Capitol Hill Report: Spotlight on the AAN's Cognitive Care Efforts

September 7, 2011

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This special edition of Capitol Hill Report is authored by Rod Larson, AAN Chief Health Policy Officer, to update readers about the Academy's efforts to restore balance in reimbursement between procedural services and cognitive care.

Since AAN President Bruce Sigsbee, MD, FAAN, sent an email to US members on June 2 citing cognitive reimbursement as the top priority of the Academy's advocacy work, the Academy has been intimately involved in a number of initiatives on your behalf with Congress, CMS (Centers for Medicare and Medicaid Services), other cognitive specialties, and patient groups.

AAN Leads Efforts of Cognitive Specialty Coalition (CSC)

The AAN hosted an August meeting of CSC members at the Washington, DC, office to discuss joint strategy—developed by AAN staff members—for consistency in congressional messaging among the groups.

Cognitive Coalition Urges MedPAC to Consider Specialists that Provide Cognitive Care

The AAN and the Cognitive Specialty Coalition requested and were granted a meeting with key MedPAC staff and leadership to share data on the cognitive care crisis. Cognitive specialists who provide a majority of E/M services are facing the same problems as primary care physicians in a system currently set up to recognize higher reimbursement for procedures over cognitive care.

MedPAC Recognizes Need to Realign Payments for Cognitive Specialists

In its June report to Congress, the Medicare Payment Advisory Commission (MedPAC) indicated it is considering a variety of policy ideas for health reform, including: "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."

AAN and CSC Commend MedPAC; Submit Additional Supporting Data

The Cognitive Specialty Coalition released a joint statement commending MedPAC for its recognition in the June report and submitted a follow-up letter citing additional related data.

AAN Agrees with CMS, at Least in Part

On August 30, the AAN submitted a 10-page comment letter citing support for CMS's goal in regards to the agency's proposed changes to the Medicare Physician Fee Schedule for CY 2012, which would revalue physician work for evaluation and management (E/M) services.

While the AAN supports this concept, we do not believe the proposed methodology—re-review of all E/M codes by the AMA's Relative Value Scale Update Committee (RUC)—will accomplish the vital restoration of the balance in reimbursement for procedural services and cognitive care management services provided by primary care physicians as well as certain specialists like neurologists.

Restructure the RUC?

At the request of the American Medical Association (AMA), the AAN submitted a letter to the Relative Value Scale Update Committee (RUC) citing opposition to recent American Academy of Family Physicians (AAFP) requests for restructuring the RUC. The AAN would support a restructuring of the RUC to reflect more closely the distribution of physicians among primary and specialty care, however the particular AAFP proposal unfairly favors one medical specialty and does not address methods to value cognitive care provided by specialists.

Work Intensity

At the same time as efforts abound on Capitol Hill and with regulatory bodies, the AAN agreed to fund a first-of-its-kind study into the validity and reliability of work intensity measures in the physician setting. The study hopes to advance the development of a reliable, scientific measurement for physician work intensity that may guide national policy in patient safety, practice management, and payment. Several other specialty societies have joined the AAN to fund the effort.

What the Future Holds

Between now and the end of the year, Congress must also pass legislation to stop the 29.5 percent cut in Medicare physician payment due to the flawed SGR formula. In addition, the newly appointed Debt Commission will be looking for additional cuts to meet the mandated $1.2 trillion in debt reduction.

The AAN is monitoring all of these issues closely, and will need the help of all members when the time is right. Watch your emails for updates and respond to AAN's Action Alerts. Taking action is easy, fast, and effective. Let us know if you have any questions. This is a critical time for you to stand up to ensure your patients maintain access to high quality neurologic care.

For a complete summary of related actions, view a timeline of AAN efforts.