• Vol. 64, November 2019 CNS DC E-Newsletter

    • Dec 08, 2019

    Legislative Affairs

    CNS and AANS Join Alliance of Specialty Medicine in Supporting the Safe Step Act

    On Oct. 29, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) joined the Alliance of Specialty Medicine in endorsing S. 2546, the Safe Step Act. Sponsored by Sens. Lisa Murkowski (R-Alaska) and Doug Jones (D-Ala.), the legislation would provide patients and providers with a clear and transparent appeals process when they are subject to step therapy protocols instituted by health plans. Step therapy, also known as “fail first,” typically requires patients to try and fail an insurer-preferred medication before being covered by the physician-prescribed medication. The letter points out that, “while this practice may initially reduce insurer costs, it can have devastating health consequences for patients and ultimately lead to more expensive health care costs in the long run.” Click here to read the letter.

    Neurosurgery Endorses Pediatric Subspecialty Loan Repayment Legislation

    Joining more than 60 organizations dedicated to improving the health and well-being of children and adolescents, on Oct. 24, the CNS, AANS, AANS/CNS Section on Pediatric Neurological Surgery and the American Society of Pediatric Neurosurgeons endorsed S. 2443, the Investment in Tomorrow's Pediatric Health Care Workforce Act. Sponsored by Sens. Jack Reed (D-R.I.) and Bill Cassidy, MD, (R-La.), this legislation would reauthorize the Pediatric Subspecialty Loan Repayment Program. Under the program, qualified health professionals — including pediatric surgical subspecialists — would be eligible for loan repayments of up to $35,000 per year for no more than three years.

    AANS and CNS Support Bill to Expand Telemedicine

    On Oct. 30, Sens. Brian Schatz (D-Hawaii) and Roger Wicker (R-Miss.) introduced S. 2741, the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act. Reps. Co-chairs of the Congressional Telehealth Caucus, Mike Thompson (D-Calif.), Peter Welch (D-Vt.), Bill Johnson (R-Ohio) and David Schweikert (R-Ariz.), introduced the companion bill, H.R. 4932, in the House. Supported by the CNS and the AANS, this legislation would expand access to telehealth services. Click here for a summary of the legislation.

    Neurosurgery Urges Congress to Reauthorize PCORI

    On Nov. 4, the CNS and the AANS joined the Friends of PCORI Reauthorization in urging Congress to finalize a long-term reauthorization of the Patient-Centered Outcomes Research Institute (PCORI). In the letters to House and Senate leaders, the groups urged Congress to maintain PCORI’s current funding so the center can continue to conduct comparative clinical effectiveness research. PCORI’s mission is to generate relevant, trustworthy evidence to help all Americans make informed health care decisions.

    Grassroots Alert

    Contact Congress to Co-sponsor the Resident Physician Shortage Reduction Act

    Legislation has been introduced in the U.S. Senate and House of Representatives to address the current and future physician shortage. The Resident Physician Shortage Reduction Act (S. 348/H.R. 1763) would increase the number of Medicare-supported graduate medical education (GME) slots by 15,000 with a rate of 3,000 per year over five years. One-half of these slots are designated for shortage specialty residency programs. The remaining funds will be distributed to new programs and to hospitals that have training positions above the 1997 cap.

    Click here to send an email message urging your senators and representative to cosponsor this important legislation. A sample message, which can be personalized, is provided.

    Coding and Reimbursement

    CMS Publishes Medicare Physician Fee Schedule for 2020

    On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the CY 2020 Medicare Physician Fee Schedule Final Rule. According to CMS, overall payments to neurosurgery will not change next year. In the rule, the agency finalized plans to adopt the new American Medical Association (AMA) CPT coding structure for office visit codes and the AMA/Specialty Society RVS Update Committee-recommended values for these evaluation and management (E/M) office/outpatient visit codes. Unfortunately, despite organized medicine’s advocacy efforts, CMS will not adjust the E/M portion of the global surgery codes to reflect the increased values, citing the agency’s continued work to evaluate the current global surgery code values. The AANS and the CNS, along with most of medicine, had pressed CMS to include these increased values in the global surgical codes. Click here for a summary of the provisions of the rule most relevant to neurosurgeons and here for a comprehensive summary.

    CNS and AANS Comment on Stereotactic Radiosurgery Coverage Policy

    On Nov. 9, the CNS and the AANS submitted comments to National Government Services, Inc. regarding its proposed local coverage determination for stereotactic radiosurgery. In commenting on “Local Coverage Determination (LCD) DL 35076 Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT),” the CNS and the supported the proposed change to add choroidal and other ocular melanomas to the list of Medicare-covered indications for SRS.

    Regulatory Affairs

    CNS and AANS Register Concerns about Medicare Executive Order

    On Oct. 29, the CNS and the AANS joined the AMA and 100 other state and national medical societies in expressing concerns about the scope of practice provisions in the Oct. 3 Executive Order on Protecting and Improving Medicare for our Nation’s Seniors. The letter noted that the language in section 5 related to the supervision and reimbursement of non-physician professionals could eliminate or weaken current Medicare supervision requirements of these professionals, “a critical safeguard to ensure the health and safety of Medicare patients and the cornerstone of the widely adopted team-based approach to health care.” In addition, on Nov. 8, the CNS and the AANS, along with the Alliance of Specialty Medicine, submitted a letter commenting on the following topics that were included in the executive order:

    • Medicare Advantage and fee-for-service payment rates;
    • Network adequacy;
    • Innovation;
    • Cost and quality transparency;
    • Waste, fraud and abuse;
    • Utilization management practices;
    • Merit-based Incentive Payment System;
    • Appropriate Use Criteria Program; and
    • Private contracting.

    Click here to read the AMA coalition letter and here to read the Alliance letter.

    Of Note

    Neurosurgeon Honored with MedChi’s Distinguished Member Award

    Recently, the Maryland State Medical Society (MedChi) awarded Neal J. Naff, MD, FAANS, with its Henry P. and M. Page Laughlin Distinguished Member Award. This annual award recognized the outstanding leadership and contribution of Dr. Naff’s time and talents on behalf of organized medicine and the physicians and patients of Maryland. Dr. Naff is the immediate past president of the Maryland Neurosurgical Society and chief of the department of neurosurgery at LifeBridge Health in Baltimore.


    CNS/AANS Comment on Medicare for All

    On Nov. 11, CNS/AANS Washington Office staff were featured in a Medscape news article titled, “Many Doctors Feel Angry, Undervalued by Warren's Health Plan.” While the CNS and the AANS have not taken an official position on Sen. Elizabeth Warren’s (D-Mass.) plan, we noted our concerns about her proposal to pay physicians at Medicare rates. As noted in the article, two-thirds of respondents to a recent yet-to-be-published CNS/AANS survey said that if they had to accept Medicare rates for all their patients, they would not be able to cover their practice expenses. Only 7% of the neurosurgeon respondents said they would be able to cover their costs. At its upcoming meeting in December, the CNS/AANS Washington Committee will revisit the issue of single-payer, government-sponsored health insurance — particularly in light of the ongoing debate over “Medicare for All” legislation. Since 2009, organized neurosurgery has opposed the creation of a single-payer system.

    Join the Conversation on Social Media

    Connect with the CNS/AANS Washington Committee and Washington Office on various social media platforms to keep up with the many health policy activities happening in the nation's capital and beyond the Beltway.

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