Capitol Hill Report: 'Sequester' Rhymes with 'Monster'

February 22, 2013


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

Have you heard of “sequester?”  To many in Congress, this word rhymes with “monster.” Sequester is an across-the-board, potentially devastating cut to all kinds of spending, including two percent to physician Medicare payments, significant cuts to medical research, and billions from defense.

I looked up back issues of Capitol Hill Report and found the first time “sequester” was mentioned was August 5, 2011, in a recap of the debt deal that created a deficit commission to find $1.2 trillion in cuts in federal spending.

The commission was supposed to identify spending cuts and sequester never was supposed to happen. The threat of sequester was designed to be so draconian that Congress would come together and find cuts everyone could agree to through negotiations.

Today, everyone I talk to on both sides of the aisle, say sequester is going to happen on March 1, 2013.

Congressional Gridlock to Blame?

Congressional gridlock is certainly to blame and is an easy target, but I think motives may go far deeper. For some Republicans, sequester offers a guaranteed opportunity to cut $1.2 trillion in federal spending as a down payment on the $16 trillion national debt. Some Democrats see this as an opportunity to cut from defense like never before.

Read more about sequester implications for neurologists.

AAN Opposes Sequester

The AAN does not believe that an across-the-board cut is wise policy. We are making the argument on the Hill that cuts in research (see Advocacy Notes below) and physician payments will be harmful to patients with neurologic conditions.

We recognize there may be disagreement from our members for the very reasons it appears that some Republicans and Democrats seem willing to allow sequester to take place, but we hope you will respond to an AAN Action Alert in your inbox on Tuesday, February 26, which asks you to express your views to your members of Congress in just a few mouse clicks.

Are electronic messages to Congress really helpful? Yes, they are. All of these messages are counted weekly by congressional offices to measure the intensity of constituent feelings. So please respond to this email and send those messages.

AAN Follows Up with White House on Brain Mapping

In a nod to the need for dramatic investment into brain research, President Obama outlined his support for a decade-long program to map the human brain.

Details are sketchy right now, but AAN Chief Health Policy Officer Rod Larson and I met with the White House Office of Science and Technology Policy last week to discuss this and other issues impacting neurology.

AAN Chief Health Policy Officer Rod Larson (center) with Bess Evans and Philip Rubin of the White House Office of Science and Technology Policy

This was actually one of the first substantive conversations we in DC have had with the administration specifically focused on neurology. For the first time we were able to discuss the need to include cognitive physicians in efforts to improve the practice climate for primary care providers. White House staff were appreciative of our dilemma and understood that efforts to only boost primary care could have unintended consequences on cognitive physicians like neurologists.

I think this meeting with the White House offered the AAN an excellent opportunity to improve the profile of neurology and influence the process more favorably for our patients. Hopefully we will be able to enlist the support of the Administration in the near future.

Regulatory Corner
by Daneen Grooms

Last week, I participated in a meeting with CMS officials, along with other members of the complex chronic care coordination (CCCC) work group, to present a proposal requesting that CMS provide reimbursement for these services in 2014. These codes would allow neurologists to receive compensation for overseeing the management and coordination of services for patients with mild cognitive impairment who have problems with ADL/IADL and require extra assistance.

We explained why these codes are medically necessary and how they should ultimately be used, stressing that they should not be restricted to primary care providers because these services also are performed by specialists who function as principal care providers, like neurologists.

We described how a typical patient with Parkinson’s disease and dementia and is on multiple medications would benefit from these services. Even though we mentioned that these services are not restricted to patients in patient-centered medical homes (PCMH), I am concerned that CMS is leaning toward limiting these codes to PCMH or similar practice settings.

Overall, CMS appeared receptive to our proposal. Given that we didn’t receive push back, we plan to discuss our proposal with CMS Director of Medicare Jonathan Blum in the near future.

Advocacy Notes
by Tim Miller

  • New Advocacy Webpage Feature: You now can view bills the AAN is monitoring at the state legislative level. Don’t see a bill we should know about? Contact Tim Miller.
  • The Academy signed a letter with multiple organizations and institutions to Congress expressing concerns about planned sequester cuts to the National Institutes of Health (NIH).
  • A letter has been sent to the Nevada Assembly stating the AAN’s opposition to a bill that would allow chiropractors to perform procedures such as electromyography.
  • Movements:
    • Sports concussion bills are moving forward in Montana, Georgia, South Carolina, and Tennessee
    • Anti-epileptic drug substitution bills have been introduced in Iowa and Massachusetts
    • The Virginia General Assembly has passed biosimilar legislation (gubernatorial signature pending) while a committee in the Mississippi State Legislature voted against it