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

Legislative and Regulatory Updates

Economic Survival Strategies in the COVID World: A Guide From the ACS Practice Protection Committee

As part of its ongoing efforts to assist surgeons managing the intense financial burden placed upon them by the pandemic, the American College of Surgeons (ACS) Practice Protection Committee has built upon the Practical Suggestions and Options to Consider section of its resource document to provide a guide to economic survival strategies. The document can be found here and includes a set of key principles and a suggested process for Fellows to undertake based on an Excel spreadsheet exercise of personal and business finances. In addition, the committee has provided suggestions to consider based on which of three specific scenarios they believe most accurately describes their financial situation.

Newly Introduced Legislation May Provide Financial Relief to Physician Practices

The Coronavirus Aid, Relief, and Economic Security (CARES) Act expanded the Centers for Medicare & Medicaid Services’ (CMS) Accelerated and Advance Payment (AAP) program to allow hospitals, physicians, and other Medicare-participating providers to apply for upfront payments from Medicare to help cover revenue shortfalls during the COVID-19 public health emergency. However, the American College of Surgeons (ACS) was dismayed that CMS’ plan for implementation has rendered the program unworkable for physician practices in the short term. CMS has since suspended the program, and the ACS believes modifications are necessary to ensure its usefulness for physicians. Read the College’s letters to the Senate and House.

Sens. Jeanne Shaheen (D-NH) and Michael Bennet (D-CO), along with Reps. Brad Schneider (D-IL) and Ron Kind (D-WI), recently introduced the Medicare Accelerated and Advanced Payments Improvement Act, H.R. 6837/S. 3750, which would greatly enhance the utility of the program by reducing interest rates (currently as high as 10.25 percent) to 1 percent and modifying repayment obligations to provide more time for physicians. The ACS supports this legislation, which would bring needed flexibility to the AAP program.

ACS Supports Telehealth Coverage for Patients Who Have ERISA Health Care Coverage

The American College of Surgeons (ACS) supports legislation that Reps. Kim Schrier, MD (D-WA), and Phil Roe, MD (R-TN), and Sen. Tina Smith (D-MN) recently introduced—The Health Care at Home Act, H.R. 6644/S. 3741, which would establish payment parity for telehealth and in-office visits. More specifically, the legislation would require private payors, including employer-provided Employee Retirement Income Security Act (ERISA) plans, to reimburse telehealth services for normally covered benefits at the same rate as office visits during the COVID-19 public health emergency (PHE). Read the College’s letter here.

The Centers for Medicare & Medicaid Services (CMS) has made several important changes to ease regulatory barriers to telehealth and enforce payment parity for telehealth visits during the PHE; however, private payors, including employer-provided ERISA health plans, have not necessarily followed suit.

ACS Provides Testimony on Trauma, Cancer, and Patient Identification Appropriations to Senate Subcommittee

The American College of Surgeons (ACS) recently provided written testimony to the U.S. Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies as the subcommittee plans for fiscal year 2021 appropriations. The ACS’ testimony outlined several appropriation-related priorities, including complete funding of $11.5 million for the MISSION ZERO program, increased funding for cancer prevention and research, funding specifically for public health research into firearm morbidity and mortality, and removal of a ban that prevents the Department of Health and Human Services from evaluating a range of patient identification solutions.

CMS Releases FY 2021 IPPS Proposed Rule Projecting $2 Billion Increase in Hospital Spending

The Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2021 Medicare Inpatient Prospective Payment System (IPPS) proposed rule May 11. Under the provisions in this rule, CMS projects a more than $2 billion increase in total Medicare Part A spending on inpatient hospital services furnished October 1, 2020, to September 30, 2021.

CMS proposes to conduct a comprehensive review of its process for determining whether certain surgical procedures should be classified as operating room (OR) services—which are reimbursed at a higher rate than non-OR services—for the purposes of IPPS payment. The agency would review several factors, including Medicare claims data and relative resource requirements of various services to better recognize the complexity and costs of surgical procedures. CMS also proposes to provide additional reimbursement for certain new medical devices and technologies under the IPPS with the intent to reduce financial barriers to investment and adoption by hospitals.

CMS previously finalized a rule requiring that hospitals make publicly available their Medicare cost reports, which list various standard charge data for the clinical services performed at each hospital. The agency proposes to require hospitals to add more information to their cost reports, including median payor-specific charges per Medicare Severity Diagnosis Related Group (MS-DRG). CMS indicates that these market-based charge data may provide a more accurate estimate of relative hospital resources use across different MS-DRGs.

The agency proposes various changes to IPPS quality incentive programs. Some key proposals include minor changes to the Hospital Acquired Condition (HAC) Reduction Program and Hospital Readmissions Reduction Program (HRRP) applicable performance periods and validation processes to continue alignment of hospital quality programs. CMS also proposes to and incrementally increase the electronic Clinical Quality Measures data a hospital has to report under the Hospital Inpatient Quality Reporting (IQR) Program and the Promoting Interoperability (PI) program. Additionally, CMS opted not to make anticipated changes to the Hospital Quality Star Ratings methodology at this time.

The ACS is evaluating this proposed rule and will submit comments to CMS on policies relevant to surgeons and surgical patients. Read the proposed rule and related fact sheet. Contact regulatory@facs.org with questions.

CMSS Encourages Congress to Maintain and Sustain Health Care Workforce

The Council of Medical Specialty Societies (CMSS), which includes the American College of Surgeons, sent a letter last week to U.S. congressional leaders recommending additional efforts to maintain the nation’s health care workforce by retaining physicians and scientists in the U.S. and by expediting entrance of physicians into the country. The letter notes that the U.S. health care system relies heavily on international medical graduates (IMGs), who represent more than 25 percent of the physician workforce in the U.S. These physicians are training or practicing here legally on a visa or other protected status. Nearly 21 million Americans live in an area where at least half of the physicians are foreign-trained. These highly qualified physicians are an important segment of the nation’s health care workforce in U.S. teaching hospitals and in medically underserved areas—especially during the COVID-19 pandemic. The nation will face numerous challenges in the coming months.

CMSS urges Congress to encourage the federal government to engage in the following activities:

  • Ensure that visa policies will continue to identify physicians as important for national security in terms of health
  • Continue and prioritize visa processing for physicians and medical residents
  • Expedite adjudications of extensions and changes of status for physicians and medical residents practicing or otherwise lawfully present in the U.S.

Read the letter here.

HHS Continues Efforts to Combat COVID-19

The U.S. Department of Health and Human Services (HHS) and its agencies took the following actions last week to address the COVID-19 pandemic: