• Vol. 81, October 2021 DC E-Newsletter

    • Oct 21, 2021

    COVID-19

    Biden Administration Mandates Vaccinations for Health Care Workers

    On Sept. 9, the Centers for Medicare & Medicaid Services (CMS) announced that it will require COVID-19 vaccinations for workers in most health care settings that receive Medicare or Medicaid reimbursement, including hospitals and ambulatory surgical settings. These requirements will apply to approximately 50,000 providers and cover most health care workers across the country. The administration plans to issue an interim final rule implementing this policy in early October.

    Click here for President Biden’s COVID-19 action plan.

    Legislative Affairs

    CNS and AANS Support GME Funding in Budget Reconciliation Legislation

    On Sept. 1, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) joined a Graduate Medical Education (GME) Advocacy Coalition letter urging Congressional leadership to include additional Medicare-supported GME training positions in the $3.5 trillion budget reconciliation package. Physicians are a vital component of our nation’s health care infrastructure, and investments to increase the number of physicians are sorely needed — particularly given that the U.S. faces a shortage of up to 124,000 physicians by 2034.  If incorporated into the budget bill, the Resident Physician Shortage Reduction Act (S. 834/H.R. 2256) would provide 14,000 new Medicare GME slots over seven years — building on the Consolidated Appropriations Act, 2021 (P.L. 116-260), which provided 1,000 new Medicare-funded GME positions.

    Click here to read the GME Advocacy Coalition’s letter.  

    Good Samaritan Health Professionals Act Introduced

    On Sept. 10, Reps. Raul Ruiz, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) introduced the Good Samaritan Health Professionals Act (H.R. 5239) and on Oct. 6, Sens. Bill Cassidy, MD, (R-La.) and Angus King (I-Maine) introduced the Senate companion bill (S. 2941). This legislation offers health professionals providing voluntary care in response to a federally declared disaster with medical liability protections. While federal and state laws are intended to protect volunteer health professionals from unwarranted lawsuits, there are many inconsistencies, which may leave physicians vulnerable.

    The CNS and the AANS sent a letter of support to Reps. Ruiz and Bucshon and one to Sens. Cassidy and King.

    Neurosurgery Joins Alliance in Urging Congress to Prevent Medicare Cuts

    On Sept. 20, the CNS and the AANS joined the Alliance of Specialty Medicine (Alliance), urging congressional leaders to avoid Medicare payment cuts in 2022. The letter — sent to House Speaker Nancy Pelosi (D-Calif.), House Minority Leader Kevin McCarthy (R-Calif.), Senate Majority Leader Charles Schumer (D-N.Y.) and Senate Minority Leader Mitch McConnell (R-Ky.) — expresses concerns that proposed Medicare cuts scheduled to take effect on Jan. 1, 2022, could have serious financial consequences for physicians who are already under financial distress due to the sustained COVID-19 pandemic.

     Click here to read the Alliance’s letter.

    Coding and Reimbursement

    CNS and AANS Comment on Proposed 2022 Medicare Fee Schedule Payment Provisions

    On Sept. 13, the CNS and the AANS submitted detailed comments to CMS regarding the 2022 proposed Medicare PFS rule. In the letter, the neurosurgical societies offered the following recommendations related to the rule’s payment provisions: 

    • Urged CMS to incorporate the increased evaluation and management code values into the global surgery codes;
    • Rejected the proposal to bundle separately reportable critical care services into the underlying global codes;
    • Requested that CMS accept the AMA/Specialty Society RVS Update Committee values for the new laser interstitial thermal therapy (617X1 and 617X2) and arthrodesis decompression (630XX and 630X1) codes; and
    • Supported the proposal to extend flexible telehealth policies.

    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.

    Click here to read the CNS/AANS letter and here for the Alliance letter.

    Neurosurgery Comments on 2022 Medicare Hospital OPPS ASC Proposed Rule

    On Sept. 17, the CNS and the AANS submitted comments to CMS regarding the 2022 Medicare Hospital Outpatient Prospective Payment (OPPS)/Ambulatory Surgery Center (ASC) Payment System proposed rule. In the letter, the neurosurgery groups agreed with the agency’s plans to restore the Medicare Inpatient Only List and increase the procedures on the ASC list, while at the same time stressing that the site of service should be determined by the surgeon in consultation with the patient. The CNS and the AANS also reemphasized that CMS should rescind the prior authorization requirements for spinal cord stimulator and cervical spine procedures when they are performed in the hospital outpatient department.

    Neurosurgery Comments on New Surprise Medical Billing Rules

    Leading the way along with the American College of Surgeons, the CNS and the AANS sent comments to CMS in response to the first set of rulemaking implementing the No Surprises Act. The law bans surprise medical bills for out-of-network care and removes patients from payment disputes between health plans and providers. The comment letter urged the Departments of Health and Human Services, Labor and Treasury to:

    • Apply the “prudent layperson” definition for emergency medical services;
    • Require self-funded Employee Retirement Income Security Act plans to follow federal rather than state surprise medical billing rules;
    • Improve the methodology for calculating the qualifying payment amount (QPA) — generally the median in-network rate — for determining patient cost-sharing;
    • Compel health plans to provide physicians with information on how the QPA is calculated, among other information; and
    • Clarify that the QPA does not necessarily reflect actual commercial market payment rates.

    Click here to read surgery’s comment letter.

    Neurosurgery Objects to DRG Reassignment for LITT

    On Aug. 19, the CNS and the AANS sent a letter to CMS objecting to a proposal in the Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System final rule to reassign Laser Interstitial Thermal Therapy (LITT) Brain Procedures to new diagnosis-related groups (DRGs) without first giving notice in the proposed rule. The letter did not specifically address the reassignment but strongly opposed the lack of opportunity for public comment. Neurosurgery has asked CMS to rescind the action, conduct a thorough analysis of the impact of such DRG reassignment and allow the public a chance to comment.

    Click here to read neurosurgery’s letter.

    Neurosurgery Develops Position Statements for LITT

    In September, the CNS/AANS Joint Section on Tumors and the American Society for Stereotactic and Functional Neurosurgery produced two position statements regarding LITT for brain tumors, radiation necrosis and epilepsy. The documents provide an analysis of current clinical literature for the indications of LITT. The neurosurgical societies will use these statements in their advocacy efforts seeking appropriate coverage and reimbursement for this procedure in appropriately selected patients.

    Click here for the brain tumor statement and here for the epilepsy statement.

    Quality Improvement

    CNS and AANS Comment on Proposed 2022 Medicare Fee Schedule Quality Provisions

    On Sept. 13, the CNS and the AANS submitted detailed comments to CMS regarding the 2022 proposed Medicare PFS rule. In the letter, the neurosurgical societies offered the following recommendations related to the rule’s quality provisions: 

    • Advised against making the Merit-based Incentive Payment System (MIPS) Value Pathways mandatory;
    • Urged CMS to maintain the current threshold for determining MIPS penalties and bonus payments; and
    • Supported delaying the Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging for another year.

    The CNS and the AANS also joined the Alliance in advising against making the MIPS Value Pathways mandatory. Additionally, the neurosurgical societies partnered with the Physician Clinical Registry Coalition (PCRC) in a letter to CMS commenting on issues related to qualified clinical data registries. Finally, the Alliance letter also urged CMS to continue to delay implementation of the AUC Program, as did a Regulatory Relief Coalition (RRC) letter that the CNS and the AANS signed.

    Click here to read the CNS/AANS letter, here for the Alliance letter, here for the PCRC letter and here for the RRC letter.

    Neurosurgery Adopts Position Statement on Arthrodesis of the Spine

    The CNS, the AANS and CNS/AANS Joint Section on Disorders of the Spine and Peripheral Nerves recently adopted a new position statement titled “Arthrodesis of the Spine by the Non-Spine Surgeon.” Increasingly, non-surgeon spine practitioners are performing interventional services, such as percutaneous instrumentation, without the requisite training or ability to handle complications. The neurosurgical groups believe optimal and safe patient care occurs when neurosurgeons and orthopaedic surgeons — trained in the full spectrum of spinal biomechanics, including instrumentation and fusion techniques — manage surgical diseases affecting the spine.

    Click here to read the position statement.

    Drugs and Devices

    CNS and AANS Join AMA Substance Use and Pain Care Task Force in Issuing New Recommendations

    On Sept. 29, as members of the American Medical Association (AMA) Substance Use and Pain Care Task Force, the CNS and the AANS released new recommendations to help end the nation’s drug-related overdose and death epidemic. The recommendations are focused on actions physicians, policymakers and public health officials must take to remove barriers and improve access to evidence-based care for patients with pain and substance use disorder. Jason M. Schwalb, MD, FAANS, represents neurosurgery on the task force.

    Click here for the recommendations.

    Communications

    Neurosurgeon Publishes Op-Ed Encouraging COVID-19 Vaccination

    On Aug. 22, the Wall Street Journal published an op-ed by Richard Menger, MD, MPA, a CNS/AANS Communications and Public Relations (CPR) Committee member. Titled “A Better Way to Encourage Vaccination: Lecturing and moral superiority aren’t working. Healthcare workers should try humility and respect,” Dr. Menger discusses strategies for encouraging individuals to get vaccinated against COVID-19.

    Neurosurgery Blog Continues Faces of Neurosurgery Interview Video Series

    The Neurosurgery Blog: More than Just Brain Surgery recently launched a Faces of Neurosurgery interview video series. Conducted by Kurt A. Yaeger, MD, a member of the CNS/AANS CPR Committee, these neurosurgery luminaries are asked about their early mentors, proudest achievement and advice for neurosurgical residents. To date, interviews with Kalmon D. Post, MD, FAANS (L), R. Michael Scott, MD, FAANS (L), Kim J. Burchiel, MD, FAANS, FACS and Volker K. H. Sonntag, MD, FAANS (L) have been published.

    Click here for Dr. Post’s interview, here for Dr. Scott’s interview, here for Dr. Burchiel’s interview and here for Dr. Sonntag’s interview.

    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 in the nation’s capital and beyond the Beltway.

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