• Vol. 67, April 2020 DC E-Newsletter

    • Apr 24, 2020

    COVID-19

    CNS and AANS Urge HHS to Direct COVID-19 Funding to Physicians

    Joining more than 145 state and national medical associations, on April 7, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) wrote U.S. Department of Health and Human Services (HHS) Secretary Alex M. Azar requesting “immediate financial assistance for physicians across the country who are taking heroic action to treat patients with the novel coronavirus, providing ongoing care for patients with chronic conditions and urgent needs, and incurring significant financial losses due to postponing non-essential procedures and visits.” The letter asks that HHS provide each physician, nurse practitioner and physician assistant enrolled in Medicare or Medicaid an automatic one-time lump sum payment equal to one month of expected lost revenue from Medicare and other payers due to COVID-19.

    Click here to read the letter.

    HHS Begins Delivering Provider Relief Funding

    On April 10, HHS began delivering the initial $30 billion in COVID-19 relief funding to eligible providers. This is a partial distribution of the $100 billion provider relief fund provided for in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L.116-136), which was signed into law on March 27. These funds — which need not be repaid — may be used for health care expenses and lost revenue attributable to the coronavirus. According to the HHS notice, even if physicians have ceased operations as a result of the COVID-19 pandemic, they are still eligible to receive funds as long as they provided diagnoses, testing or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

    HHS has partnered with the UnitedHealth Group (UHG) to deliver the initial $30 billion distribution to providers as quickly as possible. Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. Click here to sign the attestation form and here for more information about the program.

    Additionally, on April 9, the Centers for Medicare & Medicaid Services (CMS) announced the approval of more than $51 billion to health care providers — an increase from the $34 billion the agency previously promised — under the Accelerated and Advance Payment Program. A fact sheet on the payment process and how to submit a request can be found here. Neurosurgeons can also contact their Medicare Administrative Contractor for any questions.

    Neurosurgery Leads Effort for COVID-19 Medical Liability Protections

    On April 9, the Health Coalition on Liability and Access (HCLA) sent a letter to Congress requesting broad medical liability protections related to COVID-19. Katie O. Orrico, Esq., director of the CNS/AANS Washington Office, serves as HCLA’s vice-chair and co-authored the letter. The letter asks Congress to follow the lead of several states and immediately adopt legislation that “provides healthcare professionals and facilities immunity from civil liability for any injury or death alleged to have been sustained because of any acts or omissions undertaken in good faith while providing health care services in support of the Nation’s COVID-19 response.”

    The letter 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 letter.

    Contact Congress to Support COVID-Related Medical Liability Protections

    The CNS and the AANS are urging Congress to adopt legislation that provides physicians immunity from civil liability for any injury or death alleged to have been sustained because of any acts or omissions undertaken in good faith while responding to the COVID-19 pandemic.

    Click here to send an email message urging your members of Congress to support medical liability protections for COVID-related care. A sample message, which can be personalized, is provided.

    Neurosurgery Asks Congress for Additional COVID-19 Relief

    Joining the surgical community, on April 13, the CNS and the AANS sent a letter to Congress recommending additional relief in response to the COVID-19 pandemic. Specifically, the letter asks Congress to build on the critical support already provided and incorporate the following into the next COVID-19 legislative package: 

    • Additional financial support for physicians;
    • Refinements to the Medicare Accelerated and Advance Payment Program;
    • Relief from scheduled cuts to Medicare physician payment;
    • Medical liability protections for physicians;
    • Student loan relief for physicians; and
    • Supply chain support for life-saving equipment.

    In addition, on April 15, the CNS and the AANS joined the American Medical Association (AMA) and more than 130 state and national medical societies in sending a similar letter to Congress.

    Click here to read the surgical group letter and here for the AMA-led letter.

    From the COVID-19 Frontlines: UCSF Establishes Neurosurgical Treatment Algorithm

    With insufficient data to create formal guidelines, hospitals and neurosurgical departments across the country have developed individual COVID-19 treatment protocols. Physicians from the University of California San Francisco (UCSF) Department of Neurological Surgery and Department of Anesthesia have presented their institutional neurosurgical treatment algorithm during the California COVID-19 shelter-in-place order. The UCSF protocols are based on outbreak “surge levels,” and using these levels to guide operating room utilization based on the acuity of neurosurgical cases. The protocols and checklists from UCSF, which are published online in Neurosurgery, offer some guidance to neurosurgeons in other centers.

    Click here to read “Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm.” The CNS also offers a related webinar presentation, “UCSF’s Experience with COVID-19 in the Midst of the California Shelter-in-place Order.” Click here to view the webinar.

    CMS Announces Quality Payment Program Relief Due to COVID-19

    CMS recently announced that the agency will provide COVID-19-related relief for clinicians participating in a variety of Medicare quality reporting and value-based purchasing programs. For the Merit-Based Incentive Payment System (MIPS), CMS extended the 2019 data submission deadline from March 31 to April 30. The agency will also apply its automatic extreme and uncontrollable circumstances policy to MIPS eligible clinicians who participated in MIPS in 2019 as individuals and submitted less than two categories of performance data. These clinicians automatically qualify for a neutral MIPS adjustment in 2021 and need not take any additional action. For all other MIPS eligible clinicians — including those who participated in MIPS in 2019 at the group level and those who participated as individuals, but already submitted two or more categories of data — CMS has re-opened its Extreme and Uncontrollable Circumstances Exception application. Eligible clinicians will have until April 30 to request an exception for all four MIPS performance categories due to the COVID-19 pandemic. If approved, CMS will re-weight all four categories, and the clinician or group will receive a neutral payment adjustment for the 2021 payment year.

    Additional information about 2019 MIPS flexibilities is available here.

    CMS Issues Updated COVID-19 Information

    On April 7, CMS released a letter to physicians related to COVID-19. The letter addresses the following items:

    • Accelerated and Advanced Payments
    • Medicare Telehealth Visits
    • Expanded Options for Telehealth Services
    • Workforce Flexibilities
    • Quality Payment Program
    • Testing and Claims Reporting for COVID-19
    • Virtual Check-ins
    • Emergency Waivers 

    Click here to read the letter. CMS also repackaged its guidance on elective surgery. Click here for that document.

    Check the CNS and AANS COVID-19 Information Hubs for Updated Information

    The CNS and the AANS have published COVID-19 information hubs on their respective websites. Neurosurgeons 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
    • CNS/AANS Advocacy Efforts
    • Continuing Medical Education
    • Additional Resources

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

    Legislative Affairs

    Neurosurgery Urges Congress to Fund Research on Firearms Safety

    On March 30, the CNS and the AANS joined nearly 200 health care organizations in letters to House and Senate appropriators requesting $50 million in federal funding to the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) for research on firearm-related morbidity and mortality prevention. As a testament to the success of the collective advocacy on this issue, the CDC and NIH have issued funding opportunity announcements for the first time in more than 20 years. The goal of this letter is to help protect and expand this crucial funding.

    Click here for a copy of the House letter and here to read the Senate letter.

    Senate Letter in Support of Funding for MISSION Zero Act

    At the request of the Trauma Coalition, a letter in support of Fiscal Year 2021 funding for the Military and Civilian Partnership for the Trauma Readiness Grant Program was sent to the Senate Appropriations Committee and the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. Led by Sens. Martha McSally (R-Ariz.) and Chris Van Hollen (D-Md.), the letter requests $11.5 million for the grant program, formally known as MISSION Zero, to provide funding to ensure trauma care readiness by integrating military trauma care providers into civilian trauma centers. These partnerships allow our military trauma care providers to gain exposure to treating critically injured patients in our communities and keep their skills sharp to increase readiness for deployment. Additionally, they allow our civilian trauma care providers to gain insight into best practices from the battlefield that can be integrated into civilian trauma care.

    Sens. Sherrod Brown (D-Ohio), Bill Cassidy, MD, (R-La.), Christopher Coons (D-Del.), Dianne Feinstein (D-Calif.), Maggie Hassan (D-N.H.) and Kyrsten Sinema (D-Ariz.) also signed the letter.

    Grassroots Alert

    Contact Congress to Support GME Funding

    The CNS and the AANS are urging Congress to adopt the legislation to address the current and future physician shortage. The Resident Physician Shortage Reduction Act (S. 348/H.R. 1763) would increase the number of Medicare-supported graduate medical education (GME) slots by 15,000, a rate of 3,000 per year over five years. One-half of these slots are required to be used for shortage specialty residency programs. The remaining slots would be distributed to new programs and to hospitals that have training positions above the 1997 cap.

    Click here to send an email message urging your members of Congress to co-sponsor this legislation. A sample message, which can be personalized, is provided.

    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.

    Participate in a Congressional Town Hall Event

    Neurosurgeons are encouraged to participate in local town hall meetings and teleconference calls that members of Congress are holding across the nation. To determine whether your member of Congress is holding a town hall meeting, visit the Town Hall Project website, which provides locations and call-in numbers for these events. This resource is a great way to keep up with your elected officials and let them hear about your specific concerns. The Town Hall Project is dedicated to the conviction that our democracy is stronger when Americans and their elected representatives regularly meet face-to-face. Its work empowers constituents across the country to have face-to-face conversations with their elected representatives.

    Coding and Reimbursement

    Neurosurgery Comments on Washington State Evidence for VNS for Depression

    On March 30, the CNS, the AANS, the American Society for Stereotactic and Functional Neurosurgery and the Washington State Association of Neurological Surgeons submitted a letter to the Washington State Health Care Authority (HCA) Health Technology Assessment (HTA) Program regarding a recent evidence report on vagal nerve stimulation (VNS) for epilepsy and depression. Organized neurosurgery disagreed with the report’s conclusion that “there is a lack of robust evidence on the effectiveness of VNS for depression in adults.” The letter outlined additional evidence supporting coverage for VNS for depression.

    The Washington State HCA HTA program Health Technology Clinical Committee will meet on May 15 to vote on expanding its coverage policy for VNS. More information on the review is available here

    Quality Improvement

    CNS and AANS Urge CMS to Modify New Medicare Value Pathway Program

    On April 10, the CNS and the AANS joined 35 other national medical societies in urging CMS to modify the new Merit-based Incentive Payment System (MIPS) Value Pathway (MVP) program. In the letter, the groups agreed that the MVP may reduce quality reporting, and the high-level framework outlined by CMS is an important step in the right direction. Nevertheless, neurosurgery believes that the MVP pathway needs to be structured appropriately to effectively improve the relevance of MIPS to clinical practice and reduce unnecessary paperwork burdens. Specifically, the letter recommends that CMS: 

    • Ensures that MVP participation is voluntary;
    • Creates a transition period;
    • Focuses on measures that are meaningful to physicians;
    • Promotes the use of new and innovative health information technology; and
    • Reduces reporting burden by streamlining reporting.

    Click here to read the letter. The CNS and the AANS also joined the Physician Clinical Registry Coalition in asking CMS for MVP relief. Click here to read this letter.

    Drugs and Devices

    FDA Issues Aneurysm Safety Update

    On Dec. 18, 2019, MicroVention released a letter to health care providers with an update on reported adverse events for the MicroVention Woven EndoBridge (WEB) Aneurysm Embolization System. Specifically, six intra-procedural, intracranial aneurysm ruptures caused by aneurysm wall perforation were reported to MicroVention in 2019. These events resulted in patient deaths due to iatrogenic intra-procedural subarachnoid hemorrhage. The Food and Drug Administration (FDA) is asking neurosurgeons to take note of this information.

    Neurosurgery Comments on Proposed Medicare Opioid Prescribing Rules

    On April 6, the CNS and the AANS submitted a letter to CMS responding to the agency’s proposed regulation of Medicare Advantage (MA) and Medicare Part D prescription drug programs. The proposal includes several provisions required by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act (P.L. 115-271). The letter states that opioid prescribing for pre- and post-operative neurosurgical patients, and those with chronic pain, is highly individualized. Therefore, any assessment of whether the prescription is appropriate should be made by a physician of the same specialty. Additionally, the letter supports adequate coverage and reimbursement for evidence-based and effective non-opioid neuromodulation and other device-based therapies.

    The CNS and the AANS also joined the Alliance of Specialty Medicine in sending comments on the opioid prescribing and other provisions of the proposed rule.  

    Communications

    CNS/AANS Washington Office Welcomes New Staff

    On March 30, Lara C. Kanitra joined the CNS/AANS Washington Office as the new senior manager for communications. Lara comes to organized neurosurgery from the National Foundation for Infectious Diseases, where she served as the manager for communications and marketing. She will be the principal point of contact for all CNS/AANS Washington Office communication efforts. Lara can be reached via email at lkanitra@neurosurgery.org.

    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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