Capitol Hill Report: Neurology Incentive Bill Introduced in Senate; Top Republican Leaders Ask AAN To Meet On Medicare Reimbursement

March 18, 2011

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By Mike Amery, Legislative Counsel, Federal Affairs, (202) 506-7468, mamery@aan.com

Neurology Bill Introduced in the Senate

At the request of the Academy, Senators Amy Klobuchar (D-MN) and Susan Collins (R-ME) have introduced S. 597 to add neurology to the list of physicians eligible for the primary care incentive in the Affordable Care Act (ACA), the health reform bill that was enacted into law last year.

The primary care incentive is a 10 percent bonus for eligible physicians, including subspecialties of internal medicine, who provide at least 60 percent of their services to Medicare patients under evaluation and management codes. The average neurologist meets the 60 percent threshold, but many in Congress either forgot neurology or thought it was a subspecialty of internal medicine!

This has been a top priority of the Academy since neurology's omission from the bill and we have worked closely with the senators to introduce this bill. For a detailed look at what happened during debate of the ACA please see Capitol Hill Report from April 2, 2010.

The Klobuchar/Collins bill mirrors a bipartisan amendment that was offered to the ACA during Senate debate but was not considered because it did not have a cost analysis from the Congressional Budget Office (CBO). After intensive advocacy work by the AAN, last summer the CBO scored the provision at $300 million over 10 years.

The next step for the Academy is to build Senate support. Please contact your senators and ask them to cosponsor S. 597 by accessing the Academy's online advocacy program. If you are from Minnesota or Maine, please be sure to thank Sens. Klobuchar and Collins!

AAN Meets With House Leadership to Prevent 29.5 Percent Medicare Reimbursement Cut

The Academy was invited to a meeting in House Speaker John Boehner's (R-OH) Capitol office last Friday. Along with a few select medical specialties and an AMA lobbyist, I met with top health staff from the House Republican leadership and the two key committees of jurisdiction, Ways & Means and Energy & Commerce about looming Medicare reimbursement cuts should the Sustainable Growth Rate (SGR) formula go into effect.

The Congressional staff asked us to offer a list of suggestions for cutting growth in spending and preserving access to care. The Academy's Government Relations Committee (GRC) and Medical Economics and Management (MEM) Committee have been compiling ideas and will be responding. I would also encourage members to login to the Advocacy Section of the AAN Communities to share your ideas on fixing SGR.

The meeting was labeled by Republican staff as the first of many to work with us on finding a permanent solution to the SGR. The problem is daunting, but the fact that the AAN was invited to this meeting is quite significant. When I moved from AAN headquarters in St. Paul to open the DC office in 2005, I would only hear about these high level policy meetings other specialties were participating in. It has taken some time, but the increased efforts of members' e-mails to Congress, onsite interactions such as Neurology on the Hill, and the use of BrainPAC are paying off.

SGR Cut Looms Larger

The Department of Health and Human Services announced that the cut in physicians' pay will be 29.5 percent on January 1, 2012, unless Congress makes a fix. The current cost of a permanent fix is $330 billion over 10 years according to the Congressional Budget Office.

On the very same day that news of the 29.5 percent cut was announced, the Academy joined 130 state and medical specialty societies in sending a letter to the House and Senate asking for a fix and pledging to lead efforts in "developing and pilot testing payment and delivery reforms that can provide a foundation" to replace the flawed formula.

AAN Meets With Minority Leadership

I had the pleasure of meeting with House Minority Whip Steny Hoyer (D-MD) for the first time since Republicans took control of the House. Meeting with Hoyer is always a treat as he is one of the most politically savvy politicos in America.

With a grin on his face, he described his new position as a "minority stockholder after a hostile takeover" after losing the majority held by Democrats in the house. But he also mentioned that new Speaker Boehner has been gracious and fair and quite good to work with. Hoyer compared the new Congress much more favorably to the situation in 1994 when Republicans also took the House majority.

Hoyer said he has sat down with the Republican leadership and hopes that over the next 12 months they can come to agreements just as President Reagan did with House Speaker Tip O'Neill (D-MA) during the 1986 restructuring of the tax code, when Reagan and O'Neill were literally on the phone with each other as each released their agreement so that neither side could get a leg up on bashing the other for a compromise. Hoyer said he is working to get to the same place.

National MS Society Advocates for Neurologists

More than 300 advocates for the National MS Society (NMSS) went to Capitol Hill for their annual advocacy day on March 9. Just as AAN advocates brought the issue of the primary care incentive to the Capitol on March 1, NMSS did the same. For the first time in my 10 years at the Academy, a patient group has taken a neurology physician issue right up to Congress.

Before they went to the Hill, I had the pleasure of joining AAN GRC and BrainPAC Executive Committee member Lily Jung Henson, MD, FAAN, in addressing the group on the specifics. We were also joined by MS advocate and patient Rob Engel as we discussed the interaction between MS patients, neurologists, and efforts to encourage Congress to recognize the needs of cognitive care physicians.

And it is working!

Dr. Jung Henson sent me a message at the conclusion of her day: "I have to tell you something really cool from today. I was riding the shuttle back from the Capitol and the MS folks from New Jersey and Oregon told me that all eight congressional offices they went to today, when they brought up the primary care bonus, they were told that "oh yeah the neurologists were here last week." All eight! We made a real impact!"

imgage of lily jung henson, us senator Maria Cantwell and others

Picture of Lily Jung Henson, MD, FAAN, (second from the left) with US Senator Maria Cantwell (D-WA) (middle) and other NMSS advocates including AAN member Eugene May, MD, (right).

I can't thank enough Dr. Jung Henson and every Academy member working to raise this and other issues in Congress. Every day, members of Congress and their staffs become more aware of the needs of cognitive specialists like neurologists. Just take a look at the video of Congressman Russ Carnahan (D-MO) and House Majority Leader Eric Cantor (R-VA) as they address Neurology on the Hill. And now with patient advocates making the same case, our argument is becoming even more powerful.