State Legislative Update

• Ohio voters will have the opportunity to vote in November on the Ohio Drug Price Relief Act, a citizen-initiated ballot measure that would require state government agencies to purchase prescription drugs at prices no higher than those paid by the US Department of Veterans affairs.

• The number of states that have adopted the Interstate Medical Licensure Compact stands at 22. 3 states currently have active legislation, which the AAN is active in supporting. The compact offers an expedited licensing process for physicians interested in practicing medicine in multiple states.

If you have any questions or would like to discuss how to improve your advocacy efforts, contact Grant Niver.

Federal Legislative Update 

• The AAN joined other medical groups in releasing a statement opposing the initial Senate health care bill, the Better Care Reconciliation Act of 2017. The proposed bill included provisions such as cuts to Medicaid funding that would increase the number of people without health insurance by 22 million by 2026. The Senate is currently voting on various versions of health care reform legislation, and the AAN continues to advocate for access to health insurance coverage for patients with neurologic conditions.
• The Furthering Access to Stroke Telemedicine (FAST) Act (H.R. 1148) now has 130 cosponsors in the House, and was featured at an Energy and Commerce Health Subcommittee hearing on July 20 entitled “Examining Bipartisan Legislation to Improve the Medicare Program.” AAN Board member Brett Kissela, MD, FAAN, MS of the University of Cincinnati testified at the hearing on the benefits of telestroke.
• The House Appropriations Committee approved the draft FY2018 Labor, HHS, and Education funding bill which includes a 3.2% increase in NIH funding for a total of $35.2 billion, including a $76 million increase in BRAIN Initiative funding.
• In June, Immediate Past President Terrence L. Cascino, MD, FAAN, visited Capitol Hill after receiving an invitation from the House Doctors Caucus to discuss physician burnout. After an extended conversation, members of Congress asked Cascino for additional resources on burnout from the AAN, and indicated they are willing to bring these issues up in search of legislative and regulatory solutions.

• The Senate Appropriations Committee unanimously approved the FY2018 Military Construction, Veterans Affairs, and Related Agencies funding bill, which includes $10 million in funding to create at least five VA Headache Centers of Excellence. If enacted, these centers will join the VA Centers of Excellence for Parkinson’s, MS, and Epilepsy.

Stay up-to-date on #AANAdvocacy by reading the Capitol Hill Report and following the AAN’s Senior Legislative Counsel Mike Amery on Twitter at @MikeAmeryDC.

Medical Economics Update

• The AAN is continuing its efforts to create awareness and educate members about MACRA and the Quality Payment Program (QPP). The AAN continues to lobby on behalf of neurology, and the MACRA proposed rule, released June 20, reflects AAN recommendations around Quality Metrics and Improvement Activities that may make reporting easier for members. The AAN will submit comments by the August 2017 deadline, and the final rule is expected in the fall.
• AAN advocacy yielded reduced regulatory burdens in the proposed 2018 Medicare Physician Fee Schedule rule, released by CMS on July 13. The rule contains several proposals to reduce regulatory burdens that were specifically advocated for by the AAN in meetings with HHS this year. CMS is soliciting further ideas to reduce regulatory hassles on physicians and potential ways to update E/M documentation processes.

• ·         Are you in a small or solo practice? Your views and experiences are important to us. The Academy would like to offer you the opportunity to have an AAN practice management specialist visit your office, at no cost to you, between August and October 2017. We believe it is important for the Academy to visit small and solo practices such as yours to gain a more comprehensive understanding of challenges facing our practicing members, connect these members to relevant AAN resources, and provide a feedback loop to the Academy on the value of our improvements to member resources. For more information, please contact Sochenda Nelson at stnelson@aan.com.
• ·         Need an answer to your practice management questions? Whether you have questions concerning CPT or ICD-10 codes, payer issues, health information technology, or other practice management topics, AAN members can get answers within one business day by emailing questions to practice@aan.com.
• ·         The 2017 Neurology Compensation and Productivity report and interactive dashboard is now available! It is free to members who participated in the most recent survey and $600 for those who did not participate. Find it in the AAN Store.

For more information on AAN practice resources, visit our webpage

AAN Membership Update

• Seven out of 10 neurology residents and five of 10 neurology fellows have one or more symptoms of burnout, according to a large study by the AAN that was published online in Neurology^® on July 5 and in print in the August 1, 2017, issue of the journal. Read the study.

• Review the AAN’s 2016 accomplishments, financial results, and an outline of the 2017 strategic plan in the 2016 Annual Report: We’ve Got Your Back.

• A new regional conference is scheduled for January 13 through 15, 2018, concurrent with the Breakthroughs in Neurology Conference in Orlando, FL. Career Essentials Conference: Foundation for Your Future is geared toward early career neurologists who are three to five years’ post-residency.

Quality Update

• The AAN and American Psychiatric Association released the dementia management quality measurement set update on May 1. The measures and publication are available online. Select dementia management measures are available in 2017 for use in CMS’ Merit-based Incentive Payment System (MIPS).

• The Axon Registry® has been designated a Quality Clinical Data Registry (QCDR) for reporting year 2017 by CMS. This means the registry can report neurology specific quality measures under the MIPS program. Visit our website for information on how to join the Axon Registry and what it could do for your practice.

September 14-16, 2017 (Thursday-Saturday), Pyle Center, Madison, WI

This Wisconsin Society of Addiction Medicine (WISAM) conference is open to individuals working in addiction prevention and treatment across disciplines, including clinicians, social workers, recovery coaches, individuals in recovery, law enforcement and public health officials. This year's conference will feature a number of workshops, lectures, and a special presentation by Joseph LMS Green (poet. performer. educator.). 

Our post-conference workshops on Saturday, September 16th, 2017 will provide training for clinicians in the use of buprenorphine and naltrexone for the office-based management of substance use disorders, and in the Wisconsin Medical Examining Board Opioid Prescribing Guidelines.

Click here to download an agenda for the two day conference and the post-conference day.

Click here to register for the conference.

Appeals court strikes down cap on malpractice awards

July 6, Wisconsin Health News

An appeals court struck down a state law Wednesday capping the amount of money that injured patients can receive for some malpractice claims.

The 1st District Court of Appeals ruled that a state law capping awards for noneconomic damages at $750,000 was unconstitutional. Noneconomic damages are intended to compensate for pain and suffering.

Judge Joan Kessler, who penned the majority opinion, wrote that the law imposes "an unfair and illogical burden only on catastrophically injured patients, thus denying them the equal protection of the laws."

The case involves Ascaris Mayo, who lost her limbs after she wasn't notified she had an infection after visiting a Milwaukee-area emergency room in May 2011. Mayo and her husband sued, and a jury awarded them $16.5 million for noneconomic damages. 

The state's Injured Patients and Families Compensation Fund, which is funded by hospitals and doctors and covers large medical malpractice claims, moved to reduce that amount to the $750,000 limit. The Mayos challenged that.

Hospitals and doctors in the state were concerned about the Wednesday's ruling. Wisconsin Hospital Association CEO Eric Borgerding expects the state's Supreme Court to review the decision. 

"We believe the court will uphold the well-supported and bipartisan public policy balance set by the Legislature to help ensure accessible healthcare in Wisconsin," he said in a statement.

A spokeswoman for the Office of Commissioner of Insurance, which provides administrative staff to the 13-member board, didn't respond to a request for comment on whether the state would appeal the decision.

Dr. Noel Deep, Wisconsin Medical Society president, said the decision"endangers the long-term solvency of the Injured Patients and Families Compensation Fund and its ability to adequately compensate patients." He warned that it could incentivize "attorneys to file questionable cases in hopes of astronomical jury awards seen in other states without caps."

Dan Rottier, an attorney for the Mayos, called the society's claim regarding fund's solvency "ridiculous." The fund reported a net position of $879 million as of June 2016, according to an annual report.

Rottier said that pursuing such cases are difficult because "they're extremely expensive...these cases are not taken lightly.

Rottier said the court's decision has "implications for a few cases every year where there's horrendous injuries...it's those cases where the inequity is the most severe." He noted that applying a cap in this case would have reduced the jury award by more than 95 percent.

"I would call it 5 percent justice instead of 100 percent justice," he said. 

The 4th International Conference on Neurology and Neuroimmunology operating committee formally invite Neurology Research Team to attend as honorable speakers and Delegates at “4th International Conference on Neurology and Neuroimmunology” during Sep 18-19, 2017 in Dallas, USA.

This conference is containing sum of 15 sessions and the following sessions are: Neurology, Neurosurgery, Neurodegenerative Diseases, Neuroimmunology, Auto Immune Disorders, Multiple Sclerosis, Neurotransmitters & Neuroimmune Interactions, Aging & Degeneration, Neuroendocrinology, Pediatric Neurology, Clinical Neuroimmunology, and Neuropharmacology, Stem Cells in Neuroimmunology, Novel Therapeutics, Diagnosis and Therapy.

For more information please follow: http://neuro.alliedacademies.com/

Neuroimmunology 2017 Operating Committee requires the earliest acknowledgement to secure your slot in the agenda.

Doctor Day 2018 has been set for Tuesday, January 30.  The event will again be held at the Monona Terrace in Madison and is hosted by over 20 medical societies.

The event provides physicians an opportunity to meet with their legislators, and have input on important health care issues. The day will conclude with a reception in downtown Madison.

Registration is available online (link).

June 22, 2017

Despite opposition from 22 organizations representing physicians, nurses, physician assistants, hospitals, the WIAA, insurers and others – and support from only one (the Wisconsin Chiropractic Association) – AB 260 passed the full Assembly on Wednesday, June 21 and is now being considered in the Senate for consideration.

It is critically important for physicians to let Senators know their opposition before the Senate makes their decision about how to proceed.  To find your State Senator’s office contact information, type in your home address under “Find my Legislators” (link). Please do not delay – sending an email will take you no more than 2 minutes.  The coalition memo opposing the bill (link) and related infographic (link) are attached for more information.

The Senate approved the final two proposals that are part of a special legislative session on opioids that Gov. Scott Walker called in January.

All 11 proposals that are part of that session have now passed the Legislature and await Walker's signature to become law. 

The bills were based on recommendations from an interim report released in January by the Governor's Task Force on Opioid Abuse, which was chaired by Lt. Gov. Rebecca Kleefisch and Rep. John Nygren, R-Marinette.

"We have a lot of work left to do on a massive epidemic that's sweeping our state," said Ashland Democratic Sen. Janet Bewley, who served on the task force as well. "We are learning that it's even bigger and more profound than we ever thought."

The Senate approved a proposal Tuesday that would provide limited legal immunity to overdose victims. Sen. Steve Nass, R-Whitewater, was the sole no vote. 

The chamber also approved a bill allowing for families and others to involuntarily commit a person with drug dependence.

The Senate also voted down along party lines a Democratic amendment to the latter proposal requesting the attorney general to consider filing a lawsuit against opioid manufacturers. A few states, like Ohio, have filed lawsuits against drugmakers. 

Senate Majority Leader Scott Fitzgerald, R-Juneau, predicted that a class action lawsuit against drugmakers "is coming. It's just a matter of time...and I'm sure we'll be part of that at some point." He moved to reject the proposal as he didn't want it tied with the bill. 

See a list of the special session bills. 

CALL OR EMAIL YOUR STATE SENATOR TODAY – ASK THEM TO OPPOSE CHIROPRACTORS’ SCOPE EXPANSION BILLS: ASSEMBLY BILL 260 SENATE BILL 232 Despite opposition from 22 organizations representing physicians, nurses, physician assistants, hospitals, the WIAA, insurers and others – and support from only one (the Wisconsin Chiropractic Association) – AB 260 is expected to pass the full Assembly on Wednesday, June 21. Once passed by the Assembly, AB 260 will move to the State Senate for consideration – and it is critically important for physicians to let Senators know their opposition before the Senate makes their decision about how to proceed. To find your State Senator’s office contact information, type in your home address under “Find my Legislators” (right-hand side of this website: http://legis.wisconsin.gov). Please do not delay – sending an email will take you no more than 2 minutes. 

What do AB 260/SB 232 do? Rep. Chuck Wichgers (R-Muskego) and Sen. Frank Lasee (R-DePere) have introduced legislation that would dramatically expand the current scope of practice for chiropractors in Wisconsin. These bills would allow Wisconsin chiropractors to conduct pre-participation physical exams for studentathletes (high school, technical colleges and 2-year UW colleges) and require that the WIAA, Wisconsin technical colleges or 2-year UW campuses to accept pre-participation exams conducted by “certified” chiropractors. The Chiropractic Exam Board is exclusively authorized to set the criteria for a chiropractor to be “certified” – there are no criteria or parameters specified in the bill. In short, comprehensive pre-participation physical exams involve examination and assessment of the musculoskeletal structures as well as an athlete’s heart and lungs, vision, neurological (concussion history), mental health and more – areas in which chiropractors have little or no training. These bills put student-athletes at risk, and represent a significant and unnecessary expansion of chiropractors’ scope. * * * * Also included in these bills, but already largely decided at the Federal level -- the Federal Motor Carrier Safety Administration (FMCSA) sets criteria by which health providers may qualify as a certified medical examiner and conduct FMCSA driver exams. The FMCSA authorizes chiropractors to qualify as medical examiners if they meet FMCSA standards, but leaves to states the final authorization. These bills would allow Wisconsin chiropractors to become FMCSA medical examiners if they meet FMCSA’s standards.

June 13, Wisconsin Health News

As a consequence of opting out of the federal health reform law's Medicaid expansion, Wisconsin could receive an estimated $37 billion less by 2025 under the Republican healthcare proposal that passed the House earlier this year, according to a new analysis.

The American Health Care Act has "assurances" that aim to "restore equity in Medicaid spending" for the 19 states that chose not to accept federal funds to expand the program, according to a policy brief by the Missouri Hospital Association.

But the association's analysis finds that by 2025, those states would get $683.9 billion less in federal Medicaid funding than they would if they expanded the program under the Affordable Care Act. 

That amounts to $36.9 billion less during that period for Wisconsin, according to data used in the report provided by the Wisconsin Hospital Association. 

"The report is eye-opening and should be of concern to anyone in a non-expansion state," Eric Borgerding, WHA CEO, said in a statement. "While the AHCA did attempt to provide a measure of relief to non-expansion states like ours, clearly it is insufficient and must be addressed by the U.S. Senate during their deliberations."

Rather than taking federal funding to expand the program, Wisconsin made eligibility changes to Medicaid to cover childless adults up to 100 percent of the federal poverty level and cut eligibility for parents and caretakers. 

Arkansas, which previously expanded Medicaid under the ACA, is asking CMS for permission to cap eligibility at 100 percent.

At a Wisconsin Health News event last week, Joint Finance Committee Co-Chair Rep. John Nygren, R-Marinette, said "if a state is going to be rewarded for something that Wisconsin has already done, Wisconsin should be awarded for what Wisconsin has done."

"One of my frustrations with the proposal coming out of Washington was that it basically didn't reward states like Wisconsin that did it the right way and basically continued to reward states that went a different course," he said.

Read more.

June 12, 2017

Leading health experts have grave concerns over AB260, mandating Wisconsin’s schools and colleges to accept physical exams completed by chiropractors. Currently primary care providers examine students for clearance to compete in athletic programs.

The coalition opposing the measure includes 19 key physician organizations, other health care providers, health systems, hospitals, academic centers and other parties with a vested interest in the health and well-being of Wisconsin’s student athletes.

“Chiropractors do not have the comprehensive medical training to provide the wrap-around care provided in the primary care office,” said Dr. David Bernhardt, a team physician for the University of Wisconsin-Madison and pediatric and adolescent sports medicine expert. “The safety of youth athletes is at stake.”

During public testimony on the bill in April, some commented that chiropractors “often have more training than physicians in certain areas,” a claim contested by physicians and others.

In contrast, a 2016 American Medical Association issue brief reports that while physicians complete 10,000+ clinical patient care hours (plus additional classroom and laboratory experience), chiropractors are required only to complete 4,200 hours of combined classroom, laboratory and clinical experience.

Dr. Kevin Walter, Program Director for Children’s Hospital of Wisconsin’s Primary Care Sports Medicine program, also cautioned against the proposal. "We want these young athletes to have quality screening by medical experts. When medical professionals are evaluating their health and physical readiness to participate in a sport, the exam includes so much more such as their cardiovascular condition, mental and behavioral health as well as educating them on health issues. The goal should be what is best for Wisconsin's kids and this proposal to allow chiropractors to handle these exams misses that mark."

The Assembly Committee on Health has scheduled a vote on the measure on Tuesday, June 13.

Take Action
Now is the time for physicians concerned about this bill to contact your State Assembly representatives—please feel free to use the coalition’s April 26, 2017 memo as a source for talking points; you also can share the document with your representative.  To verify the contact information for your elected officials, visit the State Legislature’s website and enter your address into the box under the “Find My Legislators” section at the right of the screen.