On June 10, the AANS and the CNS commented on CMS’ newly proposed mandatory episode-based payment model, under which select acute care hospitals would be responsible for reducing Medicare spending while preserving or enhancing quality of care for Medicare beneficiaries undergoing certain surgical procedures, including spinal fusion, starting in 2026. Organized neurosurgery’s primary concern focused on the mandatory nature of the program and the failure of CMS to provide physicians with a role in the development and governance of the model. The AANS and the CNS also opposed CMS’ proposed use of broad quality metrics that have little relevance to spinal fusion patients; its use of a 30-day episode window, which impedes meaningful analyses of spinal fusion patients; and the use of inadequate risk adjustments to set target prices, which prioritize simplicity over accuracy. Finally, the AANS and the CNS cautioned against CMS’ rushed implementation timeline, which fails to account for a complete evaluation of predecessor payment models and for a concurrent CMS proposal to update spinal fusion MS-DRGs. CMS will consider the public’s feedback when determining whether and how to finalize this model.
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