Despite AAN Pushback, MedPAC Recommends SGR "Fix" to Congress

October 6, 2011


Despite strenuous opposition from the AAN and many other physician specialties, the Medicare Payment Advisory Commission (MedPAC) voted to officially recommend to Congress that the broken Medicare sustainable growth rate (SGR) formula be replaced and paid for in part by cutting payment to physicians classified as "specialists" by almost 18 percent over the next three years, followed by a seven-year freeze.

Physicians defined as "primary care" according to the Affordable Care Act two-part definition would not be subject to any cuts in Medicare pay and would receive only a 10-year freeze. Neurologists would be considered "specialists" under this proposal because the ACA did not list neurology as an eligible specialty for the primary care bonus even though neurologists derive over 60 percent of their income from evaluation and management (E/M) services.

If Congress were to approve MedPAC's recommendations the consequences to neurology could be devastating and exacerbate the following issues:

  • There are already fewer US medical students choosing neurology, which is leading to a workforce shortage. One physician workforce study in Massachusetts found severe shortages in the neurology workforce for three years in a row, while other studies suggest neurologic shortages in rural areas.
  • Wait times for a new patient to visit a neurologist (28.1 days) are significantly longer than the average wait time for other specialties, including cardiology (15.5 days) and family practice (20.3 days).

In a letter to MedPAC on September 27, AAN President Bruce Sigsbee, MD, FAAN, stated that categorizing all non-"primary care" specialties together is overly simplistic, and that any fix to SGR needs to recognize specialties that coordinate and manage care for patients with chronic conditions. Failure to recognize this will lead to less appropriate care for Medicare beneficiaries.

What's next?

MedPAC is an independent congressional agency whose role is to advise Congress on issues affecting the Medicare program. Congress is not obligated to do anything with their recommendations. As mentioned in the September 23 edition of Capitol Hill Report, MedPAC's SGR proposal doesn't seem to have a lot of traction with lawmakers. However, this proposal could still be introduced as a stand-alone bill, as part of legislation to address the pending SGR cut in 2012, or even as part of the Joint Select Committee on Deficit Reduction debt resolution package.

With an almost 30-percent cut in Medicare reimbursement scheduled to take effect on January 1, 2012, Congress will face some tough decisions before the end of the year. Currently, the Joint Committee is deliberating on ways to cut the deficit, with its report due to Congress by Thanksgiving. Congress will then have 30 days to vote up or down on their proposal. Whether or not their proposal addresses SGR remains to be seen.

AAN members can be assured the Academy is following this situation very closely and will continue to voice objections to any proposals that will harm reimbursement to neurology. Stay tuned to for further updates.

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