Neurologists Advocate on Capitol Hill

March 7, 2010

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

Updated on March 11, 2010

Neurology on the Hill is the Academy's yearly advocacy event, where more than 100 neurologists visit congressional offices to educate lawmakers on the importance of neurology and the ways legislation impacts our ability to care for our patients. As your Advocacy Editor, I will be reporting daily from the event. —Glen R. Finney, MD, AAN.com Advocacy Editor

Part III: Neurologists Take Capitol Hill

Breakfasting with Congress

Posted on March 11, 2010

The neurologists rose before 7:00 a.m. to catch the Metro to Capitol Hill, where we had an early breakfast in a Senate committee chamber and heard talks from three members of Congress. The first speaker was Representative Michael Burgess, MD, an obstetrician from Texas who was the only Republican to vote for a permanent repeal to the Sustainable Growth Rate (SGR). He noted the impressive number of neurologists assembled for this event.

Representative Michael Burgess, MD, meets with NOH attendees.

The second speaker was Democratic Senator Amy Klobuchar of Minnesota, author of the Senate amendment to add neurology to the fields of medicine eligible for the primary care benefit in the Senate health care reform bill. The final speaker was Senator Mike Enzi of Wyoming, the ranking Republican on the Senate Committee on Health, Education, Labor, and Pensions (HELP). Senator Enzi noted in his talk that one of his important advisors on health information technology was Wyoming neurologist Allen Gee, MD, PhD, a member of the Academy's Government Relations Committee.

Storming the Halls of Congress

After breakfast, the neurologist advocates used their training by visiting congressional offices, meeting key health care staff and sometimes members of Congress. Congressional staff help members of Congress keep track of the thousands of issues that come before them, so it is important for neurologists to be able to educate them on our role in health care. Many staff members are just out of college and may not have had much personal experience with neurology and neurologists. Neurology on the Hill had two key issues this year:

  • Include neurologists in the primary care bonus in health care reform
  • Permanently fix the SGR

Neurology Forgotten!

Neurology advocates informed staff that neurology is not a procedure-oriented specialty, with up to 60 percent of the average neurologist's work consisting of talking with and examining patients. We also noted that subspecialties of internal medicine would qualify for the primary care bonus, but that neurology was not a part of internal medicine—a misunderstanding we encountered at several stops in our Washington, DC, visit. We also informed them of the several patient advocacy groups who support our inclusion and are concerned about their ability to find neurologists in the future.

Physicians Already 'Bend the Curve'

Neurologists noted too that there has been no significant raise in physician reimbursement since 2001, while the rest of health care costs have grown at a high rate. In this way, physicians have essentially 'bent the curve' on health care costs. Every year since the SGR's inception, Congress has had to pass legislation to keep our reimbursement as-is, rather than allowing it to decline. Every office I met with acknowledged that it is past time for a permanent fix, but no one knew how that would happen.

Marisa Prego-Lopez, MD, Glen Finney, MD, and Chut Sombutmai, DO, discuss neurology's federal issues with Tom Power from Rep. Cliff Stearns' office.

At the End of the Day

Our own Florida contingent met with the staff of six Representatives, five of whom were available thanks to members of our group being from their district, and another who was gracious enough to hear us when we just dropped by. We left behind Academy materials on the critical role of the neurologist in health care and our key issues at four additional offices. We also met staff of our two Florida Senators. At the end of the day we were physically exhausted, but proud of having shown up to have our voices heard on Capitol Hill.


Part II: Neurologists Learn Advocacy in DC

Neurology on the Hill Convenes

Posted on March 9, 2010

Over 100 neurologists assembled today to train for legislative visits to Congress. We sat at tables by state. At my table were six of us from Florida, five of whom are new to visiting Congressional offices. Glenn I. Kolluri, MD, is a stroke neurologist from the New Smyrna Beach area who had heard about Neurology on the Hill through an Academy email. He was motivated to participate because of the lack of neurology coverage available to patients in Volusia County, FL. Marisa Prego-Lopez, MD, is a solo practice neurologist from Fort Lauderdale, FL, who has experience in advocacy, but this is her first time advocating with the Academy. There are two from Mayo Clinic Jacksonville (in fact, there were three people from Mayo Jacksonville, but one was with the Georgia contingent): Brittany Dugger, MS, is a Ph.D. candidate in neuropathology from Mayo Jacksonville, and Megan R. Rahmlow, MD, is a senior neurology resident and member of the Florida Society of Neurology board of directors from Mayo. Chut Sombutmai, DO, is a senior neurology resident from University of Florida at Jacksonville.

Introduction to Neurology Advocacy

The program started with a welcome from Government Relations Committee co-chairs Elaine C. Jones, MD, FAAN, and Laurence J. Kinsella, MD, FAAN. Bruce Sigsbee, MD, FAAN, AAN president elect, gave an introduction about the importance of advocacy on Capitol Hill. Academy Legislative Counsel Mike Amery, Esq., followed with an overview of the current state of health care reform and the key issues for neurology.

Neurologists Ask for Inclusion in Care Bonus

The main issue for Neurology on the Hill 2010 is the exclusion of neurologists from the "primary care" bonus, despite this bonus being available to subspecialties of Internal Medicine. Neurology has managed to get bipartisan sponsored amendments at a time when bipartisanship is rare, as well as support from patient advocacy groups for Alzheimer's disease, Parkinson's disease, Multiple Sclerosis, just to name a few. Given the linear, positive correlation reported in JAMA  (September 10, 2008; 300: 1131-1132.) between physician earnings and the percent of US graduates in residency, keeping neurology reimbursement in line with others is a matter of survival for our specialty.

We Need a Permanent Fix to SGR!

This year, neurologists will inform Congress that the time has come for a permanent fix to the unsustainable Sustainable Growth Rate (SGR). This formula bases physician reimbursement on the Gross Domestic Product. No other part of health care is held to this standard. The SGR has never been put into practice. Every year Congress passes a patch to this formula so that physicians' payments do notdecline, but there has been no significant increase in physician reimbursement since 2001. While others talk about "bending the curve" to curb the cost of health care, physicians have been doing it for a decade. The Academy will emphasize to Congress that it is past time to pass a permanent fix to the SGR.

Advocacy Training Begins

The first exercise of the day paired neurologists  to tell short stories in layperson's terms about a patient whose life they had helped in the past month. The goal was to provide a clear and concise personal story that explains the importance of neurologists in providing care to patients.

Formal Arguments versus Personal Stories

In the next demonstration,  two neurologists new to Neurology on the Hill presented two different types of supporting evidence for our positions: the formal argument and the local story. While having the facts right is important, it is often the personal story that makes the greater impact on Capitol Hill.

The House Wants to Make You Happy, But . . . .

This is a mid-term election year. Every member of the House of Representatives is running for reelection. There are fewer voters than in a presidential election year. These factors make advocates who care enough about policy to come to Washington, DC, even more important. However, we are also in a major economic crisis, and there are many competing concerns fighting for support from Congress.


Part I: Dr. Finney Goes to Washington

The Academy Goes to Congress

Posted on March 8, 2010

Since its inauguration in 2003, the Academy's Neurology on the Hill has brought neurologists to Congress every year, to advocate for issues vital to the survival and improvement of neurologic care in America. The first event took place in June of that year, with 30 neurologists visiting Capitol Hill as advocates for neurology.

I first learned of Neurology on the Hill as a senior resident. I volunteered for this important effort, willing to pay for travel out of my own pocket. Fortunately, nearly all expenses are covered: those in residency programs or DC residents pay only $50, and all others pay $100.

Neurology on the Hill Grows

In 2007, Neurology on the Hill moved to March to coincide with an Academy's leadership conference. This both increased the number of Congressional offices visited and introduced the program to leaders in neurology. The move to March made neurology advocates more effective, as we were able to educate lawmakers earlier in the year when more changes could be made to the progress of legislation.

Last year, the Academy increased the number of neurologists at Neurology on the Hill to over 100. You can view this year's slate of attendees here.

Reporting Advocacy in 2010

Neurology on the Hill 2010 takes place on March 8 and 9. The Academy continues its efforts to educate Congress about the critical role of neurologists in health care, and to make certain that neurology is heard in the debate on health care reform. As your AAN.com Advocacy Editor, I will be providing daily blog updates on the event on AAN.com to track the latest updates from Capitol Hill.

Author Disclosure

Within the past year Dr. Finney received research support from Novartis, for work conduced as a Site Principal Investigator for a study of the Exelon patch in Alzheimer's disease participants. He serves as Associate Editor for Advocacy on AAN.com.