Special Announcements
FDA Issues Safety Notice for Imaging Software for Intracranial Large Vessel Occlusion
On April 11, the Food and Drug Administration (FDA) issued a notice reminding health care providers about the intended use of radiological computer-aided triage and notification devices for intracranial large vessel occlusion. The statement includes the following information:
- Intended use of these devices;
- Recommendations for health care providers;
- Actions that the FDA is taking; and
- Instructions for reporting problems with these devices.
More information on the FDA process for reporting adverse events is available here.
COVID-19
Administration Renews COVID-19 Public Health Emergency Declaration
On April 12, U.S. Department of Health and Human Services Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) declaration. Effective April 16, the PHE was extended for an additional 90 days. This means that all telehealth and other waivers and flexibilities implemented during the PHE will remain in effect. The department has also stated that it will provide 60 days’ notice when a decision is made to terminate the declaration or let it expire.
Legislative Affairs
Neurosurgery Urges Funding for Firearms Injury Prevention Research
On April 28, the Congress of Neurological Surgeons (CNS), American Association of Neurological Surgeons (AANS) and CNS/AANS Joint Section on Neurotrauma & Critical Care, AANS/CNS Section on Pediatric Neurological Surgery and the American Society of Pediatric Neurosurgeons joined in a letter to Congress urging additional funding for firearms-related research. Specifically, the groups requested $35 million for the Centers for Disease Control and Prevention and $25 million for the National Institutes of Health to conduct public health research into firearm morbidity and mortality prevention.
Click here to read the letter.
Coding and Reimbursement
Federal Watchdog Agency Raises Concerns about Prior Authorization in Medicare
On April 28, the U.S. Department of Health and Human Services Office of Inspector (OIG) General released a report criticizing prior authorization in the Medicare Advantage program. According to the report titled “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care,” an estimated 13% of denied prior authorization requests reviewed met Medicare coverage rules and likely would have been approved under fee-for-service Medicare. Moreover, the OIG found that about 18% of denied payment requests met Medicare coverage and Medicare Advantage billing rules. The OIG recommends, among other things, that the Centers for Medicare & Medicaid Services (CMS) update its guidance on the clinical criteria for medical necessity reviews and revise audit protocols for Medicare Advantage plans.
Following the report, the sponsors of H.R. 3173, the Improving Seniors’ Timely Access to Care Act, which would streamline prior authorization in the Medicare Advantage Program, issued a press release stating:
Today’s HHS Inspector General report underscores the urgent need for reforms in the current prior authorization system. Seniors should not be denied care for routine treatments and procedures that would otherwise be covered. This complicates and delays care and worsens health outcomes for this vulnerable population.
It is well past time to bring prior authorization into the 21st century so seniors can get the care they deserve by passing the Improving Seniors’ Timely Access to Care Act. The reforms in this legislation have widespread bipartisan support and the backing of hundreds of leading national health care organizations. The House must move on this bill quickly.
With nearly 300 co-sponsors, this legislation is poised to move forward in the House of Representatives and would be a significant step in reforming prior authorization in Medicare.
Click here for the OIG report and here for a video related to the report.
AMA Issues Updated Guidance on No Surprises Act
The American Medical Association has released additional guidance to help physicians comply with the requirements of the No Surprises Act (NSA). The NSA prohibits surprise medical billing for emergency care and some non-emergency care at in-network facilities. The document provides information on the process and rules related to disputing out-of-network payments using the independent payment dispute resolution process.
Click here for the March guidance document and here for the first toolkit released in January.
CMS Issues Proposed 2023 Medicare Inpatient Payment Rule
On April 18, the Center for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2023 Medicare Hospital Inpatient Prospective Payment proposed rule. Among other things, CMS proposes to return laser interstitial thermal therapy (LITT) procedures to open craniotomy Medicare Severity Diagnosis-Related Group (MS-DRG) Classifications. Last year neurosurgery joined other stakeholders in objecting to the reassignment of LITT to MS-DRGs associated with percutaneous procedures. The CNS and the AANS plan on submitting comments in response to the proposal, which will be finalized before Oct. 1. A fact sheet is available here.
Neurosurgery Urges CMS to Reconsider Shared Visit Policy
On March 29, the CNS and the AANS joined the AMA and more than 30 national medical societies in urging the CMS to rescind its shared visit policy. The policy, finalized in the 2022 Medicare Physician Payment Fee Schedule, outlines how providers should bill for split or shared visits when elements of the visit are performed by both a physician and qualified health care professional (QHP). Rather than the long-standing policy of permitting reporting by the providers that perform the critical medical decision-making elements of the visit, the new CMS policy only allows billing based on the physician or QHP who conducts more than 50%of the total time of the visit. In the letter, the societies ask that CMS withdraw this new policy requirement and allow for additional public comments.
Click here to read the letter.
Drugs and Devices
CNS and AANS Comment on Updated CDC Opioid Guidelines
On April 4, the CNS and the AANS submitted comments to the Centers for Disease Control (CDC) regarding its updated draft Clinical Practice Guideline for Prescribing Opioids. The letter notes that while the document addresses many of the misinterpretations of the 2016 version and devotes significant discussion regarding nonpharmacologic treatments for pain as alternatives to opioid therapy, the new guideline fails to adequately explore surgical treatment options to reduce or eliminate opioid use. The groups recommended adding decompressive (spinal, peripheral nerve, cranial nerve), reconstructive, ablative and neuromodulatory options for treating pain in the guideline as additional pain management strategy options.
Click here to read the comments.
Graduate Medical Education
Neurosurgery Joins Alliance in Commenting on VA GME Proposal
On April 5, the CNS and the AANS joined the Alliance of Specialty Medicine (Alliance) in commenting on a U.S. Department of Veterans Affairs pilot program on graduate medical education. The program aims to expand access to care for veterans while increasing the training opportunities for residents in a way that will support our national workforce and medical training needs.
Click here for the letter.
Of Note
AMA Survey Shows Widespread Support for Telehealth
A recent survey conducted by the AMA demonstrates that physicians have enthusiastically embraced telehealth and expect to use it even more in the future. Nearly 85% of physician respondents indicated they are currently using telehealth to care for patients, and almost 70% report that they plan on continuing to use telehealth in their practice. These figures generally compare to data from an CNS/AANS survey conducted in 2021.
Click here for the AMA survey results.
Former Washington Committee Chair Reappointed to AMA Council on Legislation
Former Washington Committee chair and AANS president, Ann R. Stroink, MD, was reappointed to serve another one-year term on the AMA’s Council on Legislation. The COL reviews proposed federal legislation and recommends appropriate action. The council also develops model state legislation, recommends changes in existing AMA policy to accomplish effective legislative goals, and recommends to the Board of Trustees new federal legislation and legislation to modify existing laws of interest to the AMA.
Communications
Neurosurgery Blog Publishes New Blogs in Tumor Series
Neurosurgery Blog continued to publish new blogs in its tumor series. Recent posts include:
In addition, the blog highlighted the work made possible by the CNS Getch K12 Scholar Award in a post titled “The Long Game: The CNS’ Investment in the NINDS/CNS Getch K12 Scholar Award.”
Join the Conversation on Social Media
Connect with the CNS/AANS Washington Committee and Washington Office on various social media platforms to keep up with the many health policy activities in the nation’s capital and beyond the Beltway.