• Vol. 66, March 2020 DC E-Newsletter

    • Mar 30, 2020

    COVID-19

    Congress Poised to Pass $2 Trillion COVID-19 Relief Bill

    Congress is poised to approve H.R. 748, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the third phase of an unprecedented legislative effort to provide more than $2 trillion in economic stimulus and financial assistance to address the COVID-19 pandemic. The bill will provide more than $140 billion to support the health care system, as well as small business loans to help physician practices. Stay tuned for more details.

    CNS and AANS Establish COVID-19 Information Hubs

    The Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) have established COVID-19 information hub on their respective websites. Neurosurgeons will have access to a wide variety of COVID-19-related information and resources. Topics include:

    • Recommendations on Elective Surgery
    • Government Information and Resources
    • Practice Management
    • AANS/CNS Advocacy Efforts
    • Continuing Medical Education
    • Additional Resources

    Click here to access the CNS COVID-19 information hub and here for the AANS hub. Information will be updated throughout the duration of the crisis.

    CMS Issues Guidance for Elective Surgery During COVID-19 Crisis

    Building on guidelines developed by the American College of Surgeons, on March 18, the Centers for Medicare & Medicaid Services (CMS) issued recommendations on CMS adult elective surgery and procedures during the COVID-19 crisis. The agency’s guidelines urge health care providers to limit all non-essential planned surgeries and procedures, including dental, until further notice.

    CNS and CNS Urge Congress to Provide COVID-19 Relief for Surgeons

    Facing steep Medicare payment cuts and economic strains due to the COVID-19 pandemic, on March 20, the AANS and the CNS asked Congress to take action “to fortify the long-term financial stability of physician and non-physician practices across the health care delivery system.” In the letter, the groups urged Congress to waive the budget neutrality requirements stipulated in the Medicare law to prevent payment cuts to global surgery codes resulting from the changes to the office and outpatient visit codes. Without relief, neurosurgeons face a minimum 6% pay cut on Jan. 1, 2021.

    In addition, on March 19, the AANS and the CNS joined 20 national surgical organizations in urging Congress to help stave off the extreme challenges created by this crisis by providing the following relief:

    • Ensure that physicians have the equipment they need;
    • Adopt medical liability protections for physicians who volunteer to provide care during the COVID-19 pandemic;
    • Relieve unnecessary prior authorization requirements;
    • Ensure physician practices are treated like other small businesses receiving financial assistance;
    • Suspend Medicare physician pay cuts, including the annual 2% budget sequester and pending cuts to global surgery codes; and
    • Pause Medicare Quality Payment Program reporting requirements.

    Click here to read the letter.

    Neurosurgery Advocates for COVID-19-Related Medical Liability Protections

    The AANS and the CNS, as leaders of the Health Coalition on Liability and Access (HCLA), are advocating for a range of medical liability protections for physicians during the COVID-19 pandemic. Examples include:

    • Good Samaritan protections for physician volunteers who cross state lines to provide care in response to the federally declared emergency;
    • Federal Tort Claims Act coverage for retired or inactive physicians who reenter the physician workforce; and
    • Protections for physicians are asked to provide treatments or care outside their general practice areas and for which they may not have the most up-to-date knowledge.

    The third COVID-19 legislative package limits liability for volunteer health care professionals during this public health emergency.

    CMS Announces Quality Payment Program Relief During COVID-19 Crisis

    On March 22, CMS announced that it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs concerning upcoming measure reporting and data submission for those programs. The agency is implementing additional extreme and uncontrollable circumstances policy exceptions and extensions for future measure reporting and data submission deadlines for the following CMS programs. Click here for details.

    FDA Issues Guidance for Clinical Trials During COVID-19 Pandemic

    On March 18, the Food and Drug Administration (FDA) announced that it issued guidance for industry, investigators and institutional review boards conducting clinical trials during the COVID-19 pandemic. The agency issued the guidance recognizing that the COVID-19 pandemic may impact the conduct of clinical trials and challenges may arise — such as from quarantines, site closures and travel limitations — leading to difficulties in conducting the clinical trials. “With this guidance issued today, the FDA is helping industry and investigators navigate the COVID-19 pandemic and help assess how to move forward with critical clinical trials,” said Anand Shah, MD, FDA Deputy Commissioner for Medical and Scientific Affairs.

    Click here to access the “FDA Guidance on Conduct of Clinical Trials of Medical Products during COVID-19 Pandemic: Guidance for Industry, Investigators, and Institutional Review Boards.”

    Legislative Affairs

    Neurosurgery Leads Effort on Surprise Medical Bills

    Led by the CNS and the AANS, on March 4, a coalition of 19 national and state medical associations, sent a letter to congressional leaders outlining medicine’s recommendations on surprise billing legislation. The letter, which was sent to the chairs and ranking members of the House Committees on Energy and Commerce, Education and Labor, and Ways and Means, outlines key components for a fair and effective solution to address surprise medical bills. At present, Congress continues to work on final compromise legislation that could be included in a broader health care package later this spring.

    CNS and AANS Recommend Safeguards Around Medicare Demonstration Projects

    On March 12, the AANS and the CNS joined nearly 150 leading health care organizations in a letter supporting H.R. 5741, the Strengthening Innovation in Medicare and Medicaid Act. Sponsored by Reps. Terri Sewell (D-AL) and Adrian Smith (R-NE), this bill would clarify the parameters for model testing and add accountability to model expansion under the Center for Medicare and Medicaid Innovation (CMMI). As noted in the letter, “We are concerned that too many CMMI models endanger patient access to healthcare providers and medically necessary treatments and create unnecessary obstacles for vulnerable patients.” The letter goes on to state that, “H.R. 5741 provides safeguards for CMMI to ensure CMMI demonstrations are patient-focused and benefit beneficiaries.” Click here to read the letter.

    Good Samaritan Health Professionals Act Introduced in the House

    On March 13, Reps. Raul Ruiz, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) introduced H.R. 6283, the Good Samaritan Health Professionals Act. This legislation will ensure that health professionals who provide voluntary care in response to a federally declared disaster are protected from unwarranted lawsuits. The bill specifically applies to health care providers who cross state lines to aid disaster victims. The CNS and the AANS sent a letter to Reps. Ruiz and Bucshon supporting this bill. Companion legislation (S. 1350) was introduced in the U.S. Senate by Sens. Bill Cassidy, MD, (R-La.) and Angus King (I-Maine) on May 7, 2019.

    CNS and AANS Support Funding for MISSION Zero Act

    On Feb. 12, the AANS and the CNS joined 11 other national organizations to send letters to congressional appropriators requesting $11.5 million in funding for the Military and Civilian Partnership for the Trauma Readiness Grant Program. 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 (PAHPAI) Act (P.L. 116-22). It created the above grant program within the U.S. Department of Health and Humans Services (HHS) to cover the administrative costs of embedding military trauma professionals in civilian trauma centers. These partnerships will allow military trauma care teams and providers to gain exposure to treating critically injured patients and increase readiness for when these units are deployed. Similarly, best practices from the battlefield are brought home to further advance trauma care and provide civilian access to excellent trauma care.

    Click here to read the Senate letter and here to read the House letter.

    Grassroots Alert

    Contact Congress to Co-sponsor H.R. 3107, the Improving Seniors' Timely Access to Care Act: Tell Your Representative about the Need for Prior Authorization Reform

    To bring needed transparency and oversight to the Medicare Advantage (MA) program, the CNS and the AANS are urging Congress to adopt H.R. 3107, the Improving Seniors’ Timely Access to Care Act. If passed, this legislation would reduce the hassles of prior authorization and help curb unnecessary delays for patients covered by MA plans.

    Click here to send an email message urging your member of Congress to co-sponsor H.R. 3107. A sample message, which can be personalized, is provided.

    Coding and Reimbursement

    Neurosurgery Comments on Proposed Coverage for Vertebral Augmentation

    On Jan. 28, the CNS and the AANS joined 10 specialty society members of the Multispecialty Pain Workgroup (MPW) in submitting comments to Medicare Administrative Contractors (MACs) regarding proposed Local Coverage Determinations (LCDs) for Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture. The letters express concerns regarding the LCDs’ exclusion of all fractures over six weeks old and the requirement for a four-physician multidisciplinary team to determine treatment by consensus.  The Novitas and First Coast LCDs are identical and follow a March 20, 2019, multi-jurisdictional MAC Carrier Advisory Committee (CAC) conference call on the issue. Renee Chambers, MD, FAANS, served as a subject matter expert on the call, and John K. Ratliff, MD, FAANS, and Philipp M. Lippe, MD, FAANS(L), participated as voting CAC members.

    Click here for the Novitas letter and here for the First Coast letter.

    Neurosurgery Comments on MRI Guided Focused Ultrasound for Essential Tremor

    On Feb. 8, the AANS, the CNS and the American Society for Stereotactic and Functional Neurosurgery (ASSFN), sent letters to Novitas and First Coast, thanking them for proposing positive draft Local Coverage Determinations (LCDs) for MRI Guided Focused Ultrasound (MRgFUS) for Essential Tremor (ET). The draft LCDs specifically cite an ASSFN position statement. The paper titled, “MR-guided Focused Ultrasound for the Management of Essential Tremor,” includes a robust review of the literature for the procedure.   

    Quality Improvement

    HHS Issues Strategy for Reducing HIT and EHR Burdens

    On Feb. 21, the U.S. Department of Health and Human Services (HHS) issued a report titled, "Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.” The report identifies regulatory and administrative burdens relating to the use of health information technology (HIT) and electronic health records (EHRs), while also outlining strategies and recommendations that can be used to help clinicians focus their attention on patients rather than paperwork. As required by the 21st Century Cures Act, the report was led by the Office of the National Coordinator for Health Information Technology (ONC) in conjunction with CMS. The report outlines three primary goals and offers recommendations to:

    • Reduce the effort and time required to record information in EHRs for health care providers when they are seeing patients;
    • Reduce the effort and time needed to meet regulatory reporting requirements for clinicians, hospitals, and health care organizations; and
    • Improve the functionality and intuitiveness (ease of use) of EHRs.

    In related news, the CNS and the AANS joined the Alliance of Specialty Medicine in commenting on HHS’ draft “2020-2025 Federal Health IT Strategic Plan.”

    CMS and ONC Release Final Rules to Advance the Interoperability of Health Information

    On March 9, HHS announced the release of their long-awaited final rules implementing the 21st Century Cures Act requirements to enhance interoperability and patient access to data. The final rule issued by CMS focuses on driving interoperability and patient access to health information by implementing policies that will help patient data flow freely and securely between payors, providers, and patients. The ONC rule aims to provide additional opportunities for innovation through secure access to health data and new tools to help patients shop for and coordinate their own care. The ONC rule also prohibits HIT vendors and providers from engaging in information blocking.

    Click here a fact sheet on the CMS final rule and here for information on the ONC rule.

    Communications

    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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