Academy Objects to Mandated Needle EMG

The Academy recently took a Medicare carrier to task for its proposal regarding draft Medicare local coverage determination on electrodiagnostic studies, saying the proposal would adversely affect FPs' ability to provide high-quality and comprehensive care to their patients.

Specifically, AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., objected to the carrier's proposal that all patients receiving nerve conduction services, or NCS, also must undergo a needle electromyography study.

"We firmly believe that a mandate that needle EMG studies must be performed on all patients receiving a NCS is fundamentally a highly restrictive position, is not sound policy and is not clinically valid," said Frank in a letter to Charles Haley, M.D., carrier medical director for region VI of Trailblazer Health Enterprises LLC.

If put into policy, the draft local coverage determination would "effectively restrict many family physicians from performing NCS," said Frank. "NCS are a highly valuable diagnostic tool well within the scope and ability of family physicians. NCS allow physicians to advance their diagnosis of patients, determine the proper treatment options and provide high-quality care."

On the other hand, needle EMG requires more specific training than NCS, said Frank. "This training and experience is usually held exclusively by neurologists and physiatrists." Mandating that all patients be subjected to both procedures is entirely inappropriate and would limit the performance of electrodiagnostic studies "only to neurologists and physiatrists who primarily perform needle EMG procedures," she said.

In addition, said Frank, the proposed policy increases the risk of infection to the patient and "it increases the cost to Medicare by requiring two services in situations where only one might suffice." The proposed policy would be bad for patients because it would be more difficult, costly and inconvenient for Medicare patients to access needed care, she said.

As further fuel for her position, Frank pointed out that some peer-reviewed clinical studies published in premier neurology journals conclude that mandated needle EMG is not a standard of care and often provides no additional diagnostic data. The same studies have shown that performing the procedure in all patients "is unnecessary, unkind and not cost effective," said Frank.

The Academy asked that the draft local coverage determination be modified to allow physicians to use their clinical judgment to decide when needle EMG studies are indicated and to give all physicians the right to perform clinically appropriate nerve conduction studies.

Similar letters were sent to Trailblazer medical directors in Virginia, Texas, Delaware, Maryland and the District of Columbia. Corresponding AAFP constituent chapters also received copies of the letter.