Capitol Hill Report: Department of Defense Saves Physicians?

Payment Cut Delayed—Reform Still Up In the Air

January 5, 2010


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.

Just before Christmas, the Senate passed the FY 2010 Department of Defense Appropriations bill. This legislation included a House-drafted provision to delay the scheduled 21 percent Medicare reimbursement cut for physicians by two months. This gives the physician community a little more time to work on a permanent solution for replacing the flawed Sustainable Growth Rate (SGR) formula. Leadership on both sides of the Hill pledged to fix the problem as part of an overall health reform effort—but don't hold your breath.

Although both the House and Senate have passed Health Reform bills (without a physician fix), the language of the two bills remains far apart on a number of key issues, and both legislators and interest groups have begun digging in their heels.

Medicaid Expansion

An interesting development over the holidays was the threat by 13 Republican state attorneys general to file suit over a provision in the Senate health reform bill that grants Nebraska increased funding for the cost of the proposed Medicaid expansion. The provision was added in order to secure the support of Sen. Ben Nelson (D-NE). South Carolina Attorney General Henry McMaster (R) called the deal resulting from Nelson's voting for health reform, in exchange for the federal government picking up the cost of Medicaid expansion in Nebraska, the "Cornhusker Kickback."

Abortion Language

According to the Washington Post, House Democrats Bart Stupak (D-MI) and Diana DeGette (D-CO) have said that disputes over abortion language in a final reform bill could result in a number of lawmakers changing their vote on the legislation. Stupak, who introduced an amendment to the House bill (HR 3962) that would prohibit insurance plans participating in the exchange from offering abortion coverage except in cases of rape, incest or to save the life of the woman, said he expects 10 to 12 other Democrats to vote against final health reform legislation if language regarding abortion coverage under federally subsidized insurance plans from the Senate bill (HR 3590) is included. Meanwhile, DeGette, co-chair of the Congressional Pro-Choice Caucus, stated that 42 House members have pledged to vote against any legislation that "goes beyond existing law."

Neurology Amendment

The AAN worked over the holidays to craft a strategy with staff from both Sen. Amy Klobuchar (D-MN) and Rep. Ed Perlmutter (D-CO) office's to include neurology as part of the House/Senate Conference Committee work on the primary care bonus, which was discussed in earlier posts. We are fortunate to have several members of Congress advocating on behave of patients with neurologic conditions.

Consult Codes and the Practice Expense Survey

Congress took no action on two issues of interest to neurology in the last days before leaving for the holidays. The Center for Medicare and Medicaid Services (CMS) plan to eliminate consult codes will be implemented. Learn more about the impact of this decision.

CMS will also implement the new Practice Expense Survey, which increases reimbursement for neurology. In December, along with representatives from several specialties, I met with staff from more than 20 members of Congress to advocate for implementation of the survey which cost more than $2 million and was paid for by the AMA and specialties like AAN. The American College of Cardiology (ACC), whose members will see a decrease, had been advocating for congressional action to prevent the survey data from being used and Rep. Charlie Gonzales (D-TX) introduced HR 4371 to keep cardiology at 2009 rates. When the Gonzales bill was not included in the health reform bills, ACC filed a complaint, as well as motions for a preliminary injunction and expedited discovery, against Health and Human Services (HHS) Secretary Kathleen Sebelius in US District Court in Florida. The complaint alleges that Sebelius, in her capacity as HHS secretary, unlawfully adopted the payment rates for cardiology services in the 2010 Medicare Physician Fee Schedule. The AAN will continue to oppose any efforts to overturn the survey, in which many specialties participated.

Read the Academy's response to the Gonzales legislation.