• Vol. 73, December 2020 DC E-Newsletter

    • Jan 14, 2021

    Special Announcement

    Congress Prevents Steep Medicare Cuts in $2.3 Trillion Spending Package

    On Dec. 27, 2020, President Donald J. Trump signed the Consolidated Appropriations Act, 2021 (H.R. 133) into law (P.L. 116-260) — a massive omnibus spending bill that includes nearly $900 billion for coronavirus relief and an additional $1.4 trillion spending package to fund the federal government through the end of the Fiscal Year 2021.The measure incorporates several priorities of the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS). Specifically, the legislation:

    • Prevents steep Medicare cuts by earmarking $3 billion to help offset the budget- neutrality adjustment and by delaying for three years the new G2211 add-on code for certain complex office visits;
    • Extends the moratorium on the 2% Medicare payment sequester for an additional three months through March 2021, allocating $3 billion for this purpose;
    • Provides funding for 1,000 additional Medicare-funded graduate medical education (GME) residency positions;
    • Bans surprise medical billing and incorporates a process for resolving payment disputes for out-of-network care; and
    • Includes $284 billion for the Paycheck Protection Program (PPP) and extends the PPP through March 31, 2021.

    A more detailed summary of the legislation will be forthcoming.

    COVID-19

    Revised Guidance on Essential Surgery Issued


    On Nov. 23, the American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses and American Hospital Association released revised guidance on how health facilities and workers can better serve the needs of patients presenting for essential surgery during the pandemic. The considerations include:

    • Pursuing regional alliances to ensure local capacity;
    • Establishing an in-hospital prioritization policy committee; and
    • Addressing health care workers’ well-being, so they do not burn out.

    “Now in their ninth month of stretching to treat growing numbers of COVID-19 patients, health care organizations, physicians and nurses must be able to meet the escalating demands for patients hospitalized with COVID-19 and those in need of essential surgical services,” the groups said in a joint statement.

    Click here to read the “Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic.”

    HHS Begins Distributing Phase 3 COVID-19 Provider Relief Funding

    On Dec. 16, the Trump Administration announced that it completed the review of Phase 3 applications for the Provider Relief Fund program and will distribute $24.5 billion to more than 70,000 providers — a $4.5 billion increase from the $20 billion initially planned. The funding aims to help providers recoup nearly 90% of their lost revenues and net expenses caused by the pandemic. Payments began Dec. 16 and go through January 2021. A state-by-state breakdown of the first batch of Phase 3 payments can be found here. This data will be updated through January, as Phase 3 payments are completed.

    Report Demonstrates Benefits of Telehealth during COVID-19

    The COVID-19 Healthcare Coalition — comprising more than 1,000 health care organizations, technology firms and nonprofits — recently published the “COVID-19 Telehealth Impact Physician Survey.” The findings show strong support for telehealth:

    • 60% reported that telehealth had improved the health of their patients;
    • 68% said they are motivated to increase telehealth use in their practices;
    • 55% indicated that telehealth had improved the satisfaction of their work;
    • More than 80% indicated that telehealth improved the timeliness of care for their patients; and
    • 80% said their patients had reacted favorably to using telehealth for care.

    Click here to read the full report.

    AMA Develops COVID-19 Vaccine Information Materials

    Physicians and patients must have confidence in the safety and efficacy of COVID-19 vaccines when they become available for public use. To promote factual information, the American Medical Association (AMA) has established a resource center with materials on topics related to COVID-19 vaccination. Additional frequently asked questions (FAQs) are also available from the AMA:

    Legislative Affairs

    Neurosurgery Endorses Legislation to Increase Global Surgery Payments

    On Dec. 1, Sen. Rand Paul, MD, (R-Ky.) introduced S. 4932, the “Medicare Reimbursement Equity Act.” In the final 2021 Medicare Physician Fee Schedule (MPFS) rule, the Centers for Medicare & Medicaid Services (CMS) refused to adjust the E/M portion of the 10- and 90-day global surgery codes to reflect the increased values of the revised office and outpatient E/M visit codes. If enacted, this legislation would require CMS to value the E/M portion of the global codes equal to the stand-alone E/M codes.

    Click here to read surgery’s letter endorsing the bill.

    Neurosurgery Urges Congress to Adopt its Plan for Preventing Medicare Cuts  

    On Dec. 4, the CNS and the AANS joined 18 other surgical organizations in sending a letter to Congressional leadership urging immediate intervention to stop devastating Medicare physician payment cuts scheduled to be implemented on Jan. 1, 2021. 

    The groups called on Congress to incorporate the provisions of the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act” (H.R. 8702/S. 5007) and S. 4932, the “Medicare Reimbursement Equity Act,” into any year-end legislative package. Additionally, the letter urges Congress to halt the implementation of the G2211 add-on code for certain complex E/M services.

    Click here for a copy of the letter.   

    Prior Authorization Legislation Introduced in the Senate

    On Dec. 17, Sens. Sherrod Brown (D-Ohio) and John Thune (R-S.D.) introduced S. 5044, the “Improving Seniors’ Timely Access to Care Act.” Building on similar legislation (H.R. 3107) introduced last year in the U.S. House of Representatives, this bill would reform the use of prior authorization in Medicare Advantage (MA) through a streamlined and standardized process that focuses on increased transparency and accountability. The bill reflects a neurosurgery-supported consensus statement on prior authorization, developed by leading national organizations representing physicians, hospitals and health plans.

    Specifically, the legislation directs the Secretary of the U.S. Department of Health and Human Services to:

    • Establish a real-time, electronic prior authorization process;
    • Minimize the use of prior authorization for routinely approved services;
    • Ensure prior authorization requests are reviewed by qualified medical personnel; and
    • Require MA plans to report on their use of prior authorization, including delay and denial rates.

    In the press release announcing the bill’s introduction, Senator Brown stated, “Older Americans shouldn’t be held up with unnecessary delays when seeking out medical treatment.” Senator Thune acknowledged that “Modernizing and streamlining the prior authorization process is important for seniors and providers.”

    More information about the legislation is available from the Regulatory Relief Coalition, of which the CNS and the AANS are founding members.

    Neurosurgery Urges Funding for MISSION ZERO Program

    On Nov. 20, the CNS and the AANS sent a letter to the Senate Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee supporting $11.5 million in funding for the Military and Civilian Partnership for the Trauma Readiness Grant Program. Authorized by the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (Public Law 116-22), this grant program will enhance trauma training for military health care personnel while simultaneously bolstering civilian trauma care and saving lives. Known initially as MISSION ZERO, the program will provide funding to ensure trauma care readiness by integrating military trauma care providers into civilian trauma centers.

    Neurosurgery Urges President-Elect Biden to Continue Commitment to Biomedical Research Funding

    On Dec. 4, the CNS and the AANS joined the Ad Hoc Group for Medical Research in sending a letter to President-elect Joseph R. Biden, Jr., urging him to continue his commitment to biomedical research funding. The letter praised President-elect Biden for supporting increased and sustainable funding growth for the National Institutes of Health as part of $300 billion in new research and development investments in his Build Back Better plan.

    Coding and Reimbursement

    CMS Releases 2021 Medicare Physician Fee Schedule Final Rule

    On Dec. 1, the CMS released the 2021 MPFS final rule. Under the proposal, neurosurgeons face overall Medicare payment cuts of approximately 6% beginning on Jan. 1, 2021. The reductions are primarily driven by new values for office and outpatient E/M and other visit codes. But for the passage of the Consolidated Appropriations Act, 2021, the new payment policies would have resulted in a significant budget-neutrality adjustment to the Medicare conversion factor. Now the 2021 conversion factor is $34.8931 rather than $32.4085, although still shy of the 2020 CF of $36.0896.

    Click here for a comprehensive summary prepared by the AMA and here for a side-by-side analysis of the proposed and final rules developed by Hart Health Strategies. A CMS press release and fact sheet are available here and here.

    New Office and Outpatient E/M Codes Go Into Effect on Jan. 1, 2021

    On Jan. 1, CMS will implement the CPT guidelines to report office and outpatient E/M visits based on either medical decision making or physician time. These services will be valued in line with the AMA/Specialty Society RVS Update Committee (RUC) recommendations.

    More information about the new E/M codes is available here.

    CMS Issues 2021 Hospital Outpatient Department and ASC Payment Final Rule

    On Dec. 2, CMS published the 2021 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center (ASC) Payment final rule. Provisions of interest to neurosurgery include:

    • A three-year transition to eliminate the inpatient-only (IPO) list;
    • Modifications to certain expansion limits for physician-owned facilities;
    • The establishment of two new categories of services requiring prior authorization — cervical fusion with disc removal and implanted spinal neurostimulators; and
    • Revised criteria for the ASC list, including several neurosurgical procedures.

    Click here for the CMS press release and here for the CMS fact sheet.

    Blues Plans Will Expand LITT Coverage in 2021

    Beginning Jan. 1, the Health Care Service Corporation (HCSC) — an independent licensee of the Blue Cross and Blue Shield Association operating Blue Cross and Blue Shield® plans in Illinois, Montana, New Mexico, Oklahoma and Texas — will cover MRI-guided Laser Interstitial Thermal Therapy (LITT) to treat brain tumor, epilepsy and radiation necrosis. The criteria are similar to a policy implemented by Blue Cross Blue Shield of North Carolina in July 2020. In addition to advocating for coverage of LITT, the CNS and the AANS applied for a new Category I CPT® code for the procedure, which was approved by the AMA’s CPT Editorial Panel in October and will be included in the 2022 CPT book. 

    Click here for a copy of the new HCSC policy. 

    CMS Unveils Rule To Streamline Prior Authorization Decisions

    On Dec. 10, CMS issued a proposed rule titled “Reducing Provider and Patient Burden by Improving Prior Authorization Processes, and Promoting Patients’ Electronic Access to Health Information.” The proposal would place new requirements for improving the electronic exchange of health care data and streamline prior authorization processes on Medicaid and Children’s Health Insurance Program (CHIP) managed care plans, state Medicaid and CHIP fee-for-service programs and Qualified Health Plans. Most of the provisions in the rule would go into effect on Jan. 1, 2023.

    Click here for the CMS press release and here for the agency’s fact sheet about the proposal.

    Neurosurgery Urges CMS to Re-evaluate AUC Imaging Program

    Neurosurgery has long advocated that Medicare’s Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging will place an excessive burden on physicians across a broad range of specialties with little evidence of clinical benefit. On Nov. 27, the CNS and the AANS sent a letter urging CMS to re-evaluate the stand-alone AUC program for its necessity and value. CMS has delayed full implementation of the program until 2022.

    NGA Releases Future of State Telehealth Policy Report

    The National Governors Association (NGA) recently released a report titled, “The Future of State Telehealth Policy. The publication summarizes the policy flexibilities provided by states and the federal government during the COVID-19 pandemic. It also identifies longer-term considerations for governors to consider as they decide what flexibilities should remain permanent. The report addresses issues related to interstate licensure, coverage, payment, equity, interoperability and privacy.

    Click here for a copy of the report.

    Quality Improvement

    Applications for MIPS Exceptions Due to COVID-19 Now Due Feb. 1

    CMS has pushed back the deadline for physicians to apply for extreme and uncontrollable circumstances exceptions from the Merit-based Incentive Payment System (MIPS) to Feb. 1. This process can include a request to omit one or more performance categories from their score due to the COVID-19 pandemic.

    Click here for more details.

    Communications

    Neurosurgery Featured in Articles about Medicare Payment Cuts

    John A. Wilson, MD, FAANS, was featured in a Dec. 2, Inside Health Policy article titled “Verma Downplays Medicare Cuts, But Providers Want Congress To Step In.” The article discussed the response by specialty physicians to pay cuts finalized by CMS on Dec. 1.

    “This rule was a dangerous policy even before the pandemic, and enacting it during the worst health care crisis in a century is unconscionable. If Congress fails to act, it will further strain a health care system that’s already been pushed to the brink due to the COVID-19 pandemic and undermine patient care,” said Dr. Wilson.

    Dr. Wilson was also featured in a Dec. 2, Health Care Dive article titled “CMS Makes Some Telehealth Coverage Permanent, Finalizes Specialty Rate Cuts.” Medical groups spoke out against the cuts to pay of many specialties in the physician fee schedule, arguing they could be disastrous for providers if 2021 sees a continuation of the rising expenses and declining revenue that’s defined 2020 during the COVID-19 pandemic.

    Neurosurgery Applauds Introduction of Prior Authorization Bill in the Senate

    The CNS and the AANS joined the Regulatory Relief Coalition in announcing its strong support for S. 5044, the “Improving Seniors’ Timely Access to Care Act.” In the coalition’s press release, Ann R. Stroink, MD, FAANS, immediate past-chair of the CNS/AANS Washington Committee, stated, “Neurosurgeons like take care of very sick patients who suffer from painful and life-threatening neurologic conditions such as brain tumors, debilitating, degenerative spine disorders and Parkinson’s Disease, and they cannot afford to wait or jump through unnecessary hoops to get their life-saving care. We are grateful to Senators Brown and Thune for taking this important step to improve prior authorization for our nation’s seniors.”

    Neurosurgery Blog Continues to Publish Women in Neurosurgery Series

    2020 marks the historic 30th anniversary of the founding of Women in Neurosurgery (WINS) and brings an exciting time to the WINS community and neurosurgery. To celebrate the 30th anniversary of WINS, Neurosurgery Blog: More than Just Brain Surgery is publishing a series of articles highlighting the section’s goals — to educate, inspire and encourage women neurosurgeons to realize their professional and personal goals. WINS also serves women in neurosurgery by addressing the issues inherent to training, and maintaining a diverse and balanced workforce is the mission of this section. To date, the following blogs have been published:

    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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