American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Bulletin Advocacy Brief: July 29

ACS Joins 100-Plus Organizations in Asking Congress to Continue Medicare Payment Relief

Last week, 109 organizations including the American College of Surgeons (ACS) that represent more than 1 million health care professionals sent a letter to congressional leadership urging legislative action to maintain the 3.75 percent increase to the Medicare Conversion Factor (CF) through at least calendar years (CY) 2022 and 2023. The CY 2021 Medicare Physician Fee Schedule (PFS) rule finalized by the Centers for Medicare & Medicaid Services (CMS) included increases to reimbursement for evaluation and management services, which in turn required decreases to the CF used in the PFS due to the statutory "budget neutrality" requirement.

In December 2020, Congress intervened and passed the Consolidated Appropriations Act of 2021, which mitigated the impact of the cuts to most surgical specialties by providing a 3.75 percent payment adjustment to all PFS services in 2021. Unfortunately, the CY 2022 PFS Proposed Rule, which is expected to be finalized later this year, maintains the original decreases, and will result in Medicare payment cuts without congressional intervention to extend the 3.75 percent increase to the CF. The ACS continues to advocate that Congress extend this critical relief and looks forward to working with Congress to address the long-term challenges of the Medicare physician payment system.

Take action! Visit SurgeonsVoice and urge your Representatives and Senators to prevent cuts to Medicare payment before the end of the year.

For details, contact Carrie Zlatos, ACS Senior Congressional Lobbyist, at czlatos@facs.org.

Leading the Coverage: “These Cuts Harm the Care Patients Need and Deserve”

Several media outlets covered the release of the new Medicare Physician Fee Schedule proposed rule, which included a reaction from the Surgical Care Coalition.

Fierce Healthcare published an article on the latest rule including reactions from physician groups, highlighting the Surgical Care Coalition specifically. Fierce Healthcare cited Alan Speir, MD, the Society of Thoracic Surgeons Council on Health Policy and Relationships Chair, who emphasized the need for congressional intervention to stop these harmful cuts. Speir explained, “By acting to mitigate reimbursement cuts for surgical care, Congress acknowledged how misguided and devastating CMS's policies are to patients. Congress must intervene again to ensure that patients are able to access the lifesaving care they need.”

Meanwhile, in Becker’s ASC Review, Richard Hoffman, MD, president of the American Society of Cataract and Refractive Surgery, was quoted saying, "At a time when medical practices have been dramatically impacted by the COVID-19 pandemic, causing a significant backlog of patients in need of surgical care, further cuts are not only unsustainable, they ultimately threaten patient access to care. This is especially true for patients receiving sight-restoring cataract surgery, one of the most successful and frequently performed procedures for Medicare beneficiaries."

Read more about the latest Medicare Physician Fee Schedule in Medscape, Modern Healthcare, and Healthcare Dive.

Surgical Care Coalition Will Host Webinar Discussing Medicare Payment Cuts August 11

To help educate surgeons about the misguided Medicare payment cuts in the Medicare Physician Fee Schedule proposed rule, the Surgical Care Coalition will host a webinar, Pending Cuts to Surgical Care Are Back: How Patients Will Be Harmed by the Cuts. The webinar will outline the pending cuts, how they will impact your practice and your patients, and what actions you can take to stop them. The webinar will take place 7:00–8:00 pm Wednesday, August 11.

One of the three featured speakers will include David B. Hoyt, MD, FACS, ACS Executive Director, who will discuss these harmful cuts to surgical care, the advocacy efforts of the Surgical Care Coalition, and how you can help stop these cuts from taking effect with the other participants, who include the following:

  • Margaret C. Tracci, MD, JD, Vice President of the Policy and Advocacy Council of the Society for Vascular Surgery
  • David B. Glasser, MD, Secretary for Federal Affairs of the American Academy of Ophthalmology

If you are unable to make the live webinar, you are still encouraged to register now, as you will be sent a link to the recording following the live event. Contact the Surgical Care Coalition at info@surgicalcare.org.

RSVP today!

ACS Submits Comments on Cures 2.0 Discussion Draft

The ACS submitted comments earlier this month on a discussion draft of the Cures 2.0 Act, legislation that would build on the landmark 21st Century Cures Act passed in 2015. The draft legislation, released by Representatives Diana DeGette (D-CO) and Fred Upton (R-MI), includes provisions to develop a testing and vaccine distribution strategy to prepare for future pandemics, improve Medicare coverage of innovative technologies, increase diversity in clinical trials, expand the collection and use of real-world evidence by the Food and Drug Administration, provide training and educational programs for caregivers, increase patient access to health information, and increase access to telehealth services. Finally, the bill would establish the Advanced Research Projects Agency for Health, a medical research agency responsible for accelerating new medical breakthroughs that was first proposed by President Joe Biden in his budget.

The ACS’ comments highlight strategies for future pandemic preparedness, including expansion of Regional Medical Operation Centers and the development of a National Trauma System, among other issues. Lawmakers are expected to formally introduce the legislation in late summer or early fall and to push for its passage before the end of the year. The ACS looks forward to engaging with Congress to ensure that the bill includes policies that promote high-quality care, reduce the regulatory burdens placed on physicians, streamline clinical workflows, and empower patients with data. Read the draft text and a section-by-section summary.

For more information, contact Emma Zimmerman, ACS Congressional Lobbyist, at ezimmerman@facs.org.

Bipartisan Solution to Cyclical Violence Act Introduced in the Senate

Last week, Senators Ben Cardin (D-MD) and Roger Marshall, MD (R-KS), introduced the Bipartisan Solution to Cyclical Violence Act, S. 2422. The legislation would authorize grants to expand services and conduct research for hospital-based violence intervention programs (HVIPs). Earlier this year, the House of Representatives passed companion legislation, H.R. 1260, with bipartisan support from key Energy and Commerce Committee leaders. The ACS strongly supports S. 2422/H.R. 1260, not only as a way to prevent violent injury, but also as a step toward the reduction of health inequities.

Take action! Visit SurgeonsVoice and urge your senators to cosponsor and support Senate passage of the Bipartisan Solution to Cyclical Violence Act.

For more information, contact Amelia Suermann, ACS Congressional Lobbyist, at asuermann@facs.org.

ACS Submits Statement for the Record for Senate Hearing on COVID-19 Response

The Senate Committee on Health, Education, Labor, and Pensions (HELP) on July 20 held a hearing, “The Path Forward: A Federal Perspective on the COVID-19 Response.” The ACS submitted a statement for the record to the HELP Committee which highlights a few key areas to help strengthen the nation’s preparedness and response to future pandemics. The statement highlights the success of Regional Medical Operations Centers (RMOCs) in managing the COVID-19 response, the benefits of establishing a National Trauma System, the importance of leveraging the existing clinical data registry structure, management of the blood pool and blood products, and how to manage ongoing acute care needs during and post-pandemic. As the HELP Committee develops public health preparedness legislation, the ACS looks forward to working together to leverage knowledge and best practices in order to strengthen our collective response to future pandemics.

For more information on HELP Committee activity, contact Carrie Zlatos, ACS Senior Congressional Lobbyist, at czlatos@facs.org.

For more information on trauma legislative efforts, contact Amelia Suermann, ACS Congressional Lobbyist, at asuermann@facs.org.

ACS Leads Sign-on Letter from Surgical Coalition Effort on E/M and Global Codes

Last week, the ACS led a sign-on letter with 23 other surgical specialties to express disappointment that CMS continue to fail to incorporate payment increases to stand-alone office/outpatient evaluation and management (E/M) codes into the payment for global codes. Global surgical packages include the payment for postoperative E/M visits, which are not separately billable. Effective in 2021, CMS increased the values of the stand-alone, or separately billable, E/M visits, but would not make corresponding increases to the values of the equivalent postoperative visits that are included in global codes. The letter requests a meeting with CMS to discuss further, and the ACS continues to advocate on this issue, both at the regulatory and legislative levels. The letter can be found here

CMS Issues CY 2022 OPPS/ASC Proposed Rule

CMS released the proposed CY 2020 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) payment rule on July 19. The Agency projects an overall 2.3 percent Medicare payment increase for both hospital outpatient departments (HOPDs) and ASCs in CY 2022.

In last year’s CY 2021 OPPS/ASC rule, CMS finalized a policy to eliminate the Inpatient Only (IPO) list—which includes services that can be safely provided only in an inpatient setting—over the course of three years and removed 298 codes from the list in the first year of the transition. Due to strong stakeholder feedback opposing this policy, including input shared by the ACS through letters and in-person meetings with CMS staff, the Agency has decided to retract such policy and maintain the IPO list. CMS now proposes to stop the phased elimination of the IPO list and to restore the 298 codes back to the IPO list beginning in CY 2022.

CMS also proposes to establish processes through which stakeholders may nominate surgical procedures to be covered in ASCs and to apply for separate payment for non-opioid pain management drugs or biologicals that function as surgical supplies. In addition, other provisions build on CMS priorities to close health equity gaps in quality reporting programs and drive CMS quality incentive programs toward full utilization of digital quality measures. CMS also proposes updates to the various measures included in the Hospital Outpatient Quality Reporting (OQR) Program and Ambulatory Surgical Center Quality Reporting (ASCQR) Program.

The ACS is evaluating these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule and related fact sheet are available online for public review. Contact regulatory@facs.org with questions.