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Cross-Post: Medicare cuts ensure disaster to doctor-patient relationship

By Congress, Cross PostNo Comments

On the Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they may interest our readers. In case you missed it, we wanted to bring attention to a recent op-ed by Reps. Greg Murphy, MD, (R-N.C.), Brad Wenstrup, DPM, (R-Ohio) and Michael Burgess, MD, (R-Texas) in Washington Times titled, “Medicare cuts ensure disaster to doctor-patient relationship.” On Jan. 1, 2024, the Centers for Medicare & Medicaid Services cut payments to physicians by nearly 3.4% for services rendered to Medicare patients, which will cripple independent physicians and rural health care providers across the country.

Reps. Murphy, Wenstrup and Burgess, members of the GOP Doctors Caucus, are greatly troubled by another round of payment cuts to the Medicare Physician Fee Schedule, “It is our goal to navigate the ever-increasing challenges facing those who try to provide care for Medicare recipients.” In anticipation of this rule, the GOP Doctors Caucus introduced legislation seeking to reform the physician fee schedule, prevent extreme fluctuations in future reimbursement and update how costs are determined.

Efforts continue to press Congress to halt these cuts as soon as possible.

Click here to read the article.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FixMedicareNow.

January 12, 2024
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It’s Time to Fund MISSION ZERO

By Congress, TraumaNo Comments

It’s been five years since the National Academies of Science, Engineering and Medicine (NASEM) released a report titled, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.”

Having led a model for military-civilian collaboration at the Army Trauma Training Center in Miami, Fla., I was invited to be a reviewer of this report. I appreciated the wisdom of focusing on military-civilian trauma collaboration to save more lives from injury — whether on the battlefield or at home.

Such structured collaboration:

  • Shares best practices for civilian and military injury care and prevention;
  • Preserves hard-won lessons of combat casualty care;
  • Improves civilian access to trauma care;
  • Sustains military trauma surgeon and team skills; and
  • Promotes national readiness, particularly in the reflection of COVID-19 recovery.

With three years of hard work in advocacy, the MISSION ZERO Act was signed into law in 2019 as part of (H.R. 269/S. 1379), the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (P.L. 116-22).

This Act:

  • Followed the recommendations of the NASEM report;
  • Created the Military and Civilian Partnership for the Trauma Readiness Grant Program (MISSION ZERO) in the U.S. Department of Health and Human Services; and
  • Authorized grants to cover the administrative costs of integrating military trauma surgeons and teams into civilian trauma centers.

However, although the program was created (i.e., authorized), it has yet to be funded (i.e., appropriated). In 2020, the House of Representatives did include funding, but the Senate did not.

Five years later, trauma remains the leading cause of death for children and adults under age 44.

We are working quickly with the new Congress to achieve funding for Fiscal Year (FY) 2022. There is already good news. On April 27, 34 members of the U.S. House of Representatives sent a letter requesting full funding for MISSION ZERO to the House Labor, Health and Human Services, Education, and Related Agencies Subcommittee leadership. Sens. Chris Van Hollen (D-Md.) and Bill Cassidy, MD, (R-La.) are leading a similar effort in the Senate.

May is National Trauma Awareness Month, which is an opportunity for you to take action.  So please ask your Senators and Representatives to support full funding at the authorized amount of $11.5 million for MISSION ZERO in the FY 2022 appropriations bills.

Fully funding this critical program will help improve injury care and public health response in our communities, states and nation, inclusive of our military health system.

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter during National Trauma Awareness Month this May by following @Neurosurgery and @AmCollSurgeons, using the hashtags #TraumaAwarenessMonth and #Trauma.

John H. Armstrong, MD, FACS, FCCP
Chair, Advocacy Pillar, American College of Surgeons Committee on Trauma
Former Florida Surgeon General and Secretary of Health, 2012-16
University of South Florida, Morsani College of Medicine
Tampa, Fla.

May 20, 2021
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Congressional Docs Urge Americans to Take Action and Get the COVID-19 Vaccine

By Congress, COVID-19, Guest Post, HealthNo Comments

Last year, the entire world was forced to face the COVID-19 pandemic head on. And now, we — the American people — have the opportunity to achieve peace of mind and live life as free as before by choosing to receive a COVID-19 vaccine. Concerned for the health and safety of our nation, I recently joined some of my fellow colleagues in Congress — each of us are also health care professionals — in a public service announcement encouraging Americans to get vaccinated. Very soon we will have more COVID-19 vaccines than we have people willing to take it. In fact, almost half of adults in my home state of Kansas are uncertain about getting vaccinated.

Operation Warp Speed brought us safe and effective vaccines in record time. The process was rigorous and transparent, and a process that I personally followed very closely, resulting in a clear path to the eradication of the pandemic. The Food and Drug Administration (FDA) did not skip any steps. Instead, the FDA cut bureaucratic red tape — not corners — and got the job done in record time. By now, over 200 million vaccines have been given in our country.

Doctors, nurses and pharmacists nationwide recommend the COVID-19 vaccine to their patients, and over 90% of doctors in the U.S. have already chosen to get vaccinated. But, we have much more work to do. I encourage all neurosurgeons, primary care doctors, nurses, and community pharmacists to discuss the vaccine with your patients. Who better to have that conversation than someone who knows their medical history and has their trust? As a physician from Small Town, USA, I’ve given critical advice to my patients facing a number of issues including getting a vaccine for disease prevention. The most respected advice comes from a person’s own health care provider or pharmacist, and it’s conversations with them that help make the best health decisions.

I look forward to the freedom I, along with my loved ones, will regain once the vast majority of Americans are vaccinated. If everyone does their part, in the coming weeks we will once again be able to worship together as a congregation, gather with extended family, and travel near and far with friends.

Please join me in watching and sharing this important message!

Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtags #VaccinesWork and #ThisIsOurShot.

U.S. Senator Roger W. Marshall, MD (Kansas)

 

 

May 3, 2021
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2020 — A Year in Review

By Advocacy Agenda, Congress, Health Reform, Medical Innovation, Medical Liability, Prior AuthorizationNo Comments

While 2020 is a year that most people want to forget, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) made significant strides in accomplishing its legislative and regulatory agenda, thus ensuring that neurosurgical patients continue to have timely access to quality care. Following are some highlights of these advocacy efforts.

Congress Prevents Steep Medicare Cuts

On Jan. 1, the Centers for Medicare & Medicaid (CMS) implemented the new CPT guidelines to report office and outpatient visits based on either medical decision making or physician time. These evaluation and management (E/M) services are valued in line with the AMA/Specialty Society RVS Update Committee (RUC) recommendations. Unfortunately, to comply with Medicare’s budget neutrality requirement, any increases must be offset by corresponding decreases, and CMS estimated that the 2021 policies would increase Medicare spending by approximately $10.6 billion. This necessitated significant cuts for many specialties, including an overall 6-7% payment cut for neurosurgery.

Faced with these steep Medicare payment cuts (and potential future cuts to the 10- and 90-day global surgical codes), in June 2020, the AANS and the CNS — with significant funding support from the Council of State Neurosurgical Societies and the Section on Disorders of the Spine and Peripheral Nerves — along with 10 other national surgical associations, founded the Surgical Care Coalition (SCC). The SCC launched a targeted, multi-faceted advocacy and public relations campaign to prevent these cuts. Specifically, the SCC advocated that Congress adopt legislation that would:

  • Increase the global surgery code values;
  • Halt implementation of the G2211 add-on code for complex E/M visits; and
  • Prevent any additional cuts resulting from the new E/M payment policies.

Working with the SCC and other physician and allied health professional organizations, the AANS and the CNS successfully advocated for legislation to prevent these cuts. On Dec. 27, 2020, President Donald J. Trump signed the Consolidated Appropriations Act, 2021 (H.R. 133) into law (P.L. 116-260) — a massive omnibus spending bill that includes nearly $900 billion for coronavirus relief and an additional $1.4 trillion spending package to fund the federal government through the end of the Fiscal Year 2021. Specifically, the legislation:

  • Prevents steep Medicare cuts by earmarking $3 billion to help offset the budget- neutrality adjustment and by delaying for three years the new G2211 add-on code for certain complex office visits;
  • Extends the moratorium on the 2% Medicare payment sequester for an additional three months through March 2021, allocating $3 billion for this purpose;
  • Increases payments for the work component of the MPFS in areas where labor cost is determined to be lower than the national average through Dec. 31, 2023; and
  • Temporarily freezes alternative payment model (APM) payment incentive thresholds for two years, allowing more physicians to qualify for the 5% APM bonus payments.

As a result of this combined relief, overall, neurosurgeons should not experience any Medicare payment cuts (although the specific impact will depend on the mix of services provided) in 2021.

However, our work is not complete. The surgical community will continue to advocate for CMS to adjust the 10- and 90-day global codes to reflect the increased values of the E/M portion of these codes. In that regard, on Dec. 1, Sen. Rand Paul, MD, (R-Ky.) introduced S. 4932, the “Medicare Reimbursement Equity Act.” If enacted, this legislation would require CMS to value the E/M portion of the global codes equal to the stand-alone E/M codes.

Progress Made in Reforming Prior Authorization

For the past two years, the AANS and the CNS have been tireless in their efforts to reform prior authorization in the Medicare Advantage (MA) program. Significant progress has been made, setting the stage for reforms in the coming year. Neurosurgery-backed legislation — the “Improving Seniors’ Timely Access to Care Act” (S. 5044 / H.R. 3107) — garnered overwhelming bipartisan support from nearly 300 members of Congress. If enacted, this bill would reform the use of prior authorization in Medicare Advantage (MA) through a streamlined and standardized process that focuses on increased transparency and accountability. The bill reflects a neurosurgery-supported consensus statement on prior authorization, developed by leading national organizations representing physicians, hospitals and health plans.

Specifically, the legislation directs the Secretary of the U.S. Department of Health and Human Services to:

  • Establish a real-time, electronic prior authorization process;
  • Minimize the use of prior authorization for routinely approved services;
  • Ensure prior authorization requests are reviewed by qualified medical personnel; and
  • Require MA plans to report on their use of prior authorization, including delay and denial rates.

This legislation will be reintroduced in the 117th Congress. More information is available from the Regulatory Relief Coalition, of which the AANS and the CNS are founding members.

Protecting Patients from Surprise Medical Bills

The AANS and the CNS have been advocating for federal legislation to protect patients from unanticipated medical bills (otherwise known as “surprise” medical bills) while at the same time providing for a fair process for resolving payment disputes. Organized neurosurgery adopted a set of principles for a balanced solution to the problem. After more than two years of sustained advocacy, Congress incorporated into the Consolidated Appropriations Act, 2021 (P.L. 116-260) the “No Surprises Act,” which applies to federally-regulated plans, including ERISA plans, and does not preempt state laws governing state-regulated health plans. The provisions of the new law, which will be implemented on Jan. 1, 2022, meet many of organized neurosurgery’s principles and include the following elements:

  • Patients are protected from surprise medical bills and only responsible for the in-network cost-sharing amount for out-of-network (OON) emergency services and other services provided in in-network facilities.
  • Insurers are required to make initial payments directly to OON providers for OON services within 30 days. The law does not define the payment rate.
  • If a provider objects to the payment, they may proceed to an independent dispute resolution (IDR) process.
  • The IDR process is baseball-style arbitration. There is no negotiation. Both parties submit a payment rate, and the arbiter selects one.
  • The arbiter may consider several factors, including median in-network rates and any other information the provider or health plan submits, other than billed charges, Medicare, Medicaid, CHIP and Tricare rates.

The AANS and the CNS will work with the incoming Biden Administration on the implementing regulations.

Supporting Quality Resident Training and Education

An appropriate supply of well-educated and trained physicians — both in specialty and primary care — is essential to ensure access to quality health care services for all Americans. Looming physician shortages — by 2033, the nation faces a physician shortfall of between 54,100 to 139,000 — threaten this access to care. To help ease this shortage and support quality resident training and education, the AANS and the CNS successfully advocated for legislation to increase the number of Medicare-sponsored residency training positions. The “Resident Physician Shortage Reduction Act” (S. 348 / H.R. 1763), with a total of 242 bipartisan cosponsors, would increase the number of available medical residency positions by 15,000 over five years.

While falling short of what is necessary to adequately address the looming physician workforce shortage, the Consolidated Appropriations Act, 2021 (P.L. 116-260) did provide funding for 1,000 additional Medicare-funded graduate medical education (GME) residency positions. The AANS and the CNS will build on this down payment by advocating for additional funding in the 117th Congress.

COVID-19 and the Global Pandemic

On March 13, 2020, President Trump issued an executive order declaring the COVID-19 pandemic a national emergency. Shortly after that, neurosurgical practices began temporarily suspending non-emergency neurosurgical cases and experiencing significant cash-flow challenges. Working with multiple coalitions of physician organizations in Washington, D.C., the AANS and the CNS stepped into high gear to advocate for financial and other relief for neurosurgeons.

Congress passed several COVID-19-related bills, which included vital assistance for physicians and hospitals. The Coronavirus Aid, Relief, and Economic Security (CARES) Act (H.R. 748) and the Paycheck Protection Program and Health Care Enhancement Act (H.R. 266) established and funded the Paycheck Protection Program (PPP), allowing neurosurgical practices to receive grants to help keep their employees paid and their practices afloat. The Consolidated Appropriations Act, 2021 (P.L. 116-260) expanded current PPP legislation, adding $284 billion in funding for the PPP and extending it through March 31, 2021. Legislation also allocated more than $175 billion to the Public Health and Social Services Emergency Fund, helping with bridge funding for neurosurgeons and the hospitals in which they practice.

The expansion of telemedicine, and increased payments for telemedicine services, helped neurosurgeons continue to take care of their patients remotely and will likely be an integral part of neurosurgical practices in the future. Finally, the AANS and the CNS led efforts to secure COVID-19-related medical liability protections. The CARES Act included liability protections for physicians rendering volunteer medical services during the COVID-19 public health emergency. In addition, Reps. Phil Roe, MD, (R-Tenn.) and Lou Correa (D-Calif.) introduced H.R. 7059, the Coronavirus Provider Protection Act, and Sens. John Cornyn (R-Texas) and Mitch McConnell (R-Ky.) introduced S. 4317, the “SAFE TO WORK Act.” Both bills would provide physicians protections from certain COVID-19-related lawsuits. The AANS and the CNS will continue to advocate for the adoption of COVID-19 related liability protections in the 117th Congress.

Turning the Corner to 2021

The inauguration of Joseph R. Biden, Jr. as the 46th president of the United States will bring with it a new administration, along with changes in the 117th Congress, mean new health care policy priorities will be front and center on the national legislative and regulatory agenda. While these changes present organized neurosurgery with new opportunities to continue advocating for sound health policy that improves patient care, 2020 will go down as a year in which the AANS and the CNS made significant positive strides for neurosurgeons and patients alike.

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

January 11, 2021
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A Year in review: Making Progress on Neurosurgery’s Legislative and Regulatory Agenda

By Advocacy Agenda, Congress, Health Reform, Medical Innovation, Medical Liability, Prior Authorization, UncategorizedNo Comments

As we come to the end of a decade and head into 2020, it is fitting to reflect on the progress that the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have made in advancing organized neurosurgery’s legislative and regulatory agenda to ensure that neurosurgical patients have timely access to quality care. At the beginning of 2019, we set forth an ambitious agenda, and throughout the year, the AANS and CNS continued to make progress on achieving our health policy goals.

Some highlights:

  • Protect Patients’ Timely Access to Care. Prior authorization is a cumbersome process that requires physicians to obtain pre-approval for medical treatments or tests before rendering care to their patients. To protect patients’ timely access to care, as leaders of the Regulatory Relief Coalition, the AANS and the CNS collaborated with key champions in Congress — Reps. Suzan DelBene (D-WA); Mike Kelly (R-PA); Roger Marshall, MD, (R-KS); and Ami Bera, MD, (D-CA) — to introduce H.R. 3107, the Improving Seniors’ Timely Access to Care Act. With 156 sponsors at year’s end, this bill would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program.
  • Improve the Health Care Delivery System. Narrow insurance networks restrict patient access to the physician of their choice and leave patients vulnerable to unanticipated medical bills. Working to improve the health care delivery system, the AANS and the CNS successfully advocated for the introduction of legislation to protect patients from unanticipated medical bills. The Protecting People from Surprise Medical Bills Act (H.R. 3502), and the Stopping The Outrageous Practice (STOP) of Surprise Medical Bills Act (S. 1531), would hold patients harmless and ensure that they would only be responsible for in-network cost-sharing amounts when out-of-network providers take care of them. Patients would also be kept out of the middle of payment disputes between health plans and providers, and a process for fairly reimbursing providers for their services would be established.
  • Support Quality Resident Training & Education. An appropriate supply of well-educated and trained physicians — both in specialty and primary care — is essential to ensure access to quality health care services for all Americans. Looming physicians shortages — by 2032, the nation faces a physician shortfall of between 46,900 to 121,900 — threaten this access to care. To help ease this shortage and to support quality resident training and education, the AANS and the CNS successfully advocated for legislation to increase the number of Medicare-sponsored residency training positions. The Resident Physician Shortage Reduction Act ( 348 / H.R. 1763), with a total of 185 cosponsors, would increase the number of available medical residency positions by 15,000 over five years.
  • Continue Progress with Medical Innovations. America has a long tradition of excellence and innovation in patient care, and neurosurgeons have been on the cutting edge of these advancements. However, due to the medical device excise tax, American medical innovation and patient care have been at risk. Working with our partners in the medical technology industry for the past decade, the AANS and the CNS have been advocating for Congress to repeal this tax. This year, with the passage of H.R.1865, the Further Consolidated Appropriations Act, 2020, Congress demonstrated its commitment to continuing progress with medical innovation by repealing this tax. President Trump signed the legislation into law (P.L. 116-94). This bill also included increased funding for biomedical research in the neurosciences. Finally, Reps. Diana DeGette (D-Colo.) and Fred Upton (R-Mich.) released their initial vision for their Cures 2.0 initiative, which aims to modernize insurance coverage policies and improve access to life-saving cures. Cures 2.0 would build on the original 21st Century Cures Act (P.L. 114-255), which aspires to advance medical research and foster a new era of medical innovations.
  • Fix the Broken Medical Liability System. Medical lawsuit abuse is driving up health care costs, and driving good doctors out of the practice of medicine, leaving patients without the care they need when they need it. Many doctors — particularly in high-risk specialties like neurosurgery — are cutting back on high-risk and life-saving services, relocating to states with more patient-friendly liability laws, retiring early or leaving the practice of medicine altogether. To help fix the broken medical liability system, as a leader of the Health Coalition on Liability and Access, the AANS and the CNS worked with leaders in Congress to introduce H.R. 3656, the Accessible Care by Curbing Excessive LawSuitS (ACCESS) Act, which is modeled after proven reforms that are in place in California and Texas. In addition, legislation to help ensure that physicians are available to take care of patients with medical emergencies is pending before the House and Senate — the Good Samaritan Health Professionals Act (S. 1350) and the Health Care Safety Net Enhancement Act (H.R.3984).

We still have our work cut out for us to continue advocating for sound health policy that improves patient care, but 2019 will go down as a year in which the AANS and the CNS made significant positive strides.

          

 

 

December 31, 2019
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