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  • Vol. 72, November 2020 DC E-Newsletter

    • Nov 24, 2020

    COVID-19

    Neurosurgery Asks Congress to Suspend Medicare Payment Sequester

    On Nov. 9, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) joined the Alliance of Specialty Medicine in a multi-specialty letter urging Congress to extend the Medicare sequestration relief provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136). Section 3709 provided a temporary suspension of the annual 2% Medicare payment sequester from May 1, 2020, through the end of 2020. This provision of the CARES Act has provided critical relief when the provider community is suffering severe financial losses due to the drastic decreases in non-COVID-19-related and non-emergency care.

    Following this action, on Nov. 11, the CNS and the AANS also signed a coalition letter asking Congress to extend the current moratorium on the Medicare sequestration cuts until the end of the public health emergency. The letter notes that the pandemic will continue to place financial stress on our nation's health care system, threatening the viability of those serving the most vulnerable communities. Therefore, Congress should act before the end of the year "to prevent the additional, damaging financial stress that would be caused by the return of the Medicare sequester."

    AMA Publishes COVID-19 Physician Practice Financial Impact Survey Results

    The results of an American Medical Association (AMA) nationwide physician survey illustrate the precarious trends and realities physicians now face. The economic impact of COVID-19 on health care continues to reveal itself through reductions in patient volume, revenue and higher practice costs. While initial federal financial relief programs were helpful to practices that applied, it appears the road to recovery, particularly for smaller physician-owned practices, remains challenging and more economic relief is needed. Click here to read the AMA's press release.

    COVID-19 Funding by State

    Responding to the devastating health and economic effects of the COVID-19 pandemic, federal policymakers have enacted several bills that include significant funding for new and existing programs to aid hospitals, physicians, individuals, businesses and governments across the country.

    Click here for a Peter G. Peterson Foundation analysis to see how this money has been distributed on a state-by-state basis.

    Legislative Affairs

    Legislation to Prevent Medicare Payment Cuts Introduced

    On Oct. 30, eight bipartisan members of Congress — Reps. Ami Bera, MD, (D-Calif.); Larry Bucshon, MD, (R-Ind.); Brendan Boyle (D-Pa.); George Holding (R-N.C.); Raul Ruiz, MD, (D-Calif.); Phil Roe, MD, (R-Tenn.); Abby Finkenauer (D-Iowa); and Roger Marshall, MD, (R-Kan.) — introduced H.R. 8702, the "Holding Providers Harmless From Medicare Cuts During COVID-19 Act." The purpose of the legislation is to hold health care providers harmless from Medicare payment cuts in 2021 and 2022, while the nation continues to contend with the effects of the COVID-19 pandemic. Under the legislation

    • Providers billing for eligible services under Medicare Part B — including certain E/M services — would receive an additional per service relief payment in 2021 and 2022 if the payment for the service would be lower than the 2020 payment rate;
    • The additional relief payment will equal the difference between the Medicare Physician Fee Schedule (MPFS) amount in 2021 and 2022 and the amount the service was paid in 2020;
    • Services with 2021 and 2022 payment rates higher than in 2020 are not eligible for the additional relief payment; and
    • E/M services with higher 2021 and 2022 payment rates than in 2020, including E/M codes paired with the new GPC1X add-on code, would not be eligible for the additional relief payment.

    Neurosurgery praised the legislation individually and through our efforts with the Surgical Care Coalition and Reps. Bera and Bucshon, taking the following actions: 

    • CNS/AANS letter to Reps. Bera and Bucshon endorsing the bill;
    • CNS/AANS press release announcing neurosurgery's endorsement of the bill;
    • Coalition letter supporting the bill;
    • Surgical Care Coalition press release announcing the legislation;
    • Surgical Care Coalition announces its support for the bill; and
    • Bera and Bucshon press release unveiling the bill.

    As a precursor to the introduction of H.R. 8702, Reps. Bera, Bucshon and others led a Congressional sign-on letter to House leaders urging Congress to act before the end of the year to prevent the cuts. This bipartisan letter was signed by 229 members of Congress. The CNS and the AANS issued a press release thanking them for their efforts.

    In the release, Ann R. Stroink, MD, FAANS, chair of the CNS/AANS Washington Committee, stated, "America's neurosurgeons appreciate the leadership of Reps. Bera, Bucshon and others for their efforts on multiple fronts to prevent these harmful cuts." She added that such "an overwhelming showing on this letter to House leaders clearly demonstrates significant bipartisan support for Congress to act this year to protect Medicare beneficiaries' timely access to care."

    Neurosurgery Calls on Congress to Delay AUC Imaging Program

    Organized neurosurgery has long advocated that Medicare's Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging will place an excessive burden on physicians across a broad range of specialties with little evidence of clinical benefit. Reiterating this message, on Nov. 6, the CNS and the AANS sent a letter to Congress, urging it to delay the program. The letter asks for the delay to "allow for a thoughtful and long overdue re-examination of the program" and points out that this added regulatory burden is the "last thing physicians need as they struggle through the COVID-19 pandemic."

    Grassroots Alert

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

    Starting on Jan. 1, 2021, the Centers for Medicare & Medicaid Services (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. Please take a moment and ask Congress to pass legislation before the end of this year.


    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 Objects to Burdensome Prior Authorization Requirements

    On Nov. 2, the CNS and the AANS sent a letter to Independence Blue Cross of Philadelphia regarding coverage guidelines requiring a physiatry consultation to authorize lumbar spinal fusion procedures, including fractures and tumors. The CNS/AANS Section on Disorders of the Spine and Peripheral Nerves (DSPN) prepared the response, objecting to the care delays that will ensue if patients must first see a physiatrist as a condition of prior authorization for medically necessary spine surgery. The organizations have requested a follow-up meeting with the plan's medical director.

    Neurosurgery Supports Medicare Coverage for Innovative Technologies

    On Nov. 2, the CNS and the AANS sent a letter to CMS regarding a proposed rule for Medicare coverage of medical devices approved by the Food and Drug Administration (FDA) under the expedited FDA breakthrough" device pathway. To date, the FDA has approved 16 devices under the breakthrough program. The neurosurgery letter — prepared by the CNS/AANS Coding and Reimbursement and Drugs and Devices Committee leaders — supports the expedited path to coverage. The groups also encouraged the agency to work with organized neurosurgery to use data from the NeuroPoint Alliance.

    The CNS and the AANS also joined the Alliance of Specialty Medicine in a multi-specialty letter on the subject.

    Neurosurgery Supports Payment for Additional Practice Expenses During Public Health Emergencies

    On Nov. 11, the CNS and the AANS signed joined a coalition letter to implement and pay for CPT code 99072 immediately. On Sept. 8, the CPT Editorial Panel approved the code to be used to report the additional supplies, materials and clinical staff time included in an office visit or other non-facility service(s) when performed during a public health emergency.

    Quality Improvement

    ONC Extends Deadline for Implementing Information Blocking Rule

    On Oct. 29, the Office of the National Coordinator for Health Information Technology (ONC) announced it is extending compliance deadlines for certain information blocking and health information technology (IT) certification requirements. Initially, ONC's information blocking rule required all physicians and hospitals to comply with information blocking requirements by Nov. 2. Due to the COVID-19 pandemic, ONC's interim final rule now pushes the information blocking compliance date to April 5, 2021.

    The AMA has created a two-part educational resource for physicians. Part 1 — "What is Information Blocking" — outlines what information blocking is, key terms to know and examples of information blocking practices. Part 1 also includes a summary of exceptions for when physicians may restrict access, exchange and use of electronic health information. Part 2 — "How do I comply with Information Blocking and where do I start?" — helps physicians start down the path of compliance, including questions to consider, considerations for maintaining a compliance program and next steps.

    Neurosurgery Joins Coalition Letter to CMS Regarding Data Validation for MIPS

    On Nov. 10, the CNS and the AANS joined the Physician Clinical Registry Coalition (PCRC) in sending a letter to CMS voicing concern about the agency's decision to retroactively require additional and burdensome data validation and auditing criteria for Qualified Clinical Data Registries (QCDR) participating in the 2020 Merit-Based Incentive Payment System (MIPS). 

    Drugs and Devices

    AHRQ Report on Opioid Use in Older Adults

    On Nov. 3, the Agency for Healthcare Research and Quality's (AHRQ) Evidence-based Practice Center (EPC) Program published an evidence review titled, "Prevention, Diagnosis, and Management of Opioids, Opioid Misuse, and Opioid Use Disorder in Older Adults." The report noted that the literature explicitly addressing opioid use in people over age 60 is sparse. Unfortunately, the studies were not designed to evaluate predictive models or screening tools for clinical decision making and may not be directly applicable to patient care. The AHRQ concluded that more research is needed to establish factors associated with clinically-important, patient-centered opioid-related outcomes in older adults and identify interventions to reduce unnecessary opioid use, opioid-related harms and treatment for opioid use disorder.

    Communications

    Neurosurgery Recognized in Article about Medicare Payment Cuts

    A Nov. 3, The Ripon Advance article titled, "Bucshon Proposes Bipartisan Bill to Defer Scheduled Medicare Physician Pay Cuts" highlighted neurosurgery's support of H.R. 8702, the Holding Providers Harmless From Medicare Cuts During COVID-19 Act.

    Neurosurgery Blog Publishes Women in Neurosurgery Series

    2020 marks the historic 30th anniversary of the founding of Women in Neurosurgery (WINS) and brings an exciting time to the WINS community and neurosurgery. To celebrate the 30th anniversary of WINS, Neurosurgery Blog: More than Just Brain Surgery is publishing a series of articles highlighting the section's goals — to educate, inspire and encourage women neurosurgeons to realize their professional and personal goals. WINS also serves women in neurosurgery by addressing the issues inherent to training, and maintaining a diverse and balanced workforce is the mission of this section. To date, the following blogs have been published:

    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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