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

Bulletin Advocacy Brief: October 8

October Advocacy at Home Push: Help Educate Lawmakers about Cuts to Medicare Physician Payment

Working to prevent steep cuts to Medicare physician payment remains a top priority for the American College of Surgeons. Congress is listening and together we are making an impact, but you can play an important role to help raise the profile of this issue.

Advocating at home is a simple, effective method of making surgery's voice heard. During the October congressional district work period, help educate elected officials about this critical advocacy priority by doing the following:

  • Meeting with your legislators at home. Requesting a meeting or phone call is easy—use the SurgeonsVoice online scheduling tool to submit your request, and congressional staff will contact you for more information. Once your meeting is confirmed, review Advocacy at Home resources and tips for successful meetings. ACS Division of Advocacy and Health Policy staff also can provide specific talking points or other information to help make your meeting a success.
  • Acting now at SurgeonsVoice. Visit SurgeonsVoice to send prewritten letters to Congress. Current efforts include asking your members of Congress to sign a letter led by Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD, FACS (R-IN), to congressional leadership, plus urging all of Congress to act immediately to help stop the cuts. Action items are updated regularly to reflect recent activity and congressional asks.

For more information, contact ACS DAHP staff at ahp@facs.org.

PPC Updates Financial Resources with Information on Phase 3 Distribution of CARES Act Funds

The ACS Practice Protection Committee's Financial Resources have been updated to include two important new developments from recent days regarding a Phase 3 General Distribution from the CARES Act Provider Relief Fund and significant changes to the repayment provisions of the Medicare Accelerated and Advance Payments program.

On October 1, the Centers for Medicare & Medicaid Services announced a Phase 3 disbursement of $20 billion from the Provider Relief Funds. Applications are currently being accepted through November 6, 2020. The purpose of this distribution is to ensure that all who apply will have the opportunity to receive 2 percent of annual revenue from patient care plus an add-on payment to account for revenue losses and expenses attributable to COVID-19. This funding opportunity is available both to providers who received or rejected funding from prior opportunities, as well as those who entered practice in 2020. Surgeons who have already received funds from previous disbursements may be eligible for an add on payment.

On October 2, legislation was signed into law that extends the grace period for repayment of funds received via the Medicare Accelerated and Advance Payments Program and reduces the percentage of Medicare payments withheld during the repayment period. Physicians can now request up to one full year grace period for deferment before new Medicare charges are used as an offset to recoup the advance payments previously received. Once recoupment begins, physicians have up to 15 months to repay the full amount without interest and the amount withheld is reduced to 25 percent for the first 11 months and 50 percent of charges for the next 6 months. Any balance remaining 29 months after the loan was made will accrue interest at a new lower rate of 4 percent.

More information and the link required to apply for the Phase 3 distribution can be found in the PPC Financial Resources.

SurgeonsPAC-Sponsored VIP Teleconference: Congressional Update with House Majority Leader Steny H. Hoyer

All members are encouraged to participate in an upcoming VIP teleconference with House Majority Leader Steny H. Hoyer, sponsored by SurgeonsPAC. To accommodate the Leader's schedule, this timely Congressional update will take place 2:00–2:45 pm Eastern time Monday, October 19. While a contribution to SurgeonsPAC is not required to join, having a politically active and engaged membership is essential to our efforts. Consider attending and making a 2020 contribution* to SurgeonsPAC. Contributing is easy—additional details are available below.

To contribute online: Visit www.surgeonspac.org and log in using your facs.org username and password. To determine your contribution status once logged in, hover over the "Contribute" tab and click "View Profile" to review your current year/total giving history.

To contribute via your mobile device: Text ACSPA to 41444.

*Note: Contributions to ACSPA-SurgeonsPAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of ACSPA have the right to refuse to contribute without reprisal. Federal law prohibits ACSPA-SurgeonsPAC from accepting contributions from foreign nations. By law, if your contributions are made using a personal check or credit card, ACSPA-SurgeonsPAC may use your contribution only to support candidates in federal elections. All corporate contributions to ACSPA-SurgeonsPAC will be used for educational and administrative fees of ACSPA and other activities permissible under federal law. Federal law requires ACSPA-SurgeonsPAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. ACSPA-SurgeonsPAC is a program of the ACSPA, which is exempt from federal income tax under section 501c(6) of the Internal Revenue Code.

Funding Agreement to Prevent Government Shutdown Signed into Law

President Trump September 30 signed a $1.4 trillion stopgap spending measure to avert a government shutdown and fund the federal government at current levels through December 11. Among other provisions, the bill extends the time in which health care providers must repay Medicare Accelerated and Advance Payment Program loans and reduces the interest rate of those loans to four percent until the COVID-19 public health emergency ends. In addition, the bill extends funding for several health care related programs and initiatives, including the Medicare geographic practice cost index floor, the National Quality Forum, community health centers, community behavioral health clinics, the National Health Services Corps, and Teaching Health Centers.

ACS Opposes Bill to Inappropriately Expand Psychologist Scope of Practice

The ACS joined several physician organizations in opposing the Medicare Mental Health Access Act (H.R. 884/S. 2772), which would expand the scope of practice of psychologists in the Medicare program, particularly in inpatient settings. The bill seeks to amend Medicare's definition of "physician" to include clinical psychologists, which would prevent a coordinated approach to care, creating silos within the care delivery system. The letter notes that psychologists do not have the medical training and expertise necessary to manage the complexities of caring for patients with mental and physical illness in the inpatient setting. In addition, the bill would not expand access to mental health and substance use disorder services, as Medicare already recognizes and allows psychologists to provide and bill for the such services.

ACS Comments on 2021 OPPS/ASC Proposed Rule

The ACS submitted a comment letter to the CMS on October 5 in response to the calendar year 2021 Outpatient Prospective Payment System/Ambulatory Surgery Center Payment Systems Proposed Rule.

Under this rule, CMS proposes to eliminate, over a three-year period, the Inpatient Only list, which includes procedures that can only be paid for in a hospital inpatient setting. Elimination of the IPO list allows such procedures to be paid by Medicare in either the outpatient or inpatient setting. The ACS opposes the elimination of the IPO list, stating that this policy would put patient safety and access at risk, and also create increased documentation and audit burden for physicians and hospitals. The College also expressed concern that other payors will use the lack of the IPO list to inappropriately force patients into the outpatient setting for cost-only reasons, regardless of the decisions made between the patients and their surgeons. In addition, the ACS opposes CMS' proposal to expand prior authorization requirements under Medicare.

The proposed rule also includes updates to the Outpatient Quality Reporting and Ambulatory Surgery Center Quality Reporting Programs. The ACS' comments emphasize that the framework for building quality should be thought of as a clinical improvement program, rather than a set of measures in a payment system. Furthermore, the ACS encourages alignment with hospital and other facility-focused quality programs to reduce administrative burden.

ACS Comments on CY 2021 MPFS Proposed Rule

The ACS submitted a comment letter to the CMS on September 22 in response to the CY 2020 Medicare Physician Fee Schedule proposed rule.

Under this rule, CMS introduced several changes related to office and other outpatient evaluation and management visits, which, if finalized, would become effective in 2021. Because the agency increased the values of the office/outpatient E/Ms, CMS proposed a corresponding increase in analogous codes including maternity, emergency department, end-stage renal disease, behavioral health, and transitional care management services, among others. However, CMS failed to apply the same increases to the value of global surgical codes. The ACS urged the agency to incorporate the increased values of stand-alone E/M codes into global codes to avoid disrupting the relativity in the MPFS, creating specialty differentials, and ignoring recommendations by nearly all medical specialty societies.

The ACS also commented on several telehealth-related issues. First, the College expressed concern that CMS does not consider the differences in the provision of an in-person versus telehealth service as the agency considers adding codes to the Medicare telehealth list, which is the list of services that Medicare allows clinicians to provide using telehealth. The ACS recommended that CMS identify the various inputs needed to provide certain services specifically via a telehealth platform. In addition, the ACS urged CMS to update existing telephone E/M codes for future reintegration as covered services in the Medicare program once the COVID-19 public health emergency is lifted; telephone E/M codes are typically not payable under the Medicare program, but have been temporarily covered during the PHE. The ACS also asked that CMS develop discrete and concise coding, billing, and documentation criteria substantiating the use of audio-only services in specific clinical scenarios to reduce patient safety risks and maintain program integrity.

For more information about the rule and College's comments, contact Lauren Foe, Senior Regulatory Associate in the ACS Division of Advocacy and Health Policy, at lfoe@facs.org.

ACS Submits Comments on CY 2021 QPP Proposals

The ACS submitted comments on September 30 to the CMS proposed policies for the CY 2021 Quality Payment Program, which were included in MPFS proposed rule. As part of the proposed rule, CMS delayed the implementation of the previously finalized Merit-based Incentive Payment System Value Pathways (MVP) as a result of the COVID-19 pandemic.

The MVP is intended to streamline MIPS reporting by limiting the number of required measures to best assess the quality and value of care within a particular specialty or condition to allow for an easier transition to Alternative Payment Models. The program aims to connect measures and activities across the four MIPS performance categories, incorporate a set of administrative claims-based population health quality measures, provide meaningful data and feedback to clinicians, and enhance information to patients.

The ACS supports the delay of MVPs and emphasizes that the framework for building quality should be thought of as a clinical improvement program—not a set of measures in a payment system like the current MIPS program. The ACS advocates for MVPs based on clinical service lines, rooted in a surgical verification program with conformance measures to track avoidable harms, include patient reported outcome measures, and provide resources to understand the cost of delivering outcomes for an episode. The ACS also encourages incorporating alignment with hospital and other facility-focused quality programs to reduce administrative burden while providing multidisciplinary teams with one quality program to fully focus on.

In addition, the ACS comments on the Merit-based Incentive Payment System performance categories—Quality, Cost, Improvement Activities, and Promoting Interoperability—and a newly proposed reporting pathway, the Alternative Payment Model Performance Pathway, as well as Advanced APMs. The ACS' comments focus on ways that administrative burden can be decreased while surgeons' practices and medical care is disrupted as a result of the COVID-19 pandemic.

Read the full text of the ACS comments. For any additional questions or comments, email qualityDC@facs.org.