Prior Authorization Takes Center Stage
The Washington Committee continues to lead efforts to reform prior authorization (PA), with momentum accelerating on multiple fronts.
At the center of growing concern is the Centers for Medicare & Medicaid Innovation’s (CMMI) proposed Wasteful and Inappropriate Services Reduction (WISeR) Model. Beginning January 2026, this six-year mandatory demonstration will use third-party vendors to review claims for selected “low-value” services, including epidural steroid injections for pain management, electrical nerve stimulator implants, percutaneous vertebral augmentation for vertebral compression fracture, cervical fusions, and percutaneous image-guided lumbar decompression for lumbar spinal stenosis. The model will apply to traditional Medicare patients in six states (NJ, OH, OK, TX, AZ, WA) and marks a sharp policy turn that could reintroduce the very access and administrative issues recently addressed in Medicare Advantage reforms.
The Washington Committee responded through several of its coalitions. The Regulatory Relief Coalition (RRC), of which the AANS and CNS are founding members, submitted formal comments opposing the WISeR model. The Washington Committee also joined the Surgical Coalition in a parallel letter opposing the model, citing concerns about reduced patient access, increased administrative burden on physicians, and perverse payment incentives for third-party vendors.
The Washington Committee took those letters to the Hill in a grassroots advocacy campaign led by Chair Alexander Khalessi, MD, MBA, FCNS, where leading neurosurgeons met directly with congressional champions in the Senate and House. These conversations prompted CMMI to offer a meeting with Washington Committee staff and its allies to come to the table and offer solutions to improve the demo.
Physician and patient backlash on WISeR has drawn bipartisan scrutiny on Capitol Hill. On July 22, the House Ways and Means Committee held a hearing, Medicare Advantage: Past Lessons, Present Insights, Future Opportunities, where many Representatives discussed insurer abuse in PA. Representative Suzan DelBene (D-WA) focused her line of questioning on WISeR to highlight the perverse payment incentives and administrative burdens it would place on already stretched practices. Rep. DelBene followed her remarks with serious questions in a sign-on letter alongside Representative Ami Bera, MD (D-CA), and 15 other Representatives. The letter requests that CMS respond by September 1.
Newsweek, MedPage Today, The Hill, MarketWatch, and other news outlets have spotlighted the backlash, amplifying concerns raised by Members of Congress and the physician community.
In preparation for the hearing, the Washington Committee met with Committee members and submitted formal testimony for the record. It called for final passage of the Improving Seniors’ Timely Access to Care Act (S. 1816/H.R. 3514). Support for the legislation continues to grow with 169 House and 54 Senate cosponsors.
Washington Committee Members Lobby Congress and HHS
On July 10, the Washington Committee held a targeted fly-in to advocate for neurosurgery’s top legislative and regulatory priorities. Neurosurgeons conducted 20 meetings across the House and Senate, engaging directly with key lawmakers and staff on physician payment reform, prior authorization, Medicaid proposals in the One Big Beautiful Bill Act, the WISeR model, and graduate medical education.
Neurosurgeons met directly with Senators Roger Marshall, MD (R-KS), and U.S. Representatives Kim Schrier, MD (D-WA), Neal Dunn, MD (R-FL), Suzan DelBene (D-WA), and Herb Conaway, MD (D-NJ). They also met with senior staff with Senators Elizabeth Warren (D-MA), Chuck Schumer (D-NY), Ed Markey (D-MA), Alex Padilla (D-CA), and Chuck Grassley (R-IA), and Representatives John Joyce, MD (R-PA), Danny Davis (D-IL), Katherine Clark (D-MA), Yasmin Ansari (D-AZ), August Pfluger (R-TX), and David Schweikert (R-AZ).
The following day, Dr. Khalessi welcomed two senior federal officials for a forward-looking policy dialogue on digital health. Thomas Keane, MD, Director of the Advanced Standards and Technology Partnerships Division at the Office of the National Coordinator for Health Information Technology, discussed interoperability, artificial intelligence, and the Trusted Exchange Framework and Common Agreement (TEFCA). He emphasized ASTP/ ONC’s commitment to keeping physicians central to digital health innovation while acknowledging persistent challenges related to EHR usability and information blocking.
Kenneth Callahan, Chief Policy Officer at the U.S. Department of Health and Human
Washington Committee Update
Charlotte Pineda, MPP
Vice President, Health Policy and Advocacy
Alexander Khalessi MD, MBA, FACS, FCNS
Chair, Washington CommitteeWWW.CNS.ORG 27
Services, outlined the Administration’s regulatory streamlining agenda, including implementation of the Unleashing Prosperity Through Deregulation Executive Order. He also highlighted opportunities for specialty societies to inform Medicare administrative simplification efforts. Committee members raised concerns regarding real-world data integration, burdensome quality reporting requirements, and the need for meaningful reforms to prior authorization.
Neurosurgery Urges Congress to Close Gaps in Digital Health Policy
On July 9, the Washington Committee submitted a statement for the record in response to the House Ways and Means Subcommittee hearing, Harnessing the Power of Digital Health.
The statement emphasized the promise of digital health data to improve patient outcomes, efficiency, and research, while highlighting ongoing challenges related to interoperability, standardized patient matching, meaningful access to federal claims data, and quality reporting under the Merit-Based Incentive Payment System.
The Washington Committee urged Congress to advance policies that enable seamless data sharing, support the role of registries, and foster responsible innovation to improve patient care. The letter also highlighted the value of telehealth in neurosurgical care. It urged flexible, safety-focused regulation of emerging digital technologies, such as artificial intelligence, that recognize the unique needs of each patient.
Alliance for Specialty Medicine Endorses GME Bill
On August 6, the AANS and CNS joined the Alliance of Specialty Medicine in supporting the Resident Physician Shortage Reduction Act of 2025 (S.2439/H.R.4731). The legislation would increase the number of Medicare-supported GME positions by an additional 2,000 residency positions each year for seven years.
The letter emphasized that specialty shortages are particularly acute in surgical and non-primary care fields and are especially pronounced in rural and underserved areas. It urged lawmakers to consider targeted distribution strategies that ensure the new slots expand access to needed specialty services.
Access to Claims Data Act Reintroduced
On August 4, the Neurosurgery Quality Council, chaired by John Knightly, MD, led efforts to join the Registry Coalition in thanking Representatives John Joyce, MD (R-PA), and Kim Schrier, MD (D-WA) for their leadership in reintroducing the bipartisan Access to Claims Data Act (H.R. 4331).
Under the Medicare Access and CHIP Reauthorization Act (MACRA), CMS is required to provide Medicare claims data to registries “for purposes of linking such data with clinical outcomes data and performing risk-adjusted, scientifically valid analyses and research to support quality improvement or patient safety.”
The Access to Claims Data Act seeks to address significant ongoing regulatory barriers that have prevented meaningful access to this data by requiring CMS to establish a process to allow clinician-led clinical data registries to request and obtain timely, broad, and continuous access to federal claims data for research, quality of care measurement, and reporting.
CMS Releases 2024 Open Payments Data
On June 30, CMS published Open Payments Program Year 2024 data, along with newly submitted and updated payment records for Program Years 2018 – 2023. The data is accessible on the Open Payments Search Tool.
Open Payments, a national disclosure program, publishes information on payments from pharmaceutical and medical device companies to physicians, non-physician practitioners, and teaching hospitals.
The Open Payments data will be refreshed in 2026 to reflect any updates made to the data between now and December 31. The Drugs and Devices Committee, chaired by Joshua Rosenow, MD, FCNS, encourages neurosurgeons to routinely review their records and address discrepancies during the annual review and dispute period (April 1–May 15).
MEDCAC Reviews Clinical Endpoints for Parkinson’s and Essential Tremor
On June 25, the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) convened to examine what clinical endpoints should be of interest to CMS in studies of devices for the management of tremor in patients with Parkinson’s Disease or essential tremor. CMS selected this topic due to its relevance to the Medicare population and the broad range of potential endpoints.
Representing neurosurgery, Joshua Rosenow, MD, FCNS, presented evidence supporting the use of deep brain stimulation (DBS), outlined optimal clinical endpoints for DBS in Parkinson’s and essential tremor, emphasizing motor function, quality of life, cognition, and safety. “Most active DBS centers are doing both presurgical and 12-month postsurgical testing,” noted Dr. Rosenow, highlighting the importance of consistent cognitive assessments in evaluating patient outcomes. He cautioned against using balance, speech, or swallowing as primary endpoints, stating these are unlikely to improve postoperatively and are often confounded by disease progression.
Dr. Rosenow also responded to questions on device tolerability, explaining that chronic discomfort is rare and modern implants are smaller and more tolerable. He concluded that outcome measures should reflect realistic surgical benefits.
More information, including Dr. Rosenow’s presentation and meeting materials, is available here.
JGRC Endorses New Pituitary Adenoma Guideline
The Joint Guidelines Review Committee, chaired by Jennifer Sweet, MD, FCNS, endorsed a new CNS evidence-based Guideline on the treatment of functioning pituitary adenomas in adults. This marks the first guideline on the topic jointly considered by AANS and CNS, with evidence-based recommendations on endocrine management, imaging, surgery, and radiation