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  • Vol. 93, May 2023 DC E-Newsletter

    • May 25, 2023

    Vol. 93, May 2023 DC E-Newsletter

    Special Announcements

    Please Complete the Washington Committee’s Firearms Survey

    The Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) Washington Committee Firearms Task Force is conducting a brief survey of CNS/AANS members regarding their views and experience with firearms and member’s opinions regarding the involvement of organized neurosurgery in advocacy efforts to reduce firearm injury and death and to make firearm ownership as safe as possible.

    The Washington Committee sent the survey to members on Friday, April 21, and reminders on May 6 and 20. Each email invitation included a unique link to access the survey. Please check your spam/junk folders if you cannot find it. 

    This effort aims to allow CNS and AANS members an opportunity to share their views on this topic. By completing the survey, you can contribute to this critical discussion. If you have not already done so, please consider completing the survey so that your voice is heard.


    Apply for the Washington Committee Fellowship Today

    Applications are now being accepted for the 2024-25 CNS/AANS Washington Committee/American Medical Association (AMA) Fellowship. This program offers an eligible neurosurgical resident or fellow an opportunity to participate in the Washington Committee and its five subcommittees and to serve as the CNS/AANS delegate to the AMA’s Resident and Fellow Section. This two-year fellowship provides a full immersion experience into the socioeconomics of neurosurgery. The program is open to individuals in a neurosurgical residency or fellowship during this two-year timeframe. Applicants must be at least a postgraduate year three (PGY-3) resident at the start of the fellowship, which begins on Jan. 1, 2024.

    Click here for the application. The deadline to apply is Aug. 31.


    Legislative Affairs


    Neurosurgery Endorses Legislation to Improve Medicare Payment System

    On April 3, 2023, bipartisan legislation to improve the Medicare physician payment system was introduced. Sponsored by Raul Ruiz, MD, (D-Calif.); Larry Bucshon, MD, (R-Ind.); Ami Bera, MD, (D-Calif.) and Mariannette Miller-Meeks, MD, (R-Iowa), the Strengthening Medicare for Patients and Providers Act (H.R. 2474) would put in place an annual physician payment update starting in 2024 based on the Medicare economic index (MEI). The MEI reflects increases in physician practice costs and would reverse a downward spiral of Medicare physician payments, which have failed to keep pace with inflation, jeopardizing the viability of physician practices and patients’ timely access to care.

    Upon introduction, the CNS and the AANS endorsed the legislation. In a press release, Russell R. Lonser, MD, FAANS, chair of the CNS/AANS Washington Committee, stated:

    Medicare physician payments have failed to keep pace with inflation, jeopardizing the viability of physician practices and patients’ timely access to care. While we are grateful that Congress has stepped in to mitigate steep Medicare cuts over the past few years, comprehensive reform of the physician payment system must be a priority for Congress this year.

    Several media outlets picked up the press release, including Becker’s Spine and MedPage Today, which reiterated Dr. Lonser’s statement that neurosurgery agrees “with the Medicare trustees that access to Medicare-participating physicians will become a significant issue in the long term unless Congress takes steps to fix the payment system today.”

    The CNS and the AANS also joined several coalition letters endorsing the bill, including the American Medical Association, Alliance of Specialty Medicine and a coalition of more than one million physician and allied health professional groups.


    CNS and AANS Endorse Safe Step Act

    Once again, the CNS and the AANS endorsed the Safe Step Act (S. 652/H.R. 2630). Health insurers often use step therapy — also called “fail first” — to control costs. Step therapy occurs when insurers require patients to fail the first step of treatment — typically a generic or low-cost drug — before moving on to the second step. This legislation — sponsored by Sens. Lisa Murkowski (R-Alaska) and Maggie Hassan (D-N.H.) in the Senate and Reps. Brad Wenstrup, DPM, (R-Ohio) and Raul Ruiz, MD, (D-Calif) in the House — would require health plans to establish specific exceptions to medication step-therapy protocols.

    Click here to read the House coalition letter, and here and here for letters to the Senate bill sponsors.


    Alliance Comments on Health Care Workforce Shortages

    On March 20, the CNS and the AANS joined the Alliance of Specialty Medicine in responding to the Senate Committee on Health, Education, Labor and Pensions request for information about health care workforce shortages. The Association of American Medical Colleges estimates that the U.S. will face a shortage of specialty care physicians between 21,000 and 77,100 by 2034. The coalition urged Congress to take additional steps now to ensure there are enough practitioners to support an aging population, outlining several recommendations to address the shortages, including:

    • Authorizing a loan repayment program to reduce specialty physician shortages;
    • Reauthorizing the Children’s Hospital Graduate Medical Education Payment Program; and
    • Increasing the number of Medicare-funded residency training slots.

    Click here to read the Alliance of Specialty Medicine letter.


    Neurosurgery Supports Bill to Fund Brain Aneurysm Research

    The CNS and the AANS have endorsed Ellie’s Law (S. 895/H.R. 902), legislation that would authorize $10 million in funding for the National Institute of Neurological Disorders and Stroke to further knowledge and understanding of brain aneurysms and how to manage and treat this condition effectively. The legislation is sponsored by Sen. Richard Blumenthal (D-Conn.) and Rep. Yvette Clarke (D-N.Y.). In letters to the bill’s sponsors, the neurosurgical groups noted that an estimated 6.6 million people in the U.S. have an unruptured brain aneurysm, and an estimated 30,000 people suffer a rupture, 50 percent of which are fatal. Of those who survive, about 66 percent suffer some permanent neurological deficit. Notwithstanding its widespread prevalence, federal funding for brain aneurysm research is almost non-existent.

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


    CNS and AANS Call for Increased Funding for NIH

    The CNS and the AANS joined the Ad Hoc Group for Medical Research Funding and more than 370 organizations requesting increased funding for the National Institutes of Health (NIH) in Fiscal Year 2024. The $50.924 billion request is a nearly 5% increase over current funding levels and would allow continued vital investment in the NIH to improve our nation’s health.


    Neurosurgery Asks Congress to Fund Pediatric Device Consortium

    On April 4, the CNS and the AANS signed a letter urging Congressional appropriators to fund the Food and Drug Administration’s Pediatric Device Consortia (PDC) Grant Program. Medical devices for children often lag five to ten years behind those for adults. To address the need for improved pediatric medical devices, Congress created the PDC program and has renewed it since its inception in 2007. Funding for the PDC program is necessary to continue improving device availability for children.

    Click here to read the letter.


    CNS and AANS Request Funding for Gun Violence Prevention Research

    On April 19, the CNS, AANS, CNS/AANS Joint Section on Neurotrauma & Critical Care, CNS/AANS Section on Pediatric Neurological Surgery and the American Society of Pediatric Neurosurgeons joined more than 400 organizations in a letter to Congressional appropriations urging them to allocate $61 million to conduct public health research into forearm morbidity and mortality prevention. These investments are focused on applying a public health approach to increase gun safety and reduce firearm-related injuries and deaths.


    CNS and AANS Urge Congress to Fund MISSION ZERO Program

    On March 24, the CNS and the AANS joined the Trauma Coalition in sending a letter to the House Committee on Appropriations Labor, Health and Human Services, Education Subcommittee asking for $11.5 million to fund the Military and Civilian Partnership for the Trauma Readiness Grant (MISSION ZERO) Program for Fiscal Year 2024. The MISSION ZERO program was signed into law in 2019 as a part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act provides funding for civilian trauma centers to train and incorporate military trauma care providers and teams into care centers. The CNS and the AANS also submitted a statement to the subcommittee supporting funding for this program.


    Neurosurgery Endorses Good Samaritan Health Professionals Act

    On April 25, Reps. Raul Ruiz, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) introduced the H.R. 2819, the Good Samaritan Health Professionals Act. 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, many inconsistencies may leave physicians vulnerable.

    Click here to read the CNS and the AANS letter and here to read the Health Coalition on Liability and Access letter.


    CNS and AANS Urge Congress to Reauthorize Pandemic Preparedness Programs

    On March 21, the CNS and the AANS submitted comments to the House Committee on Energy and Commerce supporting the reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA). Initially passed in 2006, PAHPA has continued to improve the nation’s public and medical preparedness and response capabilities during public health emergencies and disasters. Reauthorizing these essential health programs will continue to foster opportunities for these ongoing successful public-private collaborations. The CNS and the AANS also submitted similar comments to the Senate Committee on Health, Education, Labor and Pensions. PAHPA programs will expire on Sept. 30.

    One specific recommendation from the neurosurgery groups is for Congress to include the Good Samaritan Health Professionals Act in the PAHPA reauthorization legislation, providing liability protections for health care professionals who volunteer their services during a federally declared disaster or emergency. The CNS and the AANS also joined the Alliance of Specialty Medicine and Health Coalition on Liability and Access in making this same recommendation.


    Grassroots Alert


    Contact Congress to Co-Sponsor the Strengthening Medicare for Patients and Providers Act

    The Medicare physician payment system is broken, requiring Congress to intervene to prevent steep cuts year after year. One flaw is that Medicare payments do not automatically receive an annual inflationary update. Medicare physician pay has eroded by 22% over the last two decades relative to inflation, and temporary patches to the Medicare physician payment system are not sustainable year after year.

    Click here to go to neurosurgery’s Advocacy Action Center to contact Congress to co-sponsor the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would implement an annual Medicare physician payment update based on the Medicare economic index. A sample message, which can be personalized, is provided.


    Coding and Reimbursement


    Neurosurgery Comments on FTC Proposal to Ban Non-compete Agreements

    On April 19, the CNS and the AANS sent a letter to the Federal Trade Commission (FTC) supporting, in part, its proposed ban on non-compete clauses. The letter agreed with the FTC that non-competes can be anti-competitive and unduly restrict physicians’ ability to choose their employer or practice setting, stifling competition and impeding patient access to the physician of their choice. Nevertheless, the neurosurgical groups did not support a blanket prohibition on non-competes, which fails to recognize reasonable contracts to protect certain business owners’ legitimate competitive interests, notably smaller independent neurosurgical practices.

    Click here to read the letter.


    CNS and AANS Lead Amicus Brief in Surprise Medical Billing Case

    Under the No Surprises Act (NSA), physicians and insurers can use an independent dispute resolution process to determine the payment amount for services. The process was intended to keep patients out of the middle of these billing disputes. Unfortunately, the final rule implementing the law unfairly favors insurers when settling out-of-network payment disputes. Last year, the CNS and the AANS spearheaded an amicus brief supporting a lawsuit filed in Texas challenging these rules. Earlier this year, the Texas court ruled in favor of physicians, and the Biden Administration has notified the court it intends to appeal this decision.

    Another lawsuit challenging the NSA is also making its way through the courts, and the CNS and the AANS are leading another amicus brief. In Haller v. U.S. Dep’t of Health & Human Servs., Dr. Haller argued that the NSA violates the U.S. Constitution’s Seventh Amendment (right to trial by jury in federal court for certain civil disputes). The U.S. District Court for the Eastern District of New York disagreed, determining that providers could only resolve out-of-network billing disputes through the NSA’s process. The CNS and the AANS disagree with this interpretation of the law and filed an amicus brief asking the court to affirm that the NSA does not interfere with a physician’s right to pursue all available legal remedies, including litigation, to obtain fair reimbursement from insurers. Simply put, the NSA “does not replace providers’ common-law claims and merely offers a voluntary alternative to civil litigation.”

    Insurers are weaponizing the NSA to slash both in-network and out-of-network physician reimbursement. The CNS and the AANS will continue to advocate that neurosurgeons are fairly compensated, including advocacy efforts to implement the NSA as Congress intended.   

    Click here to read the amicus brief in the Haller case.


    CNS and AANS Urge Cigna to Rescind Modifier 25 Policy

    On April 18, the CNS and the AANS joined more than 100 state and national medical organizations in a letter urging Cigna to immediately rescind its policy requiring the submission of office notes with all claims that include CPT® codes 99212, 99213, 99214 and 99215 and modifier 25 when a minor procedure is billed. The groups asked Cigna to reconsider this policy due to its practice burdens and increased administrative costs associated with compliance.

    Click here to read the letter.


    Quality Improvement


    2023 MIPS Exception Application Now Available

    On May 1, the Centers for Medicare & Medicaid Services (CMS) opened the online portal to accept 2023 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) exception applications. CMS will continue to allow clinicians, groups, virtual groups and alternative payment model entities to request MIPS performance category reweighting for performance year 2023 under its EUC policy through Jan. 2, 2024. As a reminder, MIPS EUC exception applications can be submitted for one or more performance categories. On a recent webinar, CMS confirmed that it would allow stakeholders to cite COVID-19 as a triggering event on exception applications despite the end of the public health emergency. 

    Click here for more information about the EUC exception.


    Of Note


    AMA Analyses: Medical Liability Premiums Surge; One in Three Physicians Sued

    According to a recent American Medical Association (AMA) analysis, a surge in medical liability premiums has extended into a fourth consecutive year. It suggests a “hard” insurance market has spread across many states, making it difficult for physicians to find affordable coverage. Fifteen states reported double-digit percentage increases in premiums in 2022, and the analysis also found striking differences in premiums by geography.

    Another AMA report found that nearly one-third (31.2%) of U.S. physicians in 2022 reported they had previously been sued. While the study did not include neurosurgery, previous studies have found that as many as 80% of all neurosurgeons have been sued at least once in their career.

    For information on neurosurgery-supported solutions to reshape the current medical liability system to better serve both physicians and patients, read the AMA’s Medical Liability Reform– Now!




    Neurosurgeon Pens Op-Ed on Why Alabama Hospitals Need Competition

    On March 17, published an op-ed titled “Guest opinion: Alabama hospitals need competition.” In the op-ed, Richard P. Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama, discusses why the “game of Hospital Monopoly needs to end.” Dr. Menger argues that reform needs to break up the large hospital system mergers, acquisitions and consolidation. “This is destroying competition, limiting care options for patients, and burning out our physician and nurse workforce,” according to Dr. Menger. The solution requires reform, accountability and competition.

    On April 3, Neurosurgery Blog published a cross-post to amplify the message.


    Neurosurgery Blog Publishes Guest Blog Post from CDC

    During Brain Injury Awareness Month in March, the Center for Disease Control and Prevention (CDC) highlighted the meaningful progress that has been made related to concussion education over the last 20 years. During that time, the CDC’s HEADS UP concussion education initiative started as a small campaign and grew to become an integral part of concussion education. This had a substantial impact on concussion laws and policies nationwide.

    Click here to read the blog post.


    Neurosurgery Blog Features Op-Ed Highlighting the Need for Brain Injury Awareness Treatmen

    On March 6, Roll Call published an op-ed titled, “We need more than brain injury awareness: We need new treatment.” In the op-ed, Rep. Bill Pascrell Jr. (D-N.J.), co-chair and founder of the Congressional Traumatic Brain Injury Task Force, and Vishal Bansal, MD, FACS, discuss the need for more than brain injury awareness — the need for new treatment. Each March, Brain Injury Awareness Month promotes learning more about brain injury and ending its dangerous effects. More than 3 million patients visit hospital emergency rooms with suspected TBI annually. Despite progress, concussions are still a significant unmet medical need.

    On March 24, Neurosurgery Blog published a cross-post to amplify the message.


    Neurosurgeon Authors Op-Ed on Border Wall Injuries

    On April 13, Los Angeles Times published an op-ed titled, “As a San Diego neurosurgeon, I see the devastating toll of the raised border wall.” In the op-ed, Alexander Tenorio, MD, a neurological surgery resident at the University of California San Diego, poignantly discusses the horrific spinal cord and brain injuries caused by falls from the border wall. Dr. Tenorio relays stories of patients coming to the emergency department with serious injuries, such as a 30-year-old male with an unstable spinal fracture after falling off the border wall.

    On April 14, Neurosurgery Blog published a cross-post to amplify the message.


    Neurosurgeon Pens Op-Ed on the Health Insurance Monopoly in Alabama

    On April 21, 1819 News published an op-ed titled “Ending the health insurance monopoly will make life healthier for Alabamians” by Richard P. Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama. The op-ed — the second in a series Dr. Menger is writing — states that Alabama is tied with Alaska as the least competitive insurance market in the nation, which limits patient options, hurts hospitals and physicians and feeds the insurance industry. 


    Neurosurgery Blog Features Article on Stereotactic Radiosurgery

    On May 1, the Neurosurgery Blog cross-posted a recent publication in Neurosurgery, the official journal of the Congress of Neurological Surgeons.​ The article, “Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk” was published as part of Neurosurgery’s High-Impact Manuscript Service (HIMS).

    Lead author Hussam Abou-Al-Shaar, MD and colleagues reviewed data from 267 patients with 328 vestibular schwannomas from 12 surgical centers who underwent stereotactic radiosurgery. They found that stereotactic radiosurgery is effective while preserving serviceable hearing and not causing radiation-related tumor development or malignant transformation.

    Click here to read the article.


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