How might Congress change the Medicare payment structure for physicians to enhance quality care and improve the structure of the physician workforce? This was the theme of the testimony by Bruce Sigsbee, MD, a trustee of the AAN Professional Association (Academy), before the House Committee on Energy and Commerce Subcommittee on Health in Washington, DC, on April 2.
Dr. Sigsbee, a neurologist in private practice in Rockport, ME, was the only practicing physician invited to testify before the subcommittee.
A week before the Academy's annual advocacy event — Neurology on the Hill — when 110 neurologists headed to Capitol Hill to meet with their Congressional representatives, Dr. Sigsbee and Mike Amery, the Academy's legislative lobbyist, met with several key members and staff on Capitol Hill, said Rod Larson, Chief Health Policy Officer at the AAN.
“One of the meetings was with the Energy and Commerce staff, which then led to the invitation to testify,” Larson said. “Providing testimony is particularly important because it gets our message on the record as Congress develops legislation to reform health care.”
Larson explained that the Academy has spent months developing documents reflecting “the unique concerns our members face in diagnosing and treating patients with difficult neurologic conditions,” including educational materials for policymakers on what neurologists do day to day, who neurology patients are, and the increasing need for well-trained neurologists to meet the burgeoning patient population as projected in the future.
“There is little doubt that they are interested in tying payment reform to the provision of high quality care,” he added, “so we included information on the quality initiatives developed by the AAN including practice guidelines, evidence-based medicine, and quality measures.”
In his testimony, Dr. Sigsbee discussed “the misaligned incentives of the current Medicare fee schedule, whose consequences include expansion and overuse of some healthcare services and underuse of others.”
“The focus should always be on what the best available evidence indicates the individual patient needs,” he said.
Dr. Sigsbee pointed out that the crisis in primary care also extends to neurology. “Both family practice and internal medicine US residency slots are only 50 percent filled by graduating US medical school seniors at a time that the number of graduating seniors is expanded.” Less than 5 percent of those who select internal medicine go into primary care, he pointed out, compared to 60 percent in 1996. He noted that only 52 percent of neurology residency slots are filled by US graduating seniors, making it difficult to recruit physicians.
“This imbalance leads to a problem with patient access to primary and cognitive care,” he said.
“The Medicare Payment Advisory Commission has recommended to Congress in a recent report that more resources, including increasing payment levels, should be directed to primary care. There is also considerable discussion on the medical home concept as a model for improving the provision and management of chronic conditions,” Larson said. That concept involves a system that would include a physician and team set up to coordinate care.
“The Academy has supported the principles for the patient-centered medical home, yet we also want to be sure policymakers understand that the practice of neurology faces many of the same concerns — namely the lack of payment incentives for cognitive medical specialties. The payment structure should recognize that neurologists have extensive training in evaluating patients, recommending treatment plans, managing very difficult neurologic conditions, and communicating with patients and their families — yet these time-intensive practices are not well-recognized today.”
“One of the main goals of health reform should be to return to a greater emphasis on face to face time between physician and patient, with more time for preventive care, counseling, and support for adjustment to illness, encouragement of lifestyle changes and less reflexive prescriptions, diagnostic tests and referrals,” said Dr. Sigsbee. “If successful, the result would be higher quality patient care, better outcomes, and lower cost.”
Larson said the Academy hopes that additional invitations to appear before the House and Senate health-related committees are possible. “The key to success is to get as many of our members involved in advocating with their own Congressional members on these important issues. What Congress does on health reform and specifically payment reform will impact the practice of neurology for many years so we must not miss this opportunity to tell our story and make sure our concerns are addressed.”
Visit the AAN Web site for updates on payment and health reform and how to assist in this important effort: www.aan.com/advocacy.