Capitol Hill Report: AAN Working to Enlist Congressional Support on NCS Cuts

November 26, 2012


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

A number of members have asked for specifics about the AAN’s strategy for combating the decision of the Centers for Medicare & Medicaid Services (CMS) on nerve conduction and needle EMG services that we reported on in the last Capitol Hill Report. With no notice or opportunity to even comment, CMS dramatically reduced the values for 2013.

Although the ruling goes into effect in January, the AAN is looking at every possible avenue to alter the values in the next year. The Academy is working with the American Association of Neuromuscular & Electrodiagnostic Medicine and the American Academy of Physical Medicine and Rehabilitation to propose higher values—just as we did at the AMA RUC for these services. If we do not succeed, we will argue to phase in the cuts as we work to find a fair solution.

We are actively engaged on several fronts.

First, we are appealing directly to CMS and expect a face–to–face meeting soon. In the near future, we will be asking AAN members to contact CMS directly on this issue. They need to hear how this draconian cut will affect your patients and your bottom line. We’ve heard from members that this change will force them to close their practice, lay off staff, and hurt patient care. CMS needs to hear these stories so they can better understand the ramifications of their actions.

Second, we are working with Congress to have a letter sent to CMS signed by as many members of the House and Senate as possible. These types of letters have been used to successfully communicate and ramp up pressure on CMS in the past. My colleague Derek Brandt and I are currently meeting with a dozen congressional offices to line up the champions for this letter. AAN members will be asked to contact their members of Congress in support this letter when the time is right.

Third, we are reaching out to patient organizations that rely on nerve conduction and needle EMG services and expect them to join our efforts.

Also, we are reaching out to organizations representing academic settings that often rely on studies for revenue.

I’ve been asked if we plan to introduce legislation to fix this problem. Introducing legislation is always an option, but for now a sign–on letter is a quicker way for CMS to hear Congress's outrage over this issue. Standalone bills that fix niche issues are difficult to maneuver through Congress, especially considering the ongoing partisan gridlock in DC. Other physician associations have taken this route in the current Congress but with plenty of congressional support, good arguments and more than a year of effort, they still have been unsuccessful.

We will continue to work diligently on all these fronts, and at the same time we are committed to preparing you for these changes. The AAN is 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.

Election Webinar a Success

More than 200 AAN members signed up for a webinar after the elections that I hosted with Elaine Jones, MD, FAAN, and Anna Hohler, MD, FAAN, reviewing the election results and their implications for neurology.

Dr. Jones, who chairs the AAN Government Relations Committee, and Dr. Hohler, who chairs the BrainPAC Executive Committee, discussed some of the important issues like nerve conduction study payments, our cognitive care efforts, and how AAN members can participate in the process.
If you didn’t get a chance to join us, I’d encourage you to watch the recording here.

Viste Neurology Public Policy Fellow Starts

The 2012–13 Viste Neurology Public Policy Fellow, Jai Hira, MD, of New York, recently accepted a fellowship position on the staff of Sen. Al Franken (D–MN). Dr. Hira will spend the next year as health care policy fellow and assist Franken’s legislative team as they prepare for the Ryan White Act re–authorization and plan for effects of sequestration.

We are excited about Dr. Hira’s position as Sen. Franken has shown interest in neurologic issues. Plus it doesn’t hurt that the American Academy of Neurology’s headquarters are based in Minnesota.

Because of conflict of interest issues, the AAN will not actively lobby Dr. Hira, but we expect in the long run that his work will enhance the AAN’s relationship with Sen. Franken and his staff.

The Viste Neurology Public Policy Fellowship is jointly sponsored by the AAN, the Child Neurology Society, and the American Neurological Association.

SGR – One Month to Go

With the conclusion of the Thanksgiving break, the lame duck Congress returns to Washington with a Christmas deadline for solving the “fiscal cliff,” that threatens to derail the US economy like never before.

The AAN continues to press Congress on the need for a solution for the Sustainable Growth Rate (SGR) that will result in a 26.5 percent cut in physician reimbursement on January 2, 2013.

After several recent discussions with both Republicans and Democrats, I remain confident that a short–term patch will prevent the cut and that the issue will be left to the new 113th Congress to deal with in early in 2013. I have heard that there is still a chance for a one–year fix (cost $11 billion) but I’m doubtful.

The big question among congressional staff is whether these issues will be solved by Christmas Eve or if they should be making plans for House and Senate floor action on New Year’s Day to complete their work. Whenever the deal is struck, we will be here to let you know.