Subscribe to eTOC



Medicare reimbursement for evaluation and management (E&M) services will increase starting this year, according to the Centers for Medicaid and Medicare Services (CMS). But one AAN expert commented that coupled with scheduled cuts to the program, the increase will not be major.

Laura Powers, MD, chairs the AAN Medical Economics and Management Committee, which lobbied CMS to increase E&M reimbursement. She said that since CMS is required by law to maintain budget neutrality, the agency had to make adjustments to the system to balance these gains. It did this by creating a “work adjustor” that reduces by 10 percent the work component of the overall reimbursement equation. But even with this adjustment, on average, neurologists will have a positive update in Medicare payments, she said. For example, the work relative value units (RVUs) for a level 3 office visit, the most billed service on the Medicare fee schedule, will increase by 37 percent.

“We are pleased that the work values for evaluation and management codes were increased, and over the years, this will benefit neurologists,” Dr. Powers said.

The problem, she said, is that the sustainable growth rate formula (SGR), which the government uses to calculate Medicare payments, reduces payments when the rate of spending on medical services exceeds a predetermined limit. At press time, Congress had passed a bill that would avert a scheduled 5 percent reduction to Medicare reimbursements in 2007.

Dr. Powers also pointed out that since the payment formula includes a geographic component, physicians may experience a further reduction depending on where they practice.

The new E&M reimbursement stems from a Medicare law that requires CMS to review the way it pays physicians for certain services at least every five years. To calculate how these changes might affect your practice, visit, where you can use the AAN's E&M Impact Tool.


In December, Congress passed the Combating Autism Act of 2006, which authorizes close to $1 billion dollars over the next five years for the research, screening, detection, and early intervention of autism. The bill will increase federal funding for autism by at least 50 percent. At press time, it was scheduled to be signed by President Bush.

“I am not surprised that the legislation has passed, given the enormous importance to families and pressure for this to move forward,” University of Pittsburgh neurology and psychiatry professor Nancy Minshew, MD, told Neurology Today in an interview. “Autism has been a growing public concern because of increased rates in diagnosis. To date, this concern has not been adequately reflected in federal policy.”

One in 166 children are diagnosed with autism, according to the Centers for Disease Control and Prevention. “Diagnosis is often late, services are often limited or may not be available, and their quality varies,” said Dr. Minshew.

Judy Van de Water, PhD, associate professor of internal medicine at the University of California-Davis, whose research focuses on the immunobiology of autism, added: “I think that the health of our children has, justifiably, become more of a priority and that this reflects one area that has become very visible. We have also begun to gather data that support the increase in biological research in autism.”

Dr. Minshew stressed that more support for the translation of research findings into programs and services is warranted. And she cited the need for more large-scale genetics studies with well-characterized families to identify genes and multidimensional braom imaging studies to characterize the neuroanatomy of autism.

Dr. Minshew added that there should be concerted efforts to “identify children, adolescents, and adults that have been missed and misdiagnosed, and to develop parent and self-identification screeners online and in office video-presentations.

Both Drs. Minshew and Van de Water are optimistic about the road ahead, but said that progress can't continue without federal funding, and the support of private foundations, as well as parents and patient advocacy groups.


President Bush signed into law the Animal Enterprise Terrorism Act (AETA), which increases penalties against animal rights advocates who threaten or commit violent acts against scientists conducting animal research or institutions associated with such research. The AAN supported the bill, said legislative affairs counsel Mike Amery.

The punishments range from a fine or one year in jail for interfering with the operations of an animal enterprise (if the damage does not exceed $10,000) to 20 years in jail if the offense results in serious physical injury to another person or in property damage that exceeds $1,000,000.

Jasper Daube, MD, chair of the AAN Task Force on Animals in Research, said the new penalties are hefty enough to deter some violent activists. He cited a February 2006 report from the Foundation for Biomedical Research, which states that illegal acts by animal rights extremists have increased dramatically since 1981. Amery said the AAN supported the bill through a coalition coordinated by the National Association for Biomedical Research, a nonprofit organization that advocates humane animal research.