Capitol Hill Report: Will New Physician Payment Plans Benefit Neurology?

April 19, 2012

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

We met with House Energy Commerce Health Subcommittee Chair, Rep. Joe Pitts (R-PA) last week and had a productive discussion about his goals for reforming the physician payment system. Chairman Pitts is committed to eliminating the Sustainable Growth Rate (SGR) problem and replacing it with a workable system that ensures that physicians continue to participate in the Medicare program.

Much of the discussion this year has revolved around the desire to move away from a fee-for-service system to one that pays physicians for quality. But Pitts conceded that this might not be possible and that some physicians will probably have to continue on a fee-for-service basis.

In a later meeting, Rep. Joe Heck, DO (R-NV) agreed and suggested that one way to eliminate the SGR might be to declare the $300 billion owed as "emergency spending" because it may imperil the Medicare program. This would mean adding the cost to the deficit rather than offsetting it with additional revenues or spending cuts. Heck said he might consider supporting this if there was a solid policy on moving forward with a workable system post-SGR.

It is still my contention that real reform is unlikely until the Supreme Court rules on the Affordable Care Act and probably not until after the November elections.

The SGR will have to be dealt with prior to what will amount to a cut of almost 30 percent on January 1, 2013. The big questions will be whether we can get substantive SGR reform in a lame duck session of Congress, or if we will again be stuck with a temporary patch or even a cut.

IPAB and Medical Malpractice Still on the Table

Last month, the House passed a bill to repeal the Independent Payment Advisory Board (IPAB) but used medical malpractice liability reform as the "pay for." This left the physician community with two key pieces of legislation passed through the House, but because they were linked, there is virtually no chance of getting either of them through the Senate.

I had conversations with both Rep. Heck and Rep. Phil Gingrey, MD (R-GA), the author of the malpractice bill, this week on their thoughts about the House action and the prospects for actually getting it done. Heck was frustrated by the linkage and talked about the need to add IPAB to a "must-pass" SGR bill in the lame duck session in order to get it through the Senate. Both the president and a few senators have said they will vigorously oppose an IPAB repeal bill, but would they if it were attached to an SGR elimination or fix?

Gingrey supported the linkage and commented that it drew the support of 22 Democrats who might not have supported liability reform. An IPAB repeal-only bill would have attracted many more Democrats, but 22 isn't bad.

House Republicans already are making plans to bring both issues up separately as their committee chairs have been tasked with saving significant sums for the budget. Liability reform is scored as saving $41 billion over ten years which makes it a very attractive offset, though I still do not think there is any hope for passage of a liability reform bill in the current Congress. IPAB has a small cost of $3 billion over ten years, but if the House can pass its repeal on a bipartisan, standalone basis, there is a chance it could be added to an SGR fix at the end of the year. We intend to work with other medical specialties and supportive members of Congress to get a clean IPAB repeal passed before the next Congress arrives.

Another Endangered Neurology Supporter

As we come closer to Election Day, I will continue to detail some of the neurology supporters in Congress who face tough elections. An earlier Capitol Hill Report reviewed the races of Reps. Ed Perlmutter (D-CO) and Russ Carnahan (D-MO).

Another supportive Democrat's fate may have been decided by the time you read this post. Just like Missouri, Pennsylvania lost a seat in the redistricting process. The new lines put three-term Rep. Jason Altmire (D) into the same district with freshman Mark Critz (D) and they are both battling to be the Democratic nominee in the suburbs of Pittsburgh.

As of this writing, Altmire, who has steadfastly supported the issues of cognitive care providers like neurologists, holds a small lead. Altmire is a member of the moderate Blue Dog Coalition, has extensive background in health care administration, and is widely supported by the medical community. Critz is primarily backed by union interests and has garnered the support of former President Bill Clinton.

The AAN's BrainPAC has been supportive of Altmire in this close race. If you are in New Orleans on Wednesday come and ask me about the results. If not, look for the results in the next Capitol Hill Report.

Annual Meeting Advocacy

Are you in New Orleans for the Academy's Annual Meeting? If so, come talk some politics with Derek Brandt or me anytime from 8:00 a.m. to 6:00 p.m. Saturday through Friday. We are usually near Academy Central at the BrainPAC booth near the entrance of the Convention Center.

I also will be at the Best Care Expo demonstrating mock legislative visits on Monday from 1:00 p.m. to 3:00 p.m. and at the BrainPAC reception on Tuesday from 6:00 p.m. to 7:30 p.m. at the Hilton River Room.

Don't forget some of the other events:

  • Practice Colloquium: Sunday, April 22, from 1:00 p.m.-4:00 p.m. (Convention Center Room 333/334)
  • PALF Graduate Reception: Monday, April 23, from 5:30 p.m.-7:30 p.m. (Hilton Compass Room)
  • PALF Roundtable: Tuesday, April 24, from 7:00 a.m.-9:30 a.m. (Convention Center Room 264).

I hope to see you there!