Academy Evolved to Meet Needs of Members in Private Practice

continued from page 13 is really quite an achievement considering the size of our society,” Powers said.

Richards explained the RUC as “the committee of the AMA that establishes the levels for reimbursement in relationship to other specialties’ reimbursements. Our members, Drs. Marc Nuwer, Neil Busis, and Bruce Sigsbee, were very active and successful at the RUC for the AAN, adjusting our fees of imbursements for EEGs, EMGs/ NCVs, consultations, and follow-up.”

Bruce Sigsbee, MD, FAAN, who served as president from 2011 to 2013, said, “Nelson was really, in a very real sense, a lone voice in the Academy, really trying to tell people how important it was that you attend these meetings as they’re putting the whole new coding system together and to really be able to move that coding system forward, and often on his own time was spending time in Washington, and really began the process of getting the Academy involved in just this kind of role, and now it’s considered essential. We would not consider ignoring these kinds of opportunities to really—as much as we can— modify what happens in Washington.”

The new Practice Committee’s responsibilities were expansive, including ethics, legal affairs, federal health policy and legislation, quality standards, and technology assessment. Over the years, several Practice Committee subcommittees were elevated to the level of full committees to reflect their significant scope of responsibility, including Legislative Affairs, Medical Economics and Management, and Ethics, Law, and Humanities. New subcommittees were formed in response to emerging issues, such as Patient Safety, Practice Improvement, and Quality Measurement and Reporting. This evolution of new or renamed leadership groups has continued to present day to better reflect and act upon the needs of members.

In 2004, the Academy established the Business and Research Administrators in Neurology Society (BRAINS) to help practice managers navigate the steady stream of changes in the office environment. In 2008, the Business Administrator membership category was created and BRAINS evolved into a work group under the leadership of the Practice Management and Technology Subcommittee. Support for business administrators has continued, most recently with the first Business Administrators’ Day held at the 2023 Annual Meeting, a day dedicated helping administrators navigate the changing health care landscape, grow in their careers, and network with colleagues.

The AAN has continually expanded the number and type of tools it offers members in practice, from Annual Meeting and regional conference courses to online ICD-9 and guidelines tools to EHR vendor reports and quality measurement tools for pay-for-reporting and pay-for-performance initiatives.

Guidelines, Quality Measures, and Registry Help Improve Health Care

Evidence-based clinical practice guidelines, published in Neurology® , have been a mainstay of the Practice Committee’s efforts, through the efforts of Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee. The guidelines, initially considered by some as “cookbook medicine,” have increased in popularity as members have better understood them to be guides to patient care that do not supplant their professional skills and judgments as neurologists. The guidelines are often supplemented with clinician summaries and patient versions, as well as slide shows, and case studies. In 2004, they were recognized as the only guidelines to receive perfect marks in all domains used by the Agency for Healthcare Research and Quality in determining the quality of guidelines. The AAN’s 100th guideline was published in 2006.

In 2009, practice management webinars were introduced to help share information about changes in coding and reimbursement and help members identify ways to be more efficient in their practices.

The following year, the Academy received $1 million from the Centers for Disease Control and Prevention to develop and disseminate evidence-based guidelines on muscular dystrophy. A position statement was published on evaluation and management of sports concussion, which helped set the stage for the first Sports Concussion Conference in 2015. The Academy developed resources and tools for coaches, trainers, athletes, and the public to spread awareness of the dangers of concussion and goals for safe treatment.

After two pilot issues, the 2012 premiere of Neurology® Clinical Practice, edited by John R. Corboy, MD, FAAN, and provided free to members, became the first of several offshoot publications from the Neurology® journal. Corboy stated the new journal would “feature a variety of articles, including those that explore problems confronted while caring for a complex patient or addressing an ethical challenge. Reports will offer analyses of office-based and health policy issues and will introduce new drugs and devices that may affect patient care…. We hope this journal becomes an important part of your ongoing education, especially as it relates to maintenance of certification.”

Just as the Academy had reached out to bring practice managers into its membership, advanced practice providers were welcomed in 2014 and immediately attracted 228 new members. As of the beginning of 2023, that number had grown to more than 1,900.

After considerable discussion over the years, in 2015 the AAN embarked on its most ambitious project to date: the Axon Registry®, a free US member benefit designed to capture and use clinical data to improve quality of care and demonstrate the value of neurologists both in private practice and in large institutions. To a great extent, this was the brainchild of Bruce Sigsbee, MD, FAAN, a private practice neurologist who served as president from 2011 to 2013. “Actually, there was a task force that looked at it and it was felt that it wasn’t time,” recalled Sigsbee. “Then a couple years later, there was another task force that I had the privilege of being on that really moved this idea forward, and the reason—there’s been people who have said, ‘Why do we need this? I know what to do. I’m well-educated, I stay up to date with my care.’ But I’ve become a real fan of measurement. As Lord Kelvin said centuries ago, that ‘You can’t improve what you can’t measure.’….One of the things that we all struggle with is medicine changes very quickly and by choosing the right quality measures—if it’s really been clearly shown that a different approach to a disease really makes a big difference—then we conclude that in a quality measure and really try to help accelerate the integration of that change in care into day-to-day practice. There was a study in Great Britain where they found that it was an average of 18 years before new knowledge got integrated into day-to-day practice. Basically, a generation, and obviously that’s not a good thing for us or our patients.”

The registry was set up to seamlessly collect data from electronic health records so as not to be a burden to the neurologist. “It’s done in the background,” said Sigsbee, “which is really fantastic. You can’t ask physicians to do more checkboxes. So, if you can do this somewhere in the background where it captures it without really any major change in documentation or anything else and not more click boxes, fantastic, and that’s what I think we really set up here.” The Axon Registry helps improve patient care in tandem with reducing administrative burden by automatically collecting quality improvement data and simplifying CMS Quality Payment Program reporting for proper reimbursement and Part 4 Self-assessment for Continuing Certification. Since 2016, the number of quality measures in the registry has expanded from 25 to 49.

Resources Created for Wellness, Reimbursement, COVID-19

Through the 2010s, the Academy tackled numerous problems, from physician burnout (myriad resources and tools for members, as well as studies from the AAN Wellness Task Force published in Neurology) to the high costs of neurologic drugs (a Drug Pricing Task Force helped influence Congress to start a congressional investigation into high drug costs for multiple sclerosis, for example) to creating the AAN Principles for Health Care Delivery to address health care reform. The AAN continued to advocate with commercial payers for appropriate coverage of neurologic therapies to decrease the burden on providers. It also advocated on behalf of members and helped them understand the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA) and informing members about changes in how clinicians are reimbursed through the Quality Payment Program (QPP), the Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS). Practicing neurologists also benefited in 2020, when the Centers for Medicare & Medicaid Services gave the Academy a hard-earned advocacy victory on reimbursement increases for E/M coding and telehealth expansion.

The Academy has seized on novel ways to help extend support to members. Between 2017 and 2019, 24 small and solo practices were visited through the Practice Ambassador Program to better understand their challenges, listen to their feedback, and uncover themes to aid in resource development to help them thrive in practice. And in 2017, the Practice Leadership Program was launched to provide selected participants an intensive six-month opportunity to develop their knowledge and skills to better manage their practice as well as lead staff and office management. Graduates of this program join the Practice Support Network, a group of practicing neurologists available to assist answering questions that come into the practice@aan.com inbox, which was created as an efficient way to reach Academy staff and member experts with practice-related questions about payer relations, MIPS/MACRA, coding, and practice management.

When the COVID-19 pandemic emerged in early 2020, sharing accurate, timely information with members became a major priority. The COVID-19 Neurology Resource Center at AAN.com/COVID19 and weekly COVID-19 Neurology Resource Center digest email kept members up to speed about diagnosis and treatment experiences around the globe, what researchers were uncovering, as well as additional resources from the AAN and others. As relief rolled out from Congress, the Academy provided members with helpful webinars and resources to understand the Small Business Paycheck Protection Program, Economic Injury Disaster Loan Program, and other opportunities. Resources were produced to help members successfully use telehealth to maintain virtual visits with patients and guidance to safely reopen their neurology practices. And as the pandemic abated, the Academy has helped members understand the winding down of government programs.

Thanks to the determination and passion of “pioneers” like Resch, Rosenbaum, and Richards, practicing neurologists have benefited from leaders who have come from their ranks with the experiences and insights necessary to help the AAN deliver on its mission to promote the highest quality patient-centered neurologic care and enhance member career satisfaction. 