Capitol Hill Report: Senate Finance Bill - No Permanent SGR Fix, No Bonuses Yet for Neurology

September 21, 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.

After months of wrangling, Senate Finance Committee Chair Max Baucus (D-MT) finally released a health reform draft last week. The bill lacks many of the solutions physicians, including neurologists, have been seeking to improve the practice of medicine for physicians and patients. The most glaring omission is the failure to provide a permanent fix to the Sustainable Growth Rate formula, which calls for cuts in Medicare reimbursement to physicians each year. The bill continues the policy of providing inadequate increases (.5 percent for 2010) in exchange for delaying cuts into the future.

The bill does provide a bonus for primary care providers, but at the last minute the provision to include neurology in the list of eligible providers was deleted. The Academy is working several angles trying to get neurology added as an amendment, since fairness for those providing high percentages on E/M should not be dictated by the specialty a physician declares, but rather by the services the physician provides to patients. If we are not successful at the committee stage, we feel confident that we can add an amendment on the Senate floor, once the bill makes it out of committee.

The bill will be marked up in the full Finance Committee this week, but it moves forward with no support from Republicans, and it also lacks the support of some committee Democrats because it does not include a public insurance option.

On a more positive note, tort reform is being talked about with real action for the first time in many years. President Obama on Thursday announced that he is moving forward with a $25 million program aimed at curbing costly medical malpractice lawsuits. Under the program, the federal government will provide states and health systems with grants to experiment with new approaches to medical liability. Federal officials will then try to find innovative ways to improve physician practices, thereby reducing costly and dangerous medical mistakes. ("Obama to Speed Up Tort Reform Tests, but Doctors Want More," Washington Post, September 18, 2009)

When announcing the program, Health and Human Services Secretary Kathleen Sebelius said that applications will be posted on the Web site within 30 days. Applicants will then have 60 days to apply for either one-year grants worth as much as $300,000 for state and local government and medical organizations, or implementation grants for demonstration projects that are ready to be implemented. Sebelius said that the grant applications will be peer reviewed and that the awardees will be announced in early 2010 ("HHS Plans Grants to Lower Malpractice Premiums," Jonathan Weisman, September 17, 2009, The Wall Street Journal). The grants will be offered at a maximum of $3 million each for three years ("White House seeks ways to curb malpractice suits, " September 17, 2009, AP/Google News).

It is encouraging to see efforts on liability reform moving, even if we are not yet at the stage of setting caps on damages, an arrangement that has been so successful in states like Texas ("Texas Medical Malpractice Reforms Result In Landmark Wins for Physicians and Patients, States PIAA," September 12, 2009, Business Wire).

Lastly, the Academy was successful in passing a resolution in the Senate designating September 2009 as Atrial Fibrillation Awareness month. The resolution was a bipartisan effort by Senators Russ Feingold (D-WI) and Susan Collins (R-ME). Sen. Collins agreed to introduce the resolution at the request of AAN President-elect Bruce Sigsbee, MD, FAAN, of Maine. The Academy is working with a coalition of interested groups to sign on House members to a companion resolution before the end of September.

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