AAN in Action While Congress Adjourns

September 22, 2014

AAN Meets with Medicare Leadership  
By Timothy A. Pedley, MD, FAAN, AAN President

Earlier this month, I had the pleasure of meeting with Sean Cavanaugh, deputy administrator and director of the Center for Medicare at the Centers for Medicare & Medicaid Services (CMS). Mr. Cavanaugh is responsible for overseeing the regulation and payment of Medicare fee-for service providers. We discussed a number of issues of concern to both the AAN and CMS. I was joined by the AAN’s President Elect Terry Cascino, MD, FAAN; Past President Bruce Sigsbee, MD, FAAN; and Medical Economics and Management Committee Chair Orly Avitzur, MD, MBA, FAAN.

We brought a message to Mr. Cavanaugh that CMS needs to help ensure an adequate supply of neurologists by implementing policies that properly value and recognize the role of neurologists.

Using our workforce data, we showed the current crisis neurology is facing. We explained how neurology is having trouble attracting medical students into the specialty and is experiencing the same workforce challenges as primary care. I shared with Mr. Cavanaugh that many of the diseases impacting the Medicare population are neurologic conditions that represent a huge drain of Medicare resources. In particular, disorders such as Alzheimer’s disease are increasing in frequency as our population ages.

We also spoke to CMS about the value of neurology by highlighting our episodes of care for stroke, epilepsy, and dementia. We also talked about the AAN’s longstanding commitment in developing relevant and useful neurology-specific quality measures. Dr. Kate Goodrich, CMS’ medical officer responsible for PQRS, was pleased to hear that the AAN is working on a registry. As a result, AAN staff has scheduled a meeting with her to continue the dialogue.

We concluded the meeting by thanking CMS for supporting physicians who perform care coordination by agreeing to pay for these services in 2015 through the chronic care management codes. As principal care physicians, often times our role is to coordinate all aspects of our patients' care. We urged CMS to move forward with their proposal to eliminate the global surgical periods because it’s about fairness. Physicians should be paid for the work performed and documented. 

I view this meeting as a significant success because we were able to really delve into issues of importance to our membership. This year’s meeting included several CMS senior officials from quality reporting, physician reimbursement and the accountable care organization program. This shows me that there is definitely greater familiarity of the Academy and I look forward to continuing to build a productive relationship with CMS. 

Congress in Pre-election Limbo  
By Mike Amery, Esq, Legislative Counsel

Mark Twain is attributed with the saying, “No man’s life, liberty, or property are safe while the legislature is in session.” If that is true, we are a little safer on the federal level as the 113th Congress has adjourned until after the November elections.

Before leaving Washington, Congress passed a continuing resolution (CR) funding the government through December 11, 2014. The CR avoided health care issues other than boosting efforts to fight the Ebola virus outbreak overseas.

With the December CR deadline, Congress will return in a “lame duck” session after the elections to ensure that the government doesn’t shut down. The length of the lame duck and the issues to be considered won’t be known until after the elections and may turn on the outcome of control of the US Senate. Republicans need to pick up six seats to take control and three open seats seem assured with Montana, South Dakota, and West Virginia almost certain to switch from Democratic to Republican.

I talked with several members of Congress about the prospects of completing the SGR deal in the lame duck, including one of the lead authors, Rep. Michael Burgess, MD, (R-TX). Burgess said that he would be working along with his physician colleagues in the House to get the SGR deal done before the next Congress convenes.

I am skeptical that a lame duck Congress will be able to take care of such a big issue. We also are closely watching out for efforts to extend the Medicaid bump. The Medicaid bump expires on January 1 and the current SGR fix in March and these issues are sure to come up.

Odds and Ends 
By: Tim Miller, Sr. Program Manager, Communications and State Advocacy

  • State neurological society meetings were held in Florida and Pennsylvania recently. These events provide neurologists an opportunity to learn more about the health care environment in their respective states, network with colleagues, as well as obtain CME. Neil Busis, MD, FAAN, and Anup Patel, MD, gave presentations on payment reform and quality measures in Pennsylvania. Bruce Sigsbee, MD, FAAN, provided an update on the practice environment and advocacy in Florida. Interested in attending your state society meeting? You can find a list of upcoming meetings here.
  • The AAN was one of 110 signatories to a letter to House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) opposing recently introduced legislation that would give audiologists unlimited direct access to Medicare patients and include audiologists in the definition of physician. The Academy strongly opposes this measure, as audiologists do not have the necessary medical training to perform the same duties as physicians or are able to medically diagnose or treat patients with the options required.
  • Rep. Ami Berra (D-CA) recently signed as a co-sponsor for H.R. 1838, which would add neurology, psychiatry, and OB/GYN to the Medicaid bump. Berra’s support brings the number of co-sponsors on this bill up to 51. 


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