2014 AANS Annual Report - page 41

Regulatory Relief
Faced with an ever-growing morass of regulations with which neurosurgeons must
comply, the AANS, through the Washington Committee and Washington Office, has been
working with Congress and regulators to reduce the burdens associated with practicing
medicine. A top priority for Fiscal Year 2014 was the repeal of the ICD-10 coding system.
Working with the Alliance of Specialty Medicine, the American Medical Association
(AMA) and others, the AANS was successful in halting implementation of ICD-10 for
an additional year. The AMA estimates that the implementation of ICD-10 will cost
physicians anywhere from $56,639 to $226,105 (for small practices) up to $2,017,151
to $8,018,364 (for large practices). Thus, while implementation is now set for Oct. 1,
2015, neurosurgery continues to press Congress and the Obama Administration to scrap
ICD-10 in favor of ICD-11, which is right around the corner.
Under current law, neurosurgeons face Medicare care cuts totaling more than $325
million over the next seven years if they fail to comply with Medicare’s quality-related
incentive programs. Unfortunately, these programs are primarily oriented towards
primary care and provide very little opportunity for neurosurgeons to successfully participate. For the
past several years, organized neurosurgery has been pressing Congress and CMS to delay and revise
Medicare’s Electronic Health Care Record (EHR) Incentive Program. This ongoing advocacy has resulted
in CMS extending Stage 2 of the meaningful use (MU) program. Originally, CMS planned for Stage 2 to
end after 2015, but now it will remain in place through the end of 2016. Failure to comply with the MU
requirements could mean Medicare cuts of $22 million over the next two years, so neurosurgery continues
to push for changes to this burdensome program to allow more flexibility for physicians to meet all states of
MU. Additionally, due to the advocacy efforts of organized neurosurgery, Congress directed the Centers for
Medicaid and Medicare Services (CMS) to allow physicians to satisfy Physician Quality Reporting System
(PQRS) requirements by participating in clinical data registries. This will allow neurosurgeons participating
in the National Neurosurgery Quality Outcomes Database (N
QOD) or other similar initiatives to qualify for
PQRS, thereby avoiding Medicare payment cuts of $25 million over the next two years.
Joining with colleagues at the AMA and American Hospital Association (AHA), the AANS helped secure
a delay of the “two-midnight” inpatient-hospital admission policy. In addition, legislation passed Congress
(H.R. 4302), permitting the Department of Health and Human Services (HHS) to suspend the Recovery
Audit Contractors (RAC) program through March 2015. The AANS continues to oppose the two-midnight
policy due to concerns about increased physician hassles and audit exposure, as well as increased
beneficiary financial liability.
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