Capitol Hill Report: Anxiously Awaiting a Bill

July 13, 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.

Last week I worked with Chris Dawe, who is responsible for physician issues as a majority staff member of the Senate Finance Committee, to include neurology in the list of physicians eligible for bonuses for providing evaluation and management (E/M) services. So far, the Senate bill is set to include these bonuses for Primary Care, Internal Medicine, Geriatrics, and Pediatrics, as long as an individual physician provides more than 60 percent E/M.

Dawe indicated that he supports adding neurology to the list, and I believe he sent the issue to the Congressional Budget Office to get a score (i.e., cost figure). I have also met with minority staff, who also seem supportive of including neurology. The Senate Finance Committee is expected to release a health reform draft bill any day now, and we are hopeful it will include some good news for neurology.

A few weeks ago I mentioned that a fiscally conservative group of House Democrats, known as the "Blue Dog Coalition," might hold the keys to whether health care reform moves forward in the House. This week, the Blue Dogs flexed their muscles with a letter to House Speaker Nancy Pelosi. This resulted in House leaders delaying plans to release health reform legislation for markup, after 40 members of the Blue Dogs demanded that health reform legislation do more to rein in costs. The letter states the group believes the House bill "lacks a number of elements essential to preserving what works and fixing what is broken" in the US health system.

The letter also states the reform bill "must start with finding savings within the current delivery system and maximizing the value of our health care dollar before we pay more." The Blue Dogs' greatest opposition was directed at proposals for a new public plan to use Medicare reimbursement rates, Roll Call reports.

Rep. Mike Ross (D-AR), the group's chair, said, "We cannot accept a public plan based on Medicare rates," adding that those levels would be too low in many geographic areas. He said, "We are losing doctors," adding, "We could give people a real shiny insurance card but that's not going to matter if they don't have access." (Blue Dogs' Objections Could Delay Release of Health Care Bill, Roll Call, July 9)

Among the several meetings I had last week to promote the Academy's effort to focus on patients, was a meeting with Sen. Debbie Stabenow (D-MI), who is a member of the Senate Finance Committee. Sen. Stabenow has been a long time supporter of eliminating the physician reimbursement problem, known as the Sustainable Growth Rate formula or "SGR."

The key message I got from our meeting was her discouragement that current plans do not call for an elimination of the SGR, only temporary fixes that physicians have endured for several years. However, the House Tri-Committee bill does call for its elimination. So, assuming bills eventually pass both the House and Senate, the Academy will work to include neurology in any bonus system provided to E/M physicians, as well as work to completely eliminate the SGR, which currently calls for a physician reimbursement cut of 21 percent on January 1, 2010.

The goal of both the House and Senate is to have health reform bills ready by the August recess. As the rest of us anxiously wait, that timeline continues to slip on a daily basis.

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