Vol. 97, February 2024 DC E-Newsletter
Special Announcement
CMS Finalizes Prior Authorization Reform
On Jan. 17, the Centers for Medicare & Medicaid Services (CMS) finalized rules streamlining prior authorization in Medicare Advantage, state Medicaid and Children’s Health Insurance Program (CHIP) fee-for-service, Medicaid managed care, CHIP managed care and Qualified Health Plans on the federal exchange. The final rule requires, among other things, covered plans to:
- Implement an electronic prior authorization process;
- Reduce care delays by responding to prior authorization requests within 72 hours for urgent requests and seven days for standard requests; and
- Report the use of prior authorization, including specific reasons for denials and other prior authorization metrics.
CMS projects this rule could save providers more than $15 billion by reducing administrative burdens associated with prior authorization.
Following the rule’s publication, the Regulatory Relief Coalition, of which the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) are leaders, issued a press release lauding CMS for its finalized landmark rule. “This is a watershed moment for patients’ access to care,” said Russell R. Lonser, MD, FAANS, chair of the department of neurosurgery at The Ohio State University and chair of the CNS/AANS Washington Committee. He added, “The rampant overuse of prior authorization, particularly in Medicare Advantage, continues to cause inappropriate delays and denials of medical treatments that our seniors need.”
Click here for a CMS fact sheet on the rule and here for the agency’s press release.
AANS Names Katie O. Orrico, Esq., Incoming CEO
On Dec. 20, 2023, the AANS named Katie O. Orrico, Esq., senior vice president of health policy and advocacy for the CNS and AANS, as the new AANS CEO. Ms. Orrico is set to transition to this new role by early spring 2024. “I am incredibly humbled and honored to have been selected as AANS CEO and look forward to continuing to serve neurosurgery in this new role,” said Ms. Orrico.
Click here to read the press release announcing Ms. Orrico’s new role.
Please Complete the AMA Physician Practice Expense Survey
The American Medical Association’s (AMA) Physician Practice Information (PPI) Survey is underway, and the CNS and the AANS urge all selected neurosurgeons to participate in this effort. The survey — endorsed by more than 170 organizations, including the CNS and the AANS — aims to collect updated and accurate data on practice costs (current data are 15 years old), a key element of Medicare physician payment.
Mathematica, a well-regarded consulting firm, is helping the AMA run this survey. Be on the lookout for an email from ppisurvey@mathematica-mpr.com and a United States Postal Service Priority Mail® packet from Mathematica containing a link to the survey and supporting information. An email reminder from Mathematica was sent to 10,000 physician practices on Jan. 25. We urge you to speak with your practice administrators to determine if they have received these communications and ask them to complete this critical survey.
Click here for more information about this survey.
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, with Congress taking several steps on one of neurosurgery’s top advocacy priorities.
- Physicians in Congress Lead Effort to Mitigate Payment Cuts. On Dec. 5, 2023, physician members of Congress introduced R. 6545, the Physician Fee Schedule Update and Improvements Act. Sponsored by Reps. Mariannette Miller-Meeks, MD, (R-Iowa), Kim Schrier, MD, (D-Wash.) and others, this bipartisan bill would mitigate the 3.4% Medicare physician fee cut and modify elements of Medicare’s budget-neutrality rules and extend bonus payments to physicians participating in alternative payment models. The House Energy and Commerce Committee advanced this bill on Dec. 6, 2023.
- Legislation to Halt the 3.4% Physician Payment Cut Introduced. On Dec. 7, 2023, a bipartisan group of legislators led by Reps. Greg Murphy, MD, (R-N.C.) and Danny Davis (D-Ill.) introduced the Preserving Seniors’ Access to Physicians Act (R. 6683). This bill would eliminate the scheduled 3.4% physician payment cut if enacted.
- House Members Urge Action on Medicare Physician Payment Cuts. On Dec. 13, 2023, a bipartisan group of 194 members of Congress wrote 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.) urging Congress to prevent the 3.37% cut to Medicare reimbursement payments.
As previously reported, additional legislation to provide an annual inflation-based update to Medicare physician payments and to reform Medicare’s budget-neutrality rules is also pending. The CNS and the AANS will continue their efforts to prevent Medicare cuts this year and adopt longer-term reforms. To this end, the neurosurgical societies joined two coalition efforts urging Congress to stop the 3.4% pay cut.
Click here and here to read the letters.
CNS and AANS Support Prior Authorization Legislation
The CNS and the AANS recently joined the Regulatory Relief Coalition in sending a letter supporting H.R. 5213, the Reducing Medically Unnecessary Delays in Care Act. Sponsored by Rep. Mark Green, MD, (R-Tenn.), this legislation would reform prior authorization in Medicare by requiring that all prior authorizations and adverse determinations must be made by a licensed physician who is board certified in the specialty relevant to the health care item or service requested.
Neurosurgery Urges Congress to Reauthorize Pandemic Preparedness Programs
On Dec. 13, the CNS and the AANS joined the Trauma Coalition, urging House and Senate leaders to encourage the reauthorization of the Pandemic All-Hazards Preparedness Act (PAHPA). Initially passed in 2006, PAHPA has continued to improve the nation’s public and medical preparedness and response capabilities during public health emergencies and disasters. Reauthorizing these essential health programs will continue to foster opportunities for these ongoing successful public-private collaborations.
Click here to read the letter.
Coding and Reimbursement
CNS and AANS Urges CMS to Address Network Adequacy Standards
On Jan. 8, the CNS and the AANS joined the Alliance of Specialty Medicine in submitting comments to the Centers for Medicare & Medicaid Services (CMS) regarding the 2025 Notice of Benefit and Payment Parameters, urging the agency to address network adequacy concerns. Physician network adequacy is an ongoing issue, particularly for consumers that require specialty and subspecialty care. The comment letter urges CMS to take necessary steps to ensure robust access to specialty medicine.
Neurosurgery Asks CMS for Additional Prior Authorization Reforms
On Jan. 5, the CNS and the AANS joined the Regulatory Relief Coalition in commenting on the Centers for Medicare & Medicaid Services (CMS) 2025 Medicare Advantage proposed rule. The comment letter offers several reforms to prior authorization in the Medicare Advantage program, including improvements to ensure health equity and prior authorization reporting requirements.
Click here to read the letter.
CMS Provides Guidance on Reporting of New G2211 Complexity Add-on Code
On Jan. 18, the Centers for Medicare & Medicaid Services (CMS) posted guidance for using the new G2211 complexity add-on code. Effective Jan. 1, the new code may be reported with new and established patient office/outpatient evaluation and management services. The CMS guidance provides instructions and examples for using this new code.
Click here for the guidance document.
Quality Improvement
Utilization Data Now Available on Medicare.gov Compare Tool
CMS has added utilization data on the volume of procedures for the first time on the Medicare.gov compare tool’s profile pages for doctors and clinicians. The procedures initially added to profile pages were performed by physicians and clinicians for Original Medicare and Medicare Advantage patients in the last 12 months, after allowing a three-month claim processing period (for example, claims for dates of service occurring between June 1, 2022, through June 30, 2023, that were processed by Sept. 30, 2023).
Utilization data was first published only in a downloadable format in late 2017. This information is a subset of the “Medicare Physician & Other Practitioners – by Provider and Service” dataset and is currently published in the Provider Data Catalog (PDC). A procedure volume data file is now available and includes the procedure category information now publicly reported on the compare tool on Medicare.gov profile pages for physicians and clinicians. Included in the initial release is data on spinal fusion procedures.
A fact sheet on the data release is available here.
Neurosurgery Expresses Concerns about EHR Information Blocking
On Jan. 2, the CNS and the AANS joined the Physician Clinical Registry Coalition in sending a comment letter to the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC) expressing concerns about the proposed rule to enforce the information blocking provisions of the 21st Century Cures Act (Public Law 114-255). The letter applauds ONC’s and CMS’ commitment to addressing information blocking by electronic health record (EHR) vendors and hospitals. The letter stresses that for clinical data registries to accomplish their missions, they must be able to collect data from providers and EHR vendors.
Drugs and Devices
Neurosurgery Comments on FDA Off-Label Guidance
On Dec. 21, 2023, the CNS and the AANS joined the Alliance of Specialty Medicine in sending a letter commenting on a Food and Drug Administration (FDA) notice regarding a revised draft industry guidance titled “Communications From Firms to Health Care Providers Regarding Scientific Information on Unapproved Uses of Approved/Cleared Medical Products: Questions and Answers.” The revised draft guidance, when finalized, will provide the FDA’s current thinking on common questions regarding communications by industry to healthcare providers of scientific information on the off-label use of approved/cleared medical products. The revised guidance replaces the 2014 FDA document on the topic. In the letter to the FDA, the specialty societies commend the agency for a concerted effort to support health care providers’ interest in access to scientific information about unapproved uses of approved/cleared medical products.
CMS Updates Open Payment Data
In January, the Centers for Medicare & Medicaid Services (CMS) released updated Open Payments data to reflect changes since the last publication in June 2023. Open Payments collects and publishes information about financial relationships between drug and medical device companies. The data is “refreshed” each January to include updates from disputes and other data corrections made since the annual June data publication.
The CNS and the AANS encourage neurosurgeons to check the accuracy of their data. Click here to verify your information on the CMS Open Payments website.
Of Note
Neurosurgery Issues Position Statement on Firearms
In 2023, the Washington Committee Firearms Task Force conducted a survey of CNS and AANS members regarding their views and experience with firearms and opinions regarding the involvement of organized neurosurgery in advocacy efforts to reduce firearm injury and death and to make firearm ownership as safe as possible. On Jan. 2, the CNS and the AANS also published an updated position statement on firearms, reflecting the views expressed by neurosurgeons nationwide.
Click here for the survey results, published in the Journal of Neurosurgery, and here for the position statement.
Communications
Neurosurgery Blog Announces the Retirement of Ann R. Stroink, MD, FAANS
AANS past president and interim CEO Ann R. Stroink, MD, FAANS, retired from neurosurgery practice at Carle BroMenn Medical Center on Nov. 22, 2023. Throughout her career, Dr. Stroink has been an indefatigable force in advocating — in the halls of Congress, before the Illinois state legislature, with health plans and within organized medicine — for sound health policy to ensure patients have timely access to care. Dr. Stroink also served as chair of the CNS/AANS Washington Committee and is a current member of the American Medical Association’s Council on Legislation.
Click here to read the Neurosurgery Blog post highlighting her career.
Neurosurgery Blog Features Article on Medicare Payment Cuts
On Jan. 12, the Neurosurgery Blog cross-posted a recent op-ed in the Washington Times by Reps. Greg Murphy, MD, (R-N.C.), Brad Wenstrup, DPM, (R-Ohio) and Michael Burgess, MD, (R-Texas). Titled “Medicare cuts ensure disaster to doctor-patient relationship,” the op-ed states that the nearly 3.4% CMS payment cuts to physicians for services rendered to Medicare patients that went into effect on Jan. 1 will cripple independent physicians and rural health care providers across the country. In anticipation of this rule, physician members of Congress introduced legislation seeking to reform the physician fee schedule, prevent extreme fluctuations in future reimbursement and update how costs are determined.
Neurosurgery Blog Continues Series on Making and Maintaining a Neurosurgeon
Neurosurgery Blog continues its series on becoming a neurosurgeon. Read the latest three articles published:
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