Vol. 94, July 2023 DC E-Newsletter
Special Announcements
Neurosurgery Residents: Apply for the Washington Committee Fellowship Today
Applications are now being accepted for the 2024-25 Congress of Neurological Surgeons (CNS)/American Association of Neurological Surgeons (AANS) Washington Committee/American Medical Association (AMA) Fellowship. This program offers an eligible neurosurgical resident or fellow an opportunity to participate in the Washington Committee and its five subcommittees and to serve as the CNS/AANS delegate to the AMA’s Resident and Fellow Section. This two-year fellowship provides an immersion experience into the socioeconomics of neurosurgery. The program is open to individuals in a neurosurgical residency or fellowship during this two-year timeframe. Applicants must be at least a postgraduate year three (PGY-3) resident at the start of the fellowship, which begins on Jan. 1, 2024.
Click here for the application. The deadline to apply is Aug. 31.
AMA to Conduct Survey of Physician Practice Expenses
The American Medical Association (AMA) has contracted with Mathematica, an independent research company, to survey randomly selected physicians regarding practice expenses. Mathematica will contact the selected practices from July 2023 to April 2024. The CNS and AANS urge members to complete the survey if contacted. The AMA Physician Practice Information Survey aims to understand better the costs faced by physician practices to support physician payment advocacy. The study will serve as an opportunity to communicate accurate financial information to policymakers, including members of Congress and the Centers for Medicare & Medicaid Services. It will also be used to update the practice expense component of the Medicare Physician Fee Schedule.
Legislative Affairs
Surgeons Release 7-Point Plan to Fix Broken Medicare Physician Payment System
The CNS and AANS continue their efforts to fix the broken Medicare physician payment system. On June 21, the neurosurgical groups joined the Surgical Coalition in outlining a plan for reforming the Medicare physician payment system. The plan points out that the current Medicare payment system impedes efforts to improve the quality and value of care, calling on Congress to, among other things:
- Stop all Medicare physician payment cuts scheduled for calendar year 2024;
- Establish an annual payment update based on the Medicare Economic Index;
- Eliminate certain budget neutrality requirements;
- Halt implementation of the G2211 evaluation and management complexity add-on code; and
- Appropriately value the global surgery codes.
Click here to read the plan.
AMA Launches Website to Fix Medicare Payment System
The American Medical Association recently launched fixmedicarenow.org, a one-stop-shop for all the information, resources and ways to make your voice heard to ensure that Congress works to address the critical issues physicians and their patients face due to the flawed Medicare physician payment system. Physicians are the only providers whose Medicare payments do not automatically receive an annual inflationary update. As a result, Medicare physician payments have lagged 26% behind the rate of inflation growth since 2001. Temporary patches and ongoing cuts to the Medicare physician payment system have left patient access to care at serious risk.
Congress Continues to Shine Light on Health Plan Abuses
On May 17, the Senate Homeland Security & Governmental Affairs Committee, Permanent Subcommittee on Investigations, chaired by Sen. Richard Blumenthal (D-Conn.), held a hearing on “Examining Health Care Denials and Delays in Medicare Advantage.” Among the witnesses was a widow whose husband had difficulty getting medically necessary treatment, despite the efforts of their neurosurgeon. The AANS and CNS submitted letters for the record urging Congress to take action to hold MA plans accountable, including reforming prior authorization.
Click here for the Regulatory Relief Coalition letter and here for the Alliance of Specialty Medicine letter.
Congress Urges CMS to Finalize Prior Authorization Rules
Nearly 300 bipartisan members of Congress signed letters urging the Centers for Medicare & Medicaid Services (CMS) to finalize proposed regulations to increase transparency, streamline and standardize prior authorization (PA) in the Medicare Advantage (MA) program. Sixty-one senators and 233 members of the House of Representatives signed the letters to U.S. Department of Health and Human Services Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure.
The letters also urged the agency to align the final rules with the Improving Seniors’ Timely Access to Care Act (S. 3018/H.R. 3173) by:
- Establishing a mechanism for real-time PA decisions for routinely approved services;
- Requiring MA plans to respond to PA requests for urgently needed care within 24 hours; and
- Requiring MA plans to report detailed transparency metrics related to delays, denials and appeals.
The CNS and AANS issued a press statement joining Congress in calling on CMS to swiftly finalize these PA reforms. In the press release, Russell R. Lonser, MD, FAANS, chair of the CNS/AANS Washington Committee, stated:
Our message to policymakers is simple: our patients cannot afford to wait or jump through unnecessary hoops to get care for painful, debilitating and life-threatening neurologic conditions. When finalized, these rules would remove barriers to patients’ timely access to care and allow physicians to spend more time treating patients and less time on paperwork.
Dr. Lonser was also featured in a Regulatory Relief Coalition press release, stating, “Congress has seen the harm that MA overreach has on seniors and the physicians who care for them. Millions of Medicare Advantage patients are frustrated by delays and denials of care. Our patients are demanding action from policymakers, and it’s clear that our patients are being heard.”
Neurosurgery Supports Telehealth Expansion Legislation
On June 6, the CNS and AANS joined the Alliance for Connected Care in sending a letter from 188 health care and patient support organizations urging the House Committee on Ways and Means to advance the Telehealth Expansion Act of 2023 (H.R. 1843/S. 1001) to the full House of Representatives for consideration. The Telehealth Expansion Act of 2023 is a bipartisan, bicameral bill that would make permanent the pandemic-era policy that enabled employers to provide telehealth services on a pre-deductible basis to individuals with high-deductible health plans coupled with a health savings account. The committee passed the bill on to the full House of Representatives following a markup of the bill on June 7.
Legislation Introduced to Fund Additional GME Slots
The Resident Physician Shortage Reduction Act (S. 1302/H.R. 2389) has been reintroduced in the U.S. House and Senate. Sponsored by Sens. Robert Menendez (D-N.J.), John Boozman, OD, (R-Ark.), Charles E. Schumer (D-N.Y.) and Susan Collins (R-Maine) in the Senate, and Reps. Terri A. Sewell (D-Ala.) and Brian Fitzpatrick (R-Pa.) in the House, this neurosurgery-endorsed legislation would provide 14,000 new Medicare graduate medical education (GME) slots over seven years. The bill builds on the GME provisions included in the Consolidated Appropriations Act, 2021 (P.L. 116-260) and the Consolidated Appropriations Act, 2023 (P.L. 117-328), which provided 1,200 new Medicare-funded GME positions — the first such increases in nearly thirty years.
This bipartisan legislation is crucial to expanding the physician workforce and ensuring that patients nationwide can access quality care from providers. The need for physicians grows faster than supply, leading to an estimated shortfall of up to 124,000 primary care and specialty physicians by 2034.
Click here to read the GME Advocacy Coalition’s letter to the Senate and here for the letter to the House.
Neurosurgery Continues Support for Pediatric Subspecialty Loan Program
On May 17, the CNS and AANS urged Congress to provide $30 million in funding for the Pediatric Subspecialty Loan Repayment Program (PSLRP). The letter stressed the need to fund the PSLRP since without “federal investment in the pediatric medical subspecialty, pediatric surgical specialty, and child mental health workforce, children will continue to face long wait times for subspecialty care, need to travel long distances to receive that care, or go without care altogether.”
Click here to read the House letter and here for the Senate letter.
Also noteworthy, the Health Resources and Services Administration recently released the first-ever application for the PSKRP. The application deadline is July 20.
CNS and ANS Urge Congress to Address Medical Student Debt
On June 6, the CNS and AANS called on the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) to address the high student loan debt facing physicians by advancing the Resident Education Deferred Interest (REDI) Act (S. 704). The bipartisan REDI Act would allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical internship or residency program. Earlier this year, the neurosurgical groups endorsed this legislation.
Click here to read the letter to the HELP Committee leaders.
Neurosurgery Supports Gabriella Miller Kids First Research Act 2.0 Legislation
In May, the CNS and AANS sent letters to the Senate and House sponsors of the Gabriella Miller Kids First Research Act 2.0 (S. 1624/H.R. 3391). Introduced by Sen. Tim Kaine (D-Va.) and Rep. Jennifer Wexton (D-Va.), this legislation would expand the available funds to support research on pediatric diseases and disorders at the National Institutes of Health (NIH). By redirecting penalties collected from certain health care organizations, this legislation provides a new funding source for NIH pediatric and childhood cancer research.
CNS and AANS Urge Congress to Fund MISSION ZERO Program
On May 18, the CNS and AANS submitted a statement to the Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies asking for $11.5 million to fund the Military and Civilian Partnership for the Trauma Readiness Grant (MISSION ZERO) Program for Fiscal Year 2024. The MISSION ZERO program was signed into law in 2019 as a part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act provides funding for civilian trauma centers to train and incorporate military trauma care providers and teams into care centers.
The CNS and AANS also submitted a statement to the House Subcommittee on Appropriations Labor, Health and Human Services, Education supporting funding for this program.
Neurosurgery Supports BLEEDing Act
In May, the CNS and AANS sent a letter of support for S. 1653, the Prevent Blood Loss with Emergency Equipment Devices Act. Introduced by Sens. Robert Menendez (D-N.J.) and John Boozman, OD, (R-Ark.), this legislation would expand access to life-saving bleeding control kits in schools, malls, houses of worship, libraries and other gathering places in communities across the country. By authorizing a new grant program with the U.S. Department of Health and Human Services and Administration for Strategic Preparedness and Response, this funding would provide quick access to the resources people need to stop severe bleeding during a medical emergency.
Neurosurgery Opposes Bill to Expand Non-Physician Scope of Practice
On June 1, the CNS and AANS joined the American Medical Association (AMA) in a letter to the House Committees on Energy and Commerce Committee and Ways and Means opposing H.R. 2713, 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 Proposed Edit for Decompression Add-on Codes Rescinded
On June 23, staff for the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) reached out to the CNS and AANS, stating that as of July 1, NCCI edits would be implemented that restrict the reporting of spinal fusion codes 22630, 22632, 22633 and 22634 with add-on decompression codes 63052 and 63053. In the same notice to our societies, CMS acknowledged this was an error and will delete this edit as soon as possible. Neurosurgeons should brace themselves for the possibility that the deletion may not occur until Jan. 1, 2024. Fortunately, CMS stated that the edit deletion would be retroactive to July 1.
To bypass this erroneous code pair error, CMS recommends that from July 1 until the error is corrected, neurosurgeons should submit claims for these services using modifier 59, Distinct Procedural Service. Alternatively, practices may hold claims for these codes until CMS has corrected the error and submit at that time.
NCCI edits are intended to prevent inappropriate payment of services that should not be reported together. However, these edits were clearly inaccurate since the add-on codes 63052 and 63053 were explicitly created to be used with the interbody fusion codes 22630-22634. Similar inappropriate NCCI edits for these codes were proposed last year, but the CNS/AANS Coding and Reimbursement Committee leaders led a call with CMS staff to review the history of the codes. Following this conversation, on Feb. 7, 2022, CMS agreed not to implement the edits.
Rest assured, CNS/AANS Coding and Reimbursement Committee leaders and Washington Office Staff are aware of the disruption and confusion caused by this error and are seeking further clarification from CMS and NCCI on this issue. If you have questions or problems related to this or other coding and reimbursement issues, contact the Washington Office staff at reimbursement@neurosurgery.org.
For more information on the history of these codes, click here and here.
Quality Improvement
Neurosurgery Comments on HIT Proposed Rule
The Office of the National Coordinator for Health Information Technology recently released a proposed rule, Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1), which aims to update electronic health record certification requirements and adopt standards to better support data sharing and interoperability. The CNS and AANS joined the Alliance of Specialty Medicine (Alliance) in submitting comments supporting ONC’s goal of advancing interoperability, enhancing health IT functionality, improving transparency and reducing burden and costs. However, the Alliance expressed concerns that the rule does not address certification criteria needed to support electronic prior authorization requirements recently proposed by the Centers for Medicare & Medicaid Services.
Click here to read the Alliance’s comment letter.
Drugs and Devices
New Training Requirement for Initial and Renewed DEA Registration
Beginning on June 27, physicians obtaining a new Drug Enforcement Administration (DEA) registration or renewing their current registration are required to attest to training requirements under the federal Medication Access and Training Expansion Act, passed as part of the Consolidated Appropriations Act, 2023 (P.L. 117-328). The law requires physicians to complete eight hours of training “on the treatment and management of patients with opioid or other substance use disorders.”
A guidance document issued by the DEA is available here. Resources from the American Medical Association — including educational opportunities to satisfy the DEA training — are available here.
2022 Open Payments Data Released
On June 20, the Centers for Medicare & Medicaid Services published the 2022 Open Payments Program data and newly submitted and updated payment records for previous program years. The Open Payments program collects and publicly reports information annually about biopharmaceutical and medical device companies’ payments to physicians and teaching hospitals for travel, research, gifts, speaking fees and meals.
Click here to access the data.
Communications
Neurosurgeon Pens Op-Ed on Misuse of Prior Authorization
On May 16, The Lincoln Star published an op-ed titled “When Insurance Fails” by neurosurgeon Jeremy Hosein, MD. The op-ed discusses the misuse of prior authorization, which delays care, prolongs suffering and adds significant administrative costs to health care.
According to Dr. Hosein, prior authorization is increasingly used to deny or delay basic medical care such as blood tests, imaging and other medically necessary procedures. A 2023 Kaiser Family Foundation analysis found that 82% of appeals in Medicare Advantage resulted in overturned denials. Fortunately, some hope may be on the horizon, states Dr. Hosein. The Centers for Medicare & Medicaid Services (CMS) issued rules to increase transparency and reduce the burden of prior authorization with an automated electronic process.
Click here to read the op-ed and here to read more about CMS’ proposed rules.
Washington Committee Chair Featured in Articles on Prior Authorization
Following an CNS/AANS Washington Office press release, Becker’s Spine Review published an article on June 22, “Neurosurgeons call on CMS to finalize prior authorization rules.” The article quoted CNS/AANS Washington Committee chair Russell R. Lonser, MD, FAANS, “Our message to policymakers is simple: Our patients cannot afford to wait or jump through unnecessary hoops to get care for painful, debilitating and life-threatening neurologic conditions.” Dr. Lonser went on to state, “When finalized, these rules would remove barriers to patients’ timely access to care and allow physicians to spend more time treating patients and less time on paperwork.”
Fierce Healthcare published an article on June 22, “Legislators urge CMS to finalize prior authorization reforms — and go further.” The article highlighted that a bipartisan group of legislators from both chambers of Congress is urging the Biden administration to finalize updates to prior authorization and quoted Dr. Lonser.
Please Provide Us with Your Social Media Handles
The CNS/AANS Washington Committee and Washington Office are working to expand their social media reach. Our goal is to increase and enhance our engagement with neurosurgeons. With nearly 125,000 total followers across the Washington Committee’s social media accounts, we have a broad and extensive audience for you to reach.
Click here to provide us with your public social media account handles.
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