2013 AANS Annual Report - page 31

Finally, it is well known that America has a long tradition of excellence and innovation in patient care, and
neurosurgeons have been on the cutting edge of these advancements. To ensure continued forward progress with
medical innovations, we have joined the fight to repeal the 2.3 percent excise tax levied on the sales of medical
devices. In a major breakthrough, by a margin of 79-20, the Senate passed a bipartisan amendment to the fiscal
year 2014 Senate Budget Resolution, calling for the repeal of this irrational tax.
With an aging population and rising health-care costs, the current Medicare program is on an unsustainable path,
and yet again, physicians are on the chopping block. Absent congressional action, physicians face a 27-percent
cut in Medicare reimbursement on Jan. 1, 2014. These cuts result from Medicare’s flawed sustainable growth
rate (SGR) formula and the automatic two-percent budget sequestration cuts. The AANS, through the Washington
Committee, is committed to working with Congress to pass a long-term solution to avert these significant cuts
and identify innovative approaches for reforming the Medicare payment system. One avenue the AANS is pursuing
is to seek passage of legislation that will remove Medicare’s balance-billing restrictions and allow patients and
physicians to privately contract without penalty. Additionally, organized neurosurgery has been collaborating
with a coalition of surgical societies to continue to press Congress to avoid kick-the-can solutions for fixing the
physician payment system — and once and for all replace Medicare’s SGR formula with a stable mechanism for
updating and reimbursing physicians. To that end, Washington Office staff worked with the House Energy and
Commerce Health Subcommittee to develop H.R.2810, bipartisan legislation that would repeal the flawed SGR and
reform the Medicare physician-payment system.
Organized neurosurgery also has been aggressively challenging other third-party payer coverage policies,
which limit reimbursement for many common neurosurgical procedures — particularly in the area of spine and
cerebrovascular disease. The Coding and Reimbursement Committee, in consultation 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 Coding and Reimbursement Committee and the appropriate
sections have formed “Rapid Response Teams” to help in these efforts, as many payers provide very short
comment periods. Materials developed are posted on the AANS website and may be referenced by neurosurgeons
as they find useful in their interaction with insurance carriers. It is organized neurosurgery’s goal that these
efforts will ensure patients get access to the full range of treatment options of innovative neurosurgical care.
Quality Improvement
Due in large part to the advocacy efforts put forth by organized neurosurgery, the Center for Medicare & Medicaid
Services (CMS) will allow physicians to satisfy Physician Quality Reporting System (PQRS) requirements by
participating in clinical data registries. Per neurosurgery’s suggestion, CMS is considering allowing such
participation to also satisfy Medicare’s Electronic Health Record (EHR) Program’s meaningful use requirements.
This will allow neurosurgeons to participate in the National Neurosurgery Quality and Outcomes Database
QOD) or other similar initiatives. In 2013, the AANS was successful in obtaining CMS approval of N
QOD as a
PQRS-certified registry. Neurosurgeons can now satisfy their PQRS requirements and avoid the 2015 penalty by
reporting through N
QOD in 2013.
Neurosurgery also continued to strongly advocate for improvements to the ineffective and largely irrelevant quality
improvement programs currently mandated by Medicare and other third-party payers. The AANS, through its
work with other parties in the Quality Improvement Workgroup, has successfully advocated for changes that will
minimize the application of reimbursement penalties, including:
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