Zeroing in on Reimbursement, Telemedicine, and Lower Drug Prices
May 10, 2021
Top Advocacy Priority Continues to be Cognitive Reimbursement
We’ve seen major changes in 2021 with the implementation of a new coding and payment structure for evaluation and management (E/M) services that simplifies documentation requirements and provides a substantial increase in reimbursement for neurologists—estimated at +7 percent. This change is a product of a multi-year AAN advocacy effort that reversed a previous proposal that was projected to be highly detrimental to neurology and other cognitive specialties.
However, the AAN knows the economic impact of COVID-19 continues to affect neurology practices across the country and is continually making sure Congress and the administration implement policies to prioritize patient access to care.
Since 2011, Medicare payments have been subject to a two-percent across-the-board reduction, known as the Medicare sequester. The sequester is required by the Budget Control Act and was originally intended to incentivize policymakers to find alternative ways to save money. Last year, Congress acted twice to temporarily avert this cut to alleviate some of the financial pressures placed on medical practices by the COVID-19 pandemic. The delay was set to expire on March 31, 2021, but President Joe Biden recently signed into law a bill to extend the delay through the end of 2021. This was a result of over 500 AAN members emailing their members of Congress using the AAN Advocacy Action Center, and the AAN’s advocacy along with other physician groups.
With the Medicare sequester scheduled to go into effect on January 1, 2022, the AAN is also anticipating other Medicare policies that could negatively affect reimbursement in 2022 by up to 10 percent, leading to a “Medicare cliff.” Nearly 200 AAN advocates are meeting virtually with their congressional offices next week at the annual Neurology on the Hill, and one of the priority issues is addressing this impending Medicare cliff. The AAN is urging Congress to act as soon as possible to avoid a substantial negative impact on neurologic patient care. You can follow #AANadvocacy on social media for the latest AAN activity in protecting Medicare reimbursement.
Preserving Telemedicine Gains Steam in Congress
On April 29, 50 senators reintroduced key telehealth legislation known as the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021 (S. S. 1512/ H.R. 2903). The CONNECT for Health Act aims to expand coverage of telehealth services through Medicare, make permanent COVID-19 telehealth flexibilities, improve health outcomes, and make it easier for patients to safely connect with their doctors. A one-page summary of this bill can be found here. The fact that half of the Senate supported this legislation at its outset is a testament to the broad support that telehealth has on Capitol Hill.
In another sign of progress, the Ways and Means Health Subcommittee held a hearing on April 28 focused exclusively on telehealth. Surprisingly, this is the first ever hearing devoted to telehealth within the Ways and Means Committee, which is the oldest standing committee in the House, founded in 1789. The AAN’s recent letter outlining our federal telehealth policy priorities was recognized by Health Subcommittee Chair Rep. Lloyd Doggett (D-TX-35) during his opening remarks (at 52:17 time mark here). This is already the second hearing on this issue in the 117th Congress, following one that took place in the House Energy and Commerce Committee in February.
To help build on this momentum, next week AAN advocates will urge Congress to support the CONNECT for Health Act (S. 1512/ H.R. 2903), along with the Telehealth Modernization Act (S. 368/ H.R. 1332), to help maintain access to telehealth for neurologic patients following the public health emergency.
Congress Debates Measures to Lower Rx Prices
Efforts to improve the affordability of prescription drugs were in the spotlight over the last few weeks, as both Democratic and Republican leadership began to release their proposals to lower the costs of prescription drugs in the United States.
- President Biden during the State of the Union: “Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower prices for prescription drugs. That won’t just help people on Medicare—it will lower prescription drug costs for everyone,” Biden said in his address. “Let’s get it done this year.”
- House Democrats reintroduced their signature bill, the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3).
- House Republicans reintroduced their signature bill, the Lower Costs, More Cures Act of 2021 (H.R. 19).
- Two House committees hosted hearings focused on this issue, including one featuring a person living with MS who highlighted her struggles to afford her expensive medications.
The AAN supports lowering the cost and improving access to prescription medications and is working closely with the key congressional champions on this issue as it moves forward.