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Another top priority for neurosurgery was easing the

burdens of implementing the new ICD-10-CM diagnoses

coding system. While further delays of ICD-10 were not

likely, the AANS worked with Congress to urge CMS to

smooth the transition to the new system. Due to ongoing

advocacy pressure from medical societies, including the

AANS, CMS shifted course and announced that it would

implement a one-year grace period for transitioning to

ICD-10. Beginning on Oct. 1, 2015, Medicare claims

will not be denied solely on the specificity of the ICD-

10 diagnosis codes provided, as long as the physician

submitted an ICD-10 code from an appropriate family.

In addition, Medicare claims will not be audited based on

the specificity of the diagnosis codes as long as they are

from the appropriate family of codes. To avoid potential

problems with mid-year coding changes in CMS quality

programs for the 2015 reporting year, physicians using

the appropriate family of diagnosis codes will not be

penalized if CMS experiences difficulties in accurately

calculating quality scores. CMS will also establish an

ICD-10 Ombudsman to help receive and triage physician

problems. Finally, in certain circumstances, CMS may also

make advanced payments to providers if challenges arise

during the ICD-10 grace period. Studies have shown that

the ICD-10 costs ranged from an estimated $83,290 for

a small practice up to $2,728,780 for a large practice so

progress on this issue is an enormous financial benefit to


Reforming the Reform

While the Affordable Care Act (ACA) is the law of the

land, the AANS has not ceased in advocating significant

changes to this landmark health-care reform law. A top

priority remains abolishing the Independent Payment

Advisory Board (IPAB). The IPAB is a 15-member

unelected and unaccountable government board, whose

principal responsibility is to cut Medicare. In leading

the Physician IPAB Repeal Coalition, the AANS was

instrumental in getting the “Protecting Seniors’ Access to

Medicare Act” (H.R. 1190/S. 141) introduced in Congress.

This legislation passed in the House of Representatives on

June 23, 2015 and support for this bill continues to grow

in the Senate. This bill, which has significant bipartisan

support, repeals the IPAB. Action on this bill is currently

pending in the Senate.

America has a long tradition of excellence and innovation in

patient care, and neurosurgeons have been on the cutting-

edge of these advancements. However, American medical

innovation is at serious risk. To ensure continued forward

progress with medical innovations, the AANS has joined the

fight to repeal the 2.3 percent excise tax levied on the sales

of medical devices. Bipartisan legislation to repeal this tax,

the “Protect Medical Innovation Act” (H.R. 160) passed the

House of Representatives on June 18, 2015. The “Medical

Device Access and Innovation Protection Act” (S. 149) its

companion bill in the Senate, also enjoys significant support.

In fact, Senate leadership has started a process to allow

the Senate to consider the House-passed bill without first

sending it to committee. If ultimately enacted, the bill would

eliminate $24.4 billion in taxes over the 2015-2025 period.

Graduate Medical Education

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 the AANS, policymakers are

beginning to understand that there are significant shortages

of physicians in both primary and specialty care. Due to

federal budget constraints, funding for graduate medical

education (GME) remains at risk, particularly following

the release of the Institute of Medicine’s report “Graduate

Medical Education That Meets the Nation’s Health

Needs.” Collaborating with the Society of Neurological

Surgeons (SNS) and the American Board of Neurological

Surgery (ABNS), the AANS developed a response to

the IOM report, which is serving as the framework for

organized neurosurgery’s advocacy on this topic. So

far, cuts have been prevented, and working with the

Association of American Medical Colleges (AAMC), the

Alliance of Specialty Medicine and others, the AANS has

successfully advocated for the introduction of legislation

to provide additional Medicare funding for GME. The

“Resident Physician Shortage Reduction Act” (H.R.

2124/S. 1148) would increase the number of Medicare-

supported residency positions by 3,000 each year for the

next five years. This bill continues to pick up momentum.