CAPITOL HILL REPORT: AAN MEMBERS ADVOCATE FOR E/M CODES WITH CMS, EDUCATE CONGRESS ON KEY ISSUES

March 25, 2019

The AAN Is Keeping E/M at the Forefront

Member Perspective by Marc Raphaelson, MD, FAAN, member of AAN Coding Subcommittee and AAN RVS Update Committee (RUC) Representative

Nine months after Centers for Medicare and Medicaid Services (CMS) first introduced its proposal to modify the payment structure for outpatient evaluation and management (E/M) services by collapsing the payment rates, the AAN is still focused on maintaining the integrity of these cognitive care services. While CMS has postponed any potential changes to the outpatient E/M code set until 2021, there is still work to be done and the AAN is coming at this issue from all angles. You learned in the February 11 Capitol Hill Report how the AAN has participated in the AMA’s CPT and RUC process of revising the E/M code set. Last Tuesday, AAN staff and I met with key leaders at CMS to discuss how a collapsed E/M payment structure would disproportionately impact cognitive specialties such as neurology.

Neurologists have performed and billed predominantly level 4 and 5 visits for decades and current coding guidelines do not recognize complicated medical care. It is difficult for CMS to recognize neurology work in caring for complex patients, and long-accepted tables of Medical Decision Making (MDM) do not adequately distinguish care for complex patients. This is a problem for all physicians who see the most complicated patients in their specialty, and it is a bigger problem for neurology than for most other specialties.

The AAN urged CMS to update and recalibrate the MDM tables if they are to be retained, and we requested that CMS evaluate more reliable methods to distinguish complex services.

Unique Advocacy Rotation Aids Resident's Congressional Visits

Member Perspective by John Legge, MD

I am currently a chief resident in adult neurology at Virginia Commonwealth University in Richmond, VA. I first became engaged in advocacy with the AAN when I attended Neurology on the Hill (NOH) in 2018 and continued that connection at NOH 2019. During this important annual event, neurologists paint Capitol Hill green with our bowties and scarves, voicing our concerns to Congress about the key issues facing our patients and profession, such as rising drug costs, the importance of robust neurological research funding, and the risk of devaluing E/M codes. We were able to share with our congressional offices our patient stories that illustrate the challenges facing patients and practices alike. The response was terrific, and several offices the Virginia delegation visited support initiatives to increase NIH funding and reauthorize the Patient-Centered Outcomes Research Institute (PCORI). Many other success stories were heard during and after NOH—a sign of growing awareness and an ever-strengthening voice of representation for the profession of neurology.    

During my residency, I have seen a multitude of patients needlessly suffer, some from an inability to afford outrageously priced drugs that they need, and others due to delays in diagnostic testing because of unreasonable insurance roadblocks. These problems brought into sharp focus the need for effective advocacy on behalf of our patients. Throughout the entire month of February, I was fortunate to have the unique opportunity to work closely with the AAN on a number of issues as part of a special rotation designed to further enhance my knowledge of the process of advocacy.

Culminating in a series of meetings on Capitol Hill with AAN staff, I met with the offices of Sen. Mark Warner (D-VA) and Rep. Abigail Spanberger (D-VA), as well as Rep. Lisa Blunt Rochester (D-DE). We revisited not only our recent asks from NOH but also discussed the invaluable role that neurologists play in treating our nation’s Veterans through the disease-specific Centers of Excellence programs within the Veterans Affairs hospitals. These programs include the Epilepsy, MS, and Headache Centers of Excellence, in addition to the Parkinson’s Disease Research, Education, and Clinical Centers (PADRECC).

My work with the AAN throughout the month of February and at NOH are a starting point for what I hope will be a career filled with advocacy efforts.  Such work helps to build important bridges of communication and knowledge, ultimately leading to better policy and regulations that impact our patients and profession in positive ways. During my rotation with the AAN, I gained a special appreciation for the art of advocacy, the importance of having an authentic ask, and the benefit of having an organization like the AAN through which one’s profession can be effectively represented.