• Vol. 78, June 2020 DC E-Newsletter

    • Jun 22, 2020

    Special Announcement

    CNS and AANS Launch Campaign to Protect Patient Access to Care

    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 because of concerns about new Medicare payment policies for office and outpatient visits that the Centers for Medicare & Medicaid Services (CMS) will implement in January 2021. Changes to these visit codes — also known as evaluation and management (E/M) codes — will reduce payments for surgical care, which may lead to reduced access to care for older Americans. The CNS and AANS are asking Congress to waive Medicare’s budget neutrality requirements to prevent the cuts and to require CMS to apply the increased E/M payment adjustments to all 10- and 90-day global surgery codes.

    The SCC recently commissioned a survey of more than 5,000 surgeons, which found that surgical practices are facing severe financial distress due to the COVID-19 pandemic. While the cuts were announced before the pandemic, with the combined impact of the planned CMS cuts and the financial challenges due to COVID-19, surgeons and hospitals will face difficult decisions to keep surgical practices afloat. For neurosurgeons, the survey found that even before the CMS cuts take effect: 

    • More than one-half (54%) of respondents are concerned that they could be forced to shut down their practice, limiting choice and access to neurosurgical care;
    • Three-quarters (74%) of neurosurgeons are concerned about the finances of their practice, and to keep the doors open, 38% have cut their own salary, and one-quarter (24%) have taken on debt as a result of COVID-19; and
    • In the face of declining revenues, 86% of respondents are worried that they will have to cut employee’s salaries and 76% fear that they may have to permanently layoff employees.

    In announcing the SCC initiative, John A. Wilson, MD, FAANS, president of the AANS, noted that “Neurosurgeons take care of critically ill patients who suffer from painful and life-threatening neurologic conditions such as traumatic brain injury, brain tumors, debilitating degenerative spine disorders and stroke, and without timely neurosurgical care, our patients can face permanent neurologic damage or death. He added, “The planned cuts to Medicare payments will further stress a healthcare system critically affected by the pandemic crisis and may negatively impact Medicare beneficiaries’ access to care.”

    Echoing his remarks, Steven N. Kalkanis, MD, FAANS, president of the CNS, stated, “It is essential that policymakers understand how these payment cuts may impact access to surgical care. COVID-19 has placed an unprecedented strain on our health care system, and additional Medicare payment cuts will not only threaten timely access to quality care but will also stress an already fragile health care system.”

    Click here to read the CNS and AANS press release. Neurosurgeons are encouraged to follow the coalition on Twitter and LinkedIn.

    COVID-19

    COVID-19 Medical Liability Protection Legislation Introduced

    On May 28, Reps. Phil Roe, MD, (R-Tenn.) and Lou Correa (D-Calif.) introduced H.R. 7059, the Coronavirus Provider Protection Act, which would provide health care professionals, and the facilities in which they work, protections from COVID-19-related lawsuits. Examples of increased liability risk that providers are confronting because of COVID-19 include: 

    • Practitioner shortages that have required providers to treat patients outside their general practice areas and prompted retired physicians to return to the workforce;
    • Inadequate protective safety gear that could result in the inadvertent transmission of the virus;
    • Lack of essential medical equipment, including ventilators, which may require the rationing of care;
    • Inadequate testing leading to delayed or flawed diagnoses; and
    • Delayed treatment of elective and non-COVID-19 medical treatments to save resources for coronavirus patients.

    The CNS and the AANS issued a press release supporting the measure and sent a letter to the bill’s sponsors endorsing the legislation. Additionally, the neurosurgery groups led the Health Coalition on Liability and Access (HCLA) effort in support of H.R. 7059. Finally, the CNS and the AANS joined the American Medical Association and more than 130 state, specialty and national medical associations in a letter to congressional leaders. Click here to read HCLA’s letter and here to read the AMA-led letter.

    Contact Congress to Cosponsor the Coronavirus Provider Protection Act

    Due to COVID-19, the risk of unwarranted medical liability lawsuits remains. Please contact Congress and ask your representatives to cosponsor H.R. 7059, the Coronavirus Provider Protection Act, and request that Senators include the provisions of the bill in any legislation considered by that chamber.

    Click here to send an email to Congress. A sample message, which can be personalized, is provided.

    Neurosurgery Urges CMS to Extend Telehealth Services Post-COVID-19

    On May 27, the CNS and the AANS joined the Alliance of Specialty Medicine in sending a letter to CMS urging the agency to work with Congress and its federal agency partners to ensure ongoing access to expanded telehealth services following the end of the COVID-19 Public Health Emergency (PHE). The letter recommends that CMS: 

    • Maintain the updated Medicare telehealth list, to include retaining all of the services added to the Medicare telehealth list in response to the PHE for COVID-19;
    • Eliminate site-of-service payment differentials for telehealth visits, and maintain Medicare coverage and enhanced payment for “telephone” Evaluation and Management services (CPT 99441 – 99443);
    • Allow key telehealth and virtual care services (e.g., virtual check-ins, e-visits and other communication technology-based services) to be furnished to both new and established patients;
    • Preserve direct supervision revisions that allow physicians to supervise in-office clinical staff using communications technologies, when appropriate; and
    • Ensure that physicians may perform telehealth services from their homes without updating their Medicare enrollment.

    The letter also encourages CMS to work with state Medicaid programs and private payers adopt similar telehealth policies and to reimburse providers for telehealth services in the same manner or at the same rate that they pay for face-to-face services.

    CMS Clarifies Scope of New COVID-19 Improvement Activity for 2020 MIPS

    Recently, the CMS announced the approval of a new COVID-19-focused activity that clinicians can use to earn credit under Medicare’s Merit-based Incentive Payment System (MIPS) improvement activities performance category. There are two separate ways that clinicians can receive credit for this new improvement activity: 

    • A clinician may participate in a COVID-19 clinical trial and have the information entered into a data platform for that study; or
    • A clinician participating in the care of COVID-19 patients may submit clinical COVID-19 patient data to a clinical data registry for purposes of future study.

    According to CMS, clinicians may attest to this new improvement activity in 2020 if they treat patients diagnosed with COVID-19 and report their data to a registry — including a Qualified Clinical Data Registry — or if they participate in a COVID-19 clinical trial utilizing a drug or biological product to treat a patient with a COVID-19 infection and report their findings through a clinical data repository or clinical data registry.

    Click here for additional information about this and other recent COVID-19-related changes to MIPS.

    Legislative Affairs

    Prior Authorization Legislation Reaches Important Milestone

    Legislation to streamline prior authorization has reached an important milestone, with a bipartisan majority in the U.S. House of Representatives now cosponsoring the bill. Introduced last year by Reps. Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Roger Marshall, MD, (R-Kan.) and Ami Bera, MD, (D-Calif.), H.R. 3107, the Improving Seniors’ Timely Access to Care Act, would protect patients in Medicare Advantage from unnecessary prior authorization practices that limit timely access to medically necessary care.

    The CNS and the AANS are leading the Regulatory Relief Coalition’s (RRC) effort to improve prior authorization. In a statement released on June 11, 2020, Ann R. Stroink, MD, FAANS, chair of the CNS/AANS Washington Committee, noted that “It is especially critical coming out of the COVID-19 crisis, that patients not face additional obstacles to getting the care they need. My patients have faced delays in their surgery for several months, so relieving prior authorization burdens will help.” The bill’s sponsors also featured Dr. Stroink in their release, where she stated:

    Neurosurgeons take care of very sick patients who suffer from painful and life-threatening neurologic conditions such as brain tumors, debilitating, degenerative spine disorders and stroke, and without timely medical care, our patients often face permanent neurologic damage, and sometimes death. Streamlining prior authorization will help ensure that our seniors get the care they need without delay, and we are thrilled that a bipartisan majority of the House of Representatives now supports H.R. 3107.

    Companion legislation is expected to be introduced in the U.S. Senate in July.

    CNS and AANS Urge Senate Appropriators to Fund the MISSION Zero Program

    On May 22, the CNS and the AANS joined with the Trauma Coalition in submitting a statement to the Senate Labor, Health and Human Services and Education Appropriations Subcommittee in support of Fiscal Year 2021 funding for the Military and Civilian Partnership for the Trauma Readiness Grant Program, formally known as the MISSION Zero program. This crucial initiative provides 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. The MISSION Zero Act passed as part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) last year.

    Coding and Reimbursement

    Neurosurgery Urges UHC to Scrap Onerous Prior Auth Policy for Spine Surgery

    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. Per the new policy, UHC intends to require the operating surgeon or office staff to upload radiographic studies as a condition for obtaining prior authorization.  The letter emphasizes that the policy will adversely affect patients’ timely access to care and provide no additional useful information to UHC.

    Click here to read the letter.

    Novitas and FCSO to Reimburse for MRI Guided Focused Ultrasound (MRgFUS) for Essential Tremor (ET)

    On May 28, two Medicare Administrative Contractors (MACs), Novitas and First Coast Service Options (FCSO) announced that they would cover Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (ET) under certain conditions. These new Local Coverage Determinations (LCDs) are a result of CNS, AANS and American Society for Stereotactic and Functional Neurosurgery (ASSFN) advocacy supporting this technology. The new policies cite an ASSFN position statement, titled, “MR-guided Focused Ultrasound for the Management of Essential Tremor,” which includes a robust review of the literature for the procedure.  With the two new positive LCDs, all Part B MACs now provide coverage for MRgFUS for ET.

    Neurosurgery Objects to CMS Rehabilitation Services Proposal

    On June 11, the CNS and the AANS joined more than 100 specialty societies and institutions in sending a letter to CMS objecting to a provision included in the Fiscal Year (FY) 2021 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) proposed rule. Specifically, if adopted, the rule would allow the use of non-physician practitioners to perform the IRF services and documentation services currently required to be performed by rehabilitation physicians. The groups expressed concern that the proposal will undermine the delivery of and access to physician-led team-based care in the IRF setting. The CNS and the AANS agreed that the change would establish a dangerous precedent for removing physician supervision requirements across all health care settings.

    Regulatory Affairs

    Neurosurgery Provides Recommendations for CDC Pain Guideline Update

    On June 16, the CNS and the AANS sent a letter to the Centers for Disease Control and Prevention (CDC) in response to the agency’s notice requesting feedback as it begins updating the CDC’s “Guideline for Prescribing Opioids for Chronic Pain.” The neurosurgical groups pointed out that the guideline, released in 2016, had the unintended consequence of leaving some chronic pain and post-operative patients without adequate treatment options. As the CDC considers updating the guideline, the CNS and the AANS recommended that the agency: 

    • Add a neurosurgeon to its proposed National Center for Injury Prevention and Control (NCIPC) Opioid Workgroup (OWG);
    • Include evidence regarding non-opioid alternatives such as neuromodulation;
    • Address complex issues surrounding opioid prescribing for post-surgical pain; and
    • Acknowledge the importance of insurance payor policy for effective pain treatment.

    Communications

    CNS/AANS Featured in News Articles about Medical Liability Protections

    Katie O. Orrico, Esq., director of the CNS/AANS Washington Office, was featured in two recent articles from the Northern California Record. In an article published on May 18, titled, “Capitol Hill efforts continue for expanded liability protections amid COVID-19,” Ms. Orrico noted that there is a bipartisan willingness for Congress to adopt targeted liability protections for health care professionals. She pointed out that, “In the context of the coronavirus, liability protections are an essential element for businesses and physicians and hospitals to get back up and running as an integral part reopening America.”

    In a follow-up piece published on June 8, titled, “New federal legislation seeks to shield physicians from COVID lawsuits,” Ms. Orrico pointed out that “During this global pandemic, physicians have been dedicated to preserving and protecting the health of the American public under extremely difficult and challenging circumstances, often at risk to themselves.” She concluded by pointing out that “Plaintiff attorneys have already begun filing COVID-19-related lawsuits, and lawsuits, even those without merit, cost time and money, which clearly interferes with the country’s economic recovery. More importantly, such lawsuits distract health care providers from keeping laser-focused on caring for their patients.”

    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, have been 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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