Capitol Hill Report: CMS Springs Surprise Cuts in 2013 Medicare Payments

November 9, 2012


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

2012 Elections and CMS Springs Surprise Cuts in 2013 Medicare Payments

This Capitol Hill Report would have begun with news from the elections, but because of the Center for Medicare & Medicaid Services (CMS), the elections will have to wait.

In a complete surprise to the AAN, the CMS released new code values that could result in decreased payments to neurologists.

Specifically, physicians who provide nerve conduction and needle EMG services will face dramatic cuts of more than 50 percent for some services starting January 1, 2013. According to CMS, the reduction is a result of the “potentially misvalued code” initiative, which impacted EMG and nerve conduction tests.

On November 1, 2012, CMS issued a final rule that updates payment policies and rates for physician services paid under the Medicare Physician Fee Schedule (MPFS) in calendar year 2013. The EMG and nerve conduction test codes were not part of the proposed rule released in August that the AAN commented on extensively. Apparently, CMS ignored the AMA Relative Value Scale Update Committee’s recommendations when setting the rates, giving the AAN and other organizations no notice that the new code values would be so undervalued.

We know this is a drastic cut that will be especially hard on neurology practices large and small, many of which rely on these services to meet their bottom line. Patients also will pay the price with less access to these services. Private health insurers often follow Medicare payment rules as well, which will exacerbate the situation.

So, although the ruling goes into effect in January 2013, the AAN is looking at every possible avenue to alter the ruling for 2014. We are teaming up with the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) and the American Academy of Physical Medicine and Rehabilitation (AAPM&R) to propose higher values for these services, and will continue to work with those societies to advocate for better reimbursement whether it be at CMS or in the halls of Congress.

We are committed to advocating for and preparing you for these changes. We are hosting a free live webinar on December 4 at 12:00 p.m. ET to discuss the 2013 NCS coding changes and the financial ramifications. If this is going to impact you, I urge you to register online.

Congressional Neurology Champions Hang On

Now for the elections. I am pleased to report that two of neurology’s biggest champions, Reps. Ed Perlmutter (D-CO) and Joe Heck, DO (R-NV), were re-elected.

Rep. Perlmutter, who has a daughter with epilepsy, will return for his third term representing the suburbs of Denver. Perlmutter passed legislation creating Epilepsy Centers of Excellence at the VA in 2008 and will support efforts to improve those centers in the 113th Congress.

Rep. Heck will return for his second term representing the suburbs of Las Vegas. Heck was responsible for ensuring that cognitive specialists like neurologists were included in legislation that improves the practice climate for primary care providers. Leadership by members of Congress like Rep. Heck will reverse policies that pick winners and losers based on physician specialty designation and focus on services provided to patients and patient access to care.

The AAN will be working closely with both of these members on key issues for neurology.

AAN Hosts Free Election Result Webinar

After $6 billion in campaign spending, Americans voted for the status quo. With the re-election of President Obama and continued Republican control of the House and Democratic control of the Senate, the AAN will take a look at the results and its implications for AAN members and patients with neurologic conditions.

Please join AAN Government Relations Committee Chair Elaine C. Jones, MD, FAAN, and BrainPAC Executive Committee Chair Anna D. Hohler, MD, FAAN, and me for a discussion on Wednesday, November 14 at 8 p.m. ET. Register for this free event.

Academy Plans for Lame Duck

The 113th Congress begins on January 3, 2013, which happens to be the day after several catastrophic financial cliffs come to bear on Washington. Expiration of the Bush-era tax cuts, $1.2 trillion in “sequestration” spending cuts, expiration of long term unemployment benefits, and the ever present Sustainable Growth Rate (SGR) cuts will go into effect before the new members of Congress will have a chance to take their seats.

In order to deal with these financial issues, the current Congress, including those who lost elections or are retiring, will return to Washington for a “lame duck” session this week.

I’m not expecting any “grand bargain” that will solve these problems but the consequences of inaction are severe. For instance, imagine the disruption in access to care for Medicare beneficiaries if Congress allowed sequestration and the SGR to combine for a 28.5 percent cut in physician reimbursement.

I expect the current Congress will come to an agreement on short-term fixes for the SGR and most other major issues which will punt these items into early 2013. The deal probably won’t pass Congress until Christmas Eve or even New Year’s Eve but you can be sure that the Academy will be actively urging Congress to find solutions. The AAN’s DC staff will be on Capitol Hill talking with both returning and departing members until they turn out the lights on the 112th Congress.

Look for email action alerts from the “AAN Grassroots Network” in November and December so you can help us keep these issues at the forefront of legislators’ minds.

Apply for the 2013 Neurology on the Hill

The elections didn’t provide a lot of clarification so we are anticipating many problems will remain as the new Congress is sworn in. We need you to join us and help us fix this mess.

The 2013 Neurology on the Hill will take place April 22–23, 2013, in DC. Participants are flown to Washington to put a face on the challenges of people with neurologic disorders and the physicians who treat them. Learn more and apply by January 21, 2013.