Capitol Hill Report: Can New SGR Proposals Fix Old Problem?

November 17, 2011


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

Early last week Rep. Allyson Schwartz (D-PA) invited me to review a proposal she planned on sending to the Joint Select Committee on Deficit Committee aimed at preventing the massive and unrealistic cuts called for by the flawed Medicare Sustainable Growth Rate (SGR) formula. Although her blueprint had some merit such as working toward a new payment system that would offer multiple innovative practice plans for physicians who move away from fee for service, in the short-term it continues to separate primary care from all other specialties.

The specifics include flat payments for physicians in 2012 and an annual increase of 0.5 percent for specialists from 2013 through 2016. Primary care providers, as defined by the Patient Protection and Affordable Care Act (ACA), would receive a 2.5 percent annual increase for each of the four years.

I met twice with Schwartz and convened a meeting with her staff and members of the Cognitive Specialty Coalition. During our conversations we were unable to get an agreement to shift their proposal from the flawed concept of primary care versus all specialties to the more accurate model that incentivizes evaluation and management over procedures.

The AAN will not be conceding to the flawed ACA definition of "primary care" which undermines the expertise that cognitive specialties provide. Especially when Schwartz's plan is untested and there is no guarantee a transition to alternative innovative payment models will take place after four years.

The Cognitive Specialty Coalition will continue to work on this issue by educating members of Congress and their staff about the problems of plans that fail to recognize specialties like neurology in efforts to bring balance to the Medicare payment system. In reality, Schwartz's plan is far from achievable as it does nothing to overcome the first problem, which is to find more than $300 billion to eliminate the flawed SGR formula.

The Latest SGR Rumor

The latest rumor surrounding elimination of the Medicare Sustainable Growth Rate (SGR) formula is that funds from the drawdown of troops in Iraq could pay for a long term SGR fix. CMS just released the 2012 physician fee schedule, which lowers the projected amount of the cut from 29.5 percent down to 27.4 percent. There is still a possibility that this could go into effect, so keep your letters going to your members of Congress! Send your message today.

Supreme Court to Take Health Care Case

The Supreme Court agreed to consider several challenges to last year's health care reform law, which sets up a major ruling on President Obama's top legislative achievement. The Court will consider questions regarding the individual mandate, which requires every individual to purchase health insurance; severability, which is the question of whether the law can stand without the individual mandate; and jurisdiction, the issue of whether the courts can consider if the law is constitutional before it has taken full effect. The court will probably hear arguments in March 2012 and announce their opinion just months before the presidential election, which should make this a very interesting campaign issue.

Free AAN Advocacy Webinar on Deficit, Medicare Reimbursement

Following the announcement of the crucial decisions from the Deficit Committee, I will hold a free Advocacy Webinar on Wednesday, December 7, at 2:30 p.m. CST. We will discuss Congress's actions and our future expectations on Capitol Hill, including:

  • Deficit Committee recommendations: Implications for neurology
  • Medicare Reimbursement Rate (SGR): What's next?
  • Top issues affecting neurology
  • Early expectations for 2012
  • How can you help?

All US AAN members are encouraged to register for this free conference today.

Register for Free Webinar

AAN Advocacy Loses a Dedicated Supporter

The AAN recently learned that Michael Sloan, MD, MS, FAAN, of Tampa, FL, passed away. Sloan was a 2003 graduate of the Palatucci Advocacy Leadership Forum and a member of the BrainPAC Founders Club. We in the AAN Center for Health Policy and the Academy members who shared his passion for advocacy will miss him.