ACS Advocacy Brief: November 7, 2024

ACS Seeks Two Qualified Surgeons to Fill Advocacy and Health Policy Medical Director Roles

The ACS has announced the availability of two part-time Medical Director roles (each 20% FTE) in the Division of Advocacy and Health Policy (DAHP), which is based in Washington, DC. The individuals selected will work with the staff of the DAHP and other staff throughout the College.

These positions include:

Medical Director for Surgeon Engagement (Part-Time)

Responsibilities include but are not limited to engaging Fellows in advocacy initiatives, drafting health policy and advocacy articles, and presenting to surgeon audiences regarding advocacy and health policy issues. The selected candidate also will lead the coordination and development of practice management resources to assist Fellows with the business aspects of their practices.

Medical Director for Health Policy Research (Part-Time)

Responsibilities of this position will include but are not limited to developing and implementing a resident scholar program in health policy and advocacy and engaging in health policy research in coordination with the ACS policy agenda.

Applications for these positions will be accepted through December 6, 2024.

MPFS Confirms Medicare Payment Cut

On November 1, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2025 Medicare Physician Fee Schedule (MPFS) final rule. This rule updates payment policies for services furnished under the MPFS on or after January 1, 2025.

The Agency estimates a CY 2025 conversion factor of $32.35, which is a decrease of nearly 3% from the CY 2024 conversion factor—as such, absent Congressional intervention, general surgery will face a 2.8% cut in Medicare Part B payments.

Help Reverse Medicare Payment Cut

Just days before the release of the final rule, a bipartisan group of legislators including Representatives Greg Murphy, MD, Jimmy Panetta, Mariannette Miller-Meeks, MD, Ami Bera, MD, Larry Bucshon, MD, Raul Ruiz, MD, John Joyce, MD, and Kim Schrier, MD, introduced the Medicare Patient Access and Practice Stabilization Act in the House of Representatives. This legislation would stop the cut and provide a 1.8% inflationary update (half of the Medicare Economic Index) for 2025.

The ACS strongly supports this bill, which, in addition to stopping the pending cut would provide partial relief towards increasing medical practice cost inflation. As measured by the Medicare Economic Index (MEI), practices are expected to face a 3.6% increase in inflation. This bill includes a partial MEI update of approximately 1.8%.

Since 2001, physicians have seen their Medicare physician payments decrease by 13% in real terms between 2001 and 2024 before indexing for inflation. Surgeons continue to face these yearly proposed cuts while also contending with a payment system that has not kept pace with inflation. When adjusted for inflation, Medicare physician payments have decreased by nearly 30% in this same period. This is not a sustainable pathway, and long-term reform is necessary to stabilize the broken payment system.

With just a few moments of your time, you can visit SurgeonsVoice and urge Representative to cosponsor the Medicare Patient Access and Practice Stabilization Act. Your efforts have led to numerous advocacy wins in 2024, and you can again play a key role in advancing this necessary legislation.

Other Notable Provisions

In the rule, CMS finalized new coding and billing requirements for global surgical packages. The agency broadened the applicability of the existing transfer of care modifier 54, which must be reported for all 90-day global packages in any case when a practitioner expects to furnish only the surgical procedure portion of the global package to now include both formal and other transfers of care.

CMS also established a new evaluation and management (E/M) add-on code, G0559, to account for resources involved in post-operative follow-up care related to a surgical procedure within the 90-day global period that the agency said are, at times, provided by a practitioner who was not involved in furnishing the procedure.

Additionally, CMS expanded access to colorectal cancer screening by adding coverage for computed tomography colonography and eliminating beneficiary cost-sharing for follow-on colonoscopies furnished after a positive blood-based biomarker test or non-invasive stool-based test.

The agency also extended several flexibilities for telehealth services—including the suspension of frequency limitations for subsequent inpatient visits, subsequent nursing facility visits, and critical care consultations furnished via telehealth; a waiver allowing practitioners to report their enrolled practice address instead of home address when performing telehealth services from their homes; and a waiver allowing the virtual supervision of residents and auxiliary personnel by a supervising physician in certain clinical scenarios—through CY 2025.

CMS Releases Final CY 2025 QPP Rule

The MPFS final rule also included updates for Performance Year (PY) 2025 of the Quality Payment Program (QPP). As part of its comment letter in response to the MPFS proposed rule, the ACS commented on several of the Agency’s QPP proposals issued earlier in the year.

The QPP offers two pathways for providers who participate in Medicare: The Merit-based Incentive Payment System (MIPS), and Advanced Alternative Payment Models (APMs). Performance in the QPP in 2025 can result in payment adjustments of up to +/- 9% in 2027.

For the 2025 performance year (2027 payment year), CMS finalized several new MIPS policies; however, many of the major MIPS policies remain the same from 2024 to 2025. Key policies that remain unchanged include the performance threshold of 75 points required to avoid a penalty in 2027 (based on 2025 performance), and the performance category weights values:

• Quality: 30%
• Cost 30%
• Improvement Activities (IA): 15%
• Promoting Interoperability (PI): 25%

New policies of note include the addition of six MIPS Value Pathways (MVPs), three of which are relevant to surgical care: ophthalmology, urology, and surgical care. MVPs are a reporting option that includes a subset of measures and activities related to a specific specialty or medical condition that are intended to offer a more connected assessment of quality and reduce complexity; however, the ACS sees flaws in the current MVP structure and did not support the addition of the Surgical Care MVP. MVPs can be reported on a voluntary basis starting with the 2025 performance year, making a total of 21 MVPs available for reporting in 2025.

CMS also finalized a revision to its cost scoring methodology and updated its methodology for scoring top quality measures for specialties with limited measures. CMS will apply the revised cost scoring methodology beginning with the 2024 performance year to rectify previously flawed methods of calculating cost category scores. The agency noted that it expects the mean final score to increase by 3.89 points under this policy.

While the ACS commented that CMS should extend the new methodology to previous years, the agency stated that applying modified scoring to finalized calculations is not feasible.

The final rule is available for public review, along with resources on its QPP provisions. Contact hjeffcoat@facs.org for more information.

OOPS/ASC Final Rule Is Released

In addition to the MPFS, CMS also released the calendar year (CY) 2025 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. In this rule, CMS increased OPPS payment rates for hospitals and ASCs that meet applicable quality reporting requirements by 2.9%.

To align with policies established in the CY 2025 MPFS rule, CMS finalized several coverage changes for colorectal cancer (CRC) screening services. In addition, the agency enacted policies to streamline prior authorization (PA) processes and shorten the period under which payors must render PA decisions from 10 business days to 7 calendar days.

CMS also finalized the addition of measures to the Hospital Outpatient Quality Reporting program and the ASC Quality Reporting program. Three notable new measures address health equity and social determinants of health, while others reflect patient understanding of key information and patient-reported outcomes.

The final rule and related fact sheet are accessible online for public review. Contact regulatory@facs.org with questions.

Congressional Leaders Raise Concern about Medicare Advantage Falling Short

Last week, Democratic Congressional leaders sent a letter to CMS expressing concern that Medicare Advantage plans are failing to provide expected high-quality standards of care for seniors. The letter highlights the growing use of prior authorization to deny or delay care, specifically with the expansion of algorithms and artificial intelligence to make these coverage determinations.

The Senate Finance Committee issued a press release quoting ACS Executive Director & CEO Patricia Turner, MD, MBA, FACS:

“The American College of Surgeons remains committed to improving care for surgical patients. The overutilization of prior authorization in Medicare Advantage plans has rapidly increased over the last several years. We thank Congressional leaders for strongly supporting increased transparency and streamlining this overly burdensome process to ensure patients have access to timely and high-quality care as part of its oversight of Medicare Advantage plans' use of prior authorization,” she said.

This letter calls on CMS to use its oversight and enforcement power to rein in the misuse of prior authorization by leaders of multiple key committees on healthcare, which demonstrates a unified message that will ideally support inclusion of congressional policy to streamline prior authorization in an end of year spending package.

Dr. Don Selzer Is ACS Advocate of the Year

Don J. Selzer, MD, FACS, of Indianapolis, Indiana, is the 2024 ACS Advocate of the Year. Dr. Selzer is the Willis D. Gatch Professor of Surgery, chief of the Division of General Surgery, and associate chair of the Department of Surgery at Indiana University School of Medicine.

The prestigious honor was awarded during the Annual Business Meeting of Members at the 2024 Clinical Congress in San Francisco, California, recognizing his strong commitment to advancing and supporting ACS advocacy activities and programs. Dr. Selzer has led by example, serving as the Vice-Chair of the ACS Coding and Reimbursement Committee, Advocacy Pillar Lead of the ACS Board of Governors, and Past-Chair of the ACS Legislative Committee.

Dr. Selzer words and actions recognize the vital importance of educating and engaging with lawmakers in Washington, DC, to drive change and ensure that the surgical community's voice is heard in Congress.

Thank You for SurgeonsPAC Contributions at Clinical Congress 2024

The ACS thanks all who contributed to SurgeonsPAC at this year’s Clinical Congress in San Franciso, which helped the College surpass its fundraising goal and raise nearly $61,000. The ACS received contributions from 235 individuals onsite, including 63 first-time contributors. Whether a first-time contributor or a recurring donor, member support of SurgeonsPAC is appreciated and will continue to make a positive impact on surgery and surgical patients.

SurgeonsPAC remains a critical tool and member benefit at our disposal which allows the ACS to develop the resources necessary to educate and engage members of Congress, plus evaluate candidates seeking federal office. SurgeonsPAC prioritizes patients over politics and works to build and maintain relationships with key policymakers who share surgery's perspective on relevant ACS-supported policies.

Visit the SurgeonsPAC webpage to learn more.