Capitol Hill Report: AAN Works with Rep. Heck on SGR Repeal

June 8, 2012

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

I had a great opportunity last week to spend some time with several members of the House GOP Doctors Caucus. This group of House Republicans includes 22 members, including 17 physicians, three nurses, a psychiatrist, and a dentist. Together, they have made great strides in bringing physician issues to the attention of congressional leadership over the last two years.

One of the members present was neurology champion Rep. Joe Heck, DO (R–NV). This was the first time I had spoken to him personally since he, along with Rep. Allyson Schwartz (D–PA), introduced a SGR repeal bill, HR 5707. As reported in the last few Capitol Hill Reports, this bill increases payments for primary care providers, and for the first time, does not include a list of eligible specialties. Rep. Heck left the list out at AAN’s request. This change means that many cognitive specialists would be eligible for increased payments. Needless to say, the Academy is a big fan of Rep. Heck and we have been strongly advocating in support for HR 5707 since its introduction.

Heck told me and other medical specialty groups that he understands that the bill is a long way from passage but it works to keep the SGR issue at the forefront, “because if there isn't a bill, no one is going to talk about it.” The hope is that we can avoid what has happened so often in the past with SGR fixes coming down to the last moment and providing no real long–term solutions.

Although SGR was the big topic, our conversation with the “Doc Caucus” also touched on several other big concerns for physicians including the automatic two–percent Medicare cut called for by the sequestration process agreed to by Congress during the deficit reduction talks last year.

In the end, the consensus was that Congress once again will be forced to pass a short–term SGR fix that will prevent the large cut but the risk of the two–percent sequestration cut going into effect is very real. Assuming Congress does not have the will to act before the November elections, it will be very difficult to deal with all of the expiring issues prior to January 1, 2013, including the highly contentious expiring Bush tax cuts,  extending unemployment benefits, Alternative Minimum Tax relief, and even a debt ceiling increase.

Some Doc Caucus Members Leery of Physician Payment Splits

For three years, the Academy has been trying to rectify the Affordable Care Act’s primary care bonus that failed to include other cognitive specialties that are facing similar reimbursement and recruitment challenges such as neurology. In an interesting twist, now that we have legislation that would correct the problem going forward, we actually have received some push back from a few physicians in the House who don't want to see the physician payments divided by specialties or codes.

I talked about this extensively with Rep. Dan Benishek, MD (R), a general surgeon from northern Michigan. He agrees that something needs to be done, but feels that no physician performing E/M should be left out. We are working with him and his staff to potentially increase the values for all E/M codes. 

Although raising the value of E/M codes probably would be a very expensive proposition, I think we can work with Dr. Benishek and others to quantify the crisis in primary and cognitive care and make certain that future efforts to alleviate that crisis make sense for all physicians.

Neurology Supporter Wins Member v. Member Primary Challenge

Eight–term Rep. Bill Pascrell (D–NJ) fought off a challenge from fellow Democratic Rep. Steve Rothman in a member versus member primary caused by redistricting in northern New Jersey.

The Academy and its political action committee BrainPAC have strongly supported Pascrell, who is co–chair of the Congressional Traumatic Brain Injury Caucus. For several years, the Academy has participated in an annual Brain Injury Awareness Fair on Capitol Hill that Pascrell sponsors. He is the lead House author on several pieces of legislation dealing with TBI and concussion. We look forward to continuing our work with Pascrell on TBI issues.

PDUFA Passed

Contrary to the contention that Congress is having trouble passing anything, both the House and Senate recently passed legislation reauthorizing the Prescription Drug User Fee Act. The measure is part of the Food and Drug Administration bill and sets up a House–Senate conference over a measure that authorizes $6.4 billion in drug and medical–device industry fees to the FDA over the next five years. Differences between the House and Senate versions are mostly minor, and both chambers passed their own renditions nearly unanimously.

This legislation is of great interest to many of our patient group partners such as the National MS Society, the Epilepsy Foundation, and Parkinson’s Action Network.

Former Rep. Giffords Returns to Capitol Hill

Finally, the highlight of the week was the return of my good friend Gabrielle Giffords (D–AZ) to Capitol Hill where she hosted an event for past supporters and friends. It was the first time I had seen her personally since the tragic shooting in January 2011. She looked good and was in high spirits. It was good to see her again.