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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


This year, the AANS 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 suspended the Recovery Audit Contractors

(RAC) program related to the two-midnight rule for an additional two years. Ultimately,

CMS announced its plans to scrap the program altogether and allow hospitals to seek

corrective reimbursements.

In addition to the relief provided by MACRA, the AANS successfully advocated for changes

to Medicare’s existing Electronic Health Record (EHR) Incentive Program, otherwise

known as meaningful use (MU). This ongoing advocacy resulted in a hardship exemption

from Stage 2 MU penalties for the 2015 program year, which 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 million in payment penalties, or $5,250 per

neurosurgeon. Additionally, as a result of organized neurosurgery’s efforts, House and

Senate lawmakers introduced legislation to help shorten the 2016 MU reporting period

from a full year to 90 days. The “Flexibility in EHR Reporting Act” (H.R.5001/S.2822) was

introduced in both the House and Senate. In the Medicare Prospective Payment System

(PPS)/Ambulatory Surgery Center (ASC) proposed rule, CMS announced that the agency

plans to reduce the 2016 EHR reporting period from a full calendar year to 90 days.


While the Affordable Care Act (ACA) is the law of the land, the AANS has not ceased in

advocating for 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 funding for IPAB eliminated for fiscal year 2016 as part of the $1.15 trillion

comprehensive spending and tax extenders package (Public Law 114-113).

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, the AANS joined the fight to

repeal the 2.3 percent excise tax levied on the sales of medical devices. Due in part to

the advocacy efforts of the AANS, the $1.15 trillion comprehensive spending and tax

extenders package (Public Law 114-113) included a two-year suspension of the 2.3

percent excise tax.