Vol. 54, August/September 2017 DC E-Newsletter

Legislative Affairs

Dr. Hunt Batjer Speaks at Rep. Roe’s IPAB Press Conference

On July 13, Rep. Phil Roe (R-Tenn.) convened a press conference on issues related to the Independent Payment Advisory Board (IPAB). AANS past president, H. Hunt Batjer, MD, FAANS, participated at this event on behalf of organized neurosurgery. Additional speakers included Reps. Raul Ruiz, MD (D-Calif.); Larry Bucshon, MD (R-Ind.) and Ami Bera, MD (D-Calif.); as well as Mary Grealy, president of the Healthcare Leadership Council (HLC). Click here for a video of the conference (Dr. Batjer is introduced at 4:05 minutes into the program, with his remarks to follow). Repealing the IPAB is one of organized neurosurgery's top legislative priorities. A majority of members of the House and Senate have cosponsored legislation (H.R. 849/S. 251/S. 260) to repeal the IPAB.

Neurosurgery Endorses the Resident Physician Shortage Reduction Act

On July 12, the AANS and CNS endorsed the Resident Physician Shortage Reduction Act (H.R. 2267/S. 1301). Neurosurgery sent letters supporting the House and Senate bills to the co-sponsors and members of the House Ways and Means and Energy and Commerce Committees and Senate Finance Committee. Introduced in the House on May 1, by Reps. Joe Crowley (D-Pa.) and Ryan Costello (R-Pa.), and in the Senate on June 7, by Sens. Bill Nelson (D-Fla.), Dean Heller (R-Nev.) and Chuck Schumer (D-N.Y), this bill would provide funding for 3,000 more residency slots, per year for the next five years for a total of 15,000 new slots. Efforts to garner additional cosponsors are underway.

AANS and CNS Oppose Bill Impeding Single Accreditation System for GME

On May 4, 2017, Reps. Mike Kelly (R-Pa.) and Vern Buchanan (R-Fla.) introduced legislation (H.R. 2373) to require the Department of Health and Human Services to certify at least two graduate medical education accreditation bodies, including at least one entity that accredits osteopathic residency training programs. The bill also removes any specific mention of the Accreditation Council for Graduate Medical Education (ACGME) in Medicare law, among other things. Concerned that if enacted this legislation would result in multiple training standards for residents in training and diminish the ACGME as the appropriate standard-setting organization for residency training, on July 12, the AANS and CNS sent a letter to the authors of the bill opposing the measure. AANS/CNS Washington Office staff are working with various stakeholders, including the ACGME, Association of American Medical Colleges (AAMC) and the American Osteopathic Association (AOA), to educate members of Congress about the single accreditation process and the importance of uniform standards in residency training.
 

Quality Improvement

Quality Payment Program Hardship Exception Application 2017 Now Available

The Medicare Quality Payment Program (QPP) Hardship Exception Application for the 2017 transition year is now available on the QPP website. Merit-based Incentive Payment System (MIPS) eligible clinicians and groups may qualify for a reweighting of their electronic health record (EHR), or Advancing Care Information (ACI), performance category score to zero percent of the final score. Hardship exceptions may be granted based on one of the following specified reasons:

  • Insufficient internet connectivity;
  • Extreme and uncontrollable circumstances; or
  • Lack of control over the availability of Certified EHR Technology (CEHRT).

Some clinicians are considered Special Status and will automatically be reweighted (or exempted in the case of MIPS eligible clinicians participating in a MIPS alternative payment model) and do not need to submit a QPP Hardship Exception Application.

Click here for more information about the QPP hardship application process. Additionally, eligible professionals (EPs) who are first-time participants in the Medicare EHR Incentive Program in 2017 are also eligible to apply for a one-time hardship exception. Applications are due by Oct.1. Visit the EHR Incentive Programs website and download the instructions on how to apply for this EHR Incentive Programs hardship application.

AANS and CNS Comment on Proposed 2018 Quality Payment Program Rule

On August 21, the AANS and CNS submitted a detailed letter to CMS commenting on the proposed 2018 QPP rule. The letter urged CMS to make multiple changes to the MIPS program including:

  • Streamlining the reporting system;
  • Adopting a flexible approach to measurement that recognizes the diversity of medical practice and allows clinicians to participate based on their unique setting, specialty and/or patient population;
  • Implementing an accurate scoring system that is transparent and simple to understand; and
  • Reporting and performance thresholds that are realistically achievable and do not result in reporting merely for the sake of reporting.

Additionally, to help bolster our efforts, neurosurgery joined the Alliance of Specialty Medicine and Physician Clinical Registry Coalition in submitting separate comment letters. CMS will publish the final QPP rules for 2018 in early November.

Coding and Reimbursement

Reminder: Neurosurgeons in Nine States Required to Submit Global Surgery Code Data

Starting on July 1, 2017, the Centers for Medicare & Medicaid Services (CMS) is requiring that certain neurosurgeons in nine states — Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island — to report the number of post-operative visits that they provide related to particular neurosurgical procedures. This reporting requirement applies to any group of 10 or more practitioners (not just surgeons) for all visits (in-hospital and outpatient) during the 10- and 90-day global period. CMS is concerned about the accuracy of the values assigned to 10- and 90-day global codes. Specifically, the agency is questioning whether the number and level of postoperative visits currently included in the reimbursement for global codes are an accurate reflection of the care that is actually provided.

The AANS and CNS strongly encourage neurosurgeons in these nine states to report all postoperative visits that occur — both in the hospital and after discharge — during the 10- and 90-day global periods. Each of these services should be billed just like a typical clinic or hospital visit using CPT 99024. CMS will use these claims to verify that services rendered by neurosurgeons in the post-surgical global period accurately reflect current values. Click here for more information.

Neurosurgery Objects to Proposed Non-coverage for MRI-Guided Focused Ultrasound

On Aug. 9, the AANS, CNS and American Society for Stereotactic and Functional Neurosurgery (ASSFN) sent a letter to the Medicare Administrative Contractor (MAC) Palmetto GBA regarding a draft Local Coverage Decision (LCD) to include CPT code 0398T (MRgFUS stereotactic lesion ablation for the treatment of movement disorders) on a list of CPT Category III (tracking) codes. Palmetto GBA has designated this procedure as investigational, and hence, not eligible for reimbursement. In our letter, we objected to this decision and included literature citing recent clinical evidence supporting the use of the procedure in appropriately selected patients.

CMS Releases 2018 Medicare Hospital IPPS Final Rule

On Aug. 2, CMS published the 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule. As previously reported, on June 13, neurosurgery sent a letter to CMS addressing several issues in the 2018 Medicare Hospital IPPS proposed rule. In our letter, the AANS and CNS reinforced our support for physician-owned hospitals and urged the agency to allow for their expansion. Click here to review a detailed summary of the final rule.

CMS Releases 2018 Medicare Hospital OPPS/ASC Proposed Rule

On July 13, CMS released the 2018 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. To view a fact sheet which provides an overview of the rule, click here. Neurosurgery will submit comments to CMS by the deadline of Sept. 11. In the meantime, to review a detailed summary of the proposed rule, click here.

Communications

Neurosurgery Sends Letter to the Wall Street Journal Regarding Medical Liability Article

On July 24, the Wall Street Journal published an article, We Won't See You in Court: The Era of Lawsuits is Waning. The article incorrectly made assertions about the prevalence of medical lawsuit abuse and its impact on health care. Thus, the Health Coalition on Liability and Access (HCLA), led by the AANS and CNS, submitted a letter to the editor, stating:

Regarding the story on recent reductions in lawsuits (“We Won't See You in Court: The Era of Lawsuits is Waning”, July 24), we would like to clarify some facts about the prevalence of medical lawsuit abuse and its impact on healthcare.

Nearly two-thirds of medical lawsuits filed are without merit and are thus dropped, withdrawn or dismissed. For cases that move through the courts, healthcare providers prevail 90% of the time. But it still costs an average of $42,000 to defend those claims that result in no payment.

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

It should also be noted that most states that cap damages limit only non-economic damages, which are purely subjective and immeasurable. The overwhelming majority of states place no limit on compensation for economic losses like lost wages and medical bills.

This means, for example, that in states like Texas with reasonable limits on noneconomic damages, all patients — including stay-at-home mothers and fathers — are eligible for the full value of services they provide and future lost wages, and children are eligible for lost lifetime earnings.

While the overall number of tort suits may have decreased, meritless medical liability lawsuits still stand in the way of resolving claims of deserving patients.

Neurosurgery Participates in Specialty Physician Twitter Town Hall

As part of the Alliance of Specialty Medicine’s 2017 Legislative Conference in Washington, DC, the group hosted a Twitter Town Hall on July 18 for providers, patients and health care leaders to discuss issues affecting specialty care. Representatives from the AANS and CNS led a 30-minute conversation dedicated to the Independent Payment Advisory Board (IPAB) and why this unaccountable Medicare cost-cutting tool should be repealed. During the IPAB discussion, Rep. Phil Roe (R-Tenn.), among other thought leaders participated. According to Tweet Binder impression statistics, the #ASMChat hashtag generated more than seven million impressions.

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