Vol. 90, November 2022 DC E-Newsletter
Neurosurgery Leads Amicus Brief in New Surprise Billing Lawsuit
The No Surprises Act, which went into effect on Jan. 1, bans surprise medical bills for out-of-network care and establishes a process for resolving payment disputes between health plans and providers. Unfortunately, the final rule implementing the law continues to give preference to the qualifying payment amount — or median in-network rate — which unfairly favors insurers when settling out-of-network payment disputes. When resolving payment disputes, the law requires arbiters to consider several factors equally — not just median in-network rates — including the physician’s training and experience, the severity of the patient’s medical condition, prior contracting history, health plan market share and other relevant information.
On Oct. 19, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) spearheaded a physician-led amicus brief, along with the Physician Advocacy Institute, supporting the Texas Medical Association’s (TMA) new lawsuit challenging these rules. Other medical groups, including the American Medical Association, also filed amicus briefs supporting the TMA lawsuit.
Click here to read neurosurgery’s amicus brief and here for the accompanying press release.
Biden Administration Renews COVID-19 Public Health Emergency Declaration
On Oct. 13, U.S. Department of Health and Human Services Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) declaration. The PHE was extended for an additional 90 days. This means that all telehealth and other waivers and flexibilities implemented during the PHE will remain in effect. The department has also stated that it will provide 60 days’ notice when a decision is made to terminate the declaration or let it expire.
Senators Urge Action to Mitigate Medicare Payment Cuts
On Nov. 2, 46 senators sent a bipartisan letter to Senate leaders urging them to take action to address Medicare payment cuts set to take effect on Jan. 1, 2023. The senators stressed that “Congress must address these vital payment challenges before the end of 2022 to ensure seniors continue to have access to care through a wide network of providers.” The letter also noted that the failure “to act on longer-term reforms will undermine Medicare’s ability to deliver on its promises to future seniors and generations.”
The CNS and the AANS continue to advocate for Congress to take action to prevent an 8.5% Medicare cut to physician payments, joining the Surgical Care Coalition (SCC) in supporting this senate effort.
Click here to read the letter and here for the SCC press release.
Neurosurgery Responds to RFI on Medicare Payment and Quality Program Improvements
On Oct. 31, the CNS and the AANS responded to the Request for Information issued by Reps. Ami Bera, MD, (D-Calif.); Larry Bucshon, MD, (R-Ind); Kim Schrier, MD, (D-Wash.); Michael Burgess, MD, (R-Texas); Earl Blumenauer (D-Ore.); Brad Wenstrup, DPM, (R-Ohio); Bradley Schneider (D-Ill.) and Mariannette Miller-Meeks, MD, (R-Iowa) seeking feedback on ways to improve the Medicare Access and CHIP Reauthorization Act (MACRA). The neurosurgical groups urged Congress to stabilize Medicare payments in the short term by:
- Preventing the scheduled 4.42% Medicare physician fee schedule cut by adopting R. 8800, the Supporting Medicare Providers Act;
- Providing an inflation update for at least 2023 based on the Medicare Economic Index;
- Waiving the 4% Statutory Pay-As-You-Go Act sequester cut; and
- Directing the Centers for Medicare & Medicaid Services (CMS) to adjust the post-operative portion of the 10- and 90-day global surgery codes to reflect recent increases in the office/outpatient evaluation and management visit codes.
Long-term solutions for reforming the system should incorporate a core set of principles — Characteristics of a Rational Medicare Physician Payment System — that the CNS and the AANS helped develop and fully support. Detailed actions Congress should take include:
- Adopting an annual inflationary update for Medicare physician services;
- Modifying Medicare’s budget neutrality requirements;
- Directing CMS to use the American Medical Association/Specialty Society RVS Update Committee to address any misvalued global surgery codes;
- Streamlining MACRA’s Quality Payment Program (QPP) and enhancing the use of clinician-led clinical data registries; and
- Repealing Medicare’s Appropriate Use Criteria (AUC) program for advanced diagnostic imaging and incorporating AUC into the QPP.
Click here to read the letter.
Neurosurgery Urges Funding for MISSION Zero Program
On Oct. 27, the CNS and the AANS joined the Trauma Coalition in urging House and Senate appropriators to include $10 million in funding for the Military and Civilian Partnership for the Trauma Readiness Grant (MISSION ZERO) Program in the final fiscal year 2023 appropriations bill.
Championed by organized neurosurgery, the MISSION ZERO Act was signed into law in 2019 as a part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act. This grant program covers the administrative costs of embedding military trauma professionals in civilian trauma centers, thus allowing military trauma care teams and providers to gain exposure to treating critically injured patients and increase readiness when these units are deployed. Similarly, best practices from the battlefield are brought home to improve civilian trauma care.
Click here to read the Senate letter and here for the House letter.
Neurosurgery Opposes Bill to Expand Non-Physician Scope of Practice
On Nov. 3, the CNS and the AANS joined the American Medical Association (AMA) in a letter to House Energy and Commerce Committee and Ways and Means Committee leaders opposing H.R. 8812, the “Improving Care and Access to Nurses Act.” Known as the “I CAN Act,” the legislation would allow non-physician practitioners to perform tasks and services outside their education and training, which could result in increased utilization of services, increased costs and lower quality of care for Medicare and Medicaid patients.
Click here to read the AMA-led letter.
Coding and Reimbursement
CMS Releases Final 2023 Medicare Physician Fee Schedule Final
On Nov. 1, CMS released the final 2023 Medicare Physician Fee Schedule rule. Overall, neurosurgeons face a 4% decrease, due primarily to the expiration of temporary financial relief provided by Congress last year to mitigate steep payment cuts in 2022. In addition, neurosurgeons face a 4% Statutory Pay-As-You-Go Act sequester cut absent Congressional action.
Provisions of interest to neurosurgeons include:
- Restoration of the American Medical Association/Specialty Society RVS Update Committee-passed values for interbody spine fusion CPT® codes 22630 and 22633.
- A one-year delay of a new policy requiring physicians to see patients for more than half of the total time of a split or shared evaluation and management visit to bill for the service. For 2023, CMS will continue to allow physicians and qualified health care professionals to use medical decision making to determine the substantive portion of the split/shared visit.
- Changes to relative weights of the fee schedule components (i.e., work, practice expenses and professional liability insurance (PLI) expenses) that will decrease the value of physician work and PLI expenses, thus leading to future reductions in neurosurgical payments. The final changes will reflect an updated practice expense data collection initiative currently underway.
A more detailed summary of the final rule will be forthcoming. In the meantime, click here for a press release about the final rule and here for a fact sheet.
CMS Releases 2023 Medicare Hospital OPPS and ASC Final Rule
On Nov. 1, CMS released the 2023 Changes to Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center (ASC) Payment System final rule. In 2023, payment rates will increase by 3.8% for hospitals and ASCs that meet applicable quality reporting requirements. CMS also adopted neurosurgery-supported changes, including:
- Removing the arthrodesis add-on CPT® code 22632 from the inpatient-only (IPO) list;
- Adding the new total disc arthroplasty additional level CPT code 22860 to the IPO list; and
- Approving pass-through payments for the Evoke® spinal cord stimulation system and Aprevo® custom intervertebral body fusion device.
Click here for a CMS press release and here for a CMS fact sheet.
Evaluation and Management Coding Resources
Effective Jan. 1, 2021, changes were made to the evaluation and management (E/M) Current Procedural Terminology® code set and reporting guidelines to reduce documentation burdens and simplify coding. However, some health plans are disputing E/M levels for submitted claims and implementing E/M “downcoding” programs that inappropriately — and often automatically, through claim editing algorithms — reduce payment for provided services. Downcoding occurs when a payer changes the reported service on a claim to a lower level service than what was submitted by the physician, resulting in payment for a lower level of care than was provided.
The AMA has created a paper about these E/M downcoding programs. The document offers examples of downcoding scenarios, sample plan communications, guidance on reviewing remittance advice to identify downcoding and documentation tips to support successful appeals. Neurosurgeons experiencing E/M downcoding may want to complete a brief AMA survey. The AMA is collecting feedback to help inform its efforts to hold health plans accountable.
Click here to complete the AMA downcoding survey and here for more resources, including sample appeal letters.
CMS Updates Quality Payment Program in Final 2023 Medicare Physician Fee Schedule Rule
Again, on Nov. 1, CMS released the final 2023 Medicare Physician Fee Schedule rule, including changes to the Quality Payment Program. Policies of interest to neurosurgeons include:
- Removing spine-focused quality measures — #460, Back Pain After Lumbar Fusion; #469, Functional Status After Lumbar Fusion and #473, Leg Pain After Lumbar Fusion — from the Merit-Based Incentive Payment System (MIPS). CMS retained #260, Rate of CEA for Asymptomatic Patients, as an available MIPS measure for 2023.
- Requiring reporting of the Query of Prescription Drug Monitoring Program measure under the MIPS Promoting Interoperability category unless an exclusion can be claimed.
- Mandating public reporting of utilization data related to certain procedures on individual clinician profile pages on Care Compare starting as early as 2023.
More information about the final rule is available as follows:
- Click here for a CMS press release;
- Click here for a CMS fact sheet;
- Click here for QPP final rule resources (zip file); and
- Click here for a Medicare Shared Savings Program fact sheet.
Drugs and Devices
CDC Updates Clinical Practice Guideline for Prescribing Opioids
The Centers for Disease Control and Prevention (CDC) has released updated and expanded recommendations for clinicians providing pain care for adults with short- and long-term pain. These clinical recommendations, published in the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, replace and addresses the agency’s 2016 guideline that caused some patients to experience abrupt loss of access to needed pain treatment.
The updated guideline focuses on the following areas:
- Determining whether to initiate opioids for pain;
- Selecting opioids and determining opioid dosages;
- Deciding duration of initial opioid prescription and conducting follow-up; and
- Assessing risk and addressing potential harms of opioid use.
A summary for physicians, “Guidelines at a Glance,” is available here.
Neurosurgeon Appointed to AMA CPT® Editorial Panel
Joseph S. Cheng, MD, FAANS, has been appointed to serve on the AMA’ CPT Editorial Panel. The CPT Editorial Panel is tasked with ensuring that CPT codes remain up to date and reflect the latest medical care provided to patients.
Neurosurgical Resident Picked for White House Fellow Program
Jeffrey Nadel, MD, a neurosurgical resident from the University of Utah, has been named to the 2022-2023 White House Fellows class and is working at the U.S. Department of Veterans Affairs. He joins 14 other individuals selected to participate in this prestigious program and follows in the footsteps of neurosurgeons Jeremy Hosein, MD (2018-2019); Lindsey B. Ross, MD (2016-2017); Anand Veeravagu, MD (2012-2013) and Sanjay K. Gupta, MD (1997-1998).
The White House Fellows Program was created in 1964 by President Lyndon B. Johnson to give promising American leaders “first hand, high-level experience with the workings of the Federal government, and to increase their sense of participation in national affairs.”
Neurosurgeon Elected to Prestigious National Academy of Medicine
On Oct. 17, the prestigious National Academy of Medicine announced the election of another neurosurgeon to its ranks: James M. Markert, MD, MPH, FAANS, chair, department of neurosurgery, University of Alabama, Birmingham. He was recognized as a world expert on oncolytic viruses, an author of the first-ever paper on genetically engineered oncolytic viruses, the primary author on the first-in-human trial of an oncolytic virus and senior author on the first use of an IL12-expressing virus for human glioma. Dr. Markert is currently conducting adult and pediatric brain tumor trials.
Neurosurgeon Featured in Articles Regarding Medicare Payment Cuts
On Nov. 1, the Surgical Care Coalition (SCC) issued a press release urging Congress to protect patients from the proposed Medicare payment cuts set to go into effect on Jan. 1, 2023, by passing H.R. 8800, the Supporting Medicare Providers Act. In the release, the SCC noted that significant medical inflation and staffing and supply chain shortages continue to harm surgical care teams across the country.
Subsequently, John K. Ratliff, MD, FAANS, chair of the CNS/AANS Washington Committee, was featured in a Becker’s ASC Review article titled, “Physician leaders balk at Medicare 4.48% physician fee cut.” Dr. Ratliff stated, “Patients deserve a more stable and durable Medicare system. Though more robust solutions are needed to create that reality, this bill would be a step in the right direction.” In addition, he was featured in a Bloomberg Law article titled “Doctors Face Nearly 4.5% Cut in Medicare Reimbursements in 2023.”
Neurosurgeon Featured in Article on Career Transition from NFL to Neurosurgery
On Oct. 11, the New York Times published an article on the career transition of Myron Rolle, MD, from playing in the National Football League to neurosurgery as part of the “It’s Never Too Late” series. Currently, a PGY-6 neurosurgery resident at Massachusetts General Hospital in Boston, Mass., Dr. Rolle’s long-term goal is to practice neurosurgery in the U.S. and spend a portion of the year in the Caribbean, developing neurosurgical services in the Bahamas and member states of CARICOM, an organization of Caribbean countries. On Oct. 28, Neurosurgery Blog published a cross-post to promote the article.
Neurosurgeon Pens Op-Ed on Medicare Payment Cuts
On Nov. 1, AL.com published an op-ed by CNS/AANS Communications and Public Relations Committee member Richard Menger, MD, MPA, titled, “Why is it hard for grandma to see her doctor?” In the op-ed, Dr. Menger discusses how steep Medicare physician payment cuts scheduled to go into effect on Jan. 1, 2023, put seniors at risk for reduced access to care. He noted that the “people most impacted by these cuts will be our Medicare patients. In the backdrop of inflation, practices will not be able to sustain themselves by treating Medicare patients.” On Nov. 3, Neurosurgery Blog published a cross-post to amplify Dr. Menger’s message.
Neurosurgery Blog Continues Tumor Series
Neurosurgery Blog continued to publish new blogs in its tumor series. Partnering with the CNS/AANS Joint Section on Tumors, the tumor series provides updates on the state of the subspecialty and highlights current issues. Read the latest article in the series, “Increasing Patient Access to Stereotactic Radiosurgery through Innovation.”
Neurosurgery Blog Highlights Global Neurosurgery ‘Moon Shot’
Neurosurgery, the official publication of the CNS, announced a Global Neurosurgery ‘Moon Shot’ with New Editorial Board Section to help advance timely, safe and affordable #neurosurgical care to all who need it. A recent announcement about the new feature highlighted that despite “rapid advancements in neurosurgical techniques and capabilities, much of the world’s population has limited or no access to modern care for brain and spinal trauma, stroke, tumors, and other neurological conditions.”
Click here to read the Neurosurgery Blog article highlighting the new feature.
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