AANS Neurosurgeon : Washington Watch

Volume 24, Number 2, 2015

D.C. News Updates

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President Obama Signs the Medicare Access and CHIP Reauthorization Act
On April 16, 2015, President Obama signed into law the “Medicare Access and CHIP Reauthorization Act,” which repealed Medicare’s sustainable growth rate (SGR) physician payment system and prevented a 21-percent pay cut. In addition, the legislation:

  • Consolidates the current Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) and Value-Based Payment Modifier (VM) programs and eliminates the penalties associated with these programs;
  • Includes positive incentives for quality improvement payment programs that allow all physicians the opportunity to earn bonus payments;
  • Enhances the ability of physicians — rather than the government — to develop quality measures and clinical practice improvement activities;
  • Clarifies that quality improvement program requirements do not create new standards of care for purposes of medical malpractice lawsuits;
  • Reverses the CMS decision to eliminate the 10- and 90-day global surgery payments; and
  • Extends the Children’s Health Insurance Program (CHIP) for two years.

The American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) will now focus on guiding this legislation through the implementation process to ensure that the Centers for Medicare and Medicaid Services (CMS) develops the new Medicare physician payment system as directed and intended by Congress.

Organized Neurosurgery Issues Response to the IOM’s GME Report
As previously reported, on July 29, 2014, the Institute of Medicine (IOM), released a report, “Graduate Medical Education That Meets the Nation’s Needs,” which recommends a sweeping overhaul of the current graduate medical education (GME) system.

The report:

  • Recommends maintaining Medicare support for GME;
  • Rejects calls from physicians and hospitals to increase GME funding to address current and future projected workforce shortages;
  • Calls for a complete overhaul of the current GME financing system, which will result in GME cuts and a shift of GME funds away from academic medical centers to community hospitals, clinics and other ambulatory care settings; and
  • Significantly increases Centers for Medicare and Medicaid Services’ (CMS) authority over workforce and GME.

Organized neurosurgery was disappointed by the report and, over the past six months, a workgroup convened by the Society of Neurological Surgeons (SNS) president, H. Hunt Batjer, MD, FAANS, developed a comprehensive response to the IOM report. Other members of the workgroup included: Robert E. Harbaugh, MD, FAANS; Nathan R. Selden, MD, FAANS; John A. Wilson, MD, FAANS; and Melanie G. Hayden, MD. The response, finalized in February 2015, will serve as the basis of organized neurosurgery’s advocacy position on this topic.

AANS and CNS Support Graduate Medical Education Legislation
On May 4, 2015, the AANS and CNS joined the Alliance of Specialty Medicine in endorsing S. 1148, the “Resident Physician Shortage Reduction Act of 2015.” Introduced by Sens. Bill Nelson (D-Fla.), Harry Reid (D-Nev.) and Charles Schumer (D-N.Y.), S. 1148 would increase the number of Medicare-funded graduate medical education (GME) residency positions by 15,000 over the next five years. The Alliance also endorsed the House companion bill, H.R. 2124, introduced by Reps. Joseph Crowley (D-N.Y.) and Charles Boustany, MD (R-La.).

Neurosurgery and 500 Other Groups Urge Congress to Repeal IPAB
On May 7, 2015, the AANS, CNS and several state neurosurgical societies, joined the Healthcare Leadership Council — with more than 500 national and state-based health-care organizations — in sending a letter urging Congress to repeal the Independent Payment Advisory Board (IPAB). The IPAB is a board of 15 unelected, and largely unaccountable government bureaucrats, whose primary purpose is to cut Medicare spending. Repealing the IPAB is one of organized neurosurgery’s top legislative priorities. Momentum to repeal the IPAB continues to grow, as H.R.1190, the Protecting Seniors’ Access to Medicare Act, now has 229 cosponsors — more than enough to pass the House of Representatives — and the Senate companion bill, S.141, has 39 cosponsors.

EMTALA Liability Bill Reintroduced
Working with other Trauma Coalition members, the AANS and CNS successfully advocated for the introduction of legislation that extends medical liability protections to all physicians who provide emergency care pursuant to the Emergency Medical Treatment and Labor Act (EMTALA). On Feb. 10, 2015, Reps. Charlie Dent (R-Pa.) and Pete Sessions (R-Texas) introduced H.R. 836, the “Health Care Safety Net Enhancement Act of 2015.” Under the bill, physicians who provide EMTALA-mandated stabilization and post-stabilization services would be covered by the Federal Tort Claims Act, rather than traditional state malpractice law, as is the case with certain federally supported health centers. The bill, which previously passed the House in 2012, currently has 47 cosponsors.

Subscribe to Neurosurgery Blog Today
The mission of Neurosurgery Blog is to investigate and report on how health-care policy affects patients, physicians and medical practice, and to illustrate how the art and science of neurosurgery encompass much more than brain surgery. Over the past few months, Neurosurgery Blog has ramped up its reporting efforts to include multiple guest blog posts from key thought leaders and members of the neurosurgical community. You’re invited to visit the blog and subscribe to it, as well as connect with the following various social media platforms, to keep up with the many health-policy activities happening in the nation’s capital and beyond the Beltway.

Katie O. Orrico, JD, is the director of the AANS/CNS Washington Office. She holds a Juris Doctor degree from the George Mason University School of Law and a Bachelor of Arts degree from The Catholic University of America. Orrico has worked for organized neurosurgery for more than 26 years, and is the recipient of both the AANS’ and CNS’ Distinguished Service Awards. For more information on these or other health-policy issues, contact her at The author reported no conflicts for disclosure.

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