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

Federal and State Regulatory and Legislative Issues

Congress Replenishes Funds for Federal Loan Relief Programs

Initial funding for both the Paycheck Protection Program (PPP) and the Economic Injury Disaster Loan Program (EIDL) was expended April 16. On April 21, the Senate passed The Paycheck Protection Program and Health Care Enhancement Act, which appropriated an additional $321 billion for PPP loans and an additional $60 billion for the EIDL loan program. The House of Representatives passed the legislation April 23, and President Trump signed it into law today. Set aside in the $321 billion of additional funds approved for the PPP is $60 billion for small- to medium-sized banks and other financial institutions. The legislation also includes an additional $75 billion for the Public Health and Social Services Emergency Fund.

HHS Makes Second Round of Disbursements from the Public Health and Social Services Emergency Fund

The U.S. Department of Health and Human Services (HHS) announced April 22 that it will begin disbursing a second round of payments, totaling $20 billion, to providers April 24 from the Public Health and Social Services Emergency Fund. These funds will augment the initial allocation of $30 billion disbursed April 10. The specific announcement can be found here. In a statement, HHS Secretary Alex Azar said, “The $20 billion will be allocated so that providers’ share of the whole $50 billion is based on the net patient revenue they received from all sources in 2018. This will entail a significant rebalancing for many providers.” It is expected that this rebalancing will address the concerns previously expressed by providers who have a lesser percentage of receipts from Medicare, including children’s hospitals, pediatric specialists, and obstetricians-gynecologists. Surgeons are reminded that recipients of the funds have to certify through a portal within 30 days or return the money.

Surgeons are encouraged to read the American College of Surgeons Practice Protection Committee’s Resource Document found here for the latest information on Medicare advance payments, small business loans, and granted federal funds.

Practice Protection Committee Continues to Address Financial Effects of COVID-19

The American College of Surgeons (ACS) Practice Protection Committee met this week and discussed a variety of issues that are affecting surgeons’ economic situation, including legislation to replenish funds for the Paycheck Protection Program and the Economic Injury Disaster Loan Program, as well as the growing financial impact the COVID-19 pandemic is having on employed surgeons.

More than 250 surgeons participated in the committee’s webinar on April 16, which included a robust discussion of financial resources available to surgeons and a segment devoted to practical tips and suggestions for all to consider during these unprecedented times.

The Practice Protection Committee will host its next webinar, Contractual Considerations, Hospital Relations, and COVID-19 Financial Resources, Monday, April 27, at 7:00 pm Eastern Time.

In addition to providing an update on the federal financial resources programs, segments of Monday’s webinar will include a discussion of physician contracts provided by Stacy L. Cook, Partner, Barnes and Thornburgh, LLP, and a discussion of hospital relations led by former ACS Board of Regents Chairs, Michael Zinner, MD, FACS, Chief Executive Officer and Executive Medical Director, Miami Cancer Institute, FL, and Julie Freischlag, MD, FACS, Chief Executive Officer, Wake Forest Baptist Health, and Dean, Wake Forest School of Medicine, Winston-Salem, NC. Drs. Zinner and Freischlag will be joined by Peter Austin, Vice-President and Chief Operating Officer, Jefferson Regional Medical Center in Pine Bluff, AR. Mr. Austin’s father, William Austin, MD, FACS, is an otolaryngologist in McComb, MS, and a long-time Fellow of the College.

ACS Fellows can register for the webinar here.

Surgical Coalition Sends Letter Outlining Payment Issues Affected by COVID-19

The American College of Surgeons and 21 other members of the Surgical Coalition sent a letter April 21 to the Secretary of the U.S. Department of Health and Human Services and the Administrator of the Centers for Medicare & Medicaid Services. The letter covers the seven areas related to COVID-19 summarized below:

Telehealth and other non-face-to-face services

  • Align dates for all policies expanding telehealth benefits during the public health emergency (PHE) to become retroactively effective March 1, 2020
  • Allow office/outpatient evaluation and management codes to be billed as telehealth services, even if those services are delivered via audio only.
  • Establish corresponding G-codes that describe new patient encounters for communication technology-based services with code descriptors referring specifically to an established patient

Accelerated and Advance Payments Program

  • Extend repayment time frame for “all other Part A providers and Part B suppliers” to match the one-year repayment time frame of inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals

Prior authorization

  • Suspend prior authorization and other utilization management requirements under the Medicare fee-for-service, Medicare Advantage, and Part D programs for the duration of the PHE

Global surgery data collection

  • Waive the requirement to report Current Procedural Terminology code 99024 throughout the PHE
  • Refrain from using data collected during the PHE to analyze the number of postoperative visits with 10- and 90-day global codes

Preoperative history and physical requirements

  • Waive the hospital Medicare condition of participation for inpatient elective procedures during the PHE to reduce administrative burden and enable physicians to exercise their own medical judgment to determine when such an examination is necessary

PPE/essential medical equipment distribution and access

  • Coordinate with the Federal Emergency Management Agency, the White House, and other agencies to streamline the personal protective equipment (PPE) distribution process, create a centralized equipment coordination unit, and share distribution data

Public Health and Social Services Emergency Fund

  • Provide additional support and immediate relief to providers when determining the disbursement of the remaining portion of the fund to ensure that a sufficient clinical workforce is available throughout the pandemic and thereafter

Contact Congress to Encourage Support for ACS Provisions in Future COVID-19 Legislation

Physicians across the country continue to serve on the frontlines battling COVID-19. As Congress proposes additional legislative solutions to address the pandemic, the American College of Surgeons (ACS) supports the inclusion of the following provisions in future COVID-19 legislation:

  • Financial assistance and relief for physicians and facilities
  • Refinements to the Medicare Accelerated and Advance Payment Program
  • Relief from scheduled cuts to Medicare physician payment
  • Reauthorization of the Health Professional Shortage Areas Surgical Incentive Payment program
  • Medical liability protections for physicians
  • Student loan relief for physicians
  • Supply chain support for lifesaving medical equipment.

Your participation is critical to ensure that Congress considers these important provisions and that the health care community remains supported, protected, and equipped during this crisis. Contact Congress via SurgeonsVoice today and urge lawmakers to include ACS-supported provisions in future COVID-19-related legislation. For more information, contact the ACS Division of Advocacy and Health Policy at ahp@facs.org.

ACS Supports Federal Liability Protections

In addition to the Surgical Coalition letter led by the American College of Surgeon (ACS), the ACS supports a letter to congressional leadership from the Health Coalition on Liability and Access (HCLA) concerning immunity for frontline providers. The letter encourages Congress to adopt legislation that provides health care professionals and facilities with immunity from civil liability for their good faith efforts to treat patients during the COVID-19 pandemic.

During this crisis, surgeons are being asked to provide treatment outside their general practice area, come out of retirement to address shortages, treat without adequate personal protective equipment, and delay elective operations. These situations pose substantial liability risk yet are unavoidable as health care professionals fight this pandemic. Action at the federal level would provide uniform protections to providers, maintain protection for victims of gross negligence or willful misconduct, and avert a patchwork of state liability laws leading to unequal treatment of surgeons who provide care on the frontlines.

For more information on liability reform, visit the Medical Liability Reform page or contact Hannah Chargin, ACS Congressional Lobbyist at hchargin@facs.org.

Contact Your Insurer for Details About Liability Premium Relief

It is the American College of Surgeons’ understanding that there is no formal, consistent position on premium relief among the various medical liability insurance carriers. However, many carriers have indicated that if a practice suspended its services during the outbreak, then insurers were either refunding policy premiums or issuing credits applicable when practice resumed or at the time the policy was renewed. For deferral of policy premium payments, many states have issued directives regarding such, and others were willing to discuss with their insureds on a case-by-case basis. Fellows should contact their individual liability insurance carrier to discuss available options. Click here for a list of the websites of carriers.

Medical Malpractice and COVID-19: A Comparative Law Review

Wilson Elser has compiled information on the state laws in all 50 states and the District of Columbia with respect to modifications to statutes regulating medical malpractice liability. It can be found here.