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Winter 2006/2007
Note: Questions relating to state legislative activity or any of the items noted in ACS Cross Country may be directed to Mindy Baker, State Affairs Associate, at mbaker@facs.org.
Surgical Advocacy a Major Focus during AMA House of Delegates Meeting
The American Medical Association’s House of Delegates (HOD) completed the business of its interim meeting in mid-November, and numerous surgical issues received prominent discussion during the course of the meeting. Delegates from the American College of Surgeons (ACS) advocated on behalf of its members on issues such as the emergency and trauma workforce, and policies on postoperative care related to itinerant surgery and fee-splitting. Not unexpectedly, reimbursement and quality improvement were two critical concerns that were the focus of much discussion, and the HOD held to a steady course of supporting advocacy efforts in Congress during the lame-duck session to address the pending physician payment cut.
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ACS Delegation
Richard Reiling, MD, FACS (delegation chair)
Charles Logan, MD, FACS
Amilu Rothhammer, MD, FACS
Thomas Whalen, MD, FACS
John Armstrong, MD, FACS (alternate delegate)
Chad Rubin, MD, FACS (alternate delegate)
Patricia Turner, MD, FACS (Young Physician Section delegate)
Jacob Moalem, MD (Resident and Fellow Section delegate)
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Prior to the HOD meeting, the Surgical Caucus of the AMA (SCAMA) sponsored an educational program titled “The Emergency Surgical Workforce--Crisis in the Emergency Department.” More than 130 surgeons and other interested physician leaders attended the session, which included presentations by John Fildes, MD, FACS, chair of the ACS Committee on Trauma, and Brian Keaton, MD, FACEP, President of the American College of Emergency Physicians. Both speakers discussed the workforce/on-call problems in the nation’s emergency departments and trauma centers and offered their organizations’ perspectives on possible solutions. The College’s report, “A Growing Crisis in Patient Access to Emergency Surgical Care,” was distributed to program participants. Copies may be downloaded at http://www.facs.org/ahp/index.html.
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Imaging Restrictions Imposed by Private Payer in Georgia
Last August, Blue Cross and Blue Shield of Georgia (BCBSGA) implemented a program called the Diagnostic Imaging Services Program (DISP). Under this program, all physicians providing diagnostic imaging services are evaluated and, depending upon the imaging/specialty area, may be required to become accredited by the American Institute of Ultrasound in Medicine, the American College of Radiology, and/or a number of additional national accreditation organizations. In addition, the policy excludes board certified general surgeons from the list of providers who are allowed to perform peripheral vascular ultrasound.The College joined with the Georgia ACS Chapter, American Medical Association, Medical Association of Georgia, and others in sending a letter to BCBS of Georgia strongly encouraging it to reevaluate the appropriateness of the DISP and similar accreditation programs. The letter also urged BCBSGA to “discontinue these programs unless and until it can be demonstrated that these programs reduce health care costs and improve quality without hindering appropriate growth or curtailing the quality or access to care.”The imposition of restrictive payment policies for imaging services by private payers is occurring in a number of states, including Connecticut, Idaho, New York, Maine, Massachusetts, Pennsylvania, and others. For further information on ultrasound examinations by surgeons, visit http://www.facs.org/fellows_info/statements/st-31.html.
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Massachusetts to Post Patient Death Rates by Surgeons on the Internet
On December 18, Massachusetts became the fourth state to publish individual heart surgeons’ patient death rates on the Internet. Only the results for cardiac bypass operations will be posted, and information will be made available on hcp.med.harvard.edu/massdac/index.htm, a site hosted by Harvard Medical School’s Mass-Dac.
According to The Boston Globe, Mass-Dac’s Web site will show the percentage of patients who died soon after their bypass operations and whether the death rate is higher or lower than the state average. Mortality rates will be computed using three years’ worth of operations in order to make the results statistically meaningful. The data will also be adjusted to weigh the surgeon’s mix of patients and the severity of their illnesses. Due to the time it will take to assemble the data, information posted on the Internet will be almost two years old, although the state Public Health Department is working to decrease the lag time by six months.
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A Look Forward Regarding the 2007 Legislative Session
The 2007 state legislative priorities will remain unchanged from those of 2006 and include: Medical Liability Reform; Trauma System Funding and Development; Provider Taxes; Scope of Practice; and Office-Based Surgery/Ambulatory Surgery Center Issues. However, individual ACS chapters and/or Fellows are encouraged to focus on whichever issues become most prominent in their respective states--and the ACS State Affairs staff continues to be available to assist in state advocacy initiatives.
Medical Liability Reform: We expect to see pushes for various reforms in Hawaii, North Carolina, Rhode Island, Wisconsin, West Virginia, Tennessee, and Delaware. We are also currently monitoring several court cases that may effect previously enacted legislation. States with active cases include Alabama, Georgia, Illinois, Louisiana, and Oregon. Legislation regarding Health Court programs are expected in Illinois, Massachusetts, Maryland, New Jersey, Pennsylvania, and Virginia.
Trauma: Legislation to formally enact verified trauma systems is expected in Arkansas, Kentucky, and Tennessee. Other trauma legislation expected includes the funding of bills in Delaware, Mississippi, and Texas. Bills to repeal the UPPL statutes are expected in Illinois, Indiana, Hawaii, Florida, Minnesota, New York, Oregon, Texas, and Wyoming. Tort reforms to deal specifically with emergency medical personnel are expected in Arizona, Delaware, and Utah.
Taxes: The push to repeal both the Ambulatory Surgery Center tax and the Cosmetic tax will continue in New Jersey, while Illinois’ Department of Revenue is expected to make changes in the statute that deals with the tax exempt status of certain “medical implants.”
Scope of Practice: Scope battles will continue to play out in many states. Since 2006 was a relatively “quiet” year, 2007 will probably see considerable state legislative scope activity.
OBS/ASC: Legislation to repeal the Certificate-of-Need (CON) statutes is expected in Kentucky, Ohio, West Virginia, and Georgia. Washington State is expecting legislation that would expand its CON statute. Georgia continues to battle to define general surgery as a single specialty.
Additional issues the State Affairs Staff are monitoring include health insurance coverage and wellness programs. Many states are closely watching Massachusetts and Vermont to determine the success of its recent legislation to mandate health insurance coverage. Several states are expected to introduce legislation to provide coverage for their residents: Maine, Maryland (similar to Massachusetts), New Mexico (three plans are being discussed), Pennsylvania (single-payer plan), Washington State (attempting to tie licensure to participation in the Medicaid program in order to increase access), Wisconsin (universal coverage), and West Virginia.
In the area of wellness programs, Florida will see legislation to mandate prostate cancer screening. Kansas is reviewing its consent laws with regard to organ donation, and both Wisconsin and West Virginia will see “healthy lifestyles/obesity prevention” legislation in 2007.
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Past Issues of ACS Cross Country:
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ACS State Affairs
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Division of Advocacy and Health Policy
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Jon H. Sutton
Manager, State Affairs
Chicago Headquarters
312-202-5358
jsutton@facs.org |
Mindy Baker
State Affairs Associate
Chicago Headquarters
312-202-5363
mbaker@facs.org |
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Revised January 3, 2007
Advocacy and Health Policy
This page and all contents are Copyright © 2003-2007
by the American College of Surgeons, Chicago, IL 60611-3211
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