Vol. 98, April 2024 DC E-Newsletter
Legislative Affairs
Congress Passes Legislation Partially Reversing 3.37% Medicare Pay Cut
Congress passed the Consolidated Appropriations Act, 2024 (H.R.4366), partially reversing the 3.37% Medicare physician payment cut that went into effect on Jan. 1. President Joseph R. Biden, Jr. signed the bill into law. The legislation reduces the cut by half, providing a 1.68% increase in current payment levels. The new payment rate took effect on March 9 and will continue through 2024.
The legislation also extended incentive payments for physicians participating in certain advanced alternative payment models, providing eligible participants with an additional 1.88% bonus payment. In a statement to MedPage Today, Katie O. Orrico, Esq., Congress of Neurological Surgeons (CNS)/American Association of Neurological Surgeons (AANS) senior vice president for health policy and advocacy, stated:
When coupled with medical inflation and ongoing sequestration cuts, physicians are now experiencing a staggering 10% Medicare payment cut in 2024. While we appreciate the additional resources Congress is providing, it is a drop in the ocean of need. This discrepancy highlights the unique and untenable position of physicians, who are the only Medicare providers without an inflationary-based payment update, emphasizing the critical necessity for long-term payment reform that genuinely reflects the economic realities faced by physicians who are the foundation of patient care in our health care system.
Subsequently, the Centers for Medicare & Medicaid Services updated its website to reflect the new Medicare Physician Payment Schedule conversion factor. The 2024 conversion factor for Jan. 1 through March 8 was $32.74. The updated conversion factor for the remainder of the year is $33.2875.
Neurosurgeons are encouraged to go to the CNS/AANS Advocacy Action Center and urge your representatives to co-sponsor H.R. 2474, the Strengthening Medicare for Patients and Providers Act. This legislation would provide physicians with an annual Medicare physician payment update based on the Medicare economic index.
Click here to send a letter to your elected officials.
Congress Urges Biden Administration to Implement No Surprises Act as Enacted
On March 20, Reps. Brad Wenstrup, DPM, (R-Ohio), Greg Murphy, MD, (R-N.C.), Bill Pascrell (D-N.J.) and Joe Morelle (D-N.Y.) sent a letter with 35 additional members to U.S. Department of Health and Human Services Secretary Xavier Becerra, Department of the Treasury Secretary Janet Yellen and Acting Secretary of the U.S. Department of Labor Julie Su, urging the Biden Administration to take action to ensure that the No Surprises Act (NSA) is appropriately implemented. The letter notes that many issues remain unresolved related to the qualified payment amount, network adequacy, compliance and enforcement with statutorily required payment timelines. Addressing such problems is essential for the NSA’s long-term success in resolving disputes and ensuring patient access to care.
Click here to read the letter.
CNS and AANS Support Legislation Banning Electronic Funds Transfer Fees
On Jan. 24, the Regulatory Relief Coalition sent a letter to Reps. Greg Murphy, MD, (R-N.C), Morgan Griffith (R-Va.), Ami Bera, MD, (D-Calif.), Mariannette Miller-Meeks, MD, (R-Iowa), Derek Kilmer (D-Wash.) and Kim Schrier, MD, (D-Wash.) in support of the No Fees for EFTs Act (H.R. 6487). This bipartisan legislation would prohibit health plans from imposing fees on health care providers for electronic funds transfers, payments and remittance advice transactions. On Feb. 27, Sens. Bill Cassidy, MD, (R-La.) and Maria Cantwell (D-Wash.) introduced the companion bill (S. 3805) in the Senate.
Click here to read the letter.
CNS and AANS Recommend Prior Authorization Reforms for ERISA Plans
On March 15, the CNS and the AANS joined the Alliance of Specialty Medicine in responding to the House Committee on Education and Workforce Committee’s Request for Information on ways to improve the Employee Retirement Income Security Act (ERISA). In the comment letter, the groups made several recommendations to ensure physicians can focus on providing high-quality patient care rather than complying with burdensome utilization management requirements, such as prior authorization.
Click here to read the Alliance of Specialty Medicine’s comments.
Neurosurgery Urges Permanent Telehealth Expansion
On Feb. 22, the CNS and the AANS joined more than 130 organizations in sending a letter to Senate Majority Leader Charles Schumer (D-N.Y.), Senate Minority Leader Mitch McConnell (R-Ky.), House Speaker Mike Johnson (R-La.) and House Minority Leader Hakeem Jeffries (D-N.Y.) urging Congress to make permanent telehealth flexibilities implemented curing the COVID-19 pandemic before they sunset on Dec. 31.
U.S. House Approves Gabriella Miller Kids First Research Act 2.0 Legislation
On March 5, the U.S. House of Representatives passed the Gabriella Miller Kids First Research Act 2.0 (H.R. 3391) by a vote of 384 to 4. Introduced by Rep. Jennifer Wexton (D-Va.), this legislation would expand the available funds to support research on pediatric diseases and disorders at the National Institutes of Health (NIH). In October 2023, companion legislation, S. 1624, passed the Senate Committee on Health, Education, Labor and Pensions.
The CNS and the AANS have supported the Senate and House bills.
CNS and AANS Support GME Funding Legislation
On March 13, the CNS, AANS and Society of Neurological Surgeons joined the Graduate Medical Education (GME) Advocacy Coalition in supporting the Substance Use Disorder Workforce Act (H.R. 7050). This bipartisan legislation would provide Medicare funding for 1,000 new GME positions over five years in hospitals with accredited residency programs in addiction medicine, addiction psychiatry or pain medicine and their prerequisite programs.
Click here to read the GME Advocacy Coalition’s letter.
FY 2024 Funding Bill Signed Into Law
On March 23, President Joseph R. Biden, Jr. signed the bill into law, H.R. 2882, the Further Consolidated Appropriations Act, 2024. The spending package includes $225.4 billion in funding for HHS. Highlights include:
- $48.6 billion for NIH;
- $25 million firearm morbidity and mortality prevention research;
- $390 million for the Children’s Hospitals Graduate Medical Education program;
- $10 million for the Pediatric Specialty Loan Repayment program;
- $24 million for the Emergency Medical Services for Children program;
- $761 million for Injury Prevention and Control at the Centers for Disease Control and Prevention;
- $4 million for the Military and Civilian Partnership for the Trauma Readiness grant program; and
- $13 million for traumatic brain injury.
President Releases FY 2025 Budget Proposal
On March 11, President Joseph R. Biden, Jr. released his $7.3 trillion Fiscal Year (FY) 2025 budget. The U.S. Department of Health and Human Services (HHS) budget request includes $130.7 billion in discretionary spending — a $2.2 billion (1.7%) increase from FY 2023.
Highlights include:
- $3.6 billion to fund the Cancer Moonshot;
- $48.3 billion for the National Institutes of Health (NIH);
- $60 million — $35 million for the Centers for Disease Control & Prevention and $25 million for NIH — for firearm morbidity and mortality prevention research;
- $385 million for the Children’s Hospitals Graduate Medical Education program;
- $2.8 billion for the National Institute of Neurological Disorders and Stroke;
- $32 million for Alzheimer’s research and programs; and
- $13 million for traumatic brain injury prevention.
Click here for the HHS budget details.
Senate Armed Services Committee Holds Hearing on Military-Related TBI
On Feb. 28, the U.S. Senate Committee on Armed Services Subcommittee on Personnel held a hearing to discuss the impact of blast injuries and the need for the Department of Defense (DoD) to provide better care for military service members who sustain a military-related traumatic brain injury (TBI). Subcommittee chair, Sen. Elizabeth Warren (D-Mass.), is concerned that the DoD is not meeting its responsibilities and reinforced four critical solutions needed to address the growing risks and harm presented by blast overpressure:
- Developing strategies specific to the military occupational specialties that are most at risk of blast overpressure;
- Establishing blast exposure and TBI logs for recordkeeping;
- Requiring regular cognitive health assessments for service members; and
- Establishing more accurate safety limits for weapons usage during training.
Click here for details, including the hearing video and witness testimony.
Neurosurgery Participates in Trauma Association’s Lobby Day
On March 20, the Trauma Center Association of America (TCAA) hosted its annual lobby day to advocate for trauma centers and patients. Participants requested the reauthorization of the Military and Civilian Partnership for the Trauma Readiness (also known as MISSION Zero) grant program and $11.5 million in funding for FY 2025 grants authorized by the MISSION Zero Act. Initially authorized by the Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI) Act, MISSION Zero was passed to assist civilian trauma centers in partnering with military trauma professionals to create a pathway to provide patients with the highest quality of trauma care in times of both peace and war. The program recently received $4 million in funding for FY 2024.
House Committee Advances Multiple Health Care Bills
On March 20, the House Committee on Energy and Commerce approved multiple health care bills, including:
- R. 7208, the Traumatic Brain Injury (TBI) Reauthorization Act, reauthorizing the TBI Program at $5 million a year through FY 2029 to fund TBI prevention, research and service delivery through grants to states;
- R. 6960, the Emergency Medical Services (EMS) for Children Reauthorization Act, reauthorizing the Children’s EMS Program at $24 million annually through FY 2029; and
- R. 7153, the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, reauthorizing this program at $45 million per year through FY 2029 to support mental health and wellness programs for health care professionals.
Coding and Reimbursement
CMS Hosts Prior Authorization Final Rule Information Session
On March 26, the Centers for Medicare & Medicaid Services Office of Burden Reduction & Health Informatics hosted an information session on the agency’s prior authorization final rule. The recording (password: 5PAMV^vN) and slides from the information session are available online.
To learn more about the final rule, visit the Federal Register and read the press release and fact sheet.
HHS OIG Update on Medicare Advantage Plan Prior Authorization
On March 18, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) published an “impact brief” highlighting the OIG’s work on Medicare Advantage (MA) plan prior authorization issues. The report notes that MA organizations deny over one million prior authorization requests yearly. In 2019, an estimated 13% were for services the OIG deemed medically necessary for the patient. The document outlines specific concerns and steps undertaken to address the problems.
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 rules implementing the law unfairly favor insurers when settling out-of-network payment disputes. Several lawsuits challenging the NSA are making their way through the courts, and on March 20, the CNS and the AANS joined a physician-led amicus brief to ensure fair payment for physician services.
Click here to read the amicus brief.
Neurosurgery Urges VA to Respect State Scope of Practice Laws
On Feb. 21, the CNS and the AANS joined the American Medical Association in writing a letter to convey ongoing concerns with the Department of Veterans Affairs (VA) effort to develop National Standards of Practice (NSP) through the Federal Supremacy Project. The letter urged the VA to address flaws in the NSP development process, including halting efforts to supersede well-established state scope of practice laws.
Click here to read the letter.
MedPAC Releases March Report to Congress
On March 15, the Medicare Payment Advisory Commission (MedPAC) released its March 2024 Report to the Congress: Medicare Payment Policy. For 2025, MedPAC recommended updating Medicare’s base payment rate for physicians by the amount specified in current law plus 50% of the projected increase in the Medicare Economic Index. The commission also recommended that Congress significantly restructure the Medicare Advantage (MA) program, citing a lack of transparency and noting that the MA plans get paid more than providers who serve beneficiaries in traditional Medicare.
A news release with more details is available here.
Drugs and Devices
Open Payments Review and Dispute Period for 2023 Data is Open through May 15
Between April 1 and May 15, the Open Payments program, which collects information about financial relationships between health care providers and drug and device companies, allows providers to review their data for accuracy before it is publicly released in June. The CNS and the AANS encourage neurosurgeons to check the accuracy of their data and to dispute items that are not correct.
A video with instructions is available here. More information on the program is available here.
Neurosurgery Supports Using Registry Data for FDA Regulatory Purposes
On Feb. 20, the CNS and the AANS joined the Physician Clinical Registry Coalition in a letter to Food and Drug Administration Commissioner Robert M. Califf, MD, expressing support for using registry data as the agency develops guidance on using “real-world” data for medical device review. The letter was in response to draft guidance issued in December 2023.
Quality Improvement
CNS and AANS Comment on Cost Measures for Movement Disorders
On Feb. 28, the CNS and the AANS commented on proposed cost measures for movement disorders. Jason M. Schwalb, MD — a stereotactic and functional neurosurgeon specializing in surgery for neurological disorders that impact movement — serves on the measure development workgroup organized by Acumen, LLC, the Centers for Medicare & Medicaid Services contractor developing these measures.
The comment letter states that movement disorders cost measure should accurately reflect the role and value of neurosurgeons. It should not create real, or even perceived, disincentivizes that discourage neurologists and other clinicians from referring patients with disabling conditions for effective neurosurgical procedures that are evidence-based and considered standard of care.
Click here to read the letter.
CNS and AANS Rejects on MIPS Surgical Care MVP
Earlier this year, the CNS and the AANS submitted comments to the Centers for Medicare & Medicaid Services (CMS) on a proposed Surgical Care Merit-Based Incentive Payment System (MIPS) Value Pathway (MVP). MVPs are a new MIPS reporting pathway available to clinicians. They are intended to reduce reporting burdens, provide clinicians with more meaningful performance feedback and help prepare them to participate in alternative payment models. While MVPs are optional, CMS intends to make them mandatory in the future and continues to introduce additional MVPs to fill existing gaps in specialties and patient populations.
In rejecting the proposed Surgical Care MVP, the neurosurgical groups were highly critical given that the MVP arbitrarily combines measures that assess numerous unrelated surgical specialties (e.g., general surgery, neurosurgery, cardiac surgery and breast surgery) and provides little value to participating clinicians and their patients. The CNS and AANS also voiced concern that CMS did not consult relevant clinical stakeholders when developing this MVP and carelessly assumed certain measures broadly apply to all surgeons based on their title alone.
Click here to read the letter.
Of Note
New Report Shows Continuing Projected Physician Shortage
On March 21, the Association of American Medical Colleges (AAMC) issued new projections demonstrating that the U.S. faces a physician shortage of up to 86,000 physicians by 2036. This updated report titled “The Complexities of Physician Supply and Demand: Projections From 2021 to 2036” projects a shortfall of up to 19,900 surgeons and 40,400 primary care physicians. By comparison, the shortage projected in the new report is smaller than the findings demonstrated in the last report published by the AAMC in 2021.
The report confirms that lifting the federal statutory cap on Medicare support for GME will help alleviate the current and projected doctor shortage. To that end, the CNS and the AANS continue to urge Congress to pass the Resident Physician Shortage Reduction Act (H.R. 2389/S. 1302), which would help address the physician shortage by gradually increasing the number of Medicare-supported residency positions by 14,000 over seven years.
Click here for the full report and here for the summary.
Communications
Neurosurgery Blog Featured on Medscape’s List of Medical Blogs Physicians Love
On Feb. 16, Medscape published an article, “‘Blog MD’: Medical Blogs That Physicians Love,” featuring Neurosurgery Blog on its list of 10 medical blogs for physicians. The article notes that the blog’s mission is to investigate and report on how health care policy affects patients, physicians and medical practice and to illustrate that the art and science of neurosurgery encompass much more than brain surgery. Medscape pointed out that the “blog authored by the CNS and AANS tackles topics beyond brain surgery. Physicians and other specialists could learn from writings about a neurosurgeon’s approach to mentorship, artificial intelligence in the treatment of stroke patients, and creating a pathway for the next generation of neurosurgeons.”
Click here to read the article.
Neurosurgery Blog Continues Series on Making and Maintaining a Neurosurgeon
Neurosurgery Blog continues its series on becoming a neurosurgeon. Read the latest three articles published:
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