Increasing evidence indicates a current and growing shortage of surgeons available to serve our nation's population. A shortage of general surgeons is a critical component of the crisis in health care workforce because only surgeons are uniquely trained and qualified to provide certain necessary, lifesaving procedures. In light of growing evidence demonstrating a shortage of general surgeons, the American College of Surgeons (ACS) believes more accurate and actionable workforce data is necessary to determine exactly what constitutes a surgical shortage area and subsequently where these areas exist.
Ensuring an Adequate Surgical Workforce in Underserved Areas
Federal Legislative Efforts
Reauthorization of the HPSA Surgical Incentive Payment Program
The Affordable Care Act (ACA) created a Medicare incentive payment program for major surgical procedures provided in health professional shortage areas (HPSAs) as a way to increase and improve access to high-quality surgical care in rural and underserved areas. This initiative, called the HPSA Surgical Incentive Payment Program (HSIP), provided a payment incentive to surgeons who performed major operations—defined as those with a 10-day or 90-day global period under the Medicare Physician Fee Schedule—in a geographic HPSA. HPSAs are geographic areas that lack sufficient numbers of physicians to meet the health care needs of an area or population. HPSAs are designated by the Health Resources and Services Administration (HRSA). The HSIP program expired in 2015.
The American College of Surgeons urges Congress to reauthorize the HPSA Surgical Incentive Payment Program for a period of five years. A five-year reauthorization of the HSIP will provide general surgeons, who are a key element of rural, frontline care, with the additional support they need to recover after the crisis and continue serving rural communities.
Ensuring Access to General Surgery Act
The ACS strongly supports the Ensuring Access to General Surgery Act (H.R. 1841/S. 2859 ), sponsored by Representatives Ami Beri, MD (D-CA), Larry Bucshon, MD, FACS (R-IN), Scott Peters (D-CA), and Markwayne Mullin (R-OK) in the House and Brian Schatz (D-HI) and John Barrasso (R-WY) in the U.S. Senate. This legislation would direct the Secretary of the Department of Health and Human Services (HHS), through the HRSA, to conduct a study to define a general surgery workforce shortage area and collect data on the adequacy of access to surgical services. Additionally, it would grant the Secretary the authority to provide a general surgery shortage area designation.
ACS Letter of Support for the Ensuring Access to General Surgery Act
ACS Letter of Support for S. 2859
Keep Physicians Serving Patients Act
The ACS supports the Keep Physicians Serving Patients Act of 2019, legislation that would improve the way geographic cost indices (GPCIs) are calculated to better support rural surgeons. Currently, GPCIs are calculated using inaccurate and outdated numbers that underestimate the cost of practicing in non-urban areas. This legislation improves that calculation and establishes a set minimum based on specific regions. This will ensure physicians are appropriately reimbursed for the care they provide as well as help to incentivize new talent to practice in rural settings.
ACS Letter of Support for the Keep Physicians Serving Patients Act
ACS Submits Information on Rural Health to Congressional Task Force
The American College of Surgeons on December 6, 2019, submitted a response to a request for information from the Ways and Means Committee Health Task Force on Rural and Underserved Communities. ACS provided information to the Task Force about general surgical shortage areas and the need for both data and a formal shortage designation; the challenges associated with trauma care in rural areas, as well as information to ensure high quality care and patient safety.
ACS Response to the Rural Health RFI