Neurologist: CMS Downgraded Me Because I Followed Standard Protocol for MS Patients

December 12, 2013 - 1:21 PM

Darrell Issa

Rep. Darrell Issa (R-Calif.) (AP Photo)

(CNSNews.com) – A neurologist that treats patients with multiple sclerosis testified before the House Oversight and Government Reform Committee Thursday that he received a report from the Centers for Medicare and Medicaid Services (CMS) in February 2012, saying that he overused MRIs or brain scans, which is the best way of evaluating brain injury, and is standard protocol for MS patients to undergo every one to two years.

“Failure to do so can lead to undetected, irreversible progression of their disease,” Dr. Jeffrey English, a neurologist at the Multiple Sclerosis Center of Atlanta, and a member of Docs 4 Patients, an organization dedicated to patient care, said in prepared testimony before the committee.

When English contacted CMS, he asked whether they knew that a large majority of his patients had MS and that MRI’s were standard protocol, and whether his peers were other MS doctors. He was told that they did not know which patients English cared for and that his peer group included general neurologists and orthopedic surgeons.

“The report warned me that when patients looked up my rating on the CMS website in the future, it would include data that showed that I over used MRI’s and did not meet their standards,” English added.

“The Affordable Care Act’s biggest problem is not its website which will be fixed some day," English said. "Common sense will tell you that a top down program run by bureaucrats in Washington, D,C., with a one size fits all system for patients from Maine to Oregon, will be filled with unintended consequences.

"Unfortunately, those unintended consequences are my patients, my fellow Americans, and your constituents,” he addded.

House Oversight and Government Reform Committee Chairman Darrell Issa (R-Calif.) said doctors who have what is considered an expensive practice lose under CMS’s rating system.

“Under the Affordable Care Act, what was often called rational care is occurring, simply because you’re being told that if you take an expensive practice, you could be locked out, while a doctor who sends off, casts off the kinds of people you deal with—in other words, a doctor, a neurologist who says, ‘Look, anyone gets MS, I’m gonna dump ‘em onto Dr. English, because Dr. English costs more, and I’m going to keep my costs down by not having those patients.” He or she wins. You lose under this rating system. Is that pretty much a wrap-up for what you’re dealing with?” Rep. Darrell Issa (R-Calif.), chairman of the committee, asked English.

“Correct. That’s my interpretation,” English replied.

“But you can fix that. You simply provide marginal care and do less MRIs and so on and then you’ll be okay. Is that right?” Issa asked.

“Or I stop working for the MS Center Atlanta and just your general neurology. Correct,” English said.

“So, you can not take these difficult patients, and the same with an oncologist, you know who says, ‘Well look. I’m gonna go into a practice where I only deal with people up until the time they have a serious cancer event, but after that I’m gonna dump that person,’” Issa said.

“So the really sick under the current system, unless we change it, find themselves undesirable either to get full care, which costs more, or quite frankly, to get to the doctor at all. That’s what you’re dealing with unless we make these changes?” Issa asked.

“Yes,” English said.