Capitol Hill Report: A Look Back and the Year Ahead

January 6, 2012

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

AAN Advocacy Excels

As we look back on 2011, it is clear that the AAN’s efforts have increased the influence and profile of neurology on Capitol Hill, thanks in great part to active participation of our members:

  • Contacting Congress: 3,069 AAN members sent more than 19,000 messages to Congress, an increase over 2010 when the Affordable Care Act was being finalized
  • Congressional Contacts: AAN members and DC staff had 935 separate contacts with members of Congress or their staff, more than double the prior year
  • BrainPAC Support: 1,104 members contributed $257,675—a 25–percent increase from 2010

Much of the business of Washington is the development of one–to–one relationships that allow organizations like the AAN to be in a position to raise issues of importance to its members. In March 2011, the AAN added Derek Brandt to its DC staff. Derek came from AAN’s headquarters in Minnesota and his presence has had an immediate impact on our efforts for both lobbying on Capitol Hill and increase the effectiveness of BrainPAC.

With these record breaking numbers and improved ability to be visible on the Hill, the AAN has laid the groundwork to be an effective advocate for neurology on all the issues that are set to arise in 2012.

Outlook for 2012

Elimination of the Sustainable Growth Rate (SGR) formula remains at the top of the agenda for the AAN. The entire physician community continues to be united in calling for its elimination and the strength of this physician coalition is evident in the successful prevention of any destructive cuts to reimbursement over the last eight years.

At the end of December, Congress agreed to a two–month extension of the SGR, which will now cut physician payments by 27.4 percent on March 1, 2012, if Congress does not act. Recognizing that a permanent elimination is unlikely, the AAN is advocating for a two–year fix similar to the one the House passed in mid–December.

Another key point of the debate will be efforts to improve the practice climate for primary care providers. The AAN agrees that Congress must continue steps to increase the number and availability of primary care providers, but it cannot forget that cognitive care providers like neurologists bill the same codes, have similar incomes and recruiting challenges. Providing higher payments for primary care providers without considering the services provided to patients by similar physicians is arbitrary and will not improve access to care for Medicare beneficiaries. Any incentives should be provided to all physicians who provide significant amounts of evaluation and management (E/M) services rather than specialists who are primarily procedural based.

The 2012 lobbying effort on this issue has already begun as last week we contacted all 13 of the House members appointed to the conference committee to negotiate a long–term SGR fix prior to March 1. We received several positive responses, making us hopeful that any effort to split primary and cognitive care providers will be objected to by several members of Congress. We will contact Senate offices when those appointments are made.

Other key issues will be the need to ensure that patients with neurologic conditions have access to imaging services provided by their neurologists, research funding for entities such as the National Institutes of Health (which received $300 million in additional funding for 2012), efforts to prevent concussion/TBI, and closely monitoring how challenges to the 2010 health care reform law play out.

Health Care and the Supreme Court

The Supreme Court will begin reviewing challenges to the Affordable Care Act on March 26. Four lawsuits moved through federal courts, but the court only selected the case filed by 26 states and the National Federation of Independent Business.

Because of the depth of the discussion, the justices have scheduled three days of oral arguments covering the following issues:

  • Whether the court has the authority under the Anti–Injunction Act to rule on the individual mandate before 2014
  • The constitutionality of the individual mandate
  • The issue of severability, or whether striking down the individual mandate means invalidating the entire law

The last issue is particularly interesting as a ruling that struck down the entire law would throw a number of issues into play, including the omission of neurology and other cognitive care providers from the primary care incentive that provides a 10–percent bonus to physicians simply because they are listed as eligible.

AAN Members Get Involved

More than 140 AAN members will head to the Hill to present AAN’s positions in late February and Derek and I will be on the ground every day. Please do your part by participating in any AAN advocacy activities you can and together we will be a strong voice for neurology in Washington in 2012.