Capitol Hill Report: SGR Fire Sale?

March 25, 2013


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

I recently reported that the Congressional Budget Office (CBO) had lowered the projected cost of a complete repeal of the Medicare Sustainable Growth Rate (SGR) formula from nearly $300 billion over ten years to just $138 billion.

For the last ten years, the entire physician community has been urging Congress to eliminate the SGR, which last year called for a 27.5-percent cut in Medicare reimbursement to physicians. Congress has stepped in each year and postponed the cuts until later rather than eliminated the formula completely.

I think this could be the year when the SGR really is eliminated. “Just $138 billion” is still a lot of money, but the term “fire sale” keeps being used by members of Congress on both sides of the aisle. I talked last week with both Reps. Henry Waxman (D-CA) and Michael Burgess, MD (R-TX), both top members of the House Energy & Commerce Committee, who said that CBO had offered up a “fire sale” and that Congress needs to act before next August when the next CBO report is due, “In case they change their minds,” as Dr. Burgess said.

The AAN is working with our physician colleagues across the Hill to see if we can eliminate the SGR once and for all. We also are working to ensure that whatever replaces it keeps neurology and patients with neurological conditions in mind. No sense in passing up a fire sale, right?

Annual Meeting Update

I spent last week off of Capitol Hill and in San Diego at the AAN’s 65th Annual Meeting. It was a pleasure to hear from so many AAN members as I spent most of my time talking politics at the BrainPAC booth. As expected, the big issues were how to increase payments for cognitive care, how to deal with the NCS/EMG cuts, and some discussions on the two-percent cut from sequester coming in April, neuroimaging, tort reform, and funding for research. We handed out a document detailing the NCS/EMG issue and explained to many members how wrong it was for CMS to implement these cuts without even an opportunity for notice and comment, and what our next steps are.

I have attended 13 Annual Meetings and it is always interesting to hear the divergent views of America’s neurologists. Again this year, I was asked “Why didn’t the AAN support the Affordable Care Act?” and “Why did the AAN support ObamaCare?”—just moments apart. Fact is the AAN remained neutral, so the Annual Meetings are a great opportunity to let membership know what the issues are, listen to their opinions, and share the positions that the AAN Government Relations Committee has taken. For that reason, I thank you if you came and talked with me in San Diego and I thank you again for reading Capitol Hill Report.

Regulatory Corner
by Daneen Grooms

2013 MedPAC Report Reiterates 2011 Recommendations
On March 15, the Medicare Payment Advisory Commission (MedPAC) released its report to Congress that reiterates the Commission’s previous recommendations from October 2011. In the report, MedPAC advises Congress to repeal the SGR, proposes a 5.9-percent cut to specialists, and to freeze payment rates for primary care services. In January, the AAN sent a letter urging the Commission to exclude cognitive specialists from the recommended cuts 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. Given that the previous MedPAC recommendations did not gain traction on the Hill, the AAN is hopeful that alternative approaches will have a higher likelihood for success.

AAN Meets with CMS on IOM
In addition to the drastic cuts to nerve conduction studies, the 2013 Medicare Physician Fee Schedule (MPFS) final rule also included payment changes for intraoperative neuromonitoring (IOM). For 2013, CMS would not recognize CPT® code 95941 for concurrent IOM outside of the operating room and established HCPCS code G0453 for remote or local monitoring limited to one patient. Last week I met with CMS officials, along with several AAN leaders, to discuss the major problems for access to care for these services and to present our proposal suggesting that CMS establish additional G codes for remote or local monitoring of more than one patient in the 2014 MPFS proposed rule. We explained that our proposal will help assure that IOM services will continue to be available to Medicare beneficiaries needing this service which will not be possible if concurrent monitoring is not recognized.

Overall, I believe it was a great discussion and it gave us an opportunity to present our case as well as address CMS’ questions on concurrent monitoring. We will continue to work closely with CMS on this and any other issues affecting reimbursement of neurologists.

Advocacy Notes
by Tim Miller

  • Along with the recent release of the updated evidence-based sports concussion guideline, the AAN also released an updated sports concussion legislative position statement. Geared towards policymakers, this updated statement will be used to continue advocating for implementation of youth sports concussion regulations.
  • The AAN also release a new (and free) sports concussion app that includes current sports concussion laws in each state. Called “Concussion Quick Check”, it also includes concussion symptoms and a link to help users find a local neurologist. Download the concussion app.
  • The Academy signed on to a letter from the American Society of Association Executives opposing a proposed amendment by Senator Tom Colburn that would have limited face-to-face meetings by federal employees. The amendment was¬† not ¬†included in the recent Continuing Resolution the Senate passed on March 20, 2013.