Capitol Hill Report: Good News on SGR; Schwartz/Heck Bill Reintroduced

February 11, 2013

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

SGR Fix Drops from $300B to $138B 

The physician community received great news from the Congressional Budget Office (CBO) last week when it released a report predicting that the 10-year cost to eliminate the Sustainable Growth Rate (SGR) formula had fallen from $300 billion to $138 billion due to lower than expected growth in Medicare physician spending.

Schwartz/Heck Bill HR 574 Reintroduced

The news encouraged members of both the physician community and Congress that this could be the year to eliminate SGR permanently. I met with Rep. Joe Heck, DO (R-NV) who said that Congress “better fix it now before the CBO changes its mind again.”

I talked with Rep. Heck at a joint press conference with Rep. Allyson Schwartz (D-PA), where they reintroduced the Medicare Physician Payment Innovation Act HR 574. This is the same bill they sponsored in 2012 that eliminates the SGR, provides a transition to new physician payment models, and includes significant increases in payments to primary and cognitive physicians.

Rep. Allyson Schwartz (D-PA) and Rep. Joe Heck, DO (R-NV)

The AAN has worked closely with both Reps. Heck and Schwartz to ensure that the efforts to improve primary care do not fall into the same problems as the Affordable Care Act (ACA) by providing bonuses to some physicians but not others based on specialty designation rather than the care being provided to patients. Unlike the ACA, this bill eliminates the list of specialties eligible for increased payments for evaluation and management services, meaning that many neurologists will qualify.

Rep. Schwartz commented that the need for SGR repeal is one area where bipartisanship truly exists in Congress. Heck said that with the release of the new CBO numbers the timing of this is perfect. He also gave a shout out to the AAN mentioning our support when he was asked who would be advocating for the bill. Support of the Medicare Physician Payment Innovation Act will be a top priority for the Academy at Neurology on the Hill in April.

Helping You Navigate NCS Cuts

The AAN is redoubling its efforts in February and March in education and practice management guidance regarding the outcome of AAN advocacy initiatives and the cuts to EMG/nerve conduction studies by CMS. The Academy has hired a consultant to determine whether there are opportunities to lessen the impact of the NCS cuts for members. AAN staff members are available to answer questions regarding the coding changes. Contact Luana Ciccarelli. A new Hot Topics in Education Session has been added to the Annual Meeting to help members learn about dealing with the cuts and how quality programs will impact their practice. Attend “Neurology in Crisis: Next Steps for Practice Survival” on Tuesday, March 19, at noon.

Also at the Annual Meeting, Academy leaders and advocacy staff will hold an open microphone session immediately following the business meeting on Monday, March 18, to dialogue on AAN strategies for payment recognition for neurologists as a cognitive specialty, including discussion of the recent changes to NCS, EMG, and IOM codes. All members are invited to attend; registration is not required. The business meeting begins at 8:00 a.m. in Room 23 ABC.

Members are also encouraged to respond to AAN Action Alert requests as we continue to fight for fair reimbursement and sign up to participate in RUC surveys. Read the column by AAN President Bruce Sigsbee, MD, FAAN, “Neurology in Crisis.”

New Committees, New Members

In the US House, health care policy is largely determined by the Ways & Means Committee and the Energy & Commerce Committee. With the start of the 113th Congress, there are several new members on these committees who we are working to get to know.

We often attend fundraisers with funds from BrainPAC as the entry for these introductions. This was the case last week for a meeting with Rep. Kevin Brady (R-TX), the new chair of the Ways & Means Health Subcommittee. Brady has toiled for years on the International Trade Subcommittee but decided to take over the reins of the Health Subcommittee because of the importance of health issues and a reduction in trade issues.

We sat down for breakfast with many other physician specialties and had a great discussion about the SGR, the need for fixes to the ACA, tort reform, and many other issues. It was refreshing to discuss issues with someone with an open mind and a fresh perspective on these issues who will now be a key decision maker in the field of health policy. We definitely will be working to make him aware of issues impacting neurology.

Stroke Survivor Sen. Mark Kirk Returns to Capitol Hill

On January 21, 2012, 52-year-old Sen. Mark Kirk (R-IL) suffered a stroke. On January 3, 2013, he returned to the Senate. This op-ed from the Washington Post is worth a read.

AAN Applauds NFL Efforts to Have Independent Neurologists on Sidelines Next Season

You might already have seen this article on AAN.com but I think it is worth a mention for those who have not. This is a big success for neurology and an opportunity for a select few neurologists next football season.

The American Academy of Neurology, the world’s largest professional association of neurologists with more than 25,000 members, is applauding today’s reports that the National Football League (NFL) plans to have neurologic expertise on sidelines during games next season to help diagnose and treat concussions. The announcement was made by the NFL during a pre-Super Bowl news conference.

“It is imperative that an unbiased neurologist be involved in determining when it is safe for a player to return to play,” said Bruce Sigsbee, MD, FAAN, president of the American Academy of Neurology. “We owe it to these professional athletes to be seen by a physician with training in the evaluation and management of sports concussion. You only get one brain.”

The AAN welcomes an opportunity to work with the NFL to implement this new policy change. The Academy has a network of sports neurologists available nationwide who are members of the Academy’s Sports Neurology Section and we are looking forward to working with other professional organizations on the issue of sports concussion. It is estimated that more than one million athletes now experience a concussion each year in the United States. Learn more about concussion.

CHR Expands Its Coverage

To keep you up to date on how federal regulations and other legislative issues may affect you, even on a state level, Capitol Hill Report is broadening its coverage. “Regulatory Corner” will be hosted by my Washington colleague Daneen Grooms. “Advocacy Notes” will be compiled by Tim Miller in Minneapolis (let Tim know if you have a better title for this section). As always, please contact me if you have comments or suggestions on how we share this news with you.


Regulatory Corner
by Daneen Grooms, AAN Regulatory Affairs Manager
The Sunshine Act Implementation

In an effort to create greater transparency in health care markets (according to CMS), pharmaceutical companies, device manufacturers and group purchasing organizations (GPO) who participate in Medicare, Medicaid or the Children’s Health Insurance Program will have to track and report gifts of $10 or more given to physicians by August 1, of this year.

In addition to recording gifts these organizations will have to report physicians’ ownership or investments in manufacturers and GPOs with the first data due to CMS by March 31, 2014 for the period of August 1 to December 31, 2013. CMS will release the data publicly by September 2014. The final regulation contained important changes to address concerns raised by the AAN. Specifically, the Sunshine Act excludes certified and accredited continuing medical education and expands the time afforded physicians to challenge inaccurate, false, and misleading reports. The law will give physicians the right to review their reports and to challenge those reports that are false, inaccurate, or misleading.

Of course that AAN will be very interested to hear of members experience with this new administrative burden.

Advocacy Notes
by Tim Miller, Senior Program Manager, Communications and State Advocacy

  • The AAN signed on to a coalition letter to Rep. D. Phil Roe, MD, (R-TN) endorsing the “Protecting Seniors’ Access to Medicare Act,” which would repeal the Independent Payment Advisory Board (IPAB).
  • The National Association for Biomedical Research, which includes the AAN as a member, recently sent a letter to United Continental CEO Jeffrey Smisek, asking them to continue transporting research animals that allow lifesaving research around the world.
  • Emerging State Issues: A bill in Pennsylvania would expand the scope-of-practice of audiology, allowing them to perform intraoperative monitoring (IOM) services on an unlimited basis (see page 5, lines 16-21). The AAN is opposing this proposition, and, at a minimum, believes those performing these services should be trained properly in IOM and be supervised by a physician. Staff is working with the local medical association and neurosociety to have our concerns addressed.
  • Several states have introduced legislation that would require health insurance plans to provide coverage for telemedicine services. Academy staff is monitoring these closely.
  • Proposal preventing pharmacists to substitute biosimilars for a prescribed biologicial product unless certain conditions are met have been introduced in several states. This comes after the ACA created an abbreviated pathway for FDA approval of biologics.
  • New youth sports concussion legislation has been introduced in Georgia, Mississippi, Montana, and South Carolina. These are a few of the remaining states yet to implement new laws.

On any of these state issues, please contact Tim Miller.