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February 2016

Neurology Advocacy 2.0: After Sustainable Growth Rate Repeal

Author Affiliations
  • 1Department of Neurology, University of Utah, Salt Lake City
  • 2American Academy of Neurology, Minneapolis, Minnesota
  • 3Southern New England Neurology, Bristol, Rhode Island
JAMA Neurol. 2016;73(2):151-152. doi:10.1001/jamaneurol.2015.2666

On April 16, 2015, the Medicare Access and Children’s Health Insurance Program Reauthorization Act, known as MACRA,1 was signed into law. The following week, the American Academy of Neurology held its annual meeting where many neurologists openly questioned: “What now?”

Repeal of the Medicare Sustainable Growth Rate (SGR) formula, as part of MACRA, is historic. The SGR formula was enacted in 1997 and designed to reduce health care costs by calculating what sustainable growth within the system would be and reducing physician reimbursement if it exceeded that rate. However, such cuts (typically in the double digits) were vigorously opposed by the physician community. As a result, during the past 12 years, Congress intervened 17 times with a temporary halt to the SGR cuts. These last-minute fixes were costly to taxpayers, required a substantial lobbying effort by organizations such as the American Academy of Neurology, and caused significant uncertainty among health care professionals. Repealing the SGR required a sustained effort by the entire physician community for more than a decade. Resolution of the SGR issue provides a significant opportunity for neurologists to focus on other issues, including advocating for better recognition of cognitive care services, improving the practice of neurology, and strengthening the neuroscience pipeline.