• Vol. 68, May 2020 DC E-Newsletter

    • May 25, 2020

    Special Announcement

    Surgeons Launch Campaign to Prevent Steep Medicare Cuts

    Neurosurgeons are facing steep Medicare and other payment cuts in the next 24 to 30 months. In the near term, changes in the office and outpatient evaluation and management (E/M) codes adopted by the Centers for Medicare & Medicaid Services (CMS) will reduce Medicare payments to neurosurgeons by as much as 6% starting Jan. 1, 2021. CMS may also propose double-digit cuts in global surgery payments sometime in the future.

    These past months have been an incredibly trying time for every single American. Our country’s health care professionals who continue to fight on the front line of the COVID-19 pandemic have had to shoulder a greater share of the burden. Given the current situation and the role surgeons play in it, now is not the time to place further strains on the health care system with steep and unsustainable reimbursement cuts.

    Coming together to combat this threat, and protect and defend the interests of surgeons around the country, national surgical organizations, including the CNS and the AANS, have formed the Surgical Care Coalition. The coalition has coalesced around a comprehensive, multi-faceted campaign to educate the public and policymakers about the value of surgeons, and to prevent significant reimbursement cuts.

    While the coalition has engaged experts in a variety of areas to assist with this effort, in the coming weeks and months, neurosurgeons will also be asked to take action in support of this campaign. Whether it is responding to surveys, writing elected officials or penning an OpEd, active participation in this campaign is imperative and crucial to its success. Stay tuned for more information. 

    COVID-19

    CMS and ACS Issue Guidance for Resuming Elective Surgery

    On April 19, the CMS announced new guidelines allowing hospitals to move to Phase I of providing non-emergent, non-COVID-19 care in states and regions where COVID-19 outbreaks are deemed under control. This follows action taken by the American College of Surgeons (ACS), which issued new “Local Resumption of Elective Surgery Guidance” on April 17. Subsequently, the ACS issued the “Post-COVID-19 Readiness Checklist for Resuming Surgery.”

    Click here to read the ACS guidelines and here for the checklist.

    CNS and AANS Join Surgical Coalition in Requesting Additional COVID-19 Relief

    On April 21, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) joined the Surgical Coalition in requesting additional COVID-19-related relief. The letter, which was sent to U.S. Department of Health and Human Services (HHS) Secretary Alex M. Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, MPH, discusses the following topics: 

    • Telehealth and Other Non-Face-to-Face Services;
    • Accelerated and Advance Payments Program;
    • Prior Authorization;
    • Global Surgery Data Collection;
    • Preoperative History and Physical Requirements;
    • Personal Protective Equipment/Essential Medical Equipment Distribution and Access; and
    • Public Health and Social Services Emergency Fund.

    The CNS and the AANS also joined the Alliance of Specialty Medicine in sending a letter to CMS regarding telemedicine. The Alliance urged the agency to waive the video capability requirement for evaluation and management services and to increase payments for audio-only telehealth visits. 

    In response to efforts by organized medicine, CMS increased payments for audio-only telephone visits between Medicare beneficiaries and their physicians to match payments for similar office and outpatient visits. This policy change will increase payments from approximately $14-$41 to about $46-$110 and is retroactive to March 1.

    Click here to read the Surgical Coalition letter and here for the Alliance letter.

    Additional COVID-19 Financial Relief Approved

    On April 24, President Donald J. Trump signed into law H.R. 266, the Paycheck Protection and Health Care Enhancement Act, which provides nearly $500 billion for small businesses, health care providers and expanded COVID-19 testing. Specifically, the law provides: 

    • $310 billion to replenish the Paycheck Protection Program (PPP) to assist small businesses — including physician practices — affected by the COVID-19 pandemic. This is on top of the original $359 billion provided for the PPP in the CARES Act.
    • $75 billion for the Public Health and Social Services Emergency Fund to reimburse hospitals and physicians for COVID-19-related expenses and lost revenue. The new funds are in addition to the $100 billion already provided by the CARES Act.
    • $25 billion to develop and expand capacity for COVID-19 tests.

    CNS and AANS Urge Congress to Adopt COVID-19-Related Liability Protections

    The CNS and the AANS, 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. On May 12, HCLA submitted a statement for the record to the Senate Judiciary Committee, which held a hearing titled, “Examining Liability during the COVID-19 Pandemic.” The statement points out that because nonemergent surgical procedures have been delayed, curtailed or postponed altogether, and physicians are providing care outside of their usual practice area or specialty, these, and other unavoidable situations, pose substantial liability risks.

    Click here to read the HCLA statement and here for a fact sheet about this issue.

    Neurosurgery Ask Congress to Provide COVID-19 Relief to Pediatric Providers

    On May 13, the CNS, AANS, CNS/AANS Section on Pediatric Neurological Surgery and American Society of Pediatric Neurosurgeons, joined 25 medical organizations in asking Congress to provide “immediate financial relief payments to pediatric specialists and primary care pediatricians.” The letter notes that most COVID-19 relief funds have gone to physicians who treat Medicare patients, leaving out those who take care of children. The letter points out that without assistance, our young and most vulnerable patients will be placed at risk with increasingly limited access to patient care that they need.”

    Click here for a copy of the letter.

    CNS and AANS Continue to Advocate for Prior Authorization Relief

    Joining the Regulatory Relief Coalition, the CNS and the AANS urged the nation’s governors and state insurance commissioners to require all state-licensed health plans to waive prior authorization requirements for all health care services for the duration of the national emergency declared by President Donald J. Trump. The letter points out that prior authorization consumes considerable resources, and because many physician practices are operating with reduced staff due to COVID-19, complying with prior authorization requirements is even more challenging. Waiving prior authorization for health care services during this emergency would facilitate the deployment of physicians, nurses and other clinical staff to more urgent tasks. 

    Click here for a copy of the letter to state governors and here for the letter to state insurance commissioners.

    Coding and Reimbursement

    Neurosurgery Calls on Health Plans to Suspend Prior Authorization

    In an open letter, the CNS and the AANS joined the Regulatory Relief Coalition in calling on all health plans to suspend prior authorization and similar utilization review requirements for both COVID-19 and non-COVID-19-related services until normalcy in the health care delivery system is restored. Waiving all prior authorization requirements during this national emergency and its immediate aftermath will help ensure that patient access to critical health services is not inappropriately delayed or denied.

    CNS and AANS Express Concern with Noridian’s Percutaneous Vertebral Augmentation Policy

    On March 30, the CNS and the AANS joined 12 specialty society members of the Multispecialty Pain Workgroup (MPW) in submitting comments to Noridian regarding its Local Coverage Determination (LCD) for Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture. The letter suggested that the Medicare Administrative Contractor (MAC) revise the LCD, expressing concern about several issues, including the policy to exclude from coverage all fractures over six weeks old. Similar letters were sent earlier this year to the other six MACs.  

    Of Note

    AMA Study Highlights the Contributions Physicians Make to the Economy

    Recently, the American Medical Association (AMA) released a new study assessing the economic impact of physicians. The AMA Economic Impact Study provides state-specific data for each of the 50 states and the District of Columbia, illustrating the significant impact physicians have on our national and state economies through the: 

    • Creation of jobs;
    • Purchase of goods and services, and
    • Large-scale support of state and local tax revenue.

    Click here for the complete report and one-page state-specific summaries.

    CNS/AANS Washington Committee Chair Appointed to AMA Council on Legislation

    Ann R. Stroink, MD, FAANS, chair of the CNS/AANS Washington Committee, has been appointed to AMA’s Council on Legislation (COL). The COL reviews proposed federal legislation and recommends appropriate action in accordance with AMA policy. The COL also develops model state legislation, suggests changes to existing AMA policy and recommends to the AMA Board of Trustees new federal legislation and legislation to modify existing laws of interest to the AMA. Appointed by the AMA Board of Trustees, the COL has 12 members.

    CNS/AANS Washington Office Director Re-elected Vice-Chair of Liability Reform Coalition

    Katie O. Orrico, Esq., director of the CNS/AANS Washington Office, was recently re-elected vice-chair of the HCLA. Founded in 1993, HCLA is a national advocacy coalition working to enact medical liability reform at the federal level to help reduce health care costs for all Americans and to ensure patient access to quality medical care. Coalition members include organizations representing physicians, hospitals and medical professional liability insurance companies.

    Communications

    CNS/AANS Featured in MedPage Today Article About COVID-19 Relief

    Katie O. Orrico, Esq., director of the CNS/AANS Washington Office, was featured in a recent MedPage Today article titled, “CMS Suspends COVID-19 Advance Payment Program.” The article reported that CMS paused the program — which was giving providers advance Medicare payments to help them in the wake of COVID-19 —  suggesting that the program is no longer necessary.

    In her comments, Ms. Orrico noted that "given the 10.25% interest rate, and the short timeframe for repaying any advance payments, the program isn't likely as viable as other COVID-19 relief programs." She added that other programs for provider or small business relief —  such as the Paycheck Protection Program (PPP) and the Public Health and Social Services Emergency Fund initiative — have received mixed reviews. Ms. Orrico maintained the PPP has helped some private practices stay open during the crisis, while others were unsuccessful in obtaining PPP funds as additional money was no longer available — thus jeopardizing the viability of these practices. Additionally, she pointed out that neurosurgeons in academic departments are not “necessarily seeing funds that their institutions may have received, because the monies are going directly to the institutions and not trickling down to the individual provider level."

    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 is publishing a series of articles. The following topics, among others, are covered in this 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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