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

Legislative and Regulatory Updates

Advocacy in Action: Congress Acts to Stop Medicare Physician Payment Cuts

On December 22, 2020, Congress passed an extensive and highly anticipated COVID-19 relief package. Most notably, the measure included ACS-supported language to protect patients' access to surgical care by stopping drastic cuts to Medicare physician payment.

This legislative victory would not have been possible without ACS member participation, including a record-breaking number of grassroots efforts to contact Congress about this critical advocacy priority. Approximately 5,000 surgeons from all 50 states plus the District of Columbia sent nearly 20,000 letters to Capitol Hill demanding that Congress stop these harmful cuts, including 2,000 new surgeon advocates who had not contacted Congress prior to this call to action. To put this unprecedented level of grassroots participation into perspective, in 2020, a total of 30,000 letters were sent to Congress on any federal legislative priority.

Ultimately, this advocacy effort demonstrated that strength in numbers is key, friends of surgery in Washington are listening, and sending pre-drafted letters and making calls to legislators is effective. Additionally, personal testimonials and experiences are essential to help tell the story. Whether you contacted Congress by meeting with your lawmakers, writing letters, making phone calls, or by using social media, your efforts made a difference, and we thank you. The ACS Division of Advocacy and Health Policy looks forward to maintaining strong SurgeonsVoice grassroots momentum during the 117th Congress.

To learn more about comprehensive ACS efforts to stop CMS' Medicare payment cuts, visit

Provisions for 1,000 New Medicare-Funded Full-Time Residency Positions Included in Consolidated Appropriations Act of 2021

In addition to provisions that halted the pending cuts in Medicare reimbursement for 2021 and those that addressed surprise medical billing, the Consolidated Appropriations Act of 2021 also contained a provision for the addition of 1,000 new Medicare-funded graduate medical education full-time equivalent residency positions. These additional positions will be phased in over a five-year period beginning in fiscal year 2023.

The law specifies minimum distribution for certain categories of hospitals and directs that no less than 10 percent of the new positions be located in the following locations:

  • Rural hospitals and hospitals treated as rural hospitals
  • Hospitals over their otherwise applicable resident limit
  • Hospitals in states with certain new medical schools and medical schools with additional locations and branch campuses
  • Hospitals that serve health professional shortage areas.

The legislation also includes provisions designed to increase collaboration between rural and urban teaching hospitals allowing residents to gain experience in providing care in rural communities, and it makes adjustment to the Medicare caps and per resident amounts that limit residency training in some hospitals.

The ACS welcomes this development and believes this is an important first step toward increasing the physician workforce that will be necessary to care for a growing and aging population. The ACS has long supported legislative efforts to increase the number of available training slots, especially for disciplines expected to experience worsening shortages such as surgery. It is encouraging that the increases in training positions provided by this legislative action are not limited to only primary care specialties.

The provisions in the Consolidated Appropriations Act of 2021 will free up resources for teaching hospitals, facilitating their ability to continue to invest in the training of physicians over their caps. In addition, the focus on training in rural programs could ultimately serve to alleviate problems with physician maldistribution as studies indicate that residents tend to remain in the same area to practice where they were trained.