Vol. 102, December 2024 DC E-Newsletter
Legislative Affairs
Neurosurgery Supports Congressional Efforts to Prevent Medicare Payment Cuts
Efforts to advance legislation to reverse Medicare payment cuts and adopt long-term reforms continue and remain among neurosurgery’s top advocacy priorities.
A group of 233 Representatives sent a bipartisan letter urging Congressional Leadership to pass a bill providing physicians and other clinicians with a payment update that takes into account the cost of actually delivering care to patients. The Congress of Neurological Surgeons (CNS)/American Association of Neurological Surgeons (AANS) Washington Office issued a press release expressing support for the Congressional effort to prevent Medicare payment cuts.
Subsequently, a group of bipartisan House members introduced legislation, the Medicare Patient Access and Practice Stabilization Act of 2024 (H.R.10073), which would eliminate the upcoming 2.8% Medicare physician fee schedule (MPFS) cut and provide an inflationary update for calendar year 2025. On Oct. 30, the CNS/AANS Washington Office issued a press release expressing support for the bill. The Alliance of Specialty Medicine sent a letter of support to bipartisan House sponsors of the bill. The letter highlights the importance of stabilizing Medicare reimbursements to ensure financial sustainability for medical practices, protect patient access, and address systemic issues within the Medicare payment system.
On Nov. 15, 78 national medical societies and 51 state medical associations united to urge Congress to pass the Medicare Patient Access and Practice Stabilization Act before the conclusion of the 118th Congress. The letter emphasizes the urgency of addressing these cuts during the lame-duck session, noting that failure to act will exacerbate financial pressures on already strained practices. The proposed legislation, supported by bipartisan lawmakers, offers a temporary solution by providing modest inflationary adjustments and creating a pathway for broader Medicare payment reforms in the next Congress. On Nov. 27, the CNS/AANS Washington Office issued a press release urging Congress to pass the legislation and protect Medicare patients and physician practices before year-end.
Thanks to pressure from both House and Senate chambers, congressional leaders expedited the Congressional Budget Office (CBO) to provide a preliminary estimate of the Medicare Patient Access and Practice Stabilization Act. According to CBO, the temporary fix would cost $2.163 billion over 10 years to eliminate the 2.8% cut. It is currently being considered for an anticipated end-of-year temporary spending bill.
On Nov. 21, a group of 41 Senators sent a bipartisan letter to leadership urging them to address the 2.8% cut in the MPFS and pass long-term bipartisan solutions to the beleaguered payment system.
Efforts to Reform Prior Authorization Continue
The Regulatory Relief Coalition sent a letter to House and Senate leadership urging them to pass the Improving Seniors’ Timely Access to Care Act (S.4532/H.R. 8702) by the end of the 118th Congress. The stakeholders emphasized how current prior authorization practices delay patient care, impose unnecessary costs, and burden health care providers with excessive red tape.
On Oct. 17, the Senate Permanent Subcommittee on Investigations Majority Staff released a report exposing Medicare Advantage insurers' refusal of care for vulnerable seniors. The full report, available here, details how certain MA plans overuse risk adjustment coding and use prior authorization to delay or deny medically necessary care, impacting patient outcomes. It calls for enhanced oversight to ensure that the program fulfills its promise of providing high-quality, cost-effective care to seniors rather than prioritizing insurer profits. The report further evidences the need to pass the Improving Seniors’ Timely Access to Care Act as well as other reform measures.
HHS-OIG Releases Report on Inflated Payments Medicare Advantage
On Oct. 24, the Office of Inspector General for the U.S. Department of Health and Human Services (HHS) released a report highlighting how Medicare Advantage (MA) plans have continued to exploit health risk assessments to inflate payments, costing taxpayers billions annually. The report reveals that many plans leverage questionable coding practices to artificially increase risk scores and receive higher reimbursements without necessarily improving patient care. These findings underscore the urgent need to pass the No UPCODE Act (S.1002), which would crack down on these abuses by increasing oversight, promoting transparency, and ensuring that MA payments are based on accurate, clinically supported diagnoses. By addressing these systemic issues, Congress can protect the integrity of Medicare funds and ensure that payments are used to deliver meaningful care to seniors.
CNS and AANS Express Concerns Over Biosimilar Red Tape Elimination Act
On Nov. 6, the CNS and the AANS joined the Alliance of Specialty Medicine in sending a letter of concern to House and Senate leadership on advancing the Biosimilar Red Tape Elimination Act (S.2305). The CNS, the AANS, and others are concerned with the presumption that an approved biosimilar product may be deemed interchangeable with the reference biologic product without requiring additional switching studies by the biopharmaceutical manufacturer.
Click here to read the letter from the Alliance of Specialty Medicine.
CNS and AANS Support the Access to Claims Data Act
The CNS and the AANS signed a letter in support of the Access to Claims Data Act (H.R. 9805). This bipartisan legislation would establish a process to allow clinician-led clinical data registries to request and obtain timely, broad, and continuous access to federal claims data. Quality improvement, innovation, healthcare transparency, accountability, and value are at the forefront of organized neurosurgery’s mission.
Click here to read the letter.
Neurosurgery Submits Comments to Congress on Medicare Physician Payment System
On Nov. 13, the Alliance of Specialty Medicine (ASM) submitted comments to GOP leaders of the House Energy and Commerce Committee in response to their outline to address systemic issues within the Medicare physician payment system and offer specific recommendations. Key points include advocating for annual inflationary updates tied to the Medicare Economic Index, addressing payment variability caused by budget neutrality requirements, and improving access to Alternative Payment Models for specialty physicians. The comment letter also emphasizes concerns about insurer consolidation, its impact on independent practices, and the need to stabilize physician reimbursements to maintain access to care. ASM urges Congress to enact reforms that align with the goals of fairness, accountability, and sustainability in the Medicare payment system.
Neurosurgery Congratulates Prior Authorization Reform Champion to Top Position in Senate
On Nov. 25, the Regulatory Relief Coalition (RRC) sent a congratulatory letter to Sen. John Thune (R-S.D.) on his election as Senate Majority Leader. RRC members commended his leadership, strategic vision, and collaborative approach during his tenure as Senate Republican Whip. They also expressed gratitude for his bipartisan efforts to advance the Improving Seniors’ Timely Access to Care Act (S.4532/H.R. 8702). They highlighted the coalition's eagerness to continue working with him to reduce regulatory burdens and enhance patient care. The letter concludes by reaffirming the coalition’s commitment to supporting Sen. Thune's efforts to secure the legislation’s passage and enhance health care delivery in the United States.
Click here to read the RRC’s letter.
Coding and Reimbursement
Neurosurgery Urges Humana to Cover Closed-loop Spinal Cord Stimulation
Recently, the CNS and the AANS joined a coalition of groups in letters to payors, including Humana, Evercore, and Cigna, to urge them to reverse their coverage policies characterizing closed-loop spinal cord neurostimulators as “experimental, investigational, and/or unproven.” Evicore and Cigna both revised their policies earlier this year, and Humana followed suit with their Medicare Advantage plans but left restrictive language in place for Humana's commercial coverage policies. On Oct. 9, the CNS and the AANS joined a coalition letter to Humana urging them to remove the restrictive language from their commercial policies as well.
CMS Releases 2025 Medicare Physician Fee Schedule Final Rule
On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the 2025 MPFS final rule. CMS finalized a calendar year (CY) 2025 PFS conversion factor of $32.35, representing a 2.83% decrease (or $0.94) from the current conversion factor. This cut is a result of the expiration of a 2.93% temporary update to the conversion factor at the end of 2024 and a 0% baseline update for 2025 under the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act. Eligible physicians who fail to comply with the requirements of the Merit-based Incentive Payment System (MIPS) in 2025 will also be subject to a penalty of up to 9% of their Part B Medicare payments. The CNS and the AANS provided detailed comments on the CMS 2025 MPFS proposed rule on Sept. 9. A summary of issues of interest to neurosurgeons prepared by CNS/AANS Washington Office staff is available here.
Additional resources on the final rule from CMS are provided below:
- CY 2025 MPFS Final Rule: Link
- MPFS Press Release: Link
- MPFS Fact Sheet: Link
- Quality Payment Program (QPP) Fact Sheet: Link (to download)
- 2025 Finalized Merit-Based Incentive Payment System (MIPS) Value Pathways (MVPs): Link (to download)
- Medicare Shared Savings Program (MSSP) Fact Sheet: Link
- Medicare Prescription Drug Inflation Rebate Program: Link
CMS CY 2025 Medicare Hospital OPPS and ASC Final Rule
On Nov. 1, CMS released the final rule for the CY 2025 Hospital Outpatient and Prospective Payment System (OPPS) and Ambulatory Surgery Center (ACS) Payment System. CMS finalized an update to OPPS payment rates of 2.9% for hospitals that meet applicable quality reporting requirements. On Sept. 9, the CNS and the AANS sent a letter to CMS responding to several issues in the proposed rule. A highlight of our issues and the CMS Nov. 1, final rule response are below:
- Separate Payment for Non-opioid Pain Treatment. CMS finalized its proposal to implement a provision of the Consolidated Appropriations Act (CAA) of 2023, which provides temporary additional payments for certain non-opioid treatments for pain relief in the hospital outpatient department (HOPD) and ASC settings from Jan. 1, 2025, through Dec. 31, 2027. The agency identified seven drugs and one device (the Elastomeric infusion pump, non-opioid pain management delivery system, including catheter and other system components) as qualifying non-opioid treatments to be paid separately in both the HOPD and ASC settings. The CNS and the AANS have supported separate payments for non-opioid products, especially for devices, and encouraged CMS to expand payment for neurostimulators to treat pain.
- Prior authorization Issues. The CNS and the AANS urged CMS to eliminate the OPPS prior authorization program and to rescind requirements for prior authorization for cervical fusion with disc removal and implanted spinal neurostimulators. However, CMS did not rescind prior authorization for these procedures.
- APC Placement for New Cat. III CPT Codes for VNS. The CNS and the AANS urged CMS to assign the new Vagus Nerve Integrated Stimulator CPT codes 0908T and 0909T to APC 5465. However, CMS did not change the APC and finalized their proposal, with modification, to assign status indicator ‘‘E1’’ to CPT codes 0909T through 0912T. Status indicator "E1" means that a service or item is not covered by Medicare.
Additional information is available in the links below.
- CY 2025 OPPS/ASC Final Rule: Link
- OPPS/ASC Press Release: Link
- OPPS/ASC Fact Sheet: Link
Drugs and Devices
Neurosurgery Issues Position Statement on Intracranial Neuromodulation for Drug-Resistant Epilepsy in Pediatric Patients
The CNS, AANS, and CNS/AANS Section on Pediatric Neurological Surgery issued a Position Statement on Intracranial Neuromodulation for Drug-Resistant Epilepsy in Pediatric Patients. The statement urges the government, private payers, and health systems to support the use of intracranial neuromodulation devices for patients, regardless of their age, in cases deemed appropriate by the patient’s multidisciplinary treatment team.
Click here to read Neurosurgery’s Position Statement.
Quality Improvement
Neurosurgery Comments on HTI-2 Proposed Rule
On Oct. 4, the CNS and the AANS joined the Alliance of Specialty Medicine in sending a letter to HHS in support of the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule. The rule seeks to advance interoperability, improve transparency, and support the access, exchange, and use of electronic health information.
Click here to read the letter.
Of Note
Neurosurgical Residents Picked for White House Fellow Program
Alexander Tenorio, MD, a neurological surgery resident at the University of California, San Diego, has been named to the 2024-2025 White House Fellows class and is working at the U.S. Department of Veterans Affairs. Nalini Tata, MD, MPP, a neurosurgery resident at New York-Presbyterian Weill Cornell Medical Center/Memorial Sloan Kettering Cancer Center, has been named to the 2024-2025 White House Fellows class and is working at the White House Office of Cabinet Affairs.
They join 13 other individuals selected to participate in this prestigious program and follow in the footsteps of neurosurgeons Jeffrey Nadel, MD (2022-2023); Jeremy Hosein, MD (2018-2019); Lindsey B. Ross, MD (2016-2017); Anand Veeravagu, MD (2012-2013) and Sanjay K. Gupta, MD (1997-1998).
The White House Fellows Program was created in 1964 by President Lyndon B. Johnson to give promising American leaders “first-hand, high-level experience with the workings of the Federal government, and to increase their sense of participation in national affairs.”
Communications
Elad I. Levy, MD, MBA Pens Article on the Passing of Nelson “Nick” Hopkins, III, MD
Elad I. Levy, MD, MBA, FAHA, FACS, FAANS authored a touching tribute on the Neurosurgery Blog highlighting the life and accomplishments of his mentor, Nelson “Nick” Hopkins, III, MD, FAANS(L), who recently passed away. Known as the father of endovascular neurosurgery, Dr. Hopkins innovated catheter-based minimally invasive treatment of vascular diseases in the brain and spine. He trained countless neurosurgeons throughout his career, many of whom have held the highest leadership positions in departments and academic organizations nationally and worldwide. Dr. Levy concludes the piece by stating, “Our specialty lost a titan, and while we are greatly saddened, his legacy gift of endovascular neurosurgery will persist in perpetuity through his many devoted disciples in academic neurosurgery.”
Neurosurgeon Authors Op-Ed on Prior Authorization
On Oct. 3, Forbes published an op-ed by neurosurgeon Richard P. Menger, MD, MPA, titled, “1 In 4 Physicians Say Prior Authorization Harms Patients. Reform Is Coming.” Prior authorization is a tactic used by insurance companies to reduce the costs of what they believe to be potentially unnecessary treatments. However, nearly a quarter — 24% — of physicians report that such delays resulted in direct harm to patients. Dr. Menger concludes the op-ed by promoting the bipartisan Improving Seniors’ Timely Access to Care Act (H.R. 8702/S. 4532).
Neurosurgery Featured in Articles on the Reforming the Medicare Physician Fee Schedule
The AANS/CNS Washington Office issued a press release on Oct. 15 expressing support for congressional efforts to prevent Medicare payment cuts. Following the press release, Becker’s Spine Review published an article on Oct. 16 titled, “Spine groups urge Congress to prevent CMS pay cuts.” AANS/CNS Washington Committee chair Russell R. Lonser, MD, FAANS, "Year after year, Medicare payment cuts jeopardize the viability of physician practices.” He continued, “It is time to stop consolidation and protect access to quality care for patients, especially those in rural or underserved communities. Congress must prevent future cuts and focus on sustainable, long-term solutions."
On Oct. 30, the AANS/CNS Washington Office issued a press release expressing support for the Medicare Patient Access and Practice Stabilization Act. “The AANS and the CNS appreciate legislators’ efforts to offer another solution to this longstanding problem. Congressional leadership now has a full suite of legislative solutions to address Medicare payment cuts in the short and long term,” Dr. Lonser states in the press release. He continues, “We urge Congress to take action and fix the unsustainable and outdated Medicare Physician Fee Schedule.” Following the press release, Becker’s Spine Review published an article on Oct. 30 titled, “Spine groups back bill for patient access, practice stabilization.”
Washington Office VP Featured in Article on Prior Authorization
On Oct. 30, MedPage Today published an article titled, “Backers of Prior Authorization Bill Hopeful for Passage by End of the Year”. The article features Charlotte Pineda, MPP, vice president of Health Policy and Advocacy for the AANS/CNS Washington Office. "We commend the efforts of the Senate and House sponsors. They showcase the best of bipartisan, bicameral teamwork and proactive engagement in working with all stakeholders impacted by prior authorization," states Ms. Pineda.
Neurosurgery Delegate Advocates for Improved PPE for Radiation Protection
On Nov. 12, MedPage Today published an article titled, "AMA Delegates Want Better Protection From Ionizing Radiation Exposure." The article features Laura Stone McGuire, MD, an alternate delegate for the CNS. Dr. McGuire highlighted the risks that standard PPE, such as lead aprons, pose for neurosurgeons, noting gaps in coverage that leave areas like the upper body exposed, especially during complex procedures. "Institution-standard lead aprons may not always offer the best available protection," Dr. McGuire stated, underscoring the need for PPE that better accommodates different body types and pregnancy status.
Neurosurgeon Discusses Risks of Neck Injuries in Hockey
On Nov. 14, Richard Menger, MD, MPA, FAANS published an article in Forbes titled, “What Can Happen To Your Brain And Spine When You Take A Slap Shot To The Neck? A Neurosurgeon Explains.” The article discusses the risks of neck injuries in ice hockey following St. Louis Blues forward Dylan Holloway’s recent injury from a puck strike to the neck. The article highlights concerns specific to neurosurgery, explaining that impacts to the neck can cause cervical spine fractures, arterial injuries, and even concussions, with symptoms that may be delayed. It further explores the limited protection offered by standard neckguards, which currently focus on preventing lacerations rather than impact-related injuries.
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