• Vol. 85 April 2022 DC E-Newsletter

    • Apr 04, 2022

    Neurosurgeon Introduces President Biden During Cancer Moonshot Announcement

    On Feb. 2, President Joseph R. Biden, Jr. announced a series of new steps to “reignite” the Cancer Moonshot initiative, with the goal of “ending cancer as we know it” by halving the number of cancer deaths in the United States in the next 25 years. The Cancer Moonshot was initially established in 2016 by then-President Barack Obama to support cancer research and enable progress in treatment and care. It was originally authorized through the 21st Century Cures Act (P.L. 114-255) in December 2016, which included $1.8 billion for the Moonshot over seven years.

    In introducing the president, Edjah Nduom, MD, FAANS, associate professor of neurosurgery at Emory University School of Medicine, addressed the importance of the initiative in catalyzing cancer research. Referring to the president as the country’s “patient advocate-in-chief,” Dr. Nduom stated that “as a neurosurgeon scientist, constantly thinking of ways to treat cancer patients, to fight cancer, and seeing countless patients every year, I can confidently say this is the most exciting moment in the history of our field.”

    Click here to view the event. 

    Legislative Affairs

    Neurosurgery-Led Coalition Seeks COVID-19 Medical Liability Protections

    On Feb. 4, the Health Coalition on Liability and Access (HCLA) urged Senate Health, Education, Labor and Pensions Committee leaders to incorporate COVID-19-related liability protections in the Prepare for and Respond to Existing Viruses, Emerging New Threats (PREVENT) Pandemics Act, which is under development. The Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) serve as the vice-chair of HCLA. They have been urging Congress to pass a uniform set of liability protections — such as those included in H.R. 3021, the Coronavirus Provider Protection Act — for medical professionals who responded to the COVID-19 pandemic. The letter also urges the senators to include the Good Samaritan Health Professionals Act (S. 2941) in the PREVENT Pandemics Act (S. 3799). This legislation would provide medical liability protections to health care professionals who volunteer in a public health emergency or federally declared disaster.

    In a related effort, on March 9, HCLA urged House Energy and Commerce Committee leaders to incorporate the Good Samaritan Health Professionals Act (H.R.5239) and H.R. 3021 in any future legislation regarding pandemic response following a hearing titled “Lessons from the Frontline: COVID-19s Impact on American Healthcare.”

    Click here to read the Senate letter and here for the House letter.

    CNS and AANS Call on Congress to Hold Hearings on Medicare Fee Schedule

    On Feb. 7, the CNS and the AANS  joined more than 20 surgical organizations in calling on Congress to hold hearings on the future of the Medicare physician fee schedule and the status of other policies included in the Medicare Access and CHIP Reauthorization Act of 2015, including the Quality Payment Program (QPP). The letter points out that the current system results in drastic payment cuts each year. Although Congress has intervened to stop these cuts for the past two years, policymakers must devise a long-term solution to stabilize the system. On Feb. 18, the neurosurgical groups also joined the Alliance of Specialty Medicine, requesting hearings or roundtables to explore options for fixing the fee schedule and QPP. Finally, the CNS and the AANS joined 94 national health care organizations in sending a similar letter to Congress.

    Click here to read the surgery letter, here for the Alliance letter and here for the broad coalition letter.

    Neurosurgery Urges Congress to Extend Medicare Sequester Moratorium

    On Feb. 28, the AANS and CNS joined nearly 50 other health care stakeholder groups in a letter urging Congress to extend the moratorium on the 2% Medicare sequester until the end of the public health emergency (PHE). The PHE is currently set to expire on April 16, though it is expected that the administration will extend the expiration for at least an additional 90 days. In the letter, the groups thanked Congress for extending the moratorium on the Medicare payment sequester through March 31 in the Protecting Medicare and American Farmers from Sequester Cuts Act (P.L. 117-71). However, under the law, the full sequester will resume on July 1, at a time when physician practices and hospitals continue to recover from the COVID-19 pandemic. 

    Click here to read the letter.

    Congressional Neuroscience Caucus Hosts Webinar

    On March 8, the Congressional Neuroscience Caucus (CNC) hosted a webinar titled “The Importance of Brain Donation for Treating and Curing Brain Disease.” Sponsored by the Brain Donor Project and the American Brian Coalition, the purpose of the webinar was to raise public awareness of the need for brain tissue donation to promote neuroscience and research. Donated human brain tissue is more critical than ever as neuroscientists are making great strides in discovering treatments and cures for brain diseases. Still, most Americans are not aware of how necessary brain donation is, and many have incorrect assumptions about brain donation. CNC co-chairs Reps. Earl Blumenauer (D-Ore.) and Cathy McMorris Rodgers (R-Wash.) participated in the webinar and will continue to encourage brain donation.

    Click here to watch the presentation.

    President Signs Legislation to Fund the Government

    On March 15, President Joseph R. Biden signed the $1.5 trillion omnibus federal funding bill, the Consolidated Appropriations Act of 2022 (H.R. 2471). Highlights relevant to neurosurgery include:

    • A 151-day blanket extension of pandemic telehealth waivers after the Public Health Emergency ends, temporarily eliminating Medicare originating site and geographic restrictions, removing in-person requirements and allowing audio-only telehealth appointments;
    • $2,000,000 for civilian trauma centers to train and incorporate military trauma care providers and teams into care centers;
    • $7.25 million for traumatic brain injury research;
    • $12.5 million for firearm injury and mortality research; and
    • $45 billion for the National Institutes of Health, including $620 for the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative.

    Click here for the report language and here for the summary.

    Physician Wellness Legislation Passes Signed into Law

    On March 18, President Joseph R. Biden, Jr., signed the Dr. Lorna Breen Health Care Provider Protection Act (P.L. 117-105) into law. Endorsed by the CNS and the AANS, this new law establishes initiatives to address suicide, mental health, burnout and resiliency of health professionals. The measure includes programs at the Health Resources and Services Administration to promote evidence-informed strategies to improve well-being among health care trainees and professionals and a program at the Centers for Disease Control and Prevention to encourage health professionals to seek treatment for mental and behavioral health concerns.

    The law was named after Lorna Breen, MD, an emergency physician at New York-Presbyterian Allen Hospital working on the front lines of the pandemic, who died by suicide on April 26, 2020. In the wake of her loss, her family and other physicians across the country are pushing for policy changes to make it easier for physicians to seek out mental health care.

    Grassroots

    Ask Congress to Address COVID-19 Liability Now

    The continued fight against the COVID-19 pandemic threatens our frontline medical professionals and the practices and facilities where they provide patient care with the potential for a flood of unwarranted medical liability lawsuits. These issues arise from circumstances beyond their control, including workforce shortages, inadequate personal protective equipment, and delays in nonessential care resulting from public health guidance and government mandates issued during the pandemic. Congress can and must take action, and HCLA has the resources for you to advocate on behalf of physicians and patients. H.R. 3021, the Coronavirus Provider Protection Act, would grant targeted, limited immunity to pandemic responders on the front lines of the COVID-19 response.

    Click here to send an email message urging your Representatives to co-sponsor H.R. 3021.

    Coding and Reimbursement

    Texas Court Strikes Down Key Part of Biden Administration’s Surprise Billing Rules

    On Feb. 23, a federal judge in the U.S. District Court for the Eastern District of Texas issued a decision vacating parts of a Biden Administration rule implementing the ban on “surprise billing.” The decision was issued in response to a lawsuit filed by the Texas Medical Association (TMA) challenging the independent dispute resolution (IDR) process included in the No Surprises Act (P.L. 116-68) interim final rule. When considering payment disputes between health plans and providers for out-of-network care, the rule requires arbiters to select the offer closest to the insurer’s median contracted rate. This provision would lead to lower payments and unduly favors insurers, upsetting a careful balance established by Congress when it crafted the bill. According to the court, the No Surprises Act is unambiguous regarding the IDR process in stating that the qualifying payment amount (QPA) — or median in-network rate — is only one of several factors to consider resolving a billing dispute between an out-of-network provider and an insurer.

    This provision of the rule is now no longer in effect nationwide, and the Biden Administration is reviewing the court’s decision and considering whether to appeal the ruling. In the meantime, CMS announced that it notified providers, health plans, IDR entities and others of steps the administration is taking to conform to the court’s order. Click here for that information.

    District of Columbia Court Hears Arguments in No Surprises Act Lawsuit

    On March 21, the U.S. District Court for the District of Columbia held a hearing in the consolidated Association of Air Medical Services v. U.S. Department of Health and Human Services et al. case (the court consolidated the Association of Air Medical Services and American Medical Association (AMA)/American Hospital Association (AHA) lawsuits into a single action). This case involves similar issues as those considered by the court in the TMA lawsuit. In January, the AANS and the CNS filed an amicus brief, along with the Physician Advocacy Institute, supporting the AMA/AHA lawsuit.

    U.S. District Judge Richard Leon suggested that he is in no hurry to issue a ruling, pending the Biden Administration’s decision on whether to appeal the Texas case and how it handles this issue in the final rule, which is expected to be issued in May. The final rule could make the lawsuits irrelevant.

    Neurosurgery Urges CMS to Address Network Adequacy Standards

    On Jan. 27, the CNS and the AANS joined the Alliance of Specialty Medicine in submitting comments to the Centers for Medicare & Medicaid Services (CMS), urging the agency to address network adequacy concerns. Responding to the proposed rule titled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023,” the groups urged CMS to take the necessary steps to ensure health plans regulated by the Affordable Care Act meet network adequacy standards.

    Click here to read the letter.

    Neurosurgery Comments on CMS Prior Authorization Proposals

    On March 7, the CNS and the AANS joined the Regulatory Relief Coalition to urge CMS to implement the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018) into regulations governing Medicare Advantage plans. Subsequently, as members of the Alliance of Specialty Medicine, the CNS and the AANS also responded to the agency’s request for information, also encouraging CMS to adopt the provisions incorporated into the Improving Seniors’ Timely Access to Care Act.

    Click here for the Regulatory Relief Coalition letter and here for the Alliance of Specialty Medicine letter.

    Quality Improvement

    CMS Posts New and Updated QPP Resources

    CMS recently posted numerous new or updated items to the Quality Payment Program (QPP) Resource Library, including:

    Of Note

    National Academies of Sciences Releases TBI Report

    The National Academies of Sciences (NAS) recently released a new report, “Traumatic Brain Injury: A Roadmap for Accelerating Progress.” The report examines the current landscape of traumatic brain injury (TBI) care and research and identifies gaps and opportunities to accelerate progress and improve care for those affected by TBI. It discusses both acute and longer-term care and research challenges and highlights opportunities for collaborative action to advance the field. Neurosurgeon Geoffrey T. Manley, MD, PhD, FAANS, a member of the NAS Committee on Accelerating Progress, contributed to the report and participated in a webinar highlighting the report’s findings and recommendations.

    The following resources related to the report are available:

    • Click here to view the webinar;
    • Click here for a summary of the report; and
    • Click here for a JAMA viewpoint article about the report.

    Neurosurgeon Featured in AMA’s “Shadow Me” Specialty Series

    The AMA offers advice and information for medical students about different specialties by interviewing physicians in their “Shadow Me” Specialty Series. On Feb. 3, Nitin Agarwal, MD, was featured in the series, detailing a typical day as a chief resident at the University of Pittsburgh Medical Center Neurological Surgery. Dr. Agarwal is currently completing his spine fellowship at the University of California San Francisco and will start practice at Washington University in St. Louis in July. Dr. Agarwal is a member of the NeurosurgeryPAC board of directors, serves as a neurosurgery delegate to the AMA’s Resident and Fellow Section and is a member of the CNS/AANS Drugs and Devices Committee.

    Washington Committee/AMA Fellows Selected

    The 2022-23 Washington Committee/AMA fellows have been selected. The fellowship provides neurosurgical residents and fellows an opportunity for a richer, more diverse and actionable experience in health care policy and advocacy. Laura Stone McGuire, MD, a PGY-7 resident at the University of Illinois at Chicago, will serve as the primary fellow and delegate to the AMA’s Resident and Fellow Section (RFS). Michael J. Feldman, MD, a PGY-6 resident at Vanderbilt University, was appointed as an alternate fellow and will serve as an alternate delegate to the AMA’s RFS. Aladine A. Elsamadicy, MD, a PGY-4 resident at Yale University, and Jordan C. Xu, MD, a PGY-5 resident at the University of California, Irvine, were also selected as alternate fellows.

    AMA Analysis Demonstrates 3-Year Increase in Medical Liability Premiums

    Using data from the Annual Rate Survey Issues of the Medical Liability Monitor (MLM), the AMA prepared a new report summarizing changes in medical liability premiums from 2012 to 2021. According to the report, more premiums increased in 2020 and 2021 than in any year since 2006.

    AMA Releases Updated Survey Results and Other Prior Auth Resources

    On Feb. 10, 2022, the AMA released updated survey results on the impact of prior authorization on patients and physicians. Per the findings:

    • 93% of physicians report care delays;
    • 82% percent of physicians report that prior authorization can sometimes lead to a patient abandoning treatment;
    • 34% of respondents report that prior authorization has led to a serious adverse event for their patient, including hospitalization, life-threatening event, or disability;
    • Practices complete 41 prior authorizations per physician per week;
    • Physicians and key staff spend almost two business days each week completing prior authorization; and
    • 40% of physicians have staff who work exclusively on prior authorization.

    Communications

    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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