The Medicare physician payment system is on an unsustainable path that has failed to keep up with inflation over the years, threatening patient access to care. The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) are actively engaged in preventing steep Medicare payment cuts and preserving patient access to care through the Surgical Care Coalition. The coalition is in year three of its campaign to stop these cuts and implement lasting changes to the physician payment and quality improvement systems.
On Jan. 1, 2023, neurosurgeons face a minimum 8.5% Medicare payment cut, including a nearly 4.5% cut for all Medicare Physician Fee Schedule services and a 4% Statutory Pay-As-You-Go Act cut, triggered due to new federal spending. After successfully protecting patients’ timely access to quality surgical care in 2020 and 2021 by securing Congressional action to mitigate proposed cuts to Medicare, the coalition is fighting against similar cuts proposed for 2023. The AANS and the CNS are also working with Congress on long-term solutions to fix these broken systems. To that end, we submitted detailed comments in response to a Congressional request for information.
The people who the proposed cuts will most impact are our patients. Every day, neurosurgeons take care of some of the sickest patients who face painful and life-threatening neurologic conditions. Alexander A. Khalessi, MD, FAANS, John K. Ratliff, MD, FAANS and Maya A. Babu, MD, FAANS, share their experiences as neurosurgeons and how the cuts will impact neurosurgical practices and their patients. The videos are available as follows:
Patients Deserve Timely, Quality Care
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Finally, stroke, large vessel occlusions and mechanical thrombectomy have become an area of interest amid the COVID-19 pandemic. Evidence is emerging from epicenters of the crisis — like New York City — that patients, whether afflicted with COVID-19 or not, are seeking medical attention later in their stroke course due to fears regarding COVID-19. We expect many studies to be published in the ensuing months evaluating stroke and mechanical thrombectomy in COVID-19 patients. We are excited about what the future holds in cutting edge research to bring the best available care to stroke patients everywhere.
Justin R. Mascitelli, MD
Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Initially, physical classes were canceled until late March, by which time any students who had traveled to a COVID-19 hotspot would have completed a 14-day quarantine. The plan was to resume regular classes and clinical experiences following this disruption. However, it became clear within a matter of weeks that this would be impossible. For the safety of students, faculty and patients, it was eventually decided that all physical classes and clinical experiences would be canceled for the foreseeable future. Students at all levels were placed in an uncertain position as it became increasingly clear that in-person learning would not be possible for the remainder of the year. This uncertainty fostered fear and anxiety among students — many of whom were also dealing with the stress regarding their safety and that of friends and family.
Stephen Susa
Life in neurosurgery changed in step with the sweeping changes across the medical community, necessitated by potential supply shortages and increased patient volume. As social distancing took effect, the coveted morning sign-out — the bedrock of day-to-day functioning of a busy neurosurgery service — was transitioned to video conferencing. Next was the cancellation of all elective cases, then semi-urgent cases, and eventually, in some hospitals, emergency cases could only be performed after chair/faculty committee approval. Clinic visits were canceled if deemed non-urgent or conducted as telemedicine visits to provide care while limiting disease spread. To protect residents from unnecessary exposure and maintain a reserve, call schedules were changed to limit the number of residents seeing consults at one time or available for cases. As these changes were implemented, unprecedented collaboration, flexibility and ingenuity was prevalent as everyone did their part to ensure care remained as safe and effective as possible.
Redi Rahmani, MD
Nathaniel R. Ellens, MD
Tyler M. Schmidt, DO
Then, for one-week, cases of COVID-19 filled the MICU. Shortly after that, our neurosurgical step-down — followed by the neurosurgical ICU — were rapidly converted into negative pressure rooms for COVID-19 patients. That same week, our hospital system placed a hold on all elective, non-emergent surgeries. By Friday, March 20, at a time when there were 