AANS Neurosurgeon | Volume 29, Number 1, 2020


Washington Watch: 2020

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Year-end Spending Legislation Reflects Neurosurgery’s Priorities

On Dec. 20, President Donald J. Trump signed the fiscal year 2020 domestic spending bill (Further Consolidated Appropriations Act, 2020, H.R. 1865), which was previously approved by the U.S. Senate by a vote of 71-23 and the House of Representatives by a vote of 297-120. The new law (P.L. 116-94) includes several provisions of interest to neurosurgery:

  • Provides $41.68 billion to the National Institutes of Health. Funds include $500 million for the Brain Research through Application of Innovative Neurotechnologies (BRAIN) Initiative to map the human brain; $818 million for research on opioid addiction, development of opioids alternatives, pain management and addiction treatment; $12.6 million for research on childhood cancer and structural birth defects; and funding for research on the deadliest cancers, which include anaplastic astrocytoma, diffuse intrinsic pontine glioma, glioblastoma and high-risk neuroblastoma.
  • Provides $68 million for injury prevention activities at the Centers for Disease Control and Prevention, including $12.5 million to support firearm injury and mortality prevention research; funds to investigate the establishment of a national surveillance system to determine the incidence of sports- and recreation-related concussions among youth aged 5 to 21 years; and $6.7 million for traumatic brain injury
  • Encourages the Centers for Medicare & Medicaid Services (CMS) to collaborate with the Food and Drug Administration and consider approved devices and therapies for unique post-surgery patient populations for effective pain management; ensure that payment changes do not further exacerbate workforce shortages; and not make payment changes to robotic stereotactic radiosurgery and robotic stereotactic body radiation therapy in the freestanding or hospital outpatient settings.

In addition to discretionary spending items, the legislation incorporates other health care policy matters of interest to neurosurgery, including:

  • Extending the work geographic practice cost index floor, which increases reimbursement for physicians practicing in certain rural areas through May 22, 2020;
  • Extending funding for the Patient-Centered Outcomes Research Institute for 10 years through September 2029; and
  • Permanently repealing the 2.3% medical device excise tax, an AANS/CNS priority since 2010.

AANS and CNS Comment on New Surprise Medical Bills Proposals

On Dec. 9, bipartisan House and Senate committee leaders announced an agreement on legislation to address surprise medical bills. House Energy and Commerce Committee chair Frank Pallone, Jr., (D-N.J.) and ranking member Greg Walden (R-Ore.), along with Senate Health, Education, Labor and Pensions (HELP) Committee chair Lamar Alexander (R-Tenn.), released a summary of the Lower Health Care Costs Act. The compromise — which uses a median in-network payment benchmark for out-of-network care and includes a restrictive independent dispute resolution (IDR) process — fails to incorporate neurosurgery’s key principles. In commenting on the proposal, the AANS and the CNS expressed concerns that the compromise will harm patient access to care.

Following this announcement, on Dec. 11, House Ways and Means Committee leaders, chair Richard Neal (D-Mass.) and ranking member Kevin Brady (R-Texas), announced their surprise medical bills framework. The AANS and the CNS expressed appreciation for this effort, noting that “Congress must implement a thoughtful and balanced approach that will protect patients from unanticipated medical bills for out-of-network care, while at the same time facilitating a process to quickly, efficiently and fairly resolve physician and health plan billing disputes.”

On Dec. 5, nearly 900 smaller and independent physician practices across medical specialties sent a letter to Congress that outlines the potentially devastating unintended consequences that certain legislative proposals to solve surprise bills could have on physicians’ ability to care for their patients. The AANS, CNS, Council of State Neurosurgical Societies, California Association of Neurological Surgeons and the Neurosurgery Executives’ Resource Value and Education Society helped drive nearly 50 neurosurgical practices to sign the letter. The Out-of-the-Middle coalition, of which the AANS and the CNS are members, issued a press release highlighting the letter.

Neurosurgery Joins Alliance in Calling on Congress to Provide Positive Medicare Update

On Dec. 23, the AANS and the CNS joined the Alliance of Specialty Medicine in calling on Congress to quickly address the unresolved need to provide positive Medicare payment updates. Per the Medicare Access and CHIP Reauthorization Act (P.L. 114-10), beginning in 2020, physicians face a pay freeze for six years. Neurosurgeons also face a 2% pay cut from budget sequestration and additional cuts related to changes in office visit code values. The letter notes that other Medicare providers, including hospitals and skilled nursing facilities, will receive positive payment updates for 2020, while physician payments continue to fall to keep pace with inflation.

Neurosurgery Offers Suggestions for Cures 2.0 Legislation

Recently, Reps. Diana DeGette (D-Colo.) and Fred Upton (R-Mich.) released their initial vision for their Cures 2.0 legislation, calling on experts and stakeholders to submit their ideas and feedback on the plan — which aims to modernize coverage and access to life-saving cures. Cures 2.0 would build on the original 21st Century Cures Act (P.L. 114-255), which aspires to advance medical research and foster a new era of medical innovations. In our Dec. 16 comment letter, the AANS and the CNS urged Reps. DeGette and Upton to strengthen the use of clinical registry data to speed innovation and device approval as well as for use in post-market surveillance. The letter also recommends improving coverage and reimbursement policies to ensure that patients have access to innovative therapies.

AANS and CNS Join Alliance of Specialty Medicine in Supporting the Safe Step Act

On Oct. 29, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) joined the Alliance of Specialty Medicine in endorsing S. 2546, the Safe Step Act. Sponsored by Sens. Lisa Murkowski (R-Alaska) and Doug Jones (D-Ala.), the legislation would provide patients and providers with a clear and transparent appeals process when they are subject to step therapy protocols instituted by health plans. Step therapy, also known as “fail first,” typically requires patients to try and fail an insurer-preferred medication before being covered by the physician-prescribed medication. The letter points out that, “while this practice may initially reduce insurer costs, it can have devastating health consequences for patients and ultimately lead to more expensive health care costs in the long run.” Click here to read the letter.

CMS Publishes Medicare Physician Fee Schedule for 2020

On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the CY 2020 Medicare Physician Fee Schedule Final Rule. According to CMS, overall payments to neurosurgery will not change next year. In the rule, the agency finalized plans to adopt the new American Medical Association (AMA) CPT coding structure for office visit codes and the AMA/Specialty Society RVS Update Committee-recommended values for these evaluation and management (E/M) office/outpatient visit codes. Unfortunately, despite organized medicine’s advocacy efforts, CMS will not adjust the E/M portion of the global surgery codes to reflect the increased values, citing the agency’s continued work to evaluate the current global surgery code values. The AANS and the CNS, along with most of medicine, had pressed CMS to include these increased values in the global surgical codes. Click here for a summary of the provisions of the rule most relevant to neurosurgeons and here for a comprehensive summary.

AANS and CNS Register Concerns about Medicare Executive Order

On Oct. 29, the AANS and the CNS joined the AMA and 100 other state and national medical societies in expressing concerns about the scope of practice provisions in the Oct. 3 Executive Order on Protecting and Improving Medicare for our Nation’s Seniors. The letter noted that the language in section 5 related to the supervision and reimbursement of non-physician professionals could eliminate or weaken current Medicare supervision requirements of these professionals, “a critical safeguard to ensure the health and safety of Medicare patients and the cornerstone of the widely adopted team-based approach to health care.” In addition, on Nov. 8, the AANS and the CNS, along with the Alliance of Specialty Medicine, submitted a letter commenting on the following topics that were included in the executive order:

  • Medicare Advantage and fee-for-service payment rates;
  • Network adequacy;
  • Innovation;
  • Cost and quality transparency;
  • Waste, fraud and abuse;
  • Utilization management practices;
  • Merit-based Incentive Payment System;
  • Appropriate Use Criteria Program; and
  • Private contracting.

Click here to read the AMA coalition letter and here to read the Alliance letter.

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