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  • Vol. 71, October 2020 DC E-Newsletter

    • Oct 20, 2020

    Surgical Care Coalition Campaign

    Surgical Care Coalition Launches a Week of Action

    The Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS), along with 10 other national surgical associations, formed the Surgical Care Coalition (SCC) to prevent steep Medicare payment cuts in 2021. Throughout the week of Sept. 21, surgeons from across the country took steps to raise awareness about the cuts and urged Congress to take action before the end of the year. Paid digital advertising, op-eds, grassroots activism, an educational webinar and a national radio tour were among the activities undertaken during the week of action.

    To stay informed about the SCC’s activities, neurosurgeons are encouraged to sign-up for the coalition’s advocacy newsletter. Newsletters published on Aug. 27, Sept. 11, Sept. 25 and Oct. 1 highlight the group’s recent activities.

    Click here to subscribe to the SCC advocacy update newsletter.

    Neurosurgeons are also encouraged to follow the coalition on Twitter and LinkedIn.

    Lenox Hill Neurosurgeons Speak Out

    New York neurosurgeons David J. Langer, MD, FAANS, and John A. Boockvar, MD, FAANS, from Netflix’s hit docuseries “Lenox Hill,” appeared on radio stations across America to discuss the threats posed by the pending Medicare payment cuts. The pair appeared on the following programs: 

    Drs. Langer and Boockvar also penned an op-ed in the New York Daily News titled, “The death of the physician-scientist? Medicare cuts would do terrible long-term harm.”

    COVID-19

    Trump Administration Renews COVID-19 Public Health Emergency Declaration

    The Trump administration has renewed the COVID-19 public health emergency declaration for the third time. On Oct. 2, U.S. Department of Health and Human Services (HHS) Secretary Alex M. Azar announced the renewal, which is effective Oct. 23 and will last 90 days.

    HHS Announces $20 Billion in New Phase 3 Provider Relief Funding

    On Oct.1, HHS announced $20 billion in new funding for providers on the frontlines of the coronavirus pandemic. Eligible providers may apply for funding through Nov. 6. Under this Phase 3 allocation, providers that have already received Public Health and Social Services Emergency Fund (Provider Relief Fund) payments are invited to apply for additional funding related to financial losses and changes in operating expenses caused by COVID-19. Previously ineligible providers — such as those who began practicing in 2020 — will also be invited to apply.

    Click here for more information on the distribution methodology and application process and here to access the Provider Relief Fund portal.

    CMS Announces New Repayment Terms for COVID-19 Medicare Loans

    On Oct. 8, the Centers for Medicare & Medicaid Services (CMS) announced new repayment terms for payments issued under the Medicare Accelerated and Advance Payment (AAP) Program. Providers will now have one year from the issuance date to repay the loan, and the interest rate has been lowered to 4%.

    Click here for a fact sheet about the APP Program.

    CMS Offers 2020 COVID-19-Related MIPS Relief

    In response to the COVID-19 public health emergency (PHE), CMS is offering multiple flexibilities to clinicians eligible to participate in the 2020 Merit-Based Incentive Payment System (MIPS). Individual clinicians, groups and alternative payment model (APM) entities may submit a hardship exemption application requesting to opt-out of any or all of their 2020 MIPS performance categories (i.e., Quality, Cost, Improvement Activities and/or Promoting Interoperability) due to the PHE. If an application to opt-out of all four categories is approved, the clinician, group or APM will be held harmless from the -9.0% 2022 MIPS payment adjustment. Note that the submission of MIPS data to CMS will override the hardship exception application and clinicians will be scored on their submission.

    Hardship exemption applications may be submitted online now through Dec. 31. Click here for more details.

    Neurosurgery Supports COVID-19 Provider Fund Tax Relief

    On Aug. 25, the CNS and the AANS sent a letter to Rep. Cindy Axne (D-Iowa), Rep. Neal Dunn, MD, (R-Fla.) and Sen. Marsha Blackburn (R-Tenn.) expressing support and appreciation for the Eliminating the Provider Relief Fund Tax Penalties Act (H.R. 7819/S. 4525). Provider Relief Fund payments are currently taxable, reducing the benefits of these subsidies. If enacted, this legislation would deliver crucial tax relief to the nation’s health care professionals.

    Click here for a copy of the letter.

    Neurosurgery Asks CMS for DGME Cap Deadline Extension

    On Aug. 13, the CNS and the AANS sent comments to CMS asking the agency to extend the direct graduate medical education (DGME) cap deadlines for institutions currently undergoing the accreditation process to account for delays caused by the COVID-19 crisis. Each teaching hospital has a cap on the number of positions based on several metrics. Given the documented shortage of physicians now and into the future, organized neurosurgery believes providing these institutions some leeway to complete the accreditation process is warranted to avoid unnecessary reductions in the number of residency positions available to train the next generation of physicians.

    Click here to read the letter.

    Legislative Affairs

    Neurosurgery Leads Efforts to Prevent Medicare Payment Cuts

    The CNS and the AANS continue to lead legislative efforts to prevent steep Medicare payment cuts from going into effect on Jan. 1, 2021. On Sept. 18, the CNS and the AANS joined 20 other surgical organizations in sending a letter to each member of the House of Representatives, urging Congress to prevent Medicare physician payment cuts. Specifically, the letter asks Congress to pass legislation that: 

    • Increases the global surgery codes;
    • Halts implementation of the add-on code for complex E/M visits; and
    • Prevents any cuts resulting from the new E/M payment policies.

    On Sept. 24, the neurosurgical groups also joined the Alliance of Specialty Medicine (Alliance) in a letter to House and Senate leaders urging them “to act before the end of the year to prevent significant Medicare pay cuts.” The letter points out “that these steep cuts could have serious financial consequences for physicians who are already under financial distress due to the COVID-19 pandemic.”

    Legislation to Prevent Medicare Cuts Introduced in House

    On Oct. 2, Reps. Michael Burgess, MD, (R-Texas) and Bobby Rush (D-Ill.) introduced legislation (H.R. 8505) to prevent Medicare physician payment cuts for 2021. The bill would waive Medicare’s budget neutrality requirements to avoid the cuts, allocating $10 billion from the Provider Relief Fund’s unobligated funds for this purpose. The CNS and the AANS issued a press release and joined 59 national medical associations in sending a letter thanking Reps. Burgess and Rush for introducing this bill.

    Senator Collins Urges Senate Leaders to Take Action to Prevent Medicare Cuts

    On Oct. 9, Sen. Susan Collins (R-Maine) sent a letter to Senate leaders expressing her “concern with the ill-timed payment cuts proposed for certain physician specialties.” In her letter, she observes that “physicians and other health care professionals are now facing harmful payment cuts at the very time they are responding to the COVID-19 pandemic and trying to recover from the significant financial challenges brought on by this virus.” She notes that in light of the ongoing public health and economic crisis, Congress should waive Medicare’s budget neutrality requirements before the final E/M code proposal is implemented on Jan. 1, 2021. The CNS and the AANS expressed appreciation for Sen. Collins’ efforts to prevent steep and harmful Medicare cuts.

    Click here to read the letter.

    Bipartisan Lawmakers Urge HHS to Take Steps to Prevent Medicare Payment Cuts

    On Sept. 24, a bipartisan group of 161 members of Congress wrote to HHS Secretary Alex M. Azar and CMS Administrator Seema Verma, MPH expressing concerns about the pending Medicare physician payment cuts. The lawmakers asked the administration to “engage with stakeholders in establishing fair and equitable payment solutions that address Medicare payment cuts,” while at the same time “moving forward with policies to increase payments to primary care and other office-based specialties.” The letter cites the need to protect patient access to medically necessary services given the unprecedented public health and economic challenges currently facing physicians and other health care providers due to the COVID-19 pandemic.

    Congress Passes Legislation to Fund the Government

    On Sept. 30, President Donald J. Trump signed into law legislation that temporarily funds the government. The stopgap spending measure — the Continuing Appropriations Act, 2021 and Other Extensions Act (H.R. 8337) — would extend current levels of federal funding through Dec. 11. The legislation included several health care provisions: 

    • Extends Medicare’s geographic practice cost index increases for rural physicians;
    • Delays cuts to Medicaid disproportionate share hospitals;
    • Extends the Medicare AAP Program loan repayment deadline to one year and lowers the interest rate to 4% for this COVID-19 provider relief funding;
    • Allows the National Institutes of Health to provide no-cost extensions to specific multi-year grants set to expire on Sept. 30 that were negatively impacted by the pandemic;
    • Extends the Food and Drug Administration’s (FDA) rare pediatric disease priority review voucher program; and
    • Protects Medicare beneficiaries from an expected $50 Part B monthly premium hike and instead places a limit on any premium increases to $4 per month.

    Neurosurgery  Calls for Improvements to Surprise Medical Bills Proposal

    The CNS and the AANS are leading an effort to improve a compromise proposal to ban surprise medical bills. Joining 18 national and state medical organizations, the groups issued a statement urging Congress not to enact surprise billing legislation — particularly during the COVID-19 public health emergency — that further destabilizes physician practices, exacerbates disruptions in our health care system and favors an insurance industry that is setting record profits. Leaders from the Senate Health, Education, Labor and Pensions and House Energy and Commerce Committees, along with Sen. Bill Cassidy, MD, (R-La.), have reached a tentative deal and are urging their colleagues in Congress to support the new compromise agreement.

    Bill to Eliminate Health Insurance Industry Antitrust Exemption Passes House

    With broad bipartisan support, H.R. 1418, the Competitive Health Insurance Reform Act, passed the House by voice vote on Sept. 21. Introduced by Reps. Peter DeFazio (D-Ore.) and Paul Gosar, DDS, (R-Ariz.), the bill would help lower the cost of health insurance coverage for Americans by eliminating the antitrust exemption the health insurance industry currently enjoys under the McCarran-Ferguson Act of 1945. Long supported by organized neurosurgery, the legislation now goes to the Senate for further action. A Senate companion bill, S. 350, was introduced by Sens. Steve Daines (R-Mont.) and Patrick Leahy (D-Vt.).

    Neurosurgery Urges Congress to Fund National Concussion Surveillance System

    On Sept. 14, the CNS and the AANS sent a letter to Sens. Roy Blunt (R-Mo.) and Patty Murray (D-Wash.) requesting $5 million to fund the National Concussion Surveillance System. Authorized by the Traumatic Brain Injury (TBI) Program Reauthorization Act of 2018 (P.L. 115-377), this provision reflects the recommendations of the Committee on Sports-Related Concussions in Youth and others to establish and oversee a national surveillance system to accurately determine the incidence of sports-related concussions, including those ages 5 to 21.

    Click here to read the letter.

    Neurosurgery Urges Senate to Fund Pediatric Subspecialty Loan Repayment Program

    On Aug. 25, the CNS and the AANS send a letter to Sens. Richard Shelby (R-Ala.), Patrick Leahy (D-Vt.), Roy Blunt (R-Mo.) and Patty Murray (D-Wash.) asking Congress to fund the Pediatric Subspecialty Loan Repayment Program this year. Severe shortages of pediatric subspecialists are causing decreased access to care for children. Without federal investment in the pediatric subspecialty physician workforce, children will continue to: 

    • Face long wait times for subspecialty care;
    • Travel long distances to receive that care; or
    • Go without care altogether.

    Click here to read the letter.

    Grassroots Alert

    Make Your Voice Heard – Ask Congress to Take Action to Prevent Medicare Cuts

    Staring on Jan. 1, 2021, CMS will slash Medicare payments to neurosurgeons by at least 7%, jeopardizing patient access to surgical care in the middle of a pandemic. The reductions are primarily driven by new Medicare payment policies for office and outpatient visits services. Congress needs to step in and stop these cuts before they hurt patient access to surgical care.

    Click here to go to neurosurgery’s Advocacy Action Center to send an email to your elected officials asking them to take action to halt the Medicare cuts.

    Coding and Reimbursement

    Neurosurgery Urges CMS to Increase Medicare’s Global Surgery Values

    On Aug. 21, the CNS and the AANS sent a letter to CMS voicing strong opposition to certain policies related to the new E/M codes included in the 2021 Medicare Physician Fee Schedule (PFS) proposed rule. In the letter, the groups strongly urged CMS to apply the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC)-recommended work and time incremental increases for the revised E/M codes to the global surgery codes. The letter points out that to do otherwise: 

    • Disrupts the relativity of the Medicare PFS;
    • Violates the Medicare law’s ban on specialty payment differentials; and
    • Ignores recommendations endorsed by nearly all medical specialties.

    To read the letter, click here.

    Neurosurgery Comments on Proposed 2021 Medicare Physician Fee Schedule

    On Oct. 1, the CNS and the AANS commented on the 2021 Medicare PFS proposed rule. The letter stresses the need for CMS to take the following steps to prevent steep Medicare payment cuts to neurosurgery: 

    • Include the E/M increases in the global surgery codes;
    • Eliminate the proposed GPC1X add-on code; and
    • Waive Medicare’s budget neutrality requirement.

    The letter also urges the agency to: 

    • Ensure accurate practice expense survey data collection;
    • Accept RUC-passed values for new and revised codes;
    • Revalue CPT® code 22867 (Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level); and
    • Review the process for making national Medicare coverage determinations.

    The CNS and the AANS also joined the Alliance in recommending that CMS take steps to prevent the planned Medicare payment cuts and establish policies that expand access to telehealth and virtual care services. Finally, the neurosurgical societies joined more than 40 national medical organizations in urging CMS to take steps to prevent the payment cuts.

    Click here for the CNS/AANS letter, here for the Alliance letter and here for the neurosurgery-led coalition letter.

    Neurosurgery Comments on Medicare Hospital-ASC Proposed Rule

    On Oct. 5, the CNS and the AANS submitted comments to CMS regarding the 2021 Medicare Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgery Center (ASC) proposed rule. Our comments focused on the following topics: 

    • Eliminating the inpatient-only list;
    • Prior authorization for spine and neurostimulator procedures;
    • New C-APC 5465 (Level 5 Neurostimulator and Related Products);
    • Physician-owned hospitals;
    • Hospital Outpatient Quality Reporting Program; and
    • Expansion of the ASC list.

    Click here to read the letter.

    Quality Improvement

    Neurosurgery Submits Comments on Medicare’s Quality Payment Programs

    On Sept. 29, the CNS and the AANS submitted comments related to Medicare’s quality payment programs. The letter addressed the following topics:

    • MIPS Value Pathways;
    • MIPS performance categories;
    • APM Performance Pathway;
    • Qualified Clinical Data Registries (QCDRs); and
    • Certified Electronic Health Record (EHR) Technology.

    The neurosurgical groups also joined the Alliance in commenting on these same topics. Finally, the CNS and AANS also joined the Physician Clinical Registry Coalition (PCRC) in commenting on issues related to data validation and QCDR measure testing.

    Click here for neurosurgery’s letter, here for the Alliance letter and here for the PCRC letter.

    CMS Releases 2019 MIPS Performance Feedback

    CMS recently released the final 2019 MIPS performance feedback reports and final scores, which will be used for physician payment adjustments in 2021. If you submitted data for the 2019 performance period, you can view your MIPS performance feedback and final score on the Quality Payment Program (QPP) website. Note that clinicians and groups must register for a secure account to access these reports. Additional information on accessing and interpreting these reports is available for download here.

    APM Incentive Payments Available

    CMS has released a list of more than 22,000 clinicians who qualified for a 5% APM  incentive payment under the QPP but whose billing information is unknown. The bonus payments are based on 2018 performance. CMS requests that individuals on the list submit billing information to CMS by Nov. 13, 2020.

    Click here to determine if you are on the list and eligible to receive these bonus funds. 

    CMS Launches Consolidated Care Compare Site

    In September, CMS launched an updated Care Compare site — a streamlined redesign of eight existing tools that provide the public with information on quality metrics for physicians, hospitals and other providers. CMS advertises the new site as a “single user-friendly interface that patients and caregivers can use to make informed decisions about health care based on cost, quality of care, volume of services, and other data.” CMS also announced several improvements to the Procedure Price Lookup tool — including adding physician fees in addition to facility fees — to give Medicare beneficiaries a more accurate prediction of out-of-pocket costs. Finally, the agency updated the Provider Data Catalog, which will allow researchers to access and analyze publicly reported data more easily.

    Click here for more information about this announcement.

    Drugs and Devices

    Neurosurgery Supports FDA Action on Facet Screws and Bone Growth Stimulators

    On Sept. 8, the FDA’s Center for Devices and Radiological Health’s Orthopaedic and Rehabilitation Devices Panel met to consider the classification of facet spinal screws, from the unclassified pre-amendments device type to the Class II device designation. The panel also considered reclassifying non-invasive bone growth stimulator devices from the Class III designation to Class II. CNS/AANS Drugs and Devices Committee chair, William C. Welch, MD, FAANS, presented comments supporting the Class II designation for facet screws. CNS/AANS Drugs and Devices Committee member, Charles A. Sansur, MD, FAANS, offered comments supporting the Class II designation for bone growth stimulator devices. Following the discussion, the panel agreed to recommend the Class II designation for both devices. Class II devices are typically cleared through the less onerous 510(k) process.

    Click here for the meeting agenda and supporting materials, here for a summary of the meeting and here for the meeting webcast — including presentations by Drs. Welch and Sansur.

    Communications

    CNS/AANS Washington Committee Launches New Website

    The CNS/AANS Washington Committee for Neurological Surgery recently launched its new website — www.neurosurgery.org. The site will serve as a hub to the CNS and the AANS advocacy pages and includes links to the websites of the Council of State Neurosurgical Societies, CNS/AANS joint sections and Neurosurgery Blog. The website features the latest tweets from the Washington Committee’s Twitter feed @Neurosurgery, as well as the most recent posts from Neurosurgery Blog: More Than Just Brain Surgery. Notably, the web hub incorporates the CNS/AANS Advocacy Action Center, which includes action alerts on priority issues, highlights neurosurgery-supported legislation and allows neurosurgeons to see how their elected officials stand on specific bills.

    Click here to visit the new website.

    Neurosurgery Highlighted in Article about Medicare Payment Cuts

    An Oct. 9, Inside Health Policy article titled, “Providers, Lawmakers Ask CMS To Ease Cuts Tied To 2021 E/M Pay Bump,” highlighted neurosurgery’s reaction to H.R. 8505 and included information about the neurosurgery-led coalition letter to CMS. The article noted that Reps. Burgess and Russ introduced H.R. 8505, which would provide a one-year waiver of Medicare’s budget neutrality requirements, “to the delight” of the CNS and the AANS. The article concluded with a quote from neurosurgery’s press release stating that “America’s neurosurgeons are encouraged that Congress recognizes that cuts of the magnitude proposed by CMS could result in physicians taking fewer Medicare patients leading to longer wait times and reduced access to care for older Americans. Congress must act now to prevent this from happening,” said Ann R. Stroink, MD, FAANS, chair of the CNS/AANS Washington Committee.

    Article Underscores Neurosurgery’s Concerns about Medicare Pay Cuts

    Neurosurgery’s concerns about pending Medicare payment cuts were underscored in an Oct. 6 article from MedPage Today. The article, “Health Groups Turn Up Heat on 2021 Medicare Fee Schedule — Surgeons, radiologists, and others object to payment cuts, proposed add-on visit code,” included information about the neurosurgery-led coalition letter to CMS and details from neurosurgery’s comment letter regarding the proposed Medicare PFS.

    Click here to read the article.

    CNS/AANS Washington Office Director Featured in Article about Stark Rules

    Katie O. Orrico, Esq., director of the CNS/AANS Washington Office, was featured in a recent MedPage Today article titled, “Looking for That Modified Stark Rule? Better Cool Your Heels — CMS extends final rule timeline to Aug. 31, 2021.” The article reported that the Trump administration set a new deadline of Aug. 31, 2021, to issue a final rule reforming the Stark Law — a year later than initially planned.

    In her comments, Ms. Orrico noted that the CNS and the AANS “continue to recommend that the Office of Management and Budget clear the rules for implementation as submitted.” Additionally, she said that the neurosurgery organizations would like to see a speedy result, stating, “It is our understanding that nothing precludes the president from approving the proposed final rules as submitted from HHS.”

    Click here to read the article.

    Neurosurgery Featured in Article about Outpatient CPT Code Changes

    Katie O. Orrico, Esq., director of the CNS/AANS Washington Office, was featured in a Sept. 2, MedPage Today article titled, “Docs Give Outpatient CPT Code Changes Mostly Good Review — Surgery groups, though, share gripes.” The article noted that physician groups are generally satisfied with some of the pending changes to the office and outpatient visit E/M codes and documentation requirements. However, the piece points out that the surgery groups have concerns about CMS’ refusal to adjust the E/M portion of the global surgery codes.

    In her comments, Ms. Orrico said that the CNS and the AANS “supported the development of the new E/M codes since neurosurgeons can now code based on medical decision-making rather than the ‘check-the-box’ approach that the previous code set employed.” She added, however, that “our qualm is with CMS and how the agency is implementing the new codes in next year’s Medicare physician fee schedule.”

    Neurosurgery Blog Publishes Physician Burnout Series

    To explore and highlight the rising prevalence of burnout among clinicians in recent years, Neurosurgery Blog: More than Just Brain Surgery published a series of articles. Read the complete series: 

    Join the Conversation on Social Media

    Connect with the CNS/AANS Washington Committee and Washington Office on various social media platforms to keep up with the many health policy activities happening in the nation’s capital and beyond the Beltway. 

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