Our health care system is under extraordinary pressure. The COVID-19 pandemic has created an uncertain financial future for health care professionals. And now, coming on the heels of this devastating pandemic, Medicare is poised to implement drastic cuts. These cuts threaten patients’ access to timely surgical care and may impact the quality of life for the people neurosurgeons care for every day. To help policymakers and the public understand how these payment cuts will hurt patients and their neurosurgical care teams, on June 18, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), along with 10 other national surgical associations, officially launched the Surgical Care Coalition (SCC).

The coalition, which represents more than 150,000 surgeons, was formed to stop these Medicare cuts to protect patients, improve their quality of life and ensure that our nation’s seniors have access to the neurosurgeon of their choice when they need life-saving neurosurgical care. Specifically, the SCC is worried 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. Working together, the coalition is putting this issue on the nation’s agenda and is urging Congress to pass legislation that will prevent these payment cuts.

To learn just how fragile our health care system is, the SCC recently commissioned a survey of more than 5,000 surgeons. According to this study, 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 economic 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.”

Our seniors need to take comfort in the fact that a neurosurgeon will be there if and when they ever require neurosurgical care. Medicare cuts hurt patients, and the Surgical Care Coalition is fighting to prevent payment cuts that threaten patients’ timely access to neurosurgical care.

Editor’s Note: Neurosurgery Blog encourages you to follow the coalition on Twitter and LinkedIn, and we invite you to join the conversation at #CutsHurtPatients.

Katie O. Orrico, Esq., director
AANS/CNS Washington Office

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