2014 AANS Annual Report - page 40

Fighting for Fair Reimbursement
Year after year, because of Medicare’s flawed sustainable growth rate (SGR) formula, physicians face
significant cuts in Medicare reimbursement. As in years past, without congressional intervention, on April
1, 2015, physicians face a 24-percent cut in Medicare payments. Eliminating the sustainable growth rate
(SGR) payment formula is, therefore, a top priority for neurosurgery. The AANS, through the Washington
Committee, is steadfast in its commitment 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. To
this end, throughout the year, neurosurgery’s Washington Office staff
worked with leaders of the key health committees in both the U.S. House
and Senate as they crafted bipartisan, bicameral legislation to repeal
and replace the SGR. This bill, the “SGR Repeal and Medicare Payment
Modernization Act” (H.R. 4015/S. 2000), passed the U.S. House and
awaits Senate action. As an interim measure, Congress passed H.R. 4302,
the “Protecting Access to Medicare Act of 2014,” which postponed the
24-percent pay cut through Mar. 31, 2015. Both actions prevented $175
million in cuts to neurosurgery, which translates to approximately $44,000
per neurosurgeon. Organized neurosurgery continues to collaborate with
the Alliance of Specialty Medicine and the Surgical Coalition to press
Congress to fix the physician payment system and once-and for-all.
Organized neurosurgery has also 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
(CRC), in conjunction with the Quality Improvement Workgroup, Joint
Guidelines Committee, Joint Sections and Washington Committee, is responding 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 lead these efforts and have provided comments on a variety
of proposed coverage policies from Medicare and other payers, including Aetna, various Blue Cross Blue
Shield plans, Noridian, Washington State Health Care Authority, Wellpoint 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.
Going forward, the AANS, working with the Rapid Response Teams and the Council of State Neurosurgical
Societies (CSNS), will utilize 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.
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