NASS Insider

December 21, 2021

Looking Back on Advocacy in 2021

As 2021 comes to an end, it is important to look back on the work done by the staff and many volunteers NASS has advocating the federal government on behalf of spine care. Over the years, the NASS advocacy program has become more robust to include direct legislative lobbying, grassroots advocacy, and political giving. Through these different methods, we are able to have significant impact on many legislative priorities that affect the day-to-day operations of NASS members.

One of the top legislative priorities NASS has seen significant action on includes a patch on the proposed 9.75 percent cuts to the Medicare Physician Fee Schedule (MPFS). Recent Congressional action has reduced the nearly 10 percent cut to 2.75 percent, and NASS will continue to advocate to further reduce those cuts to the fee schedule. Other recent activity could lead to tremendous gains in the physician workforce.

This year saw the introduction in both the House and the Senate of the NASS-supported Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018), that would require that Medicare Advantage plans establish an electronic prior authorization program that meets specified standards (including the ability to provide real-time decisions in response to requests for items and services that are routinely approved) and annually publish specified prior authorization information (including the percentage of requests approved and the average response time). The House version of the bill has 252 cosponsors and the Senate version currently has seven. With 48 percent of the federal government supporting passage of this legislation, it is in prime position to move through both chambers in the second legislative session starting in 2022.

Other issues include a possible expansion of Graduate Medical Education payments under Medicare by as many as 4,000 additional residency positions. Current language being moved in both the House and the Senate would increase the existing cap on the number of Medicare-funded residency positions by 4,000, with no more than 2,000 slots distributed each year starting in fiscal year 2025. The bill stipulates that at least 25 percent of these positions would be awarded for primary care residencies, and at least 15 percent would be awarded for psychiatry residencies – with no stipulations on specialty for the remaining positions. This same legislative package would also establish the Rural and Underserved Pathway to Practice Program, which would provide 1,000 scholarships annually to students from underrepresented groups to attend post-baccalaureate programs and medical school, starting in fiscal year 2023.

And while not directly addressed by Congress, there has been plenty of action around implementation of the No Surprises Act. Most recently, there was a complaint filed in the U.S. District Court for the District of Columbia – by the American Medical Association and the American Hospital Association – for declaratory and injunctive relief against HHS for violating their statutory authority under the Administrative Procedures Act in implementation of the No Surprises Act. For a full explanation of this issue, I recommend you read this article by Dr. Heidi Hullinger in the NASS Insider.

The political action committee of NASS, SpinePAC, also had a really stellar year given the continued financial burden that has been the COVID-19 pandemic. As of this article, SpinePAC has raised nearly $110,000 for 2021 and has contributed to the campaigns of 27 different Members of Congress. This sort of political advocacy is instrumental to achieving our advocacy goals as it provides for opportunities to meet with Members of Congress outside the distractions of Capitol Hill and explain the effects that issues like the MPFS and surprise medical billing has on our practices and patients. While the dollars raised are great numbers, it is still shy of our goal of $150,000.00 for the year. If you need more information on SpinePAC, I urge that you going to

NASS members have also been active this year in utilizing our grassroots system to communicate directly with their Members of Congress. In our most recent campaign urging Congress to address the cuts to the MPFS, NASS members sent direct email and social media communications to more than one-quarter of all Congressional offices, and out of the 14 U.S. Senators that voted for the bill protecting us from the MPFS cuts, nine heard from NASS members through our grassroots campaign. If you would like to participate in any of our grassroots campaigns, you can visit our Legislative Action Center by clicking here, and for more information on why you should be involved in grassroots advocacy please read this article by Dr. Brian Gantwerker.

NASS will continue to build off of the success we saw in 2021 next year, and continue to strongly advocate on behalf of all spine specialists. If you would like more information on our legislative priorities or the Advocacy program, please reach out to our advocacy staff at

Philip L. Schneider, MD
Chair, NASS Advocacy Council