• Vol. 76, April 2021 DC E-Newsletter

    • Apr 14, 2021

    Special Announcement

    Senate Votes to Prevent 2% Medicare Payment Cut

    On March 25, the U.S. Senate overwhelmingly passed — by a vote of 90 to 2 — legislation to delay the 2% Medicare payment sequester cuts for the rest of the year, extending the three-month moratorium of the sequester that was included in the Consolidated Appropriations Act, 2021 (P.L. 116-260). Endorsed by the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS), the amended bill, H.R. 1868, would forestall cuts totaling $18 billion scheduled to resume April 1. The House of Representatives — which initially passed its version of this bill by a vote of 246 to 175 — is expected to pass the amended legislation once it returns from the current Congressional recess. In light of this action, the Centers for Medicare & Medicaid Services (CMS) announced that it will temporarily hold Medicare claims pending congressional action. “This will minimize the volume of claims the MACs [Medicare administrative contractors] must reprocess if Congress extends the suspension; the MACs will automatically reprocess any claims paid with the reduction applied if necessary,” the agency stated.

    Prior to this action, the CNS and the AANS supported the Medicare Sequester COVID Moratorium Act (H.R. 315) and the Medicare Sequester Relief Act (S. 748). These bills — introduced by Reps. Brad Schneider (D-Ill.) and David B. McKinley (R-W.Va.) in the House, and Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) in the Senate — would have prevented this Medicare payment reduction through the remainder of the COVID-19 public health emergency.

    Click here for neurosurgery’s letter; here, here and here for health care provider coalition letters; and here, here and here for the Alliance of Specialty Medicine letters. 

    Absent Congressional action, additional Medicare payment sequester cuts will occur on Jan. 1, 2022. These reductions were triggered under a “pay-as-you-go” law when Congress passed the $1.9 trillion American Rescue Plan Act (P.L. 117-2). The Statutory Pay-As-You-Go Act (P.L. 111-139) requires across-the-board sequestration cuts to Medicare if certain legislation affecting mandatory spending or revenues increases net deficits. The CNS and the AANS will continue advocating for legislation to avoid these cuts.


    COVID-19 Phase 5 Legislation Signed into Law

    On March 11, President Joseph R. Biden, Jr. signed into law the $1.9 trillion American Rescue Plan Act (P.L. 117-2). The legislation — which passed the Senate by a vote of  50 to 49 and the House by a party-line vote of 220 to 211 — provides additional funding for COVID-19 testing, vaccinations and treatment. It also provides an additional $8.5 billion for rural providers through the Provider Relief Fund. Additionally, the bill expands health insurance coverage through COBRA and Affordable Care Act exchange plans. Unfortunately, the legislation did not include COVID-19-related medical liability protections — a priority for neurosurgery.

    Legislative Affairs

    Washington Committee Sets 2021 Legislative and Regulatory Agenda

    The CNS and the AANS released their 2021 legislative and regulatory agenda, including health policy action items neurosurgeons plan to advance with Congress and the Biden Administration. Organized neurosurgery aims to: 

    • Protect patients’ timely access to care by reforming utilization review practices, such as prior authorization, step-therapy and Medicare’s appropriate use criteria program for advanced diagnostic imaging;
    • Improve the health care delivery system by maintaining existing insurance market reforms and advancing solutions that will lower costs, expand coverage and enhance choice, including establishing network adequacy standards and out-of-network options — with appropriate patient protections for unanticipated medical bills;
    • Support quality resident training and education by increasing the number of Medicare-funded residency positions and preserving the ability of surgeons to maximize education and training opportunities within the profession’s current regulatory structures;
    • Fix the broken medical liability system by adopting proven reforms that are in place in California and Texas and other innovative solutions;
    • Continue progress with medical innovation by prioritizing funding for the National Institutes of Health, adopting a 21st Century Cures Act 2.0 initiative to support pioneering medical technology and life-saving therapies and expanding the availability of telehealth;
    • Alleviate the burdens of electronic health records (EHRs) by achieving interoperability, preventing data blocking, reducing unnecessary data entry and improving the functionality of EHR systems to enhance, not hinder, the delivery of medical care;
    • Restructure Medicare quality improvement programs by minimizing the complexity, streamlining and reducing reporting burdens and promoting specialty-specific quality measures, clinical data registries and alternative payment models that clinicians, not the government, develop; and
    • Champion fair reimbursement by improving the Medicare physician payment system — including providing an inflationary payment update, revisiting budget-neutrality requirements and maintaining the 10- and 90-day global surgery payment package — empowering patients and physicians to privately contract fee arrangements and closing the gap in payments between Medicaid and private insurers to reduce access to care disparities.

    In a press release announcing the agenda, Washington Committee chair John K. Ratliff, MD, FAANS, stated that “During these unprecedented times, the CNS and the AANS will continue to encourage policymakers to work together to find bipartisan solutions for our nation’s top health care issues to ensure that our patients have timely access to high-quality neurosurgical care.”

    Neurosurgery Urges New York to Lower Medical Liability Premiums

    On Feb. 25, the CNS and the AANS joined other health care organizations in sending a letter to New York legislators urging them to lower medical liability insurance premiums and litigation costs as outlined in Gov. Andrew M. Cuomo’s FY 2022 New York State Executive Budget proposal. Tying the rate of judgment interest to the market rate would reduce medical liability costs and ensure that unnecessarily high interest rates do not punish physicians should they choose to utilize their right to appeal.

    Additionally, on March 23, the neurosurgical societies joined the Health Coalition on Liability and Access (HCLA) in a letter to Gov. Cuomo voicing strong opposition to  Assembly Bill A3397. This bill would repeal the Emergency or Disaster Treatment Protection Act, which protects health care facilities and professionals from liability that may result from treating individuals with COVID-19.

    Click here to read the HCLA letter urging Gov. Cuomo to veto the bill.

    Neurosurgery Urges Congress to Increase NIH Funding

    Joining the Ad Hoc Group for Medical Research and more than 360 supporting organizations, the CNS and the AANS signed a letter urging Congress to allocate $46.1 billion to the National Institutes of Health (NIH) for FY 2022 — $3.2 billion more than appropriated in FY 2021. The CNS and the AANS have also endorsed Ellie’s Law (H.R. 1553). Sponsored by Rep. Yvette D. Clarke (D-N.Y.), this legislation would authorize $10 million in funding for the National Institute of Neurological Disorders and Stroke (NINDS) to increase the knowledge and understanding of brain aneurysms, including how to manage and treat this condition effectively.

    Click here to read the letter endorsing H.R. 1553.

    Neurosurgery Continues Support for Pediatric Subspecialty Loan Program

    On March 2, the CNS and the AANS joined organizations dedicated to improving the health and well-being of children in urging Congress to provide $50 million in funding for the Pediatric Subspecialty Loan Repayment Program (PSLRP). In return for participants agreeing to work full-time for at least two years in an eligible pediatric specialty — including pediatric surgery subspecialties — in a medically underserved area, the program authorizes up to $35,000 in annual loan repayment. The letter stressed the need to reauthorize the PSLRP, since without “federal investment in the pediatric subspecialty workforce, children will continue to face long wait times for subspecialty care, need to travel long distances to receive that care, or go without care altogether.”

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

    CNS and AANS Support the Safe Step Act

    On March 16, the CNS and the AANS joined the Alliance of Specialty Medicine in supporting the Safe Step Act (S. 464/H.R. 2163), sponsored by Sens. Lisa A. Murkowski (R-Alaska), Margaret Wood Hassan (D-N.H.), Bill Cassidy, MD, (R-La.) and Jacky Rosen (D-Nev.) in the Senate, and Reps. Raul Ruiz, MD, (D-Calif.), Brad Wenstrup, DPM, (R-Ohio), Lucy McBath (D-Ga.) and Mariannette Miller-Meeks, MD, (R-Iowa) in the House. Health insurers often use step therapy — also called “fail first” — to control costs. Step therapy occurs when insurers require patients to fail the first step of treatment — typically a generic or low-cost drug — before moving on to the second step. This legislation would require health plans to establish specific exceptions to medication step-therapy protocols.

    Click here to read the Alliance of Specialty Medicine letter.

    Legislation Introduced to Fund Additional GME Slots

    The Resident Physician Shortage Reduction Act (S. 834/H.R. 2256) has been reintroduced in the U.S. Senate and House. Sponsored by Sens. Robert Menendez (D-N.J.), John N. Boozman, OD, (R-Ark.) and Charles E. Schumer (D-N.Y.) in the Senate, and Reps. Terri A. Sewell (D-Ark.), John M. Katko (R-N.Y.), Thomas R. Suozzi (D-N.Y.) and Rodney L. Davis (R-Ill.) in the House, this neurosurgery-endorsed legislation would provide 14,000 new Medicare graduate medical education (GME) slots over seven years. The bill builds on the GME provisions included in the Consolidated Appropriations Act, 2021 (P.L. 116-260), which provided 1,000 new Medicare-funded GME positions. In determining which hospitals would receive slots, CMS would consider the likelihood of a teaching hospital filling positions and would be required to distribute at least 10% of the positions in each of the following categories: 

    • Hospitals in rural areas;
    • Hospitals training over their current GME caps;
    • Hospitals in states with new medical schools or new branch campuses; and
    • Hospitals that serve areas designated as health professional shortage areas.

    Click here to read neurosurgery’s letter to the Senate sponsors and here for the House letter. Click here for the coalition letter to the House and here for the Senate letter.

    Neurosurgery Supports NOPAIN Act

    On March 23, the CNS, the AANS, the CNS/AANS Joint Section on Pain and the CNS/AANS Joint Section on Disorders of the Spine and Peripheral Nerves endorsed the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (S. 586). Sponsored by Sens. Shelly M. Capito (R-W.Va.), Jeanne Shaheen (D-N.H.), Rob Portman (R-Ohio) and Joe Manchin (D-W.Va.), the NOPAIN Act would require Medicare to provide adequate facility reimbursement for innovative and effective alternatives to opioids. In the letter, the neurosurgical groups pointed out that neurosurgeons are on the cutting edge of innovative, non-opioid treatments for chronic pain and acute postoperative pain.

    Click here to read neurosurgery’s endorsement letter.

    Neurosurgery Supports Firearms Safety Research

    On March 25, the CNS and the AANS joined more than 200 organizations in letters urging Congress to provide $50 million to the Centers for Disease Control and Prevention and the NIH to conduct public health research into firearm morbidity and mortality prevention. This research aims to provide data to help determine strategies for preventing tragic injuries and death from firearms.

    Read the letters to the House and Senate leadership.

    Neurosurgery Supports Legislation to Address Physician Burnout

    On March 25, the CNS and the AANS joined in a letter to Sens. Tim Kaine (D-Va.) and Todd C. Young (R-Pa.) and Reps. Susan E. Wild (D-Pa.) and David B. McKinley (R-W.Va.) supporting the Dr. Lorna Breen Health Care Provider Protection Act (S. 610/H.R. 1667). This legislation aims to reduce and prevent mental and behavioral health conditions, suicide and burnout, as well as increase access to evidence-based treatment for physicians, medical students and other health care professionals — especially those who continue to be overwhelmed by the COVID-19 pandemic.

    Click here to read the coalition letter.

    Grassroots Alert

    Contact Congress to Fund Additional GME Slots

    The nation is facing an acute shortage of between 54,100 and 139,000 physicians by 2033 — with a shortfall of up to 55,200 in primary care and 86,700 in specialty care, including surgeons. The supply of surgeons is projected to have nominal growth by 2033, while projected demand is expected to increase — resulting in a shortage of between 17,100 and 28,700 surgeons. The Resident Physician Shortage Reduction Act (S. 834/H.R. 2256) would support 14,000 new Medicare-funded GME positions over seven years. Please contact Congress and ask your Senators and Representative to co-sponsor the Resident Physician Shortage Reduction Act.

    Click here to go to neurosurgery’s Advocacy Action Center to send an email to your elected officials asking them to take action on S. 834 and H.R. 2256. A sample message, which can be personalized, is provided.

    Coding and Reimbursement

    Medicare Educational Information for Physicians

    The Medicare Learning Network (MLN) provides free online educational materials for health care professionals to help understand CMS programs, policies and initiatives. The CNS and the AANS participate in the MLN Provider Association Partnership, which provides neurosurgery with weekly updates on CMS activity. Neurosurgeons and their staff can also access MLN content by subscribing to the MLN Connects newsletter.

    Quality Improvement

    Neurosurgery Urges CMS to Improve Quality Payment Program

    As part of the effort to improve Medicare’s Quality Payment Program (QPP), the CNS and the AANS joined more than 40 national medical organizations in a letter to acting CMS administrator, Elizabeth Richter, urging the agency to make significant improvements in the Merit-based Incentive Payment System (MIPS) Value Pathway (MVP) program. The MVP program aims to establish a condition-focused quality reporting option.

    In a separate but related effort, the neurosurgical societies joined the American Academy of Orthopaedic Surgeons and the American Academy of Physical Medicine and Rehabilitation in asking CMS to halt the development of a Degenerative Spine Disease MVP. While organized neurosurgery does not necessarily oppose the establishment of MVPs, the CNS and the AANS are concerned about the agency’s methodology for measuring quality and costs related to this program.

    Finally, recognizing the many shortcomings of Medicare’s quality and value-based payment programs, the CNS and the AANS joined the Alliance of Specialty Medicine in urging key House and Senate Committees to convene oversight hearings to examine the implementation of physician-focused value-based care initiatives authorized under the Medicare Access and CHIP Reauthorization Act (MACRA).

    Click here to read the coalition letter, here to read neurosurgery’s letter regarding a spine MVP and here for the letter to Congress urging hearings on MACRA’s quality programs.

    Biomedical Research

    Neurosurgery Comments on NINDS Strategic Plan

    The NINDS is currently developing a strategic plan for the next five years. This new plan will help NINDS fulfill its mission to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. On March 15, the One Neurosurgery Summit group — which includes the American Academy of Neurological Surgery, AANS, American Board of Neurological Surgery, CNS and Society of Neurological Surgeons — submitted a letter in response to the request for comments on the draft plan.

    Of Note

    Senate Confirms Becerra for HHS Secretary

    On March 18, by a vote of 50 to 49, the U.S. Senate confirmed Xavier Becerra as secretary of the U.S. Department of Health and Human Services (HHS). Sen. Susan Collins (R-Maine) was the sole Republican to back Becerra. With nearly 80,000 employees and a $1.2 trillion annual budget, HHS is one of the federal governments’ largest departments, overseeing important agencies, including CMS, the Food and Drug Administration and the NIH. It is expected that Secretary Becerra will prioritize the following issues: 

    • Expanding the Affordable Care Act;
    • Health equity; and
    • Drug pricing.

    Additionally, on March 23, by a vote of 57 to 43, the Senate confirmed Vivek H. Murthy, MD, to reprise his role as the U.S. surgeon general. Finally, on March 24, by a vote of

    52 to 48, the Senate confirmed Rachel L. Levine, MD as assistant secretary for HHS.

    AMA Report Highlights Increases in Medical Liability Premiums

    Using data from the Medical Liability Monitor’s Annual Rate Survey, a new report from the American Medical Association summarizes changes in medical liability premiums from 2011 to 2020. The report highlights that more premiums increased in 2020 than in any year since 2005, which appears to be the beginning of an upward trend in increases in premiums — a trend not seen in more than 20 years. These findings suggest that the industry is in the early stages of a hard market.

    Click here to read the report.


    Neurosurgery Blog Continues Women in Neurosurgery Series

    2020 marked the historic 30th anniversary of the founding of Women in Neurosurgery (WINS), bringing with it an exciting time for 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:

    In addition to its WINS series, Neurosurgery Blog continues publishing items of importance to the neurosurgical community. Most recently, the blog highlighted March’s annual ThinkFirst Awareness Month with a blog titled “ThinkFirst About Brain Injury: A Call to Action.”

    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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