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  • Vol. 89, October 2022 DC E-Newsletter

    • Oct 20, 2022

    Vol. 89, October 2022 DC E-Newsletter


    Special Announcement

    House Passes Prior Authorization Legislation

    On Sept. 14, the U.S. House of Representatives unanimously passed by voice vote H.R. 3173, the Improving Seniors’ Timely Access to Care Act. Sponsored by Reps. Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.), the legislation would streamline and standardize prior authorization in the Medicare Advantage (MA) program. Among other things, the legislation:

    • Establishes an electronic prior authorization process;
    • Requires the U.S. Department of Health & Human Services to establish a process for real-time decisions for items and services that are routinely approved;
    • Improves transparency by requiring MA plans to report to the Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals or denials; and
    • Encourages plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.

    The Congress of Neurological Surgeons (CNS)/American Association of Neurological Surgeons (AANS) Washington Committee issued a press release applauding the passage of this legislation. Attention now turns to the U.S. Senate for its consideration. Sens. Roger Marshall, MD, (R-Kan.), Kyrsten Sinema (D-Ariz.), John Thune (R-S.Dak.) and Sherrod Brown (D-Ohio) have introduced a companion bill, S. 3018, with the same title.



    CMS Publishes Resources to Prepare for the End of the Public Health Emergency

    The Centers for Medicare & Medicaid Services (CMS) has developed resources for a comprehensive, streamlined approach to reestablish certain health and safety standards and other financial and program requirements in preparation for the end of the COVID-19 public health emergency (PHE). Most waivers and flexibilities will terminate after the PHE. CMS encourages health care providers to prepare for the eventual end of these flexibilities and to begin moving forward to reestablishing previous health and safety standards and billing practices.

    Click here to read the Health Care System Resiliency fact sheet and here to read the “Creating a Roadmap for the End of the COVID-19 Public Health Emergency” blog.

    Biden Administration Renews COVID-19 Public Health Emergency Declaration

    On Oct. 13, HHS Secretary Xavier Becerra renewed the COVID-19 PHE declaration. The PHE was extended for an additional 90 days. This means that all telehealth and other waivers and flexibilities implemented during the PHE will remain in effect. The department has also stated that it will provide 60 days’ notice when a decision is made to terminate the declaration or let it expire.

    Legislative Affairs

    Legislation Introduced to Fix Broken Medicare Physician Payment System

    On Sept. 13, Reps. Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) introduced the Supporting Medicare Providers Act (H.R. 8800), which would prevent the 4.42% Medicare Physician Fee Schedule cut. The legislation also contains a “Sense of Congress” that urges policymakers to take administrative and legislative actions to:

    • Ensure financial stability and predictability in the Medicare physician payment system;
    • Promote and reward value-based care innovation; and
    • Safeguard timely access to high-quality care by advancing health equity and reducing disparities.

    The CNS and the AANS joined several coalition letters supporting the legislation. Click here to read the Surgical Coalition letter, here for the Alliance of Specialty Medicine and here for a physician/non-physician clinician letter.

    The CNS and the AANS also joined the American Medical Association (AMA) and more than 120 national specialty and state medical societies in a letter to Congress voicing concern over the mounting financial instability of the Medicare physician payment system. According to an AMA analysis of Medicare Trustees data, when adjusted for inflation, Medicare physician payments have been reduced by 20% from 2001–2021. The letter reiterates the physician community’s desire to work with Congress to develop long-term solutions to the systemic problems with the Medicare physician payment system.

    To help identify long-term reform options, Reps. Ami Bera, MD, (D-Calif.); Larry Bucshon, MD, (R-Ind); Kim Schrier, MD, (D-Wash.); Michael Burgess, MD, (R-Texas); Earl Blumenauer (D-Ore.); Brad Wenstrup, DPM, (R-Ohio); Bradley Schneider (D-Ill.) and Mariannette Miller-Meeks, MD, (R-Iowa) are requesting feedback from health care providers and others on actions Congress should take to stabilize the Medicare payment system and ensure value-based care incentives remain in place. The CNS and the AANS will submit comments in response to this request for information (RFI).

    Click here to read the letter and here to learn more about Rep. Bera and Bucshon’s RFI.


    Reps. Bera and Bucshon Urge CMS to Increase Global Surgery Code Values

    CMS has failed to increase the global surgery codes to reflect increased evaluation and management (E/M) service values implemented in 2021, resulting in additional cuts to surgical care. On Sept. 27, Reps. Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) wrote a letter to CMS calling on the agency to apply the updated E/M values to the global surgery codes. In the letter, the congressmen stressed that adjusting these values is necessary “to ensure that these physicians are compensated the same for providing equivalent services as defined by the Medicare statute.” Each time CMS has revised the office visit E/M codes, the agency has also increased the post-operative E/M values in the global surgery codes. Failing to make these adjustments amounts to an arbitrary, across-the-board devaluation of surgical care.

    Click here to read the letter.


    Neurosurgery Urges Senate to Act on Telehealth Legislation

    On Sept. 13, the CNS and the AANS joined the American Medical Association and more than 300 physician, health care and patient organizations in calling on the U.S. Senate to continue regulatory and payment telehealth flexibilities for at least two years. Earlier this year, the House of Representatives overwhelmingly passed legislation to extend the telehealth flexibilities afforded physicians and patients during the COVID-19 PHE. The letter to Senate Majority Leader Charles Schumer (D-N.Y.) and Minority Leader Mitch McConnell (R-Ky.) notes that telehealth “has been transformational — patients now expect and often prefer telehealth as a key component of our health care system.” The letter also points out that physicians and other health care organizations “have been able to reach many patients that previously had access barriers through virtual care” because of the flexibility and waivers under the current PHE. However, at the end of the PHE, these waivers will end.

    Click here to read the letter.


    Grassroots Alert

    Ask Congress to Prevent Medicare Payment Cuts

    On Jan. 1, 2023, neurosurgeons face a minimum 8.42% Medicare payment cut, including a 4.42% cut for all Medicare Physician Fee Schedule services and a 4% Statutory Pay-As-You-Go Act cut, triggered due to new federal spending. To help mitigate these cuts, Reps. Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) have introduced the Supporting Medicare Providers Act (H.R. 8800), which would prevent the 4.42% fee schedule cut.

    Click here to send an email message urging your Representatives to co-sponsor H.R. 8800.


    Coding and Reimbursement

    Neurosurgery Leads Effort Urging CMS to Increase Global Surgery Code Values

    On Sept. 6, the CNS and the AANS, along with 18 other national surgical societies, submitted comments to CMS urging the agency to adjust the post-operative visit values of the 10- and 90-day global surgery codes to reflect the increases in the recently updated office/outpatient visit E/M codes regarding global surgery code values. The letter urged CMS to:

    • Adjust these codes to reflect the new office visit E/M values while CMS makes future decisions on how to address potentially misvalued global codes; and
    • Use the American Medical Association/Specialty Society RVS Update Committee’s misvalued code process to address any inappropriately valued global codes.

    The letter also provided detailed responses to several questions posed by the agency and included an extensive compendium of past comments, letters from Congress to CMS on this issue and other relevant information. Since the inception of the Medicare Physician Fee Schedule, CMS has increased the global codes to reflect increases in the separately billable E/M codes as the agency continues to believe the global surgery codes are overvalued.

    Click here to read the letter.


    Neurosurgery Comments on Proposed 2023 Medicare Physician Fee Schedule

    On Aug. 31, the CNS and the AANS submitted detailed comments to CMS regarding the 2023 proposed Medicare Physician Fee Schedule rule. In the letter, the neurosurgical societies offered the following recommendations regarding the payment provisions urging CMS to:

    • Delay any change in the Medicare Economic Index until additional practice cost data collection work is completed;
    • Incorporate the increased evaluation and management code values into the global surgery codes; and
    • Accept the American Medical Association/Specialty Society RVS Update Committee values for eight spine codes.

    The CNS and the AANS also supported the proposal to extend flexible telehealth policies.

    Regarding the Quality Payment Program, the societies urged CMS to:

    • Ensure a diverse inventory of measures that reflect specialty care in the Merit-Based Incentive Payment System (MIPS);
    • Refrain from lumping fusions in with discectomies/decompressions for the MIPS Back Pain After Lumbar Fusion and Leg Pain After Lumbar Fusion quality measures; and
    • Encourage Congress to make technical updates to the Medicare Access and CHIP Reauthorization Act to extend the expiring 5% incentive payment for qualifying participants (QPs) in Advanced Alternative Payment Models and maintain the current QP eligibility threshold levels.

    The CNS and the AANS also joined the Alliance in sending a letter recommending that CMS take steps to prevent the planned Medicare payment cuts and establish policies that expand access to telehealth and virtual care services. In addition, the CNS and the AANS joined the Physician Clinical Registry Coalition in a letter expressing concerns about policies that hinder the use of registries in MIPS. 

    A summary of issues of interest to neurosurgery in the proposed rule is available here.


    CNS/AANS Comment on Proposed 2023 Medicare Hospital Outpatient Rule

    On Sept. 12, the CNS and the AANS submitted comments CMS regarding the 2023 Medicare Hospital Outpatient Prospective Payment (OPPS)/Ambulatory Surgery Center Payment System proposed rule. In the letter, the neurosurgical groups agreed with the agency’s plan to remove the arthrodesis CPT code 22632 from the inpatient-only (IPO) list and to add the new CPT code 228XX (additional level total disc arthroplasty procedures) to the IPO list. The comments stressed 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 performed in the hospital outpatient department. Neurosurgery also joined the Regulatory Relief Coalition (RRC) in urging CMS to drop the spine-related procedures from the list of hospital outpatient services subject to prior authorization.

    Click here to read the CNS and the AANS letter and here to read the RRC letter.


    Neurosurgery Responds to CMS RFI on Prior Authorization Proposals

    On Aug. 31, the CNS and the AANS joined the RRC in responding to a CMS Request for Information seeking input from the public about the MA program. The letter urged CMS to reform prior authorization in the MA program, including adopting “gold card” exemptions from prior authorization requirements and implementing the policies included in the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018).

    Click here to read the RRC letter.


    Please Complete a Brief Survey on Prior Authorization

    The CNS/AANS Washington Committee has joined the Alliance of Specialty Medicine in surveying our members regarding their experience with prior authorization. This updated data will help our advocacy efforts to reform prior authorization.

    Click here to complete the survey.


    Quality Improvement

    CMS Releases 2021 MIPS Final Scores

    CMS recently released the 2021 MIPS final scores and associated 2023 payment adjustments. Neurosurgeons may view their MIPS performance feedback, final score and payment adjustment by logging into the Quality Payment Program website. The maximum incentive payment for 2023 is 2.33%, funded by the exceptional performance bonus, which expires after the 2022 performance/2024 payment year. Neurosurgeons who believe there is a calculation error in their MIPS payment adjustment may request a targeted review until Oct. 21.  

    Additional resources are listed below, including a link to a CMS survey on the process of accessing your MIPS scores and feedback: 



    CDC Hosts TBI Partner Virtual Meeting

    On Aug. 15, the Centers for Disease Control and Prevention (CDC) hosted a Traumatic Brain Injury partnership virtual call to discuss its recent research, training and initiatives and collaboration with other organizations on upcoming brain injury events and resources. The CNS/AANS Section on Neurotrauma & Critical Care was represented by chair-elect Martina Stippler, MD, FAANS.

    Dr. Stippler briefed the CDC and participating groups on the section’s collaboration with the National Neurotrauma Society, ThinkFirst, Brain Trauma Foundation and the American College of Surgeons Committee on Trauma. In addition, she reported on neurosurgery’s participation in the February 2022 National Academy of Sciences report, “Traumatic Brain Injury: A Roadmap for Accelerating Progress,” noting that Shelly D. Timmons, MD, PhD, FAANS; Odette A. Harris, MD, MPH, FAANS and Geoffrey T. Manley, MD, PhD, FAANS are representing the specialty in this effort.


    Of Note

    Neurosurgeon Appointed to CPT Assistant Editorial Board

    On Sept. 14, the AMA appointed CNS/AANS Coding and Reimbursement Committee member and CNS Current Procedural Terminology (CPT®) Advisor Henry H. Woo, MD, to CPT Assistant Editorial Board. The CPT Assistant is the AMA’s publication for educating providers, payers and coding staff about the technical aspects of CPT coding. The AMA and specialty societies provide content for the publication to help CPT users code appropriately. The CPT Assistant Editorial Board was established in 2007 to provide clinical expertise for the publication.


    Neurosurgeon Appointed to PCORI Governing Board

    On Sept. 20, the Government Accountability Office announced the appointment of six new members to the board of the Patient-Centered Outcomes Research Institute (PCORI). Zoher Ghogawala, MD, FAANS, chair of the department of neurosurgery at Lahey Hospital & Medical Center, was among those selected to serve on PCORI’s governing body. Dr. Ghogawala is a former member of the CNS/AANS Washington Committee and a past chair of the CNS/AANS Section on Disorders of the Spine and Peripheral Nerves.       


    Neurosurgeon Awarded Prestigious Teaching Award

    On Oct. 4, the Accreditation Council for Graduate Medical Education (ACGME) announced its 2023 award recipients. Richard G. Ellenbogen, MD, FAANS, a member of the ACGME’s Review Committee for Neurological Surgery was awarded the prestigious Parker J. Palmer Courage to Teach Award. The Parker J. Palmer Courage to Teach Award recognizes program directors who have fostered innovation and improvement in their residency/fellowship programs and served as exemplary role models for residents and fellows.


    Neurosurgeon Elected to Prestigious National Academy of Medicine

    On Oct. 17, the prestigious National Academy of Medicine announced the election of another neurosurgeon to its ranks. James M. Markert, MD, MPH, FAANS, chair, department of neurosurgery, University of Alabama, Birmingham. Dr. Markert was recognized as a world expert on oncolytic viruses, an author of the first-ever paper on genetically engineered oncolytic viruses, the primary author on the first-in-human trial of an oncolytic virus, senior author on the first use of an IL12-expressing virus for human glioma. Dr. Markert is currently conducting adult and pediatric brain tumor trials.


    Neurosurgical Resident Picked for White House Fellow Program

    Jeffrey Nadel, MD, a neurosurgical resident from the University of Utah, has been named to the 2022-2023 White House Fellows class. The White House Fellows Program was created in 1964 by President Lyndon B. Johnson to give promising American leaders “first hand, high-level experience with the workings of the Federal government, and to increase their sense of participation in national affairs.” He joins 14 other individuals selected to participate in this prestigious program and follows in the footsteps of neurosurgeons Jeremy Hosein, MD (2018-2019); Lindsey B. Ross, MD (2016-2017); Anand Veeravagu, MD (2012-2013); and Sanjay K. Gupta, MD (1997-1998).



    Washington Committee Chair Featured in Article on Prior Authorization

    Following an CNS/AANS Washington Office press release, Becker’s Spine Review published an article on July 29, “Neurosurgeons urge Congress to pass bill addressing prior authorization by year’s end.” The article quoted CNS/AANS Washington Committee chair John K. Ratliff, MD, FAANS, who noted that “the onerous prior authorization process has increased significantly over the last several years — causing unacceptable delays and denials of medical treatments. Dr. Ratliff went on to state that “Our patients cannot afford to wait or jump through unnecessary hoops to get care for painful and life-threatening neurologic conditions” and called on Congress to pass legislation to reform prior authorization in Medicare Advantage this year.


    Neurosurgery Mentioned in Article on 2023 Proposed Medicare Fee Schedule

    On Aug. 19, Medscape published an article titled, “Physicians’ Medicare Pay Keeps Dwindling ― How Bad Will It Get?” The report featured CNS/AANS Washington Committee chair John K. Ratliff, MD, FAANS, who stated that the “constant cutting of Medicare rates, which has been going on for years, makes it hard for practices to make ends meet.” And while Congress might pare back the steep Medicare payment cuts as it has for the past two years, Dr. Ratliff noted that “last-minute changes create a lack of stability and a lack of clarity for our practice environment.”

    Click here to read the article.

    Surgical Care Coalition Featured in Articles Regarding Medicare Payment Cuts

    On Sept. 6, CQ published an article titled, “Doctors lobby Congress for Medicare payment bump, again.” The article notes that the Surgical Care Coalition (SCC) campaign is urging Congress to increase Medicare payments to offset cuts scheduled to go into effect on Jan. 1, 2023.

    Inside Health Policy also published an article on Sept. 13 titled “Bera, Bucshon Bill Would Push Off Medicare 2023 Physician Fee Cuts.” The piece highlighted the SCC’s support for the Supporting Medicare Providers Act (H.R. 8800), which Reps. Ami Bera, MD, (D-CA) and Larry Bucshon, MD, (R-IN) introduced to mitigate planned physician fee schedule cuts for 2023. This legislation would eliminate the proposed 4.42% conversion factor cut (an additional 4% cut due to the Statutory Pay-As-You-Go Act is also pending).

    Finally, Politico Pulse highlighted the SCC’s work, spotlighting the coalition’s leadership advocacy day in Washington, DC. On Sept. 15, neurosurgeons Jason M. Schwalb, MD and Kristopher T. Kimmell, MD, joined surgeons from across the country who headed to Capitol Hill to meet with Congressional members and staff to advocate for legislation to stop the nearly 8.5% cuts from going into effect in January.

    The CNS and AANS are founding members of the SCC. Click here for more information about the coalition and its campaign to prevent steep Medicare payment cuts.


    Myths and Truths: A Medical Student Perspective

    Neurosurgery Blog: More than Just Brain Surgery published a guest post during Women in Medicine Month. Authored by Eve Tsai, MD, PhD, FAANS, Anahita Malvea, MD and Alexandra Beaudry-Richard, the post — titled “Myths and Truths: A Medical Student Perspective of Neurosurgery” — discusses Dr. Tsai’s leadership and mentorship at the University of Ottawa Neurosurgery Medical Student Chapter. The authors also dispel common myths about the specialty and what it is like to be a female neurosurgeon.

    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 updates on the state of the subspecialty and highlights current issues. Read the latest article in the series, “Brain Tumors, Drug Development and Neurosurgeons: Ending the Losing Streak,” by Nader Sanai, MD, FAANS.


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

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