Vol. 99, June 2024 DC E-Newsletter
Legislative Affairs
Neurosurgeon Testifies in Congress
On May 8, Anthony M. DiGiorgio, DO, MHA, testified before the U.S. Senate Committee on the Budget at a hearing titled “Reducing Paperwork, Cutting Costs: Alleviating Administrative Burdens in Health Care.” In his testimony, Dr. DiGiorgio, a neurosurgeon at the University of California, San Francisco, tackled the issue of administrative burdens such as prior authorization, meaningless “quality” measures and the morass of health care regulations.
Subsequently, on June 4, Dr. DiGiorgio testified before the U.S. House Committee on Energy and Commerce about the problems related to the 340B Drug Discount Program (“340B Program”), the second-largest government pharmaceutical program. The purpose of the 340B Program is to provide low-income and uninsured patients increased access to life-saving drugs. However, the 340B Program has expanded beyond its legislative purpose, resulting in additional profits for hospitals and health systems operating in affluent areas. In his statement, Dr. DiGiorgio noted, “[a]s a physician committed to serving vulnerable populations, I believe in the original mission of the 340B Program. However, reforms are necessary to prevent abuse and ensure that the program benefits those it was designed to help.”
Click here for details and to watch the Senate hearing and here for the House Hearing.
CNS and AANS Urge Senate to Address Medicare Physician Payment Reform
On April 11, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) joined the Alliance of Specialty Medicine in submitting a statement for the record to the Senate Finance Committee for convening a hearing to examine how changes to Medicare physician payment can bolster chronic care. The statement outlines suggested actions that Congress could take to stabilize the Medicare physician payment system while ensuring successful value-based care incentives are available for specialty physicians.
Click here to read the Alliance of Specialty Medicine’s statement.
Neurosurgery Asks Congress to Fund Pediatric Device Consortium
On May 6, the CNS, AANS, CNS/AANS Section on Pediatric Neurological Surgery and American Society of Pediatric Neurosurgeons urged Congress to fund the Pediatric Device Consortia (PDC) Grant Program at the Food and Drug Administration for fiscal year 2025. To address the need for improved pediatric medical devices, Congress created the PDC program and has renewed it since its inception in 2007. Funding for the PDC program is necessary to continue improving device availability for children. Medical devices for children often lag five to 10 years behind those for adults.
Click here to read the letter.
Neurosurgery Urges Funding for Pediatric Specialty Loan Repayment Program
On May 24, the CNS, AANS, CNS/AANS Joint Section on Pediatric Neurological Surgery and American Society of Pediatric Neurosurgeons joined more than 60 organizations dedicated to improving the health and well-being of children in urging Congress to invest in the pediatric subspecialties by including $30 million for the Pediatric Subspecialty Loan Repayment Program (PSLRP). With this investment, the Health Resources and Services Administration will be able to ensure more communities have access to specialized pediatric care by expanding the number of loan repayment awards it is able to make. The PSLRP aims to help alleviate pediatric subspecialty shortages by addressing the financial barriers to training and practicing in a pediatric subspecialty.
Click here to read the House letter and here for the Senate letter.
Coding and Reimbursement
CNS and AANS Oppose Expanding Prior Authorization to ASCs
On April 16, the CNS and the AANS joined the Regulatory Relief Coalition (RRC) commenting on the Centers for Medicare & Medicaid Services (CMS) notice announcing its intention to collect information from the public in conjunction with a potential demonstration project that would require Ambulatory Surgical Centers (ASCs) to obtain prior authorization (PA) before providing certain surgical procedures to Medicare beneficiaries. The comment letter opposed expanding PA and suggested that CMS consider alternative ways to address concerns about the potential overutilization of procedures subject to PA in hospital outpatient settings when they are performed in ASC settings.
Click here to read the RRC letter.
Neurosurgery Continues to Urge Aetna to Modify ACDF Surgical Policy
Despite two decades of scientific literature, Aetna remains the only major commercial insurer that routinely denies coverage for interbody spacers in anterior cervical discectomy and fusion (ACDF). Aetna’s policy deems poly-ether-ether-ketone, or PEEK, and metallic spacers (CPT code 22853) as “experimental and not medically necessary” for routine ACDFs. Neurosurgery has vigorously opposed this position for many years. Most recently, on April 25, the CNS, AANS and CNS/AANS Joint Section on Disorders of the Spine and Peripheral Nerves joined other spine societies in sending a letter to Aetna urging the health plan to update its coverage to empower the surgeon and the patient to decide which implants to use in their spine surgery. In addition, the societies contacted the Centers for Medicare & Medicaid Services, asking the agency to review this matter with Aetna-sponsored Medicare Advantage plans.
Neurosurgery Urges CMS to Recognize Complexity of “Add-on” CPT Codes
On April 23, the CNS, AANS and CNS/AANS Joint Section on Disorders of the Spine and Peripheral Nerves led an effort urging the Centers for Medicare & Medicaid Services (CMS) to ensure access to care for certain spine procedures performed in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs). Specifically, the societies recommended that CMS modify its current HOPD and ASC payment policy to better account for procedure combinations involving add-on codes using implanted devices, stating:
We urge CMS to modify its device-intensive policy and complexity adjustment policy for cases where the primary code in a complexity adjustment C code is not device-intensive, but the add-on code has device costs that meet the criteria for device-intensive status… In cases where the combined device costs exceed the 30% device-intensive procedure threshold, the complexity adjustment C code should be granted device-intensive status.
Click here to read the letter signed by nine national spine societies.
CNS and AANS Respond to CMS RFI to Improve Transparency in Medicare Advantage
On Jan. 30, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) seeking input from the public regarding various aspects of Medicare Advantage (MA) data. On May 20, the CNS and the AANS joined the Alliance of Specialty Medicine in responding to the RFI, recommending CMS improve the availability of data and information for beneficiaries and the public to evaluate MA plans. The Alliance of Specialty Medicine remains concerned about access to specialty care for beneficiaries enrolled in MA plans.
Click here to read the letter.
Quality Improvement
2024 MIPS Exception Application Now Available
The Centers for Medicare & Medicaid Services (CMS) recently released its 2024 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable (EUC) Circumstances exception application, which can be submitted for purposes of the 2024 Merit-based Incentive Payment System (MIPS) through Dec. 31. Note that CMS will not accept MIPS EUC exception applications due to COVID-19 for the 2024 performance year. However, eligible clinicians and group practices may use the 2024 MIPS EUC exception application if they were impacted by disruptions related to the Change Healthcare cyberattack in late February. Additional resources are available on the QPP website and at the links below:
Click here to go to the MIPS Exception Applications webpage and here for the 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide.
CMS Releases 2022 QPP Participation and Performance Data
Recently, the Centers for Medicare & Medicaid Services (CMS) released national participation and performance data for the Quality Payment Program’s (QPP) 2022 performance year, including data related to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation. Notable findings include:
- More than 386,000 participated as qualifying APM participants in 2022, up from 333,658 in 2021;
- Mean and median MIPS scores were lower than in previous years;
- Fourteen percent of MIPS-eligible clinicians received a penalty in 2024 (based on 2022 performance), 37% received a positive adjustment and 42% received an exceptional performance bonus (note that 2022 was the last year participants could qualify for this bonus); and
- More than 85% of neurosurgeons who were eligible to participate in MIPS received a neutral or positive payment adjustment, while 14% received a penalty.
Additional information about 2022 participation/performance data and 2024 payment adjustments is available in the following resources:
In addition, click here for resources related to the 2022 PUF and here for earlier PUFs.
Neurosurgery Urges CMS to Reduce Burdens Associated with APM Participation
On April 10, the CNS and the AANS joined dozens of national physician organizations and more than 100 Accountable Care Organizations (ACOs), health systems, hospitals, clinics and practices from across the country in opposing two recently finalized policies in the 2024 Medicare Physician Fee Schedule. These policies pertain to certified electronic health record technology utilization requirements for ACOs, alternative payment model (APM) entities and their participating practices. The letter outlines concerns that these policies will significantly increase burdens and jeopardize participation in the Medicare Shared Savings Program and other Medicare Advanced APMs with a disproportionate impact on small practices and the patients they serve.
Click here to read the letter.
CNS and AANS Voice Concerns about MIPS Total Per Capita Cost Measure
The CNS and the AANS recently submitted comments to the Centers for Medicare & Medicaid Services’ contractor, Acumen, LLC, regarding its re-evaluation of the Total Per Capita Cost (TPCC) measure currently in use under the Merit-based Incentive Payment System (MIPS). The TPCC measure evaluates the overall cost of care in both Medicare Part A and B provided to beneficiaries attributed to clinicians or groups throughout the MIPS performance year. Although the measure is intended to focus on primary care management and to exclude specialties that are not responsible for providing ongoing care, neurosurgeons are still often scored on the measure if they participate in MIPS as part of a larger, multi-disciplinary group practice. The current re-evaluation of the measure aims to address the accuracy of the measure’s current attribution methodologies.
The CNS and the AANS used this opportunity to point out the fundamental flaws of the TPCC measure, including its tendency to hold physicians accountable for costs outside of their reasonable control, its exclusive reliance on administrative claims data, its reliance on inadequate risk adjustment methodologies and its potential to create perverse incentives to undertreat patients.
Of Note
Neurosurgery Adopts Position Statement on AO Spine/PRAXIS Clinical Practice Guidelines for the Management of Acute Spinal Cord Injury
The CNS, AANS, CNS/AANS Joint Section on Disorders of the Spine and Peripheral Nerves and CCNS/AANS Joint Section on Neurotrauma and Critical Care recently adopted a new position statement titled “AO Spine/PRAXIS Clinical Practice Guidelines for the Management of Acute Spinal Cord Injury.” In the statement, the neurosurgical groups take issue with some of the recommendations contained in this guideline, stating that complete and incomplete cervical spinal cord injuries that require surgical intervention deserve individualized treatment and that only the surgeon will be able to determine the optimal timing of surgical intervention. Decisions regarding the timing of surgical management must consider both the characteristics of the injury and additional patient-specific factors that may influence outcomes.
Click here to read the position statement.
Communications
Neurosurgeon Featured in Article on Joining a Spine Practice
On May 10, Becker’s Spine Review published an article titled, “Here’s what to look out for when joining a spine practice.” Joining a spine practice takes more than finding a salary that is a good fit or managers you like. The article states that physicians should also evaluate operational factors behind a prospective employer. Neurosurgeon Richard Menger, MD, MPA, states, “[A green flag is] that your entity (hospital, practice, academics, etc.) is positioned well within the community.”
Neurosurgery Blog Continues Series on Making and Maintaining a Neurosurgeon
Neurosurgery Blog continues its series on becoming a neurosurgeon. Read the latest four articles published:
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