• Vol. 80, August 2021 DC E-Newsletter

    • Aug 17, 2021

    Special Announcement

    Neurosurgical Residents are Encouraged to Apply for the Washington Committee/AMA Fellowship

    The Congress of Neurological Surgeons (CNS)/American Association of Neurological Surgeons (AANS) Washington Committee provides eligible neurosurgical residents and fellows an opportunity for a richer, more diverse and actionable experience in health care policy and advocacy — in both the regulatory and legislative arenas. The Washington Committee/American Medical Association (AMA) Fellowship is a two-year fellowship providing the successful applicant with a liaison position on the Washington Committee and participation in the AMA’s Resident & Fellows Section as the CNS/AANS resident or fellow delegate.  

    The fellowship is open to individuals in a neurosurgical residency or fellowship program between Jan. 3, 2022, thru Dec. 31, 2023. The applicant must be at least a postgraduate year three (PGY3) resident at the start of the fellowship. Fellows must attend the two-day AMA-RFS biannual meetings — during the AMA’s annual meeting in June and its November interim meeting. In addition, when invited, fellows are expected to attend Washington Committee meetings (typically held in February/March and July). They are also encouraged to attend subcommittee meetings held during the CNS and AANS annual meetings.

    Past fellows have contributed to Washington Committee and Council of State Neurosurgical Societies’ research projects, served on expert Medicare technical advisory panels, attended legislative conferences and other valuable initiatives.

    The Washington Committee is seeking applications at this time. The deadline for submission is Aug. 31, 2021. The applicant’s program or fellowship director must provide written confirmation and approve the prospective fellow’s full participation in the program.

    Click here for more information and to download the fellowship application.

    COVID-19

    HHS Secretary Renews COVID-19 Public Health Emergency

    On July 19, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) declaration. Effective July 20, the PHE will be extended for an additional 90 days. This means that all telehealth and other waivers and flexibilities implemented during the PHE will remain in effect. HHS has previously indicated that the PHE will likely stay in place throughout the remainder of 2021. The department has also stated that it will provide 60 days’ notice when a decision is made to terminate the declaration or let it expire.

    Legislative Affairs

    Neurosurgery Leads Coalition Effort to Prevent Steep Medicare Cuts

    On July 23, the CNS and the AANS joined more than 100 health care organizations to urge congressional leaders to avoid Medicare payment cuts in 2022. The letter — sent to House Speaker Nancy Pelosi (D-Calif.), House Minority Leader Kevin McCarthy (R-Calif.), Senate Majority Leader Charles Schumer (D-N.Y.) and Senate Minority Leader Mitch McConnell (R-Ky.) — thanked Congress for mitigating cuts that were scheduled to take effect in 2021 “via a 3.75% Conversion Factor (CF) increase for all services.” The letter noted that “the provider community is again bracing for steep cuts in 2022, which could result in many beneficiaries losing timely access to essential health care services. To avoid this scenario, our organizations urge Congress to maintain the 3.75% increase to the CF through at least calendar years 2022 and 2023.”

    The letter also urged congressional leaders to consider reforms to the Medicare Physician Fee Schedule, including “addressing the budget neutrality requirement, which can lead to arbitrary reductions to reimbursement unrelated to the cost of providing care.” The letter stated that this requirement often results in providers being “forced into an adversarial role when fee schedule payment policies are developed and/or implemented.” Ultimately patients “suffer as providers adjust to unpredictable and excessive reductions to reimbursement that inhibit their ability to ensure beneficiaries have access to the care they need; services that improve outcomes and lower costs.”

    “We remain committed to partnering with Congress to identify and advance these critical reforms and appreciate your continued support of the health care providers on which older Americans rely,” the letter concluded.

    Click here to read the letter.

    Neurosurgery Joins Coalition in Providing Recommendations for Cures 2.0 Legislation

    On July 9, the CNS and the AANS joined the Physician Clinical Registry Coalition (PCRC) in sending a letter to Reps. Diana DeGette (D-Colo.) and Fred Upton (R-Mich.) offering recommendations for the new Cures 2.0 legislative package. The letter requests that Congress include language guaranteeing clinician-led clinical data registries access to Medicare, Medicaid and state Children’s Health Insurance Program claims data for quality improvement, patient safety and research purposes.

    Click here to read the letter.

    House Passes Health Spending Bill — Embracing Neurosurgery’s Priorities

    On July 15, the House Appropriations Committee approved its $253.8 billion fiscal year (FY) 2022 funding bill for the Departments of Labor, Health and Human Services (HHS), Education and Related Agencies. The legislation was packaged into a broader spending bill, H.R. 4502, which passed the House on July 29 by a vote of 219 to 208. Some highlights pertinent to neurosurgery include: 

    • $49 billion for the National Institutes of Health;
    • $612 million for the BRAIN Initiative;
    • $400 million for the Children’s Hospitals Graduate Medical Education Payment Program;
    • $25 million for the Pediatric Subspecialty Loan Repayment Program;
    • $25 million for firearm injury and mortality prevention research;
    • $43 million for opioids and pain management research at the National Institute of Neurological Disorders and Stroke;
    • $15 million for traumatic brain injury; and
    • $5 million for the Military and Civilian Partnership for Trauma Readiness Grant Program (also known as the MISSION ZERO program).

    Other priorities include funding for the early detection of brain aneurysms and brain cancer research. Finally, the House has requested that the Centers for Medicare & Medicaid Services (CMS) report to Congress on the status of the Medicare Appropriate Use Criteria Program for advanced diagnostic imaging, including any challenges the agency is experiencing in implementing the program.

    The Senate has not committed to a timeline for its FY 2022 appropriations bills, increasing the likelihood of stop-gap funding legislation to avoid a government shutdown at the end of the fiscal year on Sept. 30.

    Click here for a summary of the bill and here for the report accompanying the legislation.

    Grassroots Alerts

    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. 3173, the Improving Seniors’ Timely Access to Care Act. If passed, this legislation would reduce prior authorization hassles and help curb unnecessary delays for patients covered by MA plans. Please contact Congress and ask your Representative to co-sponsor H.R. 3173.

    Click here to go to neurosurgery’s Advocacy Action Center to send an email to your Representative asking them to co-sponsor the Improving Seniors’ Timely Access to Care Act. A sample message, which can be personalized, is provided.

    Contact Congress to Support COVID-19-Related Liability Protections for Health Care Professionals

    The Coronavirus Provider Protection Act (H.R. 3021) would protect health care professionals and the facilities in which they practice from the serious threat of COVID-19-related liability lawsuits. This bipartisan legislation would provide limited protections to help ensure that physicians who have served on the front lines of the coronavirus pandemic are not drawn into unwarranted lawsuits resulting from the selfless care they have provided. While some states have passed similar protections, a federal solution is needed to protect these vulnerable providers. Please contact Congress and ask your Representative to co-sponsor H.R. 3021.

    Click here to go to neurosurgery’s Advocacy Action Center to send an email to your U.S. Representative asking them to co-sponsor H.R. 3021. A sample message, which can be personalized, is provided.

    Contact Congress to Fund Additional GME Slots

    The nation is facing an acute shortage of between 37,800 and 124,000 physicians by 2034 — with a shortfall of up to 48,000 in primary care and 71,100 in specialty care, including surgeons. The supply of surgeons is projected to have nominal growth by 2034, while projected demand is expected to increase — resulting in a shortage of between 15,800 and 30,200 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

    Surgeons Urge CMS to Increase Global Surgery Code Values

    On July 22, the CNS and the AANS joined 22 other surgical organizations in sending a letter to CMS objecting to the agency’s ongoing failure to value global surgery codes appropriately. In 2021, the values for new stand-alone evaluation and management (E/M) office visit codes were increased, but CMS did not adjust the E/M portion of the 10- and 90-day global codes. The continued refusal to make these adjustments means that Medicare is systematically devaluing surgical care. Furthermore, in the past, when office visit code values increased, CMS also increased the post-operative E/M portion of the global surgery codes. The letter points out that to do otherwise will continue to:  

    • Disrupt the relativity in the fee schedule;
    • Create specialty payment differentials; and
    • Ignore recommendations endorsed by nearly all medical specialties.

    The surgical community will continue to advocate for fair Medicare payment policies, leveraging the efforts of the Surgical Care Coalition — of which the CNS and the AANS are founding members — to demonstrate the value of surgical care and the need to increase global surgery payments.

    CMS Releases 2022 Medicare Physician Fee Schedule Proposed Rule

    On July 13, 2021, CMS released the 2022 Medicare Physician Fee Schedule proposed rule. Overall, neurosurgery will receive a 3.2% payment cut in 2022. The cut stems from a lower conversion factor — from $34.89 in 2021 to $33.58 in 2022 — primarily due to the discontinuation of the 3.75% payment increase included in the Consolidated Appropriations Act, 2021. With the 2% Medicare sequester set to resume next year and additional Medicare payment cuts of up to 4% possible under pay-as-you-go rules to pay for the American Rescue Plan, providers could be facing up to 9% in payment cuts next year unless Congress intervenes.

    In addition, CMS rejected the American Medical Association/Specialty Society RVS Update Committee (RUC) recommended work relative values (wRVUs) for new laser interstitial thermal therapy (LITT) codes and the new arthrodesis decompression add-on codes to report decompression when performed in conjunction with posterior interbody arthrodesis at the same interspace.

     

    CPT Code

    Descriptor

    RUC-Passed wRVU

    CMS Proposed wRVU

    617X1

    Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; single trajectory for 1 simple lesion

    20.00

    19.06

    617X2

    Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; multiple trajectories for multiple or complex lesion(s)

    24.00

    22.67

    616X1

    Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; each additional segment

    4.44

    2.31

    616XX

    Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment

    5.55

    3.08

    Finally, once again, CMS proposes to delay the effective date for the penalty phase of the Medicare AUC Program to either Jan. 1, 2023, or the first January following the end of the COVID-19 PHE, whichever is later.

    Click here for a CMS press release that includes links to multiple fact sheets.

    Medicare Releases 2022 Hospital OPPS/ASC Proposed Rule

    On July 19, CMS released the 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment proposed rule. The agency plans to increase hospital outpatient and ACS payment rates by 2.3%. Hospitals and ASCs that fail to meet their quality reporting program requirements would also be subject to a 2.0% reduction in the update. Also, CMS proposes to halt the elimination of the Inpatient Only (IPO) list. In 2020, there were 1,740 services on the IPO list. In 2021, CMS initiated a three-year transition to eliminate the IPO list, beginning with 298 mostly musculoskeletal-related services. If CMS finalizes this policy, these 298 services will be added back to the IPO list in 2022. In addition, CMS proposes to re-adopt the ASC Covered Procedures List (CPL) criteria in effect in 2020 and changed last year. The agency would also remove 258 of the 267 procedures added to the ASC CPL in 2021.

    The reversals are in keeping with previous CNS and the AANS comments where we emphasized that the site of service should be determined by the surgeon and patient, not CMS. In last year’s comment letter, the neurosurgical groups raised patient safety concerns and worried that CMS would make it difficult to access the inpatient setting when necessary.

    Click here to read the proposed rule, here for the press release and here for a fact sheet.

    Communications

    Neurosurgeon Publishes Op-Ed on Prior Authorization

    On July 21, The American Spectator published an op-ed by Richard Menger, MD, MPA, a member of the CNS/AANS Communications and Public Relations (CPR) Committee. Titled “Bipartisan Bill Would Improve Medicare Patients’ Access to Care,” Dr. Menger discusses how H.R. 3173, the Improving Seniors’ Timely Access to Care Act, could bring transparency to the process of prior authorization in Medicare Advantage (MA) plans. On July 26, Neurosurgery Blog published a cross-post to amplify the message.

    Neurosurgery Blog Continues Faces of Neurosurgery Interview Video Series

    The Neurosurgery Blog: More than Just Brain Surgery recently launched a Faces of Neurosurgery interview video series. Conducted by Kurt A. Yaeger, MD, a member of the CNS/AANS CPR Committee, these neurosurgery luminaries are asked about their early mentors, proudest achievement and advice for neurosurgical residents. To date, interviews with Kalmon D. Post, MD, FAANS (L), R. Michael Scott, MD, FAANS (L) and Kim J. Burchiel, MD, FAANS, FACS have been published.

    Click here for Dr. Post’s interview, here for Dr. Scott’s interview and here for Dr. Burchiel’s interview.

    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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