8 minute read
BRAIN DAY 2023 WORLD
Carlayne E. Jackson, MD, FAAN President, AAN
cjackson@aan.com @CarlayneJackson on Twitter
Registration Still Available for This Month’s Summer Conference
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Programming includes:
Case-based updates in several areas including status epilepticus, intracerebral hemorrhage, arterial ischemic stroke, and more
Global talks on health disparities, inpatient neurology, neurology resident training, and wellness among physicians and trainees
Three case-based programming tracks in neurocritical care; hospital neurology topics; and business, training, education, and wellness, as well as diversity, equity, and inclusion
Hands-on skill building sessions on brain death, burnout, neurosonology, device programming 101, and point-ofcare EEG technology
Exhibit Hall offers the opportunity to network with organizations that are at the forefront of advancing patient care
Those looking to attend live online will enjoy a streamlined experience with seamless communication between the mobile and virtual platforms, as well as the ability to create agendas, view schedules, livestream sessions, watch recordings, view posters, and message other attendees all on your mobile device and desktop.
Visit AAN.com/Summer to learn more and secure your spot today!
July
AAN Advocacy: AAN Advocacy: Where We Stand continued from cover
Below is where the AAN stands on these main issues.
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.
Latest Advocacy Newss
The AAN submitted a Formal National Coverage Determination (NCD) Reconsideration Request to the Centers for Medicare & Medicaid Services regarding the existing NCD on Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease [CAG-00460N]. The AAN had originally submitted a request on February 2 and has been engaged in frequent communication with CMS since submission to refine and expand on our recommendation to promote access for appropriate patients if lecanemab were to receive traditional approval in the coming weeks.
Take action! Both the House and Senate are leading letters to CMS urging the swift finalization of a rule on prior authorization. The letter also encourages CMS to make additional updates that would align the rule more closely with the Seniors’ Timely Access to Care Act introduced last Congress. Visit AAN.quorum.us/campaign/48593/ and tell your legislators to sign onto the letter and support prior authorization reform.
With many state legislatures' 2023 sessions coming to a close, the Michael J. Fox Foundation (MJFF) for Parkinson’s Research has made tremendous progress advancing legislation to enact Parkinson’s disease registries in states across the country. To date, registries have been passed/established in California, Maryland, Nebraska, South Carolina, Utah, Washington, and West Virginia.
The AAN has been active in supporting this important initiative to advance Parkinson’s disease research. If you are interested in helping your elected officials learn more about Parkinson’s policy and research priorities, join the MJFF’s policy network at michaeljfox.org/advocacy and follow #AANadvocacy for more updates.
Issue in Focus
On June 4, President Biden signed into law the bipartisan deal lifting the debt ceiling until 2025. While we applaud the bipartisan effort to prevent the nation from defaulting on our debt, the deal presents some concerns to the research community as it creates stifling caps on FY24 and FY25 non-defense discretionary (NDD) spending.
NDD spending is the source of funds for NIH, AHRQ, FDA, and other research agencies, and in whole represents less than one-sixth of the federal budget. NDD funding is slated to freeze at $637 billion―$1 billion below the current FY23 levels. These caps will make it incredibly difficult to fund essential medical research at NIH, which was already on track to outpace the allocated funding.
The AAN was pleased to see that veterans’ health funding is set at President Biden’s requested level, with defense funding seeing an increase of about three percent over FY23 levels. While we are reassured with the FY23 funding for the VA Neurology Centers of Excellence, we will continue advocating for increased funding with our patient group partners.
Following passage of the debt ceiling deal, congressional appropriators have begun conversations on specific allocations for the various bills they are required to pass in regular order before January 1. If they fail to pass these bills, there will be a mandatory cut of one percent across all programs for the next fiscal year as imposed by the debt limit deal. The budget outline for FY24 and FY25 allows for a one-percent growth each year and includes a nonbinding outline for FY26–29 funding.
Action on these priorities has taken many forms, from meeting with members of Congress and regulators at the Centers for Medicare & Medicaid Services, to authoring comment letters or signing support letters with collaborating organizations. We have also invited your direct participation through Action Alert emails that provide a quick and effective way for you to contact your members of Congress and express your views. To view a more comprehensive list of actions taken on your behalf on these priorities and other issues, visit AAN.com/advocacy/ priority-issues
REGULATORY BURDENS:
The AAN is fighting to reduce regulatory burdens.
Physicians, including neurologists, face growing administrative requirements from the federal government, insurers, and their institutions. Despite the medical community constantly working toward providing more efficient high-quality patient care, they are forced to adhere to many redundant and ineffective processes. Neurologists need relief from overwhelming regulatory requirements so they may prioritize caring for patients with complex diseases of the brain and nervous system.
Physician Wellness
Physician wellness and mental health has always been critical when addressing workforce challenges, but it has become even more pressing in the wake of the COVID-19 pandemic.
The AAN has supported efforts to increase access to mental health services, like the Dr. Lorna Breen Health Care Provider Protection Act, and advocates for policy changes that are conducive to physician wellness. These efforts ensure that physician health is not forgotten as our members care for their patients, and that physicians are able to stay in the workforce to provide their much-needed expertise.
ACCESS TO CARE:
The
AAN advocates for access to high-quality neurologic care.
Telehealth
The AAN believes that telehealth will continue to play an essential role in the care of patients with neurologic conditions.
The AAN supports coverage of telehealth services regardless of patient location, equitable provider reimbursement, simplified state licensing requirements, and expanded telehealth research and quality initiatives.
Drug Costs and Access
Prescription drug prices continue to rise. Drugs that treat complex, chronic conditions like Alzheimer’s disease, Parkinson’s disease, epilepsy, and migraine, and specialty drugs that require special handling or administration, such as those used for multiple sclerosis, are particularly expensive.
The AAN supports action to ensure that prescription medications are accessible for patients with complex, chronic neurologic conditions; and potential solutions which may include price negotiation and transparency.
The AAN supports reducing physician regulatory and administrative burdens such as prior authorization, step therapy requirements, and other administrative tasks so that neurology providers can spend less time on administrative tasks and more time on patient care.
NEUROLOGY WORKFORCE:
The AAN supports strengthening the neurology workforce.
Reimbursement
Our current Medicare payment system is broken. Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which began as a well-intended and widely supported fix to previous issues in the payment system, is now fraught with barriers to patient access to care. These issues are compounded by the lack of an annual inflationary update for physician payment. Due to these widespread payment issues and other added workforce challenges, neurology practices continue to struggle to stay afloat and provide care to their patients.
The AAN is committed to payment reform efforts to promote a sustainable payment system and to working with regulators and legislators to ensure that the work done by neurologists is appropriately valued.
Immigration
The AAN values our diverse membership and the compassionate care that our members provide to patients around the world. Immigration policy is an important part of addressing the issues facing the neurology workforce in the United States. With international medical graduates (IMG) making up 31.5 percent of the active neurology workforce, these members are essential to providing quality neurologic care to patients across the country.
The AAN supports the reauthorization of the Conrad 30 program, including improvements such as increasing the number of waivers and creating additional employment protections. This allows more IMGs to provide quality neurologic care to patients in rural and underserved areas across the country.
Axon Registry 2022 MIPS Results Released
One of the many benefits of Axon Registry ® participation is that it provides participants with a solution to submit Merit-based Incentive Payment System (MIPS) reporting to the Centers for Medicare & Medicaid Services (CMS). The 2022 MIPS submission period ended on March 31, 2023.
For the 2022 MIPS submission period, 30 practices used the Axon Registry to submit their MIPS reporting. Thirteen practices submitted MIPS individual reporting, 19 practices submitted MIPS group reporting, and two practices submitted in both reporting types. During the 2021 MIPS submission cycle, 38 practices used the Axon Registry to submit their MIPS reporting. The number of practices submitting MIPS via Axon Registry for 2022 went down from that in 2021 because more practices applied for the 2022 MIPS hardship exemptions than for 2021 MIPS.
The estimated average score for practices that submitted MIPS reporting for all three categories (quality, improvement activities, and promoting interoperability), through the Axon Registry for the 2022 MIPS submission period was 66.56 points. Participants that use the Axon Registry for MIPS submission can submit for three out of the four categories of the MIPS program. The fourth category, cost, uses Medicare claims data to calculate performance, which means clinicians and groups do not have to submit any data. The cost data usually becomes available in the late summer.
The MIPS final score will be between 0 and 100 points. Payment adjustments will be dependent on the overall performance of clinicians. Though the MIPS quality category requires the submission of six quality measures, most submissions included more than six quality measures, which aids in benchmark creation for future reporting years.
To enroll in or learn more about the Axon Registry, visit AAN.com/axon or contact registry @ aan.com
Meet Your New Board Member: Gregory J. Esper, MD, MBA, FAAN
Gregory J. Esper, MD, MBA, FAAN, is professor of neurology at Emory University School of Medicine and is a general neurologist. He earned his medical degree at Vanderbilt University, completed neurology residency at Washington University in St. Louis, and finished a clinical neurophysiology fellowship and a clinical research fellowship in electrical impedance myography with Dr. Seward Rutkove at Harvard University's Beth Israel Deaconess Medical Center. He earned his MBA from Emory’s Goizueta Business School in 2009. Esper was recently recognized in Emory’s Physician Group Practice as a Diamond Provider, earning 99-percentile patient satisfaction ratings.
How did you initially get involved as a volunteer member for the AAN?
Early in my time at Emory, I was asked to be the medical director of our outpatient clinics, and began to get involved in the operations, finances, and electronic medical record deployment. I was looking for resources on the AAN website and came across the Medical Economics and Management (MEM) Committee. I emailed Amanda Becker, who was then the staff liaison. I mentioned my interests and reasons for wanting to join the group, and I was added to the listserv initially, and was invited by Dr. Laura Powers as a guest to one of the MEM meetings in early 2008. I was warmly welcomed by Dr. Powers and met Drs. Orly Avitzur, Neil Busis, Joel Kaufman, Marc Raphaelson, Peter Donofrio, Marc Nuwer, Dan Hier, and others. I was, well, in a word, “starstruck ”! These were major contributors to the AAN and the practice of neurology, and I had an opportunity to learn from and contribute alongside them.
and that happened because the board has always taken an expansive view of neurology and has created a fertile field of opportunities that create the best environments for people to grow in a myriad of ways. I’ve both experienced that and seen that with many of my colleagues. There is no greater honor than to contribute to that cycle of growth, and for the opportunity to pay it forward, I am very fortunate. Many neurologists who are early in their career look to differentiate themselves. Mid- and late-career neurology clinicians, educators, and researchers struggle in this constant change that is the world of health care and science but still have lofty professional goals and desires. I hope to positively influence the landscape and resources that can reduce barriers and improve flow.
What experiences and viewpoints do you bring to this role?
