End-of-Year Funding Bill Includes ACS Legislative Victories, Payment Updates
Carrie Zlatos, Amelia Suermann, and Emma Zimmerman
Wrapping up year-end legislative business, Congress passed a last-minute omnibus funding package on December 23, 2022. The bill, Consolidated Appropriations Act, 2023, was signed into law by President Biden on December 29. The approximately $1.7 trillion spending package funds the federal government through September 30, 2023.
Thanks to significant efforts by ACS members through grassroots advocacy and SurgeonsPAC and coalition lobbying efforts led by ACS staff, several of the College’s top-priority issues were included in this package, some of which are described below. In addition, the bill included updates on Medicare reimbursement and other areas related to payment. Be sure to read the upcoming February Bulletin of the American College of Surgeons for a complete breakdown of the bill, as well as notable exclusions and the work to come in 2023.
Physician Payment
Surgeons and other health professionals were facing nearly 8.5% in cuts to Medicare payment on January 1, 2023. The omnibus provides significant relief, but unfortunately does not entirely stop the cut. Surgeons will experience a nearly 2% payment reduction due to budget neutrality policies in the Medicare Physician Fee Schedule, which went into effect on January 1.
Conversion Factor Cuts
The omnibus includes a 2.5% adjustment to the conversion factor for services furnished in 2023 and a 1.25% adjustment for services furnished in 2024. With the temporary adjustment to the conversion factor, surgeons and physicians can expect an approximately 2% decrease in payment relative to the 2022 conversion factor.
PAYGO
The omnibus delays, but does not eliminate, the pending Statutory Pay-As-You-Go Act (PAYGO) sequestration (which is capped at 4% for Medicare). PAYGO cuts will not be implemented in 2023 or 2024, but the balance due is added to the 2025 scorecard.
Public Health Research Funding
Cancer Funding
The ACS successfully lobbied for increased funding for several agencies in fiscal year (FY) 2023. The omnibus provides $47.5 billion for the National Institutes of Health (NIH), including $7.32 billion for the National Cancer Institute. Additionally, the law provides increases for each line item within the Centers for Disease Control and Prevention (CDC) Cancer Prevention and Control programs, including $22.4 million for the Comprehensive Cancer Control Initiative and $53.4 million for the National Program of Cancer Registries.
Firearm Injury Prevention Research Funding
A longstanding priority for the ACS, Congress appropriated $12.5 million each to the NIH and CDC ($25 million total) the same level as FY22, to fund public health research on firearm injury and mortality prevention. Additionally, Congress recommends that the NIH and CDC take a comprehensive approach to studying the underlying causes of violence and suicide and evidence-based methods of prevention of injury, including crime prevention.
Trauma-Related Provisions
MISSION ZERO Grant Funding
Congress appropriated $4 million, an increase of $2 million over previous funding levels, for the MISSION ZERO grant program. The MISSION ZERO grant program was funded for the first time in 2021 thanks to the direct advocacy efforts of the ACS, its Committee on Trauma, and the continued support of and collaboration with the Military Health System Strategic Partnership American College of Surgeons.
Violence Intervention Programs
The omnibus provides an increase to support violence interventions and encourages CDC to fund a range of interventions, including programs that provide de-escalation and conflict mitigation skills. The ACS looks forward to continued collaborations with coalition and congressional partners to advance legislation supporting hospital-based violence intervention programs.
Other Priority Areas
Healthcare Workforce
The omnibus includes a variety of grants and other programs aimed primarily at increasing access to primary care, mental health, and substance use treatment services. It includes $125.6 million for expanded primary care services, $60 million for grants to public institutions of higher education to expand or support graduate education for physicians, and $12.5 million for the Rural Residency Development Program.
Physician Well-Being
The Dr. Lorna Breen Health Care Provider Protection Act establishes a variety of grant programs to address mental health and well-being for healthcare providers. The omnibus provides an exception to laws preventing physicians who are part of a hospital’s medical staff, but are not directly employed by the hospital, from accessing mental health care programs provided by the hospital for physician wellness programs.
The Road Ahead
As the 118th begins with a Congress divided between a Republican majority in the House and a Democratic majority in the Senate, ACS staff is turning its attention to the new Congress. We look forward to working with both chambers to advance the needs of patients and surgeons.
