- \n
- 2018 MACRA-Quality Payment Program Final Rule provides greater flexibility, reduces complexity and minimizes potential penalties.<\/li>\n
- The Bipartisan Budget Act of 2018 (L. 115-123<\/a>) included additional flexibility to minimize penalties for years 2021-23 and eliminated the requirement that electronic health record (EHR) standards become more stringent over time, while also maintaining EHR hardship exemptions.<\/li>\n<\/ul>\n
Neurosurgeons were facing payment cuts of at least 25 percent due to changes proposed by CMS to the way in which 10- and 90-day global surgical codes would be valued. Due in large part to organized neurosurgery\u2019s efforts, Congress passed legislation preventing these cuts and instead requiring CMS to collect data on global surgical services. CMS launched a focused claims-based data collection project in nine states \u2014 Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island \u2014 where certain neurosurgeons were required to report information on post-surgery visits using CPT code 99024. In addition, CMS developed a time-consuming survey, which the agency attempted to launch in late 2017. Joining with the American College of Surgeons and others, the AANS sent a letter<\/a> raising significant concerns about the survey. Organized neurosurgery also continued to raise alarm bells over problems with the claims-based data collection. As a result of this ongoing pushback, massive changes to global surgery codes will not be forthcoming in 2019.<\/p>\n
The AANS\/CNS Coding and Reimbursement Committee continued to promote the need for new and revised CPT codes and to ensure that neurosurgical services are appropriately valued and reimbursed. This past year, the Rapid Response Teams worked tirelessly to ensure that third-party payers cover necessary neurosurgical services, including topics such as deep brain stimulation (DBS), magnetic-resonance-guided focused ultrasound surgery for essential tremor, stereotactic radiosurgery, vagus nerve stimulation for treatment resistant depression, laminectomy, posterior cervical fusion, sacroiliac joint fusion, spine arthroplasty and the use of interspinous devices.[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/3″]
![\"img\"](\"\/2018\/wp-content\/uploads\/sites\/1\/2018\/08\/DC1.png\")
<\/figure>[vc_column_text]<\/p>\nFormer AANS\/CNS Pediatric Section chair, Sarah J. Gaskill, MD, FAANS, with Rep. Kathy Castor (D-Fla.).<\/p>\n
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Regulatory Relief<\/h2>\n
Faced with an ever-growing morass of regulations with which neurosurgeons must comply, the AANS\/CNS Washington Committee has been working with Congress and regulators to reduce the burdens associated with practicing medicine. CMS Administrator Seema Verma launched the \u201cPatients over Paperwork Initiative<\/a>,\u201d a crosscutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. Priority topics include prior authorization reform; repeal of Medicare\u2019s mandatory appropriate use criteria (AUC) for advance diagnostic imaging program; and streamlining the Food and Drug Administration\u2019s (FDA) device approval process.<\/p>\n
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![\"img\"](\"\/2018\/wp-content\/uploads\/sites\/1\/2018\/08\/DC2.png\")
<\/figure>[vc_column_text]<\/p>\nNeurosurgeryPAC board member, Kenneth B. Blumenfeld<\/strong>, MD, FAANS, with Rep. Ami Bera<\/strong>, MD (D-Calif.)<\/p>\n
[\/vc_column_text][vc_empty_space height=”16px”][\/vc_column_inner][vc_column_inner width=”2\/3″ css=”.vc_custom_1534943105612{padding-left: 10px !important;}”][vc_column_text css=”.vc_custom_1536607634082{padding-left: 10px !important;}”]<\/p>\n
Reforming the Reform<\/h2>\n
The AANS strongly supports improving the nation\u2019s health care system, including expanding access to affordable health insurance coverage for every American, enhancing patients\u2019 choice of insurance plans and providers and maintaining reforms that redress a number of inexcusable insurance practices \u2014 including high-deductibles, narrow provider networks and prior authorization requirements. While the Affordable Care Act<\/a> (ACA) continues to be the law of the land, the AANS\/CNS Washington Committee continued its advocacy to make improvements to the ACA.<\/p>\n
- \n
- Legislation expanding funding for the Children\u2019s Health Insurance Program (CHIP) for ten years was signed into law (L. 115-120<\/a>). CHIP provides coverage to nine million children in families who earn too much to qualify for Medicaid but cannot afford private insurance. Neurosurgery has long supported reauthorization of this program to ensure that the nation\u2019s children have health insurance coverage.<\/li>\n
- Congress repealed the Independent Payment Advisory Board (IPAB) with the passage of the Bipartisan Budget Act of 2018 (L. 115-123<\/a>). Repealing this unelected, unaccountable board has been a top legislative priority since the passage of the ACA. Leading the repeal effort, the AANS also aligned with the\u00a0Physician IPAB Repeal Coalition<\/a>, the\u00a0Alliance of Specialty Medicine<\/a> and more than\u00a0800 health care stakeholder organizations<\/a> who supported IPAB repeal.<\/li>\n
- Legislation suspending the medical device tax for an additional two years through 2019 was signed into law (L. 115-120<\/a>). Originally passed to help fund the ACA, the medical device tax is a 2.3 percent tax on gross revenue. Additionally, the House passed H.R. H.R. 184<\/a>, the Protect Medical Innovation Act, which aims to repeal the device tax permanently. Action now moves to the Senate companion bill, S. 108<\/a>, which also has strong bipartisan support. Repealing the device tax is one of organized neurosurgery’s top legislative priorities to ensure continued progress on innovative treatments for neurological diseases and disorders.<\/li>\n
- Signed into law on Jan. 22, 2018, the continuing funding resolution (L. 115-120<\/a>) suspended the so-called \u201cCadillac tax\u201d for an additional two years to 2022. If implemented, employers would be required to pay a 40 percent tax on the costs of certain health plans.<\/li>\n<\/ul>\n
[\/vc_column_text][vc_empty_space height=”16px”][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row][vc_column][vc_row_inner css=”.vc_custom_1536608862726{padding-right: 15px !important;padding-left: 15px !important;}”][vc_column_inner][vc_empty_space height=”16px”][vc_column_text]<\/p>\n
Medical Liability Reform<\/h2>\n
The House of Representatives passed comprehensive medical liability reform legislation \u2014 the Protecting Access to Care Act (H.R. 1215<\/a>) \u2014 which included, among other things, a $250,000 cap on noneconomic damages and expert witness reforms. Multiple additional medical liability reform bills are pending in the House and Senate, including:<\/p>\n
- \n
- Sports Medicine Licensure Clarity Act ( 808<\/a>\/H.R. 302<\/a>);<\/li>\n
- Health Care Safety Net Enhancement Act ( 527<\/a>\/H.R. 548<\/a>);<\/li>\n
- Saving Lives, Saving Costs Act (R. 1565<\/a>); and<\/li>\n
- Good Samaritan Health Professionals Act ( 781<\/a>\/H.R. 1876<\/a>).<\/li>\n<\/ul>\n
Graduate Medical Education<\/h2>\n
To ensure an adequate supply of physicians, organized neurosurgery has been on the frontlines advocating to improve the current GME system. Through the continued advocacy of the AANS, bills for additional Medicare graduate medical education (GME) funding were introduced. The Residency Physician Shortage Reduction Act (H.R. 2267<\/a>\/S. 1301<\/a>) would increase by 15,000 the number of Medicare-supported GME residency training slots. Organized neurosurgery also worked to prevent the passage of legislation (H.R. 2373<\/a>) to eliminate the single accreditation system for allopathic and osteopathic residency training programs.[\/vc_column_text][vc_empty_space height=”16px”][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row css=”.vc_custom_1536608749623{background-color: #00bac7 !important;}”][vc_column][vc_row_inner css=”.vc_custom_1536608871899{padding-right: 15px !important;padding-left: 15px !important;}”][vc_column_inner width=”2\/3″][vc_column_text css=”.vc_custom_1536608894569{padding-right: 10px !important;}”]<\/p>\n
Addressing the Nation\u2019s Opioid Crisis<\/h2>\n
The growing opioid crisis is having a devastating impact on communities across the country, with nearly 500,000 deaths occurring over the past decade. Today, nearly 12 million Americans ages 12 and over misuse prescription pain medicine. As policymakers continue to struggle to find solutions to this problem, the Washington Committee, working with the AANS\/CNS Drugs and Devices Committee, the AANS\/CNS Pain Section and the AANS\/CNS Section on Disorders of the Spine and Peripheral Nerves, has been actively engaged in the debate. Priority issues for neurosurgery include flexibility to prescribe opioids to manage post-surgical pain \u2014 particularly for spine surgery and trauma patients \u2014 without undue restrictions; creating a national Prescription Drug Monitoring Program (PDMP) to standardize the process for making informed prescribing decisions; developing a Risk Evaluation and Mitigation Strategy (REMS) tool to facilitate the dispensing of medically necessary and appropriate opioid prescriptions; and expanding access to non-pharmaceutical therapies for chronic pain, such as neuromodulation nervous system ablation, by improving reimbursement and third-party payer coverage policies.<\/p>\n
[\/vc_column_text][vc_column_text]<\/p>\n
- \n
- As Congress has debated comprehensive opioid legislation, the AANS has advocated for neurosurgery\u2019s key policy positions, including several letters to sponsors of legislation in the House<\/a> and Senate<\/a>. To date, legislation pending before the House and Senate reflect the views of organized neurosurgery.<\/li>\n
- Drugs and Devices Committee chair, Robert F. Heary<\/strong>, MD, FAANS, testified at an FDA public hearing. Subsequently, FDA Commissioner,\u00a0Scott Gottlieb<\/strong>, MD, announced that the agency will pursue several of the strategies that the AANS proposed.<\/li>\n
- The AANS\/CNS Pain Section secretary, Jennifer A. Sweet<\/strong>, MD, FAANS, and Washington Office staff, serve as organized neurosurgery\u2019s representatives to the AMA Opioid Task Force<\/a>.<\/li>\n
- Christopher J. Winfree<\/strong>, MD, FAANS, and Washington Office staff, serve as the AANS representative to the Health Care Leadership Council\u2019s (HLC) National Dialogue for Healthcare Innovation program\u2019s Opioid Crisis Solutions Summit. The group issued its Comprehensive Roadmap to Address the Opioid Crisis<\/a>, which reflected neurosurgery\u2019s key priorities.<\/li>\n<\/ul>\n
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![\"img\"](\"\/2018\/wp-content\/uploads\/sites\/1\/2018\/08\/DC3.png\")
<\/figure>[vc_column_text]<\/p>\nFrom left:\u00a0 House Ways and Means Committee chair, Rep. Kevin Brady<\/strong> (R-Texas); AANS\/CNS Washington Committee chair, Ann R. Stroink<\/strong>, MD, FAANS; Ways and Means Health Subcommittee chair, Peter Roskam<\/strong> (R-Ill.); and AANS past-president, Alex B. Valadka<\/strong>, MD, FAANS.<\/p>\n
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![\"img\"](\"\/2018\/wp-content\/uploads\/sites\/1\/2018\/09\/DC4.png\")
<\/figure>[vc_column_text]<\/p>\nAANS alternate delegate to the AMA, Maya Babu<\/strong>, MD, visits Rep. Seth Moulton (D-Mass.) at his office on Capitol Hill.<\/p>\n
[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”2\/3″][vc_column_text css=”.vc_custom_1537289911434{padding-left: 10px !important;}”]<\/p>\n
Advocating for Trauma Care<\/h2>\n
Given the significant gaps in our trauma and emergency health care delivery systems, the AANS continued to urge Congress to provide the full funding for trauma and emergency care regionalization programs. The House Energy and Commerce Committee passed the Pandemic and All-Hazards Preparedness Reauthorization Act (H.R. 6378<\/a>), which would reauthorize several preparedness and response programs for five years. The bill also includes H.R. 880<\/a>, the MISSION Zero Act, which would assist U.S. military health care providers in maintaining a state of readiness by embedding military trauma teams and providers in civilian trauma centers.[\/vc_column_text][vc_empty_space height=”16px”][vc_column_text css=”.vc_custom_1541689442786{padding-left: 10px !important;}”]<\/p>\n
NeurosurgeryPAC\/Grassroots<\/h2>\n
An essential arrow in the AANS advocacy quiver is a political action committee. NeurosurgeryPAC is a nonpartisan political action committee that backs candidates for federal office who support organized neurosurgery\u2019s advocacy goals. During fiscal year 2018, hundreds of neurosurgeons donated to NeurosurgeryPAC to help the PAC reach its $500,000 fundraising goal. Beyond political dollars, however, it is people that make a difference in Washington, D.C., and the AANS actively engaged its members in the political process through a variety of grassroots activities. To this end, the AANS helped make the Alliance of Specialty Medicine\u2019s annual Washington, D.C., legislative conference an overwhelming success.<\/p>\n
View a full list of donors<\/a>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width=”2\/3″][vc_empty_space height=”16px”][vc_column_text css=”.vc_custom_1536337354028{padding-right: 10px !important;}”]<\/p>\n
Communications Outreach<\/h2>\n
Beyond its direct lobbying and grassroots advocacy, the Washington Committee garners support for neurosurgery\u2019s health policy positions by carrying out a nationwide earned media campaign and by providing the media with timely information that can be used for their reporting. The Washington Office\u2019s traditional media\/communication efforts include Op-Eds, letters to the editor, radio \u201ctours\u201d and desk-side briefings with reporters from the Wall Street Journal<\/em>, Washington Post<\/em>, CBS<\/em>, NBC<\/em>, Politico<\/em> and others. In addition, the Washington Office\u2019s digital media platforms continue to see significant expansion and have garnered more than 524 million individual impressions and have amassed a subscription audience of more than 130,000. These communication tools include:<\/p>\n
- \n
- Neurosurgery Blog: More Than Brain Surgery<\/a><\/em>, a web-based opinion and perspective column, through which AANS offers insights and perspective on contemporary health issues as they relate to organized neurosurgery.<\/li>\n
- Various social media platforms that are used to gain greater visibility for neurosurgery’s advocacy efforts, including Twitter<\/a>, Facebook<\/a>, Instagram<\/a>, LinkedIn<\/a>, Tumblr<\/a>, YouTube<\/a> and Google+<\/a>.<\/li>\n<\/ul>\n
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![\"img\"](\"\/2018\/wp-content\/uploads\/sites\/1\/2018\/08\/DC5.jpg\")
<\/figure>[vc_column_text]<\/p>\nJeffrey W. Cozzens<\/strong>, MD, FAANS, meets with Rep. Darin LaHood (R-Ill.).<\/p>\n
[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"
[vc_row][vc_column][vc_row_inner css=”.vc_custom_1536607323663{padding-right: 15px !important;padding-left: 15px !important;}”][vc_column_inner][vc_column_text]Through advocacy, policy development and public relations, the AANS\/CNS Washington Committee and Washington Office have played a fundamental role in advancing key health care initiatives. Throughout the year, the Washington Office staff are in the halls of Congress or working with government agencies and other health care stakeholders advocating on…<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":4,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2359","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/annualreports.aans.org\/2018\/wp-json\/wp\/v2\/pages\/2359","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/annualreports.aans.org\/2018\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/annualreports.aans.org\/2018\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/annualreports.aans.org\/2018\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/annualreports.aans.org\/2018\/wp-json\/wp\/v2\/comments?post=2359"}],"version-history":[{"count":41,"href":"https:\/\/annualreports.aans.org\/2018\/wp-json\/wp\/v2\/pages\/2359\/revisions"}],"predecessor-version":[{"id":3281,"href":"https:\/\/annualreports.aans.org\/2018\/wp-json\/wp\/v2\/pages\/2359\/revisions\/3281"}],"up":[{"embeddable":true,"href":"https:\/\/annualreports.aans.org\/2018\/wp-json\/wp\/v2\/pages\/4"}],"wp:attachment":[{"href":"https:\/\/annualreports.aans.org\/2018\/wp-json\/wp\/v2\/media?parent=2359"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
- Various social media platforms that are used to gain greater visibility for neurosurgery’s advocacy efforts, including Twitter<\/a>, Facebook<\/a>, Instagram<\/a>, LinkedIn<\/a>, Tumblr<\/a>, YouTube<\/a> and Google+<\/a>.<\/li>\n<\/ul>\n
- Drugs and Devices Committee chair, Robert F. Heary<\/strong>, MD, FAANS, testified at an FDA public hearing. Subsequently, FDA Commissioner,\u00a0Scott Gottlieb<\/strong>, MD, announced that the agency will pursue several of the strategies that the AANS proposed.<\/li>\n
- Health Care Safety Net Enhancement Act ( 527<\/a>\/H.R. 548<\/a>);<\/li>\n
- Congress repealed the Independent Payment Advisory Board (IPAB) with the passage of the Bipartisan Budget Act of 2018 (L. 115-123<\/a>). Repealing this unelected, unaccountable board has been a top legislative priority since the passage of the ACA. Leading the repeal effort, the AANS also aligned with the\u00a0Physician IPAB Repeal Coalition<\/a>, the\u00a0Alliance of Specialty Medicine<\/a> and more than\u00a0800 health care stakeholder organizations<\/a> who supported IPAB repeal.<\/li>\n
- Legislation expanding funding for the Children\u2019s Health Insurance Program (CHIP) for ten years was signed into law (L. 115-120<\/a>). CHIP provides coverage to nine million children in families who earn too much to qualify for Medicaid but cannot afford private insurance. Neurosurgery has long supported reauthorization of this program to ensure that the nation\u2019s children have health insurance coverage.<\/li>\n