AANS Neurosurgeon | Volume 26, Number 3, 2017

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Washington Watch

Tom Price, MD, Becomes New HHS Secretary
On Feb. 10, 2017, the U.S. Senate voted by a margin of 52 to 47 to confirm Tom Price, MD, to become the next secretary of the U.S. Department of Health and Human Services (HHS). Dr. Price, an orthopaedic surgeon, has served as a member of the House of Representatives from Georgia’s 6th congressional district since 2005. Before going to Washington, D.C., Dr. Price served four terms in the Georgia State Senate — two as Minority Whip and rising to become the first Republican Senate Majority Leader in the history of Georgia. For nearly 20 years, Dr. Price was in private practice as an orthopaedic surgeon. He also served as an assistant professor at the Emory University School of Medicine and as medical director of the orthopaedic clinic at Grady Memorial Hospital in Atlanta. Dr. Price received his bachelor and doctor of medicine degrees from the University of Michigan and completed his orthopaedic surgery residency at Emory University.

The AANS and CNS strongly supported Dr. Price’s nomination for HHS Secretary. In a letter to Senate Majority Leader Mitch McConnell (R-Ky.), we noted that throughout his time, Dr. Price “has been a staunch advocate for the preservation of the doctor-patient relationship, a fierce protector of private practice, and a stalwart supporter of academic medicine.” Our letter went on to add that as “a practicing physician, and because of his work on key congressional committees with jurisdiction over health care issues, he understands all aspects of the health care system, which is essential to run HHS effectively.” Organized neurosurgery has every confidence that Dr. Price will work tirelessly to create a health care delivery system that promotes high-quality, high-value and better-coordinated care for our nation’s patients.

Ben Carson, MD, Becomes New HUD Secretary
On Feb. 2, 2017, the U.S. Senate voted by a margin of 58 to 41 to confirm retired neurosurgeon Benjamin S. Carson Sr., MD, FAANS(L), to become the next secretary of the U.S. Department of Housing and Urban Development (HUD). On Feb. 3, 2017, the AANS and CNS released a statement thanking Dr. Carson for serving his country and congratulating him on his appointment.

AANS and CNS Release 2017 Legislative and Regulatory Agenda
On Feb. 14, 2017, the AANS and CNS released their 2017 legislative and regulatory agenda, which includes action items such as improving the health care delivery system, abolishing the Independent Payment Advisory Board (IPAB), expanding support for graduate medical education, alleviating the medical liability crisis and restructuring Medicare’s quality improvement programs. To read the full legislative and regulatory agenda, click here.

Bipartisan Legislation to Repeal IPAB Introduced
During the week of Jan. 30, 2017, bipartisan legislation to repeal the Independent Payment Advisory Board (IPAB) was introduced in the House and Senate. The IPAB was created by the Affordable Care Act (ACA) and is a board of 15 unelected and largely unaccountable government bureaucrats whose primary purpose is to cut Medicare spending. Legislation introduced included the following:

  • R. 849, the Protectioning Seniors’ Access to Medicare Act, sponsored by Reps. Phil Roe (R-Tenn.) and Raul Ruiz (D-Calif.);
  • J. Res. 51, a joint resolution discontinuing IPAB, sponsored by Reps. Roe and Ruiz, ;
  • 251, the Protecting Medicare from Executive Action Act, sponsored by Sen. Ron Wyden (D-Ore);
  • 260, the Protecting Seniors’ Access to Medicare Act, sponsored by Sen. John Cornyn (R-Texas);
  • J.Res.16, a joint resolution discontinuing IPAB, sponsored by Sen. Wyden; and
  • J.Res.17, a joint resolution discontinuing IPAB, sponsored by Sen. Cornyn.

Repealing the IPAB is one of organized neurosurgery’s top legislative priorities, and the AANS and CNS are leading a physician coalition representing more than 400,000 physicians across 26 specialty physician groups dedicated to this mission. Additionally, we joined the Alliance of Specialty Medicine in sending letters of support to Sens. Cornyn and Wyden and Reps. Roe and Ruiz.

CMS Announces Plans for Global Surgery Code Data Collection Initiative
As previously reported, on Nov. 15, 2016, the Centers for Medicare & Medicaid Services (CMS) published the final 2017 Medicare Physician Fee Schedule. Included in the rule was the final policy related to global surgery payments. Rather than implementing the 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 in 10-minute increments, CMS will implement a less onerous data collection process. While not perfect, it is a significant improvement over the initial proposal. On Jan. 6, 2017, CMS published the details of this data collection effort on its website.

Beginning on July 1, 2017, neurosurgeons in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island are required to report information on post-operative visits furnished during the 10- and 90-day global period of certain specified procedures using CPT code 99024. These procedures include those that are reported annually by more than 100 practitioners and that are either reported more than 10,000 times annually or have more than $10 million in annual allowed charges. Neurosurgeons who practice in practices with fewer than 10 practitioners (including physicians and qualified non-physician practitioners) are exempted from required reporting. Click here for the full list of codes subject to reporting.

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. CMS anticipates that approximately 10,000 physicians will be surveyed, yielding a 50 percent response rate. The survey should be in the field by mid-2017. We expect further details shortly.

Medicare’s New Merit-based Incentive Payment System Now in Effect
Medicare’s new Merit-based Incentive Payment System (MIPS) went into effect on Jan. 1, 2017. Created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), this new quality payment program combines aspects of the Medicare Electronic Health Records (EHR) Incentive Program, Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs into the new system. Unlike these programs, under MIPS, neurosurgeons have the opportunity to earn bonus payments. Any payment adjustments (whether bonuses or penalties) will not be made until 2019, based on 2017 reporting.

MIPS quality scores are based on four weighted performance categories:

  • Quality;
  • Advancing Care Information (previously known as EHR meaningful use);
  • Clinical Practice Improvement Activities; and
  • Cost.

For more information on MIPS, including fact sheets and other informational downloads, visit the Quality Payment Program (QPP) website. Also, stay tuned for more detailed announcements from the AANS and CNS about what neurosurgeons need to do to prepare for MIPS.   

CMS Updates June 2016 Open Payment Data
On Jan. 17, 2017, CMS updated the Open Payments dataset to reflect changes to the data that took place since the last publication on June 30, 2016. Click here to view the updated dataset. Every year, CMS “refreshes” the Open Payments data at least once to include updates from disputes and other data corrections made since June’s annual publication. CMS will publish 2016 data on June 30, 2017. Manufacturers will submit 2016 data to CMS in February and March 2017. Physicians will be able to review and dispute their 2016 data in April and early May of 2017, and manufacturers will correct data in May and June of 2017. 

Subscribe to Neurosurgery Blog Today!
The mission of Neurosurgery Blog is to investigate and report on how health care policy affects patients, physicians and medical practice, and to illustrate how the art and science of neurosurgery encompass much more than brain surgery. Neurosurgery Blog has ramped up its reporting efforts to include multiple guest blog posts from key thought leaders and members of the neurosurgical community. We invite you to visit the blog and subscribe to it, as well as connect with us on our various social media platforms. This will allow you to keep up with the many health-policy activities happening in the nation’s capital and beyond the Beltway.


For more information on this or other health policy issues, please contact Katie O. Orrico, director of the AANS/CNS Washington Office, at
korrico@neurosurgery.org.

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