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ACS Response to Major Categories of Concerns
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In October 2008, ACS advocacy staff and their colleagues from other physician organizations, met with staff to Rep. Nydia Velázquez (D-NY), Chairwoman of the House Small Business Committee. Topics discussed during the meeting included surgical workforce issues and concerns about the Centers for Medicare and Medicaid Service's (CMS) proposal to transition to International Classification of Diseases (ICD)-10 code sets.
On October 21, the ACS submitted comments to the US Department of Health & Human Services (HHS) in response to proposed rules for the implementation of ICD-10 code sets and Health Insurance Portability and Accountability Act (HIPAA) 5010. The letter supported the HHS decision to move toward use of ICD-10, but expressed deep concern about the proposed timeframe for initiation.
ACS regulatory staff drafted comments on the final 2009 physician fee schedule rule, which the CMS released October 30. Under the final rule, the conversion factor for 2009 was $36.067. The final rule also changed Medicare enrollment retrospective billing policies and encompasses other payment-related issues.
On October 30, CMS released the 2009 Medicare outpatient prospective payment system (OPPS) final rule. Under the final rule, hospitals' average payments per service increased about 3.9 percent, including a market-basket update of 3.6 percent, and the OPPS conversion factor for 2009 was $66.059. ACS submitted comments to the proposed rule that served as the basis for the final regulation. To view the College's comments, go to: http://www.facs.org/ahp/views/ambulatory-2009-opps-asc.pdf.
On November 20, Frank Opelka, MD, FACS, Chair of the College's Patient Safety and Quality Improvement Committee, and ACS advocacy staff met with aides to Sen. Chuck Grassley (R-IA) to discuss means of reducing waste, fraud, and abuse within the Medicare program.
On January 5, the American College of Surgeons and 67 other physician organizations sent a letter to the Medicare Payment Advisory Commission (MedPAC) supporting a 2.4 percent increase in Medicare payments and opposing MedPAC's draft recommendation that physician reimbursement be adjusted based on productivity. Under the proposal, physicians would receive only a 1.1 percent payment increase because estimated growth in productivity (1.3 percent) would be subtracted from expected growth in price outputs (2.4 percent).
During MedPAC's January 8 meeting, several commissioners--including Karen Borman, MD, FACS--voiced concern about the inclusion of the productivity adjustment, especially in light of the fact that it did not apply to other providers, such as hospitals. Subsequently, MedPAC modified its recommendation by removing any mention of price inputs or productivity and unanimously approved a 1.1 percent increase in Medicare payments in 2010. Dr. Borman also objected to MedPAC's recommendation calling for increased payments to primary care that would be financed through cuts in payments for other services, including major operations.
On January 6, the College and 14 surgical specialty organizations released Surgery's United Agenda for Medicare Physician Payment Reform, which outlined the groups' support for separate conversion factors based on type of service and opposition to payment increases for primary care at the expense of reimbursement to other specialties. ACS advocacy staff and their colleagues at the surgical specialty societies met with key senators and their health policy assistants to discuss surgery's priorities on the payment front.
On January 14, ACS Executive Director Thomas R. Russell, MD, FACS, sent a letter to Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Committee Member Sen. Grassley commenting on proposed legislation that would implement a value-based purchasing program for Medicare hospitals. The letter expressed the College's concern about language in the bill that would grant the Secretary of the US Department of Health and Human Services consider-able authority to establish measures, set performance standards, and determine bonus amounts. In addition, Dr. Russell voiced the College's concern about the provisions pertaining to public reporting.
On February 27, the College released a statement expressing support for steps that President Barack Obama has proposed to address Medicare's broken physician payment system. The president's budget plan called for stopping a 21.5 percent cut in Medicare payments in 2010. The proposal also addressed one of the most significant problems with using the sustainable growth rate to calculate Medicare payment by setting a new budget baseline in 2010. This measure would prevent Medicare payments from falling below current levels. Dr. Russell voiced the College's interest in working with the new Administration to reform the Medicare payment system.
On March 18, ACS Regent John T. Preskitt, MD, FACS, testified at a House Committee on Small Business hearing on President Obama's budget and the possible effect of its Medicare provisions on physicians in small group practices. Dr. Preskitt's testimony praised the budget plan for taking steps to reform the Medicare physician payment system by establishing a new baseline for reimbursement. Dr. Preskitt also described how the ACS National Surgical Quality Improvement Program could be a useful model for carrying out the budget's proposed expansion of quality improvement efforts. Nonetheless, he expressed the ACS's concerns about the president's proposal to limit physician ownership and investment in specialty hospitals. Dr. Preskitt's testimony is available at: http://www.facs.org/ahp/testimony/preskitt031809.pdf.
The ACS asked that Fellows contact their members of Congress and urge them to join Reps. Shelley Berkley (D-NV) and Mark Kirk (R-IL) in sending a letter to House Speaker Nancy Pelosi (D-CA) and Republican Leader John Boehner (R-OH) . The letter urged the House leadership to take the following actions: stop the pending 21.5 percent cut in 2010 Medicare payments, enact long-term payment reforms, and oppose measures that would finance increased payments to some physicians through cuts to others. Fellows contacted their representatives through the College's Legislative Action Center at: http://www.capitolconnect.com/acspa/alert_detail.aspx?AlertID=121.
On May 8, the Government Accountability Office announced the reappointment of Karen Borman, MD, FACS, and Ronald Castellanos, MD, FACS, to the Medicare Payment Advisory Commission (MedPAC). Earlier in the year, ACS Executive Director Thomas R. Russell, MD, FACS, sent letters to Gene Dodaro, Acting Comptroller General of the United States expressing the College's support of reappointment of Drs. Borman and Castellanos—the only surgeons in active practice who serve on the panel.
ACS regulatory staff reviewed the 2010 Medicare physician fee schedule proposed rule, which the Centers for Medicare & Medicaid Services (CMS) released July 1. Among many other provisions, the proposed rule calls for a 21.5 percent decrease in physician reimbursement. This reduction is attributable to CMS's use of the sustainable growth rate (SGR) to calculate payment updates. The College's advocacy staff is working with Members of Congress to ensure the enactment of long-term fixes to the problems created by the SGR. Other provisions in the proposal would have a more positive effect on physician payment. To access the proposed rule, go to: http://edocket.access.gpo.gov/2009/pdf/E9-15835.pdf.
The ACS submitted comments on the Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year (FY) 2010. CMS estimates that if all of the changes in the proposed rule are implemented, total payments to all hospitals will decrease by $979 million, or an average of 0.8 percent, in FY 2010. This represents a historically low payment update. In addition, CMS proposes to add four additional quality reporting measures. CMS has not proposed to add or remove any additional categories to the list of 10 hospital-acquired conditions in effect in FY 2009. To view a copy of the comment letter, go to: http://www.facs.org/ahp/views/hit.html.
ACS regulatory staff submitted comments to the office of the National Coordinator for Health Information Technology regarding the definition of "meaningful use" of electronic health records (EHR), which physicians must meet to ensure receipt of financial incentives specified in the stimulus bill. The American Recovery and Reinvestment Act (ARRA) authorizes CMS to provide financial incentives for Medicare-participating physicians who meaningfully use certified EHR starting in 2011. The College's comments addressed the meaning of "certified" EHR and the specific measures for determining meaningful use. Medicare physicians who do not demonstrate that they are meaningful users of EHRs by 2015 will face reductions, starting at 1 percent, in payment. To view the comment letter, go to: http://www.facs.org/ahp/views/ipps.html.
Professional Liability/Malpractice/Tort Reform and Risk Management/Patient Safety
On September 2, the College released a statement regarding medical liability reform. The American College of Surgeons applauded Democrats for recognizing the need for Congress to address medical liability reform as part of the overall health care reform bill. The statement can be viewed at: http://www.facs.org/news/acsdemsupport.html.
In October 2008, the ACS issued a Statement on Health Care Reform, which outlined three interrelated goals for health care: quality and safety, access/workforce, and reduction of health care costs. The ACS Health Policy Steering Committee drafted the statement, which was approved during a joint meeting of the ACS Board of Governors and the ACS Board of Regents at the Clinical Congress. Read it online at: http://www.facs.org/ahp/hcreform08.pdf.
The ACS hosted a health policy summit with 13 surgical specialty societies in Washington, DC, on October 22 to discuss how the organizations could work together on health care reform and Medicare issues in the year ahead. Elizabeth Fowler, PhD, JD, Senior Counsel to Sen. Baucus spoke at the meeting and provided the legislative outlook for 2009.
On November 21, ACS advocacy staff met with advisors to Sen. Baucus to discuss the College's Statement on Health Care Reform, as well as a white paper that the Senator had released. Staff expressed the College's desire to work with the chairman on health care reform legislation, as well as the organization's support of a new Medicare reimbursement structure based on type of service and opposition to proposals that would increase payments for primary care services by decreasing payments for surgical care.
On December 5, ACS advocacy staff and their colleagues at other surgical societies delivered a letter to Sen. Baucus's health policy advisors reiterating the organizations' opposition to proposals that would increase payments for primary care services at surgery's expense.
Throughout November and December, ACS staff shared the College's Statement on Health Reform with health advisors to many members of Congress. During these discussions, staff expressed the College's desire to work with policymakers to enact responsible health reform legislation, which addresses surgical workforce shortages and Medicare payment concerns. In addition to meeting with Finance Committee staff and staff of the House Ways and Means Committee, ACS lobbyists visited the offices of numerous legislators.
ACS advocacy staff and their associates at other physician organizations engaged in ongoing meetings with health policy advisors to Rep. Velázquez. These discussions centered on surgical workforce issues, health information technology, and other health policy issues.
ACS lobbyists continued to meet with congressional health policy aides to promote the College's Statement on Health Reform and to express this organization's desire to work with lawmakers to enact responsible health reform legislation. During these meetings, ACS staff encouraged health policy assistants to encourage their legislators to address surgical workforce shortages and to enact responsible Medicare payment reforms.
On Friday, February 13, Dr. Russell sent a letter to House Speaker Nancy Pelosi (D-CA) and Senate Majority Leader Harry Reid (D-NV) commenting on the American Recovery and Reinvestment Act of 2009 (H.R .1). The "economic stimulus" bill passed in both chambers of Congress on February 13 with a vote of 246-183 in the House and with a vote of 60-38 in the Senate. The legislation, costing $787 billion to implement, contains a number of key provisions pertaining to health care.
Consistent with the ACS Statement on Health System Reform, H.R. 1 takes appropriate steps to ensure that Americans can retain their health insurance coverage if their employment status changes. In addition, the College applauds the inclusion of $10 billion for research conducted at the National Institutes of Health.
The bill also would establish a Federal Coordinating Council for Comparative Effectiveness Research (CER). The legislation allocates a total of $1.1 billion for CER, of which $400 million is to be used at the discretion of the US Secretary of the Department of Health and Human Services (HHS) to "accelerate the development and dissemination of CER.." CER includes: (1) comparative analysis of items, services, and procedures used to prevent, diagnose, and treat patients; and (2) the work conducted through clinical registries, clinical data networks, and other electronic means for purposes of generating outcomes data. The College weighed in on the use of language stating that the board would not "mandate coverage, reimbursement, or other policies for any public or private payer." The College maintained that clinical research holds promise for improving the quality and safety of health care delivery. However, the comment letter expressed the College's dismay that the legislation does not use the term "clinical" comparative effectiveness research specifically, to clarify that the council would assess the overall value of services—not just their cost.
H.R. 1 also would invest $20 billion in health information technology (HIT) infrastructure. The ACS supports the financing provided upfront for infrastructure, including provisions pertaining to the expansion of existing clinical registries and quality improvement tools. The comment letter notes that the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) serves as an important quality improvement database for more than 200 US hospitals. The correspondence expressed the ACS's hope that the Secretary of HHS will consider ACS NSQIP when assessing programs in which to invest the monies.
Also under the legislation, providers would be eligible for Medicare and Medicare bonus payments of $40,000 to $65,000 through 2016 if they switch to electronic health records and report quality measures, whereas payments would be reduced for providers who do not make the change by 2015. Additionally, the legislation provides funds to states for low-interest loans to help providers pay for HIT. The ACS applauds the inclusion of bonus payments to facilitate the adoption of HIT. However, the organization has some concerns about directly tying these funds to participation in a quality improvement program because adoption of interoperable HIT may precede an individual physician's ability to participate in such a reporting system. The College also expressed concern about the aggressive timeline of implementation and the penalties for non-adoption of HIT.
In the areas of privacy and security, the legislation would allow patients to request an audit trail showing all non-oral disclosures of their health information done through an electronic record. It would require that providers obtain authorization from a patient in order to use their health
information for marketing and fundraising purposes. The College expressed concern about the new administrative burdens that may be associated with these requirements.
On February 26, President Obama released his Fiscal Year 2010 Budget proposal, which called for making a $634 billion "down payment" on efforts to expand access to care, to improve health care quality, and to reduce the growth of health care spending. The College's statement on the plan noted the organization's commitment to improving patient outcomes and highlighted the successful efforts of the Commission on Cancer as a model for systems that would measure performance and generate standards of care.
At the invitation of Sen. Baucus, the College joined four other physician organizations and several other stakeholders in a March 5 meeting with committee staff to discuss the timeline and substance of comprehensive health care reform legislation. The College and other stakeholders were asked to provide regular input on the Finance Committee's efforts to develop legislation, and Chairman Baucus planned to meet with this group on a regular basis.
On March 6, the College and 30 other stakeholder organizations sent a letter to the Senate and House Budget Committees expressing support for including in the budget resolution the resources needed to enact comprehensive health reform legislation. The groups also requested that the committees consider the long-term savings that such reforms could achieve.
ACS lobbyists continued to meet with congressional health policy aides to promote the College's Statement on Health Care Reform. During these meetings, ACS staff encouraged health policy assistants to ask their legislators to address surgical workforce shortages and to enact responsible Medicare payment reforms.
On March 12, the College participated in a stakeholder meeting with the Senate Health, Labor, Education, and Pensions (HELP) Committee staff to discuss Chairman Edward Kennedy's (D-MA) plans for comprehensive health care reform. The College was asked to participate in monthly conference calls to address the various provisions that are likely to be included in the HELP Committee legislation.
The ACS submitted testimony for an April 1 House Ways and Means Committee hearing on reforming the health care delivery system. The College's testimony provided information on its system-based approach to quality improvement. Witnesses at the hearing discussed private models that had been successful in improving the quality of patient care and in containing costs. The College's statement can be accessed at: http://www.facs.org/ahp/testimony/testimony040109.pdf.
On March 24, the House Energy and Commerce Subcommittee on Health held the third in a series of hearings titled "Making Health Care Work for American Families: Improving Access to Care." James Bean, MD, FACS, President of the American Association of Neurological Surgeons, testified at this hearing. Dr. Bean's testimony stressed the relevance of medical liability reform as a key element of any effort to reform the nation's health care delivery system.
Frank Opelka, MD, FACS, Chair of the ACS Patient Safety and Quality Improvement Committee, represented the College at an April 21 Senate Finance Committee roundtable discussion on "Reforming America's Health Care Delivery System." The College and the American College of Physicians were the only two physician organizations among the 12 panelists included in the roundtable discussion. Dr. Opelka's testimony highlighted the numerous successful efforts the College has undertaken to improve the quality of surgical care, advocated for system reforms based on sound clinical data, discussed the ACS proposal for Medicare payment reform, and cautioned against actions that could worsen workforce shortages by cutting surgical payments to finance other initiatives. http://www.facs.org/ahp/testimony/opelka042109.pdf
On April 28, the Senate Finance Committee released a document titled, "Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs," which was a follow-up to the April 21 roundtable. The white paper laid out various policy options, including a proposed 5 percent bonus for certain services provided by general surgeons in underserved rural areas. Later that day, ACS advocacy staff was part of a select group of organizations included in a roundtable discussion with House Small Business Committee Chairwoman Nydia Rep.Velazquez (D-NY) and Democratic members of the committee. The discussion examined the health care challenges facing small businesses, including small surgical practices, in the current environment.
On May 14, the College and 19 other surgical organizations submitted comments on the policy initiatives proposed in "Transforming the Health Care Delivery System." ACS advocacy staff spearheaded the surgical community's 20-page response, which addresses the full range of proposals outlined in the document. In its comments, the surgical community expressed support for a transitional payment reform system that would replace the current structure with one based on type of service and opposition to proposals that would finance increased payments for some physician services through reduced payments for others, including surgical care. A copy of this letter is available at: http://www.facs.org/ahp/surgfinance051509.pdf.
ACS advocacy staff and their colleagues from more than 20 physician organizations met with House Ways and Means Chairman Charlie Rangel (D-NY) and Health Subcommittee Chairman Pete Stark (D-CA) to discuss the physician community's shared issues and priorities with respect to health system reform.
On May 21, ACS advocacy staff and their colleagues at other surgical specialty organizations met with advisors to Senate Finance Committee Chairman Baucus to discuss the surgical community's comments on another committee report, "Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs." At the meeting, ACS staff discussed the surgical community's proposal to replace the current Medicare payment system with a structure based on type of service, including a category for major surgical procedures. ACS advocacy staff also emphasized the importance of including Medicare payment reform in health care reform legislation.
The ACS was included in a select group of stakeholder organizations that participated in a separate meeting with aides to Senator Baucus on May 21 to discuss the process for achieving health care reform legislation in the coming months.
On May 28, the ACS and five other leading physician organizations participated in a meeting with health advisors to the House Committees on Ways and Means, Energy and Commerce, and Education and Labor to discuss Medicare payment and health care reform legislation. Again, ACS staff stressed the importance of including long-term solutions to the troubled Medicare physician payment system in health reform legislation.
On May 29, a coalition of 21 surgical organizations, including the ACS, commented on the Senate Finance Committee's proposals outlined in "Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans" and "Financing Comprehensive Health Care Reform: Proposed Health Savings and Revenue Options." The group's remarks were sent to Senate Finance Committee Chairman Baucus. The letter expressed the surgical community's concerns regarding a variety of issues, including opposition to the development of a government-based insurance plan that would be modeled on Medicare's payment structure and that would require Medicare participating physicians to also accept patients covered under this plan. The group also asserted that comprehensive Medicare payment reform is essential to the success of health care reform efforts.
The ACS was among select a group of organizations included in a May 29 roundtable discussion with House Small Business Committee Chairwoman Nydia Velazquez (D-NY) and other Democratic committee members. The discussion centered on health care challenges for small businesses and small physician practices in the current environment. Issues raised included workforce shortages and the obstacles to implementing health information technology systems.
In May and June, ACS advocacy staff met with aides to Senators to discuss health care reform legislation and the College's proposal for Medicare physician payment reform. ACS advocacy staff and their colleagues at several other stakeholder organizations participated in a June 18 briefing with advisors to the House Ways and Means and Energy and Commerce Committees to discuss Medicare physician payment and health care reform legislation. The following day, the House Ways and Means, Energy and Commerce Committee, and Education and Labor Committee, the three House Committees with jurisdiction for health reform legislation, released a draft of their health care reform proposal. This document, referred to as the "House Tri-Committee Draft," served as the basis for "America's Affordable Health Choices Act of 2009" (H.R. 3200), which the Ways and Means and the Education and Labor Committees approved on July 17.
On July 1, ACS advocacy staff met with aides to the House Ways and Means and Energy and Commerce Committee to discuss surgery's views on the Medicare payment provisions and other aspects of the legislative draft. The meeting provided an opportunity for staff to share and discuss a June 30 letter submitted by the American College of Surgeons and 20 other surgical organizations to the three House committees that share jurisdiction over this legislation. The comment letter on the "House Tri-Committee Draft" can be accessed at: http://www.facs.org/hcr/index.html.
George F. Sheldon, MD, FACS, Director of the ACS Health Policy Research Institute, testified on behalf of the ACS at a July 8 House Committee on Small Business hearing. The focus of the hearing was on the looming physician workforce shortage and how health care reforms could address the problem. Dr. Sheldon's testimony is available at: http://www.facs.org/ahp/testimony/sheldontestimony0709.pdf. Another ACS Fellow, Robert E. Harbaugh, MD, FACS, testified on behalf of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.
On July 15, the Senate Health, Education, Labor, and Pensions (HELP) Committee approved The Affordable Health Choice Act, a health system reform bill designed to improve access to affordable, high-quality care. Importantly, the bill includes provisions intended to strengthen and improve trauma and emergency care services, which ACS advocacy staff and their colleagues at other stakeholder groups promoted.
In July, advocacy staff met with aides to Sen. Debbie Stabenow (D-MI) to discuss Senate health reform legislation and the importance of including Medicare payment reforms in the bill. ACS advocacy staff also met with staff to Representatives to discuss health reform legislation and the College's priorities and concerns.
On July 21, the ACS and 15 other surgical organizations sent a letter to House Speaker Nancy Pelosi opposing proposals that would divest Congress of its authority over Medicare payment policy decisions and would place these important health care decisions in the hands of an unelected, unaccountable board. Such proposals include the “Independent Medicare Advisory Council (IMAC) Act of 2009”, which had been proposed by the Obama Administration, and the “Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009” (H.R. 2718, S. 1110, S. 1380).
Members of the ACS leadership met with Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, on July 27 to brief her on a broad range of health care issues. Topics discussed during the meeting, which took place at the Secretary's request, included the ACS Statement on Health Care Reform, the College's quality and outcomes initiatives, the organization’s support of clinical comparative effectiveness research, and the nationwide surgical workforce crisis.
ACS advocacy staff met personally with advisors to Finance Committee Chairman Baucus on July 29 to discuss health care reform legislation and the College’s support for measures to stop scheduled cuts in Medicare physician payments through full-scale reform of the reimbursement system.
On July 31, Rep. Richard Neal (D-MA) led a coalition of 45 Democrats and 30 Republicans in sending a letter to House Speaker Pelosi opposing proposals calling for the establishment of the an unelected panel that would be responsible for making Medicare payment policy decisions. The College supported this effort and asked other Representatives to sign the letter.
ACS advocacy staff met with Senate health policy advisors to discuss the surgical community’s opposition to proposals that would divest Congress of its authority over Medicare payment policy and place this authority in an executive branch agency or commission. In some cases, staff from other surgical organizations joined the College at these meetings.
In August, ACS staff met with staff to Rep. Allyson Schwartz (D-PA) to discuss health care reform legislation and the College’s concerns regarding proposals to create a Medicare payment commission and to change how work is valued under the Medicare physician fee schedule through the use of a value index.
On March 12, the Senate Committee on Finance held a hearing on "Workforce Issues in Health Care Reform: Assessing the Present and Preparing for the Future." The College submitted testimony that discusses the emerging surgical workforce crisis and its implications for patient access to surgical care. The College also offered several recommendations for addressing workforce shortfalls and warned Congress about the potentially negative effects of proposals that would finance increased reimbursement for primary care through reduced payments for other physician services, including surgical care.
http://www.facs.org/ahp/testimony/workforce031209.pdf.
Some witnesses at the House Ways and Means Committee hearing on health care reform discussed the possible effects of a shortage of primary care physicians. Rep. Shelley Berkley (D-NV) conveyed her concerns about shortages in all specialties, and Rep. Charles Boustany, MD, FACS (R-LA) pointed out that specialties other than primary care, including general surgery and cardiothoracic surgery, also are experiencing shortages.
On March 2, ACS Executive Director Thomas R. Russell, MD, FACS, sent a letter to Reps. Michael C. Burgess, MD (R-TX), and Gene Green (D-TX) expressing the College's support for The Physician Workforce and Graduate Medical Education Enhancement Act of 2009, HR 914. The letter can be viewed at: http://www.facs.org/ahp/hr914.pdf.
On March 4, the House Energy and Commerce Committee approved the bill, which Representatives Burgess and Green cosponsored. The College maintains that this measure will be useful in improving the nation's ability to meet future surgical workforce needs because it provides appropriate incentives to stimulate the creation of new general surgery training programs in geographic areas that have an inadequate supply of surgeons.
Pay-for-Performance/Competency Measurement for the Practicing Surgeon
ACS Regent H. Randolph Bailey, MD, FACS, and regulatory staff represented the College at a CMS-sponsored "listening session" on value-based purchasing for physicians' services. The ACS made public comments at this meeting and submitted a letter on CMS's value-based purchasing initiative.
On November 17, ACS staff attended a meeting during which the National Priorities Partnership, convened by the National Quality Forum, introduced a set of national priorities and goals that will drive future efforts in strategic planning and quality measurement. The six cross-cutting priority areas included patient and family engagement, population health, safety, care coordination, palliative and end-of-life care, and overuse.
On November 21, the Department of Health and Human Services published a final rule pertaining to the implementation of the Patient Safety and Quality Improvement Act of 2005. The final regulation is generally consistent with the February 12 proposed rule, on which the College commented.
ACS regulatory staff attended a December 18 CMS meeting on nonpayment for hospital-acquired conditions in both inpatient and outpatient settings.
More than 45 representatives of 23 surgical societies participated in the June 29 meeting of the ACS-initiated Surgical Quality Alliance (SQA), which took place in Washington, DC. A variety of topics were discussed during the program, including: the activities of the National Quality Forum, National Priorities Partnership, and AQA; cross-cutting measures; comparative effectiveness research; quality provisions in pending health care reform legislation; the develop-ment of a surgical patient experience of care survey; and continuing efforts to create a surgery and anesthesiology data registry.
The American College of Surgeons and 39 other organizations that want to ensure that all children have access to high-quality emergency care wrote a letter to Rep. Jim Matheson (D-UT), the primary sponsor of HR 479, which reauthorizes "The Wakefield Act." HR 479 provides five additional years of funding for the Emergency Medical Services for Children (EMSC) program. On March 4, the House Energy and Commerce Committee approved the bill.
On March 30, ACS Executive Director Thomas R. Russell, MD, FACS, sent a letter to Rep. Mary Bono Mack (R-CA), applauding her leadership in introducing the Mitigating the Impact of Uncompensated Service and Time Act of 2009, HR 1678. This legislation would provide physicians with a tax deduction for uncompensated care that is equal to the amount of the Medicare fee schedule payment. It is designed to alleviate the burden of providing unpaid services in our nation's emergency departments and to encourage surgical specialists to take emergency call.
Also on March 30, the House of Representatives passed the "Wakefield Act," HR 479, with an overwhelming vote of 390 to 6. The College supported the legislation, which authorizes $25 million for the Emergency Medical Services for Children program for fiscal year (FY) 2010 and a 5 percent increase on that amount each year through FY 2014.
In April, ACS advocacy staff and their colleagues at organizations that are concerned about trauma and emergency care, met with Mike Handrigan, MD, Acting Director of the Emergency Care Coordination Center (ECCC), and David Marcozzi, MD, from the White House. The purpose of the meeting was to learn more about the ECCC and the Obama Administration's budget plans for regionalizing emergency care. Under the President's proposed budget, the ECCC also will be involved setting national standards for emergency care performance measurement.
For fiscal year (FY) 2010, the ACS requested that funding for the Health Resources and Services Administration's Trauma and Emergency Medical Services (EMS) program be set at $12 million due to the lack of funding for FYs 2006, 2007, 2008, and 2009. In an effort to ensure passage of the necessary legislation, the ACS and trauma coalition colleagues sent a funding request letter to the House and Senate appropriators.
The ACS worked closely with Reps, Gene Green (D-TX) and Michael Burgess (R-TX) and Sens. Jack Reed (D-RI) and Pat Roberts (R-KS) to send sign-on letters in the U.S. House and Senate, requesting $12 million in funding for the Trauma-EMS program for FY 2010.
The ACS has worked closely with advisors to Rep. Mary Bono-Mack (R-CA) to ensure reintroduction of the Mitigating the Impact of Uncompensated Service and Time Act, H.R. 1678. This legislation would provide physicians a deduction equal to the amount of the Medicare fee schedule payment to help alleviate the financial burden associated with providing uncompensated care mandated by the Emergency Medical Treatment and Labor Act (EMTALA).
Likewise, the College successfully sought reintroduction of H.R. 1188/S.468, The Access to Emergency Medical Services Act, introduced by Rep. Bart Gordon (D-TN) and Sen. Debbie Stabenow (D-MI). This legislation would provide a 10 percent added bonus payment through Medicare to all physicians who provide EMTALA-related care to Medicare beneficiaries, including on-call specialists whose services are needed to stabilize the patient.
The College worked closely with Reps. Bart Gordon (D-TN) and Charlie Dent (R-PA) to ensure that the Health Care Safety Net Enhancement Act, H.R. 1998, would be introduced in Congress. This legislation, which was introduced on April 21, would provide liability protections under the Federal Tort Claims Act for physicians providing EMTALA-related care. ACS worked closely with Representative Gordon and Representative Dent to draft and ensure introduction of this important legislation.
Revised December 1, 2009