Capitol Hill Report: It Just Keeps Getting More Expensive

February 6, 2012


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

SGR Costs Escalate

Greetings again from Washington, where the cost of an SGR fix just keeps increasing. Last week, the Congressional Budget Office (CBO) raised the cost of a 10-year fix for the Sustainable Growth Rate formula (SGR) to $316 billion over ten years. This is up from the last estimate in November of $290 billion. Without a fix of some sort by March 1, physician reimbursement under Medicare will be cut 27.4 percent.

We continue to be assured by members of Congress on both sides that Congress will prevent the cut. I recently spoke with Sen. Bob Menendez (D-NJ) who said he'd like to see a permanent fix, but as little as 10 months is a real possibility. We are still working with other medical specialties including the American Medical Association to use Overseas Contingency Operation (OCO) funds to offset the cost of a permanent fix. I talked with House Majority Whip Kevin McCarthy (R-CA) last week and urged him to use OCO funds but I got the distinct impression that he wasn't going to be in favor.

It does look like Senate Republicans and Democrats as well as house Democrats will be in favor of using OCO so, as Rep. Bill Cassidy, MD (R-LA) suggested to me, we will keep "shaking the tree" of House leadership. Cassidy is a gastroenterologist and member of the House Doctor Caucus, which is pushing the use of OCO for a permanent SGR fix.

Cognitive Care Effort Continues

We continue to work with our cognitive care specialty friends to ensure that if an SGR fix does occur that any transition to new payment systems will include recognition of cognitive care providers and not just primary care providers.

I have appreciated all of the comments that we received from AAN members in support of our efforts. I would like to bring one in particular to the attention of Capitol Hill Report readers. An AAN member from the Midwest provided a great example of why it makes no sense to pay primary care providers more than cognitive care providers for treating Medicare beneficiaries.

"I work for a multi-specialty group in a clinic attached to a hospital. We have primary care and limited representation in various subspecialties including two neurologists and a geriatrician, etc. We are considering setting up a formal "Memory Clinic" to help care for the increasing numbers of Alzheimer's disease patients and other demented patients as these population figures steadily increase.

"Our administration has been very supportive, but finances will be an issue as nearly all patients will be Medicare beneficiaries which often take a lot of time. We neurologists are involved and want to stay involved but clearly if our geriatrician makes 10-15 percent more per patient due to the 'primary care bonus' for the exact same work then it seems almost inevitable that the neurologists will get squeezed out over time. It makes no financial sense for a multispecialty group interested in dementia with geriatrics or even adult medicine to include neurologists in the initial evaluation and on-going care of dementia patients. In fact, there will be incentive for them not to involve us."

That's a perfect example and one that congressional offices are already starting to hear in our meetings.

AAN Members Create an MS Success!

The National Multiple Sclerosis Society (NMSS) shared good news recently. After several years of effort, the society was successful at adding malignant MS as a condition qualifying for the "Compassionate Allowances Program" at the Social Security Administration.

The Compassionate Allowances Program expedites the review of Social Security Disability Insurance (SSDI) applications for diseases and other medical conditions that invariably qualify for disability insurance based on minimal objective medical information. The benefit of this is two-fold: it gets the sickest and most severely impacted applicants approved for Social Security Disability quicker and it alleviates the backlog of applications for others in line.

NMSS specifically mentioned that the victory wouldn't have happened without several MS activists including AAN members John Booss, MD, FAAN, of Connecticut, who testified at a March 2011 Autoimmune Hearing held by Social Security; Fred Lublin, MD, FAAN, of New York; and Lily Jung-Henson, MD, MMM, FAAN, of Washington State, who currently sits on the Academy's Government Relations Committee and BrainPAC Executive Committee.

Glenn Graham, MD, PhD, Named Deputy Director at VA Neurology

Longtime AAN advocacy supporter Glenn Graham, MD, PHD, has been named Deputy National Director of Neurology, Office of Specialty Care; and Clinical Consultant, Office of Specialty Care Transformation Department of Veterans Affairs. He has transferred from Albuquerque, NM, to his new position in Washington, DC.

We in AAN advocacy would like to congratulate him on this appointment as Dr. Graham has been instrumental in our efforts for several years as a former member of the Government Relations Committee, as a graduate of the first Palatucci Advocacy Leadership Forum in 2003, and as a veteran of the Academy's Neurology on the Hill events.