Washington Update: CMS Proposes Major Overhaul of Medicare Physician Payment System

Katie O. Orrico

On April 27, 2016, the Centers for Medicare & Medicaid Services issued a proposal to overhaul the way Medicare pays physicians. The proposed rule implements key elements of the Medicare Access and CHIP Reauthorization Act (MACRA). This legislation repealed Medicare’s sustainable growth rate (SGR) formula and replaced it with a new payment system. Through a single framework called the Quality Payment Program, the new payment paradigm has two paths; the Meritbased Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). The new program consolidates components of three existing Medicare penalty programs— Physician Quality Reporting System (PQRS), Electronic Health Record (EHR), and Value- Based Payment Modifier (VM)—and creates an opportunity for neurosurgeons to earn quality improvement bonus payments.

Initially, most neurosurgeons will likely participate in the Quality Payment Program through MIPS, which will allocate payments based on performance in four categories: quality, Advancing Care Information (formerly EHR meaningful use), clinical practice improvement activities, and cost/resource use. CMS would begin measuring performance for physicians through MIPS in 2017, with payments based on those measures starting in 2019. Neurosurgeons participating to a sufficient extent in risk-based APMs would be exempt from MIPS reporting requirements and qualify for financial bonuses in addition to any shared-savings earned through the APMs.

Members of the AANS/CNS Neurosurgery Quality Council (NQC) and Washington Office staff are currently analyzing the proposed rule and will submit comments by the June 27, 2016 deadline. Stay tuned for more details from the CNS.

Medicare PQRS Experience Report Sheds Light on Neurosurgical Participation Patterns

In April 2016, the Centers for Medicare & Medicaid Services (CMS) released its 2014 Physician Quality Reporting System (PQRS) Experience Report, which summarizes the historical reporting experience of eligible professionals (EPs) and group practices in Medicare’s Physician Quality Reporting System (PQRS) through program year 2014. The report also provides preliminary PQRS data for the 2015 program year.

Overall, nearly two-thirds of all EPs are now participating in PQRS; however, less than half of those eligible received a bonus payment, while more than one-half avoided a 2.0 percent pay cut in 2016, leaving 558,885 EPs subject to the penalty. The report also provided limited data regarding specialty participation rates and trends. Regarding neurosurgery:

  • •66 percent of neurosurgeons participated in the PQRS in 2014 compared to 56 percent in 2013. Claims-based reporting remained the most popular reporting mechanism among neurosurgeons in 2014.
  • 1,635 neurosurgeons (or 31.7 percent of neurosurgeons) were subject to a PQRS penalty in 2015 while 2,239 (or 38.4 percent) will receive a penalty in 2016. By comparison, the specialty with the smallest proportion of EPs subject to the payment adjustment was pathology (at 16 percent). The specialties with the highest proportion of EPs subject to the penalty were oral/maxillofacial surgery and general practice, both at 72 percent.
  • Among participating EPs, 74.6 percent of neurosurgeons were eligible for an incentive in 2014.

The current PQRS program will be phasedout when CMS rolls-out the new Merit-based Incentive Payment System (MIPS) on Jan 1, 2017.

2015 Mid-Year Quality and Resource Use Reports Now Available

In April 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2015 Mid-year Quality and Resource Use Reports (QRURs) to physician solo practitioners and groups of physicians nationwide who bill for Medicare-covered services under a single tax identification number (TIN). The reports contain information on cost and quality measures used to calculate the 2017 Value-Based Payment Modifier (VM). The mid-year reports are for informational purposes only and will not affect physician payments under the Medicare Physician Fee Schedule. Individual physicians and group practices can access their reports on the CMS Enterprise Portal using an Enterprise Identity Management (EIDM) account.

Organized Neurosurgery Testifies at ACGME Resident Duty Hours Congress

On March 16–17, 2016, the Accreditation Council for Graduate Medical Education (ACGME) convened the “Resident Duty Hours in the Learning and Working Environment Congress” in Chicago. In his capacity as president of the Society of Neurological Surgeons (SNS), Dr. Robert E. Harbaugh, testified on behalf of the SNS, CNS, AANS, and the American Board of Neurological Surgeons. Other neurosurgeons attending included CNS President Russell R. Lonser, AANS President H. Hunt Batjer, and AANS/CNS Washington Committee Chair Shelly D. Timmons. Neurosurgical resident Maya Babu, presented testimony on behalf of the American College of Surgeons Residents and Associate Society. Dr. Harbaugh testified on the need for flexible resident duty hours and reiterated key points from organized neurosurgery’s detailed written comments.

Neurosurgery Hosts Successful GME Awareness Campaign

Throughout the month of March (and part of April), Neurosurgery Blog hosted a graduate medical education (GME) awareness campaign. To maximize attention on GME and physician workforce issues, we planned our efforts around Match Day, which occurred on March 18, 2016. Dubbing March as “GME Month,” the CNS and AANS utilized the hashtags #GMEMonth and #GMEMatters on Twitter. Neurosurgery Blog and other AANS/ CNS communications outlets focused on GME-related topics with multiple guest blog posts. Dr. Atul Grover, executive vice president of the Association of American Medical Colleges, authored our first guest post. Rep. Joe Crowley (D-N.Y.), vice chair of the House Democratic Caucus and a member of the powerful Ways and Means Committee, authored another guest post. Many others in the neurosurgical community took the time to contribute additional blog posts on this important topic. In addition, Neurosurgery Blog created an engaging animation on GME-related issues and developed two infographics to clearly illustrate the facts about the physician workforce shortage and how it affects patient access to specialty care.

We invite all neurosurgeons to continue the conversation using the #GMEMatters hashtag so we can grow awareness through social media. In the meantime, if you have not already done so, we also encourage you to subscribe to Neurosurgery Blog to stay informed on this and other important topics facing neurosurgery. Visit neurosurgeryblog.org to enter your email address, confirm your subscription, and away you go!

U.S. House Energy and Commerce Committee Hosts Concussion Roundtable

On March 14, 2016, the U.S. House Energy and Commerce Committee hosted a roundtable to conduct a broad review surrounding the causes, effects, and treatments for concussions. The meeting brought together experts from the medical, military, athletic, and research communities to increase collaboration and expand the body of knowledge to help improve the diagnosis and treatments of concussions. Dr. Geoffrey T. Manley, past-chair of the AANS/CNS Section on Neurotrauma and Critical Care, chief of neurosurgery at San Francisco General Hospital, and professor of neurosurgery at the University of California at San Francisco, participated in the roundtable. The CNS and AANS issued a press release applauding the committee for its leadership on the issue of concussions.

Neurosurgery Advocates for Pediatric Trauma Care

On May 24, 2016, the AANS/CNS Section on Neurotrauma and Critical Care, and AANS/CNS Section on Pediatric Neurosurgery participated in a “Day on the Hill.” Additionally, we contributed at a Congressional briefing convened to highlight the challenges facing pediatric trauma patients and the need to find bipartisan solutions to ensure adequate trauma care for children. Dr. P. David Adelson, director of Barrow Neurological Institute at Phoenix’s Children’s Hospital and chief of pediatric neurosurgery at Phoenix’s Children’s Hospital, represented the CNS and AANS. Throughout the day, he met with several members of Congress and joined with other pediatric experts in raising awareness about the number one killer of children in the United States. Also, as part of this effort, Reps. Richard Hudson (R-N.C.) and G.K. Butterfield (D-N.C.) announced the establishment of the Pediatric Trauma Caucus.

Rep. Richard Hudson (R-N.C.) and Dr. P. David Adelson, together at a Congressional briefing on pediatric trauma care in the US.

To aid in awareness, the CNS and AANS convened an expert workgroup of prominent pediatric neurosurgeons. Led by Dr. Adelson, the group, which included Douglas L. Brockmeyer, Ann-Christine Duhaime, Gerald A. Grant, Leon E. Moores, and Nathan R. Selden, developed a background paper titled “Pediatric Trauma in the United States: Challenges of Ensuring Adequate Trauma Care for the Pediatric Patient.”

For more information on these or other health policy issues, please contact Katie O. Orrico, director of the AANS/CNS Washington Office at korrico@neurosurgery.org.