Vol. 52, April/May 2017 CNS DC E-Newsletter

Legislative Affairs

Accessible Care by Curbing Excessive lawSuitS (ACCESS) Act Introduced

On April 6, Rep. Richard Hudson (R-N.C.) introduced H.R. 1704, the Accessible Care by Curbing Excessive lawSuitS (ACCESS) Act of 2017. The bill, which includes a $250,000 cap on non-economic damages, is modeled after proven reforms already in place in Texas, California and many other states around the country that have had a positive effect on increasing access to care and keeping health care costs affordable for patients and physicians. The bill also would establish expert witness qualifications, require the filing of an affidavit of merit as part of a lawsuit and provides protections for physicians who offer an apology following an adverse medical event. The AANS and CNS helped develop this legislation and sent a letter to Rep. Hudson supporting this bill.

Good Samaritan Health Professionals Act Re-introduced

On March 30, Sens. Bill Cassidy, MD (R-La.) and Angus King (I-Maine) introduced S. 781, the Good Samaritan Health Professionals Act of 2017. Additionally, on the same day, Reps. Marsha Blackburn (R-Tenn.) and David Scott (D-Ga.) introduced H.R 1876, a companion bill. This legislation, previously passed by Congress in March 2012, would ensure that health professionals who want to provide voluntary care in response to a federally declared disaster can do so without facing unwarranted lawsuits. While there are both federal and state laws intended to protect volunteer health professionals from unwarranted lawsuits, there are many inconsistencies, which may leave physicians vulnerable. The medical profession has a long history of stepping forward to assist disaster victims; however, the current Volunteer Protection Act, which was enacted specifically to encourage such actions, fails to address the issue of liability protections for health care providers who cross state lines to aid disaster victims. S. 781 and H.R. 1876 tackle this shortcoming. The AANS and CNS sent letters supporting this legislation to both Senate and House bill sponsors. Organized neurosurgery also joined forces with the Health Coalition on Liability and Access (HCLA) in sending endorsements letters to the Senate and House bill sponsors.

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.  

Grassroots Action Alert

Join the Alliance of Specialty Medicine for its Annual Capitol Hill Advocacy Conference

In July, the Alliance for Specialty Medicine will host its annual Capitol Hill advocacy conference. This two-day event will feature informative speakers, events with Members of Congress and an opportunity for neurosurgeons to meet with their elected officials. The conference will begin on the evening of Monday, July 17, and conclude the afternoon of July 19. If you are interested in attending, please contact Katie Orrico, director of the AANs/CNS Washington Office, at korrico@neurosurgery.org. Space is limited.

Quality Improvement

AANS and CNS Meet with HHS Secretary Tom Price, MD

On April 13, AANS/CNS Washington Office staff met with Tom Price, MD, secretary of the Department of Health and Human Services (HHS), and his senior staff, to discuss options for reducing the regulatory burden on physicians. At the meeting, we specifically requested that HHS consider taking immediate action to preclude the imposition of penalties associated with several Medicare quality-related programs including the Value-Based Payment Modifier (VM), Electronic Health Record (EHR) meaningful use (MU) program and Physician Quality Reporting System (PQRS). In 2018, neurosurgeons who do not meet the requirements of these programs face Medicare cuts as high as 10 percent. Organized neurosurgery is participating in a coalition of physician specialty groups advocating for regulatory relief.

MIPS Participation Status Letter

The Centers for Medicare & Medicaid Services (CMS) is reviewing claims and letting practices know which clinicians need to take part in the Merit-based Incentive Payment System (MIPS) in 2017. MIPS is one of two ways physicians can participate in Medicare’s new Quality Payment Program (QPP), which began on Jan. 1. In late April through May, practices will get a letter from their Medicare Administrative Contractor that processes Medicare Part B claims. This letter will identify the participation status of each MIPS clinician associated with the Taxpayer Identification Number, or TIN, in a practice. Clinicians are exempt from the MIPS reporting requirements for the 2017 transition year if they are new to the Medicare program in 2017 or they are exempt under the low-volume threshold rules because they:

  • Bill less than or equal to $30,000 in Medicare Part B allowed charges a year; or
  • Provide care to less than or equal to 100 Part B-enrolled Medicare beneficiaries a year.

CMS will apply the same low-volume threshold to both individual MIPS eligible clinicians and groups. While groups have the option to report at an individual or group level, that decision could influence whether or not they exceed the low-volume threshold.  

Please note that these letters will not include information about special participation status (e.g., hospital-based or small/rural clinicians). That information, which does not exempt a clinician from MIPS, but could result in special reporting accommodations, will be available at a later date. Additionally, although not yet available, CMS is working to develop a web-based look-up tool that clinicians can use to confirm their MIPS participation status.  

Click here for more information about the MIPS participation status letter.

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.

Coding and Reimbursement

Neurosurgery Asks HHS Secretary to Stop Global Codes Data Collection

On April 20, the AANS and CNS joined forces with other surgical groups in sending a letter to Tom Price, MD, secretary of HHS, and Seema Verma, CMS administrator, urging them to stop the global codes data collection process, at least until certain key issues are addressed.

Per the Medicare Access and CHIP Reauthorization Act (MACRA), CMS is embarking on a three-pronged data collection effort. Beginning on July 1, neurosurgeons in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island are required to report information on post-operative visits furnished during the 10- and 90-day global period of certain specified procedures using CPT code 99024. These procedures include those that are reported annually by more than 100 practitioners and that are either reported more than 10,000 times annually or have more than $10 million in annual allowed charges. Neurosurgeons who practice in practices with fewer than 10 practitioners (including physicians and qualified nonphysician practitioners) are exempted from required reporting. Click here for the full list of codes subject to reporting. 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. CMS anticipates that approximately 10,000 physicians will be surveyed, yielding a 50 percent response rate.

CMS has released new guidance on its global surgery code reporting policy. These slides contain additional information on how to comply with the new data reporting requirement, along with an updated list of frequently asked questions and answers. More information on the CMS website is available by clicking here.

MedPAC Releases March 2017 Report

On March 15, the Medicare Payment Advisory Commission (MedPAC) issued its annual March Report to Congress on Medicare payment policies. The principal focus of the document is the commission’s recommendations for annual rate adjustments under Medicare’s various payment systems. For calendar year 2018, MedPAC recommended that Congress should increase payment rates for physicians and other health professional services by the amount specified in current law. Per the Medicare Access and CHIP Reauthorization Act (MACRA) statute, this is a 0.5 percent base increase in payments. Absent regulatory or legislative relief by Congress, Physicians are also subject to quality-related adjustments from the Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) meaningful use and Value-Based Payment Modifier legacy programs, as well as the 2 percent sequester cut. More information about this report is available here.

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.

Drugs and Devices

Special FDA Safety Announcement

On March 1, the Food and Drug Administration (FDA) issued a letter to health care providers titled “Differences In Review and Intended Use of Neurovascular Thrombus Retrieval Catheters and Guide Catheters Used During Neurological Interventional Procedures.”

In the communication, the FDA clarifies the differences between neurovascular thrombus retrieval catheters and guide catheters (e.g., intermediate catheter, distal access catheter) used during neurological interventional procedures. A copy of the FDA notice is available here.

While on-label usage of devices is highly desirable, the AANS and CNS believe that both the variety of clinical situations and limited indications for the use of currently available devices require physicians to use their best clinical judgment in making patient-specific decisions. FDA-approved devices may be utilized for other indications when safe, reasonable and in the best interest of the patient.

Neurosurgery Joins the Alliance to Support Scott Gottlieb, MD for FDA Commissioner

On March 31, organized neurosurgery joined the Alliance of Specialty Medicine in sending a letter to Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) of the Senate Health, Education, Labor and Pensions (HELP) Committee endorsing the nomination of Scott Gottlieb, MD, to be Commissioner of the Food and Drug Administration (FDA). In the letter, the group highlighted Dr. Gottlieb's significant medical background and his deep experience on the front lines of U.S. health care policy. Furthermore, the letter stated, "Given that wealth of policy experience, we believe he will provide a steady hand at the FDA to ensure that our patients receive products that are both safe and effective."

Open Payment Data Review and Dispute Period Ends on May 15

On April 1, the Centers for Medicare & Medicaid Services (CMS) announced the beginning of the annual 45-day period for physicians and teaching hospitals to review and dispute manufacturer reported payments to the Open Payment (Sunshine Act) database. The opportunity to review and dispute 2016 payments will end on May 15. On June 30, CMS will publish the 2016 payment data and any corrections or updates to previous year data. More information about the Open Payments program, including instructions on how to review your 2016 Open Payments Data, is available on the Open Payments website.

AANS and CNS Urge Neurosurgeons to Promote Safe Storage and Disposal of Opioids

The AANS and CNS have joined the American Medical Association (AMA) in producing a guide to promote safe storage and disposal of opioids and all medications. The guide is a product of the AMA’s Task Force to Reduce Opioid Abuse, of which organized neurosurgery is a member. The guide recommends that physicians take the following three steps:

  1. Talk to your patients and educate them about the safe use of prescription opioids.
  2. Remind patients that medications should be stored out of reach of children, and in a safe place.
  3. Talk to your patients about the most appropriate way to dispose of expired, unwanted and unused medications.

Learn more at ama-assn.org/opioids-disposal.

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


KevinMD.com Highlights Three Neurosurgery Blog Posts

The popular health website, KevinMD.com, recently featured three Neurosurgery Blog posts.  On April 3, the website featured a post written by Robert E. Harbaugh, MD, FAANS, titled “Defending the change in resident duty hour restrictions.” Click here for the original post. Later in the month, on April 17, the site published a post authored by Ezriel Edward Kornel, MD, FAANS. Click here to go to the post titled, “The fundamental cause of surprise medical bills and how to fix it.” Click here for the original post. On April 28, the website posted an article by Deborah L. Benzil, MD, FACS, FAANS and Clemens M. Schirmer, MD, PhD, FAANS, FAHA. Click here for the article entitled, “Narrow networks have no connection to quality or value.” Both the Surprise Billing and Narrow Network posts were generated during Neurosurgery Blog’s health care reform focus-month.

Neurosurgery Sends Letter to New York Times Regarding Medical Liability Article

On April 15, The New York Times published an article, “G.O.P. Bill Would Make Medical Malpractice Suits Harder to Win.” The article incorrectly asserted that medical liability reform efforts pending in Congress would make it harder for patients to win lawsuits. Thus, the Health Coalition on Liability and Access (HCLA), led by the AANS and CNS, submitted a letter to the editor, stating:

Representing a grassroots network of patients and physicians, the Health Coalition on Liability and Access understands how our broken liability system helps neither.

Meritless lawsuits are the heart of the problem. More than two-thirds of liability claims are dropped, dismissed, or withdrawn, but still waste significant amounts of time, money, and energy.

The costs of an inefficient system – the expense of defensive medicine, high liability premiums – lead to higher medical bills. Our government shoulders the burden too to the extent liability reform would achieve $55 billion in federal health savings and $62 billion in deficit reductions over 10 years.

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

Fixing the system by mirroring successful state reforms will help reduce costs while providing unlimited compensation for economic losses of deserving patients -- medical bills, lost wages, and out-of-pocket expenses.

Medical liability reform legislation recently introduced in Congress won’t make it harder to win a legitimate lawsuit, but it will make it harder for to file one that lacks merit. And that should be a win for both patients and physicians.

Neurosurgery Spotlighted in Specialty Medicine On-call

In April 2016, the Alliance of Specialty Medicine featured neurosurgery in its spring 2017 e-newsletter On-Call. The publication was circulated to all members of Congress, certain media and others. Each issue spotlights a specialty, and this issue looks at narrow networks and neurosurgical care; 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.