American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Health Care Reform

On March 23, 2010, the Patient Protection and Affordable Care Act, or Affordable Care Act (ACA) for short, was signed into law. This page provides information on regulatory issues related to the ACA, including proposed policies released by federal agencies and ACS letters to those federal agencies, advocating on general surgeons’ behalf. 

Accountable Care Organizations (ACOs)

The Patient Protection and Affordable Care Act (ACA) requires the implementation of the Medicare Shared Savings Program. This program is intended to encourage physicians, hospitals, and other health care providers to come together voluntarily to form accountable care organizations (ACOs) to share the responsibility for providing cost-effective and coordinated care to their Medicare patients. Under the ACA, an ACO would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years. In the Medicare context, an ACO that meets established quality and performance standards and surpasses a minimum savings target will be able to share a percentage of savings (in addition to traditional fee-for-service payments under Medicare Parts A and B).

ACS Comment Letters

ACO Rules

Articles

General Surgery Bonus Payment

The Affordable Care Act (ACA) authorizes a Medicare incentive payment program for major surgical procedures provided by general surgeons in Health Professional Shortage Areas (HPSAs). This new initiative is called the HPSA Surgical Incentive Payment program, or the general surgery bonus program. The bonus applies to major operations (defined as 10-day and 90-day global procedures) provided by a surgeon who is enrolled in Medicare with primary specialty code of 02 (General Surgeon). The major procedures must be provided in a geographic HPSA between January 1, 2011, and January 1, 2016. The bonus payment amount is 10 percent of the amount actually paid for service.

ACS Comment Letters

Articles


Medicare Claims Data

The Affordable Care Act (ACA) requires that certain Medicare claims data be made available for the purpose of allowing qualified entities (as defined by the Centers for Medicare & Medicaid Services) to prepare publicly available evaluations and comparisons of provider performance. The American College of Surgeons (ACS) advocacy efforts stress that appropriate safeguards must be put in place to guarantee the accuracy and validity of any performance reports that will be made publicly available. The ACS supports efforts to help physicians and patients better understand the quality and cost of their care and provide them with tools that will allow for the continuous improvement of care.

Availability of Medicare Data for Performance Measurement Rules

Physician Payment Sunshine Act

The Affordable Care Act (ACA) requires that, beginning in 2012, manufacturers of specified drugs, medical devices, and biologicals participating in U.S. federal health care programs must begin tracking any transfers of value or payments of $10 or more (as indexed by Consumer Price Index) to physicians and teaching hospitals. These reports must be submitted to the Secretary of the Department of Health and Human Services on an annual basis. The majority of the information contained in the reports will be available on a public, searchable website in 2013. In addition, the ACA mandates that manufacturers and group purchasing organizations must report ownership interests held by physicians and their close family members.

CMS Physician Sunshine Rule

Physician Value-Based Payment Modifier (VBM)

The Affordable Care Act (ACA) requires that the Centers for Medicare & Medicaid Services (CMS) implement a value-based payment modifier that would apply to Medicare fee-for-service payments starting with some physicians on January 1, 2015, and applying to all physicians and groups by January 1, 2017. The value-based payment modifier is intended to pay physicians differentially based on the quality of care they provide and the cost of that care. It would incorporate the use of Physician Feedback reports, which are confidential reports that quantify and compare the quality of care furnished and costs among physicians and physician group practices, relative to the performance of other physicians. 

Review a CMS presentation on the value-based payment modifier proposals in the CY 2013 Physician Fee Schedule proposed rule.

ACS comment letter that discusses proposals on the value-based payment modifier starting on page 25.

CMS rules that address changes to provider ordering and referring requirements are outlined in CY 2013 Physician Fee Schedule Proposed Rule.

Program Integrity

The Affordable Care Act (ACA) made several changes and created several mandates with the intention of protecting the integrity of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) and preventing waste, fraud, and abuse. Among other issues, the ACA addressed provider screening, application fees, and temporary moratoria on enrollment under Medicare, Medicaid, and CHIP. The Centers for Medicare & Medicaid Services (CMS) implemented these changes via notice and comment rulemaking. The American College of Surgeons (ACS) prepared a joint comment letter for submission to CMS in response to the CMS Medicaid Integrity Program proposed rule, and 13 surgical specialty societies signed on to this letter.

CMS Program Integrity Rules

Reporting and Returning of Overpayments

The Affordable Care Act (ACA) requires that Medicare providers and suppliers report and return Medicare overpayments within a certain time period. The overpayments must be reported and returned to the Secretary of the Department of Health and Human Services, the State, an intermediary, a carrier, or a contractor, as appropriate. The overpayment must be reported and returned by the later of: (1) 60 days after the date on which the overpayment was identified or (2) the date any corresponding cost report is due. Failure to meet the deadline for returning an overpayment exposes the provider or supplier to civil monetary penalties under the federal False Claims Act.

Rules Implementing ACA Provision

For further information, please contact Vinita Ollapally at vollapally@facs.org, or Neha Agrawal at nagrawal@facs.org.