ACS Response to Major Categories of Concerns
2010 Board of Governors Survey
Timothy C. Flynn, MD, FACS
October 23, 2011
2010 Board of Governors Survey Response Slides (10K PDF)
This report summarizes American College of Surgeons activities over the past year in response to the top major concerns expressed in the 2010 survey of the Board of Governors.
On December 3, the ACS and 16 surgical specialty societies provided feedback to the Centers for Medicare & Medicaid (CMS) on the accountable care organizations and the Medicare shared savings program established under the Affordable Care Act (ACA) of 2010. The comments stress that a new delivery system must focus on promoting quality care and improving patient access and, ultimately, provide cost-effective care.
The Surgical Quality Alliance (SQA) sent comments to the CMS regarding the Physician Compare website mentioned in the ACA as well as the Medicare e-prescribing penalty program described in the Medicare physician fee schedule final rule.
ACS congressional affairs staff participated in the Brooklyn and Long Island Chapter’s and the Nassau Surgical Society’s Annual Clinic Day, which took place in Uniondale, NY, on December 8. The ACS staff presentation focused on how health care reform legislation may affect surgeons and their patients.
In December and January, ACS staff met with advisors to Rep. Sam Johnson (R-TX) and Rep. Dean Heller (R-NV), both of whom are members of the House Ways and Means Subcommittee on Health. The meetings included a discussion of the College’s legislative priorities for the coming year, such as long-term, meaningful Medicare physician payment reform and issues related to the implementation of the Affordable Care Act.
In January, ACS staff met with staff to Sen. Pat Roberts (R-KS) to discuss priorities to improve the delivery of trauma and emergency surgical care. Senator Roberts serves on the Senate Committee on Finance and the Committee on Health, Education, Labor, and Pensions (HELP).
ACS staff participated in a March 4 symposium at Danbury (CT) Hospital titled “Advances in Surgical and Management of Cardiac and Vascular Diseases.” College staff presented an update on federal health policy developments and the outlook for the coming year, as well as the potential impact of current federal policies on the delivery of care.
In early April, ACS staff met with health policy staff to Rep. Patrick Tiberi (R-OH) to discuss the congressman’s legislative priorities for the coming year, including his support for legislation to provide coverage for children needing reconstructive surgery.
In late March, ACS advocacy staff met with an advisor to Rep. Aaron Schock (R-IL) to express concerns regarding efforts to limit physicians’ ability to provide imaging and radiation services in their offices.
On May 2, the ACS sent a letter to Rep. Thomas E. Price, MD, FACS (R-GA), expressing the College’s support for the Medical Practice Freedom Act of 2011 (H.R. 969). This bill would prohibit the Secretary of the U.S. Department of Health and Human Services or any state from requiring that a physician or other health care provider participate in any health plan as a condition of licensure. A copy of the letter is available at http://www.facs.org/ahp/price-hr969-support.pdf.
On May 13 and 14, ACS congressional affairs staff participated in the annual meeting of the Northern California Chapter of the ACS in San Francisco, CA, and provided an update on federal legislative issues and the advocacy efforts of the College in Washington, DC. Staff also participated in a panel discussion regarding health policy and advocacy with Thomas Russell, MD, FACS, Immediate Past Executive Director of the ACS, and James Hinsdale, MD, FACS, president of the California Medical Association.
In April, ACS staff and representatives from other physician organizations met with key policy staff to Senator Orrin Hatch (R-UT), Ranking Member on the Senate Committee on Finance to discuss concerns about proposals that could potentially limit the ability of physicians to provide imaging and other services within their offices.
In May, ACS staff and colleagues from other physician organizations met with health policy staff to Rep. Earl Blumenauer (D-OR) to express concerns about proposals that could potentially limit the ability of physicians to provide imaging and other services in their offices.
In June, ACS staff met with a health policy advisor to Sen. John Thune (R-SD), Chair of the Senate Republican Policy Committee, to discuss several issues of interest to the ACS. Topics discussed included the success of the College’s quality improvement programs, such as the ACS NSQIP, in improving surgical outcomes and potential applications in the development of Medicare payment reform and alternative payment systems.
In May and June, ACS advocacy staff met with advisors to several members of Congress to discuss the College’s positions on several issues. Discussions focused on such topics as the outlook for Medicare physician payment reform legislation, medical liability reform, and the success of ACS quality improvement programs, including the ACS NSQIP.
In June, ACS advocacy staff met with health policy advisors to key members of the House Committee on Small Business to discuss the committee’s agenda as it considers the challenges facing small medical and surgical practices. Topics discussed included health information technology, electronic prescribing, and recent proposed regulations to provide for the creation of accountable care organizations (ACOs) under the Medicare Shared Savings Program in the Affordable Care Act.
The ACS drafted and submitted three comment letters on the proposed rules pertaining to the development of ACOs. These letters are as follows:
- Comments addressing a number of issues in the CMS’ proposed rule on ACOs, including the following: the importance of specialists to the success of the ACO model, the need to take specialists into consideration when assigning patients to ACOs, the value of prospective rather than retrospective attribution of patients to ACOs, the necessity of providing patients with adequate information regarding the ACO program, and the use of appropriate quality measures. View the letter (225K PDF).
- Suggestions regarding the need for the CMS and the Office of the Inspector General to develop possible Medicare fraud and abuse waivers in connection with ACOs to ensure that these laws do not unduly impede the development of beneficial ACOs. The comment letter suggests ways that the waivers could be used to encourage surgeon participation. View the letter (190K PDF).
- A total of 15 other specialty societies signed on to an ACS-drafted letter submitted to the CMS that addresses an important graduate medical education issue raised in the CMS ACO proposed rule. The CMS’s proposed method of calculating ACOs’ shared savings could provide ACOs with a strong incentive to realize savings by avoiding referrals to teaching hospitals that receive indirect medical education payments. The comment letter expressed strong concern regarding this proposal. View the letter (15K PDF).
ACS advocacy staff met with health policy advisors to several senators in July to discuss the need for Medicare payment reform. Other health policy issues, including medical liability and quality of care, also were discussed. With regard to medical liability reform, ACS staff expressed support for the Health Care Safety Net Enhancement Act of 2011 (H.R. 157), which should help address the liability challenges faced by those surgeons and providers caring for patients in emergency situations. In addition, ACS staff discussed the role that the College’s successful quality improvement initiatives, such as the ACS NSQIP and the Commission on Cancer, might play in improving outcomes and reducing rising health care costs.
In July, ACS advocacy staff and colleagues from other physician organizations met with a health policy advisor to Rep. Mike Thompson (D-CA), a member of the Ways and Means Committee’s Health Subcommittee. The discussion focused on policy proposals that the medical and surgical communities maintain could undermine patient access to imaging services and could impede the ability of physicians to provide imaging services to their patients.
In October, ACS advocacy staff met with a key health policy advisor to Senate Finance Committee Chairman Max Baucus (D-MT) to discuss the implementation of 10 percent bonus payments to general surgeons who provide services to Medicare patients in health professional shortage areas. The bonus payments are provided for under the Patient Protection and Affordable Care Act. ACS staff discussed how to best ensure that the bonus payments are delivered to those general surgeons who provide care to patients in areas that have a demonstrable shortage of surgeons.
The ACS and more than 30 surgical societies signed on to a letter encouraging Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, to institute a national testing period in 2011 for Version 5010 of the Health Insurance Portability and Accountability Act (HIPPA) electronic transactions. The societies are concerned that without this designated testing period many HIPAA-covered entities will be unprepared to conduct Version 5010 transactions by the January 1, 2012, compliance deadline, which will result in significant disruptions to claims processing and payments. To view the full sign-on letter, go to http://www.facs.org/ahp/hipaa-sebeliu.pdf.
On November 10, the ACS and 18 surgical specialty societies sent a letter to Donald M. Berwick, MD, Centers for Medicare & Medicaid Services Administrator, expressing concern regarding the upcoming deadline for physicians to modify their Medicare participation status. The letter (55K PDF) requests that the deadline be extended from December 31 until a time when Congress and the Administration are able to settle on a physician payment update for the entirety of 2011. To view Medicare participation status information, go to http://www.facs.org/ahp/medicareoptions2011.html.
ACS congressional and regulatory affairs staff attended the recent meeting of the Medicare Payment Advisory Commission. Major topics discussed included variation in private-sector payment rates, Medicare’s role in motivating and supporting quality improvement, and findings from rural site visits.
ACS staff attended the most recent meeting of the Medicare Payment Advisory Commission, which included discussion of assessing payment adequacy and the Medicare Advantage Program.
On July 19, the ACS and 16 other physician organizations issued a statement commending the Senate Bipartisan “Gang of 6” for recognizing that reform of the Medicare physician payment formula—specifically a full repeal of the sustainable growth rate (SGR) formula over the next 10 years—must be included in deficit reduction legislation. A copy of the statement is available at http://www.facs.org/ahp/gangofsix.pdf.
On June 27, the American College of Surgeons and 112 other national and state physician organizations sent a letter to President Obama, Vice-President Biden, and key congressional leaders expressing support for addressing the broken Medicare physician payment system in the context of debt ceiling legislation. Unless Congress intervenes, Medicare physician payments are scheduled to be cut 29.5 percent on January 1, 2012, because of the SGR formula that is used to calculate Medicare payments. Click here to view the letter (20K PDF).
ACS advocacy staff and their colleagues at other medical organizations met with key physician members of House of Representatives in June and July to discuss support for addressing Medicare payment issue in legislation designed to raise the nation’s debt ceiling. Meetings took place with Rep. Dan Benishek, MD, FACS (R-MI), and Rep. Paul Broun, MD (R-GA), and their health policy advisors.
In June, the ACS was among a select group of physician and health professional organizations invited to a meeting with key senators to discuss strategies for stopping the 29.5 percent cut in Medicare payments in 2012 and for developing an alternative to the SGR.
On June 20, the ACS submitted a comment letter to the CMS regarding the hospital inpatient prospective payment system. The comments addressed several topics, including three new Medicare severity diagnosis-related groups for excisional debridement of skin and subcutaneous tissue, and the CMS’s proposal to add a new condition—contrast-induced acute kidney injury—to the list of hospital-acquired conditions (HACs) subject to reduced payment if not documented as present on admission. Also discussed in the letter is the reclassification of thoracic aortic repair procedures and the changes to the hospital inpatient quality reporting program.
In July, ACS advocacy staff met with a health policy advisor to Rep. Dan Benishek, MD, FACS (R-MI), to discuss the College’s priorities with regard to congressional efforts to reform the Medicare physician payment system and repeal the SGR formula, which currently is used to calculate Medicare physician payments. At present, Medicare payments are scheduled to be cut 29.5 percent from current levels on January 1, 2012, largely because of the SGR.
On July 19, members of the ACS General Surgery Coding and Reimbursement Committee—John Gage, MD, FACS; Charles Mabry, MD, FACS; and Christopher Senkowski, MD, FACS—and ACS regulatory staff met with representatives of the CMS. The meeting centered on a discussion of suggested changes in the fourth five-year review of the resource-based relative value (RBRVS) scale proposed rule. During the meeting, ACS Fellows and staff questioned the CMS’ understanding of the categories for postoperative work and asked that the agency provide a clinical rationale for many of its planned changes. The AMA/Specialty Society RVS Update Committee (RUC) recommendations for the five-year review reflected a total of 292 services submitted to the CMS from April 2010 through February 2011. The CMS plans to accept two-thirds of the RUC recommendations.
On July 25, the ACS submitted comments on the CMS on the fourth five-year review proposed rule. To read the ACS comment letter, go to http://www.facs.org/ahp/5yearreview.pdf.
ACS leaders met with key advisors to Rep. Dave Camp (R-MI), Chair of the House Committee on Ways and Means, and to Sen. Max Baucus (D-MT), Chair of the Senate Committee on Finance, on August 31 to discuss the College’s support for repealing the sustainable growth formula, which is used to calculate Medicare physician payments. Surgeon participants in the meetings included David B. Hoyt, MD, FACS, ACS Executive Director; Don Detmer, MD, FACS, Medical Director, ACS Division of Advocacy and Health; Frank Opelka, MD, FACS, Assistant Medical Director, ACS Division of Advocacy and Health Policy; and ACS advocacy staff. Drs. Hoyt, Detmer, and Opelka discussed the College’s longstanding commitment to optimal care and how the organization’s quality improvement programs, such as the ACS NSQIP, the Commission on Cancer, and the Committee on Trauma, can help improve outcomes and lower costs.
On September 1, the College sent letters to the 12 members of the Joint Select Committee on Deficit Reduction, calling for the elimination of the SGR and highlighting the ACS’ proven quality programs, which may serve as models of how Congress can reduce costs, prevent complications, and improve quality. The “super committee” was created under the Budget Control Act (BCA) for purposes of cutting $1.2 trillion to $1.5 trillion in federal spending over the next 10 years. The committee has authority to consider spending cuts, taxes, and changes to discretionary and mandatory government programs, including Medicare, Medicaid, and other health care programs. For sample letters, go to http://www.facs.org/ahp/medicare/deficit-reduction-letter.pdf.
In early September, ACS staff met with advisors to a member of the House Ways and Means Committee—Rep. Jim Gerlach (R-PA)—and to two key members of the Senate Finance Committee—Sen. Jon Kyl (R-AZ) and Sen. Pat Roberts (R-KS)—to discuss efforts to reform the Medicare physician payment system and repeal the SGR. The meetings also included a discussion of the College’s quality improvement programs and their relevance to Medicare payment reform.
On September 1, Mark Savarise, MD, FACS, a general surgeon in Sandpoint, ID, and the Pend Oreille Surgery Center hosted Sen. Mike Crapo (R-ID), a senior member of the Senate Finance Committee, for a tour of their ambulatory surgery center (ASC). The meeting included a discussion of efforts to improve Medicare payments for care provided in ASCs. Senator Crapo is the lead Republican cosponsor of the Ambulatory Surgical Center Quality and Access Act of 2011 (S. 1173) in the Senate. The College supports this legislation, which has been introduced in the House as H.R. 2108.
On August 30, the ACS submitted comments to the CMS in response to the calendar year (CY) 2012 Medicare physician fee schedule proposed rule. The letter raises concerns about the CMS’ proposal to refer a list of 70 high-expenditure codes and a list of 91 evaluation and management codes to the American Medical Association Relative Value Scale Update Committee (AMA RUC) codes for review. The letter also discusses a rank order anomaly of the work relative value units for codes 47600 (cholecystectomy) and 47605 (cholecystectomy; with cholangiography). ACS comments also address the CMS’ proposed revisions to various quality reporting and incentive programs. In addition, the letter raises concerns related to the CMS’ proposal to apply a “three-day payment window” policy to payments when a physician furnishes services to a Medicare beneficiary in a hospital’s wholly owned or wholly operated physician practice and the beneficiary is subsequently admitted as an inpatient within three days. The comment letter is available at http://www.facs.org/ahp/medicare_pfs2012.pdf.
The ACS submitted a comment letter to the CMS in response to the fiscal year (FY) 2012 inpatient prospective payment system proposed rule. The letter raises concerns about the CMS’ proposal to include contrast-induced kidney injury as a hospital-acquired condition. The letter also expresses concern about a proposal to remove procedure code 86.22 (excisional debridement of wound, infection, or burn) from the list of codes considered to be operating room procedures. In addition, the letter addresses a number of issues pertaining to the Hospital Inpatient Quality Reporting Program. The comment letter is available at http://www.facs.org/ahp/ippsfy2012.pdf.
On December 11, the General Surgery Coding and Reimbursement Committee met in Chicago, IL. Major topics discussed at the meeting included the 2011 Medicare physician fee schedule and outpatient prospective payment system final rules, and ACS comment letters.
The CMS has accepted the ACS’ suggested changes to National Correct Coding Initiative edits for central-venous catheter placement and updates to the Physician as Assistants Manual.
ACS staff attended the most recent meeting of the Medicare Payment Advisory Commission, which included discussion of payment adequacy for physician, other health professional, and ambulatory surgical center services and hospitals inpatient and outpatient services.
In January, ACS advocacy staff met with a health policy advisor to Sen. Mike Crapo (R-ID) to discuss the College’s legislative priorities for the coming year, including Medicare physician payment reform. College staff also discussed the success of the ACS NSQIP in improving surgical outcomes and expressed appreciation for the senator’s leadership on issues facing ambulatory surgery centers.
ACS advocacy staff met with staff to Rep. Phil Roe, MD (R-TN), to discuss his plan for repealing the Independent Payment Advisory Board (IPAB). The College remains very concerned that the IPAB, which was created by the Affordable Care Act, would largely limit congressional oversight of Medicare policies and threaten patient access to surgical care.
On March 15, ACS staff attended a hearing of the House Ways and Means Subcommittee on Health to hear testimony from Glenn Hackbarth, JD, the chair of the Medicare Payment Advisory Commission (MedPAC). Mr. Hackbarth presented the commission’s March 2011 report to the Congress, Medicare Payment Policy. In the report, MedPAC recommended a one percent increase in Medicare physician payments in 2012. At present, Medicare payments are scheduled to be cut by 29.5 percent in 2012.
ACS staff met with advisors to several representatives to discuss concerns about provisions in the Affordable Care Act calling for the creation of an IPAB. The College remains very concerned that an IPAB would largely limit congressional oversight of Medicare policy and threaten patient access to surgical care.
On April 6, the ACS and 46 other physician organizations wrote to House Speaker John Boehner (R-OH) to express concern about comments made at the March 15 hearing of the Ways and Means Health Subcommittee. During the hearing, some subcommittee members questioned the composition and role of the American Medical Association (AMA) Relative Value Update Committee (RUC). The letter addresses misconceptions about the composition and role of the RUC and highlights the committee’s value as a multispecialty physician expert panel. The letter also addresses the criticism that the RUC has a bias toward nonprimary care specialties, noting that Medicare payments to primary care increased by 22.5 percent between 2006 and 2011.
On March 29, ACS advocacy staff and their colleagues from the AMA and other physician organizations met with staff to Sen. Ron Wyden (D-OR) and Sen. Charles Grassley (R-IA) to discuss the potentially negative impact that proposals calling for the release of Medicare claims data could have on the delivery of care to patients.
In March and April, ACS staff met with advisors to several representatives to discuss concerns that provisions in the Affordable Care Act calling for establishment of an IPAB would lead to cuts in Medicare in 2015 and future years. The College maintains that the IPAB would largely limit congressional oversight of Medicare policy and threaten patient access to surgical care.
On March 26–27, the ACS General Surgery Coding and Reimbursement Committee met in Washington, DC. Topics discussed at the meeting included the comment letters on proposals pertaining to the Emergency Medical Treatment and Active Labor Act and hospital value-based purchasing. The ongoing transition from ICD-9 (International Classification of Diseases, 9th edition) to ICD-10 also was discussed.
On March 9–10, ACS regulatory staff attended a meeting on the transition from ICD-9 to ICD-10. Topics discussed at the meeting included the creation of new codes for pneumothorax and air leaks, hemorrhoid reclassification, and ventral hernia codes.
In May, David B. Hoyt, MD, FACS, Executive Director of the American College of Surgeons, was invited to testify at a House Energy and Commerce Health Subcommittee hearing titled “The Need to Move beyond the SGR.” Dr. Hoyt and ACS advocacy staff had met with Energy and Commerce Committee staff previously in March to discuss the SGR and related issues. In his testimony, Dr. Hoyt emphasized the importance of making quality and patient safety the focus of reforms and highlighted the value of the College’s quality programs, such as the ACS NSQIP. His statement is available at: http://www.facs.org/ahp/medicare/hoyt050511.html.
In April, ACS staff met with advisors to members of the Senate Finance Committee to discuss the outlook for the consideration of legislation to reform the Medicare physician payment system. They also discussed how possible reforms might build upon the success of ACS quality improvement programs, such as ACS NSQIP, in improving surgical outcomes for patients. Meetings included advisors to Sen. Mike Crapo (R-ID) and Sen. Orrin Hatch (R-UT), Ranking Member, Senate Finance Committee.
In April, ACS staff and colleagues from other physician organizations met with key health policy staff to Rep. Dave Camp (R-MI), Chairman of the House Committee Ways and Means, to discuss concerns about the formation of an Independent Payment Advisory Board. They also addressed the outlook for possible consideration of measures to either eliminate or alter the IPAB.
In April and May, ACS advocacy staff met with advisors to several representatives, including several members of the House Committee on Ways and Means, to discuss ACS interests and concerns regarding a number of issues, including Medicare physician payment reform, medical liability reform, funding for graduate medical education, and the success of ACS quality improvement programs, such as ACS NSQIP.
David C. Han, MD, FACS, has been appointed to the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC). Dr. Han, a vascular and general surgeon practicing in Hershey, PA, has served as the Society for Vascular Surgery’s advisor to the RUC for the past several years. The RUC makes annual recommendations regarding new and revised physician services to the Centers for Medicare & Medicaid Services and performs broad reviews of the resource-based relative value scale every five years. Dr. Han’s service begins in October 2011.
On May 4, the ACS sent a letter to the leaders of key House committees expressing opposition to the Medicare Physician Payment Transparency and Assessment Act of 2011 (H.R. 1256). This bill would require that the CMS employ the services of outside contractors and annually analyze services and codes under the Medicare physician fee schedule (MPFS). The ACS believes that this legislation is unnecessary, duplicative, and fails to consider previous lessons about contractors’ inability to assess the relative value of services under the MPFS. A copy of the letter is available at http://www.facs.org/ahp/medicare/mcdermott-opposition.pdf.
In May, the House Energy and Commerce Committee approved H.R. 5, the Help Accessible, Efficient, Low-Cost, Timely Healthcare (or HEALTH) Act, which would, among other things, cap noneconomic damages at $250,000, limit contingency fees paid to attorneys, require defendants to pay only their “fair share” of the damages, and implement periodic payments of future damages. In the days before the committee vote, ACS advocacy staff was in communication with committee members to shore up support for the legislation. An action alert also was sent to Fellows in committee members’ districts asking them to call and encourage their representatives to support the bill.
The ACS sent a letter to the Department of Health and Human Services (HHS) expressing concern about the implementation of a section of the Affordable Care Act (ACA), which provides incentive payments to general surgeons who perform major operations in health professional shortage areas (HPSAs). Under the ACA, the Centers for Medicare & Medicaid Services must limit the incentive payment to general surgeons who perform the operations in primary care or mental health geographic HPSAs. The ACS maintains that a disconnect exists between the goals of the provision and the means by which it can be implemented, because these HPSAs are not necessarily locations in need of general surgeons.
The ACS and 25 other organizations sent a letter on July 26 to House and Senate appropriators in support of funding for the pediatric subspecialty loan repayment program, which was created under the Affordable Care Act. If funded, this program would provide up to $35,000 in loan repayments per year for up to three years for pediatric surgeons and other pediatric specialists who agree to practice in shortage areas for at least two years. The program was authorized at $30 million for each fiscal year (FY) between 2010 and 2014 but to date has received no funding. Given the current difficult budget environment, the letter requests a modest appropriation of $5 million for the program for FY2012, which begins October 1, 2011. To access the letter, go to http://www.facs.org/ahp/pediatric/pediatricloanrepayment.pdf.
ACS advocacy staff have organized and attended coalition meetings with senators and their advisors to build support for funding of the pediatric subspecialty loan repayment program. Meetings with the aides to Sen. Daniel K. Inouye (D-HI), Chair of the Appropriations Committee, and Sen. Herb Kohl (D-WI), who serves on the Appropriations, Judiciary, and Banking Committees, took place the last week of July. Additional meetings are planned for after the August recess.
American College of Surgeon Committee on Trauma Advocacy Chair, Edward Cornwell E. III, MD, FACS, and Trauma Coalition colleagues met with Health Resources and Services Administration Administrator Mary Wakefield, PhD, and her staff on December 6. The purpose of the meeting, which included ACS Division of Advocacy and Health Policy staff, was to request funding for the trauma programs authorized in the Affordable Care Act. Also in attendance were representatives of U.S. Department of Health and Human Services Secretary and the Office of the Assistant Secretary for Preparedness and Response. The discussion centered on grants for trauma centers and trauma service availability, as well as the importance of trauma systems and regionalization of emergency care funding.
In January, the ACS and other organizations representing the trauma care community met with Nicole Lurie, MD, MSPH, Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services. The purpose of the meeting was to request that President Obama’s budget for fiscal year (FY) 2012 include support for funding trauma and emergency medical services. Edward E. Cornwell III, MD, FACS, Chair of the ACS Committee on Trauma, offered the College’s perspective.
ACS advocacy staff met with health policy advisors to Sen. Jon Kyl (R-AZ) and Sen. John McCain (R-AZ) to discuss the role of trauma surgeons and the trauma system in delivering life-saving care to the victims of the tragic shooting in Tucson on January 8.
In February, ACS advocacy staff spearheaded a meeting of stakeholder organizations and the office of Sen. Pat Roberts (R-KS) to discuss funding of trauma and emergency medical care programs for FY 2012.
On March 9, 25 members of the Committee on Trauma (COT) participated in an Advocacy Day on Capitol Hill. ACS staff briefed participants on pertinent issues and the current political environment. COT members also attended advocacy training led by Capitol Hill staffers and heard from keynote speaker Rep. Joe Heck. COT Advocacy Day attendees participated in a total of 53 meetings with senators, representatives, and Capitol Hill staff to discuss trauma funding, the Emergency Medical Treatment and Active Labor Act, and Medicare physician payment.
The College successfully lobbied for inclusion of language in the House Energy and Commerce Committee’s bill reauthorizing the Pandemic and All-Hazards Preparedness Act (PAHPA), H.R. 2405, which would ensure that our nation is adequately equipped to respond to public health emergencies. The committee approved the legislation on July 28. It is now scheduled to go before the House for a vote. The Senate is working on its own version of the bill, and the College is pursuing the inclusion of similar language in that measure as well. For details, go to http://www.facs.org/ahp/trauma/pahpa.pdf.
The ACS and nine other SQA member societies sent a letter to more than 60 regional extension centers to address their desire to assist in provider outreach and education for meaningful use of Electronic Health Records (EHRs).
On February 2, the ACS and 37 other organizations sent a letter to the Office of the National Coordinator (ONC) for Health Information Technology. The letter addressed the Health Information Technology Policy Committee’s proposals and recommendations for Stage 2 of the meaningful use of EHRs, including thresholds, exclusions, and participation rates. The organizations also expressed the overall concerns about potentially pushing too many requirements into meaningful use and thereby creating an onerous burden for many health care providers implementing EHRs. Additionally, the ACS and nine other societies in the Surgical Quality Alliance sent a letter to the ONC addressing concerns specific to surgery.
On May 13, Don Detmer, MD, FACS, Medical Director, ACS Division of Advocacy and Health Policy, testified before the Health Information Technology Policy Committee’s Meaningful Use Workgroup. His testimony focused on population data, specifically addressing how electronic health records can facilitate specialty management of populations, including measure and feeding back performance.
The ACS has submitted comments to the ONC regarding the Health Information Technology (HIT) Strategic Plan. The plan consists of five goals: (1) achieve adoption and information exchange through meaningful use of HIT; (2) improve care, improve population health, and reduce health care costs through the use of HIT; (3) inspire confidence and trust in HIT; (4) empower individuals with HIT to improve their health and the health care system; and (5) achieve rapid learning and technological advancement. Following the analysis of the feedback received during the public comment period, the ONC will publish a final version of the plan. To access the College’s comments, go to http://www.healthit.gov/buzz-blog/from-the-onc-desk/hit-strat-plan/. This site is in a blog format, so search for Dr. Hoyt’s name to find the ACS comments.
More than 50 representatives of more than 20 surgical societies attended the SQA meeting on February 7 in Washington, DC. Topics discussed at the meeting included the National Care Quality Alliance’s accountable care organization criteria, NQF measure maintenance and testing, and the Physician Consortium for Performance Improvement’s (PCPI) perioperative measures revision project.
The ACS and the SQA collaborated on the development of a surgical patient experience of care survey which has been approved by the Agency for Healthcare Research and Quality (AHRQ) for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) trademark. The survey was adopted as the CAHPS Surgical Care Survey, which is designed to assess patients’ experiences with surgeons and their staff. AHRQ now recommends that users of the CAHPS Surgical Care Survey report the following six composite measures and one rating item: information to help patients prepare for surgery; surgeon communication with patients before operations; surgeon attentiveness on the day of an operation; information to help the patient recover from a procedure; surgeon communication after an operation; the helpfulness, courteousness, and respectfulness of the surgeon’s office staff; and patients’ rating of the surgeon on a scale of 0 to 10. For more information, go to https://www.cahps.ahrq.gov/content/products/sc/PROD_SC_Surgical_Care.asp.
The Affordable Care Act (ACA) directs the Secretary of Health and Human Services (HHS) to seek multi-stakeholder input on the use of quality measures for public programs and assigns new duties to the consensus-based entity. Among those new duties, the entity is required to convene multi-stakeholder groups to provide input to the Secretary on the selection of measures for public reporting and payment programs. The NQF sought nominations in early 2011 for organizations and individual subject matter experts for the Patient-Focused Coordinating Committee for the Measure Applications Partnership (MAP). The ACS received an organizational seat on the coordinating committee, which will set the strategy for the MAP, provide direction to advisory work groups, and make recommendations to HHS.
The ACS commented on the hospital value-based purchasing (HVBP) program proposed rule, which calls for providing incentive payments to hospitals meeting performance standards established for a fiscal year performance period. The HVBP program will reduce hospitals’ base diagnosis-related group payments by one percent and use those funds to pay for the incentives. The ACS supports advancing the quality and safety of surgical care through value-based purchasing efforts designed from the perspective of the patients. The College’s National Surgical Quality Improvement Program is one of the only prospective, risk-adjusted, audited, validated, outcomes-based surgical improvement programs in the U.S. The ACS strongly maintains that use of ACS NSQIP risk-adjusted outcomes measures in the HVBP program would improve the quality of care delivered to patients.
On April 12, U.S. Department of Health and Human Services Secretary Kathleen Sebelius and the CMS Administrator Donald Berwick, MD, announced a new national partnership to stop millions of preventable injuries and complications in the next three years. The ACS and other major stakeholders endorsed the effort.
In April and May, ACS advocacy staff met with key assistants to Sen. Max Baucus (D-MT), Chairman, Senate Committee on Finance, and Rep. Sander Levin (D-MI) and Rep. Pete Stark (D-CA), Ranking Members of the House Ways and Means Committee and the Ways and Means Subcommittee on Health, respectively. ACS staff discussed concerns about the implementation of measures to promote electronic prescribing among physicians and the challenges that some surgeons are presently facing under the e-prescribing program.
ACS regulatory staff is alerting Fellows to a free e-prescribing software program for health care professionals that the National e-Prescribing Patient Safety Initiative (NEPSI)—a joint project of organizations dedicated to eliminating preventable medication errors—is offering. For more information, go to https://erxnowregistration.allscripts.com/.
More than 50 surgical society representatives attended the SQA meeting on June 20 in Washington, DC. Topics discussed at this meeting included the electronic prescribing and the Center for Medicare & Medicaid Innovation Center established under the Affordable Care Act.
On August 8, the SQA, which comprises 21 surgical organizations, including the ACS, submitted comments on the CMS’ proposed rule entitled Medicare Program: Availability of Medicare Data for Performance Improvement. The proposed rule implements section 10332 of the ACA, which will make Medicare claims data available so that qualified entities can prepare publicly available evaluations and comparisons of provider performance. The letter states that physician claims data should not be released because this financial information is protected under the privacy act. However, if the data are going to be released, the SQA urges the CMS to move toward standardization of many of the factors that qualified entities would use to develop and disseminate public reports to guarantee accuracy and validity. The letter also notes that clinical data are better indicators of quality and strongly encourages the CMS to incorporate this information into its value-based purchasing programs. A copy of the letter is available at http://www.facs.org/ahp/medicareclaimsdatarelease.pdf.
On July 19, the ACS hosted a meeting of medical and surgical associations and members of the Patient-Centered Outcome Research Institute (PCORI) Board and Methodology Committee. Topics discussed included the role PCORI should play in comparative clinical effectiveness and outcomes research efforts, areas for major investments, and the process and criteria PCORI should use to set priorities. The PCORI representatives also requested feedback on the working definition of “patient-centered outcomes.”
Health policy advisors to Sen. Orrin Hatch (R-UT), Ranking Republican Member of the Senate Finance Committee, participated in an August 23 meeting at the University of Utah Hospital and Clinics, Salt Lake City. The event, which ACS advocacy staff arranged and participated in, included presentations and a discussion about how the ACS NSQIP has helped to improve surgical outcomes at the university hospital and at Intermountain Medical Center in Murray, UT. Surgeon participants included were Sean Mulvihill, MD, FACS; Leigh Neumayer, MD, FACS; Robert Glasgow, MD, FACS; Larry Kraiss, MD, FACS; and Mark Ott, MD, FACS.
The 4th Annual Joint Surgical Advocacy Conference (JSAC) took place March 27–29 at the JW Marriott Hotel in Washington, DC. The JSAC is the perfect opportunity to amplify surgery’s collective voice on Capitol Hill. Cosponsored by the College and 16 other surgical societies, this year’s conference featured a continuing medical education course on accountable care organizations; updates on legislative issues from members of Congress; resident, beginner, and advanced advocacy training; and a role-playing seminar to help participants prepare for their meetings on Capitol Hill.
The ACS and several other surgical societies cosigned a letter providing feedback to the Centers for Medicare & Medicaid Services on the agency’s request for comments on the need for a proposed rule to address policies related to the Emergency Medical Treatment and Labor Act (EMTALA). In the letter, the surgical community indicates that they do not believe it is necessary for the CMS to publish a proposed rule revisiting the applicability of EMTALA to inpatients. The societies also recommended that any review of EMTALA be conducted from the patient-centered perspective, allowing for decisions to be made based on each patient’s best interests and his or her prospects for long-term survival.
In January, the ACS and other surgical societies commented on the National Correct Coding Initiative’s Medically Unlikely Edit (MUE) for the Healthcare Common Procedure Coding System (HCPCS) code J9395 (Fulvestrant/Faslodex, 25 mg). This code was assigned a MUE value of 10 based on Food and Drug Administration (FDA)-approved prescribing information (250 mg dose). However, in September 2010 the FDA approved a higher dose (500 mg). Hence, the MUE value has been increased to 20. Starting April 1, the CMS will be making the MUE change retroactive to January 1. The CMS has instructed providers to delay submission of these claims until April 1. If providers have had claims denied due to the incorrect MUE value, they may resubmit or appeal those claims after April 1.
The ACS submitted comments to the CMS on President Obama’s Executive Order 13563, Improving Regulation and Regulatory Review, which requires federal agencies to identify rules that may be excessively burdensome or that could be streamlined, expanded, or clarified. The ACS comments indicated that better coordination and synchronization among the various incentive payment programs is needed, the Medicare enrollment process should be streamlined, general surgery health professional shortage areas need to be recognized, and the physician lab requisition signature requirement is excessively burdensome. To access the College’s comment letter, go to http://www.facs.org/ahp/burdensomeregulation.pdf.
On August 1, the ACS submitted a comment letter to the Office for Civil Rights (OCR) in response to the Health Insurance Portability and Accountability Act (HIPAA) accounting for disclosures proposed rule. The letter expresses support for proposed changes that would improve the HIPAA accounting for disclosures requirement but raises strong concerns about the OCR’s proposed right to an access report. The letter requests that the OCR find ways to consult with stakeholders outside of the formal rulemaking process about access report-related issues. The ACS and 14 specialty societies cosigned this letter. The comment letter is available at http://www.facs.org/ahp/hipaa-acctletter.pdf.
On August 26, the ACS submitted a comment letter to the CMS in response to their proposed rule, which would retract the policy adopted in the CY 2011 physician fee schedule, requiring physicians or other qualified health professionals to sign requisitions for diagnostic tests paid under the clinical laboratory fee schedule. The ACS supports the retraction because of the administrative burden such a mandate would impose on physicians and the negative impact it could have on patient care. The comment letter is available at http://www.facs.org/ahp/clinical_letter2012.pdf.
On August 1, the ACS and 15 specialty societies submitted comments to the OCR on a proposed rule relating to HIPAA’s accounting for disclosures of protected health information (PHI) and establishing a new right to receive access reports. The comment letter offered support for providing patients with information about the release of PHI to outside entities. However, it raised concerns about allowing patients to obtain access reports. Whereas the College agrees that patients should be able to obtain information about their PHI, the right to access reports will impose significant administrative costs and burdens on physician practices. The letter urges the OCR to either withdraw the access report provision of the proposed rule or to promulgate an interim final rule instead of releasing a final rule so stakeholders have time to provide the OCR with more information on the implications of these policies. To read the letter, go to http://www.facs.org/ahp/hipaa-acctletter.pdf.
On July 22, the ACS submitted comments to the CMS regarding proposed changes to the Electronic Prescribing (eRx) Incentive Program. The eRx program applies either an incentive payment or a payment adjustment to the Medicare Part B physician fee schedule allowed charges for eligible professionals based on whether they are successful electronic prescribers. Under this rule, the CMS proposes to modify the 2011 eRx quality measure, provide additional significant hardship exemption categories for eligible professionals and group practices to request an exemption during 2011 for the 2012 eRx payment adjustment, and extend the deadline for submitting requests for consideration for the two current significant hardship exemption categories for the 2012 eRx payment adjustment. A copy of the letter is available at http://www.facs.org/ahp/erx-proposedrule.pdf.
Revised January 3, 2012