• Volume 47, October 2016 CNS DC E-Newsletter

    • Oct 01, 2016

    Special Announcement

    CMS Finalizes Rules Implementing New Medicare Quality Payment Program

    On Oct. 14, 2016, the Centers for Medicare & Medicaid Services (CMS) released the final rules implementing the new Medicare Quality Payment Program (QPP). Mandated by the Medicare Access and CHIP Reauthorization Act (MACRA), the QPP provides a new framework for rewarding the delivery of quality patient care through two pathways: the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (Advanced APMs).

    While AANS/CNS Washington Office staff are still reviewing the 2,400-page regulation, it appears that CMS made many significant positive changes that reflect the recommendations put forth by the AANS and CNS. Key elements that changed as a result of our advocacy include:

    • Increased the number of physicians exempt from the program. Initially, physicians with less than $10,000 in Medicare payments and fewer than 100 Medicare patients per year were exempt from the program. CMS has instead adopted neurosurgery’s recommendation, and now physicians with less than $30,000 or 100 Medicare patients need not participate in the QPP — exempting approximately 1,217 neurosurgeons.
    • Adopted a transition period to avoid penalties. Recognizing that physician readiness to implement the new QPP will vary, during the 2017 transition year, CMS has established the “pick-your-pace” program for participation. Compatible with neurosurgery’s recommendation to delay implementing the program for six months to one year, during 2017, neurosurgeons can choose one of four reporting options to avoid any penalties and possibly earn bonus payments.
    • Reduced the reporting burden. Heeding the calls of the AANS and CNS, CMS has reduced both the number of measures to be reported and the percent of Medicare patients for whom measures must be reported. For example, initially, the agency would have required physicians to report on 80 or 90 percent of their patients, depending on the data submission method. For 2017, neurosurgeons will only need to report on 50 percent of relevant patients, which mirrors the AANS and CNS request.

    While far from perfect, these and other changes CMS made in the final rule should make it easier for neurosurgeons to participate in the new QPP. In the coming months, the AANS and CNS will unveil additional education materials to ensure that neurosurgeons are prepared, educated and ready to succeed under this Medicare payment program. In the meantime, multiple resources related to the QPP are available from CMS, including:

    Also, on Nov. 21 and Dec. 6, 2016, the AMA will host educational webinar sessions to help physicians prepare and understand what the final rule means for their practice. Click here to register for the Nov. 21 session, which will be held from 7-8 p.m. EST. Click here to register for the Dec. 6 program, which will convene from 8-9 p.m. EST.

    Stay tuned for more detailed information, which will be available at www.cns.org/MACRA.

    Legislative Affairs

    Neurosurgeon Testifies at Congressional Pediatric Trauma Caucus Briefing

    On Sept. 21, 2016, Shelly Timmons, MD, PhD, participated in a Congressional Pediatric Trauma Caucus Briefing. Launched in May 2016 by co-chairs Reps. Richard Hudson (R-N.C.) and G.K. Butterfield (D-N.C.), the Pediatric Trauma Caucus aims to identify strategies for strengthening the nation's pediatric trauma system and reducing traumatic injuries in children. The briefing had a “back-to-school” theme and brought together experts to discuss pediatric trauma and youth sports. The AANS/CNS Washington Office also issued a press release about the briefing, featuring Dr. Timmons and thanking Reps. Hudson and Butterfield for their efforts to strengthen the pediatric trauma system. For more information about this event, click here.

    Bicameral Bill to Improve Trauma Care With Military-Civilian Partnerships Introduced

    On Sept. 28, 2016, Sen. Mark Kirk (R-Ill.) and Rep. Michael Burgess, MD (R-Texas) introduced the MISSION ZERO Act (S. 3407/H.R. 6229). Sens Johnny Isakson (R-Ga.) and John Cornyn (R-Texas) and Reps. Kathy Castor (D-Fla.), Gene Green (D-Texas) and Richard Hudson (R-N.C.) joined as original cosponsors. The bill will facilitate the assignment of military trauma surgeons to civilian trauma centers to maintain military trauma readiness and to help fill a gap in care recently examined by the National Academies of Sciences, Engineering and Medicine. This legislation will address variations in care methods that exist, while also providing military surgeons with additional training. This bill would also provide $40 million in grant funding through the Department of Health and Human Services (HHS) to facilitate partnerships between military trauma care teams/providers and high-volume civilian level 1 trauma facilities.

    In endorsing the MISSION Zero act, AANS/CNS Washington Committee chair, Shelly D. Timmons, MD, PhD, noted that the “legislation would provide an outstanding opportunity for our nation's trauma centers and military to collaborate for the benefit of our servicemen and women, and to augment the capabilities of trauma centers around the country."

    House Passes Sports Medicine Legislation

    On Sept. 12, 2016, the U.S. House of Representatives passed by voice vote H.R. 921, the Sports Medicine Licensure Clarity Act. Sponsored by Rep. Brett Guthrie (R-Ky.), the bill would ensure that sports medicine professionals are covered by their medical liability insurance when providing care to their athletes or teams in states other than where they are licensed. The legislation applies to team physicians who travel as part of their contract to provide services to a team or league. The AANS and CNS have endorsed this bill.

    If you have questions about these, or other legislative issues, please contact Katie Orrico, director of the AANS/CNS Washington Office, at korrico@neurosurgery.org.  

    Coding and Reimbursement

    Neurosurgery Responds to Proposed 2017 Medicare Physician Fee Schedule

    In September, the AANS and CNS submitted comments to CMS regarding the 2017 Medicare Physician Fee Schedule (MPFS) proposed rule. Overall, if adopted, the proposed changes will result in a net one percent decrease in payments to neurosurgeons — due primarily to the impact of changes in the work relative value units. In the letter, organized neurosurgery objected to reductions in proposed values for the following procedures: embolectomy, spinal instrumentation, insertion of spinal stability distractive devices and endoscopic spinal decompression. The AANS and CNS also provided suggestions to CMS concerning the Open Payments program and joined forces with the Alliance of Specialty Medicine in sending an additional comment letter. The agency is expected to publish the final fee schedule rule on or about Nov. 1, 2016

    Neurosurgery Makes Progress on Defeating Global Surgery Data Reporting Mandate

    In the 2017 Medicare Physician Fee Schedule (MPFS) proposed rule, CMS proposed a sweeping mandate that would require surgeons to use an entirely new set of “G-codes” to document the type, level and number of every pre- and postoperative visit furnished during the global surgery period for every surgical procedure — rather than a representative sample, as directed by Congress. Under this system, surgeons would be required to report on each 10-minute increment of service provided. To combat this onerous mandate, the AANS and CNS launched an aggressive advocacy campaign. While we won’t know the outcome until November, organized neurosurgery has been making progress in raising awareness of, and opposition to, this proposal.

    • In late August, John K. Ratliff, MD, and Katie O. Orrico, director of the AANS/CNS Washington Office, testified at town hall meetings convened by CMS. All participants spoke in opposition to the agency’s proposed G-code proposal. Ms. Orrico presented the results of the Surgical Coalition’s “Survey Global Surgery Data and Reporting Requirements: Report on Medicare’s New Coding Proposal and the Impact on Surgeons and their Practices.” Dr. Ratliff provided real-world feedback on the burdens of this mandate, particularly on top of Medicare’s other quality reporting programs.
    • On Sept. 2, 2016, the AANS and CNS submitted detailed comments urging CMS to scrap the proposed global surgery reporting requirements. An accompanying press release was issued, and several media outlets reported on this story.
    • Due in large part to the grassroots advocacy of nearly 300 neurosurgeons from across the country, 110 members of Congress signed a letter to CMS opposing the global surgery code mandate. This effort was spearheaded by Reps. Larry Bucshon, MD (R-Ind.) and Ami Bera, (D-Calif.). The AANS and CNS issued a press release thanking Reps. Bucshon and Bera for their leadership on this issue and encouraging CMS to adopt a less burdensome plan.

    The AANS and CNS are hopeful that CMS will abandon this ill-conceived plan.

    Neurosurgery Comments on Proposed Medicare Hospital Outpatient and ASC Rule

    On Sept. 5, 2016, the AANS and CNS commented on the 2017 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) proposed rule. In our letter, the AANS and CNS supported the CMS proposal to remove four spine codes from the inpatient-only list — spine instrumentation procedures (CPT codes 22840, 22842 and 22845) and total disc arthroplasty second level (CPT code 22858). Additionally, we supported the proposal to add eight spine codes to the ASC list — CPT codes 20936, 20937, 20938, 22552, 22840, 22842, 22845 and 22851. Finally, we supported the proposed modifier for reporting a single session of stereotactic radiosurgery (SRS) and payment adjustments for bilateral placement of single-array deep brain stimulation (DBS) devices.

    CMS Corrects Payment Indicator for Assistant for Craniotomy with Lobectomy

    On Sept. 9, 2016, CMS notified the AANS and CNS that the agency has corrected the payment indicator for CPT code 61323 — Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; with lobectomy — to allow the use of a physician as an assistant at surgery for the procedure. The AANS and CNS brought the issue to the attention of CMS and pointed out that the use of an assistant was permitted for CPT code 61322, the same procedure without lobectomy, and asked the agency to allow the use of an assistant for both procedures. The change will become effective Jan. 1, 2017.

    Neurosurgery Comments on Medicare Coverage of PILD for Lumbar Spinal Stenosis

    On Oct. 7, 2016, the AANS and CNS submitted a letter to CMS in response to a proposed National Coverage Determination notice to broaden the agency’s existing policy for percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis. Currently, Medicare covers this procedure when it is provided in the context of a clinical trial meeting specified conditions. The AANS and CNS letter contained an analysis of current data and stated that further study is needed before broadening coverage for this procedure. A final decision regarding expanded coverage is expected by Dec. 7, 2016.

    ICD-10 “Grace Period” Ends

    On Oct. 1, 2015, Medicare began using ICD-10 diagnosis codes. At the urging of medical specialty societies, including the AANS and CNS, CMS agreed to a year grace period or “coding flexibility policy” in which claims would not be denied based on the specificity of the code used if the claim included an ICD-10 code from the correct family of codes. Effective Oct. 1, 2016, however, the grace period has ended, and physicians are now required to code to the highest level of specificity possible. In rare cases, some unspecified codes may continue to be appropriate, such as when a definitive diagnosis cannot be determined. However, surgical codes billed with an unspecified diagnosis will no longer be exempted from audit review, and the most specific code should be used. Click here for more information.

    If you have any questions regarding these, or other reimbursement issues, please contact Cathy Hill, AANS/CNS senior manager for regulatory affairs, at chill@neurosurgery.org.

    Quality Improvement

    2015 Annual QRURs and 2017 Payment Adjustment Notices Now Available

    On Sept. 26, 2016, CMS made available 2015 Annual Quality and Resource Use Reports (QRURs) to every group practice and solo practitioner nationwide. The QRURs summarize 2015 performance on quality and cost measures used to calculate the 2017 Value-based Payment Modifier (VM), which could result in as much as a 4 percent Medicare pay cut. Physicians (or their authorized representatives) can access the 2015 Annual QRURs on the CMS Enterprise Portal using the appropriate Enterprise Identify Data Management (EIDM) account. CMS offers an informal review period, open through Nov. 30, 2016, for physicians to request a correction of any perceived errors in 2017 VM calculations. More information about how to request an informal review, as well as other resources for accessing and understanding your QRUR, is available here.  

    Additionally, CMS recently began distributing letters to physicians and group practices regarding 2017 Physician Quality Reporting System (PQRS) negative payment adjustments, which are based on 2015 reporting and could result in a 2 percent Medicare pay cut. For the 2015 reporting period, the majority of eligible clinicians successfully reported to PQRS and avoided the negative payment adjustment. Neurosurgeons who believe a negative PQRS adjustment is being applied in error can submit an informal review request by Nov. 30, 2016, by clicking here.

    Physician Compare 30-day Preview Period Begins

    On Oct.12, 2016, the Physician Compare 30-day preview period opened to allow clinicians and group practices to review select 2015 Physician Quality Reporting System (PQRS) measures and Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS measures before they are publicly reported on the Physician Compare website. The preview period is an opportunity for neurosurgeons to review their performance scores, which will appear on Physician Compare profiles later this year.

    Click here to access the secured preview site through the PQRS Provider Quality Information Portal (PQIP). More information about Physician Compare is available here.

    If you have any questions regarding these, or other quality-related issues, please contact Rachel Groman, Vice President for Clinical Affairs and Quality Improvement at Hart Health Strategies, at rgroman@hhs.com.

    Graduate Medical Education

    Neurosurgeons Appointed to ACGME

    H. Hunt Batjer, MD, has been appointed to serve on the board of directors of the Accreditation Council for Graduate Medical Education (ACGME). Dr. Batjer, who previously chaired the Residency Review Committee (RRC) for Neurological Surgery, will represent the Council of Medical Specialty Societies (CMSS) on the ACGME board. Also, the ACGME board has appointed Robert E. Harbaugh, MD, and Sepideh Amin-Hanjani, MD, to serve on neurosurgery’s review committee. Drs. Harbaugh and Hanjani are the new representatives from the American Medical Association (AMA) and will replace outgoing members, Kim J. Burchiel, MD, RRC chair, and Nelson M. Oyesiku, MD, PhD. Thanks to Drs. Burchiel and Oyesiku for their outstanding service!

    If you have any questions about this issue, please contact Katie O. Orrico, director of the AANS/CNS Washington Office, at korrico@neurosurgery.org.

    Of Note

    Cancer Moonshot Blue Ribbon Panel Report Released

    On Sept. 14, 2016, Vice President Joe Biden’s National Cancer Moonshot initiative released its 2016 Blue Ribbon Panel report. Neurosurgeons Mitchel S. Berger, MD, and Neal F. Kassell, MD, serve on the Blue Ribbon Panel that wrote the report. The expert panel was formed in April to offer scientific guidance from thought-leaders in the cancer community.


    Neurosurgery Blog Hosts Successful Concussion Awareness Campaign

    Throughout the months of September and October, Neurosurgery Blog hosted a concussion awareness campaign to put the spotlight on key issues surrounding traumatic brain injury (TBI). To maximize attention on concussions, we launched our efforts around back-to-school activities, including sports. During the campaign, the AANS and CNS utilized the hashtag #ConcussionFacts on Twitter. Neurosurgery Blog and other AANS/CNS communications outlets focused on concussion-related topics with multiple guest blog posts. Gen. Peter W. Chiarelli, a retired U.S. Army general who now serves as the CEO of One Mind, authored our first guest post. Rep. Richard Hudson (R-N.C.), a member of the House Energy and Commerce Committee and co-chair of the Pediatric Trauma Caucus, authored another guest post. Many others in the neurosurgical community took the time to contribute additional blog posts on this important topic.

    We invite all neurosurgeons to continue the conversation using the #ConcussionFacts hashtag so we can grow awareness through social media. In the meantime, if you have not already done so, we also encourage you to subscribe to Neurosurgery Blog to stay informed on this and other important topics facing neurosurgery. Just click here to enter your email address, confirm your subscription and away you go!

    If you are interested in this, or other communications activities, please contact Alison Dye, AANS/CNS senior manager of communications, at adye@neurosurgery.org.

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