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AANS Neurosurgeon | Volume 27, Number 2, 2018

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Washington Watch: The Latest in Neurosurgery Advocacy

Lawmakers Release “Dear Colleague” Letter to CMS Regarding Prior Authorization

On Aug. 9, Reps. Phil Roe, MD (R-Tenn.), and Ami Bera, MD (D-Calif.), released a “Dear Colleague” letter urging their congressional colleagues to join them in sending a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, MPH, asking CMS to provide guidance to Medicare Advantage (MA) plans regarding the use of prior authorization (PA). The use of prior authorization by health plans has gotten out of control, and the AANS/CNS Washington Committee has identified this as a priority topic. Finding a solution is complicated, however, since the individual states regulate most health plans. While the federal government has limited power to address prior authorization abuses in these plans, it does have the power to regulate Medicare Advantage (MA) plans. Since most health plans participate in MA, efforts by Medicare to rein-in these plans may have a spill-over effect in state-regulated plan practices.

House Ways and Means Red Tape Relief Project Status Report

As a part of its effort to modernize and improve the Medicare program for American seniors and the providers that serve them, the House Ways and Means Committee launched the Medicare Red Tape Relief Project. This initiative seeks to identify opportunities to reduce legislative and regulatory burdens on Medicare providers, improving the efficiency and quality of the Medicare program for seniors and individuals with disabilities. Last summer, the AANS and CNS submitted multiple recommendations on topics, including:

  • Rescind Medicare Appropriate Use Criteria (AUC) for Imaging
  • Prior Authorization reform in Medicare Advantage
  • Suspend Medicare Global Surgery Data Collection
  • Improve Medicare Quality Payment Program

The committee has continued working on this project throughout the past year, and organized neurosurgery has been part of the ongoing conversations. In this regard, representing the Alliance of Specialty Medicine, Katie O. Orrico, Esq., director of the AANS/CNS Washington Office, participated in two roundtable discussion sessions with members of the committee, focusing primarily on prior authorization reform. Responding to our concerns, the committee plans to request that CMS standardize reporting and billing authorization requirements. Click here for a copy of the status report.

House Completes Action on Comprehensive Opioid Abuse Legislation

After months of development and deliberation, the U.S. House of Representatives completed its efforts to address the opioid epidemic by passing more than 60 bills. On June 22, the House passed H.R. 6, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act by a 396-14 vote. H.R. 6 is a comprehensive package that includes the majority of the bills previously passed by the House. The package contains policies impacting Medicare, Medicaid, public health and public safety programs that are intended to curb abuse, improve access to substance abuse treatment, and support law enforcement efforts. Other bills direct federal agencies to produce studies, reports and guidelines related to opioid use, abuse, and treatment among other matters. Attention now turns to the U.S. Senate, which has yet to act on opioid-related legislation.

House Passes Bill to Repeal the Medical Device Tax

On July 24, the U.S. House of Representatives passed H.R. 184, the Protect Medical Innovation Act. The bipartisan vote was 283-132, with 57 Democrats joining 226 Republicans to advance the measure. Attention now turns to the Senate. While temporarily suspended for two years (2018-19), the Affordable Care Act’s 2.3 percent medical device excise tax may adversely affect medical innovation and patient care. Because America has a long tradition of excellence and innovation in patient care, and because neurosurgeons have been on the cutting edge of these advancements, the AANS and CNS have advocated for the repeal of this tax. In the run-up to the vote, AANS/CNS Washington Office staff worked with our industry partners and patient advocacy groups to encourage members of Congress to vote to repeal the tax. On July 23, we participated in a Twitter event using the hashtag #RepealDeviceTax to draw attention to the vote. At one point, this effort was fifth highest trending conversation on Twitter.

House Energy & Commerce Committee Passes Pandemic and All-Hazards Preparedness (PAHPA) Reauthorization Act

On July 18, the House Energy and Commerce Committee overwhelmingly endorsed renewing programs to respond to bioterrorism, pandemics and other hazards. The panel unanimously voted to advance H.R. 6378, the Pandemic and All-Hazards Preparedness (PAHPA) Reauthorization Act. Championed by Reps. Marsha Blackburn (R-Ky.) and David Scott (D-Ga.), the bill contains H.R. 1876, the Good Samaritan Health Professionals Act, which protects health care professionals from being held liable for harm caused by providing health care services during a national or public health emergency, or a major disaster. The bill would also reauthorize the Emergency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP), setting total annual funding at $5 million between 2019 and 2023. Finally, the bill includes language from H.R. 880, the MISSION Zero Act, which would assist U.S. military health care providers in maintaining a state of readiness by embedding military trauma teams and providers in civilian trauma centers.

Senate HELP Committee Passes Liability Protections for Sports Medicine Professionals

On June 26, the Senate Health, Education, Labor and Pensions (HELP) Committee approved S. 808, the Sports Medicine Licensure Clarity Act. The bipartisan bill, introduced by Sens. John Thune (R-S.D.) and Amy Klobuchar (D-Minn.), would extend medical liability protections to sports medicine professionals traveling with athletic teams to a secondary state, thereby ensuring that injured athletes have timely access to health care. The bill now awaits full Senate consideration. House companion legislation, H.R. 302, passed in the House in early January.


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CMS Releases Proposed 2019 Medicare Physician Fee Schedule Rule

On July 12, CMS released the 2019 Medicare Physician Fee Schedule proposed rule. Overall, CMS estimates that the proposed changes result in a net one percent increase in payments to neurosurgeons, due primarily to the impact of changes in malpractice relative value units. The biggest — and most controversial — change is a sweeping new plan for evaluation and management (E/M) visit documentation requirements and a corresponding proposal to collapse payment for E/M visit levels 2 through 5 into a single blended payment amount of $135 for new patient office visits and $93 for established patients. Fortunately, CMS did not recommend any changes in payments for 10- and 90-day global surgery services, however, in 2019, the agency will continue with its global surgery data collection initiative. This program requires neurosurgeons in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island are required to report post-operative visit information furnished during the global period for certain procedures using CPT code 99024. In the document, CMS proposes to continue to ramp-up requirements for the third year of the Merit-Based Incentive Program (MIPS), during which 2019 performance will determine whether clinicians are subject to up to a 7 percent cut in Medicare payments in 2020. At the same time, CMS proposes to maintain certain flexibilities, particularly for small practices.

Click here for a summary of the payment provisions of the proposed rule and here for a CMS fact sheet. For a detailed summary of the quality provisions, click here and here for the agency’s Quality Payment Program (QPP) fact sheet on the proposed rule.

CPT Corrects Significant Error for Reporting Decompression with Interbody Fusion

Following vigorous multi-specialty advocacy led by organized neurosurgery, in the May 2018 CPT Assistant publication, the American Medical Association (AMA) has corrected the erroneous October 2018 instruction regarding the use of the decompressive laminectomy CPT code 63047 at the same level as interbody fusion codes 22630 or 22633. The correction appropriately states that codes 22633 and 63047 may be reported for the same interspace when additional work is required to complete a decompression at the same spinal level. The AANS and CNS have always maintained that the CPT coding descriptions for these codes allow for reporting 63047 at the same level as 22633 or 22630 when work for decompression of neural elements is required in addition to the work required to perform the interbody fusion. The need for decompression for clinical scenarios, such as neurogenic claudication, alongside the need for interbody fusion, such as instability, must be accurately documented in the operative note.

The May 2018 CPT Assistant publication notes that a -59 modifier should be added to 63047 when used with the 22633 or 22630 for non-Medicare patients. Medicare continues to apply a separate National Correct Coding Initiative (NCCI) edit that prevents reporting of these codes at the same interspace. The NCCI edit is inconsistent with the precise definition and spirit of these codes and runs directly counter to the May 2018 CPT Assistant publication. The AANS and CNS continue to object to the NCCI edit and are actively working to have it rescinded. 

Neurosurgery Responds to 2019 Medicare Hospital IPPS Proposed Rule

On June 25, the AANS and CNS sent a letter to CMS addressing several issues in the 2019 Medicare Hospital Inpatient Prospective Payment System (IPPS) proposed rule. In our comment letter, the AANS and CNS supported a new technology add-on payment for a cerebral protection device providing significant new clinical benefit by reducing the risk of embolic shower to the brain during interventional cardiovascular procedures. CMS agreed with neurosurgery’s recommendation, and on Aug. 17, published the final rule granting the new technology add-on payment for the Sentinel Cerebral Protection System for FY 2019.

AMA Releases Opioid Task Force Progress Report

In 2014, the American Medical Association (AMA) Opioid Task Force convened to coordinate efforts that were underway within organized medicine to help end the nation’s opioid epidemic. Together, the Task Force identified six recommendations, focused on the actions that physicians could take — and the Task Force committed to measure progress on each recommendation. On Aug. 9, AMA released a status report titled “AMA Opioid Task Force Helping Guide Physicians’ Progress to End the Nation’s Opioid Epidemic,” which is aimed at showing what the Task Force organizations have accomplished.  AANS/CNS Pain Section Secretary Jennifer A. Sweet, MD, continues to represent organized neurosurgery on this task force.

Neurosurgery Joins Other Health Care Organizations to Develop Comprehensive Roadmap to Address Opioid Crisis

On June 26, organized neurosurgery worked with the National Dialogue for Healthcare Innovation, which is run by the Healthcare Leadership Council (HLC), to release first-of-their-kind comprehensive recommendations aimed at addressing the escalating opioid crisis in the United States. The “Roadmap for Action” gives clear guidance to health care leaders, lawmakers and regulators on comprehensive approaches to stemming the crisis. Prior to the release of the recommendations, Christopher J. Winfree, MD, FAANS, participated in the Opioid Crisis Solutions Summit on behalf of organized neurosurgery to provide his expertise on the topic.

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