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capitol hill report: AAN ADVOCATES FOR E/M, EEG CODES, MEDICARE DRUG BENEFITS, EHR ISSUES

February 11, 2019

AAN Safeguarding E/M Services Kevin Kerber, MD, AAN advisor to the American Medical Association RVS Update Committee (RUC)

Member Perspective by Kevin Kerber, MD, AAN advisor to the American Medical Association RVS Update Committee (RUC)

As we all know by now, in July of last year the Centers for Medicare & Medicaid Services (CMS) put forth a proposal that would have collapsed the payment for level 2-5 E/M office visits into a single rate. Then, in the November final rule, CMS indicated a plan to only collapse levels 2-4. While any payment changes to E/M has been postponed until 2021, the message from CMS is clear: the agency intends to review the documentation guidelines, code structure, and payment rates for E/M services. We are in a window of time now when CMS is listening to stakeholders with ideas about how best to structure E/M. The AAN is positioning itself to make neurology’s voice heard.

CMS announced it would consider the recommendations of an AMA-convened workgroup that is developing a new E/M coding structure. As an AAN advisor to the RUC, I see firsthand the importance of the Academy having a seat at the table. Read more in AANnews® about how the AAN participates in the process to establish and review CPT codes through the AMA’s CPT® (Current Procedural Terminology) Editorial Panel and Relative Value Scale Update Committee (RUC) process. The AAN participates in all calls and in-person meetings of the AMA E/M workgroup with the goal of ensuring that any revisions properly support the work of neurologists. This is critically important since our analysis of Medicare payments showed that two-thirds of neurologists receive more than 60 percent of their payments from E/M services (Skolarus, et al. 2015) and that neurologists are among the most likely physicians to be negatively impacted by collapsing codes (Callaghan, et al. 2018). 

The AMA workgroup submitted a proposal for consideration at the February CPT Editorial Panel meeting, which will be followed by review of the codes by the AMA RUC. The AAN will participate in the RUC survey to recommend RVUs for the codes. While it is important that the AAN is part of the conversation at the AMA, we are one of many medical societies participating in that process. We recognize the importance of our AMA presence and participation in cognitive coalitions that make the voice of cognitive specialists louder, but we need to make sure that the unique voice of neurology isn’t lost. This means CMS hearing directly from the AAN on what is best for our members when it comes to E/M services, which are the foundation of neurology practices.

What does this mean? While CMS considers the recommendations of the AMA, they also consider comments from all their stakeholders, including the AAN. We are continuing to analyze data to best understand how various changes to existing E/M codes might impact neurologists. We will take this data-driven message to CMS leaders to ensure the time that neurologists spend with patients is appropriately valued.

In the next few weeks, you may be selected to participate in an AMA RUC survey for physician office visits. This survey will help our Academy, in concert with the RUC, recommend accurate relative values for physician work and direct practice expense to CMS.

 

AAN, CMS Discuss Appropriate Valuation for New EEG Monitoring Codes

AAN physician experts and staff met with leadership at CMS to discuss a new code set for long-term EEG monitoring. Representatives from the National Association of Epilepsy Centers also participated. The goals of the meeting were to ensure CMS understands the indications for long-term EEG monitoring and appropriate coding of the services and to influence the CMS reimbursement levels for EEG in the upcoming proposed 2020 Medicare Physician Fee Schedule that will be published in July.

The code set that was passed at the May 2018 AMA CPT Editorial Panel meeting includes deletion of 95827, 95950, 95951, 95953, 95956, the addition of 10 new codes for reporting professional services and 13 new codes for reporting technologist services. The full 2020 CPT code set, including revised language and descriptors, are under AMA embargo until fall 2019.

 

AAN Submits Comments on Major Drug Rule and EHR Draft Strategy

The AAN submitted regulatory advocacy comments in response to two significant administration proposals.

  • The first comments were in response to a proposed rule from CMS that would significantly reform the Medicare drug benefit through changes to Medicare Advantage and Medicare Part D. In the comments, the AAN opposed the expansion of prior authorization and step therapy protocols but was supportive of several other provisions that are aimed at improving price transparency and lowering drug costs. The comments also detail a set of needed guardrails that are supported by the AAN, if CMS does not reverse its decision to allow step therapy in Medicare Advantage.
  • The second comments were in response to the Office of the National Coordinator’s “Draft Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.” In the comments, the AAN addressed several recommendations made in the draft strategy related to clinical documentation simplification, EHR usability and design, EHR reporting, public health reporting, and issues related to qualified clinical data registries.

Drug Pricing News

  • The AAN was cited in press releases from Sen. Dick Durbin (D-IL), Sen. Amy Klobuchar (D-MN), and Sen. Tina Smith (D-MN) as a supporter of their new drug pricing bill, the Forcing Limits on Abusive and Tumultuous (FLAT) Drug Prices Act of 2019. The bill would discourage price hikes by reducing a pharmaceutical company’s FDA regulatory exclusivity period by six months if they choose to increase prices by more than 10 percent in a year (or 18 percent over two years, or 25 percent over three years).
  • AAN member Ted M. Burns, MD, was interviewed by NBC News on the recent decision by Catalyst Pharmaceuticals to set the price of Firdapse, a drug used to treat the rare neuromuscular disease Lambert-Eaton myasthenic syndrome, at $375,000 per year. 
  • AMA released the results of their 2018 Prior Authorization Physician Survey, finding 91 percent of respondents experienced significant or somewhat negative clinical impact due to prior authorization.