November 7, 2016

By Daniel Spirn, AAN Regulatory Counsel

Positive News for Neurologists in Final 2017 Medicare Physician Fee Schedule

On November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued its final Medicare Physician Fee Schedule for 2017. We are pleased to see CMS finalize several proposals enabling neurologists to have more opportunities to be reimbursed for the cognitive care provided to patients. These changes to the Fee Schedule reflect the AAN's work in developing a proactive relationship with officials at CMS. In September, the AAN submitted comments to the agency and held numerous meetings with Medicare officials to explain the need for more appropriate reimbursement in the cognitive specialties. As a result, CMS will now reimburse for four new CPT codes and four existing, previously unpaid, codes. Newly covered codes capture non-face-to-face work associated with patient care outside of an E/M visit.

The final rule indicates that CMS agrees with the AAN regarding the value neurologists play in the health care system, as the final rule specifies that Medicare will begin paying for cognitive and functional assessment and care planning services for patients with cognitive impairment. CMS also is finalizing payment for non-face-to-face time spent outside of E/M. Under the new policy, neurologists will be paid for the significant amount of time spent outside of the in-person office visit caring for the individual needs of their patients. The final rule also improves payment for visits that initiate chronic care management (CCM) services. 

Additionally, CMS is finalizing several revisions to CPT codes to more accurately recognize the work of cognitive specialties like neurology. Previously, certain care management and cognitive work elements were “bundled” into E/M visit codes. This meant that additional work efforts by neurologists were not paid for outside of the E/M visit. However, through this rule, CMS hopes to improve payment for this kind of care by recognizing the codes that separately pay for chronic care management. We are also pleased to see CMS finalize two new codes that describe initial and subsequent encounters for critical care consultations furnished via telehealth. The new codes provide a mechanism to report an intensive telehealth consultation service for the critically ill patient under the circumstance when a qualified health care professional has in-person responsibility for the patient but the patient benefits from additional services from a distant-site consultant specially trained in providing critical care services.

Learn more about how the provisions of the final Medicare Physician Fee Schedule affect neurology.

Is There a Doctor in the House?

By Mike Amery, Esq., Senior Legislative Counsel

Physicians have been leaders in politics going back to the founding of the United States. In fact, five of the 56 signers of the Declaration of Independence were physicians, including Benjamin Rush of Pennsylvania, who later served as treasurer of the US Mint.

The very first Congress in 1789 included a New Jersey doctor, Sen. Jonathan Elmer, and four physician colleagues in the US House of Representatives. There are 17 physicians serving in the 114th Congress. The Senate counts three: orthopedic surgeon John Barrasso (R-WY), ophthalmologist Rand Paul (R-KY), and gastroenterologist Bill Cassidy (R-LA). House physician members include 11 Republicans and three Democrats. 

There can be no doubt of the impact these members of Congress have had on recent health care policy that impacts physicians. The best example is the elimination of the SGR (Sustainable Growth Rate) formula in 2015. For more than a decade, this policy called for significant cuts to Medicare physician payments. Each year, after intense lobbying by physician specialties like the AAN, Congress would stop the cuts at the last moment at the behest of the doctors in the House and Senate. Finally, in 2015, physicians such as OB/GYN Michael Burgess (R-TX) and orthopedic surgeon Tom Price (R-GA) pushed an SGR repeal bill over the finish line on a huge bipartisan vote that was supported by every doctor in Congress.

Changes to the ranks of physicians in Congress are certain in the 2016 elections. Two of the three physicians from the state of Louisiana, Reps. Charles Boustany (R) and John Fleming (R), are competing for a promotion to the US Senate, so both will be leaving their House seats. Another doc looking for a promotion is emergency physician Rep. Joe Heck (R), who is competing for the open Senate seat in Nevada. Rep. Jim McDermott (D-WA) and Rep. Dan Benishek (R-MI), are retiring. All of the others are expected to win reelection, although family physician Rep. Ami Bera (D) will have a difficult fight in the highly competitive California District 7. 

Replacements are on the way tomorrow. A couple of physicians who won Republican primaries and are strong favorites in the general election are probably already scouting out office space on Capitol Hill. Roger Marshall, an OB/GYN from western Kansas, defeated an incumbent, and Drew Ferguson, a dentist from Georgia's 3rd district won a very close primary election run-off.

Doctors are critical to the creation of sound public policy for physicians and patients. They are constantly looked to for real life experience on how federal policies impact the practice of medicine. The AAN works to develop relationships with all of the physicians in Congress. 

Unfortunately, there aren't any neurologists running for Congress this year, but the AAN is working on that. The AAN Government Relations Committee and BrainPAC Executive Committee recently approved a plan that will position the AAN to be a significant help to any AAN member who becomes a viable candidate for a seat in Congress in the near future. The plan will provide viable candidates with the skills needed to get a campaign started and put the AAN's political action committee, BrainPAC, in a position to help with direct support and independent expenditures.

Tune into Free Post-election Webinar

This edition of CHR publishes on Monday, November 7, so don't forget to vote tomorrow Tuesday, November 8. Then, plan on tuning in on Tuesday, November 15, at 12:00 p.m. ET to the AAN's free post-election webinar. I will join AAN Government Relations Committee Chair Nicholas E. Johnson, MD, and BrainPAC Executive Committee Chair Lily Jung Henson, MD, MMM, FAAN, for a rundown of the top races and discuss the potential impacts on AAN priorities.