MedPAC Proposal Threatens Access to Care for Seniors with Brain Disease

October 6, 2011

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Today, brain disease such as Alzheimer's disease, Parkinson's disease, epilepsy, stroke and migraine affect more than 50 million Americans. Alzheimer's alone currently affects 5.4 million—a number that is expected to triple by 2050. This brain disease epidemic will only increase as baby boomers age. Who will care for these people? If you or a loved one were diagnosed with a brain disease, would it be acceptable if you could not readily find a physician with the proper training to care for such a complex disease?

Not all doctors have the same background and knowledge, making timely access to a physician with the proper training and expertise essential. However, if Congress doesn't adequately reform the system by which doctors are paid for treating Medicare patients, there is a real and looming threat that our seniors with brain disease may not have access to care from properly trained physicians.

The way physicians are paid in the US is inherently flawed. Physicians have a perverse financial incentive to provide more care, do more procedures and spend less time with patients. As the CEO of the largest professional association of neurologists—physicians with expertise in diagnosing and managing brain disease—I hear every day from members who are deciding to retire early, are unable to sell their practices or are accepting fewer patients because they can't afford to keep their doors open any longer. I fear that these struggles will only get worse as "solutions" are put forward that ultimately do nothing to correct the misaligned incentives in the Medicare reimbursement system.

On Thursday, an advisory committee to Congress on Medicare, the MedPAC, voted to remove a controversial formula for paying physicians who see Medicare patients by passing the majority of the cost to fix it on to specialty physicians, including neurologists. Specifically, primary care physicians, or family physicians, would receive a freeze in the amount they are paid to care for Medicare patients for the next ten years, while all other "specialist" physicians would receive cuts of nearly 18 percent over the next three years, followed by a pay freeze for seven years.

While no one is happy with the formula used now, this recommendation is not supported by anyone in the medical community, and worse, could threaten the future stability of the Medicare program and our patients' access to care.

The proposal does not meaningfully change fundamental problems in the current system. The risk of doing more of the same is that fewer medical students will choose to go into specialties like neurology—even though neurology is similar to primary care in that our doctors need to spend time with patients, taking care to diagnose and manage complex brain disease that affects not only the patient, but the caregiver and loved ones.

We simply can't support a proposal that aims to solve one problem by creating another. We can and need to do better to meaningfully reform a system so important to America's seniors.

Catherine M. Rydell, CAE
Executive Director and CEO, American Academy of Neurology