Neurology On the Hill: Q&A with AAN President Terrence Cascino, MD, FAAN

terrence cascino
terrence cascino
Hundreds of neurologists advocate for Congress to support the Telestroke FAST Act and the BRAIN Initiative.

More than 200 members and advocates from the American Academy of Neurology (AAN) and American Heart Association/American Stroke Association met with Congress this week to advocate for funding of the Telestroke FAST Act and the BRAIN Initiative.

The 2-day event, dubbed “Neurology on the Hill” focused on Medicare funding for videoconferencing services with off-site neurologists regardless of where a patient is located, as well as continued support for the BRAIN research initiative introduced by President Obama in 2013. Discussions on decreasing the burden of Meaningful Use requirements also took place.

Neurology Advisor spoke with AAN president Terrence L. Cascino, MD, FAAN about the effects that these initiatives have on neurologists and their patients, and why it’s important to continue to vocalize the needs and concerns of the medical community.

Neurology Advisor (NA): Why is it important that Medicare reimburse telestroke services for patients at any location?

Terrence L. Cascino, MD, FAAN: Right now, Medicare will only reimburse for telestroke services in rural areas, but about 94% of all strokes occur in an urban or suburban location. Time is brain, so it’s vitally important that all stroke patients have the opportunity for a timely evaluation regardless of where they are when they have a stroke. 

NA: What are some of the expected outcomes of implementing a telestroke service?

Dr Cascino: Telestroke would allow more acute stroke patients to be evaluated by a stroke specialist. This would increase the number of eligible patients who receive clot-busting treatment, allowing more people to be discharged to their homes instead of to rehab facilities. 

NA: Why it is important that Congress continue to fund the BRAIN Initiative?

Dr Cascino: Brain disease affects 100 million Americans at some point in their lives. Too many neurologic diseases lack disease-modifying treatments and few have cures. The BRAIN Initiative is a bold effort that seeks to improve our understanding of the brain and to apply these research gains to prevent and cure brain disease. 

NA: After Phase 1 of this initiative, what are the next steps planned?

Dr Cascino: Fiscal year 2017 is a watershed year — as the first round of pilot projects end, the BRAIN Initiative is poised to undertake large scale, bold efforts with new awards that will build on the pilot projects to uncover fundamental insight about how the nervous system functions in health and disease. One such project builds on new high-throughput, single-cell genetic analysis technology to create a census of all cells in the mouse brain — a remarkable goal, but one which will also serve as preparation for completing a census of the roughly 85 billion cells in the human brain. To manage the plethora of brain cell census data and increase the value of that data for the broader scientific community, the National Institutes of Health aims to set up a data repository/sharing system for BRAIN Initiative data.   

NA: What types of relief from Meaningful Use are AAN members hoping for?

Dr Cascino: Congress has the authority to make fundamental changes to the Meaningful Use program. Adding flexibility would go a long way toward improving this flawed program. Specifically, the reporting period should be shortened to less than 1 year. This would allow for technology changes and system upgrades. Secondly, penalties should incentivize participation and be proportional to achievement. Finally, to avoid duplication, PQRS or qualified clinical data registry participation should automatically satisfy Meaningful Use quality reporting requirements.