AANS Neurosurgeon | Volume 29, Number 1, 2020


D.C. News Updates

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AANS and CNS Continue to Make Progress Advancing Legislative Agenda
Last month, the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) took two additional steps forward in advancing the AANS/CNS 2015 Legislative Agenda. On June 18, 2015, the House of Representatives passed, by a vote of 280 to 140, H.R. 160, the Protect Medical Innovation Act. Forty-six Democrats joined 234 Republicans in voting for the bill. The legislation would repeal the Affordable Care Act’s (ACA) 2.3-percent medical device excise tax. Senate Majority Leader, Mitch McConnell (R-Ky.), has started a process to allow the Senate to consider the House-passed bill without first sending it to committee.

Several days later, on June 23, 2015, by a vote of 244 to 154, the House passed H.R. 1190, the Protecting Seniors’ Access to Medicare Act. This bill repeals the Independent Payment Advisory Board (IPAB). Eleven Democrats joined 233 Republicans in voting for the legislation. Created by the ACA, the IPAB is a board of 15 unelected government bureaucrats whose primary purpose is to cut Medicare spending.

Repealing the medical device tax and IPAB are two of organized neurosurgery’s top legislative priorities, and the AANS/CNS Washington Office played an active and critical role in advancing both bills.

CMS Announces ICD-10 “Grace Period”
Throughout the past 18 to 24 months, organized neurosurgery, working with others in medicine, have been lobbying Congress and the Centers for Medicare and Medicaid Services (CMS) to address the challenges that many physicians face in implementing the new ICD-10-CM diagnoses coding system. These efforts have led to positive results when on July 6, 2015, CMS released additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD-10 code set.

For a one-year period starting Oct. 1, 2015, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors. To avoid potential problems with mid-year coding changes in CMS quality programs for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores. CMS will also establish an ICD-10 Ombudsman to help receive and triage physician problems. Finally, in certain circumstances, CMS may also make advanced payments to providers if challenges arise during the ICD-10 grace period.

The AANS and CNS will continue to monitor this issue and will keep neurosurgeons informed of any additional changes. We also encourage neurosurgeons to report to us any problems you experience during the transition, to better inform our advocacy and education efforts.

Click here for more information about ICD-10.

CMS Releases Physician Specific Medicare Payment Data
On June 1, 2015, the Centers for Medicare & Medicaid Services (CMS) released 2013 data on services and procedures provided by more than 950,000 individual health-care professionals. According to CMS, its intent in releasing the data is to improve transparency, affordability and accountability in the healthcare system. The data is organized by National Provider Identifier (NPI) and Healthcare Common Procedure Coding System (HCPCS) code. The data set includes:

• Name, NPI and address of each provider;
• Number of services, identified by CPT code;
• Average submitted charges and standard deviation in submitted charges;
• Average allowed amount and standard deviation in allowed amount;
• Average Medicare payment and standard deviation in Medicare payment; and
• Number of the unique beneficiaries treated.

This is the second data release by the CMS, and organized neurosurgery continues to be concerned that the physician payment data could be misinterpreted. Because the data do not provide the context for the physicians’ payments, patients, researchers, the media or others may draw inaccurate conclusions. Neurosurgeons are therefore encouraged to review their data for accuracy. Although the agency has informed the medical community that it will not initiate a process for addressing data errors, it is important for neurosurgeons to be able to explain the details behind their claims data.

Neurosurgery Comments on Electronic Health Record Incentive Programs
On June 15, 2015, the AANS and CNS submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding changes to the Electronic Health Records (EHR) Incentive Program. In the letter, organized neurosurgery acknowledged the potential value of EHRs to improve the quality of patient care. We nevertheless expressed our ongoing concerns about existing barriers that make it a challenge for physicians to achieve widespread EHR adoption. These barriers include:

• The high cost of EHR adoption;
• The lack of EHR functionality that cater to specialists’ needs;
• A meaningful use program that continues to rely on a one-size-fits-all approach to measurement and fails to recognize the diversity of medicine and patient populations; and
• Ongoing interoperability challenges.

Previously, on May 29, 2015, neurosurgery sent a letter to CMS to address concerns with proposals for Stage 3 of the EHR Incentive Program. Our letter highlighted the need for CMS to work more closely with the specialty provider community to develop meaningful-use criteria that facilitate the use of health information technology to achieve improvements to specialty patient care.

2014 Open Payments Financial Data Published
On June 30, 2015, the Centers for Medicare and Medicaid Services (CMS) released a full year of 2014 physician-industry financial data on the Open Payments public website. Congress passed the Sunshine Act as part of the Affordable Care Act (ACA). Each year, manufacturers of drugs, devices, biologicals and medical supplies must report payments or others transfers of value they make to physicians and teaching hospitals. Physicians may continue to register and review their data, but corrections will not occur until CMS performs its annual refresh to include updates to data disputes and other data corrections made since the initial publication.

Supreme Court Upholds Federal Health Insurance Premium Subsidies in King v. Burwell Case
On June 25, 2015, the U.S. Supreme Court ruled in favor of the Obama Administration in the King v. Burwell case. At issue was the lawfulness of federal tax subsidies for individuals enrolled in federal health insurance exchanges. The 6-3 decision was authored by Chief Justice John C. Roberts. Justices Anthony M. Kennedy, Ruth Bader Ginsburg, Stephen G. Breyer, Sonia Sotomayor and Elena Kagan joined Roberts in upholding the subsidies. Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. dissented. While not opining on the specifics of this case, the AANS and CNS used the opportunity to issue a press release urging Congress to adopt a number of changes to improve the Affordable Care Act (ACA). Neurosurgery’s statement was picked up by multiple news outlets, including U.S. News and World Report, MedPage Today and The Hill.

Neurosurgery Blog Launches New Military Feature
In conjunction with Memorial Day, Neurosurgery Blog launched a new series, titled “The Military Faces of Neurosurgery.” The first feature highlighted the 2002 AANS Richard C. Schneider Lecture, “Vietnam 1968-69: A Place and Year Like No Other,” presented by Patrick J. Kelly, MD, FAANS(L). It is a remarkable and powerful presentation that honors surgeons, medical personnel and others who have served our country in the military. In future posts, Neurosurgery Blog plans to feature the role of neurosurgeons in the military, going back to at least Harvey Cushing’s service in World War I, and moving forward to current times. Your suggestions and contributions are welcome to this feature.

Additionally, you are invited to visit the blog and subscribe to it, as well as connect with organized neurosurgery’s 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.

Neurosurgery Blog: More Than Just Brain Surgery
Neurosurgery’s Twitter Feed: @Neurosurgery
Neurosurgery’s Facebook Page
Neurosurgery’s LinkedIn Group
Neurosurgery’s YouTube Channel
Neurosurgery’s Google+ Page

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


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