Washington Watch

0
1090

Shelly D. Timmons, MD, PhD, FAANS, Appointed New Washington Committee Chair
On Jan. 1, 2016, Shelly D. Timmons, MD, PhD, FAANS, a practicing neurosurgeon at Geisinger Health System in Danville, Penn., became chair of the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Washington Committee. Dr. Timmons is the first female neurosurgeon to lead this important committee. For more than a decade, she has served on the committee in one capacity or another — as the liaison from the AANS/CNS Section on Neurotrauma and Critical Care, as chair of the committee’s Neurosurgical Emergency Care Regionalization Task Force and as an AANS appointee to the committee. Dr. Timmons is a current director-at-large on the AANS Board of Directors, is on the NeurosurgeryPAC Board and chairs the American College of Surgeons’ Advisory Council for Neurological Surgery. She replaces John A. Wilson, MD, FAANS, who completed a three-year term on the committee in December 2015.

CMS Extends Deadline to Avoid Meaningful Use Penalties: Apply for Hardship Exception by July 1
On Friday, Feb. 26, 2016, the Centers for Medicare & Medicaid Services (CMS) announced that the agency is extending the application deadline for the Medicare Electronic Health Record (EHR) Incentive Program hardship exception process. Neurosurgeons now have until July 1, 2016 to submit their applications and avoid Medicare payment penalties in 2017. Click here for more information from CMS.

o

The AANS and CNS are recommending that all neurosurgeons apply. CMS has stated that it will broadly grant hardship exceptions as a result of the delayed publication of recently updated meaningful use rules, which were issued in late 2015, and left physicians with insufficient time to report under the modified requirements. Advocated for by organized neurosurgery and other medical societies, this exception is a result of the Patient Access and Medicare Protection Act, which became law (Public Law No: 114-115) on Dec. 28, 2015.

CMS has posted new, streamlined hardship applications, reducing the amount of information that neurosurgeons must submit to apply for an exception. Click here for the new applications and instructions for which hardship exception to claim. Neurosurgeons can also click here for a step-by-step instruction sheet created by the American Medical Association (AMA).

All neurosurgeons should apply for the exception since there are no downsides to doing so. This includes physicians who have not yet implemented an EHR, as well as physicians who already attested to satisfying meaningful use in 2015. Applying for the hardship will not prevent indiviudals from receiving incentive payments if CMS determines they have satisfied the program requirements.  

Additional details about the requirements for 2015, including exclusions that might apply to specific measures, are available here.

If you have any questions regarding this topic, please contact Rachel Groman, vice president for Clinical Affairs and Quality Improvement at Hart Health Strategies, via email at [email protected]

President Signs Spending and Tax Bills: Provisions of Interest to Neurosurgery
On Dec. 18, 2015, President Obama signed into law a $1.15 trillion comprehensive spending and tax extenders package, Public Law No: 114-113. Most notably, the law suspends the 2.3 percent excise tax imposed on the sales of medical devices, which was enacted as part of the Affordable Care Act (ACA), for two years. Additionally, it prevents CMS from spending $15 million, the amount authorized for FY 2016, on the Independent Payment Advisory Board (IPAB), which is the unelected and unaccountable government board created by the ACA to cut Medicare spending. Finally, the law allocates increased funding for the National Institutes of Health (NIH), Centers for Disease Control (CDC) and other federal health care agencies. 

CMS Finalizes 2016 Medicare Fee Schedule
On Nov. 15, 2015, the Centers for Medicare & Medicaid (CMS) published the 2016 Medicare Physician Fee Schedule (MPFS) final rule in the Federal Register. Overall, neurosurgical payments will be reduced by about three percent due to changes in the methodology for malpractice relative value units, across-the-board payment reductions for so-called misvalued services and the Medicare sequestration cut. CMS announced that it will launch its data collection project for purposes of evaluating the global surgical codes on Jan. 1, 2017. Any changes to 10- and 90-day global surgical payments will be implemented in 2019. The AANS and CNS were successful in advocating against the revaluation of three “add-on” spine codes. However, CMS proposed to lower the values for three new CPT Codes for intracranial lysis and mechanical embolectomy. Organized neurosurgery is vigorously objecting to these reductions.

Neurosurgery Challenges Lumbar Spinal Fusion Coverage Policy
On Dec. 18, 2015, the AANS, CNS and the Washington State Association of Neurological Surgeons (WSANS) sent a letter to the Washington State Healthcare Authority (HCA) Health Technology Assessment (HTA) Program objecting to its decision not to cover lumbar spinal fusion for degenerative disc disease (DDD). At an HTA Program Health Technology Clinical Committee (HTCC) meeting on Nov. 20, 2015, representatives of organized neurosurgery supported a continuation of coverage for appropriately selected patients, but the HTCC voted not to cover the procedure for DDD unless other clinical indications were present. The non-coverage decision reverses a policy implemented in 2008 permitting coverage with some restrictions. Click here for more information.

CMS Finalizes Physician Fee Schedule Quality Provisions for 2016
On Nov. 15, 2015, the Centers for Medicare & Medicaid Services (CMS) published the 2016 Medicare Physician Fee Schedule (MPFS) final rule in the Federal Register. In addition to the payment provisions, the rule also finalizes policies for several Medicare quality reporting initiatives, including the Physician Quality Reporting System (PQRS), the Physician Compare website and the Physician Value-based Payment Modifier (VM). Most current program requirements will remain the same as the agency prepares to transition to the new Merit-Based Incentive Payment System (MIPS) in 2017. CMS will maintain all 2015 PQRS reporting options that eligible professionals must satisfy to avoid a negative two percent payment adjustment in 2018. The PQRS Individual Measure Specifications for Claims and Registry Reporting can now be viewed using a new web-based tool, which will allow neurosurgeons to search for measures on which to report. In addition, the 2016 Measure documents are now posted and are available here.

For the first time, in 2016, group practices will be able to participate in PQRS via a Qualified Clinical Data Registry (QCDR), and the National Neurosurgery Quality and Outcomes Database (N2QOD) should ultimately qualify for this program. The VM will continue to apply to all physicians, and neurosurgeons may receive bonus payments or pay cuts of up to four percent. Finally, CMS plans to publicly report on all individual and group practice PQRS data via the Physician Compare website in 2016.

AANS and CNS Provide Feedback to CMS on New Medicare Physician Payment System
On Nov. 17, 2015, the AANS and CNS submitted feedback to the CMS in response to the agency’s Request for Information (RFI) seeking input from stakeholders on the Medicare Access and CHIP Reauthorization Act (MACRA).  Developed by the AANS/CNS Neurosurgery Quality Council (NQC), the letter discussed numerous issues pertaining to the implementation of MACRA’s Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) programs. A press release highlighting our comments was issued on Nov. 19, 2015. To amplify organized neurosurgery’s own efforts, the AANS and CNS also partnered with the Alliance of Specialty Medicine in submitting comments. In addition, the AANS and CNS teamed up with the American Medical Association (AMA) and more than 100 other medical groups, in sending yet another letter. CMS is expected to issue an official proposed rule implementing the MACRA law in the spring of 2016, and the program goes live in 2017. 

CMS’ New PQRS Web Search Tool is Live
The 2016 Physician Quality Reporting System (PQRS) Individual Measure Specifications for Claims and Registry Reporting can now be viewed on the CMS new web-based tool. This is a measures-list tool that eligible professionals (EPs) can use to search for measures to report for the 2016 PQRS Program. The web-based measures-list tool allows users to search for measures using a number of criteria and then access detailed information about each measure, including measure specification materials. In addition, the 2016 measure documents are now posted, and are available here.

Organized Neurosurgery Submits Comments to ACGME on Resident Duty Hours
The Accreditation Council on Graduate Medical Education (ACGME) will be convening the “Resident Duty Hours in the Learning and Working Environment Congress,” in March 2016. The purpose of the meeting is to seek input and perspectives from across the medical community, as the ACGME embarks on a review of the current resident duty hours. On Jan. 14, 2016, the Society of Neurological Surgeons (SNS), American Board of Neurological Surgery (ABNS), AANS, CNS and AANS/CNS Washington Committee submitted detailed comments to the ACGME. Our letter pointed out that the “current duty hour rules have led to the development of a ‘shift work’ mentality and loss of commitment and professional responsibility to the patient.” We are advocating for increased flexibility within the current overall 80-hour work week restrictions. Representatives from organized neurosurgery will attend the conference.

Subscribe to Neurosurgery Blog Today!
The mission of Neurosurgery Blog is to investigate and report on how health care policy affects patients, physicians and medical practice and to illustrate how the art and science of neurosurgery encompasses much more than brain surgery. Over the past few months, Neurosurgery Blog has ramped up its reporting efforts to include multiple guest blog posts from key thought leaders and members of the neurosurgical community. We invite you to visit the blog and subscribe to it as well as connect with us on our 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.

 

For more information on this or other health policy issues, please contact Katie O. Orrico, director of the AANS/CNS Washington Office, at [email protected]

Print Friendly, PDF & Email
o