The View from the Hill

June 1, 2013

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Timothy A. Pedley

Fair and stable reimbursement.

That was the rallying cry for 138 of your fellow AAN members who attended Neurology on the Hill in Washington, DC, at the end of April. It was a sobering and, at the same time, an invigorating experience. Sobering, in that the issues are complex and—as participants heard from policymakers before meeting with members of Congress—the current economic challenges facing our country mean that everyone’s back is up against a wall. There is plenty of pain to go around, and there are no easy solutions.

On the other hand, it is wonderfully invigorating to have so many committed neurologists able to articulate their needs—our needs—and the needs of our patients so clearly and compellingly. In the face of daunting economic headwinds, our member advocates and staff have been working tirelessly to find—and create—opportunities to gain fair and stable reimbursement for our work while preserving access to appropriate care for our patients.

We know that there are a host of issues that affect us, from the need for liability reform to assuring that graduate medical education is sustained at levels needed to provide adequate numbers of physicians to serve our population. The Academy’s priorities remain focused on cognitive care reimbursement, repealing the sustainable growth rate (SGR), and assuring that neurologic research is adequately funded. The first two of those issues were highlighted in conversations on the Hill.

Cognitive Care Reimbursement

The AAN and its political action committee BrainPAC have spent considerable time and resources to educate members of Congress on the disparities that affect cognitive care reimbursement, and how these are adversely affecting the decisions of medical students and residents to choose careers in neurology. Our efforts seem to be having a positive effect, in that those we spoke to on the Hill were generally more informed, receptive, and sympathetic to our issues than in the past.

Just before Neurology on the Hill, legislation was introduced in both the House and the Senate to add neurology to the Medicaid “bump” provision of the Affordable Care Act. The Enhanced Access to Medicaid Services Act will fix the inequity created by that landmark legislation. When we were on the Hill, we sought co–sponsors to the legislation, which is sponsored by Sens. Amy Klobuchar (D–MN) and Susan Collin (R–ME), and was introduced in the House by Reps. Steve Stivers (R–OH) and Jim Moran (D–VA).

I can assure you that the AAN will continue to advocate strongly for legislative solutions that restructure the physician payment system to value all neurology services more appropriately.

Sustainable Growth Rate

The AAN continues to advocate for the elimination of the SGR formula by emphasizing the crisis in accessing medical care that would result from implementation of the draconian cuts physicians face annually. We made significant headway last year with a bill championed by Reps. Joe Heck, DO, (R–NV) and Allyson Schwartz (D–PA) and others, but Congress did not pass it.

This year may be different, however, as the estimated cost of fixing SGR has declined dramatically. The Academy recently submitted a second round of comments regarding a draft plan by the House Energy & Commerce and Ways & Means Committees to replace the SGR formula permanently and provide fixed payment rates for some as yet to–be–determined period. Subsequently, the health care system would shift from the current fee–for–service model to one that rewards physicians for quality care. After a number of years, the plan would give bonus payments to doctors who deliver efficient high–quality care.

If we can achieve this, it would be a monumental victory for neurologists and all other physicians. The key, though, is that Congress must swallow the $130 billion cost to fix this disastrous law. However, as reforms to our health care system and entitlements such as Medicare and Medicaid overlap, it’s imperative that the needs of our patients remain foremost in mind.

Other Major Issues

Our advocacy efforts go beyond lobbying Congress. Since we were made aware of the drastic cuts to NCS, EEG, and IOM late last year, we have met several times with representatives from the Centers for Medicare & Medicaid Services (CMS) to explain how damaging these cuts are to neurologists. We have urged CMS to take action to reverse these decisions and help protect fair reimbursement for these services.

As heartened as we are about the Obama administration’s new BRAIN Initiative, we are disturbed by the sequestration cuts that are indiscriminant and jeopardize such important institutions as the National Institutes of Health. Advances in biomedical research are one of the achievements Americans should be most proud of. The Academy will continue to work vigorously with its coalition partners to advocate for long–term solutions that provide increased and stable funding for the NIH. For our part, we are doing more than ever to support research through our American Brain Foundation, which is dedicated to curing brain disease and educating the public about neurologic disorders. I hope you will give generously when asked and encourage others to do the same.

What You Must Do

As proud as I am of the hard work of those 138 neurologists who were able to join together in Washington, they are a tiny minority of the AAN’s 22,000 US members. Last year 3,700 members responded to our Action Alerts and contacted their legislators, and nearly 200 members participated in Neurology on the Hill and the Palatucci Advocacy Leadership Forum. In 2012, BrainPAC set a record in total donations and the number of new donors.

But there is clearly so much more we have to do. And we can only do it with your help. We know that reimbursement cuts have been painful. We know the frustrating uncertainty of annual threats to our practices by SGR cuts. However, change is rarely radical or sweeping. It is almost always incremental, sometimes maddeningly so. But it can happen more quickly if all 22,000 of us join in the Academy’s advocacy efforts on behalf of our profession and our patients. Our future is ultimately in no one’s hands but our own. This is our obligation and our responsibility.

Timothy A. Pedley, MD, FAAN
President, AAN