AANS Neurosurgeon | Volume 27, Number 3, 2018


Washington Watch

AANS and CNS Representatives Meet With HHS and CMS Leaders
On June 20, Washington Committee chair, Ann R. Stroink, MD, FAANS, and Katie O. Orrico, JD, director of the AANS/CNS Washington Office, met with Health and Human Services (HHS) secretary, Tom Price, MD, and the Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma. The meeting was one of three roundtables that Dr. Price convened in connection with his Physician Regulatory Relief project. A wide-range of topics were discussed, including:

  • Mandatory appropriate use criteria for advanced diagnostic imaging;
  • Delaying the global surgery data collection project;
  • Minimizing the reporting burden under Medicare’s Quality Payment Program (QPP);
  • Halting mandatory bundled payments;
  • Streamlining and reforming prior authorization requirements; and
  • Achieving EHR interoperability.

The AANS and CNS will continue to interface with HHS and CMS on this project, which will hopefully lead to positive changes for neurosurgeons and their patients. 

  1. Hunt Batjer, MD, FAANS, Speaks at Rep. Roe’s IPAB Press Conference
    On July 13, Rep. Phil Roe (R-Tenn.) convened a press conference on issues concerning the Independent Payment Advisory Board (IPAB). AANS past president, Dr. Batjer, participated on behalf of neurosurgery at this event. Additional speakers included Reps. Raul Ruiz, MD (D-Calif.); Larry Bucshon, MD (R-Ind.); and Ami Bera, MD (D-Calif.), as well as Mary Grealy, president of the Healthcare Leadership Council (HLC). Click here for a video of the conference (Dr. Batjer is introduced at 4:05 minutes into the program, with his remarks to follow). 

Repealing the IPAB is one of organized neurosurgery’s top legislative priorities. A majority of members in the House and Senate have cosponsored legislation (H.R. 849/S. 251/S. 260) to repeal the IPAB.

House Passes Comprehensive Medical Liability Reform Legislation
On June 28, by a vote of 218 to 210, the U.S. House of Representatives passed H.R. 1215, the Protecting Access to Care Act, as amended. Organized neurosurgery endorsed the legislation. Additionally, the AANS and CNS joined the Alliance of Specialty Medicine and the Health Coalition on Liability and Access (HCLA) in supporting this bill.

Key provisions of the bill include:

  • Encouraging speedy resolution of claims. The statute of limitations is three years after the injury or one year after the claimant discovers the injury, whichever occurs first.
  • Compensating patient injury. Noneconomic damages are limited to $250,000. Parties are liable for the amount of damages directly proportional to their responsibility.
  • Maximizing patient recovery. Courts must supervise the payment of damages and may restrict attorney contingency fees. The bill sets limits — on a sliding scale — on contingency fees.
  • Future damages. The bill provides for periodic payment of future damage awards.
  • Product liability. A health care provider who prescribes, or dispenses pursuant to a prescription, a medical product approved by the Food and Drug Administration (FDA) may not be named as a party to a product liability lawsuit or a class action lawsuit regarding the medical product.
  • State Flexibility. Protects the rights of states that have already enacted comprehensive medical liability reforms or do so in the future.

Several amendments passed, including one offered by Rep. Richard Hudson (R-N.C.) — by a vote of 222 to 197. The Hudson amendment (1) sets forth expert witness criteria; (2) requires an affidavit of merit prior to bringing a lawsuit; (3) allows a physician to apologize to a patient for an unintended outcome without having the apology count against them in the court of law; and (4) requires a 90-day cooling off period before lawsuits can be filed to facilitate voluntary settlements. 

House Passes Health Reform Legislation; Senate Struggles to Find Consensus
On May 4, by a narrow margin of 217 to 213, the U.S. House of Representatives passed H.R. 1628, the American Health Care Act (AHCA). In a letter to House committee leaders, the AANS and CNS registered our views on the bill, as well as other topics not addressed by the AHCA. We also shared with Congress the results of a health care reform survey of neurosurgical leaders.

Following passage, the AANS and CNS sent a letter to Senate leaders expressing our significant concerns about aspects of the AHCA, as well as our opinion on those provisions with which we agree. As with the letter to committee leaders in the House, the AANS and CNS also expressed our views about other health reform issues that need to be adopted as well. Furthermore, on May 23, neurosurgery joined forces with the Alliance of Specialty Medicine to send a letter to Senate lawmakers highlighting several health reform principles that the legislation should incorporate. On June 22, Senate Majority Leader Mitch McConnell (R-Ky.) unveiled Senate leadership’s discussion draft bill, the Better Care Reconciliation Act. In general, the legislation aims to:

  • Helps stabilize collapsing insurance markets;
  • Repeals the individual and employer mandates;
  • Improves the affordability of health insurance;
  • Preserves access to care; and
  • Provides States with more flexibility under Medicaid.

Despite these goals, the Congressional Budget Office (CBO) estimates that 22 million will lose health insurance coverage under the draft. Finding consensus in the Senate remains elusive; thus, stalling forward progress on reform legislation for the moment.

Neurosurgery Supports the Affordable Health Insurance for the Middle Class Act
On May 25, the AANS and CNS sent a letter endorsing S. 1307, the Affordable Health Insurance for the Middle Class Act. Introduced by Sen. Dianne Feinstein (D-Calif.), this bill would expand access to affordable health insurance coverage for those Americans in financial need. The bill is consistent with neurosurgery’s policy that the federal government should provide need-based financial assistance to help individuals obtain health insurance under the individual mandate.

Neurosurgery Endorses the Resident Physician Shortage Reduction Act
On July 12, the AANS and CNS endorsed the Resident Physician Shortage Reduction Act (H.R. 2267/S. 1301). Neurosurgery sent letters supporting the House and Senate bills to the cosponsors and members of the House Ways and Means Committee, Energy and Commerce Committee and Senate Finance Committee. Introduced in the House on May 1, by Reps. Joe Crowley (D-Pa.) and Ryan Costello (R-Pa.), and in the Senate on June 7, by Sens. Bill Nelson (D-Fla.), Dean Heller (R-Nev.) and Chuck Schumer (D-N.Y.), this bill would provide funding for 3,000 more residency slots, per year for the next five years for a total of 15,000 new slots. Efforts to garner additional cosponsors are underway.

New Video Shows Physicians How to Avoid Medicare Payment Penalties
As a reminder to neurosurgeons, the Quality Payment Program (QPP) is the new Medicare physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA) and administered by CMS. Because the QPP is new this year, the AANS and CNS, and our partners at the American Medical Association (AMA), want to make sure neurosurgeons know what they have to do to participate and the QPP’s “pick your pace” options for reporting. This is especially important for those physicians who have not participated in past Medicare reporting programs and may be less knowledgeable about the steps they can take to avoid being penalized under the QPP.

The AANS, CNS, AMA and others in organized medicine stressed to CMS the importance of establishing a transition period to QPP and, as a result, physicians only need to report on at least one quality measure for one patient during 2017 in order to avoid a payment penalty in 2019 under the Merit-based Incentive Payment System (MIPS).

A new short video developed by the AMA, “One patient, one measure, no penalty: How to avoid a Medicare payment penalty with basic reporting,” offers step-by-step instructions on how to report so physicians can avoid a negative 4 percent payment adjustment in 2019. On this website, ama-assn.org/qpp-reporting, there are also links to CMS’ quality measure tools and an example of what a completed 1500 billing form looks like.

CMS Unveils Lookup Tool for Neurosurgeons to Determine Participation in MIPS
In May, the CMS unveiled a new interactive tool on the QPP website to determine if neurosurgeons should participate in the Merit-based Incentive Payment System (MIPS) in 2017. To determine your status, enter your national provider identifier (NPI) into the entry field on the tool located on the QPP homepage. You will then receive information on whether or not you should participate in the MIPS this year. To avoid financial penalties and qualify for an opportunity to earn bonus payments in 2019, neurosurgeons should participate in MIPS in 2017 if they:

  • Bill Medicare Part B more than $30,000 a year; or
  • See more than 100 Medicare patients a year.

Neurosurgeons new to Medicare in 2017 do not need to participate in the QPP. To learn more, review the MIPS Participation Fact Sheet. CMS also recently sent letters in the mail notifying clinicians of their MIPS participation status. For more information, the QPP Service Center may be reached at 866.288.8292 Monday through Friday from 8 a.m.-8 p.m. EDT, or via email at QPP@cms.hhs.gov.           

Quality Payment Program Hardship Exception Application for the 2017 Transition Year Is Now Open
The Quality Payment Program Hardship Exception Application for the 2017 transition year is now available on the Quality Payment Program website. MIPS eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to zero percent of the final score and can submit a hardship exception application for one of the following specified reasons:

  • Insufficient internet connectivity;
  • Extreme and uncontrollable circumstances; or
  • Lack of control over the availability of Certified EHR Technology (CEHRT).

There are some MIPS eligible clinicians who are considered Special Status, who will be automatically reweighted (or exempted in the case of MIPS eligible clinicians participating in a MIPS APM) and do not need to submit a Quality Payment Program Hardship Exception Application. For more information about the Quality Payment Program hardship application process, visit the Quality Payment Program website. Additionally, eligible professionals (EPs) who are first-time participants in the Medicare EHR Incentive Program in 2017 are also eligible to apply for a one-time hardship exception. Applications are due by Oct.1. Visit the EHR Incentive Programs website and download the instructions on how to apply for this EHR Incentive Programs hardship application.

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 these or other health policy issues, please contact Katie O. Orrico, JD, director of the AANS/CNS Washington Office at korrico@neurosurgery.org.


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