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17

FIGHTING FOR FAIR REIMBURSEMENT

The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) presents

an unprecedented opportunity to fix the currently broken and burdensome Medicare

quality programs, which have little meaningful impact on quality and have been extremely

disruptive to physician practices. To this end, the AANS and CNS have been on the front

lines helping to guide the MACRA legislation through the implementation process to

ensure that CMS gets this right and develops the new Medicare physician payment

system as directed and intended by Congress.

In April 2016, CMS issued the proposal rules related to the main elements of MACRA. This

legislation repealed Medicare’s sustainable growth rate (SGR) formula and replaced it with

a new payment system. Through a single framework called the “Quality Payment Program,”

the new payment paradigm has two paths — the Merit-based Incentive Payment System

(MIPS) and Advanced Alternative Payment Models (APMs). The new program consolidates

components of three existing Medicare penalty programs — Physician Quality Reporting

System (PQRS), Electronic Health Record (EHR) and Value-Based Payment Modifier (VM)

— and creates a quality opportunity for neurosurgeons to earn quality improvement bonus

payments. Organized neurosurgery expressed serious concerns with the new proposed

payment rules and urged CMS to make substantial changes before finalizing the payment

overhaul. The program’s final rules will be released in late 2016, and the AANS plans to

release a variety of educational materials to ensure that neurosurgeons are “MACRA ready”

and can thrive under the new quality payment program.

Additionally, the AANS has aggressively challenged other third party payor coverage

policies, which limit reimbursement for many common neurosurgical procedures. The

Coding and Reimbursement Committee (CRC), along with representatives from the

National Quality Council (NQC), 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

have provided comments on a variety of proposed coverage policies from Medicare and

other payors, including Aetna, Anthem, various Blue Cross Blue Shield plans, Noridian,

Washington State Health Care Authority and others. These comments involved topics such

as cervical spine fusion, carotid artery stenting, intracranial stenting, lumbar spine fusion,

pain management, percutaneous image-guided lumbar decompression, stereotactic

radiosurgery and thrombolysis. One particularly successful initiative targeted more than

30 negative coverage policies related to endovascular intervention for acute ischemic

stroke. As a result of organized neurosurgery’s advocacy, approximately 90 percent of these

policies were reversed, with the health insurers now covering these therapies.

Finally, during the past year, the AANS, working with the Rapid Response Teams and

the Council of State Neurosurgical Societies (CSNS), established a quarterly information

tool, which informs neurosurgeons about significant local coverage policies, allowing our

members to track and respond to these to ensure that neurosurgical patients get access

to the full range of treatment options for neurosurgical care.