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46

2015 ANNUAL REPORT

Fighting for Fair Reimbursement

For more than a decade, physicians have faced a significant

annual Medicare payment cut — the result of a flawed

sustainable growth rate (SGR) formula. After nearly 14

years of lobbying and 17 temporary “patches,” on April

16, 2015, President Obama signed into law the Medicare

Access and CHIP Reauthorization Act (MACRA), which

repealed Medicare’s SGR physician payment system and

prevented a 21 percent pay cut. The bill passed the House

and Senate by overwhelming margins. In addition to

repealing the SGR, the legislation:

n

Consolidates the current Physician Quality Reporting

System (PQRS), Electronic Health Record (EHR) and

Value-Based Payment Modifier (VM) programs, and

eliminates the penalties associated with these programs;

n

Includes positive incentives for quality improvement

payment programs that allow all physicians the

opportunity to earn bonus payments;

n

Enhances the ability of physicians — rather than the

government — to develop quality measures and clinical

practice improvement activities;

n

Clarifies that quality improvement program

requirements do not create new standards of care for

purposes of medical malpractice lawsuits; and

n

Reverses the CMS decision to eliminate the 10- and 90-

day global surgery payments.

The estimated financial impact of preventing the 2015

SGR and global surgery-related cuts is $276 million or

$69,000 per neurosurgeon. In addition, although difficult

to precisely estimate, at a minimum, when MACRA’s

incentive program becomes operational, in 2019 this

legislation will prevent penalties totaling $46 million or

$11,500 per neurosurgeon. Individual neurosurgeons

will also have the opportunity to earn significant bonus

payments of up to $23,000 in 2019 and even higher

amounts in future years.

Over the course of the next several years, organized

neurosurgery will focus on guiding this legislation through

the implementation process to ensure that the CMS

develops the new Medicare physician payment system as

directed and intended by Congress.

The AANS has also aggressively challenged third-party

payer coverage policies, which often limit reimbursement

for many common neurosurgical procedures. The

Coding and Reimbursement Committee, along with

representatives from the Quality Improvement Workgroup,

Joint Guidelines Committee, the Joint Sections and

Washington Committee work together to respond to these

coverage issues to provide a balanced assessment of the

current literature and experience with procedures under

review. The CRC’s “Rapid Response Teams” are organized

to lead these efforts, and working with the Council of State

Neurosurgical Societies (CSNS), utilized new tools to

track and respond to proposed coverage policies to ensure

that neurosurgical patients get access to the full range of

treatment options of neurosurgical care.

Throughout the past year, the AANS provided comments

on a variety of proposed coverage policies from Medicare

and other payers, including Aetna, United, Cigna, various

Blue Cross-Blue Shield plans, Noridian, Washington

State Health Care Authority, Wellpoint and others.

These comments involved topics such as cervical, thoracic

and lumbar spine fusion; lumbar artificial disc; epidural

steroids for low back pain; intraoperative eletromyographic

monitoring; carotid artery stenting; intracranial stenting;

mechanical embolectomy; thrombolysis; stereotactic

radiosurgery; responsive neurostimulation for epilepsy and

deep brain stimulation.