ACS Advocacy Brief: August 10, 2023

Medicare Physician Fee Schedule Proposed Rule Would Cut Surgeon Reimbursement, Affect Patient Access

The Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) proposed rule In July, which included a CY 2024 conversion factor of $32.75—a decrease of approximately 3.4% from the CY 2023 conversion factor. The impact charts from CMS indicate that many surgical specialties are facing a 2% to 3% cut, which would hurt both surgeons and affect patient access to care, especially in medically under resourced areas where surgeons may be priced out of practicing.

Most of the proposed cut is due to the establishment of a separate payment for add-on code G2211 to account for visit complexity associated with certain office/outpatient evaluation and management (E/M). Originally proposed 3 years ago, the G2211 code predominately aids primary care; however, the majority of the office visit codes for this type of care were increased in 2021.

In a letter to CMS, the ACS and 18 other surgical organizations explained that there is no longer a valid justification for G2211. Under the new coding rules for office visits, physicians and qualified healthcare professionals have the flexibility to bill a higher-level code and account for increased medical decision-making or total time of the encounter.

G2211 would inappropriately result in overpayments for those using it and at the same time penalize all physicians due to a reduction in the Medicare conversion factor that will be required for maintaining budget neutrality under the 2024 proposed rule.

Budget neutrality in Medicare physician payment is one of the many aspects of a broken system. The ACS is continuing the work to both stop the cuts and stabilize the payment system in the short term and reform the system in the long term-work that includes supporting several pieces of legislation. 

100+ Members of Congress Prompt Action to Fix Broken Medicare Payment System

Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) sent a bipartisan letter to Congressional leadership signed by more than 100 members of Congress calling for urgent action to enact Medicare Access and CHIP Reauthorization Act (MACRA) reforms and for establishing a stable payment mechanism.

The letter highlights that the implementation of MACRA has faced challenges and the yearly adjustments to the MPFS, which is subject to a budget neutrality requirement, have caused decreases in reimbursement for many physicians. As physician practice costs rise with inflation, the MPFS is not adjusted accordingly. The letter further highlights that these factors are adding to physicians’ financial instability and encouraging consolidation of providers.

Make an Advocacy Impact at Home: Urge Lawmakers to Prioritize Physicians and Patient Access

While the ACS will continue its efforts to stop the proposed Medicare payment cuts, surgeons can play an important role in helping raise the profile of the issue by advocating for action at home.

Advocating at home is easy, and you can use your legislators’ in-district work periods during the August Congressional recess to maximize your impact.

Use the following online resources, available via SurgeonsVoice, to educate your elected officials about the importance of surgical care and how Medicare payment cuts could impact patient access to quality care:

Meet with your legislators at home. Requesting a meeting or phone call is easy—use the SurgeonsVoice online scheduling tool to submit your request and congressional staff will contact you for more information. Once your meeting is confirmed, review Advocacy at Home resources and tips for successful meetings. ACS staff is available to provide specific talking points or other information to help make your meeting a success.

Act now at SurgeonsVoice. Visit SurgeonsVoice to send pre-drafted letters to Congress. Current efforts include urging the House and Senate to consider ACS-supported solutions for addressing the cuts in a legislative fix before the end of 2023. Action items are updated regularly to reflect recent activity and current Congressional asks.

Key Committee Advances Legislation that Includes Prior Authorization Reform

At the end of July, the House Committee on Ways and Means advanced the Heath Care Transparency Act of 2023. This legislation included language from the ACS-supported Improving Seniors’ Timely Access to Care Act, which would bring transparency and oversight to the prior authorization process under Medicare Advantage (MA). 

Reforming the prior authorization process would reduce barriers to care, lessen physician administrative burden, and help ensure that Medicare beneficiaries who enroll in MA plans have the same access to Medicare-covered items and services as beneficiaries who opt for traditional Medicare. The Health Care Transparency Act aims to promote transparency and better usability of health insurance pricing information by mandating price transparency requirements via a patient-specific transparency tool and implementing a requirement to make machine readable files for out of network rates, in-network rates, and drug prices public. 

As prior authorization reform remains a legislative priority for the College, the ACS will continue to track this legislation.

Bill to Improve Access to STOP THE BLEED Kits Is Introduced in Senate

US Senators John Cornyn (R-TX), Sheldon Whitehouse (D-RI), Thom Tillis (R-NC), and Chris Coons (D-DE) recently introduced the American Law Enforcement Sustaining Aid and Vital Emergency Resources (SAVER) Act, which would ensure law enforcement and first responders have access to lifesaving supplies in a bleeding emergency. If enacted, the legislation would allow states and local governments to purchase STOP THE BLEED kits and supplies using funds from the Edward J. Byrne Memorial Justice Assistance Grant Program (Byrne JAG), a grant program administered by the US Department of Justice.

The ACS thanks the Senators for their leadership in introducing this important legislation and looks forward to working with Congress to further advance Stop the Bleed efforts. Read the ACS Letter of support.

ACS Urges House to Include Regional Coordination of Medical Operations in PAHPA Bill

The Pandemic and All-Hazards Preparedness Act (PAHPA) was enacted to improve the nation’s response to public health and medical emergencies and was last authorized in 2019. Without Congressional action, these important programs will expire on September 30, 2023. As part of the process to reauthorize the legislation this year, both the House Energy and Commerce and Senate Health, Education, Labor and Pensions Committees have released proposed bills that seek to strengthen and improve the programs that directly affect public health preparedness and response.

The House bill offers a simple reauthorization of existing programs, while the Senate proposal includes new programs and bipartisan updates. The ACS has been working closely with Congress during this process and has advocated for the establishment of a National Trauma and Emergency Preparedness System built on a connected network of Regional Medical Operations Coordination Centers. The ACS believes that a healthcare system that can oversee and coordinate daily medical needs is key to surging when needed in an emergency scenario. 

Due directly to ACS advocacy, the Senate bill, the Pandemic All-Hazards Preparedness and Response Act, contains language in Section 103 that reauthorizes the Hospital Preparedness Program and improves coordination and surge capacity of regional medical operations within and among healthcare coalitions. The language also requires eligible entities to establish and maintain or leverage existing capabilities to enable coordination of regional medical operations within a coalition and between multiple coalitions in close geographic proximity.

Because the House and Senate have proposed different bills that will need to be combined into final legislation, the ACS urges Congress to ensure that the language in Section 103 of the Senate bill is maintained in the final legislative package.