Capitol Hill Report: AAN Presents Payment Reform Plan to Congressional Leaders

May 6, 2011

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

Last month, I met with top Republican staff and a few other medical specialties to discuss options for reforming Medicare's flawed Sustainable Growth Rate Formula (SGR) and eliminate the pending 29.5 percent cut scheduled for January 1, 2012. As a result, after taking extensive input from AAN members including the Academy's Leadership, Government Relations Committee, and Medical Economics and Management Committee, the AAN submitted comments to the House Energy & Commerce Committee .

The Academy's position is controversial as it calls for a complete restructuring of the Medicare payment system in a way that would provide much greater emphasis on cognitive care for Medicare patients. If implemented, it would redraw the lines for discussion from the current standard of "primary care vs. specialty care" to "cognitive care vs. procedural care."

Several other medical specialties are interested in this concept, including representatives of infectious disease, rheumatology, and endocrinology. We have been on Capitol Hill with these organizations discussing the elimination of consult codes by CMS with congressional offices and are now in discussions with each about how to increase awareness and support of cognitive specialties.

House Hearing Discusses Replacement Options for SGR

The Academy's response came in advance of a May 5 hearing by the House Energy & Commerce Committee's Health Subcommittee on "The Need to Move Beyond SGR". With the new Congress in place there are now four physicians on the subcommittee, so the understanding of physician issues, and particularly the SGR, is high.

Although little was said about potential solutions for the huge financial implications of a full repeal ($330 billion over ten years at the latest Congressional Budget Office predictions), it was clear that members of Congress on both sides of the aisle are supportive of eliminating the SGR. The Academy's letter was recognized and placed into the record of the committee hearing and an AAN member was one of the physicians asked to testify. Todd Williamson, MD, a practicing neurologist from Lawrenceville, GA, testified as a spokesman for the Coalition of State Medical and National Specialty Societies. Williamson is a former president of the Georgia Medical Association and spoke in favor of a bill that would open up contracting between physicians and Medicare beneficiaries, known as the Medicare Patient Empowerment Act, HR 1700. Williamson's testimony can be found on the Energy & Commerce website.

Medical Malpractice Reform Progress?

For many years the hopes of federal tort reform have been dashed on the rocks of the US Senate, but the waters may be getting a little smoother. It started during the health care debate in 2010, when the Congressional Budget Office scored the savings from a medical malpractice liability reform provision at $54 billion over ten years. This effort got another significant bump when President Obama expressed his interest during his State of the Union address last January. Last week, House Financial Services Committee Ranking Member Barney Frank (D-MA) stated that:

"I also am ready, as a liberal, to look at the whole question of malpractice and liability reform. People who are injured ought to be compensated, but I do think that that's something that I would throw in if we had an otherwise overall compromise [on the national debt], because I recognize everybody's got to give something to get this."

The House will likely pass the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (HR. 5), a bill sponsored by Rep. Phil Gingery, MD, (R-GA) that would take dramatic steps to reform malpractice policies. We also are tracking similar legislation in the Senate. The Academy sent a letter of support for HR. 5 earlier this year and sent an action alert out last week asking members to contact their members of Congress to sign on as supporters.

Although federal tort reform remains an uphill climb, we are making progress. This issue will remain a top priority for the AAN until it is adequately addressed by Congress. If you haven't already, please contact your members of Congress today and let them know that you support HR. 5.