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AANS Neurosurgeon | Volume 27, Number 4, 2018

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Washington Committee Sets 2019 Legislative and Regulatory Agenda

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Neurosurgeons like many other physicians report regulatory burdens such as limited interoperability of electronic health records (EHRs), prior authorization and mandates to utilize appropriate use criteria (AUC) as some of the most maddening aspects to the daily practice of neurosurgery.

Proponents of EHRs promised the medical profession that we could expect a seamless system that patients and physicians could use to communicate medical histories, lab results and images with other doctors, hospitals and pharmacies. Thus far this has not been accomplished and will not be resolved within the near future given that competing EHR software companies and hospital systems are disincentivized to exchange and share information easily.

When ordering imaging of the nervous system for newly found neurologic deficits, tumor surveillance, navigation purposes or scheduling a case for surgery, prior authorization is often required and frequently results in treatment delays. In the near future, Medicare will mandate that neurosurgeons first consult with AUC when ordering MRI, CT and PET scans. This will require the use of a Medicare-approved Clinical Decision Support Mechanisms (CDSMs) necessitating the purchase of software and registration fees, an additional layer of coding plus additional staff — all which will lead to increased overhead costs and hassles. Not surprising, neurosurgeons have identified these issues as top priority items for 2019.

Earlier this year, the Washington Committee sent a survey to AANS and CNS members seeking their input in determining neurosurgery’s 2019 Legislative and Regulatory Agenda. At the time of this report, 600 surveys were completed. Individuals were asked to select their top 10 legislative priorities from a suggested list of 26 topics and top 10 priorities from a list of 26 regulatory topics. Space was provided for comments and additional suggestions. The survey was not stratified to ensure a representative demographic sample, but we did collect demographic data, and the results appear to represent an appropriate cross-section of individuals.

Based on the survey and additional deliberations at its February meeting, the Washington Committee has developed the following agenda:

  • Protect patients’ timely access to care by reforming utilization review practices such as prior authorization, step-therapy and Medicare’s appropriate use criteria program for advanced diagnostic imaging.
  • Fix the broken medical liability system by adopting proven reforms that are in place in California and Texas.
  • Improve the health care delivery system, including maintaining existing insurance market reforms and advancing solutions that will lower costs and expand choice, including out-of-network options — with appropriate patient protections for unanticipated medical bills.
  • Support quality resident training and education by increasing the number of Medicare-funded residency positions and preserving the ability of surgeons to maximize education and training opportunities within the profession’s current regulatory structures.
  • Alleviate the burdens of electronic health records, including promoting interoperability, reducing unnecessary data entry, and improving the functionality of EHR systems to enhance, not hinder, the delivery of medical care.
  • Continue progress with medical innovation by repealing the medical device tax, implementing the 21st Century Cures Act.
  • End the opioid epidemic by implementing the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment or Patients and Communities Act (SUPPORT Act).
  • Champion fair reimbursement by maintaining a viable fee-for-service option in Medicare, and by empowering patients and physicians to privately contract fee arrangements. Additionally, Medicare must maintain the 10- and 90-day global surgery payment package and minimize the burdens associated with the global surgery code data collection initiative.

The survey also identified a number of concerns that may not have made the top ten list but stood out as important to neurosurgeons: modifications to the Affordable Care Act, overlapping surgery, Medicare Access and CHIP Reauthorization Act, Medicare reform and Trauma/emergency care.

Recent turnover of members in the US House and Senate, as well as a rapidly changing health care climate, dictates that our strategy remains facile so we can effectively engage policymakers — including Congress and the administration — on the issues that affect neurosurgeons and our patients. Thus, going forward this year, while the Washington Committee will proactively pursue the above agenda, we will remain flexible in responding to a fluctuating health care environment and governmental action.

Neurosurgeons are encouraged to respond to future surveys and communicate with their state neurosurgical societies through Council of State Neurosurgical Societies (CSNS) and Joint Section leaders who serve as liaisons to bring issues or concerns to our Washington Committee. You can stay informed on health care policy topics by subscribing to Neurosurgery Blog at www.neurosurgeryblog.org and following the Washington Committee on Twitter @neurosurgery. Finally, periodic updates are available via AANS and CNS publications and through presentations at neurosurgery meetings.

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