VOLUME 35 · ISSUE 1 · JANUARY 2022
Visit AAN.com/Covid19 for the latest pandemic information and resources to support you and your crucial work.
IN-PERSON SEATTLE MEETING TO OFFER A HOST OF NEW, UNIQUE EDUCATION OFFERINGS More than 160 Courses! We’re eager to be back together in person for the Annual Meeting in Seattle where we will bring back some of your favorite interactive learning formats from previous Annual Meetings while introducing new opportunities employing exciting novel teaching techniques. Look for more than 160 courses covering 23 topics—including fresh topics in anti-amyloid therapy, autoimmune epilepsy, seizures in multiple disorders, COVID issues across disciplines, and palliative care in the Neuro ICU—and offering all the CME you’ll need for the year! Continued on page 12
Seattle: April 2 –7 Virtual Experience: April 24–26
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Updated Practice Advisory Addresses Stopping Antiseizure Medicine
Annual Meeting Emerging Science Abstract Deadline Is January 26
“Practice Advisory: Antiseizure Medication Withdrawal in Seizure-free Patients (Update)” was published in the Neurology ® journal online on December 6 and in print on December 7, 2021. According to the advisory, people with epilepsy who have been seizure free (two years for adults and 1.5 to two years for children/adolescents) and stop use of antiseizure medicine may be at risk of having seizures happen again. Rarely, the medicine may no longer work if they start using it again. Continued on page 17
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New Principal Care Management Service Codes Available January 1, 2022
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January 26 at 11:59 p.m. CT is the deadline to submit previously unpublished research in which key aspects must have been completed after the October 11, 2021, abstract submission deadline. Submissions for the 2022 Emerging Science Program at the Annual Meeting in Seattle should showcase timely, significant, and innovative content warranting expedited presentation. Visit AAN.com/22Abstracts to learn more and to submit. For questions, contact Katie Anderson at science@aan.com.
JANUARY
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2022 Promises to Be a Busy Year for AAN Advocacy Efforts
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16 Apply by January 14
for AAN Health Care Equity Scholarship
AANnews · January 2022
January Highlights
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The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction.
Many neurology practices already collect cross-cutting measure data. A cross-cutting measure is a measure that is broadly applicable across multiple providers and neurology subspecialties.
The Vision of the AAN is to be indispensable to our members. Contact Information American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415
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Phone: (800) 879-1960 (toll free) (612) 928-6000 (international) Email:
memberservices@aan.com
Website: AAN.com For advertising rates, contact: Michael J. O’Brien II Account/Relationship Manager Wolters Kluwer
Annual Meeting Industry Partnerships Offer Sneak Peek into Latest Research, Products
Seattle: April 2 –7 Virtual Experience: April 24–26
With so many excellent ways to learn and network at the 2022 Annual Meeting in Seattle, don’t forget that one of the best ways to get a sneak peek at the newest and most cutting-edge research and products advancing patient treatment and care is through the Academy’s valuable industry partners.
Phone: (978) 578-4514 Email:
Michael.Obrien @wolterskluwer.com
AAN Chief Executive Officer: Mary E. Post, MBA, CAE
Make Use of Axon Registry Cross-cutting Measures
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merging Leaders Graduate Awarded E NINDS Grant for First Trial of Its Kind
2019 Emerging Leadership Program (ELP) graduate Gregory S. Day, MD, MSc, MSCI, FAAN, together with colleagues, has been awarded a large U01 grant from the National Institute of Neurological Disorders and Stroke (NINDS) to conduct the first randomized placebo-controlled trial in patients with anti-NMDA receptor encephalitis—the ExTINGUISH Trial.
Editor-in-Chief: Melissa W. Ko, MD, FAAN, CPE Managing Editor: Angela M. Babb, MS, CAE, APR Editor: Tim Streeter Writers: Ryan Knoke and Sarah Parsons Designer: Siu Lee Email: aannews@aan.com AANnews® is published monthly by the American Academy of Neurology for its 36,000 members worldwide. Access this magazine and other AAN publications online at AAN.com. The American Academy of Neurology ’ s registered trademarks and service marks are registered in the United States and various other countries around the world. “American Brain Foundation” is a registered service mark of the American Brain Foundation and is registered in the United States. The inclusion of advertisements and/or promotions of Sponsors and other Internet sites or resources that offer content, goods, or services on the Website does not imply endorsement of the advertised/promoted products or services by AAN.
News Briefs AAN in the News A Neurology® study suggesting an anti-inflammatory diet may prevent dementia was covered by NBC’s “Today,” “CBS Mornings,” and hundreds of affiliates. Another Neurology study showing a diet rich in fish can keep your brain sharp cast a wide net of coverage, from Martha Stewart to US News & World Report. The new AAN guideline for treatment of early Parkinson’s disease was covered by Yahoo! and the Associated Press.
Research Program Applications Surpass 2021 The AAN received more than 150 applications for the 2022 Research Program, exceeding the total for 2021. The AAN will award over $4.5 million across 26 scholarships.
PLEASE RECYCLE POLYBAG WHERE #5 PLASTIC IS ACCEPTED
PRESIDENT'S COLUMN New Year’s Well Wishes According to numerologists, the year 2022 portends harmony and balance. As I reflect on the events of the past two years, I sincerely hope that proves to be true. In 2020, unimaginable stressors subjected health care professionals to feeling off-kilter at best and to severe emotional distress at worst. And this past year was fraught with new, unanticipated challenges as the pandemic ploughed on, vaccines became politicized, and employees quit their jobs in record-breaking numbers. The Great Resignation is affecting every sector of the health care workforce1 and is adding to our overburdened workloads. Neurologists, already saddled in pre-pandemic times with one of the highest burnout rates of all specialties,2 are now working with fewer staff and colleagues3 and face waning resilience. While research in the field of physician wellness has evolved over the past decade and awareness has improved, my conversations with neurologists across the country belie those efforts. New priorities borne of COVID-19 have muted the outcry for change and left best intentions broadly neglected. Instead, I have been told of a pressing emphasis on productivity for those with clinical obligations and inadequate time for educational and research responsibilities for those with hybrid roles. While some neurologists are leaving their positions for non-clinical jobs, others are seeking work that offers more flexibility or part-time employment. The exodus is worrisome—not just for its present consequences—but for its potential impact on our neurologist pipeline. According to Tait Shanafelt, MD, who pioneered the physician well-being movement, now is the time for action.4 He urges organizations to embrace wellness as a core value and the profession, leaders, organizations, and individuals to commit to change. Here at the AAN, we have created a Wellness Subcommittee, recruited wide expertise in its membership, and will be reaching out to you over time with new and expanded resources and initiatives for your consideration. Jennifer Bickel, MD, FAAN, FAHS, its chair, aims to develop multiple endeavors that promote self-care and continue to improve the environment in which neurologists work. The subcommittee hopes to go beyond reducing burnout to determining how it can assist all members to thrive at work. Dr. Bickel, who serves as chief wellness officer at the Moffitt Cancer Center in Tampa, also points out that sustainable wellness achievements depend on leadership support and buy-in. Toward that end, an AAN-sponsored Neurology Department Chairs Summit held in March of 2022 will focus on challenges and opportunities in academic neurology in a post-pandemic world, including faculty and trainee wellness. The chairs will also discuss building and supporting a diverse workforce, mentoring, and using
leadership platforms to embrace new care models and academic innovations, said S. Andrew Josephson, MD, FAAN, who leads the AAN Department Chair Subcommittee. Under the guidance of the Wellness Subcommittee, the 2022 Annual Meeting in Seattle will continue to provide education Avitzur and resources for self-care and community while expanding to include the challenging topics that can detract from our joy in practicing medicine. In future years, the Wellness Subcommittee will provide neurology leaders with guidance on how to best incorporate wellness into the workplace and also provide individuals with advice on how to determine if their workplace is doing what is necessary to improve the opportunity for professional well-being. At the individual level, Shanafelt describes the transition to Wellbeing 2.0 as one which will require a mindful consideration of how to incorporate self-compassion, set boundaries, and impose self-care alongside other professional values. He encourages us to lean on each other and create not only connection, but also a community of shared experience, mutual support, and care. Recently, I have begun to hear more colleagues speak of intentionally ridding themselves of perfectionism, incorporating mindfulness, and spending time “off-the-grid.” The pandemic has led to widespread introspection about work-life balance and a renewed commitment to the practice of self-kindness. There has been a focus on family, time away from work, avocations, and other activities that feed the soul. I hope this becomes a movement as culture change is necessary, not only for our individual survival during a multiyear pandemic, but for the preservation of our profession. Some say that 2022 also means ‘Hope is Ahead,’ and as I contemplate the coming year, I hope it brings health, harmony, and balance to all of you. In that spirit, I have asked several colleagues to share their tips and New Year’s resolutions focused on wellness. May their words inspire you as they have me. My best wishes to all of you for happiness and well-being in the new year.
Orly Avitzur, MD, MBA, FAAN President, AAN oavitzur@aan.com @OrlyA on Twitter
1. Avitzur O. For Some Neurologists, COVID-19 Has Prompted an ‘Existential Crisis,’ Now They've Revamped How and Where They Work. Neurol Today. 2021;1(12):1-30. 2. Busis N, Shanafelt TD, Keran CM, et al. Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology 2017;88:797–808. 3. Avitzur O. The Great Resignation: The Workforce Exodus Hits Neurology Practice and Research. Neurol Today. 2021;1(12):1-30. 4. Shanafelt TD. Physician Well-being 2.0: Where Are We and Where Are We Going? Mayo Clinic Proceedings October 2021:96(10)2682-2693.
PRESIDENT'S COLUMN You are more empowered than you might think. Consider your practice's pain points and ask yourself, “Do I have to do things this way?” Chances are some of these sources of friction come about from habit and assumption. If you step back and ponder a bit, you may come up with better workflows. Here's an example: revising your outpatient EHR documentation processes to reflect the streamlined 2021 outpatient CPT guidelines. ―Neil A. Busis, MD, FAAN In my opinion, I would say the key to avoiding burnout is balance. Sir William Osler said, “The young doctor should look about early for an avocation, a pastime, that will take him away from patients, pills, and potions.” Just like neurology is our “vocation,” every physician needs an “avocation.” You don’t have to be particularly gifted for it or a superstar at it, and you probably won’t be, but you just have to do something that’s not work and do it consistently. Setting the same amount of time for this every time you do it is also helpful. It could be as little as 30 minutes. Just do what you can. ―Benjamin R. Kummer, MD
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Half of the time, my New Year’s resolutions fail. Instead, I’m doing a lifestyle change by having a mindful minute before I start my day and doing a gratitude exercise before I hit the hay. ―M. Cristina C. Victorio, MD, FAHS I make sure to take off one day per month and actively do nothing work related. ―Le Hua, MD, FAAN
My wellness goal is to find more time to exercise and take better care of my body. My advice is to understand the impact of not losing hope on well-being and how it can impact resilience. Focus on resilience. Here are two quotes from movies I like about hope. “It's the greatest gift we have: to bear their pain without breaking. And it comes from the most human part of us: hope.” —Charles Xavier from Days of Future Past
My advice is to always take a walk in the middle of the day, cold or hot, rainy or sunny. It can be for as little as 15 minutes. It refreshes the brain and allows one to think about things other than work. I think that it is best to do it alone! No matter how busy my days may be, I always find that 15 minutes. ―Daniel M. Feinberg, MD, FAAN
“It's easy to feel hopeful on a beautiful day like today, but there will be dark days ahead of us, too. There will be days when you feel alone, and that is when hope is needed most. No matter how buried it gets or how lost you feel, you must promise me that you will hold onto hope. Keep it alive.” —Gwen Stacy from Amazing Spider Man 2 ―Anup Patel, MD, FAAN
My advice to my peers facing the intense pressures of our current work environment is to remember about the importance of balance and listen to the advice we give our own patients: make time to exercise, to practice mindfulness, and feed our own souls. There will always be more notes to finish and Epic requests to reply to, so we need to consciously pick a time every day to step back and take care of you. ―Drew Falconer, MD
The advice I would give members to address burnout is to make a list of things that bring you joy and get rid of things that don’t make you happy. Prioritize what is important to you and remember to do what makes you happy and fulfilled at work. —May A. Kim-Tenser, MD, MHA, FAHA
AANnews • January 2022
My resolution is to continue to try to take a few hours each week that are just for me. I started going to Pilates in the evenings last year. In addition to all the physical benefits, the mental benefits of being able to clear my mind and focus on my breathing has made me more effective in my work life and overall calmer, happier, and more centered. ―Allison L. Weathers, MD, FAAN Goal: Be more mindful and present. Tips: Go on more walks outside, use Headspace app or Calm for guided meditation, drink water more frequently. —Sarah Tanveer, PhD Candidate/Graduate Research Assistant Often systemic challenges (high drug costs, prior authorization requirements, hospital COVID visitor restrictions, etc.) impede clinical practice and cause moral distress. My New Year’s resolution is to take at least one small concrete step per month (whether conducting governmental advocacy, participating in clinical research, educating residents, writing an op-ed or opinion piece, or mentoring a colleague) to improve the health care system. ―Benjamin Tolchin, MD, FAAN
Start on time, finish on time. Avoid running late, don’t overbook, and do daily huddle with staff. ―Niranjan Singh, MD, FAAN
This year, I started journaling for a few minutes every morning and evening, writing down what I’m grateful for, highlights of my day, how the day could have gone better, and a positive self-affirmation. It has helped me focus on the good, but it has also guided me in clarifying goals, building on healthy habits, and taking action. It is a moment of peace and contemplation that belongs to me and starts and closes each busy day. ―Kara Stavros, MD My path to continuous wellness results from learning new things outside of medicine. I have tried and have loved: being a background actor in a film, taking coursework in a nonmedical field, joining a portraiture drawing class, learning pottery, trying my hand at sewing projects, watching a documentary or reading a book on the life of a person from a different background/life than mine. The outcomes? New professional and personal paths have organically emerged out of the status quo that I could not have ever dreamed or imagined! Seize the adventure within you. ―Melissa W. Ko, MD, FAAN, CPE My New Year's resolution is to make my family a priority. This past year has been all about keeping my small practice afloat and it has required most of my energy. While we are still needing in growth, we are in a much better place than we were a year ago. So, I am promising to spend more time at home...and at Zumba...I have a problem. Spending time doing what I love is what matters most. —Alison Alford, MD, FAAN Becoming involved, both at the AAN and within my local hospital system, has been my antidote to burnout in recent years. Although we cannot fix all the problems plaguing our practice and career, trying to contribute to solutions has been very rewarding. In addition, working with some amazing colleagues across the AAN has been inspirational and creates a new level of collegiality. ―Michael Markowski, DO, FAAN
AANnews • January 2022 5
PRACTICE New Principal Care Management Service Codes Available January 1, 2022 While the next phase of significant revisions to the E/M code set is not slated for another year, a new set of principal care management (PCM) CPT codes will bring opportunities for neurologists and neurology APPs to report their time spent managing the care of a patient with a single high-risk disease. The PCM codes differ from existing care management services which require the management of multiple high-risk conditions or diseases. The AAN is pleased with the addition of the new codes as our members often treat patient with a single condition that requires significant care management activities. Effective January 1, 2022, four new codes will be available: two for reporting physician time and two for reporting clinical staff time: 99424: used to report the first 30 minutes provided personally by a physician or qualified health care professional (QHP), per calendar month +99425: used to report each additional 30 minutes provided personally by a physician or other QHP, per calendar month 99426: used to report the first 30 minutes of clinical staff time directed by physician or other QHP, per calendar month +99427: used to report each additional 30 minutes of clinical staff time directed by a physician or other QHP, per calendar month As is the case with existing chronic care management services, PCM services can only be reported when certain required elements are met: One complex chronic condition expected to last at least three months, and that places the patient at significant risk of hospitalization, acute exacerbation or decompensation, functional decline, or death
The condition requires development, monitoring, or revision of a disease-specific care plan The condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities Ongoing communication and care coordination between relevant practitioners furnishing care
Coding tips to keep in mind when determining if the new codes are appropriate for your practice include: PCM services are reported for total time per calendar month. 99424 and 99426 are reported only once per calendar month. PCM services less than 30 minutes in a calendar month are not reported separately. 99424–99427 may be reported by different physicians or qualified health care professionals in the same calendar month for the same patient. Documentation should reflect coordination among relevant managing clinicians. Visit AAN.com/EM for additional E/M coding resources.
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AANnews • January 2022
Be Aware of QPP Changes for 2022 The Centers for Medicare & Medicaid Services released its updates to the Quality Payment Program (QPP) for the 2022 performance year. Here are the key changes to keep in mind as your practice prepares for 2022 participation in the QPP in either the Merit-based Incentive Payment System (MIPS) or Alternative Payment Model (APM) tracks. Performance in 2022 will affect reimbursements on Medicare Part B charges in 2024. Merit-based Incentive Payment System (MIPS) Track
Seattle: April 2 –7 Virtual Experience: April 24–26
Get Ready for the Great Neuro Reunion!
Merit-based Incentive Payment System (MIPS) eligible clinicians must achieve 75 points to avoid a negative payment adjustment. This is a significant increase from the 60-point performance threshold in 2021. To be eligible for an exceptional bonus is 2022, participants must achieve 89 points.
Reunite with your neurology community from around the globe at the Annual Meeting to experience the most comprehensive educational offerings and largest scientific program in the field with options to participate in person, virtually, or both.
The maximum payment adjustment for the 2021 reporting year is +/-9 percent, the same as 2021.
Save when you register by February 17!
The MIPS Quality component will account for 30 percent of the overall MIPS score, down from 40 percent, while the Cost component will increase to 30 percent of the total MIPS score, up from 20 percent in 2020. Several updates to the MIPS Quality component were finalized, including removal of the three points for measures that do not meet case minimum requirements and removal of bonus points for reporting additional outcome or high-priority measures. The Improvement Activities (IAs) component expanded to include seven new IAs, three of which relate to promoting health equity. Small practices (15 clinicians or less) are automatically exempt from the Promoting Interoperability component starting in 2022. Alternative Payment Models (APM) Track For the Alternative Payment Model (APM) track, CMS will sunset the CMS Web Interface as a reporting mechanism for APM entities, beginning in 2024. MIPS Value Pathways (MVPs) A new QPP pathway called MIPS Value Pathways (MVPs) was finalized to start in 2023. This pathway for MIPS clinicians includes sets of defined measures and activities related to a specialty or condition. An MVP on “Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes” will be available for reporting starting in 2023. The AAN is dedicated to providing members with tools and resources to meet reporting requirements, avoid penalties, and achieve success in the QPP. For more information and up-to-date QPP resources, visit AAN.com/QPP or email practice@aan.com.
AAN.com/AM
PRACTICE Make Use of Axon Registry Cross-cutting Measures Many neurology practices already collect cross-cutting measure data. A cross-cutting measure is a measure that is broadly applicable across multiple providers and neurology subspecialties. For example, the denominator may apply to patients diagnosed with multiple sclerosis, epilepsy, Parkinson disease, dementia, and headache or the denominator may apply to all visits for a patient seen at a neurology clinic. The Axon Registry ® is available to assist in gathering data needed for cross-cutting measures, as well as diseasespecific measures. By participating in the Axon Registry, you will be able to benchmark your performance and compare how your performance to your neurology peers. The Axon Registry is a quality improvement registry for neurology that is designated by the Centers for Medicare & Medicaid Services as a Qualified Clinical Data Registry. For 2022, there are 49 Axon Registry quality measures, of which seven are cross-cutting measures. These measures can be especially helpful for neurology practices that have small patient volumes for disease-specific measures since the cross-cutting measures in the Axon Registry are applicable to broad populations of neurologic patients. Below are the seven cross-cutting measures in the Axon Registry; measure specifications can be found at AAN.com/Axon. These measures are clinically relevant, easily implemented, and are broadly applicable. Axon 17: Documentation of Current Medications in the Medical Record Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. Axon 18: Advanced Care Plan Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record, or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. Axon 40: Quality of Life Assessment Percentage of patients age 18 years and older with a neurologic condition who had a PROMIS-29 administered, the results reviewed, and had appropriate follow up. Axon 52: Preventative Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months AND who received brief counseling if identified as an unhealthy alcohol user.
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AANnews • January 2022
Axon 54: Quality of Life for Patients with Neurologic Conditions Percentage of patients whose quality-of-life assessment results are maintained or improved during the measurement period. Axon 59: Use of High-risk Medications in the Elderly Percentage of patients 65 years of age and older who were ordered at least two of the same high-risk medications. Axon 64: Patient Reported Falls and Plan of Care Percentage of patients (or caregivers as appropriate) with an active diagnosis of a movement disorder, multiple sclerosis, a neuromuscular disorder, dementia, or stroke who reported a fall occurred and those who fell had a plan of care for falls documented at every visit. These seven cross-cutting measures can be used for internal quality improvement initiatives, continuing certification, and for MIPS submission through the Axon Registry. You may already be capturing this data for MIPS reporting and transitioning to Axon Registry would support your existing data collection needs while expanding opportunities to collect neurologyspecific data. If you are interested in joining the Axon Registry, contact registry@aan.com.
ADVOCACY 2022 Promises to Be a Busy Year for AAN Advocacy Efforts As the nation approaches the third year of the COVID-19 pandemic and public health emergency, the AAN will continue to work with Congress, federal regulatory agencies, and state legislatures to affect changes that improve the working conditions of neurologists and treatment of their patients. As a result of the mid-term elections on November 8, party control of the House of Representatives and Senate could significantly change the policy outlook. All seats in the House are up for election as members serve two-year terms. Elected for six-year terms, 34 of the Senate’s 100 seats are in play. Members of Congress will get busy campaigning and there will be less opportunity to pass legislation later in the year. Once a bill does become law, the executive branch of government determines how to implement it. Much of the policy affecting health care is executed by government regulatory agencies within the Department of Health and Human Services (including the Centers for Medicare & Medicaid Services, the Food and Drug Administration, etc.). We expect that these agencies will continue to address the ongoing COVID-19 response and recovery and the impact on the neurology workforce. Implementing permanent telehealth flexibilities has been a priority for the AAN since the beginning of the pandemic and we have successfully maintained current short-term extensions of Medicare coverage. These extensions are not guaranteed through 2022, however, so we will persist in advocating for them. CMS has raised the monthly Medicare premium from $148.50 in 2021 to $170.10 in 2022, based partly on contingency for future coverage of aducanumab (Aduhelm) for Alzheimer’s disease. The draft Medicare National Coverage Determination is expected in January, followed by a 60-day comment period, with the final National Coverage Determination in the spring. This will have important implications for future Alzheimer’s drugs and other neurology drug development and you can be sure the AAN will comment on this and any other considerations. If you missed the Academy’s recent position statement on the ethical guidance on aducanumab, refer to the November 17, 2021, online issue of Neurology ® at Neurology.org or the December issue of AANnews®. The AAN also will continue its vigilance to protect the role of the neurologist. We have increasingly heard of unqualified professionals providing neurologic services across the US. We will be advocating for the value of neurologic care to combat these infringements on scope of practice and to ensure patients receive high-quality appropriate care. For more information recapping 2021 and previewing 2022, advocacy staff have recorded Neurology Minute® episodes that you can access at AAN.com/education/neurologyminute-podcast.
2021 by the Numbers
60+
sign-on letters to Congress and federal agencies—these are letters led by other organizations and coalitions that the AAN joined
25+
comment letters to Congress and federal agencies – these letters are authored by the AAN and represent the unique neurology perspective
2,300+
AAN members used the AAN Advocacy Action Center to email Congress, post on social media, or submit a story on a policy issue
5,000+
AAN member emails to Congress (a record)
NEARLY
10 MILLION impressions of #AANadvocacy on Twitter
AANnews • January 2022 9
ADVOCACY
Capitol Hill Report Capitol Hill Report presents regular updates on legislative and regulatory actions and how the Academy ensures that the voice of neurology is heard on Capitol Hill. It is emailed to US members twice monthly and is posted at AAN.com/view/HillReport. Below are some recent highlights.
Medicare Cliff Averted Great news for neurology! Congress just averted the "Medicare Cliff," which threatened to reduce Medicare reimbursements by nearly 10 percent on January 1, 2022, by passing S. 610, the Protecting Medicare and American Farmers from Sequester Cuts Act. The AAN has long argued that a reduction of this magnitude would be catastrophic for the viability of neurology practices around the country and patient access to care. This legislation was only possible due to the significant advocacy campaign conducted by the physician community, which included hundreds of AAN members responding to action alerts and advocating virtually through Neurology on the Hill and the AAN's Legislative Summit. This legislation will alleviate most of the Medicare Cliff in the short term, but our work is not done. The AAN will continue to advocate for further relief in the short term along with other systematic reforms to make physician reimbursements more sustainable in the long term.
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AANnews • January 2022
Summary of S. 610, the Protecting Medicare and American Farmers from Sequester Cuts Act Medicare Fee Schedule Relief—three-percent increase for Medicare payments for 2022 This program was initially established in 2021 as a one-time payment of 3.75 percent—fortunately, we convinced Congress that it must remain in effect, albeit at a slightly smaller figure Medicare Sequestration—delayed a two-percent cut to Medicare payments until April when a phased in implementation is now scheduled Statutory Pay-As-You-Go (PAYGO) Act of 2010—delayed a four-percent cut until 2023 You can stay up to date on the AAN advocacy efforts by reading Capitol Hill Report and following #AANadvocacy on social media.
EVENTS Annual Meeting Industry Partnerships Offer Sneak Peek into Latest Research, Products With so many excellent ways to learn and network at the 2022 Annual Meeting in Seattle, don’t forget that one of the best ways to get a sneak peek at the newest and most cutting-edge research and products advancing patient treatment and care is through the Academy’s valuable industry partners. In addition to tirelessly working to improve the lives of patients and caregivers, industry partners also provide support that helps ensure the excellence that has become synonymous with an AAN Annual Meeting experience. As you plan your week at the Great Neuro Reunion in Seattle this April 2 through 7, make room in your schedule for these not-to-be-missed opportunities.
Seattle: April 2 –7 Virtual Experience: April 24–26
Exhibit Hall
Industry Therapeutic Updates
Engage with a diverse range of organizations, including non-profits and patient advocacy groups offering unique resources and latest products to improve patient care, help caregivers, and strengthen the neurology community. Hospital networks will offer opportunities for individuals looking for a career change—or change of scenery—and pharmaceuticals and medical device companies will showcase the latest data on research and product development that are changing the face of neurology. The Exhibit Hall will be open Sunday through Wednesday of the meeting. Visit AAN.com for more information on participating companies.
Industry Therapeutic Updates (ITUs) are evening programs that allow an opportunity for pharmaceutical companies, device companies, or other appropriately related organizations comprising the AAN Industry Roundtable to share information about pipeline activity and promote emerging therapies and projects with Annual Meeting attendees. All programming is in accordance with the standards set for the industry by the Food and Drug Administration and will take place at designated hotels on Saturday, Monday, Tuesday, and Wednesday evenings beginning at 7:00 p.m. Visit AAN.com for more information about programs, times, and host companies.
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Community Education
Professional Growth
Advocacy
Practice Management
Wellness Research
AAN.com/Membership
YOUR SOURCE FOR
SUCCESS Only AAN membership offers access to the highest quality resources from the world’s largest and most trusted community of neurology professionals.
Join or renew today.
EVENTS In-person Seattle Meeting to Offer a Host of New, Unique Education Offerings Continued from cover eLearning Opportunities With the trend in digital learning continuing to rise, sharpen your skills in small groups and take part in hands-on sessions such as How to Create Your Own NeuroByte and How to Write and Review Multiple-choice Exam Questions. Epilepsy/Seizure Semiology Course This course consists of a series of videos designed to help clinicians distinguish between epileptic and non-epileptic seizures. IDEAS: Theatre for Health Care Equity This interactive opportunity allows participants to engage in actions and words to counterbalance racism by offering guidance to actors in what to do in specific situations. Learner Engagement Centers We’re taking conference education to a new level with these dedicated spaces for informal and formal engaged learning, flexible scheduling, and longer form content through lectures, roundtable discussions, and digital
displays. Distinct areas include: Academic Exchange, Leadership University, Research Connections, The Neuro Trainee and Educator Junction, and Practice and Policy Engagement Center. Skills Workshops We’re excited to bring back these fourhour, interactive, hands-on programs, and will be offering six different learning and practice opportunities in 2022 on topics including: botulinum toxin injections for headache and trigger point injections, EMG-guided injections for spasticity and dystonia, deep brain stimulation, and EMG/nerve conduction. An additional fee is required to attend, and space is limited, so secure your spot now. Experiential Learning Areas Two unique areas for interactive learning designed to engage you intellectually, emotionally, and socially. This year’s areas include: Head Talks Health, Edutainment, Amusement, and Discussion are the focus of this area, providing lively panels, games, and more.
AANe-news. Because Your Time Is Valuable. Sent to your email address the second and fourth Wednesday of each month, AANe-news™ delivers the latest top headlines and resources from the Academy so you can quickly scan and connect directly with the information you need Another members-only solution from your AAN.
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AANnews • January 2022
Seattle: April 2 –7 Virtual Experience: April 24–26 Live Well Taking care of patients starts with taking care of you. Achieving balance and well-being in all aspects of your life extends to the quality of care you provide your patients. This area is designed to help you explore new ways to achieve success in your career and personal life. Visit AAN.com/AM to learn more about 2022 Annual Meeting education opportunities taking place in person in Seattle—and register before February 17 for the very best rates and no-risk registration for Seattle registration packages!
EDUCATION Emerging Leaders Graduate Awarded NINDS Grant for First Trial of Its Kind 2019 Emerging Leadership Program (ELP) graduate Gregory S. Day, MD, MSc, MSCI, FAAN, together with colleagues, has been awarded a large U01 grant from the National Institute of Neurological Disorders and Stroke (NINDS) to conduct the first randomized placebo-controlled trial in patients with anti-NMDA receptor encephalitis—the ExTINGUISH Trial. ExTINGUISH will be part of the NINDS-funded Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT), a network of 20 US and two European partners collaborating to increase efficiency of clinical trials, expand the capability of NINDS to test promising new therapies, and respond quickly as opportunities arise to test promising new treatments for people with neurologic disorders. The network includes clinical trial sites, a clinical coordinating center, and a data coordinating center. Day, the director of behavioral neurology in the Department of Neurology at Mayo Clinic in Jacksonville, FL, and assistant professor at Mayo Clinic College of Medicine and Science, will co-lead this multisite international study with his colleague and Neurology ® Section Podcast Editor Stacey L. Clardy, MD, PhD, FAAN, of the University of Utah. We sat down with Day to learn more about how he feels his involvement in the Emerging Leaders Program helped him achieve this success. Can you explain specific skill(s) you learned during the Emerging Leaders Program that you feel were particularly useful throughout the ExTINGUISH process? “I learned how to optimally communicate with team members from different personal backgrounds, about time management, and about setting and communicating priorities across a team. I also learned how to empower and enable team members to achieve their potential.”
The AAN Emerging Leaders Program is designed to identify, engage, and mentor talented early-career members who have the disposition to lead and are interested in future roles within the AAN and the field of neurology. Learn more about at AAN.com/ELP.
Day
Thank you to the organizations supporting this program in part: Alexion, AstraZeneca Rare Disease Allergan, an AbbVie Company Alnylam Pharmaceuticals, Inc. argenx Bristol Myers Squibb Sanofi Genzyme UCB, Inc.
In what ways were you able to apply some of these skills to your work on and subsequent success of receiving this honor for ExTINGUISH? “Framing the ExTINGUISH Trial and applying for grant funding to support this multicenter clinical trial provided an opportunity to work with people from varied backgrounds—including industry, academia, health care, and government—in multiple countries. Skills gained through participation in the ELP equipped me to work with a broad team to adopt a shared vision and mission, and to develop a plan that allowed us to reach our goals. Naturally, with a project of this size and scope, skills in ‘diplomacy’— such as conflict resolution and consensus building—also proved essential. Of course, now the real challenge comes: launching and conducting this first-in-disease study!” You can learn more about ExTINGUISH at Neuronext.org/ projects/nn111-extinguish.
AANnews • January 2022 13
EDUCATION Longtime Leader of AAN Education, Science, and Conferences Steps Down Christine E. Phelps, deputy executive director of the American Academy of Neurology Institute, stepped down at the end of December 2021 after 35 years with the AAN.
Phelps joined the AAN in 1986 as part of the Membership and Technology teams. Over the years she rose through the ranks to lead the education, science, and conference activities of the Academy. This included the Annual Meeting, which grew from 4,300 attendees in 1986 to 15,150 participants in 2019 as Phelps and her staff constantly innovated the event with an adroit responsiveness to the evolving needs of attendees, such as more interactive programming, a simplified fee structure, and wellness activities. Under her leadership the AAN created popular regional conferences in the fall and winter and the more recent Sports Concussion Conference and APP Conference. Phelps also oversaw the creation of a robust eLearning program that delivers online education products that reach around the world. These programs have become even more crucial to members during the COVID-19 pandemic, which forced the cancellation of the 2020 Annual Meeting. But Phelps and her staff created a virtual Annual Meeting for 2021 that rivaled the attendance records of past in-person Annual Meetings and helped fulfill the CME needs of the AAN’s 36,000 members. Phelps was also responsible for ensuring the AAN Institute’s education programs received Accreditation with Commendation—the highest level of recognition for a CME provider—from the Accreditation Council for Continuing Medical Education. Through her close work with numerous AAN committees and subcommittees, Phelps developed strong relationships with
member leaders and was a connector in encouraging and helping members get more involved with the Academy. She was instrumental in the development of the AAN Leadership Program, which has nurtured hundreds of neurology professionals to become leaders in the Academy and in their own institutions. And for decades, Phelps has been a strong leader in ensuring the AAN focused on inclusion, diversity, equity, anti-racism, and social justice (IDEAS). Also during her time with the AAN, Phelps helped establish the annual Brain Health Fair held during Annual Meeting in host cities to promote brain health and the work of neurology in local communities. In 2016, Phelps received the national Community Advocate of the Year award from the PCMA Foundation for her work on the Brain Health Fair. She led the AAN Foundation through its successful rebranding as the American Brain Foundation and facilitated strong relationships between the AAN and the American Board of Psychiatry and Neurology and the National Institute of Neurological Disorders and Stroke. “Christy’s knowledge, creativity, and deep dedication to the vision, mission, and goals of the AAN have had a profound impact on our success for more than three decades,” said Chief Executive Officer Mary E. Post, MBA, CAE. “We are so thankful for her leadership and guidance in working with countless members and staff over her career with the AAN, and we wish her well.”
neurology Neurology ® Podcast: PODCAST®
20 Minutes Pack a Punch! Subscribe and download the latest podcast at Neurology.org/podcast
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AANnews • January 2022
Applications Open for Certification in Headache Medicine The United Council for Neurologic Subspecialties (UCNS) is now accepting applications for certification in Headache Medicine through April 1, 2022. The four-hour, 200 multiple-choice question certification exam will take place the week of October 10 through 14, 2022, and will be administered online with virtual live proctoring. The 2022 examination schedule is: Application period: January 1–April 1 Extended application deadline ($500 fee applies): April 15 Examination registration period: June 1 Examination week: October 10–14
Continuum Seeks Peer Reviewers Continuum® is calling for peer reviewers. Editors and authors of Continuum depend on peer reviewer feedback to maintain the high quality of content. Inquiries from practicing neurologists in all subspecialties are encouraged, and applicants will be added to Continuum’s peer review database as potential future reviewers. Two peer reviewers are typically appointed to review each Continuum issue. Reviewers have approximately two to four weeks to review batches of articles at a time. All peer reviewers will receive a complimentary copy of the issue they review. Anyone interested in this opportunity should contact Cassandra Grandahl at ContinuumCME @aan.com.
Visit UCNS.org/HMcertification for more information on eligibility and to apply.
Medical Students Speak out for Neuroscience Is… Rewarding Day The AAN celebrated Neuroscience Is…™ Rewarding Day on November 30. As part of the AAN’s effort to promote the day, students and the general neurology community were asked to post in social media with the hashtags #NeuroscienceIs and #FutureNeurologist on why they find neuroscience rewarding. November 30, 1840, is the birthday of German neurologist Wilhelm Henrich Erb, MD, who is credited with popularizing the reflex hammer so widely used in today’s neurological exam and symbolizes the field of neurology.
osta e Is… Angel Ac Neuroscienc
Neuroscience Is… Tony Chan g Neuroscience Is… Tehniyat Baig
AANnews • January 2022 15
MEMBERSHIP
Apply by January 14 for AAN Health Care Equity Scholarship Inclusion is the reason the AAN was founded. To be an organization that is the home for all neurologists. It is what makes us stronger. In 2020, the AAN Board of Directors adopted a new goal to be a fully inclusive, deliberately diverse, and anti-racist organization. We also expanded our core values of Inclusion, Diversity and Equity to now include, Anti-racism, and Social Justice, otherwise known as IDEAS. We are working hard to achieve this new goal and demonstrate these expanded values through an actionable roadmap approved by the Board. Members should look for updates in AANnews to follow our progress. The AAN seeks applicants for its 2022–2023 Health Care Equity Scholarship Program. Scholarship recipients will participate in a multi-faceted program guided to continue personal development and to help the participants create a customized roadmap aimed at mitigating health care disparities. The deadline to apply is January 14. The award for scholarship participants includes 2022 Annual Meeting registration, $1,000 travel stipend, and a certificate of recognition from the AAN. The program will kick off at the 2022 Annual Meeting and will meet virtually three times until graduation in March 2023. As part of the Health Care Equity Scholarship program, each member of the scholarship cohort will work on developing a project or initiative at their institution addressing or identifying a health care disparity. We ask that each member complete a brief form to provide further detail on the project. The cohort
will have a series of check-ins to share project progress and get advice/support from other cohort members and members of the Health Care Disparity Workgroup. At the conclusion of the program, recipients will have gained knowledge on health care disparities and learned tools and resources they can put into action at their own institutions. Eligible applicants must be an active AAN member and actively certified neurologist residing in the United States or Canada. Participants are required to attend the 2022 Annual Meeting in Seattle, virtual workshops, and cohort individual project calls. AAN members interested in participating in the program should submit in PDF format a curriculum vitae and a short statement (250 words) on what you hope to gain from the program, in addition to responding to the application essay questions. To learn more and apply, visit AAN.com/IDEAS.
Cast Your Vote for Section Leadership by February 18 Voting is now open for chair and/or vice chair position of the following AAN Sections. Cast your vote no later than 11:59 p.m. CT on February 18, 2022. For questions, contact sections@aan.com. A.B. Baker Section on Neurological Education
Clinical Neurophysiology Section
Neuroepidemiology Section
Adults with Intellectual and Developmental Disabilities Section
Epilepsy Section Experimental Neurotherapeutics Section
Neurohealth & Integrative Neurology Section
General Neurology Section Geriatric Neurology Section Global Health Section Government Service Section
SECTION LEADERSHIP
LGBTQI Section Movement Disorders Section Multiple Sclerosis Section Neural Repair & Rehabilitation Section Neuroendocrinology Section
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AANnews • January 2022
Neuro-oncology Section Neuro-ophthalmology/Neurootology Section Sleep Medicine Section Spine Section Sports Neurology Section Women's Issues in Neurology Section
GUIDELINES Updated Practice Advisory Addresses Stopping Antiseizure Medicine Continued from cover Other messages of the practice advisory include: For adults who are seizure free for two or more years: over the next two to five years, recurrence risk is possibly higher among those who taper medications. For children and adolescents who are seizure free for 1.5 to two years: there is probably not a significant difference in seizure recurrence in patients who taper medication at two years vs. four years. In adults who are seizure free for at least two years, there should be a discussion between the clinician and the patient or caregiver or both about the risks and benefits of medication withdrawal, which specifically includes and documents the following information: There is higher seizure recurrence in patients who discontinue their medication.
If seizures recur during or after medication withdrawal, there is a rare chance patients will no longer respond to medications. For children and adolescents who are seizure free for at least 1.5 to two years and do not have an electroclinical syndrome suggesting otherwise, there should be a discussion between the clinician and the child/adolescent and parent/caregiver about the risks and benefits of medication withdrawal, which specifically includes and documents that if seizures recur either during or after withdrawal, there is a rare chance the child/adolescent will no longer respond to medication. To access the full guideline, patient and caregiver summaries, and slide presentation, visit AAN.com/guidelines.
ient Reported Outcome Measures Ad—Half Page Horizontal> AN ANnews +0.125 bleed, 4C
Make Your Patient Your Partner Invest in the outcomes that matter most to your patients. Learn about common Patient Reported Outcome (PRO) scales and tools used in neurology at AAN.com/PRO.
2022 Cure One, Cure Many Award A research award for early diagnosis of Lewy body dementia (LBD)
IN PARTNERSH IP WI TH
AMERICAN BRAIN FOUNDATION Foundation Furthers Commitment to Fund Brain Disease Research For 30 years, the American Brain Foundation has funded research across all brain diseases in pursuit of improved treatments, preventions, and cures. To date, Foundation funding—through your support—has provided more than $33 million to aid more than 270 researchers in the pursuit of improved treatments, prevention, and cures across a broad spectrum of brain and nervous system disorders. We believe that by curing one disease, we will cure many. To this end, we are more committed than ever in 2022 to raising awareness of brin disease and the need for research, and are putting this commitment into action through the following 2022 initiatives: A New Class of Next Generation Research Grant Recipients The Foundation will fully fund 18 of the best and brightest young investigators with research training scholarships designed to encourage their innovative research and lay the groundwork for future success. Cure One, Cure Many Award Recipient to Be Announced Early 2022 The Cure One, Cure Many Program provides large-scale catalyst funding to the world’s top researchers for multiple disease areas. We are excited to soon announce the recipient of the 2022 Cure One, Cure Many Award: A Research Award for Early Diagnosis of Lewy Body
Dementia. This $3 million, multi-year research award was created in collaboration with the AAN, Alzheimer's Association, and Michael J. Fox Foundation for Parkinson's Research to improve the diagnosis of Lewy body dementia. Continued Investment in the Health Disparities Research Fund Our 2022 funds include the $150,000 Next Generation Research Grant in Neurodisparities and $60,000 seed grant funding to promote diversity, equity, and inclusion in autism research. Public Awareness The Foundation is poised to continue its rigorous public awareness campaigns to illuminate the impacts of brain disease, the ever-increasing need for research, and the necessary support to make it happen. Join us in 2022—visit AmericanBrainFoundation.org to learn how, together, we can make life without brain disease a reality.
Careers.AAN.com
Visit the AAN’s Neurology Career Center to view hundreds of additional jobs and sign up for customized, confidential notifications when positions of interest are added. Neurohospitalist, Outpatient Neurology & Telestroke opportunities in Tampa, Florida—Bay Area Consultants —Tampa, Florida Bay Area Consultants LLC is seeking full-time board certified/ eligible Neurologists to join our Neurohospitalist, Outpatient Neurology and Telestroke teams. Residents completing training in 2022 are welcome to apply and H1B/J1 visa sponsorship may be considered. Neurohospitalist coverage in local hospitals is provided by the same team that provides separate Telestroke coverage. Individual schedules are flexible depending on physician preference for inpatient versus outpatient practice. Neurology sub-specialty focused opportunities available for fellowship trained Neurologists. Inpatient shifts are assisted by daytime nurse practitioner coverage, and back-office staff. We provide centralized backoffice support for hospital rounds saving 20-30% of physician time. Additional scribe, realtime dictation/transcription, virtual assistant, 24/7 call center support are also provided. Email careers@bactelemed.com or visit http://bactelemed.com/ for more information.
San Diego Finest City Neurologist—The Neuron Clinic— San Diego, California
AANnews® Classified Advertising
he AAN offers a complete package of print, online, T and in-person recruitment advertising opportunities. Visit careers.AAN.com for all AAN options, rates, and deadlines.
Private Premier Neurology Group in Beautiful Southern California—Thank you for taking the time to explore a career with us. At The Neuron Clinic we strive to help individuals, families, and communities with acute and chronic neurological conditions. As the fastest growing neurology practice group in Southern California, now is the perfect time to join our clinical team! We are actively looking to hire talented Neurologists who are passionate about patient care and committed to clinical excellence. Neurology fellowship trained subspecialties: dementia, movement disorders, EMG/neuromuscular, stroke and epilepsy would be especially welcome, though all interests can be supported in the context of General Neurology. Competitive salary with productivity bonus. A robust compensation and benefits package. Malpractice and professional expense stipends. Clinical Research opportunities available. Flexible schedules and exceptional work/life balance. Collegial professional environment. Two-year partnership track. In Southern California, you’ll enjoy amazing recreational activities, spectacular natural sceneries, and an exceptional climate. Located 20 minutes of San Diego beaches, our communities offer outdoor and beach activities, great shopping, award winner school districts and an expanding variety of cultural opportunities. The quality of life in San Diego is hard to beat! We invite you to make a difference in the communities we serve. For additional information about this opportunity, please contact: Lena Bueno, Director: (951) 459-0067 or visit https://theneuronclinic.com
d copy for the March 2022 print edition of AANnews A must be submitted by February 1, 2022. The same deadline applies to changes/cancellations. he American Academy of Neurology reserves the T right to decline, withdraw, or edit advertisements at its discretion. Every care is taken to avoid mistakes, but the responsibility for clerical or printer errors does not exceed the cost of the ad.
AANnews • January 2022 19
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JANUARY 1
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MARCH 1
Application Available: UCNS Headache Medicine Certification UCNS.org/HMcertification
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JANUARY 19
FEBRUARY 15–19
Deadline: UCNS Interventional Neurology Certification UCNS.org/INcertification
Webinar Guest Neurologist: Military https://bit.ly/3dKIufi
JANUARY 25
Deadline: ALS Quality Measures Public Comment AAN.com/Comment
JANUARY 26
MEM: 20 FAAN Recruitment Ad—Half Page Horizontal> Deadline: Emerging Science AbstractsAN Placed in AANnews AAN.com/22Abstracts 8.25 x 5.25 +0.125 bleed, 4C
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SHINE A LIGHT ON YOUR ACHIEVEMENTS Apply for a prestigious Fellow of the American Academy of Neurology (FAAN) designation.
AAN.com/FAAN
