Washington Committee Legislative Agenda for 2015

Alison Dye
Katie O. Orrico

The Congress of Neurological Surgeons and American Association of Neurological Surgeons released their 2015 legislative agenda in January. Priorities include abolishing the Independent Payment Advisory Board (IPAB), expanding support for graduate medical education funding, championing an improved Medicare reimbursement system, and alleviating the medical liability crisis.

IPAB Repeal Legislation
On January 22, 2014, the CNS and AANS, along with 25 medical organizations, endorsed the “Protecting Seniors’ Access to Medicare Act.” Introduced by Sen. John Cornyn (R, Texas), S 141, currently with 37 cosponsors, would repeal the Independent Payment Advisory Board (IPAB). The IPAB was created by the Affordable Care Act and is a government board whose primary purpose is to cut Medicare spending. Subsequently, on March 2, 2015, Reps. Phil Roe (R, Tennessee) and Linda Sánchez (D, California) introduced HR 1190, an identical version of this legislation, which now has 210 bipartisan cosponsors. Repealing the IPAB is one of organized neurosurgery’s top legislative priorities, and the CNS and AANS are leading a coalition of medical organizations—representing 450,000 physicians—focused on repealing this unelected and largely unaccountable board. The Physician IPAB Repeal Coalition issued a statement endorsing the legislation and praising the sponsors for their efforts.

Response to the IOM’s GME Report
On July 29, 2014, the Institute of Medicine (IOM) released a report, “Graduate Medical Education That Meets the Nation’s Needs,” which recommends a sweeping overhaul of the current graduate medical education (GME) system. The report recommends maintaining Medicare support for GME; rejects calls from physicians and hospitals to increase GME funding to address current and future projected workforce shortages; calls for a complete overhaul of the current GME financing system, which will result in GME cuts and a shift of GME funds away from academic medical centers to community hospitals, clinics, and other ambulatory care settings; and significantly increases Centers for Medicare and Medicaid Services’ (CMS) authority over workforce and GME. Organized neurosurgery was disappointed by the report, and over the past six months, a workgroup convened by Dr. H. Hunt Batjer, president of the Society of Neurological Surgeons, developed a comprehensive response to the IOM report. Other members of the workgroup included Drs. Robert E. Harbaugh, Nathan R. Selden, John A. Wilson, and Melanie G. Hayden. The response, finalized in February 2015, will serve as the basis of organized neurosurgery’s advocacy position on this topic.

EMTALA Liability Bill Reintroduced
Working with other Trauma Coalition members, the CNS and AANS successfully advocated for the introduction of legislation that extends medical liability protections to all physicians who provide emergency care pursuant to the Emergency Medical Treatment and Labor Act (EMTALA). On February 10, 2015, Reps. Charlie Dent (R, Pennsylvania) and Pete Sessions (R, Texas) introduced HR 836, the “Health Care Safety Net Enhancement Act of 2015.” Under the bill, physicians who provide EMTALAmandated stabilization and post-stabilization services would be covered by the Federal Tort Claims Act, rather than traditional state malpractice law, as is the case with certain federally supported health centers. The bill, which previously passed the House in 2012, currently has 32 cosponsors.

Medical Device Tax Repeal Bill Reintroduced
In January 2015, Rep. Erik Paulsen (R, Minnesota) reintroduced legislation to repeal the Affordable Care Act’s medical device tax—a 2.3 percent excise tax that applies to the gross sales of medical device products. Currently, HR 160, the “Protect Medical Innovation Act,” has bipartisan support with 275 cosponsors. On the other side of Capitol Hill, Senate Finance Chairman Orrin Hatch (R, Utah), along with Sen. Amy Klobachar (D, Minnesota), introduced the Senate companion bill, S 149, the “Medical Device Access and Innovation Protection Act.” The bill has 33 cosponsors. According to a recent study published by the Advanced Medical Technology Association (AdvaMed), as many as 195,000 jobs may be lost due to the tax, either through layoffs or forgone jobs that would have been created. Repealing the medical device tax is one of organized neurosurgery’s top legislative priorities, and the CNS and AANS recently joined more than 900 organizations on a letter to Congress urging repeal.

Meaningful Use EHR Certification
On January 21, 2015, the CNS and AANS joined more than 30 physician organizations in sending a letter to the National Coordinator for Health Information Technology to express ongoing concerns with meaningful use requirements and the growing frustration with the electronic health records (EHR) program, particularly the lack of interoperability. The letter demanded that the EHR program certification process focus on functionality—including interoperability, safety, and usability—rather than meaningful use criteria, which has resulted in systems that decrease efficiency and may even contribute to patient safety problems. In response to our letter, on January 29, 2015, the Centers for Medicare & Medicaid Services (CMS) announced that they intend to modify requirements for meaningful use to reduce the burden on providers, while supporting the longterm goals of the program.

Open Payment “Sunshine” Database Updated
On December 19, 2014, the Centers for Medicare & Medicaid Services (CMS) added approximately 68,000 payment records— valued at more than $200 million—to the Open Payments database. With this new data, Open Payments now reports information on $3.7 billion in payments and transfers of value made to up to 546,000 individual physicians and up to 1,360 teaching hospitals in the last five months of the 2013 calendar year. The data reported was withheld in the September 2014 release, due to uncertainty about its accuracy. The “refreshed” data includes updates to data disputes and data corrections made since the initial publication. The published information documents payments or transfers of value from healthcare manufacturing companies to physicians and teaching hospitals, as well as physician ownership and investment interests in such companies. For more information on these or other health policy issues, please contact Katie O. Orrico, director of the Washington Office, at korrico@neurosurgery.org and subscribe to neurosurgeryblog.org.

IN RESPONSE TO OUR LETTER, ON JANUARY 29, 2015, THE CENTERS FOR MEDICARE & MEDICAID SERVICES ANNOUNCED THAT THEY INTEND TO MODIFY REQUIREMENTS FOR MEANINGFUL USE TO REDUCE THE BURDEN ON PROVIDERS, WHILE SUPPORTING THE LONG-TERM GOALS OF THE PROGRAM.