Health Care Reform Threatens Patients with Neurologic Disease

A Letter to the Editor, re: Neurology

March 11, 2010

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By Elizabeth H. Minto, MD

Few of your readers are unaware of the ongoing debate regarding health care reform, or of the shift in the population toward the elderly with more chronic (and expensive) medical conditions.

However, I am terrified that few realize that there is a very real threat to a very important medical specialty: neurology. A neurologist is trained to diagnose and treat chronic conditions such as Alzheimer's disease, stroke (the third leading cause of death and #1 cause of disability in our country), multiple sclerosis, epilepsy, and Parkinson's disease, to list a few. The management of these types of patients does not require lucrative procedures and tests, but rather spending a significant amount of time talking to and examining a patient.

In "health care speak," spending time with patients is called "evaluation and management," or E/M, and this translates to codes that determine how much a physician is paid for a visit. E/M is valued at a much lower rate than complicated procedures (such as colonoscopies, endoscopies, etc.). However, most patients would agree that they would much prefer to spend face-to-face time with their doctor than with their doctor's tube with a light on the end of it.

Neurology is the only specialty that has been left out of a proposed incentive in the current health care legislation, which is aimed at improving the number of medical school graduates who choose to enter primary care. Even though neurologists bill an average of 61 percent E/M codes (the requirement in the bill is 60 percent), neurology has not been deemed eligible for this incentive due to a complete oversight: the committee that proposed this incentive mistakenly thought neurology was a subspecialty of internal medicine, which it is not. Moreover, an amendment to fix this mistake has been introduced, but cannot be considered for approval without a score from the Congressional Budget Office, which to date has not responded to numerous requests to score the amendment.

One in six Americans has a neurologic illness. Neurologists are vital to the health of millions. If these specialists are passed over, the ability of a senior to find a neurologist when they need one is going to be severely limited, because no fiscally responsible young medical graduate with $150,000 in student loans is going to choose to enter the field.

Elizabeth Harper Minto, MD
Mobile, AL

Author Disclosure

Within the past 24 months, Dr. Minto received compensation as a speaker for EMD Serono.