Neurosurgeons Announce Principles for Reforming the Medicare Physician Payment System
On May 25, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) endorsed principles for reforming the Medicare physician payment system. In collaboration with the American Medical Association, the 120 state and national medical societies developed “Characteristics of a Rational Medicare Payment System,” which outlines a unified set of shared goals for improving the current system.
Subsequently, the CNS and the AANS issued a press release announcing support for the unified goals. “The current Medicare physician payment system is on life support and needs an overhaul. We are grateful that Congress has stepped in to mitigate steep cuts over the past few years, but comprehensive reform to reflect practice costs and inflation is needed,” stated John K. Ratliff, MD, FAANS, chair of the CNS/AANS Washington Committee. The CNS and the AANS also lead several coalition efforts, including the Surgical Care Coalition, to prevent steep Medicare payment cuts and preserve patient access to care.
Prior Authorization Legislation Introduced in the House
On June 9, Reps. Michael Burgess, MD, (R-Texas) and Vicente Gonzalez (D-Texas) introduced the Getting Over Lengthy Delays in Care As Required by Doctors Act (GOLD CARD) Act (H.R. 7995), a bipartisan bill that the CNS and the AANS helped draft. This bill would exempt certain physicians from prior authorization in the Medicare Advantage (MA) program. Specifically, the legislation would exempt providers from prior authorization requirements for one year if the provider had at least 90% of prior authorization requests approved the preceding year.
In announcing the introduction of the legislation, Reps. Burgess and Gonzalez issued a press release featuring John K. Ratliff, MD, FAANS, who stated:
Since most medical services are ultimately approved, the GOLD CARD Act is a commonsense approach to addressing the unnecessary burdens caused by the widespread use of prior authorization. Neurosurgical patients suffer from painful and life-threatening neurologic conditions such as brain tumors, debilitating degenerative spine disorders, stroke and Parkinson’s Disease, and without timely care, they often face permanent neurologic damage and sometimes death. If adopted, Rep. Burgess’ and Gonzalez’s legislation would be a significant step in making sure our seniors get the care they need when they need it, and America’s neurosurgeons are proud to endorse this bill.
Neurosurgery Urges Funding for MISSION Zero Program
The CNS and the AANS joined the Trauma Coalition in sending a letter to the U.S. Senate Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee in support of the $11.5 million in funding for the Military and Civilian Partnership for the Trauma Readiness Grant Program.
Championed by organized neurosurgery, the MISSION ZERO Act was signed into law in 2019 as a part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act. It created a grant program within the U.S. Department of Health and Humans Services to cover the administrative costs of embedding military trauma professionals in civilian trauma centers. These partnerships will allow military trauma care teams and providers to gain exposure to treating critically injured patients and increase readiness for when these units are deployed. Similarly, best practices from the battlefield are brought home to advance trauma care and provide civilian access to trauma care.
Click here to read the Trauma Coalition letter.
House Committee Advances Pediatric Medical Research Legislation
In May, the House Energy and Commerce Committee passed H.R. 623, the Gabriella Miller Kids First Research Act 2.0. This legislation, supported by the CNS and AANS, modifies funding for this pediatric disease research program within the National Institutes of Health to direct certain penalties assessed by the Securities and Exchange Commission against pharmaceutical companies.
Coding and Reimbursement
Neurosurgery Adopts Position Statement on Prior Authorization Imaging Requirements
On June 7, the CNS, AANS and CNS/AANS Joint Section on Disorders of the Spine and Peripheral Nerves adopted a new position statement titled “Image Sharing Requirement for Prior Authorization.” The neurosurgical groups believe that the doctor-patient relationship is an indispensable component of shared decision-making in choosing to undergo spine surgery. The concept that image sharing should be a basis for prior authorization is an unnecessary and unwelcome impingement on the doctor-patient relationship, which will detrimentally interfere with the decision for spine surgery. Physicians who treat spine conditions adamantly oppose requiring the submission of patient images as a prior authorization requirement for spine surgery.
Click here to read the position statement.
CNS and AANS Urge CMS to Ban Step Therapy in Medicare
On June 1, the CNS and the AANS signed a letter asking the Center for Medicare & Medicaid Services (CMS) to reinstate the step therapy prohibition in Medicare Advantage plans. In the letter, the groups requested that the agency prohibit step therapy for Part B drugs as specified in the original Sept. 17, 2012, memo “Prohibition on Imposing Mandatory Step Therapy for Access to Part B Drugs and Services.” Step therapy, also known as “fail first,” is utilized by health plans to determine coverage and requires that patients fail on an insurer’s preferred medication before the therapy prescribed by their health care provider is covered.
Click here to read the letter.
Neurosurgery Comments on Proposed Medicare Inpatient Payment Rule
On June 14, the CNS and the AANS sent a letter to the CMS regarding provisions in the Fiscal Year 2023 Medicare Hospital Inpatient Prospective Payment proposed rule. In the letter, neurosurgery:
- Agreed with the CMS proposal to return laser interstitial thermal therapy procedures to open craniotomy Medicare Severity Diagnosis-Related Group (MS-DRG) Classifications;
- Urged CMS to consider MS-DRG assignment for procedures involving the intracerebral infusion of gene therapy and stem cell products in development for many neurologic disorders;
- Supported New Technology Add-on Payment for several spine and neurostimulator devices; and
- Opposed the agency’s proposal to make the query of Prescription Drug Monitoring Program Measure mandatory.
Click here to read the letter and here to view the fact sheet on the proposed rule.
CMS Selects Neurosurgeons for MEDCAC
On May 19, CMS appointed three CNS/AANS nominated individuals — Ketan R. Bulsara, MD, FAANS; Joshua M. Rosenow, MD, FAANS and Cheerag D. Upadhyaya, MD, FAANS — to serve on the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC). MEDCAC comprises 100 experts who assist CMS in reviewing and evaluating medical literature, technology assessments and other information to help determine if Medicare should cover medical items and services. Drs. Bulsara, Rosenow and Upadhyaya will serve for a two-year term.
MedPAC Submits June Report to Congress
On June 15, the Medicare Payment Advisory Commission (MedPAC) released its annual June Report to Congress. The report includes several recommendations relevant to neurosurgeons, including:
- Simplifying and reducing the number of Medicare alternative payment models;
- Approaches for addressing the prices of drugs covered under Medicare Part B; and
- Methods for equalizing fee-for-service payment rates across ambulatory settings.
MedPAC published a press release announcing the report.
Drugs and Devices
Neurosurgery Raises Concerns about Pharmacy Benefit Managers
On May 17, the CNS and the AANS joined the Alliance of Specialty Medicine in sending a letter addressing issues raised in a Federal Trade Commission (FTC) Request for Information related to the pharmacy benefit manager (PBM) industry. PBMs are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers and other payers. The letter expressed concern about the consolidation in the PBM industry, noting that just three PBMs control 80% of prescriptions in the U.S. It urged the FTC to thoroughly study PBM industry practices and their impact on the availability and cost of prescription medication for patients.
Click here to read the Alliance of Specialty Medicine’s letter.
Of Note
Washington Committee Announces Personnel Changes
Recently, the CNS/AANS Washington Committee announced several personnel changes. CNS-appointee Russell R. Lonser, MD, FAANS, has been selected as the committee’s chair-elect and will become chair of the committee on Jan. 1, 2023. The CNS appointed Clemens M. Schirmer, MD, PhD, to replace Dr. Lonser. The AANS selected Jason M. Schwalb, MD, FAANS, to serve as one of its Washington Committee appointees beginning next year. All three individuals have considerable leadership and experience and will help neurosurgery navigate challenging health policy waters.
After many years of service, William C. Welch, MD, FAANS, chair of the CNS/AANS Drugs and Devices Committee, stepped down as chair. Joshua M. Rosenow, MD, FAANS, will now chair this committee.
Communications
Neurosurgery Praises Congress for Passing Gun Safety Legislation
On June 24, the CNS and the AANS praised Congress for passing S. 2938 (117), the Bipartisan Safer Communities Act. The neurosurgical groups believe that this gun safety legislation — which would expand background checks, restrict certain individuals from owning firearms and provide incentives for states to enact “red-flag” programs — is a crucial step in preventing tragic and senseless firearm deaths.
The CNS and the AANS have long promoted education programs designed to prevent firearm injuries by teaching and encouraging proper firearm use, safety, storage and ownership responsibility.
Click here to read the press release.
Neurosurgery Blog Continues Tumor Series
Neurosurgery Blog continued to publish new blogs in its tumor series. Partnering with the CNS/AANS Joint Section on Tumors, the tumor series provides an update on the state of the subspecialty and highlights current issues. Recently published posts included:
Neurosurgeon Pens Op-Ed on Non-Surgeons Performing Spinal Fusion Surgery
On May 21, The American Spectator published an op-ed by CNS/AANS Communications and Public Relations Committee member Richard Menger, MD, MPA and Anthony M. DiGiorgio, DO, MHA. Titled “Perverse Health-Care Incentives Endanger Spine Patients,” Drs. Menger and DiGiorgio voice their support of Louisiana HB 941, a bill that would allow only spine surgeons to perform spine surgery. This legislation stems from a position statement titled “Arthrodesis of the Spine by the Non-Spine Surgeon,” which the CNS and the AANS developed. On June 2, Neurosurgery Blog published a cross-post to amplify the message.
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