Inside the CNS:
Washington Committee Report
Author: Katie O. Orrico, Esq
Surgical Care Coalition Campaign
SCC Campaign Coalition to Prevent Medicare Payment Cuts Marches Forward
On June 18, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS), along with 10 other national surgical associations, officially launched the Surgical Care Coalition (SCC). The coalition represents more than 150,000 surgeons and was formed to prevent steep Medicare payment cuts in 2021, which may lead to reduced access to care for older Americans. The CNS and the AANS are asking Congress to waive Medicare’s budget neutrality requirements to prevent the cuts and to require the Centers for Medicare & Medicaid Services (CMS) to apply the increased evaluation and management (E/M) payment adjustments to all 10- and 90-day global surgery codes.
Since the launch, the coalition has been working on converting information that was gleaned from its member survey into news stories and op-eds in national and local newspapers in targeted states. Additionally, the coalition has begun its paid digital media campaign. Finally, the AANS, CNS and coalition partners will be ramping up their grassroots efforts, urging Congress to prevent the cuts and adjust the global surgery code values.
To stay informed about the SCC’s activities, neurosurgeons are encouraged to sign up for the coalition’s advocacy newsletter. Thus far, the coalition has issued four newsletters, on July 2, July 16, July 30 and Aug. 13.
Click here to subscribe to the SCC advocacy update newsletter. Neurosurgeons are also encouraged to follow the coalition on Twitter and LinkedIn.
Neurosurgery Calls for COVID-19-Related Medical Liability Protections
As part of the ongoing efforts to provide health care providers with protections from unfounded lawsuits, the Health Coalition on Liability and Access (HCLA) — of which the CNS and the AANS serve as vice-chair — has joined a chorus of stakeholders in calling on Congress to pass legislation to safeguard medical professionals, and the facilities in which they practice, from COVID-19-related medical liability lawsuits.
To that end, on May 28, bipartisan legislation that would provide targeted relief from these lawsuits — H.R. 7059, the Coronavirus Provider Protection Act — was introduced in the House of Representatives by Reps. Phil Roe, MD, (R-Tenn.) and Lou Correa (D-Calif.). Recently, on July 9, Rep. Mike Kelly (R-Pa.) introduced H.R. 7538, the Essential Workforce Parity Act, which contains language similar to that of H.R. 7059. HCLA expressed its strong support for Section 3 of H.R. 7538 and applauded Rep. Kelly for his commitment to protecting health care professionals from the serious threat of COVID-19-related liability lawsuits.
In the Senate, on July 27, Sens. John Cornyn (R-Texas) and Mitch McConnell (R-Ky.) introduced S. 4317, the Safeguarding America’s Frontline Employees To Offer Work Opportunities Required to Kickstart the Economy (SAFE TO WORK) Act. Supported by HCLA, the Senate bill would shield health care providers from coronavirus-related medical liability claims, while allowing damage awards in situations of gross negligence or willful misconduct. The introduction of this legislation follows several Senate hearings on this topic, including one convened by the Senate Health, Education, Labor & Pensions (HELP) Committee on June 23, titled “COVID-19: Lessons Learned to Prepare for the Next Pandemic.”
Click here to read HCLA’s letter to Rep. Kelly, here for HCLA’s statement to the Senate HELP Committee and here for HCLA’s release supporting Section 3 of H.R. 7538.
CNS and AANS Urge Congress to Fund Additional Residency Slots
On July 9, the CNS and the AANS joined more than 60 health care organizations in urging Congress to include the Resident Physician Shortage Reduction Act (S. 348/H.R. 1763) in the next comprehensive COVID-19 legislation. According to a new study from the Association of American Medical Colleges, the demand for physicians continues to grow faster than supply, leading to a projected shortfall of between 54,100 and 139,000 physicians by 2033 — including a shortage of between 17,100 and 28,700 surgical specialists. The letter points out that the country has a dire need for more physicians, “not only to treat a growing and aging population, but also to respond to public health emergencies like COVID-19.”
Click here to read the letter.
Neurosurgery Calls on Congress to Increase Funding for COVID-19 Testing
As cases of COVID-19 continue to increase across the country, the CNS and the AANS are calling on Congress to prioritize robust federal funding for the critical testing needed to reopen the country. On July 21, the neurosurgery groups joined nearly 50 other health care stakeholder organizations in a letter advocating for swift action to ensure that every American — especially essential workers, frontline health care professionals and those at disproportionate risk for COVID-19 — have access to vital COVID-19 testing.
Click here to read the letter.
CNS and AANS Lead Effort Cautioning Congress About Surprise Medical Bills Legislation
On July 28, the CNS and the AANS joined more than 100 state and national medical societies in sending a letter to Congress reiterating that while “it is critical to protect patients from surprise medical bills…now is not the time to adopt divisive surprise billing legislation.” The letter restates organized medicine’s principles for surprise medical bills and urges Congress to address the issue separately from COVID-19 relief legislation.
Click here to read the letter.
HHS to Begin Distributing $1.4 Billion in Relief Funds to Children’s Hospitals
On Aug. 14, the U.S. Department of Health and Human Services (HHS) announced that it will distribute $1.4 billion to almost 80 free-standing children’s hospitals nationwide. The funds — made possible through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other health care providers — will be administered through the Health Resources and Services Administration. The CNS and the AANS have been advocating for additional COVID-19 relief funding for pediatric neurosurgeons, and previously joined nearly 30 medical groups in a letter to congressional leaders in requesting COVID-19 Public Health Emergency Fund support.
Prior Authorization Legislation Reaches Important Milestone
Legislation to streamline prior authorization has reached an important milestone, with a bipartisan majority in the U.S. House of Representatives now cosponsoring the bill. Introduced last year by Reps. Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Roger Marshall, MD, (R-Kan.) and Ami Bera, MD, (D-Calif.), H.R. 3107, the Improving Seniors’ Timely Access to Care Act, would protect patients in Medicare Advantage from unnecessary prior authorization practices that limit timely access to medically necessary care.
The CNS and the AANS are leading the Regulatory Relief Coalition’s (RRC) effort to improve prior authorization. In a statement released on June 11, 2020, Ann R. Stroink, MD, FAANS, chair of the CNS/AANS Washington Committee, noted that “It is especially critical coming out of the COVID-19 crisis, that patients not face additional obstacles to getting the care they need. My patients have faced delays in their surgery for several months, so relieving prior authorization burdens will help.” The bill’s sponsors also featured Dr. Stroink in their release, where she stated:
Neurosurgeons take care of very sick patients who suffer from painful and life-threatening neurologic conditions such as brain tumors, debilitating, degenerative spine disorders and stroke, and without timely medical care, our patients often face permanent neurologic damage, and sometimes death. Streamlining prior authorization will help ensure that our seniors get the care they need without delay, and we are thrilled that a bipartisan majority of the House of Representatives now supports H.R. 3107.
Companion legislation is expected to be introduced in the U.S. Senate.
House Adopts MISSION Zero Funding in FY2021 Appropriations Legislation
On July 31, the House of Representatives passed H.R. 7617, the consolidated appropriations act that included Fiscal Year 2021 (FY2021) funding for HHS. Included in this legislation is $11.5 million to fund the MISSION Zero Act grant program. Authorized by the Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI) Act, the grant program would assist civilian trauma centers in partnering with military trauma professionals to create a pathway to provide patients with the highest quality of trauma care in times of both peace and war.
House appropriators also included report language encouraging the Assistant Secretary for Preparedness and Response (ASPR) to support MISSION Zero efforts by pursuing “partnerships between military and civilian trauma care providers to ensure trauma care readiness by integrating military trauma care providers into civilian trauma centers.”
The CNS and the AANS strongly support this program as outlined in letters to House and Senate appropriators earlier this year.
Coding and Reimbursement
UnitedHealthcare Suspends Imaging Prior Authorization Requirements
Effective April 1, 2020, UnitedHealthcare (UHC) had issued Medical Record Requirements for Pre-Service Reviews requiring surgical practices to upload radiographic studies via a web-based portal as a condition of obtaining prior authorization for the surgical treatment of spine pain and total artificial disc replacement. To further clarify this policy, UHC also issued Medical Policy Documentation Requirement Updates frequently asked questions.
On June 23, the CNS, the AANS and the and the Section on Disorders of the Spine and Peripheral Nerves (DSPN), sent a letter to UnitedHealthcare (UHC) expressing opposition to a new policy for the surgical treatment of spinal conditions. The letter stated that the new policy “is unnecessary, ill-advised and will adversely affect patients’ timely access to care.” The groups further pointed out that “the policy inappropriately veers towards the practice of medicine” and asked UHC “to permanently end this new policy.” In addition to the letter, representatives from the CNS, AANS and the American Academy of Orthopaedic Surgeons convened a conference call with UHC leadership to discuss our concerns about this policy.
Responding to the AANS, CNS and DSPN, Russell H. Amundson, MD, FAANS, a neurosurgeon and senior medical director for UHC, acknowledged that physicians, practice administrators and others had raised similar concerns to those outlined in organized neurosurgery’s letter. He assured the neurosurgical groups that UHC was evaluating and refining its “administrative processes to address and resolve the issues identified.” Dr. Amundson also noted that the health plan was “suspending denials on initial review for lack of information/lack of required images.” However, in select cases, UHC “may require images when necessary to determine if clinical criteria are met.”
CMS Issues Proposed 2021 Medicare Physician Fee Schedule Rule
On Aug. 3, CMS released the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) proposed rule. Under the proposal, neurosurgeons face overall Medicare payment cuts of at least 7% next year. The reductions are primarily driven by new Medicare payment policies for office and outpatient visits that CMS will implement on Jan. 1, 2021. By law, any changes to the relative value units (RVUs) cannot increase or decrease expenditures for physician services by more than $20 million. If CMS increases RVUs for a given service, the increase must be offset by decreases in payments for other services. In the proposal, values for E/M and other visit codes will result in additional spending of $10.2 billion, necessitating a neutrality adjustment to the conversion factor. As a result, the proposed CY 2021 conversion factor is $32.26, a drastic 11% reduction over the CY 2020 conversion factor of $36.09. Additional details regarding the proposed rule are provided in a CMS fact sheet.
The CNS and the AANS will continue advocating to prevent the implementation of these cuts, including submitting comments to CMS and legislative action.
CMS Releases Proposed 2021 Medicare Hospital Outpatient and ASC Rule
On Aug. 4, CMS released the CY 2021 Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems proposed rule. For CY 2021, CMS proposes to increase payment rates under the OPPS and the ASC payment systems by 2.6%. Hospitals and ASCs that fail to meet their respective quality reporting program requirements are subject to a 2.0% reduction in payment. Items of interest for neurosurgeons include the following:
- A three-year transition to eliminate the inpatient-only list, beginning with 266 musculoskeletal-related services in CY 2021— including approximately 80 spine procedures, which would allow Medicare patients to receive these services in the hospital outpatient setting;
- New requirements for prior authorization for cervical fusion with disc removal and implanted spinal neurostimulator procedures performed in the hospital outpatient setting; and
- A request for comments on a new method to update the process for placing procedures on the ASC list — which would result in significantly more procedures on the list, including about 20 procedures performed by neurosurgeons.
Additional information about the proposal is available from the CMS press release and fact sheet.
BCBS of North Carolina Extends Coverage of Laser Ablation to Brain Tumor
On July 21, BlueCross BlueShield of North Carolina extended its medical coverage policy to allow coverage for MRI-guided Laser Interstitial Thermal Therapy (LITT) to treat brain tumor patients. The additional indication updates the previous policy issued in February that provides coverage for LITT for patients with epilepsy under certain conditions. In addition to advocating for coverage for LITT, the CNS and the AANS have submitted a CPT Code Change Application for a Category I CPT code for the procedure, which will
be considered at the October CPT Editorial Panel meeting.
Neurosurgeons Raise the Alarm about Medicare’s Proposed Physician Fee Schedule
On Aug. 4, the CNS and the AANS announced their strong opposition to the Medicare Physician Fee Schedule proposed rule released by CMS for calendar year 2021. Under the proposal, neurosurgeons face overall payment cuts of at least 7% at a time when the nation’s health care system is already stressed by the COVID-19 pandemic. The reductions are primarily driven by new Medicare payment policies for office and outpatient visits that CMS will implement on Jan. 1, 2021.
“Now is not the time to reduce payments for surgical care, and if implemented as is, the Medicare payment rule will challenge an already fragile health care system,” said Washington Committee chair, Ann R. Stroink, MD, FAANS. Dr. Stroink went on to conclude that this “was an ill-informed and dangerous policy for patients even before the pandemic started but could be even more detrimental as our health care system continues to weaken under COVID-19. If finalized, this proposal could result in neurosurgeons taking fewer Medicare patients leading to longer wait times and reduced access to care for older Americans, so Congress must act now to prevent this from happening.”
On Aug. 4, the CNS and the AANS also joined with other medical groups representing more than 350,000 physicians and 764,000 nonphysician health care providers in a press release calling on Congress to pass legislation to stop arbitrary Medicare cuts to specialty physicians and nonphysician providers. These organizations are calling on Congress and CMS to develop a solution that will allow the changes to the E/M services to proceed — while at the same time preventing cuts — and waiving Medicare’s budget neutrality requirements for the E/M policy is the most straightforward solution.
Neurosurgery Featured in News Articles about Proposed Medicare Payment Cuts
Following its release, the CNS and the AANS were featured in several articles about the proposed Medicare Physician Fee Schedule rule.
- “Health Groups Criticize Proposed Medicare Fee Schedule Changes for 2021,” read the Aug. 4, Medpage Today headline. The article underscored neurosurgery’s concern that drastic cuts caused by changes to the office visit codes will undermine patient access to neurosurgical care.
- On Aug. 6, Becker’s Spine Review wrote, “Neurosurgeons ask Congress to intervene in CMS’ ‘ill-informed and dangerous’ Medicare payment cuts.” The article restated neurosurgery’s concerns about the cuts, noting that the AANS and the CNS “have asked Congress to waive Medicare’s budget neutrality requirements to prevent the cuts and require CMS to apply the increased evaluation and management payment adjustments to all 10- and 90-day global surgery codes.
Neurosurgery Featured in Article on Joe Biden’s Health Care Proposals
On Aug. 12, Medscape published an article titled, “Election 2020: What Exactly Is Joe Biden’s Healthcare Plan?” The piece featured comments by Katie O. Orrico, Esq., director of the CNS/AANS Washington Office. On the question of Medicare for all, Ms. Orrico stated that the CNS and the AANS “support expanding health insurance coverage, but the expansion should build on the existing employer-based system.” She added that shifting more Americans into government-sponsored health care will inevitably result in lower payments for physicians’ services, noting that reimbursement “rates from Medicare, Medicaid, and many ACA exchange plans already do not adequately cover the costs of running a medical practice.”
On the topic of COVID-19, Ms. Orrico pointed out that the COVID-19 pandemic has exposed some cracks in the US health care system, and policymakers will likely take a closer look at issues related to unemployment, health insurance coverage, and health care costs due to the COVID-19 emergency.
Finally, Ms. Orrico acknowledged that there are ways to improve the current health care system, such as moving to value-based care.
Neurosurgery Featured in News Articles about Medical Liability Protections
Katie O. Orrico, Esq., director of the CNS/AANS Washington Office, was featured in two recent articles from the Northern California Record. In an article published on May 18, titled, “Capitol Hill efforts continue for expanded liability protections amid COVID-19,” Ms. Orrico noted that there is a bipartisan willingness for Congress to adopt targeted liability protections for health care professionals. She pointed out that, “In the context of the coronavirus, liability protections are an essential element for businesses and physicians and hospitals to get back up and running as an integral part reopening America.”
In a follow-up piece published on June 8, titled, “New federal legislation seeks to shield physicians from COVID lawsuits,” Ms. Orrico pointed out that “During this global pandemic, physicians have been dedicated to preserving and protecting the health of the American public under extremely difficult and challenging circumstances, often at risk to themselves.” She concluded by pointing out that “Plaintiff attorneys have already begun filing COVID-19-related lawsuits, and lawsuits, even those without merit, cost time and money, which clearly interferes with the country’s economic recovery. More importantly, such lawsuits distract health care providers from keeping laser-focused on caring for their patients.”
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