Capitol Hill Report: So What's Going On? Or, How Do I Find $311 Billion?

May 11, 2009


By Mike Amery, Legislative Counsel, Federal Affairs, (202) 349-4299,

The mission of the Academy is to be "indispensable to its members." One way the Academy fulfills this mission is by representing of neurology in the halls of Congress. Capitol Hill Report presents regular updates on legislative action and how the AAN ensures that the voice of neurology is heard on Capitol Hill. The Academy's legislative counsel in Washington, DC, Mike Amery, offers weekly updates on advocacy for neurology and neurologic concerns.

"So what's going on, what are we doing?" This was the question (a joke?) House Energy & Commerce Health Subcommittee Chair Frank Pallone (D-NJ) asked earlier this week when I—along with some other specialty medicine groups—met with him and his staff. Fortunately, as someone at the top of the action on health reform, he has more of an understanding than he let on, but his point was clear: health reform is a large, difficult question.

The biggest problem continues to be the Medicare physician payment system, or Sustainable Growth Rate (SGR) formula. The SGR—as it currently stands—would cause physician payment to be cut 21 percent next year. Everyone wants to avoid that, and it continues to be the top priority of all specialties and the AMA. But the Office of Management and Budget just released figures showing that the cost of fixing the SGR is now $311 billion over 10 years.

Pallone is right to ask, what can Congress do when it faces a problem this big?

A step was taken this week by the Senate Finance Committee, which released the document "Description of Policy Options. Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs." Among many suggestions is a five percent increase for some Primary Care CPT Codes at the expense of other specialties. This drew some opposition from 88 House members, who called for removal of the budget neutral rules for health care reform by opposing efforts to take from one specialty to give to others. The Berkley-Kirk letter can be read here.

The Academy weighed in this week by suggesting a bonus system for certain patients, many with neurological conditions, that would encourage physicians to provide these patients with high quality care and lower costs through reduction in duplicative or unnecessary care. We are working closely with staff from the Senate Finance Committee and the House Energy & Commerce Committee to hash out an idea that would bridge the gap between today and three to five years of demonstration programs designed to provide innovative payment systems for physicians. More details to come.

The timelines remain the same. Key congressional committees have goals of coming to agreement in committees by July 4 and have bills passed through Congress by August. Stay tuned!

Read all of Mike Amery's reports on the Capitol Hill Report page.