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.
Neuro News
AMA Supports Medical Error Tracking System.
The American Medical Association recently voted to support a system for reporting medical errors. The decision came in the wake of a Journal of American Medical Association (JAMA) article claiming over 98,000 Americans die each year as the result of medical errors and an initiative by President Clinton to reduce the number of medical-mistake deaths in the United States. Clinton urged Congress in February to create the Center for Quality Improvement and Patient Safety to reduce medical errors by 50 percent in five years. The AMA resolved to support a “non-punitive, evidence based” error reporting system that provides legal protections for participants in safety programs. The association refused to commit to making the system either mandatory or voluntary. Several states already have mandatory reporting systems, but fear of consequences prevents many doctors and nurses from reporting mistakes. The American Hospital Association, on the other hand, officially opposes any mandatory requirements for reporting fatal or other serious medical errors because of fear of litigation. Some changes, however, appear evident. New reporting requirements for all Defense Department administered hospitals, which treat a reported 8 million people each year, are under way. The Health Care Financing Administration is under executive order to mandate all 6,000 hospitals that participate in Medicare to have error-reduction plans in place by the end of the year or lose funding. The U.S. Food and Drug Administration also has a year to develop new standards to prevent mistakes caused by sound-alike or look-alike drugs. The full Clinton plan calls for mandatory reporting of all preventable deaths and major injuries, but names of individual doctors and other healthcare workers would be withheld from the public. The plan earmarked $33 million to improve the reporting system for drug-related medical mistakes and $20 million for new research on reducing medical errors and to create a new patient safety clearinghouse.
Neurosurgeon to Lead Nation’s Oldest Medical Society.
Francis X. Rockett, MD, was voted president-elect of the Massachusetts Medical Society at the group’s annual meeting in May. Founded in 1781, the medical society is the nation’s oldest continuously operating medical society with more than 17,000 physician and medical student members. Dr. Rockett practices neurosurgery in Newton and holds appointments at several hospitals, including Newton-Wellesley Hospital, where he is Chief of Neurosurgery Emeritus. He is an associate clinical professor of neurosurgery at Tufts University School of Medicine and a clinical instructor in surgery at Harvard Medical School.
AMA, Intel Devise Internet Security Plan.
The American Medical Association is working with Intel Corporation to deploy a new form of electronic identification to protect patient privacy on the Internet. The AMA plans to issue digital certificates soon to ensure the confidentiality of electronic medical activities such as filling prescriptions, verifying patient eligibility and transmitting insurance claims, according to Robert Musacchio, PhD, senior vice president of publishing and business services at the AMA. The certificates function in the online world as drivers’ licenses and passports do in the paper world and provide a more reliable authentication tool for secure transactions than passwords.
ACGME Approves Neuroendovascular Training Standards.
The Accreditation Council for Graduate Medical Education approved in June the joint Radiology and Neurolosurgery Neuroendovascular Training Standards. The training standards require the management of patients with neurological diseases, the performance of neuroendovascular surgery/interventional radiology procedures and the integration of neuroendovascular surgery/interventional radiology therapy into the clinical management of patients.
E&M Guidelines Aired
The Health Care Financing Administration (HCFA) held a “Town Hall” meeting to introduce its latest plans for implementing new Evaluation and Management Documentation Guidelines. Troy M. Tippett, MD, attended the meeting on behalf of the AANS and CNS. Although details are still vague, HCFA announced its intention to revert to the original 1995 guidelines, subject to several minor modifications, including the development of specialty– specific vignettes. HCFA anticipates that the new guidelines will be ready for implementation sometime in 2002. In the meantime, physicians may continue to use either the 1995 or 1997 guidelines, whatever are more advantageous. HCFA plans a pilot test of the revised ’95 guidelines.
FPA Hears Comments
Richard Fessler, MD, and Robert Heary, MD, testified August 3 at an FDA public hearing on “Human Bone Allograft: Manipulation and Homologous Use in Spine and Other Orthopedic Reconstruction and Repair.” AANS/CNS have previously submitted comments to the FDA on this topic.
Government to Issue Privacy Rules
The Department of Health and Human Services (HHS) is expected to publish soon rules standardizing the privacy and security of health care information. The Health Insurance Portability and Accountability Act (HIPAA) will apply to all health care providers, health plans and clearinghouses that transmit health information in electronic form in connection with Medicare or Medicaid. The standards will impact the information systems of health care providers. The regulations will implement a national provider identifier, a national employer identifier, security and electronic signatures and electronic transaction and code sets. HHS first published the standards in 1998. The agency has delayed finalizing the rules until it could respond to the thousands of comments the initial draft drew. The proposed standards can be viewed at www.aspe.hhs.gov/admnsimp.