Capitol Hill Report: MedPAC Defies United Opposition, Calls for an 18-percent Cut!

October 7, 2011


By Mike Amery, Legislative Counsel, Federal Affairs, (202) 506-7468,

MedPAC Sends Congress a Recommendation to Cut Specialist Payments by 18 Percent

The Medicare Payment Advisory Commission (MedPAC) approved a recommendation to Congress to cut all physician specialties by almost 18 percent over the next three years, with just two of the 17 commissioners dissenting.

The recommendation is the result of MedPAC's effort to provide Congress with a proposal to eliminate the flawed Medicare Sustainable Growth Rate (SGR) formula, which calls for a 29.5 percent cut in physician payments on January 1, 2012.

Prior to the vote, the Academy sent a letter to MedPAC commissioners detailing the problems of the proposal and stating our objection. Specifically, MedPAC's recommendation calls for all specialties to be cut almost 18 percent over the next three years followed by seven years of payments frozen. Primary care providers, as defined in the Affordable Care Act (ACA), would see only a freeze in payments for the same time period. This short-sighted definition of primary care is the same definition that prevented neurology from the qualifying for the 10-percent bonus known as the primary care incentive in the ACA.

During the public comment period following the vote, I addressed MedPAC commissioners on behalf of the members of the Academy, stressing our objection to separating primary care and cutting all specialties regardless of the services they provide to patients. I stressed this discrepancy in physician payments is not a primary care versus specialty issue, but rather a procedural versus non-procedural care issue. I also reminded them of the language included in their June report, which recognized the need to realign payments to promote cognitive specialties.

Two of the commission members approached me later to thank me for my comments and said that they agreed with our assessment. We are making progress, at least with some MedPAC commissioners, but that vote was definitely not in favor of cognitive care providers.

The Decision Rests with Congress

MedPAC's recommendation is now before Congress, who will decide how the SGR will be fixed and who will foot the bill. We're working our hardest to make sure it isn't you. As I mentioned in my last Capitol Hill Report, we have had a head start in educating Congress about this proposal. AAN President Bruce Sigsbee, MD, FAAN, was on Capitol Hill meeting with congressional leadership just after MedPAC floated this idea. Since then, AAN Congressional Affairs Representative Derek Brandt and I have been all over Capitol Hill, both in congressional offices and at fundraisers for members of Congress, explaining the problems with MedPAC's proposal. We have been joined by fellow members of the Cognitive Specialty Coalition, including the American College of Rheumatology and The Endocrine Society.

With this effort we have met with more than 50 key decision makers in Congress to discuss how destructive this recommendation would be to the future of cognitive care and how misguided this is from a policy and patient perspective. Pointing out that the primary care provider would receive more reimbursement for seeing the very same patient as a neurologist, rheumatologist, or endocrinologist, just because of the sign the doctor puts on the wall, is a powerful argument.

Grassroots and Media Too

We have made a lot of progress spreading the word and will continue, congressional office by congressional office, but we are not restricting ourselves just to DC lobbying. Immediately after the MedPAC vote, the Academy sent a letter to the editors of several Washington, DC, publications, another tactic to get the attention of policymakers.

A notice to members was posted on You should have received an action alert email from the Academy asking you to contact your members of Congress to make them aware of the dangers of MedPAC's recommendation. If you haven't yet responded, please do so at