ACS Advocacy Brief: December 14, 2023

Senate Passes Bill to Increase Access to STOP THE BLEED Kits

The US Senate unanimously passed the American Law Enforcement Sustaining Aid and Vital Emergency Resources (SAVER) Act on November 29. The legislation, which would help ensure law enforcement and first responders have access to lifesaving supplies in a bleeding emergency, was introduced by Senators John Cornyn (R-TX), Sheldon Whitehouse (D-RI), Thom Tillis (R-NC), and Chris Coons (D-DE).

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), which is administered by the US Department of Justice.

The ACS endorsed the legislation and thanked Senate leadership for helping to eliminate preventable deaths from bleeding.

 ACS continues to advocate for STOP THE BLEED^® legislation and looks forward to working with Congress to introduce the legislation in the US House of Representatives.

More than 100 Stakeholder Organizations Urge Passage of PAHPA

The ACS has joined more than 100 stakeholders in sending a letter to Congressional leadership urging passage and reauthorization of the Pandemic All-Hazards Preparedness Act (PAHPA) before the end of the year.  

PAHPA was enacted to improve the nation’s response to public health and medical emergencies and was last authorized in 2019. The programs authorized by PAHPA were set to expire on September 30 but were temporarily extended through January 19 as part of the most recent funding agreement.

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 College 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 that eligible entities 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 very different bills that must be combined into a final bill, the ACS urges Congress to ensure that the language in Section 103 of the Senate bill is maintained in the final legislative package.

ACS Shares AI Principles with Congressional Committees

The College submitted two statements for the record in response to recent congressional hearings on the role of artificial intelligence (AI) in healthcare.

The Senate Health, Education, Labor & Pensions (HELP) Primary Health and Retirement Security Subcommittee held a hearing on November 8, “Avoiding a Cautionary Tale: Policy Considerations for Artificial Intelligence in Health Care.” The House Energy & Commerce Health Subcommittee held a similar hearing later that month, “Understanding How AI is Changing Health Care.”

The College’s statements focus on the vital importance that AI tools are trained and maintained with high-quality, diverse, valid, and representative data and are regularly assessed for continued accuracy and reliability; that regulators engage clinical experts in the assessment of AI health tools; and that physicians’ clinical judgment remains paramount.

Read the statement to the HELP Committee and the statement to the Energy & Commerce Committee. The College will continue monitoring and offering guidance on implementation of AI in surgery and healthcare and will continue to work with Congress in this area.

Ways and Means Committee Continues Oversight of Surprise Billing Implementation

The House Committee on Ways and Means continues to provide oversight regarding the implementation of the No Surprises Act.

In November, the Committee sent a letter to the Biden Administration expressing concern that some patients still receive a balance bill following the independent dispute resolution process. The letter also urges federal agencies to enforce the patient protections established by the law and highlights the delays in issuing rulemaking on the advanced explanation of benefits provision of the law.

Additionally, the Committee held a roundtable discussion in October with Administration officials to discuss implementation of the law and held a hearing in September where Congress heard directly from witnesses who testified about delays in processing of claims, unfair payment decisions, and reduced care for patients.

The ACS continues to monitor the implementation of surprise billing regulations.

ACS Fellow Monica Bertagnolli Confirmed as NIH Director

The Senate confirmed Monica M. Bertagnolli, MD, FACS, as director of the National Institutes of Health (NIH) in a 62–36 vote last month.

Dr. Bertagnolli is a world-renowned oncologic surgeon and cancer researcher who has served as director of the National Cancer Institute since October 2022, and is now the first surgeon and second woman to serve as permanent head of NIH. She replaces principal deputy director Lawrence Tabak, DDS, who worked as NIH acting director since the departure of long-time director Francis Collins, MD, in 2021.

Dr. Bertagnolli also received the Owen H. Wangensteen Scientific Forum Award at the 2023 ACS Clinical Congress in Boston, Massachusetts. Read more about the award and Dr. Bertagnolli’s career.

Congress Works to Address Impending Medicare Payment Cuts

Last week, Representatives Greg Murphy, MD (R-NC), Danny Davis (D-IL), Brad Wenstrup, DPM (R-OH), Jimmy Panetta (D-CA), Larry Bucshon, MD (R-IN), and Michael Burgess, MD (R-TX), introduced the Preserving Seniors’ Access to Physician Care Act of 2023.

This ACS-supported legislation would eliminate the full 3.37% cut to Medicare physician payment set to take effect on January 1.

In addition, the House Energy & Commerce Committee advanced 44 pieces of legislation, including a slate of healthcare bills aimed at lowering prescription drug costs, increasing access to innovate treatments and technology, and strengthening the Medicare payment system. 

Included in the list was the Physician Fee Schedule Update and Improvements Act, led by Representatives Mariannette Miller‐Meeks, MD (R-IA), Kim Schrier, MD (D-WA), Larry Bucshon, MD (R-IN), and Robin Kelly (D-IL). The bill would partially mitigate impending Medicare physician payment cuts, as well as make changes to the budget neutrality requirements of the Medicare physician fee schedule.

The ACS led a coalition letter expressing thanks for the legislation while continuing to call on Congress to stop the full cut. Read the letter.

On November 8, the Senate Finance Committee unanimously advanced the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act. The legislation would mitigate the impending 3.37% Medicare physician fee schedule cut by extending the 2.5% payment adjustment provided in 2023, rather than letting it drop to 1.25% in 2024.

The bill contains a variety of additional policies, including provisions related to addressing mental health clinician workforce challenges, ensuring accurate provider directories under Medicare Advantage, and reforms related to pharmacy benefits under Medicare. Congress must act before the end of the year to stop the cuts from going into effect in 2024.

Write your elected officials and tell them to stop the full cut to Medicare payments! 

2023 Was Productive Year for ACS State Advocacy

State lawmakers have significant power in shaping policies and regulations directly affecting surgeons and their practice. In 2023, the ACS State Affairs team reviewed 5,823 bills, monitoring and tracking 877. A feature article in the November/December Bulletin provides an overview of the victories and work to come on a variety of issues across the US.

Key ACS priorities addressed in the article include trauma system funding and development, STOP THE BLEED legislation, efforts to remove barriers to cancer care, review of burdensome Prior Authorization and utilization that can delay care, tort reform that strikes a balance between patient rights and professional liability concerns, the sensitive issue of the criminalization of physician care, and support for ACS chapter that are instrumental in continuing to shape state-level health policies.

Read the article. 

ACS Delegation Helps Shape Health Policy at AMA Interim Meeting

The 2023 Interim Meeting of the American Medical Association (AMA) House of Delegates (HOD) took place November 10-14 and led to significant decisions and impactful discussions that will shape the future of healthcare.

ACS Presence

The ACS delegation to the HOD achieved significant progress that will see the AMA advocate for key issues important for surgeons. The Board of Trustees Report 06, calling for a national Good Samaritan law to protect physicians who provide emergency care, was adopted. Also adopted was Resolution 813, “Strengthening Efforts Against Horizontal & Vertical Consolidation,” which is aimed to enforce antitrust laws for vertical acquisitions in healthcare. The delegation provided testimony on resolutions in all Reference Committees both supporting and opposing measures impacting the practice of surgery for years to come.

The ACS delegation includes Chair Jacob Moalem, MD, FACS; John Armstrong, MD, FACS, FCCP; Ross Goldberg, MD, FACS; Leigh Neumayer, MD, MBA, MA, FACS; Naveen Sangji, MD, MPH; Kenneth Sharp, MD, FACS; Daniel Dent, MD, FACS; Lena Napolitano, MD, FACS, FCCP, FCCM, and Resident & Fellow Section Delegate Michael Visenio, MD, MPH.

A New Vice Speaker: Dr. John Armstrong

The historic election of Dr. Armstrong as Vice Speaker of the AMA HOD is an achievement marking the highest position ever held by a member of the ACS delegation. The accomplishment is a testament to Dr. Armstrong's exceptional leadership and dedication to the advancement of healthcare.

At the Interim Meeting, Dr. Armstrong led the HOD business sessions through multiple reference committees, navigating complex healthcare policy issues. His guidance and contributions helped shape the AMA's agenda and ensure the voices of all physicians were heard at the highest levels of healthcare policymaking.

As Vice Speaker of the AMA House of Delegates, Dr. Armstrong will continue to champion the cause of surgeons and advocate for policies that promote quality, accessible, and equitable healthcare for all Americans, and the ACS and the AMA delegation are grateful for his service and commitment.

Combating Medicare Payment Cuts: A Critical Issue

A central theme of the meeting was the pressing issue of Medicare payment cuts, which threaten to erode physician compensation and hinder access to quality care.

The HOD adopted Resolution 216, “Saving Traditional Medicare,” reaffirming the AMA’s efforts to fix the flawed Medicare payment system for physicians, recognizing traditional Medicare is a critical healthcare program while educating the public on the benefits and concerns of Medicare Part C and Medicare Advantage plan expansion.

The House also adopted Resolution 235, “Preventing Imminent Payment Cuts and Ensuring the Sustainability of The Medicare Program,” which prioritizes preventing the imminent 3.4% Medicare payment cut from taking effect in January 2024.

Advocating for Physician Well-being

The HOD recognized the importance of physician well-being and the need to address systemic factors contributing to burnout and stress among healthcare professionals. The House of Delegates received significant supportive testimony online and in-person for public health and the need to remove administrative burdens like prior authorization, opposing government interference in health care decision-making, and reaffirming the importance of the physician-led healthcare team.

For more information on the interim meeting, visit the AMA’s website.