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

Bulletin Advocacy Brief: August 13

Proposed Medicare Payment Cuts Would Negatively Affect Surgical Specialties and Patients

The cuts to Medicare payments for a number of surgical specialties outlined in the Centers for Medicare & Medicaid Service proposed rule on the Medicare Physician Fee Schedule for calendar year 2021 released August 3 would drastically reduce patient access to quality surgical care. Surgeons will see their Medicare payments cut by 9 percent for cardiac surgery, 8 percent for thoracic surgery, 7 percent for vascular surgery, 7 percent for general surgery, 7 percent for neurosurgery, and 6 percent for ophthalmology. In addition, the conversion factor used in the Medicare payment methodology would drop from $36.09 to $32.26—the lowest amount in more than 25 years.

The American College of Surgeons-led Surgical Care Coalition is working harder than ever to stop these cuts from taking effect January 1, 2021, by urging Congress to enact legislation to waive Medicare's budget neutrality requirements for evaluation and management services adjustments and to require that an increased E/M adjustment to all 10- and 90-day global code values. Read the Surgical Care Coalition’s response to the rule.

Medicare Payments Fail to Keep Pace with Inflation

College Continues to Oppose Flawed Proposed Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services’ proposed rule on the Medicare Physician Fee Schedule describes previously finalized changes to its coding and billing policies for office/outpatient evaluation and management (E/M) visits. Beginning in 2021, CMS will eliminate the history and physical exam as elements for evaluation and management code selection and will instead allow physicians to choose the E/M visit level based on the extent of their medical decision making or on time spent on the day of the encounter. CMS also will increase the value of most office, outpatient and E/M services, but these increases will not apply to global surgery codes.

To offset the increase in payment for E/M, CMS must cut reimbursement for other services. The agency therefore proposes to decrease the conversion factor from $36.09 to $32.26—a significant change of approximately 10.6 percent. CMS estimates a 7 percent reduction in total allowed charges for general surgery services relative to its proposals for 2021. The American College of Surgeons will continue to oppose CMS’ failure to increase payment rates for the E/M portion of 10- and 90-day global surgical packages.

In addition, the MPFS includes proposed changes to coverage for telehealth services after the COVID-19 public health emergency ends. CMS proposes to add certain services to the Medicare telehealth list permanently, along with a series of services that may be added to the telehealth list temporarily and remain payable only through the calendar year in which the PHE expires. The agency also seeks stakeholder feedback on the development of permanent coding and payment for audio-only telephone E/M visits.

The ACS is evaluating these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule is available for public review, along with a fact sheet on its payment provisions. Contact regulatory@facs.org with questions.


Take Action: Tell Congress to Stop the Cuts

You can help stop the proposed Medicare Physician Fee Schedule cuts by writing to your senators and representatives in Congress. Call on your elected officials to enact legislation to waive Medicare's budget neutrality requirements for these E/M adjustments and to require CMS to apply the increased E/M adjustment to all 10- and 90-day global code values.

Contact Congress today

Dr. John Wilson: CMS Rule Should be Considered “Public Health Malpractice”

In response to the Centers for Medicare & Medicaid’s proposed payment rule, John A. Wilson, MD, FACS, FAANS, contributed an op-ed piece to the Winston-Salem Journal examining how it would undercut surgical practices and hospitals across America, especially during the COVID-19 pandemic. Dr. Wilson noted, “A cut of this magnitude in normal times would be a shock to our health care system. But to make these cuts in the middle of this pandemic is devastating and represents public health malpractice.” Dr. Wilson urges Congress to waive budget neutrality to stop the cuts to Medicare to save patients’ access to surgical care.

CMS Releases Proposed Updates on the CY 2021 Quality Payment Program

The Centers for Medicare & Medicaid Services released proposed updates for the calendar year 2021 Quality Payment Program August 3 as part of the calendar year 2021 Medicare Physician Fee Schedule proposed rule. The proposed rule includes an increase in the overall MIPS threshold, adjustments to the Cost and Quality performance category weights, and updates to quality measure benchmarking policies to account for skewed quality reporting during the pandemic.

In 2021, surgeons participating in the QPP’s Merit-based Incentive Payment System would need to meet CMS’ proposed 50-point performance threshold across the four categories—Cost, Quality, Promoting Interoperability and Improvement Activities—to avoid a penalty in 2023. CMS’ proposed rule also reiterates that clinicians who have found their MIPS reporting has been disrupted because of the COVID-19 pandemic will be eligible to apply for reweighting of the MIPS performance categories through the extreme and uncontrollable circumstances exception for the 2020 performance year and extends this exception to Alternative Payment Model (APM) entities, which previously were unable to apply.

Furthermore, CMS delayed the implementation of the MIPS Value Pathways framework until, at the earliest, the 2022 performance year. The MVP framework was previously finalized as a new MIPS reporting pathway that would move away from reporting the siloed activities and measures in the current system to a framework that aims to align measures and activities across the four MIPS performance categories based on conditions and specialties.

In addition to proposed updates to MIPS, CMS requests feedback on a new participation framework, the APM Pathway (APP), which would be available clinicians who participate in APMs. To align with the newly proposed pathway, CMS proposes to sunset the CMS Web Interface reporting option beginning with the 2021 performance year. If finalized, clinicians who previously reported MIPS data using the CMS Web Interface will have to choose a new reporting mechanism such as the APP, direct submission via the electronic health record, Qualified Registry, Qualified Clinical Data Registry, or claims beginning in 2021.

The American College of Surgeons is analyzing these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule is available for public review, along with a fact sheet on its QPP provisions. For more information, contact qualityDC@facs.org.

MISSION ZERO Funding Included in Final House Package

As the Labor, Health and Human Services, Education, and Related Agencies (LHHS) funding bill moved through debate on the floor of the House of Representatives, Reps. Donald Norcross (D-NJ) and Vicky Hartzler (R-MO) proposed an amendment to provide the full $11.5 million in funding for the military-civilian partnerships under the trauma readiness grant program, also known as the MISSION ZERO Act. This amendment was accepted with a bundle of other bipartisan amendments to be included in the final package, which the House passed with a final vote of 217 to 197.

Now that the House has provided full funding for this critical program, attention turns to the Senate where funding conversation are still ongoing. It is critical that your senators hear from you on the importance of funding for civilian-military partnerships. Find a prewritten letter to your senator at SurgeonsVoice.

Learn more about MISSION ZERO. For more information on this effort, contact Hannah Chargin, American College of Surgeons Congressional Lobbyist, at hchargin@facs.org.

Advocate at Home to Advance Surgical Advocacy Priorities

The American College of Surgeons Division of Advocacy and Health Policy continues to advocate on behalf of surgery in Washington, DC. This includes educating lawmakers about important surgical advocacy priorities, particularly Centers for Medicare & Medicaid Services proposed cuts to Medicare physician payment beginning January 1, 2021.

However, leveraging surgery’s voice at home is equally important. Regularly engaging with elected officials at home is a powerful way to raise the profile of issues, share personal stories, become a trusted resource to members of Congress and staff and effect change. To supplement ACS Fellows’ advocacy efforts at home, the ACS DAHP recently updated several resources available to all surgeon advocates. In addition to contacting Congress about critical advocacy priorities via SurgeonsVoice, Fellows, Associate Fellows and Resident Members are encouraged to visit facs.org to learn more and use a new feature to schedule a meeting with their legislators during the August congressional in-district work period. For more information, contact ahp@facs.org.

Media Pick Up on Surgical Care Coalition’s Response to the CMS Physician Fee Schedule Proposed Rule

The Surgical Care Coalition’s efforts to prevent the payment cuts to surgical specialties was cited in many articles concerning the proposed Medicare Physician Fee Schedule. The coalition earned mentions in numerous health care publications. Fierce Healthcare, Becker’s, Medscape, Inside Health Policy, Healthcare Dive, Health Leaders, and TCTMD, all shared the Surgical Care Coalition’s response to the Centers for Medicare & Medicaid Services’ proposed payment cuts. Coverage noted the coalition’s view that the rule is disappointing for patients and surgeons alike and that the middle of a pandemic is no time to make cuts to health care providers. Media coverage also highlighted the substantial cuts to specific surgical specialties and the coalition’s proposed solutions to Congress.

“It’s Already Difficult Enough”

Society of Thoracic Surgeons President Joseph Dearani, MD, FACS, Michigan vascular surgeon Nicolas Mouawad, MD, MD, MPH, FACS, and American College of Surgeons Executive Director David B. Hoyt, MD, FACS, were quoted in a recent TCTMD article explaining the negative impact of the Centers for Medicare & Medicaid Services’ Medicare payment cuts to surgical specialties. Specifically, Dr. Dearani said, “It's inappropriate for there to be any cuts to any physicians at the current time given the parallel problem of the pandemic.” Dr. Mouawad added, “As health care providers and surgeons, we are trying so hard to take care of patients, and it’s already difficult enough with the current COVID-19 pandemic to get patients to come in for care. They are already scared. This is absolutely not the time to decrease any health care resources.”

CMS Projects Payment Increase for Ambulatory and Outpatient Surgery Services

The Centers for Medicare & Medicaid Services (CMS) August 4 released the proposed calendar year 2021 Outpatient Prospective Payment System/Ambulatory Surgical Center payment rule, which the agency projects will yield an overall 2.6 percent reimbursement increase for both hospital outpatient departments and ASCs next year.

More specifically, CMS proposes to eliminate the Inpatient Only list, which includes services that the agency has previously identified as typically provided in the inpatient setting and, therefore, not payable under the OPPS over a three-year transition period. The list would be phased out completely by CY 2024. CMS would begin this process by removing nearly 300 musculoskeletal-related services from the IPO list, making these procedures eligible for payment under the OPPS in the hospital outpatient setting. CMS also proposes to add two types of services—cervical fusion with disc removal and implanted spinal neurostimulators—to the list of procedures that will require prior authorization in the hospital outpatient department.

In addition, CMS proposes to update the methodology that is used to calculate the Overall Hospital Quality Star Rating, beginning in CY 2021. The new methodology is intended to reduce provider burden, improve the predictability of the star ratings and make it easier to compare ratings between similar hospitals. Within this rule, CMS also proposes updates to further align the Outpatient Quality Reporting and Ambulatory Surgical Center Quality Reporting programs. CMS is not proposing any measure additions or removals.

The American College of Surgeons 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 for more information.