MedPAC Releases 2013 Medicare Recommendations

March 15, 2013


The Medicare Payment Advisory Commission (MedPAC) has failed once again to recognize cognitive specialists in its recent report to the U.S. Congress. The March 2013 report, merely reiterates the Commission's previous recommendations from October 2011 on repealing the sustainable growth rate (SGR) system.

MedPAC proposes a 5.9% cut to specialists each year for the next three years followed by a freeze for the subsequent seven years. In contrast, payment rates for primary care services would be frozen for the entire period at their current levels. The Commission limits the primary care update freeze to physicians and other health provisional who meet both the following criteria:

  • Practitioner specialty designation: Physicians who—when enrolling to bill Medicare—designated their specialty as geriatrics, internal medicine, family medicine, or pediatrics. Eligible practitioners would also include nurse practitioners, clinical nurse specialists, and physician assistants.
  • Practice focused on primary care: Physicians and practitioners who have annual allowed Medicare charges for selected primary care services equal to at least 60 percent of their total allowed charges for fee-schedule services. Primary care services used to determine eligibility are: office visits, home visits, and visits to patients in nursing facilities, domiciliaries, and rest homes.

While the Commission finds it crucial to protect beneficiaries' access to primary care services, access to neurologists is getting worse. In 2012, patients had to wait 34 days on average to see a neurologist, which is a 28% increase in an appointment wait time from 2010 according to a recent AAN survey.

In January, the AAN shared this and other facts about the neurology shortage with the Commission. We also requested that the Commission exclude cognitive care specialists from the recommended cut to specialists.

As Congress continues to work on plans to reform physician payment, the MedPAC report will be one of several proposals under consideration. The AAN strongly supports the recent recommendations from the National Commission on Physician Payment Reform which acknowledges the role of cognitive specialists.

Additionally, the Academy also supports the Schwartz-Heck legislation, the Medicare Physician Payment Innovation Act, (HR 574), that would allow physicians that meet the 60 percent E/M threshold to qualify for increased payments during a transition period to new payment models. Given that the previous MedPAC recommendations did not gain traction on the Hill, the Academy is hopeful that alternative approaches will have a higher likelihood for success.