• Washington Committee Report

    Author: Alison Dye

    CNS Releases 2017 Legislative and Regulatory Agenda

    On February 14, the CNS released its 2017 legislative and regulatory agenda, which includes action items such as improving the health care delivery system, abolishing the Independent Payment Advisory Board (IPAB), expanding support for graduate medical education, alleviating the medical liability crisis, and restructuring Medicare's quality improvement programs. The full legislative and regulatory agenda is available at www.cns.org/news-advocacy.

    Progress on Health Reform Legislation Stalls

    On March 6, House of Representatives leaders unveiled the first Affordable Care Act (ACA) repeal and replacement legislation. After two marathon sessions lasting a combined 44 hours, the House Energy Committee, House Commerce Committee, and House Ways and Means Committee approved the American Health Care Act (AHCA). The CNS sent a letter to the committee chairs offering comments on several aspects of the legislation and outlining our position on additional reforms not included in the AHCA. In addition to the letter, the CNS submitted the results of a survey of neurosurgical leaders.

    Following passage by these authorizing committees, on March 16, the House Budget Committee voted by a margin of 19-17 to advance the bill. Further changes were made in an attempt to gain enough support to pass the legislation.

    Complicating passage was the cost estimate issued by the Congressional Budget Office (CBO), declaring in 2018, 14 million more people would be uninsured under the reform legislation than under current law. The number of uninsured would rise to 24 million by 2026, due in part to changes in the Medicaid expansion program. On the plus side, CBO estimated that if enacted, the AHCA would reduce the federal deficit by $150 billion over 10 years.

    Despite significant pressure from President Donald Trump and Republican leaders, they failed to secure necessary votes. Late in the afternoon on March 24, the legislation was pulled shortly before a scheduled floor vote, requiring them to go back to the drawing board. A revised version of the AHCA was passed by the House in May, and will now move on to the Senate.

    Neurosurgeon Testifies at Congressional IPAB Briefing

    On March 13, the Healthcare Leadership Council (HLC) hosted a Congressional briefing regarding the IPAB. The ACA created the IPAB, which is a board of 15 unelected and largely unaccountable government bureaucrats whose primary purpose is to cut Medicare spending. Alex B. Valadka, MD, chair of neurosurgery at Virginia Commonwealth University, participated and represented the physician point of view.

    Other participants included Mary R. Grealy, president of HLC, Robert B. Blancato, executive director of the National Association of Nutrition & Aging Services Programs, and William K. Atkinson, PhD, MPH, former president and CEO of WakeMed Health & Hospitals. The event was broadcast by C-SPAN, and is viewable via their website, www.c-span.org.

    The CNS continues to raise awareness about the need to repeal the IPAB. To this end, on February 22, The Hill published an opinion piece authored by Dr. Valadka. In the article titled, "IPAB's Medicare cuts will threaten seniors' access to care," Dr. Valadka pointed out the IPAB is one of the most insidious elements of the ACA and significant Medicare cuts from IPAB loom just around the corner, threatening seniors' timely access to vital healthcare services.

    Finally, the CNS is spearheading an IPABrepeal physician coalition effort. On this front, we recently sent letters to the lead cosponsors of the IPAB repeal bills-Reps. Phil Roe, MD (R-Tenn.), and Raul Ruiz, MD (D-Calif.) (H.R. 849), Sen. John Cornyn (R-Texas) (S. 260), and Sen. Ron Wyden (D-Ore) (S. 251).

    House Judiciary Committee Advances Medical Liability Legislation

    On February 28, the House Judiciary Committee approved H.R. 1215, the Protecting Access to Care Act. Sponsored by Rep. Steve King (R-Iowa), the bill is modeled after proven reforms already in place in Texas, California, and many other states that have had a positive effect on increasing access to care and keeping health care costs affordable for patients and physicians. According to the Congressional Budget Office (CBO), this bill would save INSIDE THE CNS Washington Committee Report Alison Dye the federal government almost $62 billion over a 10-year period.

    We worked with the committee to develop the legislation, and along with our partners in the Health Coalition on Liability and Access (HCLA), we endorsed the bill and issued a press release in support of this legislation. In a letter to House Speaker Paul Ryan (R-Wis.), the CNS called on Congress to swiftly pass this legislation.

    Complementing this effort, Rep. Richard Hudson (R-N.C.) introduced H.R. 1704, the Accessible Care by Curbing Excessive law- SuitS (ACCESS) Act of 2017. In addition to the reforms contained in H.R. 1215, the ACCESS act includes expert witness qualifications, an affidavit of merit requirement, and protections for physicians who offer an apology following an adverse medical event. The CNS helped develop this legislation.

    Good Samaritan Health Professionals Act Re-introduced

    On March 30, Sens. Bill Cassidy, MD (R-La.) and Angus King (I-Maine) introduced S. 781, the Good Samaritan Health Professionals Act of 2017. Additionally, on the same day, Reps. Marsha Blackburn (R-Tenn.) and David Scott (D-Ga.) also introduced a companion bill, H.R 1876. This legislation, previously passed by Congress in March 2012, would ensure health professionals who want to provide voluntary care in response to a federally declared disaster are able to do so without facing unwarranted lawsuits.

    While there are both federal and state laws intended to protect volunteer health professionals from unwarranted lawsuits, there are many inconsistencies, which may leave physicians vulnerable. The medical profession has a long history of stepping forward to assist disaster victims-however, the current Volunteer Protection Act, which was enacted specifically to encourage such actions, fails to address the issue of liability protections for health care providers who cross state lines to aid disaster victims. S. 781 and H.R. 1876 address this shortcoming. The CNS sent letters supporting this legislation to both Senate and House bill sponsors. Neurosurgery also joined forces with the HCLA in sending endorsements letters to the Senate and House bill sponsors.

    Neurosurgery Objects to CMS Coding Edits to Inappropriately Bundle Spinal Procedures

    On February 13, the CNS, NASS, AANS, and ISASS sent a letter to Niles Rosen, MD, medical director of the National Correct Coding Initiative (NCCI), objecting to coding edits that would bundle anterior instrumentation codes (CPT codes 22845-22847) with insertion of biomechanical devices codes (CPT codes 22853 and 22854). Specifically, the letter stressed these inappropriate edits will lead to a mis-valuation of physician work when an intervertebral body device is placed with an anterior plate. The specialties urged the NCCI not to implement the edits planned for April 1.

    Christopher Loftus, MD, Appointed to FDA

    In March 2017, Christopher M. Loftus, MD, was appointed to serve as the chief medical officer of the Division of Neurological and Physical Medicine Devices at the Food and Drug Administration's (FDA) Center for Devices and Radiological Health. Dr. Loftus has been a member of the AANS/CNS Drugs and Devices Committee, and is a past chair of the AANS/ CNS Cerebrovascular Section. He has represented neurosurgery on multiple FDA panels, working closely with the agency for more than 15 years. Congratulations on your appointment, Dr. Loftus!

    Special FDA Safety Announcement

    On March 1, the FDA issued a letter to health care providers titled, "Differences In Review and Intended Use of Neurovascular Thrombus Retrieval Catheters and Guide Catheters Used During Neurological Interventional Procedures."

    In the communication, the FDA clarifies the differences between neurovascular thrombus retrieval catheters and guide catheters (e.g., intermediate catheter, distal access catheter) used during neurological interventional procedures. The notice is available in its entirety at www.FDA.org. While on-label usage of devices is highly desirable, both the variety of clinical situations and limited indications for use of currently available devices require physicians to use their best clinical judgment in making patient specific decisions. FDA-approved devices may be used for other indications when safe, reasonable, and in the best interest of the patient.

    Neurosurgery Blog Receives Award!

    Neurosurgery Blog was named one of the Top 10 Neurosurgery Blogs on the web by Feedspot. Selected from thousands of blogs, Neurosurgery Blog achieved this status based on the following criteria:

    • Google reputation and Google search ranking
    • Influence and popularity on Facebook, Twitter, and other social media sites
    • Quality and consistency of posts
    • Feedspot's editorial team and expert review

    For more information on these or other health policy issues, please contact Katie O. Orrico, director of the AANS/CNS Washington Office at korrico@neurosurgery.org.

    Special recognition goes to our AANS/CNS Communications and Public Relations Committee team-particularly CPR committee chair, Deborah L. Benzil, MD, and CPR committee vice chair, Clemens M. Schirmer, MD. Of course, the success of our blog depends on the contributions made by many neurosurgeons and guest blog post authors from outside of the specialty's ranks. Without compelling content, our blog would not be worth reading.

    If you have not already signed up to receive Neurosurgery Blog, we invite you to visit the blog and subscribe to it, as well as connect with us on our various social media platforms, including Facebook, Twitter, LinkedIn, and more. This will allow you to keep up with the many health-policy activities happening in the nation's capital and beyond the Beltway.

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