Vol. 103, March 2025 DC E-Newsletter
Legislative Affairs
Neurosurgery Supports Congressional Efforts to Prevent Medicare Payment Cuts
The Congress of Neurological Surgeons (CNS)/American Association of Neurological Surgeons (AANS) Washington Office issued a press release on Nov. 27 urging Congress to pass the Medicare Patient Access and Practice Stabilization Act of 2024 (H.R. 10073) before the conclusion of the 118th Congress. Following the press release, Becker’s Spine Review published an article titled “Spine groups pushes for Congress to stop physician pay cut.” The article states that the legislation would prevent the scheduled 2.83% Medicare physician payment cut from going into effect and give a 1.8% positive payment update for 2025. Policy and Medicine also published an article, “Bipartisan Legislation Introduced to Avoid Decreased Medicare Reimbursement Rates,” highlighting neurosurgery’s support for the legislation.
On Jan. 31, the CNS/AANS Washington Office issued a press release in support of the Medicare Patient Access and Practice Stabilization Act, a slightly modified version of the legislation introduced last Congress. This legislation would prospectively, effective April 1 through Dec. 31, 2025, stop, in full, the 2.83% cut imposed on Jan. 1, 2025. It also provides physicians with an additional 2% payment increase to help reflect rising costs pertaining to running a practice. Three articles were published following the CNS/AANS press release:
On Feb. 10, the CNS and the AANS joined national medical societies and state medical associations in sending a letter urging Congress to include provisions that both reverse the latest round of Medicare payment cuts and provide physicians with a meaningful payment increase that reflects ongoing inflationary pressures in the forthcoming March 2025 appropriations bill.
Neurosurgery-Led Coalition Issues Press Release on Prior Authorization Bill
On Dec. 17, the Regulatory Relief Coalition (RRC), of which the CNS and the AANS are leaders, issued a press release expressing outrage that Congress failed to include The Improving Seniors’ Timely Access to Care Act (S.4532/H.R. 8702) in the end of year package. The bipartisan legislation would protect Medicare Advantage (MA) program enrollees from unnecessary delays and denials of medically necessary care by streamlining and standardizing prior authorization in MA.
“The RRC commits to working with the bill champions and our broad and strong coalition to help Congress see the light on the need to act and rein in unnecessary prior authorization delays and denials. We won’t stop fighting for what we — as a driven group of patient-focused stakeholders and providers who care for them — know is right for America’s seniors,” the press release states.
Legislative Success in Pediatric Neurosurgery Amidst Congressional Gridlock
Despite the challenges of an unproductive 118th Congress, neurosurgery celebrated legislative victories with the reauthorization of federal programs prioritizing pediatric neurosurgical care including the Gabriella Miller Kids First Research Act 2.0 and the reauthorization of the Emergency Medical Services for Children (EMSC) program.
The Gabriella Miller Kids First Research Act 2.0 reauthorizes and expands funding for the Kids First Research Program at the National Institutes of Health. The program prioritizes research on brain tumors, a leading cause of cancer-related deaths in children. Named after Gabriella Miller, a young advocate who succumbed to brain cancer at the age of 10, the law honors her legacy by ensuring sustained investment in the fight against childhood cancers and congenital anomalies. This bipartisan, bicameral legislation will support children and their families with some of the most serious and rare medical conditions, including benign and malignant brain and spinal tumors. This additional funding stream will help provide critical research to find new, innovative treatments.
Equally impactful is the Emergency Medical Services for Children program, which ensures that emergency departments across the country are prepared to address pediatric-specific needs. For neurosurgery, this program plays a vital role in enhancing care for children experiencing traumatic brain injuries and other neurosurgical emergencies. By integrating neurosurgeons into emergency medical services and supporting readiness initiatives, the program has reduced child morbidity and mortality from severe injuries.
Neurosurgery Supports the Reauthorization of Physician Mental Health Legislation
In 2022, the Dr. Lorna Breen Health Care Provider Protection Act (P.L. 117-105) was signed into law, establishing initiatives to address suicide, mental health, burnout, and resiliency of health professionals. The law was named after Lorna Breen, MD, an emergency physician at New York-Presbyterian Allen Hospital working on the front lines of the pandemic, who died by suicide on April 26, 2020.
Key provisions of the law expired last year. The CNS and the AANS support the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (S. 266/H.R. 929) to renew these essential grant programs for an additional five years, ensuring continued support for physicians and other clinicians.
Neurosurgery Issues Press Release on Senate Judiciary Hearing on Controlled Substances
On Feb. 4, the CNS and the AANS led seven other leading medical organizations in sending a joint letter to Senate Judiciary Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Dick Durbin (D-Ill.) ahead of the Committee’s hearing titled, The Poisoning of America: Fentanyl, its Analogues, and the Need for Permanent Class Scheduling. The hearing examined the public health and safety threats posed by illicit fentanyl and its analogues and evaluated the need for permanent class-wide scheduling of these substances under the Controlled Substances Act (CSA). The CNS and the AANS issued a press release following the hearing.
Subsequently, Becker’s Spine Review published an article quoting Alexander A. Khalessi, MD, MBA, chair of the CNS/AANS Washington Committee, "As physicians and DEA registrants, we are committed to the responsible stewardship of controlled substances, ensuring patients have access to evidence-based pain management."
That same week, the House Energy and Commerce Committee held a subcommittee hearing, Combatting Existing and Emerging Illicit Drug Threats, the CNS and AANS led a similar letter with additional organizations on board.
Following, on Feb. 6, the House passed the HALT Fentanyl Act by a vote of 312-108.
Neurosurgery Joins Trauma Coalition in Urging PAHPA Reauthorization to Strengthen National Preparedness and Emergency Response
The CNS and the AANS, alongside the broader Trauma Coalition representing a wide range of health professionals and trauma care organizations, urged congressional leaders to swiftly reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA). This critical legislation enhances the nation's ability to respond effectively to both natural and man-made disasters and public health emergencies, bolstering national security and supporting frontline providers. The letter emphasized PAHPA's pivotal role in ensuring trauma systems are prepared for emergencies, warning that failure to reauthorize it before its expiration on March 14, will compromise essential programs and public health readiness.
Neurosurgery Joins the Alliance of Specialty Medicine in Commenting on Draft Legislation to Improve Medicare Program
The CNS and the AANS, as leading members of the Alliance of Specialty Medicine (ASM), responded to a request for information aimed at improving the Medicare Graduate Medical Education (GME) program. The ASM emphasizes the urgent need to address critical medical specialty workforce shortages, including neurosurgery, due to projected physician deficits by 2034. ASM supports expanding Medicare-funded GME residency slots to 10,000 between fiscal years 2027–2031, with at least 25% allocated to specialty and subspecialty training. They propose specific legislative text changes to prioritize specialty care, oppose the creation of a new GME Policy Council as redundant, and recommend enhancing the existing Council on Graduate Medical Education (COGME) to include specialty representatives.
Click here to read the letter.
Coding and Reimbursement
Neurosurgery Joins the Alliance in Letter on MA and Medicare Prescription Drug Programs Proposed Rule
On Jan. 27, the CNS and the AANS joined the Alliance of Specialty Medicine (ASM) in sending a letter to the Centers for Medicare & Medicaid Service (CMS) providing feedback on proposed policy changes for Medicare Advantage (MA) and Part D prescription drug plans and their impact on access to specialty medical care. In the letter, the CNS, AANS, and ASM:
- Urge CMS to use its oversight and enforcement authority to conduct program audits to identify MA plans that fail to comply with CMS’ regulations and institute enforcement measures, including financial penalties, and where plan behavior is more egregious, termination from the MA program altogether.
- Ensure the use of prior authorization does not disadvantage underserved populations and institute metrics for the annual health equity analysis of the use of prior authorization that thoroughly measure the extent and impact of the burdensome requirements that often result in delay or denial of appropriate care.
- Implement measures to bolster MA plan access to specialty care, including requiring plans to maintain accurate, real-time provider directories that include specialty and subspecialty designations.
- Establish a star measure system to encourage MA plans to maintain an adequate network of specialty and subspecialty providers as “in-network.”
- Improve the process for medical record requests, clarify the nature of the requests, provide reasonable deadlines and reimburse practices fairly for completing medical record requests.
A letter from the American Medical Association (AMA) in response to the proposed rule is available here.
Quality Improvement
CNS and AANS Sign on to Letter Requesting MIPS Value Pathways Overhaul
In January, the CNS and the AANS signed a letter recommending vital improvements to the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) framework. MVPs attempt to group together measures that are relevant to a specific specialty, condition, or population to provide a more focused participation experience. While MVPs were intended to respond to concerns about the increasing complexity of MIPS, its lack of meaningful measures, and its failure to prepare physicians to transition to alternative payment models (APM), the framework fails to achieve any of these goals. The letter makes specific recommendations that would, among other things, result in more meaningful quality and cost comparison information for patients and create better alignment between MIPS and the hospital value-based purchasing programs.
CMS Releases 2025 MIPS Quality Measure Benchmarks
On January 30, CMS released its 2025 Merit-Based Incentive Payment System (MIPS) quality measure benchmark files. CMS assesses clinician performance against these benchmarks to determine how many points they earn on a quality measure. Whenever possible, CMS uses historical data to establish quality measure benchmarks. Historical benchmarks for the 2025 performance period are based on MIPS data submitted during the 2023 performance period. If CMS cannot calculate an historical benchmark, it will attempt to create a performance year benchmark based on 2025 performance period data. However, these benchmarks will not be available until after the close of the 2025 performance year.
The 2025 benchmark files, as well as a 2025 Quality Benchmarks User Guide and Scoring Examples, are available for download here.
CMS Offers Automatic MIPS Exception for California Wildfires
CMS recently announced that the MIPS automatic Extreme and Uncontrollable Circumstances (EUC) policy will apply to MIPS eligible clinicians in designated counties affected by the recent California wildfires for both the 2024 and 2025 performance periods. MIPS eligible clinicians in these areas will be automatically identified and have all four MIPS performance categories reweighted to 0% for both performance periods, which will translate into a neutral payment adjustment for the 2026 and 2027 payment years. Note that the MIPS automatic EUC policy only applies at the individual clinician level. It does not apply to MIPS eligible clinicians participating in MIPS at the group, subgroup, virtual group, or Alternative Payment Model (APM) Entity level. However, these entities can request reweighting by submitting an EUC Exception application. Additional information is available through the 2024 MIPS Automatic EUC Policy Fact Sheet and 2025 MIPS Automatic EUC Policy Fact Sheet.
Of Note
Neurosurgeon Serves on CMS Physician Cost Measures and Patient Relationship Codes Technical Expert Panel
In late December, CMS and its contractor, Acumen LLC, convened a technical expert panel (TEP) to gather input on its Physician Cost Measures and Patient Relationship Codes (PCMP) project. Jay K. Nathan, MD, was appointed to serve on this TEP on behalf of the CNS and the AANS. The TEP provided guidance to CMS on the prioritization of episode-based cost measure development under the Merit-Based Incentive Payment System (MIPS). Dr. Nathan called for a more patient-centered approach to cost measure development, suggesting CMS focus on which diagnoses are driving the most cost to the program rather than on developing additional cost measures simply to fill remaining specialty gaps.
CMS also announced plans to soon begin work on new “value” measures in response to concerns raised by Dr. Nathan and others that existing cost measures fail to concurrently account for quality. The TEP also discussed the use of patient-relationship codes (PRCs) to facilitate attribution of episodes to clinicians for purposes of cost measurement. Section 1848(r) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to create PRCs, with clinical expert input, to facilitate the attribution of patients to clinicians for purposes of cost measurement under MIPS. Current cost measures are attributed based on specific billing patterns, using service and diagnosis codes, but CMS believes that PRCs could facilitate attribution of episodes to clinicians who serve patients in different roles (e.g., provide additional information about attributable clinicians when multiple clinicians are involved in an episode, or when clinicians are providing care only as ordered by another clinician).
To date, PRCs have only been tested on a voluntary basis, which has resulted in low adoption rates. CMS plans to continue to conduct future analyses to explore the use of PRC for cost measurement. Click here to read more about CMS’ work on PRCs to date.
Anthony L. Asher, MD, Named Vice Dean for Neuroscience Center of Excellence
Anthony L. Asher, MD, has been appointed Vice Dean for the newly established Neuroscience Center of Excellence at Wake Forest University School of Medicine. Dr. Asher will lead initiatives that integrate groundbreaking research with clinical practice to address diseases of the brain and nervous system. His work will focus on advancing innovative clinical trials and fostering collaboration to bring transformative solutions to patients with complex conditions.
"This role represents an extraordinary opportunity to unite research and clinical care in ways that directly and positively impact patients' lives. By fostering collaboration across the enterprise, we can accelerate breakthroughs in neuroscience and create impactful solutions for many of humanity’s most challenging medical conditions. I am eager to work alongside our talented teams to drive this progress," Dr. Asher shared.
Communications
Neurosurgery Blog Features Article on Vestibular Schwannoma Koos Grade I
On Dec. 17, 2024, the Neurosurgery Blog cross-posted a recent publication in Neurosurgery, the official journal of the CNS. Titled “Cross-Post: Vestibular Schwannoma Koos Grade I International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS-K1 Study,” the article was published as part of Neurosurgery’s High-Impact Manuscript Service. “Our strategy for managing patients with Koos grade I vestibular schwannomas has traditionally involved treating larger tumors and those causing symptoms with SRS, while smaller, asymptomatic tumors were observed,” reports Jason P. Sheehan, MD, PhD, and his colleagues.
Neurosurgery Blog Publishes Article on the Legacy of Neurosurgeon Justin A. Singer, MD
On Dec. 30, 2024, the Neurosurgery Blog highlighted the accomplishments of Justin A. Singer, MD, a cerebrovascular and endovascular neurosurgeon and an advocate for neurosurgical education. Dr. Singer played an integral role in neurosurgery’s volunteer efforts, contributing to the AANS, Neurosurgery Research & Education Foundation (NREF), and the CNS/AANS Council of State Neurosurgical Societies (CSNS). He was also involved in organized neurosurgery advocacy and health policy efforts as a member of the CNS/AANS Communications and Public Relations Committee and his participation in the CSNS.
Neurosurgeon Discusses the Future of AI in Spine Surgery
On Jan. 29, Brian R. Gantwerker, MD, was quoted in a Becker’s Spine Review article titled “Spine's AI nonnegotiables.” In the article, Dr. Gantwerker states, “AI is permeating pretty much all aspects of life, and now, unsurprisingly, medicine. As spine surgeons, it is important to keep AI in a place that is comfortable for you as the doctor.”
Neurosurgeon Quoted in Article on the Pros and Cons of Physician Employment versus Private Practice
Brian R. Gantwerker, MD, was quoted in a Feb. 4 Becker’s Spine Review article titled “Employment vs. private practice: 7 orthopedic leaders weigh in.” In the article, Dr. Gantwerker discusses why working as an independent neurosurgeon has been an extremely fulfilling part of his life. “I've learned to balance things much better now while maintaining an independent private practice,” states Dr. Gantwerker.
Neurosurgeon Pens Article on Medicare Payment Reform
On Feb. 11, neurosurgeon Richard P. Menger, MD, MPA, published an article in Forbes titled, “Medicare Is Failing Patients: A New Bill Can Help Fix That.” In the article, Dr. Menger noted that a recently proposed bill, the Medicare Patient Access and Practice Stabilization Act, co-sponsored by Reps. Greg Murphy, MD, (R-NC) and James Panetta (D-Calif.), and eight other House members, aims to reverse the Medicare cut to physician pay and, more importantly, align physician reimbursement with inflation, ensuring continued access to care for Medicare patients. "Doctors in America are struggling like never before because of ongoing Medicare cuts, and that’s putting millions of seniors at risk of losing access to affordable, quality health care," Rep. Murphy remarked when quoted for the piece.
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