• Washington Report

    Through advocacy, policy development, and public relations, the Washington Committee and Washington Office have played a fundamental role in advancing key health care initiatives, including advocating for adequate reimbursement, pushing for medical liability reform, streamlining quality improvement reporting requirements, and providing neurosurgeons relief from the morass of government regulations.

    Throughout the year, the Washington Office staff are in the halls of Congress or working with government agencies and other health care stakeholders advocating on behalf of neurosurgery. In this role, the CNS frequently interacts with members of Congress, the Centers for Medicare & Medicaid Services (CMS), the Food and Drug Administration (FDA), third party payors, and state and national medical associations. As a result of these interactions, organized neurosurgery has achieved a variety of advocacy successes.

    Fighting for Fair Reimbursement

    The CNS has been on the front lines helping to guide the Medicare Access and CHIP Reauthorization Act (MACRA) through the implementation process to ensure that CMS develops the new Medicare physician payment system as directed and intended by Congress. Mandated by MACRA, the Medicare Quality Payment Program (QPP) replaces the former sustainable growth rate (SGR) payment system, under which physicians had faced nearly 14 years of significant Medicare pay cuts. Passage of MACRA prevented Medicare cuts of nearly $100,000 for many neurosurgeons, including those related to the SGR, quality programs, and preventing the elimination of 10- and 90-day global surgery codes. The new payment system also consolidates Medicare's separate quality-related programs-the Physician Quality Reporting System (PQRS), Electronic Health Records (EHR) Incentive Program, and Value- Based Payment Modifier (VM)-and provides a new framework for rewarding the delivery of quality patient care.

    As a leading member of the AMA MACRA Task Force, Washington Office staff worked to seek significant improvements in the QPP's initial regulations. As a result of these efforts, more neurosurgeons (approximately 1,200) will be exempt from the program's mandates. Additionally, CMS finally recognized that physician readiness to implement the new QPP would vary, and, therefore, adopted a "pick-your-pace" program for participating in a transition period, which would allow most physicians to avoid penalties, and for some to earn modest bonus payments. More information about the program is available at https://www.cns.org/MACRA.

    The CNS also vigorously opposed a sweeping mandate proposed by CMS that would have required all 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. Under the CMS proposal, all surgeons would have been required to report on each 10-minute increment of services provided. To combat this onerous mandate, CNS launched an extensive and successful advocacy campaign. CMS released the final 2017 Medicare Physician Fee Schedule, and it represented a vast improvement over the initial proposal, limiting the requirement to large practices in nine states and the reporting of postoperative visits to a single code for each visit.

    Finally, the CNS continues to aggressively challenge third party payor coverage policies, which limit reimbursement for many common neurosurgical procedures. The Joint Coding and Reimbursement Committee (CRC), along with representatives from the Joint National Quality Council (NQC), the Joint Guidelines Committee, the Joint Sections and Washington Committee, work together to provide a balanced assessment of the current literature under review. These comments involved topics such as deep brain stimulation (DBS), intraoperative MRI guided focused ultrasound, nerve monitoring, spine arthroplasty, treatment of sacroiliac joint pain, and use of spine allograft.

    Regulatory Relief

    Faced with an ever-growing morass of regulations with which neurosurgeons must comply, the CNS, through the Washington Committee and Washington Office, has been working with Congress and regulators to reduce the burdens associated with practicing medicine. Leading a physician regulatory relief coalition, Washington Committee chair Ann R. Stroink, MD, and Washington Office staff, have had the opportunity to personally make the case directly to former Secretary Tom Price, MD, and CMS administrator Seema Verma. As a result of these efforts, Health and Human Services (HHS) has proposed relief from Medicare quality program penalties, exempted more physicians from the burdens QPP, and is revisiting the rules for Medicare's mandatory appropriate use criteria (AUC) program for physicians ordering advanced diagnostic imaging.

    Reforming the Reform

    While the Affordable Care Act (ACA) is the law of the land, the CNS has not ceased in advocating for changes to this landmark health care reform law. Top priorities include:

    • Abolishing the Independent Payment Advisory Board (IPAB). The IPAB is a 15-member unelected and unaccountable government board, whose principal responsibility is to cut Medicare. In leading the Physician IPAB Repeal Coalition, the CNS was instrumental in getting bipartisan legislation to repeal the IPAB. As a result of these advocacy efforts, for the first time since its inception, a bipartisan, bicameral majority of members of Congress support repealing this blunt, cost-containment tool.
    • While health care reform faces tough headwinds, the CNS strongly supports improving the nation's health care system, including expanding access to affordable health insurance coverage for every American, enhancing patients' choice of insurance plans and providers, and maintaining reforms that redress a number of inexcusable insurance practices, including high-deductibles, narrow provider networks, and prior authorization requirements.
    • The CNS continues to advocate for the repeal of the medical device excise tax. Working with its advocacy partners, legislation to repeal the tax was again introduced in Congress. S.108, the Medical Device Access and Innovation Protection Act, and H.R. 184, the Protect Medical Innovation Act, continue to gain momentum.

    Medical Liability Reform

    As the physician specialty facing the highest premiums, most lawsuits, and largest average indemnity payments, the CNS recognizes the need for improving the medical liability climate for neurosurgeons. Serving as vice chair of the Health Coalition on Liability and Access and in collaboration with the trauma community and others, Washington Office staff are working to secure national medical liability reform. Through these efforts, the CNS successfully advocated for the passage of the "Protecting Access to Care Act," (H.R. 1215) by the US House of Representatives. The legislation would, among other things, cap non-economic damages at $250,000 and establish standards for expert witnesses. Additionally, the US House passed the "Sports Medicine Licensure Clarity Act of 2017," (S. 808/H.R. 302), which provides protection for team doctors who provide medical services.

    Additional bills have been introduced, including "The Health Care Safety Net Enhancement Act of 2017" (S. 527/H.R. 548) and the "Good Samaritan Health Professionals Act of 2017" (S. 781/H.R. 1876). The former would provide crucial medical liability protections to physicians providing EMTALA-related care, while the latter would ensure that health professionals who want to provide voluntary care in response to a federally declared disaster can do so without worries about potential liability.

    Graduate Medical Education

    An appropriate supply of well-educated and trained physicians is an essential element to ensure access to quality health care services for all Americans. While medical schools in the US have increased their enrollments and additional medical and osteopathic schools have been established, the number of Medicare-funded resident positions has been capped by law at 1996 levels. Through the continued advocacy of the CNS, policymakers are beginning to understand that there are significant shortages of physicians in both primary and specialty care. Working with the Association of American Medical Colleges (AAMC), the Alliance of Specialty Medicine and others, the CNS successfully advocated for the introduction of legislation to provide additional Medicare funding for graduate medical education (GME). The"Resident Physician Shortage Reduction Act of 2017" (H.R. 2267/S. 1301) would expand Medicare funding for an additional 15,000 residency training slots over a five-year period.

    Neurosurgery Advocates for Trauma Care

    Working to improve the nation's trauma and emergency care systems, the CNS has been a founding partner in efforts to establish and promote membership in the Congressional Pediatric Trauma Caucus.

    • The Washington Committee represented the CNS at a Congressional briefing convened by caucus co-chairs Reps. Richard Hudson (R-N.C.) and G.K. Butterfield (D-N.C.). The event highlighted the challenges facing pediatric trauma patients and the need to find bipartisan solutions to ensure adequate trauma care for children. Leaders from the pediatric neurosurgery community worked with the Washington Committee and Washington Office staff to meet with, and provide input to the Government Accountability Office (GAO). The resulting report, titled "Availability, Outcomes, and Federal Support Related to Pediatric Trauma Care," will serve as the basis for future efforts to improve pediatric trauma systems.
    • Due to the influence of organized neurosurgery, the "Military Injury Surgical Systems Integrated Operationally Nationwide (MISSION) to Achieve Zero Preventable Deaths Act of 2017" (S. 1022/H.R. 880) was introduced in both the House and Senate. This legislation would assist US military health care providers in maintaining a state of readiness by embedding military trauma teams and providers in civilian trauma centers.

    Communications Outreach

    The Washington Committee garners support for neurosurgery's health policy positions by providing the media with timely information. Efforts include Op-Eds, letters to the editor, radio "tours" and desk-side briefings with reporters from the Wall Street Journal, Washington Post, CBS, NBC, Politico, and others. Since December 2012, the Washington Office has generated 155 traditional media hits reaching a circulation/audience of 13.6 million.

    Additionally, the Washington Office's digital media platforms continue to expand, garnering over 435 million individual impressions, and amassing a subscription audience of 135,000. Social media platforms reach opinion-influencers in the media, on Capitol Hill, and in various health policy circles that would not have been easily achieved through more traditional means. These communication tools include:

    • Neurosurgery Blog: More Than Brain Surgery, a web-based opinion and perspective column, through which CNS offers insights and perspective on contemporary health issues as they relate to organized neurosurgery.
    • An @Neurosurgery Twitter feed that is used to gain greater visibility for neurosurgery's advocacy efforts. The Twitter feed focuses primarily on health policy updates and provides links to positive stories about neurosurgery.
    • Our YouTube channel features clever animations designed to engage the public in a fun, visually appealing manner while providing clear-cut, high-level facts centered on neurosurgery's top legislative issues.
    • Facebook, Instagram, LinkedIn, Tumblr, and Google+ sites help drive health policy influencers to information on Neurosurgery Blog and the Twitter feed, while also spotlighting CNS newsmaking successes and initiatives.

    Visit the blog and subscribe to it, read the monthly e-newsletter, Neurosurgeons Taking Action, and connect with the Washington Office on its social media platforms. For more information about CNS advocacy efforts, contact Katie O. Orrico, director of the AANS/ Washington Office at korrico@neurosurgery.org.


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