Capitol Hill Report: E/M Finally Makes It!

March 11, 2013

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

E/M Finally Makes It!

There was great news for neurology and other cognitive providers last week with the release of a report by the National Commission on Physician Payment Reform making recommendations that include significantly boosting payments for evaluation and management (E/M) care.

The Society for General Internal Medicine created the independent commission of representatives from health care, including, physicians from a wide range of medical specialties, insurers, health policy leaders, and consumer and state health department representatives.

The AAN submitted comments at the commission’s request in the summer of 2012. The report reflects a number of AAN suggestions and specifically mentions neurology as one of the specialties that would benefit from a boost to E/M. Most importantly for our efforts on Capitol Hill regarding E/M issues, it states that the issue is not between primary care providers and specialists, but rather between E/M and procedural care. 

If you haven’t had a chance, I hope you will look at the AAN’s press statement, in which AAN President Bruce Sigsbee, MD, FAAN, comments, “The commission reached out for broad input, and we are pleased the recommendations reflect many of the concerns the AAN shared several months ago about E/M services and the role of care coordination. We hope Congress and CMS act on these recommendations and reward the high-quality care that neurologists provide to their patients.”

We see this as a big step forward for the arguments we are making in the halls of Congress and we already are making it a part of our lobbying efforts and plans for Neurology on the Hill on  April 22 and 23.

Annual Meeting Events

Are you coming to the AAN Annual Meeting in San Diego next week? If you are, there are many opportunities to discuss advocacy and coding issues. We want to hear from you so come to any or all of the following:

  • There will be an open microphone session immediately following the 8:00 a.m. business meeting on Monday, March 18, to dialogue on AAN strategies for payment recognition for neurologists as a cognitive specialty, including discussion of the recent changes to NCS, EMG, and IOM codes (Room 23 ABC of the Convention Center).
  • Members of the AAN Government Relations Committee will host a Meet & Greet for all members to come by and discuss the AAN’s legislative priorities and enjoy free dessert. Join us on Monday, March 18, from 12:00 p.m. to 1:30 p.m. in the Sails area of the Convention Center. 
  • Attend “Neurology in Crisis: Next Steps for Practice Survival” on Tuesday, March 19, at noon in Room 20D of the Convention Center to learn about dealing with the NCS cuts and how quality programs will impact your practice.
  • How did the 2012 elections impact neurology? Attend the Current Practice Issues in Neurology to hear myself and other experts discuss the elections and the big issues facing neurology. On Wednesday, March 20, from 5:30 p.m. to 7:00 p.m. in Room 9 of the Convention Center.
  • AAN coding experts will be available in Academy Central throughout the week to answer your coding questions.
  • If you want to talk politics with Derek Brandt or me, come to the BrainPAC booth anytime.

Sequester Starts—Includes Decrease in Medicare Payments

The sequester has been an interesting issue for neurology. The AAN sent out an action alert asking AAN members to contact their members of Congress asking to prevent cuts to research and physician payments.

More AAN members than usual responded by sending messages. However, more members than usual also contacted us to say that they supported the sequester and disagreed with the AAN position, primarily because of the sequester’s effect on cutting federal spending.

So, thank you to everyone who responded in one way or another, we do appreciate all of the input. Be aware that Medicare physician payments will decrease by 2 percent and that impact will likely be felt beginning April 1. It is a lot better than a 27 percent SGR cut, but it is still a cut. Let us know if it impacts your practice.


Regulatory Corner
by Daneen Grooms

Nerve Conduction Update
We are urging CMS to hold a refinement panel to reconsider the values for nerve conduction studies for 2014. These drastic cuts require a more thorough, transparent review. Let us know  if your patients have been impacted. 

Patient Visits May Increase Next Year Due to Essential Health Benefits
Starting January 1, 2014, health plans must offer a core package of benefits and services (essential health benefits) to consumers in the individual and small group markets in accordance with the Affordable Care Act. The final rule is designed to improve patients’ access to care by expanding coverage for services like habilitation, mental health, and prescription drugs.

Under the final rule, states are given the flexibility to define essential health benefits (EHB) in a way that would best meet the needs of their residents. However, it is unclear how EHB will affect neurologists. “Obviously, the goal is to get more people insured, but it doesn't really deal with reimbursement to providers,” said Elaine Jones, MD, FAAN, chair of the AAN’s Government Relations Committee. While the AAN supports patients’ access to quality affordable care, it is equally important that neurologists are appropriately compensated for the care provided.

AAN Meets with CMS Medicare Director to Discuss CCCC
In a recent CHR, I mentioned that I met with CMS officials to present a proposal requesting CMS provide reimbursement for complex chronic care coordination (CCCC) services in 2014. Last week, I participated in a meeting with Jonathan Blum, CMS Medicare director, to continue discussions on the code proposal. The CCCC work group reiterated that these services are not restricted to patients in patient-centered medical homes and explained the attributes of practices that would be able to provide these services. Our goal is to show CMS that CCCC codes are ready for reimbursement and should be included in the 2014 Medicare Physician Fee Schedule proposed rule. To that end, we are working closely with CMS to address any concerns they may have.

Advocacy Notes
by Tim Miller

  • The AAN signed on to a letter with 430 other organizations urging congressional budget committees to invest in public health.
  • In addition to the 2-percent cut from sequestration, neurologists could see a 1.5-percent cut in Medicare reimbursement if they do not successfully participate in PQRS in 2013. Learn more.
  • Your AAN DC lobbyists are now on Twitter! Follow them at @MikeAmeryDC and @DerekBrandtDC.
  • Thank you to more than 800 members who responded to our Sequestration Action Alert email on February 26.
    • Messages were received by 87 of 100 Senate offices and 315 of 435 House offices. Our goal is to have every Congressional office receive a message from our members when an Action Alert is sent out. More offices receiving messages will increase awareness of neurology’s legislative priorities on Capitol Hill.
    • Neurology is only as strong as our advocates. Don’t presume somebody else is sending a message. Please take a moment to respond to our Action Alerts when you receive them. It will take less than a minute of your day!