In November the AAN, along with many other physician specialties, attended a meeting convened by Rep. Allyson Schwartz (D-PA) to discuss a policy framework that would fundamentally restructure the Medicare physician payment system. Specifically her proposal would eliminate all future payment cuts to physicians called for by the Medicare Sustainable Growth Rate (SGR) formula, and would, after four years, transition away from fee-for-service to new innovative care models in the long-term.
Although her blueprint has some merit, the most immediate and well-defined section of Schwartz's proposal provides more bonuses to primary care physicians while excluding neurology and other cognitive specialists. The plan would differentiate payment updates based on specialty designation alone by providing a 2.5-percent increase for primary care providers as defined by the Affordable Care Act (ACA) and 0.5-percent increase for all other specialties for four years. This differential would be on top of the 10 percent primary care incentive that was passed as a part of the ACA.
If enacted, after four years, Schwartz's proposal would result in the average primary care physician earning approximately 18 percent more than neurologists for billing the exact same evaluation and management (E/M) services.
After learning of this proposal the AAN has led the charge to alter this provision to include cognitive specialists, beginning with a series of follow-up meetings with Rep. Schwartz staff. The AAN has been joined in these efforts by members of the Cognitive Specialty Coalition, which include Endocrinology, Rheumatology, and Infectious Disease.
Most recently the AAN sent a letter to Rep. Schwartz detailing that cognitive specialists bill the same evaluation and management (E/M) codes, have similar recruiting problems, and commensurate income levels as primary care providers.
The letter went on to state that "picking winners and losers based on specialty designation, as the ACA did, will lead to the unintended consequence of an imbalanced physician workforce that does not provide the proper mix of physicians necessary to meet the needs of Medicare beneficiaries. Left out will be cognitive specialists who often manage care for patients with chronic disease, preventing hospital stays and costly surgeries. These valuable services go beyond primary care, improving patient outcomes and decreasing costs, and they must be properly compensated in order to ensure patient access."
Rep. Schwartz plans to introduce her proposal as a bill in the US House of Representatives in the near future. The AAN will continue to push for a change in this provision prior to the bill's introduction.