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AAN to Present to CMS Panel on Reimbursement for Nerve Conduction and Electromyography

Samson, Kurt

doi: 10.1097/01.NT.0000433496.96187.92
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Later this month, the AAN will be presenting to an advisory panel convened by the Centers for Medicare & Medicaid Services to make the case that some adjustment in the values for nerve conductive studies and electromyography is necessary.

When the Centers for Medicare & Medicaid Services (CMS) asked the Relative Value Update Committee to reassess the values assigned to nerve conduction tests and electromyography, the AAN and other concerned medical organizations partnered to speak out about the potential impact any cuts in reimbursement would have on their specialties and, more importantly, patients' access to diagnostic tools.

The changes in the relative value units for nerve conduction studies (NCS) and electromyography (EMG), effective January of this year, scaled back reimbursement rates by between 50 percent and 70 percent of 2012 values, with an additional 2 percent decrease effective in April due to government sequestration.

The AAN and a wide range of allied professional organizations, major medical institutions, and patient groups believe the cuts will limit patient access and hamper early diagnosis of a range of neuromuscular diseases and disorders. The cuts could also result in misdiagnoses and unnecessary treatment, including surgical procedures.

Later this month, the AAN and other advocates will have an opportunity to present their arguments before a panel of independent experts assembled by the CMS to serve in an advisory capacity on the issue. The move comes on the heels of months of protracted and aggressive advocacy initiatives to try to mitigate the NCS/EMG reimbursement cuts affecting many AAN members. These efforts included letter-writing campaigns to members of Congress, multiple meetings with the CMS, and the involvement of patient advocacy.

Neil A. Busis, MD, chief of neurology at University of Pittsburgh Medical Center Shadyside, who serves on the AAN board of directors, has an intimate knowledge of the reimbursement issues as a former chair of the AAN Medical Economics and Management Committee. “This is an issue that affects our members at every level, including our leadership,” he said. “We are all practicing neurologists, and we are acutely aware of the impact of these changes on our specialty and patients. We have worked extremely hard, exploring every possible angle, to advocate for fair coding and reimbursement for the services and procedures neurologists provide.”

At the same time, he continued, “we understand how important it is to maintain active relationships with the legislative and regulatory agencies in Washington, DC.”

He noted that, to that end, the AAN now has three dedicated staffers in addition to a new part-time consultant working with these governmental agencies in Washington, DC, on issues that concern AAN members. In addition, the health policy team at AAN headquarters has been working intensely on this and other related issues.

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Bruce Sigsbee, MD, immediate past AAN president, is the consulting neurologist working with the Washington office. He said that he is hopeful that those appearing before the advisory group will be able to convince the CMS panel that some adjustment in the values for these diagnostic tests is necessary.

Estimates of how much the cuts have had on individual physician practices cannot be tallied yet, he said, as the policy has been in effect only since January. But anecdotally, he said, the AAN is aware that they are having an impact that is expected to continue. “Some neurologists have closed their practices or simply retired early because of this. Others have decreased the number of EMGs they perform or have stopped accepting Medicare patients.”

“Everyone knows there is an enormous amount of political pressure to cut Medicare and Medicaid costs, but at least we have the opportunity to have this panel hear us out,” Dr. Sigsbee said.

“I think we can present a good argument, there could be a rollback of some kind, but how much is impossible to guess. We at the AAN are working hard at this, but for now we just have to see how it goes.”

AAN members should stay tuned: There will not be any decision until a final ruling is published in the Federal Register in November.

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•. Neurology Today archive on reimbursement cuts and neurology:
•. AAN resources on Medicare payments:
•. Neurology Today article, IN PRACTICE: How do you get paid? As RVU methodologies gain favor, what you should know:
© 2013 American Academy of Neurology