HCFA Proposes Medicare Fee Schedule.
The Health Care Financing Administration (HCFA) published in July the proposed 2001 Medicare Physician Fee Schedule. Contained in this proposal are a number of changes to the Medicare practice expense formula that impact neurosurgery. With these changes, overall reimbursement for neurosurgery is expected to decline by 13 percent from 1998 to 2002 (although the code specific impacts vary). The following demonstrates the impact of these changes on several common neurosurgical procedures:
| Procedure | 1998 | 1999 | 2000 | 2001* | 2002* | Percentage % |
| Endarterectomy | $1,263 | $1,263 | $1,236 | $1,172 | $1,116 | -12% |
| Brain Tumor Removal | 2,129 | 2,040 | 2,085 | 1,952 | 1,829 | -14% |
| Carotid Aneurysm | 3,071 | 3,059 | 3,359 | 3,278 | 3,215 | +5% |
| Lumbar Discectomy | 991 | 946 | 950 | 893 | 845 | -15% |
| Lumbar Spinal Decompress |
1,246 | 1,177 | 1,136 | 1,064 | 1,001 | -20% |
| Office Consultation | 97 | 103 | 117 | 118 | 122 | +26% |
| * Based on 2000 conversion factor of $36.61. | ||||||
AANS/CNS Try to Halt Practice Expense Cuts.
To halt further reductions to neurosurgical income, the AANS and CNS, along with the 40-member Practice Expense Coalition, are seeking legislation that would modify the Medicare practice expense law. The “Halt 2000” proposal would maintain the current practice expense values, except for office visit and office consultation services, which would increase to their projected 2002 values. If successful, neurosurgery’s overall reduction from the new system would be -4 percent rather than -13 percent.
Campbell Bill Passes House; Senate Action Unlikely.
HR 1304, the Quality Health Care Coalition Act (Campbell bill) passed the House of Representatives in June by a vote of 276 to 136. Neurosurgeons who had a significant role in the bill’s passage included Donald Prolo, MD, George Koenig, MD, and Troy Tippett, MD. The bill would allow individual physicians to jointly negotiate with insurance companies all provisions of their contracts (include fees) without facing antitrust liability. The bill would “sunset” after three years, unless Congress intervened to reauthorize the law. Given the strong opposition by the Senate leadership and the short time remaining on the congressional calendar for this year, it is not likely that the Campbell bill will become law this year. For information on how your member of Congress voted on the bill, visit: https://clerkweb.house.gov/evs/2000/index.asp.
Inaugural Neurosurgical Device Forum Meets.
AANS/CNS convened the inaugural Neurosurgical Device Forum in July in Washington, D.C. The Forum has been established to improve patient care by fostering an environment of open communication among the scientific community, government, public representatives and industry on neurological device issues of mutual interest. Richard G. Fessler, MD, chairman of the AANS/CNS Drugs and Devices Committee, presided over the meeting, which included participants from the Food and Drug Administration (FDA), the Health Care Financing Administration (HCFA) and major neurological device companies. Other neurosurgeons present were Allan Friedman, MD, Phil Gildenberg, MD, Robert Harbaugh, MD, Isabella Germano, MD, and Theodore Jacobs, MD.