Capitol Hill Report: Congressional Letter on NCS/EMG Cuts Moving Forward

December 7, 2012


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

Reps. Peter Roskam (R–IL) and Dutch Ruppersberger (D–MD) have drafted a letter asking Department of Health & Human Services Secretary Kathleen Sebelius to reconsider the Center for Medicaid and Medicare Services drastic cuts to needle EMG and nerve conduction studies.

The letter is the result of a campaign we have waged in Washington over the last two weeks to raise awareness among members of Congress of the impending cuts, how they will impact patients, and how the process gave AAN and others no opportunity for notice and comment. A second letter signed by over 140 organizations has also been sent to key house committee leaders raising awareness of this issue.

Several patients groups, including the ALS Association and Parkinson’s Action Network, have joined our effort to encourage members of Congress to sign on to letter prior to December 14, when it will be sent to Secretary Sebelius.

You should have received an Action Alert from AAN on the evening of December 5. We have less than a week to get as many House members on the letter as possible. If you haven’t sent your message to your representative yet, please do so as soon as possible as the letter will close on Friday, December 14.

CMS Call Goes Nowhere

The AAN also is pursuing action directly with CMS. AAN President Bruce Sigsbee, MD, FAAN, and Medical Economics & Management Committee Chair, Neil Busis, MD, FAAN, discussed the issue directly with CMS staff on a conference call.

Unfortunately, the only progress made was a suggestion by CMS to pursue a CMS Review Panel, but even success there wouldn’t affect the cuts until 2014.

We are working to schedule meetings with higher level CMS staff.

Webinar Updates AAN Members

The reality of the NCS/EMG issue is that cuts are going into effect on January 1. We are doing everything we can to prevent this unfair decision and the process that resulted in the cuts, but it is important that any AAN members who perform these studies are prepared.

The AAN held a webinar on December 4 to discuss the CMS decision to slash reimbursement. Almost 1,000 AAN members called into the meeting. If you weren’t able to make it, please watch a replay here.

Still Pushing for SGR/Sequester Fix

At the same time we are fighting the NCS/EMG cuts, we haven’t taken our eye off of the need for an SGR fix that calls for a 26.5–percent cut in Medicare reimbursement on January 2 or the possible sequester cut of two percent scheduled for the same day.

Unfortunately, the Congressional Budget Office revised its cost analysis of the SGR fix, putting it at $25 billion. This means that Congress will have to find $25 billion to offset the cost, which is a significant increase over the $11 billion that it had called for in its last analysis.

One of the “pay–fors” is certain to be the same one used for the last fix, which is to create parity between the Medicare payments for evaluation and management (E/M) services provided by physicians and by hospital outpatient services. Needless to say, hospitals are again upset, but they have a hard time explaining why they should be paid more for providing identical services.

Medicaid Rate Pay–For?

Another potential pay–for is a provision yet to be implemented in Obamacare that will pay Medicaid providers Medicare rates for 2013–2014. Medicare typically pays one–third more than Medicaid. In another example of the absurdity of the effort to improve the practice climate for primary care providers but not include cognitive physicians like neurologists, CMS declared that the Medicaid provision would apply to all internal medicine subspecialists. This, of course, continues to leave out neurologists.

It also leaves out patients. A physician for a child with juvenile diabetes will qualify. A physician for a child with epilepsy won’t.

We have sent a letter to CMS objecting to the exclusion of neurologists, but this is a problem with the health care bill. We are strongly considering asking that legislation be introduced in the next Congress to right this error. It is only a two–year program, but it is sure to get interest in renewal so an early start could help us with the entire cognitive care question.

We have also been assured by our follow medical specialties like the American College of Physicians that they will support our efforts, just as they have in supporting the elimination of the list of eligible specialties for improved E/M payments in the HR 5707 that was introduced by Reps. Allyson Schwartz (D–PA) and Joe Heck, DO (R–NV).

Fight These Issues with Us

It is pretty clear that we will be fighting these same issues in 2013, so how about joining your colleagues at Neurology on the Hill? The application process is open now, so put your name in and come bring your stories to your members of Congress.