Neurosurgery Makes Significant Progress Advancing Health Policy Agenda

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 behalf of neurosurgery. In this role, the AANS frequently interacts with members of Congress, the Centers for Medicare & Medicaid Services (CMS), the Food and Drug Administration (FDA), third-party payers and state and national medical associations. As a result of these interactions, organized neurosurgery has achieved a variety of advocacy successes, including:

Champion Fair Reimbursement


  • Due to the advocacy efforts of the AANS, no major changes in global surgery fees will be forthcoming in 2019 or 2020. The CMS global surgery code data collection initiative was poised to produce cuts in neurosurgical reimbursement by at least 25%, which translates to approximately $175,000 per neurosurgeon each year from 2018 to 2020.
  • Cuts in professional liability payments in the Medicare physician fee schedule were reversed once the AANS demonstrated to CMS that the agency’s methodology was flawed. This prevented Medicare cuts totaling approximately $9 million.

Neurosurgery Delegates to the AMA hard at work. From left: Krystal L. Tomei, MD, FAANS; Brett E. Youngerman, MD; Ann R. Stroink, MD, FAANS; Kenneth S. Blumenfeld, MD, FAANS.
  • Following vigorous advocacy by the AANS, CMS did not implement its proposed sweeping changes to the evaluation and management (E/M) codes for 2019. Rather than collapsing the office visit codes from five to two levels, the agency delayed implementing any changes to E/M codes until 2021, allowing medicine to work on updating these codes. These efforts prevented nearly $9 million in Medicare cuts to neurosurgical payments.
  • The AANS/CNS Coding and Reimbursement Committee continued to promote the need for new and revised CPT codes and ensure that neurosurgical services are appropriately valued and reimbursed. This past year, our Rapid Response Teams worked tirelessly to ensure that third-party payers cover necessary neurosurgical services, including topics such as magnetic-resonance-guided focused ultrasound surgery for essential tremor, stereotactic radiosurgery, endoscopic discectomy, interbody devices for lumbar fusion (including expandable cages), minimally invasive ablative surgery for epilepsy, vagus nerve stimulation for treatment-resistant depression, posterior cervical fusion, sacroiliac joint fusion, spine arthroplasty and the use of interspinous devices.
  • Seeking to expand neurosurgical influence over Medicare decision-making, the AANS was successful in getting Ahmed M. Raslan, MD, FAANS, appointed to the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC).

Regulatory Relief


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 “Patients over Paperwork Initiative,” a cross-cutting, collaborative process that evaluates and streamlines regulations to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. Priority topics include prior authorization reform and repeal of Medicare’s mandatory appropriate use criteria (AUC) for advanced diagnostic imaging program.

On the prior authorization front, the AANS has made progress in bringing much-needed transparency and oversight to the Medicare Advantage program. Having surveyed AANS members, the AANS/CNS Washington Committee demonstrated the growing imperative for prior authorization reform. The survey found the following:

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 “Patients over Paperwork Initiative,” a cross-cutting, collaborative process that evaluates and streamlines regulations to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. Priority topics include prior authorization reform and repeal of Medicare’s mandatory appropriate use criteria (AUC) for advanced diagnostic imaging program.


From Left: Rep. Rodney Davis (R-Ill.), Rep. Lynne Cheney (R-Wyo.) and Jeffrey W. Cozzens, MD, FAANS.

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 “Patients over Paperwork Initiative,” a cross-cutting, collaborative process that evaluates and streamlines regulations to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. Priority topics include prior authorization reform and repeal of Medicare’s mandatory appropriate use criteria (AUC) for advanced diagnostic imaging program.

On the prior authorization front, the AANS has made progress in bringing much-needed transparency and oversight to the Medicare Advantage program. Having surveyed AANS members, the AANS/CNS Washington Committee demonstrated the growing imperative for prior authorization reform. The survey found the following:

  • Eighty-two percent of respondents state that prior authorization either always (34%) or often (49%) delays access to necessary care.
  • The wait time for prior authorization can be lengthy. For most neurosurgeons (67%) it takes between two to 14 days to obtain prior authorization, but for 22%, this process can take from 15 to more than 31 days.
  • Prior authorization causes patients to abandon treatment altogether with 21% reporting that patients often abandon treatment and 60% reporting that patients sometimes abandon treatment.
  • Overwhelmingly (88%), neurosurgeons report that prior authorization has a significant (37%) or somewhat (51%) negative impact on patient clinical outcomes.
  • Ninety-one percent of neurosurgeons report that the burden associated with prior authorization has significantly increased over the past five years.

As a leader in the Regulatory Relief Coalition, the AANS worked with key members of Congress to develop and get introduced the Improving Seniors’ Timely Access to Care Act (H.R. 3107). The bill would protect patients from unnecessary prior authorization practices that limit their timely access to medically necessary care. Additionally, due to neurosurgery’s advocacy, the U.S. House of Representatives sent a letter signed by 103 bipartisan House members to CMS Administrator Seema Verma urging CMS to improve how prior authorization works under MA.

Improving the Nation’s Health Care System


The AANS made strides in improving the nation’s health care system, including expanding access to affordable health insurance coverage for every American, enhancing patients’ choice of insurance plans and providers and maintaining reforms that redress several inexcusable insurance practices — including high-deductibles, narrow provider networks and prior authorization requirements.

  • Given the growing concern over the practice of unanticipated medical bills — largely driven by narrow insurance networks — leaving some patients on the hook with the bill if they receive care from an out-of-network provider, eliminating surprise medical bills is a top priority for neurosurgery. To this end, the AANS has been instrumental in leading the charge to get legislation passed. Due to this advocacy, the Protecting People from Surprise Medical Bills Act (H.R. 3502) was introduced in the house. This legislation reflects neurosurgery’s principles on out-of-network care and strikes the right balance to protect patients from unanticipated medical bills, while at the same time facilitating a process to quickly, efficiently and fairly resolve physician and health plan billing disputes.
  • To ensure that the U.S continues to lead the world in medical innovation, the AANS helped lead an effort to repeal the medical device excise tax by getting the Protect Medical Innovation Act (H.R 2207 / S. 692) introduced in both the House and Senate. While the device tax was suspended for two years, repealing this tax is one of organized neurosurgery’s top legislative priorities to ensure continued progress on innovative treatments for neurological diseases and disorders.
  • 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. On June 24, 2019, the president signed into law the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (S. 1379), which would reauthorize several preparedness and response programs for five years. The bill also includes H.R. 880, 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.
  • Efforts to improve the Affordable Care Act (ACA) continued, and on June 17, 2019, backed by the AANS, the House passed legislation to fully repeal the ACA’s 40% tax on high-cost health plans, also known as the Cadillac tax. The tax was initially supposed to go into effect in 2018 but has been delayed twice and will go into effect in 2022 without congressional action.

Medical Liability Reform


The AANS moved the medical liability reform ball further down the field on several fronts. The president signed into law the Sports Medicine Licensure Clarity Act (S. 808 / H.R. 302) on Oct. 5, 2018, which clarified medical liability rules for physicians traveling with sports teams. Additionally, progress was made to provide physician volunteers with medical liability protections in the event they render care during a national emergency or disaster, as elements of the Good Samaritan Health Professionals Act were included in the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (S. 1379), which was signed into law on June 24, 2019 (PL 116-22). Finally, members of Congress demonstrated their support for protecting physicians from medical liability claims by cosponsoring the Accessible Care by Curbing Excessive LawSuitS (ACCESS) Act (H.R. 3656), which is modeled after proven reforms already in place in Texas, California and many other states around the country that have improved access to affordable health care by increasing the number of practicing physicians and reducing medical lawsuit abuse.


Ann R. Stroink, MD, FAANS, featured on National Public Radio’s “The 21st” news talk show. Shown in studio with show host, Niala Boodhoo, at NPR’s Washington, DC studios.

Graduate Medical Education


To ensure an adequate supply of physicians, organized neurosurgery has been on the front lines 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. A growing number of members of Congress cosponsored the Resident Physician Shortage Act (S. 348 / H.R. 1763), which would provide Medicare funding for an additional 15,000 residency training slots. To help raise awareness, the AANS past president, Alex B. Valadka, MD, FAANS, authored an opinion piece for The Hill about the need to expand Medicare’s support for residency training to ensure all Americans have access to the care they deserve now and into the future.

In addition, legislative efforts to reverse the single accreditation system between the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) were stymied as the AANS helped block the advancement of H.R. 2373, which would have reversed this historic agreement.

Addressing the Nation’s Opioid Crisis


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 over or misuse prescription pain medicine. On Oct. 24, 2018, the president signed into law the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (H.R. 6) aimed at combating the opioid epidemic. Through the advocacy of the AANS, the legislation reflects organized neurosurgery’s priorities, including no opioid prescribing limits; improved e-prescribing of opioids; enhanced prescription drug monitoring program (PDMP) interoperability; and improved payment for opioid alternatives and surgical pain therapies, such as neuromodulation.

Injury Treatment and Prevention


The AANS successfully advocated for increased funding for injury prevention and treatment and emergency preparedness. In addition, on Dec. 21, 2018, the president signed into the Traumatic Brain Injury Program Reauthorization Act (H.R. 6615), which renews federal brain injury programs and authorize more than $19 million annually for federal and state programs.

Political and Grassroots Advocacy


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’s advocacy goals. During fiscal year 2019, 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, DC, 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’s annual Washington, DC, legislative conference an overwhelming success.

Communications Outreach


Beyond its direct lobbying and grassroots advocacy, the Washington Committee garners support for neurosurgery’s 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’s traditional media/communication efforts include Op-Eds, letters to the editor, radio “tours” and desk-side briefings with reporters from the Wall Street Journal, Washington Post, CBS, NBC, Politico and others. In addition, the Washington Office’s digital media platforms continue to see significant expansion and have garnered more than 615 million individual impressions and have amassed a subscription audience of more than 130,000. These communication tools include: