On Call: The Newsletter of the Alliance of Specialty Medicine

Winter 2020

Specialty Docs Head to the Hill (Virtually)

Celebrating its 20th year as a specialty medicine coalition, the Alliance of Specialty Medicine held its first-ever virtual Capitol Hill fly-in in November, respecting the new realities of the COVID-19 pandemic while bringing the voices of 100,000 specialty physicians to Congress via Zoom.

Traditionally, the Alliance would hold its annual fly-in in July, hosting key healthcare leaders in the House and Senate as well as federal agency heads and staff to discuss healthcare policy.  Specialty doctors would fly in from all over the country, and following the policy presentations and roundtables, would head to the halls of Congress and personally meet with their respective House and Senate members.  The outbreak of COVID-19 changed all that, and there was talk of canceling the fly-in altogether.

Given the high stakes and even higher uncertainty surrounding many healthcare issues affecting patient access to specialty medicine – and with a lame-duck session of Congress on the horizon – the Alliance decided to hold a one-day, all-day Zoom conference.  The day was a complete success as over 100 Alliance doctors logged in to hear from a dozen Members of the House and Senate who participated remotely from their home states or Capitol offices.  This bipartisan, bicameral group shared their respective thoughts on healthcare policy, the results of the 2020 elections, and the shape of things to come in the lame duck and the new Congress in January.

Key issues for the Alliance include the need for additional COVID relief legislation to keep practices open and patients safe, a Congressional response to the looming Medicare payment cuts expected from the Centers for Medicare & Medicaid Services (CMS), consensus legislation to address the issue of surprise medical billing, and support for legislation that reduces the growing burdens of prior authorization and step therapy.

Because of the built-in flexibilities associated with videoconferencing, Alliance doctors could participate without taking time away from their practices, and many were seen on screen in hospital hallways and in their scrubs.  The Members of Congress were truly hearing from doctors on the front lines.

In conjunction with the fly-in, the Alliance staged an active social media campaign on Twitter and Instagram.  Using the hashtag #ASM2020, these social media posts further highlighted the Alliance’s federal policy goals, with individual member societies chiming in on behalf of their practices and their patients.  The social media campaign netted over 3 million impressions from nearly 200,000 unique Twitter users.

Provider Community Rallies Around Solution to Medicare Payment Cuts

Bera-Buchson Legislation Seeks to Hold Providers Harmless from CMS Proposal

The Alliance of Specialty Medicine joined with dozens of fellow provider groups and state and federal medical societies to endorse HR 8702, the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020. This important legislation will avert significant Medicare Physician Fee Schedule (MPFS) reimbursement cuts that would negatively impact many physician specialties.

On January 1st, 2021, the Centers for Medicare & Medicaid Services (CMS) plans to implement changes to the codes for office and outpatient evaluation and management (E/M) services, which triggers a budget neutrality adjustment that will result in large reductions in reimbursements for many Medicare providers. Due to the budget neutrality adjustment, some of the Alliance’s member specialties face cuts as high as 7%. These changes were proposed as part of the larger MPFS for 2021.

While Alliance member societies participated in the process and support the improved values for E/M services, they are concerned that the steep cuts resulting from budget neutrality will negatively impact Medicare providers who are already under financial distress due to the COVID-19 pandemic. HR 8702 leaves intact the positive updates to office and outpatient E/M services while ensuring that those providers negatively affected by budget neutrality are held harmless.

Efforts to lobby CMS to pull back the proposed cuts proved unsuccessful as the federal agency confirmed its plans by finalizing the 2021 MPFS on December 1st.  The House and Senate will need to address these cuts during the lame-duck session of the 116th Congress, or providers throughout the country will face steep payment cuts depending on their area of specialty.  HR 8702 currently has 53 bipartisan cosponsors.  In August, 92 Members of the House wrote to Speaker Pelosi and Minority Leader McCarthy, asking them to address the proposed cuts by the end of the year.

Specialty Spotlight: Remembering Dr. Alan Crandall.  Ophthalmologist and Humanitarian

Alan S. Crandall, MD, passed away on Oct. 2, 2020, due to a sudden illness. Dr. Crandall, 73, served as ASCRS President from 2009 – 2010 and was an inaugural member of the ASCRS Glaucoma Clinical Committee formed in 1997.

He was the John E. and Marva M. Warnock Presidential Endowed Chair of Ophthalmology and Visual Sciences and served as director of the glaucoma and cataract divisions at the John Moran Eye Center at the University of Utah in Salt Lake City, Utah. In addition to his 39 years at Moran, he was a glaucoma and cataract surgery specialist at The Eye Institute of Utah. Dr. Crandall was the Founder and Senior Medical Director of Moran’s Global Outreach Division. He also worked with the Himalayan Cataract Project, which took him to some of the world’s poorest and most remote communities. There, he restored and repaired the eyesight of men, women, and children who would have gone needlessly blind without access to surgery.

While on humanitarian missions, Dr. Crandall would operate from 7 am until 9 pm.  Then he would help the nurses clean up.  One trip to South Sudan was particularly difficult, but a colleague recalled that Dr. Crandall didn’t see it that way.  “We struggled with a failing generator, shortened fornixes, corneas clouded by trachoma and climatic dystrophy, hypermature cataracts, and operating in shorts and scrub tops, with no gown due to the heat.  Biting insects swarmed, and bats raced through the air feasting on the flies,” Dr. Geoff Tabin recalled.  “That night, over rice, beans, and iodinated water, Alan said sincerely, ‘That was the best day of surgery of my life.  I have never seen so many difficult cases and people with such needs!’”

For his commitment to humanitarian eyecare, Dr. Crandall was recognized with the inaugural ASCRS Foundation Chang Humanitarian Award in 2018. In October, the ASCRS Foundation announced this was being renamed the Chang-Crandall Humanitarian Award in his honor. Dr. Crandall was recognized by several other organizations for his work as well.  Dr. Crandall graduated from the University of Utah School of Medicine, completed his internship at the University of Pennsylvania Medical Center, and held his residency and fellowship in ophthalmology at the Scheie Eye Institute at the University of Pennsylvania. He returned to join the University of Utah’s faculty in 1981. Dr. Crandall was a diplomat of the National Board of Medical Examiners and the American Board of Ophthalmology.

“Alan was a talented surgeon, dedicated educator, and passionate humanitarian caregiver who always put others in front of him,” said Terry Kim, MD, ASCRS President. “We will all miss his good friendship, sound advice, and countless stories about overcoming adversity in his personal and professional life that were always filled with humor and amazement. On behalf of the ASCRS family, I extend the deepest sympathies and condolences to his wife, Julie, his son, David, and all his family and friends.”

For his near forty years of service in helping those at home and abroad receive high-quality eye care, Dr. Crandall was honored by Senator Rand Paul (R-KY), a fellow ophthalmologist who also traveled with Dr. Crandall on trips to Guatemala and Haiti.  In remarks published in the Congressional Record, Senator Paul said, “On behalf of all ophthalmologists, together we mourn the loss of an outstanding surgeon and even greater man.  Alan was a steadfast ambassador to the field of ophthalmology, and his true selflessness will never be forgotten.”

Physician Burnout in Neurosurgery

       

To explore and highlight the rising prevalence of burnout among clinicians in recent years, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) published a series of articles in the Neurosurgery Blog: More than Just Brain Surgery.

As conversations about work-life balance are becoming more prevalent, and given the stresses associated with the COVID-19 pandemic, there has been a renewed interest in the issue of physician burnout. Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization and a lack of sense of personal accomplishment.

Burned-out physicians are more likely to leave their practices or the practice of medicine altogether, which reduces patients’ access to and continuity of care. Burnout can also threaten patient safety and care quality when depersonalization leads to poor interactions with patients, and when burned-out physicians suffer from impaired attention, memory and executive function.

Understanding burnout will push more health care organizations to adopt strategies to protect their members from this phenomenon. Physician engagement will undoubtedly be crucial to the prevention of burnout. We must take the lead by being active and vocal for ourselves, our colleagues and our patients and fight against the forces that erode our mental health and the quality of our work.

Read the complete series:

·       Burnout to Wellness: Dr. Joseph Maroon’s Journey to a Balanced Life

·       Our Health Care Workers Are Struggling — That’s Why I Introduced Legislation to Help

·       The Time Has Come to Bring Physician Wellness to the Forefront of Our Profession

·       Burnout Among Physicians: A System Issue

·       Preventing Moral Injury: An Interview with ZDoggMD

·       Addressing Clinician Burnout is Essential to Achieving the Goal of Better Care

·       Physicians Suffer From Moral injury, Not Burnout

Colorectal Cancer Screening Bill Passes House by Voice Vote

Awaits Senate Action in Closing Days of 116th Congress

On December 9th, the U.S. House of Representatives passed H.R. 1570 – Removing Barriers to Colorectal Cancer Screening Act of 2020, as amended by voice vote.  This bill was introduced by Rep. Donald Payne, Jr. (D-NJ), who lost his father, former Rep. Don Payne, Sr., to colon cancer in 2012.  The bill has 344 bipartisan cosponsors, and its companion bill in the Senate, S.668, introduced by Sen. Sherrod Brown (D-OH), has 61.

The need for this legislation is long overdue.  In 2019 Dr. Shazia Siddique had the following op-ed published in the Philadelphia Inquirer discussing the issue and the need for the legislative fix.  Dr. Siddique is the Director of the Congressional Advocates program for the American Gastroenterological Association (AGA).

About one in three Americans who need colon cancer screening — about 38 million people — are still not getting it. Initiatives to improve screening rates for colon cancer are falling short, and costs remain a big factor.

So what has the government done?

Shockingly, Medicare has taken a step backward. Instead of closing the loophole within the agency — which could be done without Congress’ approval — it has proposed that physicians be required to inform patients of potential surprise costs. The idea of price transparency is one that I wholeheartedly support, but Medicare’s proposal has doctors doing its dirty work. Instead of Medicare informing patients of costs, it puts the burden on physicians. To be clear, doctors are not responsible for the surprise bills — this is in Medicare’s arena.

This is how the proposal would go, theoretically:

You are a 65-year-old man with worsening heartburn. You get an appointment to see your gastroenterologist for a 30-minute slot. The bulk of the visit is spent on heartburn management. Your doctor uses the last few minutes to discuss the importance of colon cancer screening. Taking off from work and drinking laxatives doesn’t sound fun, but you agree. Your doctor now broaches the topic of cost. Since you have Medicare, you are potentially vulnerable to fall into this loophole. Your doctor explains that it may be free if we don’t find polyps (great news), but finding and successfully removing polyps is how we prevent colon cancer.  So, you may get a bill, but you won’t know in advance for how much because it depends on how many polyps, what tools are used to remove them, and which lab techniques are used to analyze them. And your doctor won’t know until you are already sedated and undergoing the procedure. You are left with a slew of unhelpful information, and a great amount of uncertainty, all discouraging you from pursuing lifesaving preventive screening.  Imagine a different scenario in which you are guaranteed a colonoscopy will be free regardless of the findings — just as it is for your friends with private insurance or V.A. health care.

Which scenario would you prefer?

H.R. 1570 and S. 668 waive Medicare coinsurance requirements for colorectal cancer screening tests, regardless of the code billed for a resulting diagnosis or procedure.

Following its overwhelming support and passage in the House, the AGA and the American Cancer Society continue to urge the Senate to pass the Removing Barriers to Colorectal Cancer Screening Act and send it to the President’s desk before Congress adjourns for the year.