Advocacy Issues in Behavioral Neurology

January 20, 2010

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By Glen R. Finney, MD, AAN.com Advocacy Editor

In 2009, every section of the American Academy of Neurology was to submit a strategic plan, which specifically included legislative issues faced by the members of that section. This is the first of several articles highlighting the challenges facing AAN sections. Behavioral neurology has identified several areas of advocacy interest, but at the heart of this discussion lies the issue faced by the entire field of neurology: preservation of the ability to provide cognitive services to our patients.

Brain-behavior relations are the essence of behavioral neurology—and of neurology as a whole—going as far back as the nineteenth century. The unique role of behavioral neurology is difficult to grasp for those unfamiliar with the field. As part of the 2009 Behavioral Neurology Strategic Plan, behavioral neurologists identified issues facing the field.

Safeguard Access to Behavioral Neurology

The most important issue for behavioral neurologists is preserving our ability to spend time with our patients. Higher cortical function assessment takes time. We need improvement of Medicare and Medicaid reimbursement for cognitive services. We must watch that mental health parity is properly implemented for the care of behavioral neurology patients. Possible innovations to safeguard access to behavioral neurology include such ideas as specific behavioral neurology exemptions from "hold harmless" clauses, or placing behavioral neurology in a same-day service category akin to geriatric psychiatry. The inclusion of behavioral neurologists in psychiatric diseases with a neurologic base (e.g., ADHD, Tourette's, etc.) and developmental disorders that impact higher cortical function (e.g., autism, Down syndrome, etc.) should also be safeguarded.

Safeguard Quality of Behavioral Neurology

All behavioral neurologists strive to provide the best quality care to their patients, and it is important that behavioral neurology leads the way in quality innovation. Quality measures for behavioral neurology must be generated from research-specific to behavioral neurology, not generalizations from other fields. We should foster smart implementation of health information technology (HIT), so that it supports rather than stifles the richness of behavioral neurology assessment. Comprehensive medical malpractice reform is needed in order to change the emphasis from medico-legal defense to systematic analysis and reform, which will help prevent medical errors.

Safeguard Access to Treatments for Behavioral Neurology Patients

Formulary access for newer medications enhances the treatment of cognitive problems, especially where new medications cause fewer cognitive side effects. Methods to reduce the cost of drugs for patients must be safe. We need better options for support of home health care and long-term health care for cognitively disabled patients.

Advance Behavioral Neurology Research

We need increased funding for innovative research in neurologic diseases with an impact on higher cortical function, both at the NIH (especially NINDS, NIA, and NIMH) and the VA. There is also a specific need for more research into cognitive rehabilitation. We also need to maintain and consider expanding Medicare coverage for some health costs during research, which will make the process more practical.

Improve Access to Behavioral Neurology Diagnostics

While the heart of behavioral neurology remains cognitive service, new diagnostics complement the classic approach. We need to insure reimbursement for neuroimaging and neurophysiological studies of the brain, both structural and especially functional studies (e.g., fMRI, evoked potential, transcranial magnetic stimulation, etc.) when appropriately ordered by behavioral neurologists. We need access to coverage for new diagnostic tests, such as biomarkers when they become viable for clinical use. And we need to make certain that there is both covered access and non-discrimination for genetic testing for behavioral neurology disorders.

Behavioral Neurology Advocacy—What You Can Do

Volunteer for Academy advocacy activities: When you receive an Academy Grassroots Advocacy Action Alert on your email, take a few minutes to answer. If you miss one, you can always go online through Vocus. Attend Neurology on the Hill, and show Capitol Hill you care. Apply for advocacy training through the Academy's Palatucci Advocacy Leadership Forum. Take a year to be the next Viste Public Policy Fellow.

Educate lawmakers: Teach about behavioral neurology in every encounter, and explain why it is both special and valuable

Support neurology-patient advocacy coalitions: Examples of such coalitions include the Florida NeuroAlliance, and the Michigan Dementia Coalition.

Keep the behavioral neurology section informed: Become an active participant on the behavioral neurology section list serve and keep your leadership and fellow members informed about the legislative issues you encounter, and attend the behavioral neurology section meetings at the Annual Meeting to speak about advocacy important to behavioral neurology.

Help behavioral neurology provide information to the Academy: Regularly comment and provide supporting information to the behavioral neurology section relevant to Academy legislative initiatives impacting behavioral neurology.

Many of the issues and methods for success in behavioral neurology advocacy are those of neurology as a whole, but as one of the fields at the heart of neurologic tradition, behavioral neurology feels these shared needs poignantly. It is the hope of behavioral neurology that all neurologists will join us in our mission to advocate for the preservation of neurology in the twenty-first century.

Author Disclosure

Within the past five years, Dr. Finney has received research support from Novartis for his work as site principal investigator for a study of the Exelon patch in Alzheimer's disease participants.