Vol. 91, January 2023 DC E-Newsletter
Help Shape Neurosurgery’s 2023 Advocacy Agenda
Each year the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) establish neurosurgery’s legislative and regulatory advocacy priorities for the coming year. The committee is seeking neurosurgeon input to assist the CNS/AANS Washington Committee with this process.
Please click here to complete a brief survey, so your feedback is incorporated into the committee’s deliberations.
Biden Administration Renews COVID-19 Public Health Emergency Declaration
On Jan. 11, U.S. Department of Health and Human Services Secretary Xavier Becerra renewed the COVID-19 public health emergency (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.
Congress Passes Legislation to Mitigate Steep Medicare Payment Cuts
Before adjourning in 2022, Congress passed legislation to mitigate a combined 8.5% Medicare physician payment cut (a 4.5% Medicare Physician Fee Schedule (MPFS) and a 4% Statutory Pay-As-You-Go Act (PAY GO) of 2010 cut). The Consolidated Appropriations Act, 2023 (P.L. 117–328) provided partial relief from the cuts as follows.
- 5% positive adjustment to the MPFS conversion factor (CF);
- 25% positive adjustment to the CF in 2024; and
- Postponement of the 4% PAYGO cut for two years.
Despite this action, neurosurgeons face a 3% pay cut in 2023 (a 2% reduction in the MPFS CF and 1% due to changes in work values) and a minimum 1.25% cut in 2024.
In the immediate run-up to passage of the omnibus spending bill, the CNS and the AANS engaged in a variety of advocacy activities urging Congress to stop the full cut, including:
- A Surgical Care Coalition letter urging Congressional leaders to prevent the entire Medicare physician payment cut. Subsequently, John K. Ratliff, MD, FAANS, former chair of the CNS/AANS Washington Committee, was quoted in a press release about the letter, stating, “During a time when neurosurgical practices are facing steep inflation coupled with a system that fails to keep pace with the costs of delivering care, it would be Congressional malpractice if lawmakers fail to prevent the entire 4.5% Medicare physician payment cut.”
- Collaborating with bipartisan members of Congress on several letters to congressional leadership urging action to prevent the Medicare payment cuts, including a letter led by Reps. Susan Wild (D-Pa.) and Mariannette Miller-Meeks, MD, (R-Iowa) and a letter from the Doctors Caucus.
- A letter from the Alliance of Specialty Medicine to Sen. John Kennedy (R-La.) expressing support for the Protecting Medicare Patients and Physicians Act ( 5194), which would have prevented the 4.5% MPFS cut. Similar legislation, the Supporting Medicare Providers Act (H.R. 8800), was introduced by Reps. Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) in September 2022.
- A Surgical Care Coalition letter to congressional leaders expressing disappointment that the omnibus bill failed to prevent the entire cut.
- An Alliance of Specialty Medicine letter to congressional leadership expressing disappointment with Congress’ failure to stop the full Medicare cuts.
Neurosurgery Priorities Addressed in Omnibus Spending Bill
The Consolidated Appropriations Act, 2023 (P.L. 117–328) — a $1.7 trillion omnibus spending bill to fund the federal government — addressed several of organized neurosurgery’s advocacy priorities. The legislation:
- Provides bonus payments for physicians participating in Medicare advanced alternative payment models were extended for one year through 2025 — although the bonus payment for 2025 will be 3.5% rather than 5%;
- Extends the current COVID-19 public health emergency telehealth flexibilities for two years through December 2024;
- Provides funding for 200 Medicare-supported graduate medical education (GME) residency positions and increases funding for the Children’s Hospitals GME program;
- Includes funding for the Children’s Health Insurance Program for an additional two years through FY 2029;
- Increases funding for the National Institutes of Health; and
- Allocates $25 million for firearm injury and mortality prevention research.
Unfortunately, despite neurosurgery’s advocacy efforts and encouragement, and strong bipartisan support in both the U.S. House of Representatives and Senate, the spending bill did not incorporate the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018), which would streamline prior authorization in the Medicare Advantage Program. A $16 billion cost estimate from the Congressional Budget Office stalled progress.
Click here for a summary of CNS/AANS 2022 legislative accomplishments.
Medical Liability Reform Legislation Introduced
On Dec. 15, 2022, Reps. Lou Correa (D-Calif.) and Richard Hudson (R-N.C.) introduced medical liability reform legislation — the Accessible Care by Curbing Excessive LawSuitS (ACCESS) Act (H.R. 9584). Among other things, the bill would:
- Cap non-economic damages at $250,000;
- Limit attorney fees so that damage awards go to the patients in need;
- Provide for the full and unlimited recovery of economic damages; and
- Allow for the periodic payment of damages.
The Health Coalition on Liability and Access, of which Katie O. Orrico, Esq., CNS/AANS senior vice president for health policy and advocacy is vice president, issued a press release expressing support for the bill.
Click here to read the press release.
Coding and Reimbursement
Neurosurgery Lauds Proposed Rule to Streamline Prior Authorization
The Regulatory Relief Coalition (RRC), of which the CNS and the AANS are leaders, issued a press release lauding the Centers for Medicare & Medicaid Services (CMS) for its recently released proposed rule. The proposal — which applies to Medicare Advantage, Medicaid managed care, Children’s Health Insurance Program and federal Marketplace qualified health plans — closely aligns with the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018), legislation that unanimously passed the House by voice vote on Sept. 14, 2022. In the release, John K. Ratliff, MD, FAANS, former chair of the CNS/AANS Washington Committee, stated:
“Patients and physicians are thrilled that the proposed rule paves the way for commonsense, necessary, and appropriate changes to prior authorization in Medicare Advantage and other government health programs. Congress should take action before the end of this year and codify these vital principles by passing the Improving Seniors’ Timely Access to Care Act.”
CMS published a second proposal to address additional issues related to prior authorization in the Medicare Advantage program. Taken together, the proposed rules:
- Aim to advance interoperability and improve prior authorization processes by requiring health plans to adopt electronic prior authorization;
- Require plans to make prior authorization decisions within 72 hours for urgent requests and seven calendar days for others;
- Ensure that prior authorization approvals remain valid for a patient’s entire course of treatment;
- Mandate that Medicare Advantage plans follow traditional Medicare’s national and local coverage policies and stipulate that coverage determinations must be reviewed by professionals with relevant experience;
- Support efforts, such as gold carding, to waive or modify prior authorization requirements based on provider performance; and
- Compel health plans to publicly report the use of prior authorization, including information on delays and denials.
Subsequently, on behalf of the Alliance of Specialty Medicine, Katie O. Orrico, Esq., CNS/AANS senior vice president for health policy and advocacy, attended a stakeholder roundtable convened by the Department of Health and Human Services and CMS. The roundtable was organized by CMS Administrator Chiquita Brooks LaSure, U.S. Surgeon General Vivek H. Murthy, MD, and other senior CMS officials, allowing participants to share their experiences with prior authorization. Also attending on behalf of the American Hospital Association was neurosurgeon James B. Chadduck, MD, FAANS.
Click here to read the Alliance’s press release about the roundtable.
Medicare Payment Advisory Commission
Recently, the CNS and the AANS joined the Alliance of Specialty Medicine in a letter to the Medicare Payment Advisory Commission (MedPAC) expressing concerns with policy options to boost primary care reimbursement. The proposals continue to prioritize primary care over specialty care, and the letter urges MedPAC to consider alternative means of increasing interest in primary care.
Click here to read the letter.
Neurosurgery Responds to CMS RFI on National Provider Director
The CNS and the AANS joined the Alliance of Specialty Medicine in responding to a Centers for Medicare & Medicaid Services (CMS) Request for Information (RFI). The RFI sought input from the public about establishing a National Directory of Healthcare Providers & Services that could serve as a “centralized data hub” for health care providers nationwide.
The letter supports CMS’s goal of making more accurate and up-to-date directory information about providers available to the public in an easier-to-use format. The letter identifies two areas that could benefit from the adoption of a centralized provider directory:
- Identifying and tracking physicians’ specialty and payer contracts; and
- Prior authorization processes.
Click here to read the letter.
Former Washington Committee Chair Featured In Article about Medicare Cuts
On Jan. 6, Becker’s ACS published an article titled “CMS in the last year: 5 leaders weigh in.” The article featured John K. Ratliff, MD, FAANS, past chair of the CNS/AANS Washington Committee, who stated, “Once again, we are facing another year of devastating cuts to a Medicare system that is already ill-equipped to meet the needs of millions of Americans.” Dr. Ratliff went on to “urge Congress to not only stabilize payment levels in the short term but also transform the system into one that is stable and reliable in the long term.”
Neurosurgeon Pens Op-Ed on Prior Authorization
On Jan. 3, The American Spectator published an op-ed by CNS/AANS Communications and Public Relations Committee member Richard Menger, MD, MPA, Jessica Murfee, RN, BSN and Erin Roberts, RN, BSN. Titled “Insurance Companies Use Stalling Tactics to Save Themselves Money,” the authors discuss health care provider burnout from the cumbersome prior authorization process required by insurance companies to perform surgery agreed upon by patient and surgeon. The article concludes with the authors asking Congress to take action and pass legislation to streamline prior authorization in Medicare Advantage.
Neurosurgery Blog Continues Tumor Series
Neurosurgery Blog continued to publish new content 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, “Surgically Based Clinical Trials for High-Grade Gliomas — Bringing the Laboratory to the Operating Room.”
Neurosurgery Blog Highlights Neurosurgeon Videos
Every day, neurosurgeons take care of some of the sickest patients who face painful and life-threatening neurologic conditions. Alexander A. Khalessi, MD, FAANS, John K. Ratliff, MD, FAANS and Maya A. Babu, MD, FAANS, share their experiences as neurosurgeons and explain how Medicare cuts will impact neurosurgical practices and their patients.
Click here to view the Neurosurgery Blog post.
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