On the health policy and advocacy front, 2016 has been a busy year, and the AANS/CNS Washington Committee and your Washington Office staff have been working hard to promote policies that benefit neurosurgeons and their patients. Below is a rundown of recent activity:
CMS Finalizes Rules Implementing New Medicare Quality Payment Program
On Oct. 14, 2016, the Centers for Medicare & Medicaid Services (CMS) released the final rules implementing the new Medicare Quality Payment Program (QPP). Mandated by the Medicare Access and CHIP Reauthorization Act (MACRA), the QPP provides a new framework for rewarding the delivery of quality patient care through two pathways: the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (Advanced APMs).
While AANS/CNS Washington Office staff are still reviewing the 2,400-page regulation, it appears that CMS made many significant positive changes that reflect the recommendations put forth by the AANS and CNS. Key elements that changed as a result of our advocacy include:
- Increased the number of physicians exempt from the program. Initially, physicians with less than $10,000 in Medicare payments and fewer than 100 Medicare patients per year were exempt from the program. CMS has instead adopted neurosurgery’s recommendation, and now physicians with less than $30,000 or 100 Medicare patients need not participate in the QPP — exempting approximately 1,217 neurosurgeons.
- Adopted a transition period to avoid penalties. Recognizing that physician readiness to implement the new QPP will vary, during the 2017 transition year, CMS has established the “pick-your-pace” program for participation. Compatible with the neurosurgery’s recommendation to delay implementing the program for six months to one year, during 2017, neurosurgeons can choose one of four reporting options to avoid any penalties and possibly earn bonus payments.
- Reduced the reporting burden. Heeding the calls of the AANS and CNS, CMS has reduced both the number of measures to be reported and the percent of Medicare patients for whom measures must be reported. For example, initially, the agency would have required physicians to report on 80 or 90 percent of their patients, depending on the data submission method. For 2017, neurosurgeons will only need to report on 50 percent of their patients, which mirrors the AANS and CNS request.
While far from perfect, these and other changes CMS made in the final rule should make it easier for neurosurgeons to participate in the new QPP. In the coming months, the AANS and CNS will unveil additional education materials to ensure that neurosurgeons are prepared, educated and ready to succeed under this Medicare payment program. In the meantime, multiple resources related to the QPP are available from CMS, including:
- Final Rule and Executive Summary;
- Press release;
- Blog post;
- Fact sheet; and
- Quality Payment Program website.
Also, on Nov. 21 and Dec. 6, 2016, the American Medical Association (AMA) will host educational webinar sessions to help physicians prepare and understand what the final rule means for their practice. Click here to register for the Nov. 21 session, which will be held from 7-8 p.m. EST. Click here to register for the Dec. 6 program, which will convene from 8-9 p.m. EST.
Stay tuned for more detailed information, which will be available at www.aans.org/MACRA.
CMS Publishes Final Global Surgery Data Collection Requirements; Adopts Most of Neurosurgery’s Recommendations
As previously reported, in the 2017 Medicare Physician Fee Schedule (MPFS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) proposed a sweeping mandate that would require 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 — rather than a representative sample, as directed by Congress. Under this system, surgeons would have been required to report on each 10-minute increment of service provided. To combat this onerous mandate, the AANS and CNS conducted an aggressive advocacy campaign. On Nov. 2, 2016, CMS released the final 2017 Medicare Physician Fee Schedule. The final rule represents a vast improvement over the initial proposal. According to the final rule, CMS will implement a three-pronged data collection process.
Prong One: Claims-based data collection.
- CPT code 99024 will be used for reporting postoperative services rather than the proposed set of G-codes. Reporting will not be required for preoperative visits included in the global package or for services not related to patient visits. Additionally, CMS will not require time units or modifiers to distinguish levels of visits included in the reported post-visit services.
- Reporting will only be required for services related to codes reported annually by more than 100 practitioners and that are reported more than 10,000 times or have allowed charges in excess of $10 million annually. Under this policy, CMS estimates that it would collect data on about 260 codes that describe approximately 87 percent of all furnished 10- and 90-day global services and about 77 percent of all Medicare expenditures for 10- and 90-day global services under the physician fee schedule.
- Practitioners are encouraged to begin reporting postoperative visits for procedures furnished on or after Jan. 1, 2017, but the mandatory requirement to report will be effective for services related to global procedures delivered on or after July 1, 2017.
- Only practitioners who practice in groups with 10 or more practitioners (including physicians and qualified non-physician practitioners) in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island will be required to report. Practitioners who only practice in smaller practices or other geographic areas are encouraged to report data, if feasible. By excluding practitioners who only practice in practices with fewer than 10 practitioners, CMS estimates that about 45 percent of practitioners will not be required to report.
- Teaching physicians would be subject to the same reporting requirements as all physicians and would report CPT code 99024 and should use the GC or GE modifier as appropriate to identify those services in which surgical residents are involved.
Prong Two: In addition to the claims-based data collection, CMS will conduct a survey of practitioners to gain information on postoperative activities to supplement the claims-based data collection method. The survey will be stratified by specialty and will result in a sufficient qualitative data to address key procedures in each specialty furnishing procedures with global periods. CMS anticipates that just under 10,000 physicians will be surveyed, yielding a 50 percent response rate. The survey will be in the field by mid-2017.
Prong Three: CMS will also implement an effort aimed at gaining information about global surgery services from accountable care organizations (ACOs).
Finally, CMS is not implementing the statutory provision that authorizes a 5 percent withhold of payment for the global services until claims are filed for the postoperative care, if required. If, however, physicians who are required to do so are not compliant, CMS may impose the 5 percent payment withhold in the future.
Neurosurgeon Testifies at Congressional Pediatric Trauma Caucus Briefing
On Sept. 21, 2016, Shelly Timmons, MD, PhD, FAANS, participated in a Congressional Pediatric Trauma Caucus Briefing. Launched in May 2016 by co-chairs Reps. Richard
Hudson (R-N.C.) and G.K. Butterfield (D-N.C.), the Pediatric Trauma Caucus aims to identify strategies for strengthening the nation’s pediatric trauma system and reducing traumatic injuries in children. The briefing had a “back-to-school” theme and brought together experts to discuss pediatric trauma and youth sports. The AANS/CNS Washington Office also issued a press release about the briefing, featuring Dr. Timmons and thanking Reps. Hudson and Butterfield for their efforts to strengthen the pediatric trauma system. For more information about this event, click here.
Neurosurgeons Appointed to ACGME
Hunt Batjer, MD, FAANS, has been appointed to serve on the board of directors of the Accreditation Council for Graduate Medical Education (ACGME). Dr. Batjer, who previously chaired the Residency Review Committee (RRC) for Neurological Surgery, will represent the Council of Medical Specialty Societies (CMSS) on the ACGME board. Also, the ACGME board has appointed Robert E. Harbaugh, MD, FAANS, and Sepideh Amin-Hanjani, MD, FAANS, to serve on neurosurgery’s review committee. Drs. Harbaugh and Hanjani are the new representatives from the American Medical Association (AMA) and will replace outgoing members, Kim J. Burchiel, MD, FAANS, RRC chair, and Nelson M. Oyesiku, MD, PhD, FAANS. Thanks to Drs. Burchiel and Oyesiku for their outstanding service!
CMS Finalizes 2017 Medicare Fee Schedule
On Nov. 2, 2016, the Centers for Medicare & Medicaid Services (CMS) published the 2017 Medicare Physician Fee Schedule (MPFS) final rule. Overall, neurosurgical payments will be reduced by about 3 percent due to reductions in work relative value units and the Medicare sequestration cut. CMS also announced that it will drop the proposed onerous requirement for all physicians reporting 10- and 90-day global surgical services to use new G- codes to report on evaluation and management time (see special announcement above for more details). The agency also finalized its proposal to lower the values for new embolectomy, insertion of spinal stability distractive devices and spinal instrumentation codes. Finally, CMS declined to assign a value to a new code for endoscopic decompression of spinal cord, which will be priced by individual Medicare carriers. For more information about this topic, click here.
CMS Releases 2017 Medicare Hospital Outpatient and ASC Final Rule
On Nov. 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) final rule. In the regulation, CMS removed four spine codes from the inpatient-only list — spine instrumentation procedures (CPT codes 22840, 22842 and 22845) and total disc arthroplasty second level (CPT code 22858). Additionally, CMS will add eight spine codes to the ASC list — CPT codes 20936, 20937, 20938, 22552, 22840, 22842, 22845 and 22851. The AANS and CNS supported these changes in our September 2016 letter to CMS.
Medicare Adopts Imaging Appropriate Use Criteria Requirements
On Nov. 2, 2016, the Centers for Medicare & Medicaid Services (CMS) published the 2017 Medicare Physician Fee Schedule (MPFS) final rule. In addition to the payment provisions, the rule included details of the new Medicare Imaging Appropriate Use Criteria (AUC Program). Initially, prior to ordering imaging studies, ordering professionals will need to consult appropriate use criteria for eight priority clinical areas. Those related to neurosurgery include headache (traumatic and non-traumatic), low back pain and cervical or neck pain. CMS removed suspected stroke from the list but might consider it in the future. The agency will analyze ordering data to identify outlier physicians, who then may be subject to prior authorization requirements, beginning in 2020. For more information about this topic, click here.
Medicare EHR Reporting Limited to 90 Days
On Nov. 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) final rule. Included in the regulation is a key provision allowing physicians to report electronic health record (EHR) meaningful use data for a 90-day reporting period in 2016 and 2017 rather than a full calendar year. In 2017, physicians who have not successfully demonstrated meaningful use in the past may attest to modified Stage 2 objectives and measures, rather than Stage 3. New meaningful use participants who are also transitioning to the Merit-based Incentive Payment System (MIPS) in 2017 can apply for a significant hardship exception from the 2018 Electronic Health Records (EHR) Incentive Program payment adjustment, which is the last year penalties are authorized under the old structure before transitioning to MIPS.
For more information on these or other health policy issues, please contact Katie O. Orrico, director of the CNS/AANS Washington Office, at [email protected].
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