Vol. 49, December 2016 DC E-Newsletter

Legislative Affairs

President Obama Signs 21st Century Cures Act Into Law

On Nov. 30, 2016, the U.S. House of Representatives overwhelmingly passed H.R. 34, the 21st Century Cures Act, by a vote of 392-26, and on Dec. 7, 2016, the Senate followed suit with a 94-5 vote. On Dec. 13, 2016, President Obama signed the legislation into law (P.L. 114-255). The law provides approximately $4.8 billion in medical research funding and makes significant changes to the manner in which the Food and Drug Administration’s (FDA) reviews medical products. It also provides $1 billion in funds to address the opioid crisis and contains several provisions to ensure health information technology interoperability, including efforts to prevent electronic health record (EHR) vendors from data blocking practices. Prior to its passage, the AANS and CNS sent a letter of support for the legislation. Finally, neurosurgery issued a press release commending the passage of this important legislation as it provides significant investments to accelerate the discovery, development and delivery of new cures and treatments for all Americans.

Neurosurgery and 600 Other Groups Urge Congress to Repeal IPAB

On Nov. 29, 2016, the AANS, CNS and several state neurosurgical societies joined the Healthcare Leadership Council (HLC) — and more than 600 national and state-based health care organizations — in sending a letter urging Congress to repeal the Independent Payment Advisory Board (IPAB). The IPAB is a board of 15 unelected, and largely unaccountable government bureaucrats, whose primary purpose is to cut Medicare spending. Additionally, AANS president-elect Alex B. Valadka, MD, FAANS, participated on HLC’s IPAB media telebriefing to discuss the coalition effort. His comments were picked up by a number of media outlets including Medpage Today and Richmond Times-Dispatch. Repealing the IPAB is one of organized neurosurgery’s top legislative priorities.

Neurosurgery Urges Congress to Reauthorize the Pediatric Subspecialty Loan Repayment Program

On Nov. 16, 2016, organized neurosurgery joined the American Academy of Pediatrics (AAP) and 44 other professional medical and public health advocacy groups in sending a letter to Congress regarding the Affordable Care Act’s Pediatric Subspecialty Loan Repayment Program. The program provides loan repayment in exchange for service in areas of medical need. Specifically, in return for participants agreeing to work full-time for at least two years in a pediatric medical specialty, including pediatric surgical specialties, in a medically underserved area, the program pays up to $35,000 in loan repayment for each year of service for a maximum of three years. The letter stressed the need to reauthorize the Pediatric Subspecialty Loan Repayment Program as it will help to ameliorate workforce shortages. To that end, the groups called on Congress to support Section 722 of the Helping Families in Mental Health Crisis Act, H.R. 2646, which reauthorizes the Pediatric Subspecialty Loan Repayment Program (PSLRP) and the group urge that this language be included in any final mental health conference package.

Neurosurgery Requests Funds to Address the Opioid Epidemic

On Nov. 28, 2016, neurosurgery joined other medical groups in sending a letter to Congress requesting additional funding to address the opioid epidemic. In our letter, we urged lawmakers, “to provide the maximum possible allocation to fund not only the grant programs designated under the bipartisan Comprehensive Addiction and Recovery Act (CARA) passed earlier this year, but to also substantially increase funding for much-needed prevention and treatment efforts for opioid misuse and related disorders.”

If you have questions about these or other legislative issues, please contact Katie Orrico, director of the AANS/CNS Washington Office, at korrico@neurosurgery.org.  

Coding and Reimbursement

CMS Issues Final Coverage Decision for PILD Procedures for Lumbar Spinal Stenosis

On Dec. 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final National Coverage Decision (NCD) on percutaneous image-guided lumbar decompression (PILD) procedures for lumbar spinal stenosis (LSS). On Oct. 6, 2016, the AANS and CNS sent a letter to CMS recommending that further study is needed before broadening coverage for this procedure. CMS agreed and will conduct a prospective longitudinal study of PILD procedures for LSS to determine whether PILD:

  • Provides a clinically meaningful improvement of function;
  • Provides a clinically significant reduction in pain; or
  • Affects the overall clinical management of LSS and decision-making, including the use of other medical treatments or services, as compared to other treatments. 

October 2016 CPT Assistant Publishes Spine Coding Error

The October 2016 issue of the CPT Assistant, an American Medical Association (AMA) publication which clarifies coding issues, contained an error in the Frequently Asked Question (FAQ) section, incorrectly stating that CPT codes 63047 and 22633 may not be reported together if performed at the same interspace. The AANS and CNS are working with AMA staff to ensure that a correction is published. CPT codes 63047 and 22633 may be reported at the same interspace when additional work is required to complete a decompression at a single spinal level. The work involved in CPT code 22633 is inclusive of the bone work necessary to provide access for an interbody fusion to be completed. When additional work is required to complete decompression, such as on the contralateral side of a given spinal segment where CPT code 22633 is performed, then CPT code 63047 should be reported. Medicare National Correct Coding Initiative (CCI) edits continue to prohibit the use of these codes at the same interspace — a CCI edit to which organized neurosurgery has voiced strong objections.

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

CMS Releases Updated Resources for EHR Incentive Programs for CY 2017 and Stage 3

On Dec. 5, 2016, the Centers for Medicare & Medicaid Services (CMS) released updated resources for eligible professionals (EPs) to participate successfully in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. As previously reported, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rules include provisions that will affect the EHR Incentive Programs in 2017 and beyond. Click here for updated information and resources based on changes to these programs.

If you have any questions regarding this 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.

Of Note

Trump Nominates Rep. Tom Price as Next HHS Secretary

On Nov. 29, 2016, President-elect Donald Trump nominated Rep. Tom Price, MD (R-Ga.), to lead the Department of Health and Human Services (HHS). Throughout his time in Congress, Dr. Price, an orthopaedic surgeon, has been a staunch advocate for the preservation of the doctor-patient relationship, a fierce protector of private practice and a stalwart supporter of academic medicine. On Nov. 30, 2016, organized neurosurgery issued a statement strongly supporting the nomination of Dr. Price to become the next Secretary of HHS and urged the Senate to confirm him to this important position swiftly.

HHS Releases State-level Data on Impact of the Affordable Care Act

On Dec. 13, 2016, the Department of Health and Human Services (HHS) released an extensive compilation of state-level data illustrating the impact of the Affordable Care Act (ACA) on health care. To read the comprehensive report, click here.

AMA Honors Katie O. Orrico with Lifetime Achievement Award

In November 2016, the American Medical Association (AMA) awarded Katie O. Orrico, JD, director of the AANS and CNS Washington Office, with the Medical Executive Lifetime Achievement Award. The award honors a medical association executive who has contributed substantially to the goals and ideals of the medical profession. Congratulations, Katie!

Communications

Neurosurgery Spotlighted in Specialty Medicine On-call

In November 2016, the Alliance of Specialty Medicine featured neurosurgery in its fall 2016 e-newsletter On-Call. The publication was circulated to all members of Congress, select media and others. Each issue spotlights a specialty, and this issue looks at neurosurgery and concussions; drawing on a previous post we featured on Neurosurgery Blog about this topic. It is yet another way in which we try to get our advocacy messages out to policymakers, media and the general public.

Subscribe to Neurosurgery Blog Today!

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.