• Vol. 70, August 2020 DC E-Newsletter

    • Aug 25, 2020

    Surgical Care Coalition Campaign

    SCC Campaign to Prevent Medicare Payment Cuts Marches Forward

    On June 18, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS), along with 10 other national surgical associations, officially launched the Surgical Care Coalition (SCC). The coalition represents more than 150,000 surgeons and was formed to prevent steep Medicare payment cuts in 2021, which may lead to reduced access to care for older Americans. The CNS and the AANS are asking Congress to waive Medicare’s budget neutrality requirements to prevent the cuts and to require the Centers for Medicare & Medicaid Services (CMS) to apply the increased evaluation and management (E/M) payment adjustments to all 10- and 90-day global surgery codes.

    Since the launch, the coalition has been working on converting information that was gleaned from its member survey into news stories and op-eds in national and local newspapers in targeted states. Additionally, the coalition has begun its paid digital media campaign. Finally, the AANS, CNS and coalition partners will be ramping up their grassroots efforts, urging Congress to prevent the cuts and adjust the global surgery code values.

    To stay informed about the SCC’s activities, neurosurgeons are encouraged to sign-up for the coalition’s advocacy newsletter. Thus far, the coalition has issued four newsletters, on July 2, July 16, July 30 and Aug. 13.

    Click here to subscribe to the SCC advocacy update newsletter.

    Neurosurgeons are also encouraged to follow the coalition on Twitter and LinkedIn.

    COVID-19

    Maintaining Essential Surgery during COVID-19 Pandemic

    On Aug. 10, the American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses and American Hospital Association issued a “Joint Statement: Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic.” The statement reiterates the need for “ongoing governmental action to alleviate the financial burden on physician practices, health care providers and facilities.” In addition, it outlines a list of principles and considerations to guide physicians, nurses and local facilities in their care in operating rooms and all procedural areas during the ongoing pandemic. These address topics such as:

    • Regional cooperation critical to continuing to provide essential surgery;
    • Supply chain;
    • COVID-19 testing within a facility;
    • Personal protective equipment;
    • Case prioritization and scheduling; and
    • COVID-19 issues for the five phases of surgical care.

    Click here for a copy of the statement.

    Neurosurgery Calls for COVID-19-related Medical Liability Protections

    As part of the ongoing efforts to provide health care providers with protections from unfounded lawsuits, the Health Coalition on Liability and Access (HCLA) — of which the CNS and the AANS serve as vice-chair — has joined a chorus of stakeholders in calling on Congress to pass legislation to safeguard medical professionals, and the facilities in which they practice, from COVID-19-related medical liability lawsuits.

    To that end, on May 28, bipartisan legislation that would provide targeted relief from these lawsuits — H.R. 7059, the Coronavirus Provider Protection Act — was introduced in the House of Representatives by Reps. Phil Roe, MD, (R-Tenn.) and Lou Correa (D-Calif.). Recently, on July 9, Rep. Mike Kelly (R-Pa.) introduced H.R. 7538, the Essential Workforce Parity Act, which contains language similar to that of H.R. 7059. HCLA expressed its strong support for Section 3 of H.R. 7538 and applauded Rep. Kelly for his commitment to protecting health care professionals from the serious threat of COVID-19-related liability lawsuits.

    In the Senate, on July 27, Sens. John Cornyn (R-Texas) and Mitch McConnell (R-Ky.) introduced S. 4317, the Safeguarding America’s Frontline Employees To Offer Work Opportunities Required to Kickstart the Economy (SAFE TO WORK) Act. Supported by HCLA, the Senate bill would shield health care providers from coronavirus-related medical liability claims, while allowing damage awards in situations of gross negligence or willful misconduct. The introduction of this legislation follows several Senate hearings on this topic, including one convened by the Senate Health, Education, Labor & Pensions (HELP) Committee on June 23, titled “COVID-19: Lessons Learned to Prepare for the Next Pandemic.”

    Click here to read HCLA’s letter to Rep. Kelly, here for HCLA’s statement to the Senate HELP Committee and here for HCLA’s release supporting Section 3 of H.R. 7538.

    CNS and AANS Urge Congress to Fund Additional Residency Slots

    On July 9, the CNS and the AANS joined more than 60 health care organizations in urging Congress to include the Resident Physician Shortage Reduction Act (S. 348/H.R. 1763) in the next comprehensive COVID-19 legislation. According to a new study from the Association of American Medical Colleges, the demand for physicians continues to grow faster than supply, leading to a projected shortfall of between 54,100 and 139,000 physicians by 2033 — including a shortage of between 17,100 and 28,700 surgical specialists. The letter points out that the country has a dire need for more physicians, “not only to treat a growing and aging population, but also to respond to public health emergencies like COVID-19.”

    Click here to read the letter.

    Neurosurgery Calls on Congress to Increase Funding for COVID-19 Testing

    As cases of COVID-19 continue to increase across the country, the CNS and the AANS are calling on Congress to prioritize robust federal funding for the critical testing needed to reopen the country. On July 21, the neurosurgery groups joined nearly 50 other health care stakeholder organizations in a letter advocating for swift action to ensure that every American — especially essential workers, frontline health care professionals and those at disproportionate risk for COVID-19 — have access to vital COVID-19 testing.

    Click here to read the letter.

    CNS and AANS Lead Effort Cautioning Congress About Surprise Medical Bills Legislation

    On July 28, the CNS and the AANS joined more than 100 state and national medical societies in sending a letter to Congress reiterating that while “it is critical to protect patients from surprise medical bills … now is not the time to adopt divisive surprise billing legislation.” The letter restates organized medicine’s principles for surprise medical bills and urges Congress to address the issue separately from COVID-19 relief legislation.

    Click here to read the letter.

    HHS to Begin Distributing $1.4 Billion in Relief Funds to Children’s Hospitals

    On Aug. 14, the U.S. Department of Health and Human Services (HHS) announced that it will distribute $1.4 billion to almost 80 free-standing children’s hospitals nationwide. The funds — made possible through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other health care providers — will be administered through the Health Resources and Services Administration. The CNS and the AANS have been advocating for additional COVID-19 relief funding for pediatric neurosurgeons, and previously joined nearly 30 medical groups in a letter to congressional leaders in requesting COVID-19 Public Health Emergency Fund support.

    AMA Launches #MaskUp Campaign

    As the COVID-19 pandemic continues impacting our nation, the American Medical Association (AMA) recently launched a public health campaign called #MaskUp focused on mitigating the virus, specifically encouraging the public to wear masks. Supported by the CNS and the AANS, the campaign aims to debunk myths and misconceptions around mask usage, is rooted in science and equips physicians with simple tools to help patients understand their risks for transmission.

    Legislative Affairs

    HHS Releases Report on Surprise Billing

    Responding to a requirement in Executive Order 13877, “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” on July 29, HHS released the “HHS Secretary’s Report on Addressing Surprise Billing.” Among other things, the report describes federal actions to encourage price transparency for medical services, summarizes pending federal legislation and describes what Congress and HHS have done to address surprise billing during the COVID-19 Public Health Emergency. The report calls for congressional action to eliminate the threat of surprise billing that follows the principles laid out by the Administration:

    • Patients receiving emergency care should not be forced to shoulder extra costs billed by a care provider but not covered by their insurer;
    • Patients receiving scheduled care should have information about whether providers are in or out of their network and what costs they may face;
    • Patients should not receive surprise bills from out-of-network providers they did not choose; and
    • Federal healthcare expenditures should not increase.

    The report did not endorse any particular bill. Instead, it stated that legislation needs to be simple and fair for patients and not place implementation barriers on health plans and providers.

    Before issuing the report, the White House floated a proposal to simply ban surprise medical bills without any corresponding process for resolving payment disputes been physicians and health plans. The AANS and the CNS oppose this approach and worked with members of the GOP Doc Caucus to send a letter to President Donald J. Trump. Expressing concerns about a straight ban on surprise medical bills, the Doc Caucus members noted that this approach “would have a disproportionately harmful impact on providers trying to negotiate fair rates with insurers for their services” and that providers “must have some mechanism to dispute unfairly low payments.”

    House Adopts MISSION Zero Funding in FY2021 Appropriations Legislation

    On July 31, the House of Representatives passed H.R. 7617, the consolidated appropriations act that included Fiscal Year 2021 (FY2021) funding for HHS. Included in this legislation is $11.5 million to fund the MISSION Zero Act grant program. Authorized by the Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI) Act, the grant program would assist civilian trauma centers in partnering with military trauma professionals to create a pathway to provide patients with the highest quality of trauma care in times of both peace and war.

    House appropriators also included report language encouraging the Assistant Secretary for Preparedness and Response (ASPR) to support MISSION Zero efforts by pursuing “partnerships between military and civilian trauma care providers to ensure trauma care readiness by integrating military trauma care providers into civilian trauma centers.”

    The CNS and the AANS strongly support this program as outlined in letters to House and Senate appropriators earlier this year.

    Coding and Reimbursement

    UnitedHealthcare Suspends Imaging Prior Authorization Requirements

    Effective April 1, 2020, UnitedHealthcare (UHC) had issued Medical Record Requirements for Pre-Service Reviews requiring surgical practices to upload radiographic studies via a web-based portal as a condition of obtaining prior authorization for the surgical treatment of spine pain and total artificial disc replacement. To further clarify this policy, UHC also issued Medical Policy Documentation Requirement Updates frequently asked questions.

    On June 23, the CNS, the AANS and the and the CNS/AANS Joint Section on Disorders of the Spine and Peripheral Nerves (DSPN), sent a letter to UnitedHealthcare (UHC) expressing opposition to a new policy for the surgical treatment of spinal conditions. The letter stated that the new policy “is unnecessary, ill-advised and will adversely affect patients’ timely access to care.” The groups further pointed out that “the policy inappropriately veers towards the practice of medicine” and asked UHC “to permanently end this new policy.” In addition to the letter, representatives from the CNS, AANS and the American Academy of Orthopaedic Surgeons convened a conference call with UHC leadership to discuss our concerns about this policy.

    Responding to the CNS, AANS and DSPN, Russell H. Amundson, MD, FAANS, a neurosurgeon and senior medical director for UHC, acknowledged that physicians, practice administrators and others had raised similar concerns to those outlined in organized neurosurgery’s letter. He assured the neurosurgical groups that UHC was evaluating and refining its “administrative processes to address and resolve the issues identified.” Dr. Amundson also noted that the health plan was “suspending denials on initial review for lack of information/lack of required images.” However, in select cases, UHC “may require images when necessary to determine if clinical criteria are met.”

    CMS Issues Proposed 2021 Medicare Physician Fee Schedule Rule

    On Aug. 3, CMS released the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) proposed rule. Under the proposal, neurosurgeons face overall Medicare payment cuts of at least 7% next year. The reductions are primarily driven by new Medicare payment policies for office and outpatient visits that CMS will implement on Jan. 1, 2021. By law, any changes to the relative value units (RVUs) cannot increase or decrease expenditures for physician services by more than $20 million. If CMS increases RVUs for a given service, the increase must be offset by decreases in payments for other services. In the proposal, values for E/M and other visit codes will result in additional spending of $10.2 billion, necessitating a neutrality adjustment to the conversion factor. As a result, the proposed CY 2021 conversion factor is $32.26, a drastic 11% reduction over the CY 2020 conversion factor of $36.09. Additional details regarding the proposed rule are provided in a CMS fact sheet.

    The CNS and the AANS will continue advocating to prevent the implementation of these cuts, including submitting comments to CMS and legislative action.

    CMS Releases Proposed 2021 Medicare Hospital Outpatient and ASC Rule

    On Aug. 4, CMS released the CY 2021 Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems proposed rule. For CY 2021, CMS proposes to increase payment rates under the OPPS and the ASC payment systems by 2.6%. Hospitals and ASCs that fail to meet their respective quality reporting program requirements are subject to a 2.0% reduction in payment. Items of interest for neurosurgeons include the following: 

    • A three-year transition to eliminate the inpatient-only list, beginning with 266 musculoskeletal-related services in CY 2021 — including approximately 80 spine procedures, which would allow Medicare patients to receive these services in the hospital outpatient setting;
    • New requirements for prior authorization for cervical fusion with disc removal and implanted spinal neurostimulator procedures performed in the hospital outpatient setting; and
    • A request for comments on a new method to update the process for placing procedures on the ASC list — which would result in significantly more procedures on the list, including about 20 procedures performed by neurosurgeons.

    Additional information about the proposal is available from the CMS press release and fact sheet.

    BCBS of North Carolina Extends Coverage of Laser Ablation to Brain Tumor

    On July 21, BlueCross BlueShield of North Carolina extended its medical coverage policy to allow coverage for MRI-guided Laser Interstitial Thermal Therapy (LITT) to treat brain tumor patients. The additional indication updates the previous policy issued in February that provides coverage for LITT for patients with epilepsy under certain conditions. In addition to advocating for coverage for LITT, the CNS and the AANS have submitted a CPT Code Change Application for a Category I CPT code for the procedure, which will be considered at the October CPT Editorial Panel meeting.

    Regulatory Affairs

    CNS and AANS Join Effort for Prior Authorization Relief in Medicare

    On July 20, the CNS and AANS joined more than 175 patient and provider groups in sending a letter to HHS and CMS, urging CMS “to restore unfettered access to Medicare Part B covered drugs for beneficiaries enrolled in Medicare Advantage (MA) plans.” MA plans have been using prior authorization restrictions as a barrier to the timely delivery of essential medication to Medicare beneficiaries, putting the health of these patients at risk. MA plans are required by law to cover the same services as fee-for-service Medicare, and plans should not be permitted to use prior authorization to circumvent this requirement.

    Click here to read the letter.

    Neurosurgery Urges White House to Finalize Updated Stark/Anti-kickback Rules

    On Aug. 5, the CNS and the AANS joined more than 120 organizations representing physicians, hospitals, life sciences companies and employers in sending a letter to President Donald J. Trump asking for his support and prompt adoption of proposed reforms to the Stark Law and Anti-Kickback Statute (AKS) regulations. The letter states that improvements to the Stark and AKS regulations will foster collaboration and innovation among health care stakeholders, allowing hospitals, physicians, device manufacturers and others to deliver better care at a lower cost. Pointing out that these regulations were built for a fee-for-service delivery and payment system, the letter notes that they do not work in a value-based health care system.

    The neurosurgery organizations also collaborated with nearly 20 physician organizations in sending a letter conveying the same message.

    Communications

    Neurosurgeons Raise the Alarm about Medicare’s Proposed Physician Fee Schedule

    On Aug. 4, the CNS and the AANS announced their strong opposition to the Medicare Physician Fee Schedule proposed rule released by CMS for calendar year 2021. Under the proposal, neurosurgeons face overall payment cuts of at least 7% at a time when the nation’s health care system is already stressed by the COVID-19 pandemic. The reductions are primarily driven by new Medicare payment policies for office and outpatient visits that CMS will implement on Jan. 1, 2021.

    “Now is not the time to reduce payments for surgical care, and if implemented as is, the Medicare payment rule will challenge an already fragile health care system,” said CNS/AANS Washington Committee chair, Ann R. Stroink, MD, FAANS. Dr. Stroink went on to conclude that this “was an ill-informed and dangerous policy for patients even before the pandemic started but could be even more detrimental as our health care system continues to weaken under COVID-19. If finalized, this proposal could result in neurosurgeons taking fewer Medicare patients leading to longer wait times and reduced access to care for older Americans, so Congress must act now to prevent this from happening.”

    On Aug. 4, the CNS and the AANS also joined with other medical groups representing more than 350,000 physicians and 764,000 nonphysician health care providers in a press release calling on Congress to pass legislation to stop arbitrary Medicare cuts to specialty physicians and nonphysician providers. These organizations are calling on Congress and CMS to develop a solution that will allow the changes to the E/M services to proceed — while at the same time preventing cuts — and waiving Medicare’s budget neutrality requirements for the E/M policy is the most straightforward solution.

    Neurosurgery Featured in News Articles about Proposed Medicare Payment Cuts

    Following its release, the CNS and the AANS were featured in several articles about the proposed Medicare Physician Fee Schedule rule. 

    • “Health Groups Criticize Proposed Medicare Fee Schedule Changes for 2021,” read the Aug. 4, MedPage Today The article underscored neurosurgery’s concern that drastic cuts caused by changes to the office visit codes will undermine patient access to neurosurgical care.
    • On Aug. 6, Becker’s Spine Review, wrote, “Neurosurgeons ask Congress to intervene in CMS’ ‘ill-informed and dangerous’ Medicare payment cuts.” The article restated neurosurgery’s concerns about the cuts, noting that the AANS and the CNS “have asked Congress to waive Medicare’s budget neutrality requirements to prevent the cuts and require CMS to apply the increased evaluation and management payment adjustments to all 10- and 90-day global surgery codes.”

    Neurosurgery Featured in Article on Joe Biden’s Health Care Proposals

    On Aug. 12, Medscape published an article titled, “Election 2020: What Exactly Is Joe Biden’s Healthcare Plan?” The piece featured comments by Katie O. Orrico, Esq., director of the CNS/AANS Washington Office. On the question of Medicare for all, Ms. Orrico stated that the CNS and the AANS “support expanding health insurance coverage, but the expansion should build on the existing employer-based system.” She added that shifting more Americans into government-sponsored health care will inevitably result in lower payments for physicians’ services, noting that reimbursement “rates from Medicare, Medicaid, and many ACA exchange plans already do not adequately cover the costs of running a medical practice.”

    On the topic of COVID-19, Ms. Orrico pointed out that the COVID-19 pandemic has exposed some cracks in the U.S. health care system, and policymakers will likely take a closer look at issues related to unemployment, health insurance coverage, and health care costs due to the COVID-19 emergency.

    Finally, Ms. Orrico acknowledged that there are ways to improve the current health care system, such as moving to value-based care.

    ICYMI — Neurosurgery Blog Publishes COVID-19 Series

    To explore and highlight the impact of the COVID-19 pandemic on the practice of neurosurgery, Neurosurgery Blog: More than Just Brain Surgery published a series of articles. The following topics were recently added, concluding the series: 

    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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