Capitol Hill Report: AAN Success with MedPAC

July 7, 2011


By Mike Amery, Legislative Counsel, Federal Affairs, (202) 506-7468,

MedPAC Recognizes Cognitive Care

Over the last year, the Academy has spent a great deal of time trying to influence the Medicare Payment Advisory Commission (MedPAC), a relatively unknown independent congressional agency that advises Congress on issues affecting the Medicare program. For better or worse, the recommendations MedPAC releases several times a year carry a lot of weight on Capitol Hill. It is now clear that the AAN's advocacy efforts with MedPAC are paying off.

Language was included in MedPAC's June 2011 Report that clearly benefit neurology, as well as other cognitive specialties. The report commented that in the near future the commission will consider suggestions to:

Realign payments for physician and other health professionals to help ensure an adequate supply of practitioners in cognitive (nonprocedural) specialties who focus on managing patients with chronic conditions.

This comment was the result of several meetings between the Academy and MedPAC, including recent consultations with AAN President Bruce Sigsbee, MD, FAAN, and another with Marc Raphaelson, MD, who serves as AAN's representative to the American Medical Association's Relative Value Committee (RUC).

We hope to build our future advocacy efforts on this language as do other cognitive specialists such as rheumatology, infectious disease, endocrinology, and neuro-ophthalmology. In response to this report, the Academy issued a press release and sent a letter to MedPAC to renew discussions.

AAN Helps Block Unrelated Imaging Cuts

It is important to pay attention in Washington; you never know what type of issue will be attached to another.

Take the South Korean free-trade bill (S 1286) considered in the Senate last week. Congressional rules require new legislation with a cost to be offset by either cuts in other programs or generating new revenues. The proposed trade bill has a cost associated with it so some senators turned to imaging cuts, deciding to increase the imaging equipment utilization rate to 90 percent, which would pay for millions of the trade agreement's projected cost.

The AAN quickly responded and joined several other health specialties to protest using health care related funds to pay for a completely unrelated trade agreement. Our voice was heard and the Senate has backed down…for now.

Discussions about budget priorities must certainly take place, but we will be vigilant in protecting health care dollars by making sure they aren't used to pay for unrelated issues.

House Bill Would Add Neurology and Others to the Primary Care Incentive

Freshman Rep. Michael Grimm (R-NY) has introduced the Improving Physician Access in Teaching Hospitals (PATH) Act of 2011, (HR 2224) that would add neurology and other specialties designated by the Secretary of Health and Human Services to the primary care incentive of the Affordable Care Act (ACA). It is part of a larger bill primarily dealing with increasing graduate medical education (GME) positions, but the provision addressing neurology's exclusion from the primary care incentive came at the request of the AAN and the National Multiple Sclerosis Society. The bill has 10 bipartisan cosponsors, all from New York.

Although the cost of this bill is not yet known, we expect it will be very high due to the GME changes. The Academy will be sending a letter of support for the section of the PATH Act that deals with the primary care incentive and we will keep you up to date as things move forward.

Perfect Timing

Two weeks ago, the Academy joined with other medical specialties to host a lunch with House Majority Leader Eric Cantor (R-VA)—on the very day that Cantor pulled out of debt ceiling discussions with the Vice-President Joe Biden. In fact, Cantor was late to the lunch because he been on the phone with the vice-president.

The lunch gave us the opportunity at a very key time to discuss with Cantor some of the serious issues that are likely to impact health care and the physician community. Top on the agenda were the elimination of the Sustainable Growth Rate (SGR) formula and repeal of the Independent Payment Advisory Board (IPAB). Details on the IPAB can be found in my June 5 Capitol Hill Report.

Many of the groups present pushed Cantor to include an elimination of the SGR in the debt ceiling increase legislation that will need to occur before August 2 to prevent the US from defaulting on its financial obligations. A similar request also was made recently to the president and congressional leadership in a letter sponsored by the AMA and signed by many of the groups around the table including the AAN.

Unfortunately, though not unexpectedly, Cantor expressed support for the elimination of the SGR but said Republicans are pushing for decreased spending in the debt ceiling bill and were very unlikely to include a provision that would increase spending like an elimination of the SGR.

January 1, 2012, and a 29.4 percent cut gets closer and closer.