Inside the CNS:
Washington Committee Report
Author: Katie O. Orrico, Esq
CMS Releases Final 2021 Medicare Physician Fee Schedule Rule
On Dec. 1, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) final rule. Under the proposal, neurosurgeons face overall Medicare payment cuts of approximately 6% beginning on Jan. 1, 2021. The reductions are primarily driven by new values for office and outpatient evaluation and management and other visit codes. The new payment policies will result in a significant budget-neutrality adjustment to the Medicare conversion, which will be reduced from $36.0896 in 2020 to $32.4085 in 2021 — a 10.2% reduction. The Congress of Neurological Surgeons (CNS) and American Association of Neurological Surgeons (AANS) continue to advocate for Congress to override these cuts.
CMS Issues 2021 Hospital Outpatient Department and ASC Payment Final Rule
On Dec. 2, CMS published the 2021 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center (ASC) Payment final rule. Provisions of interest to neurosurgery include:
- A three-year transition to eliminate the inpatient-only (IPO) list;
- Modifications to certain expansion limits for physician-owned facilities;
- The establishment of two new categories of services requiring prior authorization — cervical fusion with disc removal and implanted spinal neurostimulators; and
- Revised criteria for the ASC list, including several neurosurgical procedures.
Click here for the CMS press release and here for the CMS fact sheet.
Neurosurgery Urges Congress to Adopt its Plan for Preventing Medicare Cuts
On Dec. 4, the CNS and AANS joined 18 other surgical organizations in sending a letter to Congressional leadership urging immediate intervention to stop devastating Medicare physician payment cuts scheduled to be implemented on Jan. 1, 2021. The groups called on Congress to incorporate the provisions of the “Holding Providers Harmless from Medicare Cuts During COVID-19 Act” (H.R. 8702/S. 5007) and S. 4932, the “Medicare Reimbursement Equity Act,” into any year-end legislative package. Additionally, the letter urges Congress to halt the implementation of the G2211 add-on code for certain complex E/M services.
The CNS and AANS also joined the Alliance of Specialty Medicine in sending a letter urging Congress to act before the end of the year to prevent Medicare payment cuts, which will impact many physician specialties effective Jan. 1, 2021. Additional letters sent by the Congressional Black Caucus, doctor members of Congress and a group of 50 Senators urged leadership to stop the impending Medicare payment cuts.
Neurosurgery Asks Congress to Suspend Medicare Payment Sequester
On Nov. 9, the CNS and AANS joined the Alliance of Specialty Medicine in a multi-specialty letter urging Congress to extend the Medicare sequestration relief provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136). Section 3709 provided a temporary suspension of the annual 2% Medicare payment sequester from May 1, 2020, through the end of 2020. This provision of the CARES Act has provided critical relief when the provider community is suffering severe financial losses due to the drastic decreases in non-COVID-19-related and non-emergency care.
Following this action, on Nov. 11, the CNS and AANS also signed a coalition letter asking Congress to extend the current moratorium on the Medicare sequestration cuts until the end of the public health emergency. The letter notes that the pandemic will continue to place financial stress on our nation's health care system, threatening the viability of those serving the most vulnerable communities. Therefore, Congress should act before the end of the year "to prevent the additional, damaging financial stress that would be caused by the return of the Medicare sequester."
Neurosurgery Objects to Burdensome Prior Authorization Requirements
On Nov. 2, the CNS and AANS sent a letter to Independence Blue Cross of Philadelphia regarding coverage guidelines requiring a physiatry consultation to authorize lumbar spinal fusion procedures, including fractures and tumors. The AANS/CNS Section on Disorders of the Spine and Peripheral Nerves (DSPN) prepared the response, objecting to the care delays that will ensue if patients must first see a physiatrist as a condition of prior authorization for medically necessary spine surgery. The organizations have requested a follow-up meeting with the plan's medical director.
Neurosurgery Urges Funding for MISSION ZERO Program
On Nov. 20, the CNS and AANS sent a letter to the Senate Labor, Health and Human Services, Education, and Related Agencies (L-HHS-E) Appropriations Subcommittee supporting $11.5 million in funding for the Military and Civilian Partnership for the Trauma Readiness Grant Program. Authorized by the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (Public Law 116-22), this grant program will enhance trauma training for military health care personnel while simultaneously bolstering civilian trauma care and saving lives. Known initially as MISSION ZERO, the program will provide funding to ensure trauma care readiness by integrating military trauma care providers into civilian trauma centers.
Neurosurgery Urges CMS to Re-evaluate AUC Imaging Program
Neurosurgery has long advocated that Medicare’s Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging will place an excessive burden on physicians across a broad range of specialties with little evidence of clinical benefit. On Nov. 27, the CNS and AANS sent a letter urging CMS to re-evaluate the stand-alone AUC program for its necessity and value. CMS has delayed full implementation of the program until 2022.
Washington Committee Transitions
All of organized neurosurgery expresses our gratitude and thanks for the dedication and service of several neurosurgeons who are transitioning off the CNS/AANS Washington Committee. Joseph S. Cheng, MD, MS, FAANS and John J. Knightly, MD, FAANS, have brought significant expertise on coding and reimbursement and quality improvement issues, working tirelessly to support neurosurgeons and their practices to ensure that patients have access to the full range of treatment options. They will continue to contribute to the specialty in other roles, and for that, neurosurgeons should be grateful.
Special thanks and appreciation goes to Ann R. Stroink, MD, FAANS, chair of the committee. Dr. Stroink began her service on the committee in 2014, serving as its chair for the past 3 ½ years. Throughout her tenure, she went to bat for neurosurgery in the halls of Congress, with federal regulators, representing the CNS as chair of neurosurgery’s delegation to the American Medical Association (AMA) and as neurosurgery’s representative to the Alliance of Specialty Medicine and the Surgical Coalition. Throughout her term at the committee’s helm, she was a trusted source of information on a full range of health policy topics — prior authorization, graduate medical education, reimbursement, quality improvement and health system reform, to name a few. Fortunately for the specialty, Dr. Stroink will also remain in a leadership role within organized neurosurgery and the AMA for the betterment of our members and the public.
Dr. Stroink chairing Reference Committee F at the AMA’s House of Delegates Meeting
Finally, stepping in to fill these roles are several stellar individuals. Joshua M. Rosenow, MD, FAANS and Luis M. Tumialán, MD, FAANS, have been appointed as new members of the committee, and John K. Ratliff, MD, FAANS, will serve as the committee’s new chair. These neurosurgeons will bring their passion for health policy and advocacy to lead the committee into the new decade.
Dr. Stroink being interviewed on NPR about the need for prior authorization reform.