Vol. 48, November 2016 CNS DC E-Newsletter

Special Announcement

CMS Publishes Final Global Surgery Data Collection Requirements; Adopts Most of Neurosurgery's Recommendations!

As previously reported, in the 2017 Medicare Physician Fee Schedule (MPFS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) proposed a sweeping mandate that would require surgeons to use an entirely new set of “G-codes” to document the type, level and number of every pre- and postoperative visit furnished during the global surgery period for every surgical procedure — rather than a representative sample, as directed by Congress.  Under this system, surgeons would have been required to report on each 10-minute increment of service provided. To combat this onerous mandate, the AANS and CNS conducted an aggressive advocacy campaign. On Nov. 2, 2017, CMS released the final 2017 Medicare Physician Fee Schedule. The final rule represents a vast improvement over the initial proposal. According to the final rule, CMS will implement a three-pronged data collection process.

Prong One: Claims-based data collection.

  • CPT code 99024 will be used for reporting postoperative services rather than the proposed set of G-codes. Reporting will not be required for preoperative visits included in the global package or for services not related to patient visits. Additionally, CMS will not require time units or modifiers to distinguish levels of visits included in the reported post-visit services.
  • Reporting will only be required for services related to codes reported annually by more than 100 practitioners and that are reported more than 10,000 times or have allowed charges in excess of $10 million annually. Under this policy, CMS estimates that it would collect data on about 260 codes that describe approximately 87 percent of all furnished 10- and 90-day global services and about 77 percent of all Medicare expenditures for 10- and 90-day global services under the physician fee schedule.
  • Practitioners are encouraged to begin reporting postoperative visits for procedures furnished on or after Jan. 1, 2017, but the mandatory requirement to report will be effective for services related to global procedures delivered on or after July 1, 2017.
  • Only practitioners who practice in groups with 10 or more practitioners (including physicians and qualified non-physician practitioners) in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island will be required to report. Practitioners who only practice in smaller practices or other geographic areas are encouraged to report data, if feasible. By excluding practitioners who only practice in practices with fewer than 10 practitioners, CMS estimates that about 45 percent of practitioners will not be required to report.
  • Teaching physicians would be subject to the same reporting requirements as all physicians and would report CPT code 99024 and should use the GC or GE modifier as appropriate to identify those services in which surgical residents are involved.

Prong Two: In addition to the claims-based data collection, CMS will conduct a survey of practitioners to gain information on postoperative activities to supplement the claims-based data collection method. The survey will be stratified by specialty and will result in a sufficient qualitative data to address key procedures in each specialty furnishing procedures with global periods. CMS anticipates that just under 10,000 physicians will be surveyed, yielding a 50 percent response rate. The survey will be in the field by mid-2017. 

Prong Three: CMS will also implement an effort aimed at gaining information about global surgery services from accountable care organizations (ACOs).

Finally, CMS is not implementing the statutory provision that authorizes a 5 percent withhold of payment for the global services until claims are filed for the postoperative care, if required. If, however, physicians who are required to do so are not compliant, CMS may impose the 5 percent payment withhold in the future.

If you have questions about this issue, please contact Katie Orrico, director of the AANS/CNS Washington Office, at korrico@neurosurgery.org.  

 

Coding and Reimbursement

CMS Finalizes 2017 Medicare Fee Schedule

On Nov. 2, 2016, the Centers for Medicare & Medicaid Services (CMS) published the 2017 Medicare Physician Fee Schedule (MPFS) final rule. Overall, neurosurgical payments will be reduced by about 3 percent due to reductions in work relative value units and the Medicare sequestration cut. CMS also announced that it will drop the proposed onerous requirement for all physicians reporting 10- and 90-day global surgical services to use new G- codes to report on evaluation and management time (see special announcement above for more details). The agency also finalized its proposal to lower the values for new embolectomy, insertion of spinal stability distractive devices and spinal instrumentation codes. Finally, CMS declined to assign a value to a new code for endoscopic decompression of spinal cord, which will be priced by individual Medicare carriers. For more information about this topic, click here.

CMS Releases 2017 Medicare Hospital Outpatient and ASC Final Rule

On Nov. 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) final rule. In the regulation, CMS removed four spine codes from the inpatient-only list — spine instrumentation procedures (CPT codes 22840, 22842 and 22845) and total disc arthroplasty second level (CPT code 22858). Additionally, CMS will add eight spine codes to the ASC list — CPT codes 20936, 20937, 20938, 22552, 22840, 22842, 22845 and 22851. The AANS and CNS supported these changes in our September 2016 letter to CMS. 

If you have any questions regarding these, or other reimbursement issues, please contact Cathy Hill, AANS/CNS senior manager for regulatory affairs, at chill@neurosurgery.org.

 

Quality Improvement

Medicare Adopts Imaging Appropriate Use Criteria Requirements

On Nov. 2, 2016, the Centers for Medicare & Medicaid Services (CMS) published the 2017 Medicare Physician Fee Schedule (MPFS) final rule. In addition to the payment provisions, the rule included details of the new Medicare Imaging Appropriate Use Criteria (AUC Program). Initially, prior to ordering imaging studies, ordering professionals will need to consult appropriate use criteria for eight priority clinical areas. Those related to neurosurgery include headache (traumatic and non-traumatic), low back pain and cervical or neck pain. CMS removed suspected stroke from the list but might consider it in the future. The agency will analyze ordering data to identify outlier physicians, who then may be subject to prior authorization requirements, beginning in 2020. For more information about this topic, click here.

Medicare EHR Reporting Limited to 90 Days

On Nov. 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) final rule. Included in the regulation is a key provision allowing physicians to report electronic health record (EHR) meaningful use data for a 90-day reporting period in 2016 and 2017 rather than a full calendar year. In 2017, physicians who have not successfully demonstrated meaningful use in the past may attest to modified Stage 2 objectives and measures, rather than Stage 3. New meaningful use participants who are also transitioning to the Merit-based Incentive Payment System (MIPS) in 2017 can apply for a significant hardship exception from the 2018 Electronic Health Records (EHR) Incentive Program payment adjustment, which is the last year penalties are authorized under the old structure before transitioning to MIPS.   

If you have any questions regarding these, or other quality-related issues, please contact Rachel Groman, Vice President for Clinical Affairs and Quality Improvement at Hart Health Strategies, at rgroman@hhs.com.

 

Drugs and Devices

FDA Holds Meeting on Off-label Use

On Nov. 9 and 10, 2016, the Food and Drug Administration (FDA) held a public hearing on off-label promotion. The purpose of the hearing was to obtain input on issues related to communications by manufacturers regarding FDA-regulated drugs and medical devices. The FDA stated in the notice that the agency “is engaged in a comprehensive review of its regulations and policies governing firms’ communications about unapproved uses of approved/cleared medical products, and the input from this meeting will inform FDA’s policy development in this area.” The agency will accept written comments until Jan. 9, 2017. William C. Welch, MD, FAANS, vice chair of the AANS/CNS Drugs and Devices Committee, presented a statement on behalf of AANS and CNS. 

If you have any questions regarding this or other drugs and devices issues, please contact Cathy Hill, AANS/CNS senior manager for regulatory affairs, at chill@neurosurgery.org.
 

Emergency Neurosurgical Services

National Academies of Science, Engineering and Medicine Hosts Meeting on Trauma Report

 
On Nov. 1-2, 2016, the National Academies of Science, Engineering & Medicine (NASEM) hosted a meeting on its new report, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.” Released in June 2016, the report calls for the creation of a national trauma care system to address the significant burden of injury in the U.S. and to ensure that knowledge on best trauma care practices is continuously shared between military and civilian trauma systems. The meeting brought together the study sponsors and representatives from other military and civilian stakeholder organizations to discuss the report recommendations. It also provided a forum to identify opportunities to advance national trauma care capacity to ensure the best possible care is delivered to trauma patients in the U.S. and to our service members wounded on the battlefield. Organized neurosurgery was represented by AANS president-elect, Alex B. Valadka, MD, FAANS, who shared the specialty’s ideas on how best to implement a national trauma care system.
 
If you have any questions about this issue, please contact Adrienne Roberts, senior manager of legislative affairs in the AANS/CNS Washington Office, at aroberts@neurosurgery.org.
 

Of Note

Neurosurgeon Receives Lifetime Service Award

In October 2016, Philipp M. Lippe, MD, FAANS(L), received the Specialty Delegation/California Medical Association Lifetime Award. In receiving this award, Dr. Lippe was recognized for his decades of selfless dedication to medicine, particularly in the fields of neurosurgery and pain. Congratulations, Dr. Lippe!
 

Communications

Neurosurgery Pens Letter to New York Times Regarding Concussions

 
On Oct. 10, 2016, the AANS and CNS sent a letter to the editor of the New York Times in response to the Oct. 6, 2016, editorial, “Head Trauma Haunts the Gridiron.” In the letter, Frederick A. Boop, MD, FAANS, AANS president, and Alan M. Scarrow, MD, JD, FAANS, CNS president, stated:
 
The Oct. 16, 2016, editorial, “Head Trauma Haunts the Gridiron,” leads readers to believe there is a concussion epidemic. While the annual number of reported sports-related concussions has increased, this is due to greater awareness, education, concussion safety laws and changing definitions. It is simply not accurate to suggest that sports-related brain trauma is more of a problem now than in the past.

The letter, which was not published by the paper, went on to point out that:

Neurosurgeons agree that concussion education for everyone involved with youth sports is essential. However, a narrative that implies sports-related concussion is a “crisis” interjects a new fear that athletes and their parents must consider when deciding to participate. This is misleading and a disservice to your readers if it dissuades youth participation in contact sports. As physicians, we want young people to be safe, but we also must encourage them to be active if they are to enjoy a lifetime of good health. Because factors that may contribute to neural degeneration or predispose some people to prolonged clinical effects of concussion remain unknown, it is irresponsible to draw conclusions about the cause and effect of concussions and neurodegenerative disease before the research is done. Fear based on what we have yet to understand should not be a compelling reason to abandon sports that have had an overall benefit on public health.

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The mission of Neurosurgery Blog is to investigate and report on how health care policy affects patients, physicians and medical practice, and to illustrate how the art and science of neurosurgery encompass much more than brain surgery. Neurosurgery Blog has ramped up its reporting efforts to include multiple guest blog posts from key thought leaders and members of the neurosurgical community. We invite you to visit the blog and subscribe to it, as well as connect with us on our various social media platforms. This will allow you to keep up with the many health-policy activities happening in the nation's capital and beyond the Beltway.

If you are interested in these, or other communications activities, please contact Alison Dye, AANS/CNS senior manager of communications, at adye@neurosurgery.org.