Vol. 101, October 2024 DC E-Newsletter
Legislative Affairs
CNS and AANS Continue Advocating for Medicare Physician Payment System Reform
Efforts to advance legislation to reverse Medicare payment cuts and adopt long-term reforms continue to be one of neurosurgery’s top advocacy priorities.
CNS and AANS Urge Congress to Fix the Medicare Physician Payment System. On July 24, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) joined national medical societies and state medical associations in sending a letter to Senate Majority Leader Charles Schumer (D-N.Y.), Senate Minority Leader Mitch McConnell (R-Ky.), House Speaker Mike Johnson (R-La.) and House Minority Leader Hakeem Jeffries (D-N.Y.). The letter urges Congress to prioritize and advance several key bills and legislative proposals that provide fiscal stability for physicians and reform elements of the Medicare Access and CHIP Reauthorization (MACRA) Act.
Senate Introduces Legislation to Fix the Medicare Physician Fee Schedule. On Aug. 1, Sens. John Boozman (R-Ark.), Peter Welch (D-Vt.), Thom Tillis (R-N.C.), Angus King (I-Maine), Roger Marshall, MD, (R-Kan.), and Jeanne Shaheen (D-N.H.) introduced the bipartisan Physician Fee Stabilization Act (S. 4935) to reform the outdated Medicare physician fee schedule. The bill addresses issues that have led to significant payment cuts, particularly in rural areas, and ensures fair compensation for health care providers. The bill has garnered strong support from medical organizations, including the CNS and the AANS.
Click here to read Sen. Boozman’s press release, highlighting the CNS and the AANS' support of the legislation, and here for Sen. Welch’s press release, featuring a quote from Russell R. Lonser, MD, FAANS, CNS/AANS Washington Committee chair.
CNS and AANS Urge Congress to Provide Physicians with Inflation-Based Medicare Payment Update. On Sept. 10, the CNS and the AANS signed onto a letter sent to Senate Majority Leader Charles Schumer (D-N.Y.), Senate Minority Leader Mitch McConnell (R-Ky.), House Speaker Mike Johnson (R-La.), and House Minority Leader Hakeem Jeffries (D-N.Y.). The letter urges Congress to take action to fix the unsustainable fee schedule so Medicare payments to physicians and other clinicians reflect the cost of practice and ensure Medicare beneficiaries have timely access to care.
Neurosurgeons Support Long-Awaited Legislation to Hold Insurance Companies Accountable on Surprise Billing
On Sept. 12, Reps. Greg Murphy, MD, (R-N.C.), Raul Ruiz, MD, (D-Calif.), John Joyce, MD, (R-Pa.), Kim Schrier, MD, (D-Wash.), and Jimmy Panetta (D-Calif.) introduced the Enhanced Enforcement of Health Coverage Act (H.R. 9572) to ensure health insurance companies do not violate balance billing requirements established under the No Surprises Act. This legislation reinforces the No Surprises Act by establishing civil monetary penalties for late payment or non-payment after an independent dispute resolution entity payment determination. The legislation also requires federal agencies to submit reports to Congress on their enforcement efforts.
Click here to read Rep. Murphy’s press release.
Neurosurgery Provides Recommendations for Cures 2.0 Legislation
On Aug. 2, the CNS and the AANS submitted comments to Reps. Larry Bucshon, MD, (R-Ind.) and Diana DeGette (D-Colo.) on the progress of and future directions for the CURES 2.0 Act. The 21st Century Cures Act has successfully advanced multiple initiatives addressing neurological diseases and disorders, but there is still much to be done to produce transformative solutions for patients. The comment letter expresses support for the use of registry data and approval of and reimbursement for innovative treatment.
Click here to read the comment letter.
Medical Liability Coalition Issues Dear Colleague for Congress on the Good Samaritan Health Professionals Act
In August, the Health Coalition on Liability and Access issued a sample letter template letter for members to ask their representatives to cosponsor the Good Samaritan Health Professionals Act (H.R. 2819). The bipartisan legislation offers health professionals providing voluntary care in response to a federally declared disaster with medical liability protections. While federal and state laws are intended to protect volunteer health professionals from unwarranted lawsuits, many inconsistencies may leave physicians vulnerable. The bill reconciles inconsistencies in state laws that may reduce the ability of health care professionals to be available to treat disaster victims, especially when applied to large-scale disasters that may cross state lines and affect patient care.
Click here to read the letter.
CNS and AANS Support Electronic Prior Authorization Legislation for Prescription Drugs
The Regulatory Relief Coalition (RRC), of which the CNS and the AANS are leaders, sent a letter to Sens. Roger Marshall, MD (R-Kan.), Ben Ray Luján (D-N.M), Roger Wicker (R-Miss.) and Joe Machin (I-W.V.) in support of the Electronic Prior Authorization for Prescription Drugs Act (S. 4349). This bill would establish a secure electronic prior authorization process for prescription drug plans in the commercial market. By providing a secure electronic transmission of these requests, this bill would streamline the process, reduce administrative burdens on health care providers, and ensure that patients receive timely access to necessary medications.
Click here to read the letter.
House Passes Traumatic Brain Injury Legislation
On Sept. 17, the U.S. House of Representatives passed the Dennis John Benigno Traumatic Brain Injury Program Reauthorization Act (H.R. 7208). Introduced by Rep. Bill Pascrell (D-N.J.) and Rep. Don Bacon (R-Neb.), this bill would reauthorize the Traumatic Brain Injury (TBI) Program at $5 million a year through 2029 to fund TBI prevention, research, and service delivery through grants to states.
House Resolution Introduced for Medical Research Week
On Sept. 19, Reps. André Carson (D-Ind.), Joyce Beatty (D-Ohio), Suzan DelBene (D-Wash.), Brian Fitzpatrick (R-Pa.) and Lloyd Smucker (R-Pa.) introduced H. Res. 1458 to designate Sept. 16-20 as Medical Research Week. The resolution highlights the vital work of the medical research community in achieving better health outcomes and notes the importance of National Institutes of Health (NIH) funding.
Earlier this summer, the CNS and the AANS joined other physician organizations in sending a letter to the House Appropriations Committee opposing their proposal to consolidate the 27 NIH institutes into 17. Under this proposal, dental and craniofacial diseases, neurological disorders and stroke, and eye diseases and visual disorders would be consolidated into a newly formed National Institute of Neuroscience and Brain Research. The letter calls on the Committee to hold congressional hearings and a deliberate bipartisan and bicameral process.
Click here to read the letter.
House Resolution Introduced for National Hydrocephalus Awareness Month and World Hydrocephalus Day
On Sept. 20, Reps. Chris Smith (R-N.J.) and Lloyd Doggett (D-Texas) introduced H. Res.1479, expressing support for the goals and ideas of National Hydrocephalus Awareness Month and World Hydrocephalus Day. Hydrocephalus, an abnormal accumulation of cerebrospinal fluid in the brain, is a life-threatening condition that affects approximately 1,000,000 people in the U.S. One out of every 770 babies will develop hydrocephalus.
Neurosurgery Issues Press Release on Physician-Owned Hospital Repeal Bill
On Sept. 23, the CNS and the AANS issued a press release urging Congress to lift the ban on physician-led hospitals and expressing strong support for the bipartisan Physician Led and Rural Access to Quality Care Act (H.R. 9001). Introduced by Reps. Michael C. Burgess, MD (R-Texas), Tony Cárdenas (D-Calif.), Morgan Griffith (R-Va.), and Vicente Gonzalez (D-Texas), this bill would increase access to care in rural areas by establishing exceptions to rules for physician-owned hospitals in rural areas. The bill removes a ban that prevents existing physician-owned hospitals from expanding.
The CNS and the AANS are members of an informal coalition led by Physician-Led Hospitals of America (PHA) and are advocating to gain more bipartisan support of the narrowed scope bill. The CNS and the AANS also support the Patient Access to Higher Quality Health Care Act (S. 470/H.R. 977). Introduced in the Senate by Sen. James Lankford (R-Okla.) and in the House by Reps. Michael C. Burgess, MD, (R-Texas) and Henry Cuellar (D-Texas), the bill would repeal the Affordable Care Act’s ban on physician-owned hospitals, enhancing patient choice and improving competition in the health care marketplace.
Click here to read the CNS and the AANS press release, here to read Rep. Burgess’ press release on H.R. 9001, and here to read the PHA letter.
Coding and Reimbursement
Neurosurgery Comments on 2025 Medicare Physician Fee Schedule Proposed Rule
The CNS and the AANS submitted comments and issued a press release on the Calendar Year (CY) 2025 Medicare Physician Fee Schedule Proposed Rule. The neurosurgical groups expressed concerns about the 2.8% decrease in the CY 2025 conversion factor, resulting primarily from the expiration of the 2024 2.93% bump provided by Congress, plus a positive budget neutrality adjustment of 0.05% triggered by CY 2025 policies. In the letter, the CNS and the AANS urged the Centers for Medicare & Medicaid Services (CMS) to:
- Halt implementation of new initiatives to require an expansion of the use of “transfer of care” modifiers in the surgical global periods and increase the E/M payments in the global periods before taking any other action on the issue;
- Finalize its plan to defer implementation of Medicare Economic Index (MEI) changes to the distribution of relative value unit components (work, practice expense, and professional liability insurance) until all stakeholders can review data from the American Medical Association (AMA) Physician Practice Information (PPI) survey;
- Accept the AMA/Specialty Society Relative Value Scale Update Committee (RUC) recommended values for the new Category I CPT code for MRI-guided focused ultrasound (MRgFUS); and
- Not finalize Osteotomy codes as “potentially misvalued.”
The CNS and the AANS also commented on proposals related to Medicare’s Quality Payment Program (QPP), including:
- Strong opposition to the proposed adoption of the arbitrarily constructed Surgical Care Merit-Based Incentive Payment System (MIPS) Value Pathway (MVP);
- Opposition to the use of MIPS quality measure #59: Back Pain After Lumbar Surgery in MIPS since improving back pain is typically not the primary goal of lumbar fusion surgery; and
- Support for CMS’s commitment to integrating more patient-reported outcome measures (PROMs) into its quality reporting programs and payment and delivery models with a request that CMS achieve a balance between the use of more universally applicable tools, such as PROMIS®, and PROMs that are more appropriate for specific patient populations.
In addition to submitting its own letter and press release, the CNS and the AANS joined several coalition letters. Click here for the Surgical Coalition statement on physician payment, here for the Alliance of Specialty Medicine letter, and here for the Physician Clinical Registry Coalition letter.
For additional details about the proposed rule, click here for a summary from the AMA and here for a CMS fact sheet regarding payment-related proposals. Click here to download a fact sheet regarding QPP proposals and here to download a guide of proposed and modified MVPs for 2025.
Neurosurgery Comments on CY 2025 Medicare Hospital OPPS and ASC Proposed Rule
On Sept. 9, the CNS and the AANS submitted comments regarding the CMS Services CY 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. In their letter, the CNS and the AANS:
- Supported separate payments for non-opioid products, especially for devices, and encouraged CMS to expand payment for neurostimulators to treat pain;
- Urged CMS to eliminate the OPPS prior authorization program and to rescind requirements for prior authorization for cervical fusion with disc removal and implanted spinal neurostimulators; and
- Requested CMS to assign the new Vagus Nerve Integrated Stimulator Category III CPT codes 0908T and 0909T to a higher-level Ambulatory Payment Classification (APC).
A link to the proposed rule is available here, A CMS OPPS/ASC press release is available here, and a CMS OPPS/ASC fact sheet is available here.
CMS Finalizes Mandatory Episode-based APM for Hospitals
As part of the FY 2025 Hospital Inpatient Prospective Payment System (IPPS) final rule, CMS finalized a new, mandatory alternative payment model (APM) that would apply to certain hospitals when episodes are triggered by the performance of one of the following procedures at that hospital:
- Spinal Fusion
- Coronary Artery Bypass Grafting;
- Lower Extremity Joint Replacement;
- Surgical Hip and Femur Fracture Treatment; and
- Major Bowel Procedure.
As part of the Transforming Episode Accountability Model (TEAM), hospitals in select geographic areas will be required to participate. The model has a finalized initial performance year of 2026 and will run for five years, although stakeholder concern about its mandatory nature may result in advocacy efforts to convert it to a “voluntary” or “opt-out” model or delay the start date.
The Agency has provided more details on the TEAM web page.
As a reminder, in June, the CNS and the AANS submitted comprehensive concerns to CMS about the implementation of this model. The CNS and the AANS will continue to engage in advocacy and member education in response to CMS’s decision to move forward with the model.
Quality Improvement:
CMS Announces 2025 MIPS Payment Adjustments and Targeted Review Period
CMS recently released Merit-Based Incentive Payment System (MIPS) payment adjustment information for the 2025 payment year based on 2023 performance scores. The release of payment adjustment factors follows CMS’s recent release of 2023 performance feedback and final scores. Clinicians who believe there is an error in the calculation of their MIPS Payment adjustment can request a targeted review now until Oct. 11. The following CMS guidance documents are available for download and provide more information on accessing 2025 MIPS payment adjustments and submitting a targeted review:
If you or your practice identify any odd patterns with 2023 MIPS calculations, including issues with cost measure performance, please email Rachel Groman, Quality Consultant to the CNS and AANS Washington Office, at rgroman@hhs.com.
CMS Offers Automatic MIPS Exception for Clinicians Impacted by Florida and Texas Hurricanes
CMS recently announced that clinicians in counties in Florida impacted by Hurricane Debby and in Texas impacted by Hurricane Beryl are eligible for an automatic Extreme and Uncontrollable Circumstances (EUC) exception from MIPS in 2024. This means that these clinicians are not required to participate in the program in 2024 at the individual level and will receive a neutral MIPS payment adjustment in 2026 so long as their group practice does not submit MIPS data on behalf of its clinicians at the group level.
Additional information about the automatic EUC exception is available for download here.
2023 MIPS Audits Begin in October
CMS will soon begin data validation and audits (DVAs) of MIPS eligible clinicians and groups to confirm the accuracy and completeness of reported data. If a participant is selected for the DVA, an email will be sent from MIPS_DVA_Request@guidehouse.com to the assigned Security Official in the participant’s Health Care Quality Information Systems Access, Roles, and Profile (HARP) account. CMS urges practices to review that contact information is up to date in the HARP system.
MIPS eligible clinicians selected for a DVA can expect notification starting October 2024 through April 2025. They will then have 45 days to provide the requested substantive, primary source documents. Failure to do so could result in a payment adjustment and may also increase the possibility of being selected for future DVAs. Also note that if a third-party is used for MIPS data submission, MIPS eligible clinicians are accountable for ensuring that all requested audit documentation is provided in a complete and timely manner.
Additional information about the DVA process can be found in this CMS fact sheet.
Of Note
Five Women Making Waves in Neurosurgery Featured in Article
On Aug. 12, Becker’s Spine Review published a list of five women from some of the U.S.' largest health systems making waves in neurosurgery. The neurosurgeons featured include Aviva Abosch, MD, PhD, FAANS; Amy B. Heimberger, MD, FAANS; Judy Huang, MD, FAANS; Maryam Rahman, MD, FAANS; and Stacey C. Wolfe, MD, FAANS. The field of neurosurgery has long been male-dominated and the gender disparity shows no sign of shrinking, the article states. Data from the AMA shows that 76% of neurosurgery residents are men.
Click here to read the article.
Ann R. Stroink, MD, FAANS Advocates for Neurosurgery on Capitol Hill
AANS past president Ann R. Stroink, MD, FAANS, a neurosurgeon at the forefront of advocacy efforts, visited Capitol Hill on Sept. 19. Dr. Stroink met with Reps. Suzan DelBene (D-Wash.) and Darin LaHood (R-Ill.) and attended a coffee meeting with Sens. Dick Durbin (D-Ill.) and Tammy Duckworth (D-Ill.). While on Capitol Hill, Dr. Stroink advocated for fixing prior authorization and reforming the Medicare physician fee schedule.
Communications
CNS and AANS Featured in Article on Prior Authorization
On July 26, Becker’s Spine Review published an article titled “The state of prior authorization in 2024,” featuring nine statistics on prior authorization for spine and orthopedic providers. The article included the CNS and the AANS’s June 12 press release supporting the bipartisan Improving Seniors' Timely Access to Care Act (S. 4532/H.R. 8702), which would streamline prior authorizations for Medicare Advantage patients.
Click here to read the article.
Neurosurgeons Publish Op-Ed on Overlapping Surgeries
On July 29, The Hill published an op-ed by Anthony M. DiGiorgio, DO, MHA, and Richard P. Menger, MD, MPA, titled “How ‘overlapping’ surgery helps patients.” The authors state how overlapping surgery helps patients and improves access to surgical care. A study published by Dr. DiGiorgio noted that patients who were able to have surgery in an overlapping fashion had a shorter wait time for surgery and a shorter hospital stay.
Neurosurgery Featured in Articles on Reforming the Medicare Physician Fee Schedule
On Aug. 1, Sen. John Boozman, OD, (R-Ark.) issued a press release on the introduction of bipartisan S. 4935, the Physician Fee Stabilization Act. This legislation would protect access to Medicare services by reforming the program’s physician fee schedule. The press release highlighted the CNS and the AANS support of the bill. Following the press release, the Newton County Times and The Robesonian published articles that highlighted neurosurgery’s support of the bill.
On Aug. 9, Sen. Peter Welch (D-Vt.) issued a press release highlighting support building for the bill, featuring a quote from Russell R. Lonser, MD, FAANS, CNS/AANS Washington Committee chair. “The Physician Fee Stabilization Act marks the Senate’s first legislative solution this year to help ensure fair and consistent Medicare payments for physician services, and Congress should pass this bill to help ensure our nation’s seniors continue to have timely access to the physician of their choice. We applaud the bipartisan group of Senators leading this initiative and look forward to working with policymakers to advance additional long-lasting Medicare policy solutions,” said Dr. Lonser. Dr. Lonser’s quote was included in subsequent SWARK Today and VermontBiz articles.
Neurosurgeon Advocates for Spina Bifida Prevention in Alabama’s Hispanic Community
On Aug. 15, Neurosurgery Blog cross-posted a blog featuring Michael J. Feldman, MD, a pediatric neurosurgery fellow at the University of Alabama at Birmingham and a former CNS/AANS Washington Committee alternate resident fellow. The blog highlights Dr. Feldman’s efforts to reduce spina bifida rates in Alabama’s Hispanic community through folic acid fortification of corn masa flour.
To address this disparity, Dr. Feldman has collaborated with various organizations to form action groups advocating for federal legislative change. These groups are working diligently to draft and promote bills that would mandate the fortification of corn masa flour in Alabama. Dr. Feldman is also working with the state’s senators, Katie Britt (R-Ala.) and Tommy Tuberville (R-Ala.), to advocate for federal policies and has met with the U.S. Department of Health and Human Services Secretary Xavier Becerra to discuss the implementation of an FDA citizen petition that would require all corn masa products to be labeled if they are not fortified with folic acid.
Washington Committee Chair Featured in Article on Medicare Physician Fee Schedule
Following a CNS/AANS Washington Office press release, Becker’s Spine Review published an article on Sept. 12. Titled “Spine groups raise concern over Medicare fee schedule,” the article noted that the proposed physician fee schedule would include a minimum 2.8% pay cut. CNS/AANS Washington Committee chair Russell R. Lonser, MD, FAANS, was quoted in the article, "Without inflation-based updates, Medicare physician payments continue to lag behind rising medical costs, jeopardizing patient access to care." Dr. Lonser added, "It's time for Congress to address this and ensure that surgical care is valued appropriately so neurosurgeons can continue delivering high-quality care."
Neurosurgery Blog Discusses Burnout and Suicide Among Physicians
On Sept. 19, the Neurosurgery Blog published an article titled “Burnout and Suicide Among Physicians” discussing two recent articles on the prevalence of suicide among physicians, particularly surgeons. Following the session “More Than 300 Surgeon Deaths Annually from Unnatural Causes: A Silent Epidemic?” presented by James S. Harrop, MD, FAANS, during the 2024 AANS Annual Scientific Meeting, Medscape published an article on the topic
Health care workers and physicians have the greatest incidence of suicide, according to the AANS Neurosurgeon article “Beating Burnout: Physician Suicide” by Drs. Harrop, Ann R. Stroink, MD, FAANS, and Isabelle M. Germano, MD, MBA, FAANS. The authors state that physicians need to be educated about this disorder in order to help patients.
Click here to read the Neurosurgery Blog post highlighting National Physician Suicide Awareness Day.
Neurosurgeon Featured in Article about Spine Surgery Advocacy
Brian R. Gantwerker, MD, FAANS, was quoted in a Sept. 19 Becker’s Spine Review article titled “The state of spine surgeon advocacy.” In the article, Dr. Gantwerker discusses post-approval denials, “It is beyond me why HHS and Congress have not mandated that authorization be a guarantee of payment, especially in terms of clean claims submitted with the same exact CPT codes that were authorized. One must wonder what motivation those in government would have for not advocating for physicians to be paid for the work they do.”
Click here to read the full Becker’s Spine Review article.
Washington Committee Chair Featured in Article on Physician-Owned Hospitals
Following the Sept. 23 press release by the CNS and the AANS, Becker’s Spine Review published an article titled “Neurosurgeons back bill to lift ban on physician-owned hospitals.” In the article, CNS/AANS Washington Committee Chair Russell R. Lonser, MD, FAANS is quoted, "For too long, physician-owned hospitals have been restricted from expanding." Dr. Lonser added, "There is no sound rationale for restricting physicians from owning hospitals. Congress should act to bring back competition and pass the Physician Led and Rural Access to Quality Care Act (H.R. 9001)." The bill would allow physician ownership in rural hospitals that are at least 35 miles away from a hospital's main patient campus. The legislation would also remove a ban that prevents existing POHs from building expansions.
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