Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
ACS Pushes Back against Existential Threats to the Profession
In July, the Centers for Medicare & Medicaid Services (CMS) released its calendar year (CY) 2026 proposed rules for the Medicare Physician Fee Schedule (MPFS), Outpatient Prospective Payment System (OPPS), and Ambulatory Surgical Center (ASC) Payment System. These proposed rules often include provisions that could be detrimental to surgeons, and the ACS continuously fights back—with some success—in efforts to ameliorate the harshest effects on reimbursement and, subsequently, patient care.
The proposed rules for 2026, however, hold some new elements that may be especially damaging. In this challenging environment, the ACS is aggressively pushing back in a number of ways, including with a series of detailed comment letters.
MPFS Proposed Rule
In its letter, the ACS strongly opposed several proposals that would negatively impact physician payment. These proposals included a reduction in the practice expense relative value units (RVUs) allocated to services performed in the facility setting, as well as an “efficiency adjustment” that would cut the work RVUs by 2.5% in CY 2026, with additional reductions every 3 years.
This proposed adjustment runs contrary to peer-reviewed, longitudinal evidence published in the Journal of the American College of Surgeons and discussed in last month’s Advocacy Brief, finding that surgeon are not taking less time to complete procedures as CMS inserted. The data clearly showed that average surgery time has increased in recent years, making this proposal particularly damaging.
While CMS did not propose immediate policy changes to global code payment, the ACS urged the Agency to maintain the current assignment of “procedure shares” within a global code, rather than make changes that would devalue global codes.
The ACS also opposed implementation of the Center for Medicare and Medicaid Innovation’s (CMMI) proposed Ambulatory Specialty Model (ASM), a new mandatory alternative payment model for specialists treating Medicare beneficiaries with chronic conditions of heart failure or low back pain. The College noted that while ASM aims to look across the episode—a positive start—it uses the traditional physician-centered MIPS Value Pathways (MVP) measure framework that will not achieve model goals.
The College commented on several issues related to the Quality Payment Program (QPP) that reduce burden and offer greater flexibility to Merit-Based Incentive Payment System (MIPS) Value Pathway (MVP) participants.
Additionally, the ACS responded to several requests for information (RFIs), including the Core Elements RFI, Medicare Procedural Codes RFI, Toward Digital Quality Measurement in CMS Quality Programs RFI, and RFI Regarding Data Quality.
OPPS/ASC Proposed Rule
In its letter, the ACS strongly opposed CMS’s proposal to eliminate the Inpatient Only (IPO) list. This list identifies services for which Medicare will make payment only when furnished in the inpatient hospital setting. The ACS urged that CMS maintain the IPO list as well as its current annual review to identify procedures that should be removed or added from the list.
The College also provided comments regarding the Hospital Outpatient Quality Reporting (OQR) Program, the Rural Emergency Hospital Quality Reporting Program, and the ASC Quality Reporting (ASCQR) Program, encouraging CMS to maintain structure measures, alongside outcome and process measures, for effective quality program.
Finally, the ACS urged CMS to implement cost measurement price transparency efforts that are inclusive of the full span of care and provide information to both patients and referring physicians on where to seek care that meets their needs.
The ACS recently joined a coalition of organizations representing physicians and other health professionals, students, and academic institutions on a letter urging the Department of Education (DoE) to preserve a long-standing federal loan exception that allows medical students and other health professions students to borrow additional Unsubsidized Direct Loans supplementing statutory limits.
The recently enacted One Big Beautiful Bill Act places lifetime caps on federal student loan borrowing that the ACS is concerned may make medical school unattainable for many students and reduce the incentive of medical graduates to practice in rural and underserved areas. However, since 1996, DoE has recognized the unique financial demands of medical education by permitting additional aggregate Unsubsidized Direct Loan borrowing supplementing statutory limits for certain specialized graduate and professional degree programs.
The letter urges the Department to continue exercising this authority in support of the healthcare workforce. Read the full letter.
On the Hill
Congress Resumes Work to Advance Government Funding Package
Looking towards the end of the governmental fiscal year on September 30, Congress must act to keep the government open. Without action, funding will lapse, and a government shutdown is possible.
Congress is charged with passing 12 appropriations bills that cover all government spending by the end of the fiscal year or, alternatively, pass a Continuing Resolution to continue the current fiscal year funding levels until an agreement has been made, effectively punting the funding deadline to a later date.
As of September 8, only three bills have passed the House of Representatives and three have passed the Senate. Eventually, these bills will need to be conferenced between the two chambers and signed into law to keep the government open.
The bill that covers most health spending has not come to the floor of either chamber. The ACS is working with legislators on advancing surgical priorities in these bills and ensuring the surgeon’s voice is heard throughout the process. However, with a limited congressional calendar for the remainder of September, it is likely Congress will be forced to pass a short-term Continuing Resolution.
Subcommittee Chair Morgan Griffith (R-VA) opened the hearing by noting that while artificial intelligence (AI) has many applications in healthcare—accelerating research, reducing administrative burden, and improving care quality and delivery—it is essential that these tools assist, not replace, the clinical workforce.
Witnesses representing health technology companies, health law, and the American Psychological Association discussed how AI can be leveraged to improve patient care and the efficiency of healthcare delivery, in addition to the legal and ethical challenges it presents.
While both lawmakers and witnesses touted the many benefits and opportunities presented by AI, many also raised concerns about both physician and patient trust, regulatory complexity, and the impact of AI chatbots on mental health, particularly among youth.
The ACS will continue to monitor this issue and engage with lawmakers on the potential impact of AI-related legislation on surgical care.
Regulatory Update
Check Your MIPS Final Scores for Performance Year 2024
On September 9, CMS released performance feedback and final scores for the 2024 performance year of the Merit-based Incentive Payment System (MIPS). This final score determines the payment adjustment that a MIPS participant will receive in 2026, and these payment adjustments will be available in approximately 1 month.
To access MIPS performance feedback and final scores, surgeons should:
Sign in to the Quality Payment Program (QPP) website using their Health Care Quality Information System (HCQIS) Access Roles and Profile (HARP) credentials
Click “View Feedback” on the home page and select their organization (Practice, Alternative Payment Model (APM) Entity, Virtual Group)
Surgeons who believe there has been an error in the calculation of their MIPS final score may select a targeted review up to 30 days after the release of the payment adjustment data. To request a targeted review, surgeons should:
Sign in to the QPP website using their HARP credentials
Select “Targeted Review” on the left-hand navigation
Surgeons should note that targeted review decisions are final and are not eligible for further review.
Register for Practice Management Course at Clinical Congress
Surgeons often are required to make complex decisions that intertwine patient care and practice management. In an industry with increasing competition and innovation, leaders of healthcare organizations—and those delivering care within such organizations—must understand how their success largely depends on the confluence of technical prowess and strategic business thinking.
This course will present topics to understand a well-functioning surgical practice, including revenue cycle, clinical staff requirements, coding, compensation metrics, quality metrics, and dyad leadership models.
The course will equip surgeons with important tools needed to effectively create and capture value, navigate the complexities of patient care, and lead their practices towards sustainable growth and innovation.
This course requires an additional fee to Clinical Congress 2025 registration and takes place October 7, 8:00 am–12:15 pm CT.
