Capitol Hill Report: SGR Crisis Averted…for One Year

January 7, 2013


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

Bowing to the deep concerns of neurologists and other physicians, Congress has again stepped in and prevented catastrophic cuts to Medicare physician payments for one year. Last Tuesday, just before a scheduled cut of 26.5 percent was to go into effect, the House passed HR. 8, the American Taxpayer Relief Act, by a vote of 257-167. The Senate previously approved the package on a vote of 89-8.

The AAN thanks all of its members who have been active in keeping this issue as a top priority for members of Congress. The SGR has been a problem for nearly a decade and there is still a need for a permanent solution. But this fix is a testament to physicians across America, including neurologists, who take the time to relay their concerns about patient access to care if Medicare were to be drastically cut.

Sequester Cuts Delayed

The bill also defers the devastating across-the-board cuts (known as “sequestration”) for two months, which represents a temporary reprieve from a two-percent cut in Medicare payments and larger program cuts for other health programs like NIH.

With the swearing-in of the new Congress and the inauguration of President Obama later in January, these two months will likely go by fast. In the New Year, your AAN team in Washington will continue to pressure Congress to permanently repeal the SGR and the sequester as we work to create a more equitable practice climate for all physicians.

In-Office Imaging Preserved, But Cut

For several years, radiology interests have been urging Congress to eliminate the in-office ancillary exception to the Stark Law, which allows non-radiologists to self-refer for imaging services. The exception was not eliminated but, as part of the offset for the SGR patch, the bill increases the utilization assumption for equipment from 75 percent to 90 percent which generates $800 million in savings over ten years.

While the overall outcome of the package is positive for medicine, an increase to the equipment utilization rate for advanced imaging modalities such as CT and MRI will result in lower payments.

AAN President Bruce Sigsbee, MD, FAAN, (right) and House Ways & Means Committee member Rep. Erik Paulsen (R-MN).

Sigsbee with House Democratic Caucus Chair Xavier Becerra (D-CA).

113th Congress Convenes

AAN President Bruce Sigsbee, MD, FAAN, joined me on Capitol Hill on January 3 as the 113th Congress began.

On swearing-in day, many congressional offices are open for well-wishers to drop in and have a few words with members of Congress and their staffs. The Academy’s political action committee, BrainPAC donated to 111 candidates who were elected in November, so Dr. Sigsbee and I worked our way through the House and Senate office buildings congratulating many of those supported by the AAN’s BrainPAC.

We were fortunate to talk with several key members of Congress including members of the powerful House Ways & Means Committee as well as the Energy & Commerce Committee, both of which have jurisdiction over health care issues.

Our conversations ranged from introducing new members of Congress to some of the issues facing neurology to in-depth discussions about the impacts of the SGR, the need for medical liability reform, and the recognition of cognitive care providers in Medicare and Medicaid payment policies.

AAN Government Relations Committee to Discuss Priorities

Each year, the AAN Government Relation Committee meets to determine annual federal priorities and set the agenda for Neurology on the Hill. There are many issues that consistently rise to the top but every so often we receive a recommendation from an AAN member that others have not have thought of.

A perfect example is the Epilepsy Centers of Excellence at the VA legislation passed by Congress at AAN’s request in 2008. This came straight from a suggestion in late 2006 by an AAN member who recognized a pending epidemic of epilepsy due to service members returning from Iraq and Afghanistan. I’ll have an update on the Centers in the next Capitol Hill Report but suffice it to say that they are providing great treatment and saving VA resources.

Do you have an idea for the Government Relations Committee? If so, I would really like to hear it. Please send me a note at

Neurology on the Hill 2013—Last Chance!

We have a one-year SGR delay, but a lot of problems remain. We need you to join us and help us fix this mess.

The 2013 Neurology on the Hill will take place April 22 and 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.