Vol. 55, October 2017 DC E-Newsletter

Legislative Affairs

House Ways and Means Committee Passes IPAB Repeal Legislation

On Oct. 4, by a vote of 24-13, the U.S. House Ways and Means Committee passed H.R. 849, the Protecting Seniors’ Access to Medicare Act out of committee. Sponsored by Rep. Phil Roe, MD (R-Tenn.), and Rep. Raul Ruiz, MD (D-Calif.), this bipartisan legislation would repeal the Independent Payment Advisory Board (IPAB). The IPAB is charged with making steep cuts to the Medicare program, thus adversely affecting seniors’ ability to see their trusted physicians and get the care they need when they need it. Earlier this year, the AANS and CNS joined the Physician IPAB Repeal Coalition, the Alliance of Specialty Medicine and more than 800 health care stakeholder organizations in endorsing this legislation. The AANS and CNS issued a press release applauding the committee for its leadership on IPAB repeal. The House Energy and Commerce Committee was also scheduled to consider the bill, but did not ultimately do so because the Ways and Means Committee had already acted, making further action unnecessary. Repealing the IPAB is one of organized neurosurgery’s top legislative priorities.

House Energy and Commerce Committee Advances Neurosurgery’s Legislative Priorities

On Oct. 4, the U.S. House Energy and Commerce Committee advanced three legislative priorities of the AANS and CNS — Children’s Health Insurance Program (CHIP) reauthorization, telestroke and electronic health record (EHR) relief.

  • The Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable (HEALTHY KIDS) Act (H.R. 3921) would reauthorize the CHIP. Introduced by Rep. Michael Burgess, MD (R-Texas), this legislation provides five years of federal appropriations for CHIP, for FY 2018 through FY 2022. The bill passed by a vote of 28-23, along party lines. The funding levels and matching rates mirror the same policies and provisions including the bipartisan Senate bill, S. 1827, the Keep Kids' Insurance Dependable and Secure (KIDS) Act. The Senate Finance Committee passed S. 1827 out of committee by voice vote.
  • The Furthering Access to Stroke Telemedicine (FAST) Act (H.R. 1148), introduced by Rep. Griffith Morgan (R-Va.), would expand the ability of patients presenting at hospitals or at mobile stroke units to receive a Medicare-reimbursed neurological consult via telemedicine. The bill passed by voice vote.
  • H.R. 3120 aims to reduce the volume of future electronic health record-related significant hardship requests. Introduced by Rep. Michael Burgess, MD (R-Texas), this bill amends the Health Information Technology for Economic and Clinical Health (HITECH) Act to remove a requirement that requires the Secretary of Health and Human Services (HHS) to continue to make meaningful use standards more stringent over time. The bill passed by voice vote.

The AANS/CNS Washington Office played an active and critical role in advancing these bills.

Senate Passes Resolution Designating September 2017 as National Spinal Cord Injury Awareness Month

Introduced and championed by Sen. Marco Rubio (R-Fla.), S.Res. 252, designating September 2017 as National Spinal Cord Injury Awareness Month, was passed by the U.S. Senate on Sept. 13. Recognizing that more than 285,000 individuals live with a spinal cord injury and 17,500 new injuries occur each year, the resolution calls for increased education and investment in research to improve outcomes for victims of spinal cord injuries (SCI). Additionally, the measure supports clinical trials for new therapies and commends the dedication of national, regional and local organizations, researchers, doctors and volunteers who are working to improve the quality of life of individuals living with SCI and their families. Organized neurosurgery sent Sen. Rubio a letter of appreciation for his leadership on this issue.
 

Regulatory Relief

Neurosurgery Participates in HHS Cut the Red Tape Summit

On Monday, Oct. 2, AANS/CNS Washington Committee chair, Ann R. Stroink, MD, FAANS, and AANS/CNS Washington Office director, Katie O. Orrico, Esq., attended a “Cut the Red Tape Summit” event. This meeting was a continuation of previous regulatory relief meetings convened by the leaders of the Department of Health and Human Services (HHS), including acting HHS Secretary, Don Wright, MD; CMS administrator, Seema Verma; and the FDA’s deputy commissioner, Anna Abram. These individuals reiterated the department’s commitment to reducing unnecessary regulations that do not add value and impede patient care. Each agency within HHS has developed a plan for reducing regulatory burden, and the Regulatory Relief Task Force meets weekly to ensure forward progress. Several issues, in particular were highlighted:

  • Reducing burdensome quality reporting requirements;
  • Concerns about EHRs getting between physicians and patients; and
  • Apprehension that regulations are leading to the consolidation of the health care market, whereby small physician practices and those in rural areas are unable to keep pace with regulatory burdens, leading to practice consolidation and hospital employment.

Dr. Stroink stressed neurosurgery’s concerns about Medicare’s future regulations requiring all ordering physicians to consult with appropriate use criteria before ordering advanced imaging.  Additionally, she raised concerns about prior authorization.

House Committee Launches Medicare Red Tape Relief Project

Earlier this year, the House Ways and Means Committee launched a “Medicare Red Tape Relief Project,” which aims to roll back burdensome Medicare regulations and mandates to improve patient care. As part of this effort, on Aug. 25, the AANS and CNS submitted comments on the following three priority topics:

Quality Improvement

Time is Ticking to Participate in MACRA for 2017

The Medicare Access and CHIP Reauthorization Act (MACRA), passed in 2015, repealed the flawed sustainable growth rate (SGR) formula and created the Quality Payment Program (QPP) with two payment pathways for physicians: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). The QPP streamlines Medicare reimbursement and is intended to pay for value. During this first transition year, neurosurgeons who are otherwise not exempt from the MIPS program are allowed to pick their pace of reporting in 2017 and can report on one patient, one measure and receive no penalty. Details about the QPP are available by clicking here. In addition, the American Medical Association has extensive resources, which can be accessed here. Act now to avoid a four percent Medicare payment penalty in 2019.

2018 PQRS and Value Modifier Notifications and Feedback Reports Now Available

Eligible clinicians can now look up their current and prior years’ Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) payment adjustments, and find out which feedback reports related to these two programs are available for your practice. To learn more about this tool, please see the “Guide for Accessing the Payment Adjustment and Reports Lookup Feature.” The 2016 PQRS Feedback Reports show 2016 reporting results, including if a practice is subject to the 2018 PQRS penalty, while the 2016 Annual Quality and Resource Use Reports (QRURs) show how practices performed in 2016 on the quality and cost measures used to calculate the 2018 VM, as well as their associated payment adjustment.  

Individuals and group practices who did not satisfactorily report 2016 PQRS quality measures will be subject to a 2.0 percent reduction in their 2018 Medicare Part B Physician Fee Schedule (PFS) payments. Those who failed the PQRS are also subject to an additional 2.0 percent reduction in their 2018 Medicare Part B payments as a result of the VM. However, CMS recently proposed to lower the bar on 2016 reporting requirements retroactively and to limit the impact of 2018 penalties under these two programs. As a result of these changes, the majority of clinicians will avoid a penalty in 2018.

Please note that an Enterprise Identity Management System (EIDM) account with the correct role will be needed to access the PQRS feedback reports and QRURs. Both reports can be accessed on the CMS Enterprise Portal using the same EIDM account. To find out if there is already someone who can access your reports, contact the QualityNet Help Desk. To sign up for an EIDM Account, visit the CMS Enterprise Portal and click “New User Registration” under “Login to CMS Secure Portal.” Instructions for signing up for an EIDM account are provided here. If you already have an EIDM account, then follow the instructions provided here to sign up for the appropriate role in EIDM. 

Practices that believe an error has been made may request an informal review of their 2016 PQRS and VM results during the informal review period, which is open now until Dec. 1, 2017, at 8:00 pm ET. Click here for more information about submitting a PQRS Informal Review. Click here for more information about submitting a VM Informal Review. For additional information, CMS provides the following documents to help you better understand these payment adjustments:

*Note that the Quality Payment Program (QPP) began January 2017 and replaced PQRS, the VM, as well as the separate payment adjustments under the Medicare Electronic Health Record (EHR) Incentive Program. The QPP’s Merit-Based Incentive Payment System (MIPS) streamlines these legacy programs, reduces quality reporting requirements and has many flexibilities that allow eligible clinicians to pick their pace for participating in the first year. To prepare for success in the QPP, we encourage you to review your PQRS feedback report, your QRUR, and to visit qpp.cms.gov to learn more about the QPP.  

AANS and CNS Comment on Proposed 2018 Medicare Physician Fee Schedule

On Sept. 11, 2017, the AANS and CNS submitted comments to CMS regarding the proposed 2018 Medicare Physician Fee Schedule (MPFS) rule. The groups also joined in signing the Alliance of Specialty Medicine’s comment letter. In the letter, the AANS and CNS:

  • Expressed support for CMS’s effort to minimize the impact of legacy quality reporting program payment penalties in 2018 to help clinicians transition to the new Merit-Based Incentive Payment System (MIPS), urging CMS to consider further strengthening these proposals so that they align even more closely with 2017 MIPS transition year policies, where a clinician can avoid a penalty by reporting on a single measure for a single patient. 
  • Raised concerns about the premature implementation of Patient Relationship Codes, which are aimed at achieving more accurate cost measure attribution and which physicians could be required to start reporting in 2018, despite many unresolved details.
  • Voiced concerns about the implementation of the Imaging Appropriate Use Criteria (AUC) Program, including its burden on practice, impact on physician payments and overall value in light of similar efforts targeting appropriate use under MIPS.   

CMS is expected to issue the final 2018 MPFS final rule by early November.  
 

Coding and Reimbursement

Neurosurgery Comments on Proposed 2018 Medicare Physician Fee Schedule

On Sept. 11, the AANS and CNS submitted a letter to CMS commenting on several reimbursement-related topics contained in the proposed 2018 Medicare Physician Fee Schedule. AANS/CNS comments included:

  • Urging CMS to delay the global surgery code data collection project and to allow for thorough stakeholder review before considering any changes to global surgery code values;
  • Recommending that CMS consider reinstating consultation codes as part of the agency’s plan to update evaluation and management documentation guidelines;
  • Pointing out the flaws in the agency’s methodology for calculating malpractice relative value units;
  • Commending CMS for accepting the RUC recommendations for percutaneous implantation of neurostimulator electrode codes 64553 and 64555 and the new bone marrow aspiration for spine code 2093X; and
  • Encouraging CMS not to revalue CPT code 27279, sacroiliac joint fusion, at this time.

The AANS and CNS also joined the Alliance of Specialty Medicine in sending a letter to CMS echoing many of the concerns raised in their letter.
 

Drugs and Devices

FDA Panel Recommends Enhanced Warnings for Gadolinium Contrast

On Sept. 8, by a vote of 13 to one with one abstention, the Food and Drug Administration’s (FDA) Medical Imaging Drugs Advisory Committee, recommended that the agency include a package warning regarding retention risks for gadolinium-based contrast agents (GBCAs). In reaching this decision, the committee highlighted the need for "risk minimization steps" for certain patient populations. Nine GBCAs are currently FDA-approved. Background material from the meeting is available here. The agency considers advisory panel comments in their decision making, but is not required to adopt panel recommendations. FDA staff emphasized that, although evidence shows retention when GBCAs are used, the risk to patients of retention, if any, has not been determined. 

Help Save Lives: Co-Prescribe Naloxone Fact Sheet

As part of organized neurosurgery’s ongoing efforts with the AMA Opioid Task Force, the AANS and CNS recently developed a co-branded fact sheet on naloxone, which encourages physicians to consider co-prescribing naloxone when it is clinically appropriate to do so. Click here for more information on the effort.
 

Communications

Neurosurgery Blog Holds Pain Awareness Campaign

In September and October, Neurosurgery Blog spearheaded a pain awareness campaign. During this initiative, the blog investigated myriad aspects of pain, while aiming to educate, inform and pose critical questions that need to be addressed. Neurosurgery Blog and other communications outlets focused on pain topics, with multiple guest blog posts. The first guest post, authored by Patrice A. Harris, MD, MA, chair of the AMA Opioid Task Force, discussed the nation’s opioid epidemic and how continued advocacy is needed to turn the tide. The second guest post, which addressed efforts by the Global Pain Initiative, was written by neurosurgery’s own Christopher J. Winfree, MD, FAANS. A plethora of blog posts — on such topics as medial innovation and pain management, trigeminal neuralgia and DRG stimulation — were authored by the neurosurgical community. We invite all neurosurgeons to join the conversation using the #PainFacts hashtag so we can grow awareness through social media.

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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.