Capitol Hill Report: SGR Momentum Continues

May 20, 2013

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

House and Senate Hold SGR Hearings

There continues to be a lot of congressional action around Medicare’s Sustainable Growth Rate (SGR) formula repeal and the momentum is building toward a final solution.

I attended a hearing held by the House Ways & Means Health Subcommittee where both Republicans and Democrats agreed on a quality/value framework. The hearing was titled "Developing a Viable Medicare Physician Payment Policy" and, as far as I heard, there was no partisan disagreement as leaders on both sides of the aisle indicated that repealing and replacing the SGR remains a primary focus.

The Senate held a similar hearing in a packed room that included Derek Brandt of our DC staff. It was clear that both sides of the aisle in the Senate also are seeking a real solution to the SGR.

Details to be Determined

Even with bipartisan agreement, the path forward with SGR is still very cloudy. The AAN has provided suggestions twice to House Republicans since the beginning of the year. The Senate Finance Committee last week asked the AAN and other specialties three specific questions on SGR repeal:

  • What specific reforms should be made to the physician fee schedule to ensure that physician services are valued appropriately?
  • What specific policies should be implemented that could co–exist with the current fee–for–service (FFS) physician payment system and would identify and reduce unnecessary utilization to improve health and reduce Medicare spending growth?
  • Within the context of the current FFS system, how specifically can Medicare most effectively incentivize physician practices to undertake the structural, behavioral, and other changes needed to participate in alternative payment models?

The Academy’s Medical Economics and Management Committee, Government Relations Committee, and Payment Alternatives Team are drafting a response to these questions to ensure that the interests of neurology and patients with neurologic conditions are made a priority. If you have any suggestions for inclusion please feel free to send them to me at mamery@aan.com.

New CBO Numbers

Two weeks ago, I had conversation with House Majority Whip Kevin McCarthy (R–CA) who assured me and several other physician specialty groups that if a bipartisan agreement could be found on SGR that the cost offset for a full repeal would be available.

No one is going to identify where that money comes from prior to an agreement as it would probably sink any deal. But it is very important that the cost of repeal be a reachable number because the question of SGR repeal has never been about good public policy, it has always been about money.

As I reported in CHR in late March, the SGR has been “on sale” after the Congressional Budget Office (CBO) reduced the cost of repeal from $245 billion to $138 in its last report. After the congressional hearings, the CBO announced it would be issuing a re–score of the cost of an SGR repeal. When this news came out, the buzz on the Hill was that momentum would be determined by the number.

The new score saw a small increase from $138 billion to $139.1 billion over ten years.

The momentum continues.


Regulatory Corner

By Daneen Grooms, MHSA, AAN Manager of Regulatory Affairs

Neurology Services Are Targeted by RACs

Recovery Auditors (RACs) are conducting reviews of claims for TIA, syncope, and seizures. The Centers for Medicare and Medicaid Services (CMS)  states that patients who present with TIA, but whose symptoms resolve spontaneously, should be placed in observation status rather than inpatient admission.

The RAC program was developed to identify and recoup Medicare overpayments and underpayments. If the RAC denial is for services provided more than 12 months ago, carriers may not allow resubmission of claims because the time limit has expired. The AAN believes this unduly penalizes physicians and suggests that the timely filing provision be reset to allow submission of claims following a RAC appeal.

The AAN also has learned that CMS revised the RACs’ scope of work to now require:

  • Submission of monthly appeal reports documenting how often Medicare Administrative Contractors affirm and/or deny a Level 1 appeal
  • Identifying and reporting Local Coverage Determinations that are outdated, etc.
  • Completion of claim reviews shortened from 60 days to 30 days

Are NCS/EMG Services Being Overutilized?

The Academy is pursuing a study of data on inappropriate use of nerve conduction studies and EMGs. We still are waiting to hear a decision from CMS on whether the codes will go to a refinement panel; CMS indicated we should hear by the end of May. Please continue to send stories about how the cuts are affecting your patients and your practice to advocacy@aan.com.


Advocacy Notes

By Tim Miller, Senior Program Manager, Communications & State Advocacy

  • Thank you to the 600+ members who responded to the action alert asking you to email your US House member to ask him or her to co–sponsor H.R. 1838, which would include neurology in the Medicaid bump included in the Affordable Care Act. However, only 324 out 435 offices (about 74 percent) received a message. Part of the goal for these alerts is for all offices to receive a message from our members. Please take a moment and respond to these alerts. The more messages sent, the larger the impact.

  • The AAN has signed on to a letter supporting the Youth Sports Concussion Act, which will introduced by Senators Tom Udall (D–NM) and Jay Rockefeller (D–WV) in the Senate and Representatives Tom Rooney (R–FL) and Bill Pascrell (D–NJ) in the House. The Youth Sports Concussion Act would ensure that new and reconditioned sports equipment for high school and younger players meet safety standards that address concussion risk and the needs of youth athletes.