spent a few days before the elections in Las Vegas at the AAN’s Fall Conference. The highlight for me was a visit to the BrainPAC donor reception by neurology champion Rep. Joe Heck, DO, (R-NV). Congressman Heck had an idea of the coming Republican sweep as he talked about how strong his party was looking in Nevada. Sure enough, voters in Nevada reelected a Republican governor, turned over the keys to the legislature to the Republicans and even defeated Rep. Steve Horsford (D-NV).
I watched election returns last week with an eye towards races involving champions for neurology like Heck who was easily reelected. Some were in safe seats with no surprises like Sen. Susan Collins (R-ME) and Rep. Frank Pallone (D-NJ), who is competing to be the lead Democrat on the important House Energy & Commerce Committee. But other elections were tight like Rep. Raul Ruiz, MD, (D-CA) one of the few Democrats in Congress who are physicians. Ruiz’s race was finally called in his favor late last week.
Most of the candidates supported by the AAN were winners, but the night was not a complete success. Some Democrats who have been helpful to our cause were defeated.
There are some races left to be determined, particularly the Louisiana Senate contest between incumbent Sen. Mary Landrieu (D) and Congressman Bill Cassidy, MD, (R) that concludes with a December 6 run-off. But as it stands today, the AAN’s bipartisan political action committee, BrainPAC, participated in 140 races with a win/loss record of 124-16 in 2014 election. More than 90 percent of BrainPAC contributions went to winners who will take seats in the 114th Congress in January.
One state ballot measure deserving a mention was California’s Proposition 46 that I reported on in Capitol Hill Report last month (link). This measure would have increased California’s limits on punitive damages in medical malpractice cases. Voters fortunately voted Prop 46 down by a wide margin. The AAN congratulates members of the California Neurological Society who were leaders in the effort to oppose the effort that would have led to less access to care for patients and potential changes in other states.
Congress is scheduled to return to Washington this week in a lame duck session. We will take a look at some of the issues they will consider in the next Capitol Hill Report. You can also learn more by listening to the recording of a recent webinar I helped host, “What the New Congress Means for Your Practice?”
Odds and Ends
- The Medicaid and CHIP Payment and Access Commission discussed and declined to recommend to Congress an extension of the Medicaid bump, which increases Medicaid evaluation and management rates to match Medicare, due to a lack of data on the effectiveness of the current policy.
- For the third year, an advocacy training session was offered at the AAN’s Fall Conference. The course, Leadership in Neurology: Be a Champion for Your Patients and Protector of Your Specialty with Payers, Policymakers, and the Public was a resounding success. Attendees received in-depth skills training in insurer negotiations, legislative advocacy, and media relations. Most of the nearly 30 attendees were new to these skills. Yet, after the four-hour session they left equipped to become leaders in their practice. It was especially helpful for the attendees to turn common practice grievances into advocacy issues and learn how to tackle them. There will be a similar course offered at the Annual Meeting in Washington, DC, on Monday, April 20 at 6:30 a.m. We hope to see you there!