Capitol Hill Report: Congress Postpones SGR Cut, Creates New Challenges

February 17, 2012

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By Mike Amery, Legislative Counsel, Federal Affairs, (202) 506-7468, mamery@aan.com

Once again, Congress has stepped in to prevent what is now a 24.7 percent cut in Medicare physician payment due to the Sustainable Growth Rate (SGR) formula. The agreement, which was part of a package including extension of the payroll tax cut, will postpone cuts until January 1, 2013.

Preventing the SGR cut cost about $20 billion and was covered by various health care spending reductions, including a $5 billion cut to the prevention and public health fund under the Accountable Care Act (ACA), which represents about one–third reduction in funding. Another significant funding source comes from a reduction in payments to hospitals for patient nonpayment of premiums and co–pays.

The AAN recognizes that a 10–month fix is a lot better than a cut, but we are disappointed to not have a permanent solution. The AAN argued vigorously for a complete elimination of the SGR by offsetting the expense, now $316 billion over ten years, with savings expected to be generated as a result of the drawdown of troops in Iraq and Afghanistan.

Sound the Alarm, SGR Cut Coming in 2013!

Because the fix is only for 10 months, plans begin immediately to try to prevent the cut now scheduled for January 1, 2013. I talked with a number of members of Congress last week who are frustrated by the fact that this problem continues year after year, because the price take just keeps getting bigger and bigger.

Rep. Phil Gingery, MD, (R–GA) told me that he objected to the fact that the payroll tax extenders weren’t paid for and he also had concerns about the fact that the SGR fix was so short. Due to this, he ended up voting against the deal on the House floor.

Rep. Tom Price, MD, also a Georgia Republican, echoed Rep. Gingrey’s concerns in a conference call with AAN BrainPAC contributors, saying that he was certainly supportive of preventing an SGR cut but found it very difficult to take just a 10–month fix rather than a two–year or even permanent solution. He pointed out that putting this issue off until December of 2012 places the expiration right into the middle of a lame–duck session after November elections and before the swearing in of the 113th Congress.

Thank you to all of the AAN members who sent letters to their members of Congress or even visited them in their offices to make sure that the SGR cut didn’t go into effect. Unfortunately, we are going to have to continue advocating on this throughout 2012, but at least we will have a short reprieve.

AAN Preps for Neurology on the Hill

A highlight of my year is our annual Neurology on the Hill event. This year, we will have more than 150 AAN members from 43 states coming to Washington on February 27 and 28 to participate in an advocacy training program followed by visits to the Capitol Hill offices of more than 200 members of Congress.

In addition to advocating for a complete elimination of the SGR, we will be on the Hill talking about the need to include cognitive care physicians in efforts to improve the practice climate for primary care providers. We also will be asking for a recommitment to increasing research dollars at the National Institutes of Health, which has seen considerable reductions in their ability to provide grants in recent years.

In an interesting twist, the American College of Rheumatology will be on the Hill just one week later, on the same issues. This should give us a good double shot at increasing awareness of the needs of cognitive care providers.

President Obama Releases 2013 Budget Plan

The President released his 2013 budget plan last week in what has largely become ceremonial process rather than a substantive policy discussion. 

On the good side, the President is making a commitment to grow NIH funding for research on Alzheimer’s disease by increasing funding in 2013 alone from $450 million to $530 million.

On the negative side, the budget calls for $177 million cut to the Children's Hospital Graduate Medical Education Payment Program, just what we need when we are already facing a shortage of child neurologists.

The 275 page document is replete with funding increases and decreases of all kinds—including health care—that could take up pages of Capitol Hill Report. But the reality is that the president’s budget is dead on arrival in Congress and spending decisions will be made through the House and Senate Appropriations Committees, which is where the AAN’s advocacy efforts will be aimed.

AAN Member Testifies on Concussion Legislation in Florida

Daniel Kantor, MD, president of the Florida Society of Neurology, recently testified twice to a Florida State Senate committee about the importance of ensuring that only appropriately trained physicians are qualified to return a student athlete to play after suffering a concussion.

In his testimony before the Senate Budget Subcommittee on Education Pre–K—12 Appropriations, Dr. Kantor, a Palatucci Advocacy Leadership Forum graduate, voiced his concerns about an amendment that would allow chiropractors to also perform this role. Dr. Kantor stated that “there should be a low bar to remove an athlete from play, and a high bar for returning to play.”

Dr. Kantor’s first testimony can be viewed at 44:43 of this video.

His second testimony is at 21:23 in this video.