NeurosurgeryPAC in Action
The AANS has an active, valuable and effective Political Action Committee, or PAC, which provides organized neurosurgery with vital access to lawmakers on Capitol Hill and allows neurosurgeons to voice their views on critical issues facing their practice and their patients.
Some of NeurosurgeryPAC's recent accomplishments include:
- The Medicare Access and CHIP Reauthorization Act of 2015 (Public Law 114-10), or MACRA, was signed into law by President Obama on April 16, 2015. This crucial bipartisan legislation prevents a 21 percent pay cut; permanently repeals the SGR and provides physicians with positive payment updates; reverses the CMS decision to eliminate the 10- and 90-day global surgery payments; and allows physicians to earn bonus payments for delivering high-quality care. Neurosurgery was actively involved in shaping this bill, which reflects many of our suggestions. This action prevented $175 million in SGR-related cuts to neurosurgery in 2015 alone, which translates into approximately $44,000 per neurosurgeon. Additionally, the cuts to global surgery payments were conservatively estimated to be 10-15 percent; thus passage of MACRA also prevented $70-105 million in annual Medicare cuts, equating to approximately $17,500 to $26,250 per neurosurgeon.
- Neurosurgery is leading efforts to promote legislation that would allow patients and physicians to privately contract in Medicare without penalty to either party. Under current law, physicians who wish to privately contract must opt out of Medicare for two years and Medicare will not pay any portion of the physician's services. Through neurosurgery's efforts, Rep. Tom Price, MD, (R-Ga.) and Sen. Lisa Murkowski (R-Alaska) introduced the Medicare Patient Empowerment Act (H.R. 1650/S. 1849), which would remove these restrictions by allowing physicians to remain in Medicare and enter into private contracts on a case-by-case basis.
- Faced with an ever growing morass of regulations with which neurosurgeons must comply, neurosurgery has been working with Congress to reduce the burdens associated with practicing medicine. A top priority for 2015 was the repeal of the ICD-10 coding system. While it was ultimately not repealed, neurosurgery was successful in halting implementation of ICD-10 until Oct. 1, 2015. In addition, the AANS successfully championed efforts for a one year “grace period” in which claims will not be denied or audited solely on the specificity of ICD-10 diagnosis until Oct. 2016.
- Neurosurgery continued to oppose Medicare’s “two-midnight” inpatient-hospital policy due to concerns about increased physician hassles and audit exposure, as well as increased beneficiary financial liability. Neurosurgery’s advocacy efforts helped secure the inclusion of a provision in MACRA that suspends the Recovery Audit Contractors (RAC) program related to the two-midnight rule for an additional two years. On April 19, 2016, CMS announced its plans to scrap the program altogether and allow hospitals to seek corrective reimbursements.
- Advocated for by neurosurgery, a hardship exemption from Medicare's Electronic Health Records (EHR) Incentive Program's Stage 2 meaningful use penalties for the 2015 program year was passed as part of the Patient Access and Medicare Protection Act (Public Law 114-115). Without this legislation, neurosurgeons could have faced a total of $21,000,000 in payment penalties, or $5,250 per neurosurgeon.
- As a result of the AANS' advocacy, House and Senate lawmakers introduced legislation to shorten the Medicare’s Electronic Health Record (EHR) Incentive Program’s meaningful use (MU) 2016 reporting period from a full year to 90 days. The legislation, the Flexibility in Electronic Health Record (EHR) Reporting Act, is sponsored by Rep. Renee Ellmers (R-N.C.) in the House and Sen. Rob Portman (R-Ohio) in the Senate.
- Neurosurgery is leading a coalition representing over 450,000 physicians seeking repeal of the Independent Payment Advisory Board (IPAB). Pursuant to these efforts, Rep. Phil Roe, MD (R-Tenn.) and Linda Sánchez (D-Calif.) in the House, and Sen. John Cornyn (R-Tex.) in the Senate, reintroduced legislation, the Protecting Seniors' Access to Medicare Act (H.R. 1190/S. 141), which would repeal the IPAB. Enacted as part of the Patient Protection and Affordable Care Act (ACA), the IPAB will give a handful of government bureaucrats sweeping authority over Medicare policy. The House voted to repeal IPAB by a vote of 244-154 on June 23, 2015. Additionally, funding for IPAB was eliminated for FY 2016.
- Introduced by Rep. Erik Paulsen (R-Minn.), the Protect Medical Innovation Act of 2015 (H.R. 160) was passed by the House on June 23 by a vote of 280-140. Also enacted as part of the ACA, this bill would repeal the excise tax on medical device manufacturers and importers. At the end of 2015, Congress enacted the Protecting Americans from Tax Hike, which included a two-year moratorium on the imposition of this arbitrary tax.
- Through neurosurgery’s leadership in the Health Coalition on Liability and Access (HCLA), language was included in MACRA that prohibits any guideline or other quality/resource standard from being used to establish the standard of care or duty of care owed by a healthcare provider to a patient in any medical malpractice or medical product liability action or claim. MACRA ensures that federal healthcare programs are not misused to create new standards of care for medical liability lawsuits.
- H.R. 4771, the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act was reintroduced by Rep. Trent Franks (R-Ariz.). Estimated to reduce spending by $50 billion over the next decade, the bill is modeled after California’s Medical Injury Compensation Reform Act (MICRA) and includes a $250,000 cap on non-economic damages.
- At neurosurgery’s urging, Reps. Charlie Dent (R-Pa.) and Pete Sessions (R-Texas) in the House, and Sen. Roy Blunt (R-Mo.) in the Senate, introduced the Health Care Safety Net Enhancement Act (H.R. 836/S. 884), providing crucial medical liability protections for neurosurgeons that provide EMTALA-related care.
- Reps. Marsha Blackburn (R-TN) and David Scott (D-GA) introduced the Good Samaritan Health Professionals Act (H.R. 865). This legislation would ensure that health professionals who provide voluntary care in response to a federally declared disaster have appropriate medical liability protections. The bill aims to address the current inconsistencies in federal and state laws, which may leave physicians vulnerable to lawsuits.
- An appropriate supply of well-educated and trained physicians is an essential element to ensure access to quality healthcare services for all Americans. Through the continued advocacy of neurosurgery, policymakers are beginning to understand that there are significant shortages of physicians in both primary and specialty care. To this end, Sens. Bill Nelson (D-Fla.), Charles Schumer (D-N.Y.) and Harry Reid (D-Nev.), and Reps. Joe Crowley (D-N.Y.) and Charles Boustany, MD (R-La.), introduced the Resident Physician Shortage Reduction Act (S. 1148/ H.R. 2124). More recently, Rep. Kathy Castor (R-Fla.) introduced H.R. 4774, the Training Tomorrow’s Doctors Today Act. These bills would increase the number of Medicare-supported residency positions by 3,000 each year for the next five years for a total of 15,000 new residency slots.
- Encouraged by neurosurgery, the Pandemic and All-Hazards Preparedness Reauthorization Act (Public Law 113-5) includes support for developing plans for trauma care, critical care and emergency medical service providers and systems, with respect to public health emergencies, taking into account regionalized systems of care.
- Based on neurosurgery's advocacy, Reps. Michael Burgess, MD (R-Texas) and Gene Green (D-Texas) reintroduced the Trauma and Systems and Regionalization of Emergency Care Reauthorization Act, H.R. 648. In addition, Reps. Michael Burgess, MD (R-Texas) and Gene Green (D-Texas) introduced the Access to Life-Saving Trauma Care for All Americans Act (H.R. 647). Both bills provide funding for vital trauma and emergency care programs and passed the House of Representatives on March 16, 2015.