Welcome to the April edition of The ACS Advocate. Recently much legislative and health policy activity has taken place at both the state and federal levels. This edition gives insight into many of those issues, as well as details about the latest activities of the American College of Surgeons (ACS) Division of Advocacy and Health Policy (DAHP).
AT THE FEDERAL LEVEL
Congress Passes SGR Patch
Two-Midnight Policy Delayed
ICD-10 Conversion Delayed
CMS to Disclose Physician Payment Data
Volunteers in Disaster Legislation
Recent ACS Congressional Activities
COT Legislative Briefing on Capitol Hill
Highlights - 2014 Leadership & Advocacy Summit
CODING CORNER: ACS 2014 Surgical Coding Workshops
AT THE STATE LEVEL
Indiana Passes Youth Concussion Bill
Virginia Passes Concussion Bill
General Surgery J-1 Visas
Idaho Trauma Systems
Trauma Bill Introduced in Minnesota
UEVHPA Legislation in Pennsylvania
Medical Malpractice Legislation
PAC AND GRASSROOTS
Fundraising Update and Annual Report Now Available
OTHER NEWS OF INTEREST
CMS Issues CEHRT Guidance
eRx Incentive Program Participation Update
Congress passes one-year SGR patch
Following months of intense lobbying efforts by DAHP staff to have the Medicare sustainable growth rate (SGR) formula repealed and replaced, Congress instead passed another short-term patch. This is the 17th short-term fix to unsustainable SGR cuts that Congress has passed in the last decade at a total cost of close to $170 billion. This new legislation is part of the Protecting Access to Medicare Act.
The ACS, along with most of the physician community, opposed the short-term patch legislation because, for the first time, physicians will be asked to cover some of its costs. More specifically, the legislation requires the Centers for Medicare & Medicaid Services (CMS) to address misvalued physician service codes for the years 2017 through 2020 to produce approximately $4 billion in savings, which is about 25 percent of the cost of the short-term patch. Unfortunately, political maneuverings by the House and Senate leadership led to its passage despite significant opposition among the House and Senate rank and file.
The ACS will continue to advocate for passage this year of the SGR Repeal and Medicare Payment Modernization Act, H.R. 4015/S.2000, a bill that would benefit America's seniors and would bring long-term stability to the SGR. Rep. Michael Burgess, MD (R-TX), cosponsor of H.R. 4015 and Vice Chairman of the House Energy and Commerce Subcommittee on Health, vowed on March 31 to continue working to repeal the SGR. "This is not the end of my efforts. I will continue to work on this issue. We are farther than we've ever been toward repealing and replacing the SGR," Representative Burgess told attendees at the 2014 ACS Leadership & Advocacy Summit, March 29–April 1, in Washington, DC. In addition, Senate Finance Committee Chairman Ron Wyden (D-OR) stated that he will continue his efforts to pass permanent SGR repeal this year. View frequently asked questions regarding the SGR.
SGR legislation delays two-midnight policy until March 31, 2015
Congress voted to delay enforcement of the Medicare two-midnight rule payment policy for hospitals until March 31, 2015. CMS has partially postponed enforcement of this rule on two prior occasions—first through March 31, 2014, and then through September 30, 2014. According to the two-midnight rule, if a physician expects a Medicare beneficiary's treatment to cross two midnights and admits the beneficiary on that belief, then CMS will generally consider the inpatient admission to be appropriate. Read details on the two-midnight rule.
ICD-10 compliance delayed until October 1, 2015
Congress voted on March 31 to delay by the implementation of the nationwide conversion to the 10th Revision of the International Classification of Diseases (ICD-10) set of diagnostic and procedural codes one year. ICD-10 is now scheduled to take effect October 1, 2015. This is the second ICD-10 delay; the initial deadline was October 1, 2013, and the U.S. Department of Health and Human Services subsequently postponed implementation until October 1, 2014. The ACS encourages members to continue to use the ACS ICD-10 preparation resources to ensure a smooth transition.
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CMS to disclose individual physician payment data
On April 2, CMS announced that it plans to release data on or after April 9 to the public on Medicare payments to physicians. The data will list procedures performed by 880,000 individual physicians, along with how much they charged and how much Medicare reimbursed the physicians in 2012. Although CMS will not release personally identifiable information about patients, the data will be organized by physicians' National Provider Identifier, Health Care Common Procedure Coding System code, and place of service. CMS indicated in a letter that it weighed the privacy interests of physicians against the public's interest in shedding light on government activity and operations, and determined that the public's interest outweighs physicians' privacy interests. CMS also indicated in a blog post that these data will allow a wide range of analyses that compare 6,000 different types of services and procedures provided and will allow consumers to compare the services provided and payments received by individual health care providers. The College will monitor the impact of this data release and will analyze any consequences for surgeons.
Senator Murkowski introduces legislation shielding volunteers in disasters
Sen. Lisa Murkowski (R-AK) introduced The Good Samaritan Health Professionals Act (S.2196) on April 1. This legislation would allow health care professionals to volunteer their services during nationally declared disasters without the threat of medical liability concerns. Rapid medical response in a disaster can greatly decrease loss of life and improve outcomes for patients who desperately need care. However, when a disaster strikes, the needs of victims often overwhelm the services that are available locally. The Volunteer Protection Act, which was enacted specifically to encourage assistance, failed to provide liability protections for health care providers who cross state lines to aid disaster victims. Companion legislation, H.R. 1733, was introduced in the House by Reps. Marsha Blackburn (R-TN) and Jim Matheson (D-UT) last year.
ACS congressional activities
The ACS along with other surgical organizations sent letters to Congress concerning the following priorities:
- The College supports efforts to make funding the Pediatric Subspecialty Loan Repayment program a critical national priority. Currently, the number of pediatric specialists, including pediatric surgeons, is inadequate to meet the growing health needs of America's children.
- The College supports efforts to halt legislation that may provide audiologists with unlimited direct access to Medicare patients without a physician referral. H.R. 4035 and S.2046 inappropriately provide audiologists with unlimited direct access to Medicare patients without a physician referral.
- The College supports the Critical Access Hospital Relief Act, H.R. 3991 and S. 2037 legislation that would remove the 96-hour physician certification requirement as a condition of payment for critical access hospitals. View House and Senate letters.
- The College supports the Saving Lives, Saving Costs Act, H.R. 4106—legislation that would take an innovative approach to fixing the nation's broken liability system and would help to increase the practice of evidence-based medicine, improve patient safety, and reduce defensive medicine.
- The College supports preservation of the in-office ancillary services exception (IOASE) to the "Stark" law and rejection of a proposal to restrict the IOASE for advanced imaging, radiation therapy, anatomic pathology, and physical therapy. View letters to the following congressional committees: Energy & Commerce, Finance, and Ways & Means.
ACS hosts legislative briefing on trauma care
The ACS Committee on Trauma (COT) hosted its first Legislative Lunch Briefing—Trauma Systems in Crisis: Fulfilling Public Expectations for Day-to-Day Emergencies and Catastrophic Preparedness and Response—March 19 on Capitol Hill. ACS DAHP staff provided assistance.
The event was well-attended by congressional staff and focused on the necessity of passing legislation that would foster the development of accessible trauma systems across the nation. The COT asserts that congressional support is needed to ensure patient access to trauma care.
More specifically, COT representatives at the briefing urged participants to support the Trauma Systems and Regionalization of Emergency Care Reauthorization Act, H.R. 4080, was subsequently advanced by the House Energy & Commerce Committee on April 3. This legislation would reauthorize Trauma Care Systems Planning Grants, which support state and rural development of trauma systems. It would also reauthorize pilot projects to implement and assess regionalized emergency care models. The Committee also advanced the Improving Trauma Care Act, H.R. 3548, legislation that would amend the Public Health Service Act to improve the definition of trauma by including injuries caused by thermal, electrical, chemical, or radioactive force. These injuries are commonly treated at burn centers. It is now up to House leadership to schedule for consideration H.R. 4080 and H.R. 3548. Additionally, DAHP staff is working with the Senate to have companion legislation introduced in that chamber.
COT presenters at the briefing included, from left to right, Robert J. Winchell, MD, FACS, Chair, COT Trauma Joint Operating Committee; Jay Doucet, MD, FACS, MSc, FRCSC, RDMS, COT member; and Leonard J. Weireter, Jr., MD, FACS, Chair, COT Advocacy Pillar.
2014 Leadership & Advocacy Summit highlights
The ACS hosted its third annual Leadership & Advocacy Summit, March 29–April 1, in Washington, DC. The Summit is a dual meeting that offers volunteer leaders and advocates comprehensive and specialized education sessions focused on the tools needed for effective leadership, followed by interactive advocacy training and coordinated visits with congressional offices. View collage of event images (passcode: acs2701)
Well-attended leadership program focuses on emotional intelligence, mentoring
The Leadership program began with a Welcome Reception on Saturday evening. On Sunday, a standing room-only crowd of more than 430 attendees gathered to hear presentations on leadership and mentoring skills, emotional intelligence, and chapter development. David B. Hoyt, MD, FACS, ACS Executive Director, and Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services, provided a joint welcome to attendees.
ACS President Carlos A. Pellegrini, MD, FACS, gave a lunchtime talk on The Surgeon Leader. In addition, current and past Presidents from the Massachusetts, Metro Philadelphia, and Puerto Rico Chapters related their successes of the past year.
Attendees convened again this year by geographic location, allowing group participants to identify areas for synergistic and unified efforts. Before adjourning for the day, a representative from each chapter or region gave a short report on how the chapter would move forward in the coming year, suggesting initiatives or ways that they could work together with chapters in neighboring states or regions. Details regarding the Leadership program will be published in the June Bulletin.
Advocacy program focuses on SGR repeal and issues on ACS legislative agenda
"The Advocacy Summit has provided me with the opportunity to network with other surgeons who are similarly interested in engaging in the political process and improving the profession and care for our patients. The program offers tangible opportunities to get involved in advocacy and health policy—even as a resident."
~Nikki Perez, MD, Resident, Atlanta Medical Center, GA
"As a practicing transplant and general surgeon, it was very beneficial for me to spend time at the Advocacy program. I have gained further insight into some of the mechanics behind the new decisions and legislation facing surgery, and where surgery is headed. Overall, this has been an invaluable experience. I believe that every surgeon should attend this meeting."
~Williams Kendall, MD, FACS, Transplant Surgery, Sanford Health, Fargo, ND
More than 200 attendees from 44 states attended 229 meetings on Capitol Hill during Lobby Day on April 1. Each year, Lobby Day concludes the Advocacy program at the Leadership & Advocacy Summit. The Summit convened this year during a pivotal time in health care—when Congress was debating whether to permanently repeal the SGR or enact a one-year patch through the Protecting Access to Medicare Act described in a previous article. Although Congress elected to "kick the can down the road" for another year, the Summit attendees delivered a strong message that permanent repeal of the SGR must happen this year. Other ACS congressional "asks" during this year's Lobby Day centered on medical liability reform, research funding, the 96-hour rule, and trauma and emergency care.
This year's Advocacy program focused equally on grassroots advocacy and motivating surgeons to get involved in the political process and become advocates at the state and national levels. To help prepare for Lobby Day and beyond, advocacy experts provided in-depth and interactive presentations on the legislative process; understanding the issues; effective communication with members of Congress; and what to expect before, during, and after Lobby Day. Other presentations included innovation as it relates to medical research and breakthroughs, the current state of the health care system, the need to create a value-based system, future challenges for providers and patients, and more. Details regarding the Advocacy program will be published in the June issue of the Bulletin.
Register for an ACS 2014 surgical coding workshop & prepare for ICD-10 conversion
The ACS is offering the following sessions on ICD-10 compliance, profitable practice operations and strategy, and mastering general surgery CPT coding workshops for the remainder of 2014.
- April 9–11, Hyatt Chicago Magnificent Mile, IL
- May 2, The Cornell Club, New York, NY (ICD-10-only workshop)
- May 14–16, 20 F Street Conference Center, ACS Washington DC office
- July 25, Hyatt Rosemont, IL (ICD-10 only workshop)
- August 20–22, Loews Vanderbilt Hotel, Nashville, TN
- November 12–14, Hyatt Chicago Magnificent Mile, IL
Indiana legislature passes youth concussion bill
On March 12, the Indiana legislature passed S.B. 222, which requires football coaches to take concussion-awareness training classes and mandates a 24-hour sit-out period for student athletes who may have sustained concussions or head injuries. This law will require football coaches to take and pass accredited courses every two years on player safety, including concussion awareness, equipment fitting, heat emergency preparedness, and proper technique. It would also provide civil immunity for football coaches in certain circumstances. Gov. Mike Pence (R) signed this legislation into law on March 24, making Indiana the first state to enact a football coaches' training law. View the ACS statement on concussion and brain injury.
Virginia legislature passes concussion bill
H.B. 410 and S.B. 172 passed in the Virginia state legislature and currently await the signature of Gov. Terry McAuliffe (D). These bills would require any non-school-sponsored athletic program using school grounds to establish policies and procedures regarding the identification and handling of suspected concussions in student-athletes.
Idaho passes bill to allow inclusion of general surgery for J-1 Visas
In early March, the Idaho legislature passed H.B. 394, which would include general surgery in the definition of primary care for the purposes of determining eligibility for J-1 Visas. Gov. Butch Otter (R) signed the bill into law on March 11.
This legislation was brought forward with the goal of increasing the primary care physician workforce in designated shortage areas of rural and frontier Idaho. The bill sponsor noted in the statement of purpose that "the specialty of general surgery is commonly regarded now as a component of a constellation of specialties often referred to as "'primary care medicine,' along with family medicine, pediatrics, obstetrics, gynecology, internal medicine, and psychiatry."
Idaho trauma system update
Idaho Gov. Butch Otter (R) signed S.B. 1329 allowing the Department of Health and Welfare to develop and administer a Time Sensitive Emergency System (TSES). The TSES will provide protocols for treating and responding to time-sensitive emergencies, such as injuries sustained from trauma, heart attack, and stroke—conditions that rank among the top-five causes of death in Idaho. For additional information on Idaho's TSES, contact the College's State Affairs team at StateAffairs@facs.org.
Trauma systems funding bill introduced in Minnesota
Legislation has been introduced in the Minnesota House and Senate that calls for creating a system to fund the state's trauma and emergency medical services (EMS) systems. The bills, H.F. 1967 and S.F. 1929, would create a covered driver's assessment of $10 per year per vehicle. These funds would be deposited into the trauma hospital and EMS account created by the legislation, and disbursement would be overseen by the Commissioner of Health through the State Trauma Advisory Council. Trauma hospitals would receive 75 percent of disbursements, air and ground ambulance services would receive 15 percent, regional trauma advisory councils would receive 5 percent distributed equally throughout the regions, and 5 percent of the disbursements would go to the comprehensive advanced life support training program to be used for trauma coordination and training. Minnesota currently lacks a sufficient source of trauma system funding.
UEVHPA legislation introduced in Pennsylvania
Uniform Emergency Volunteer Health Practitioners Act (UEVHPA) legislation, S.B. 1235, was introduced in February in the Pennsylvania Senate to allow health care practitioners to register in advance of or during a declared disaster emergency to provide volunteer services in Pennsylvania. The goal of this bill is to ensure that in future disasters, health practitioners can be quickly deployed to health care facilities and disaster relief organizations while following clear and well-understood rules that provide an effective framework to ensure the delivery of high-quality care to disaster victims. A similar bill, H.B. 512, was introduced in 2013, but has not advanced. Pennsylvania surgeons are encouraged to contact their state senators in support of this important legislation. To send a letter, visit the Surgery State Legislative Action Center.
Medical liability legislation passes in Kentucky
The Kentucky legislature recently passed S.B. 119—legislation that would avert meritless liability lawsuits filed against health care providers by instituting an independent review panel to evaluate liability claims. This panel would consist of three independent members charged with evaluating each claim. SB 119 recently passed the full Senate, but awaits a House vote. This legislation is strongly supported by Care First Kentucky and opposed by AARP. For additional information, contact the College's State Affairs team at StateAffairs@facs.org.
The following are ACS Professional Association political action committee (ACSPA-SurgeonsPAC) updates:
- Since January 1, the ACSPA-SurgeonsPAC has raised $189,272 from 539 ACS members and staff.
- So far this year, ACSPA-SurgeonsPAC staff has attended 70 events for members of Congress.
- The latest ACSPA-SurgeonsPAC annual report is now available online.
- ACSPA-SurgeonsPAC held a successful fundraiser at the 2014 ACS Leadership & Advocacy Summit. Details of the event will be published in the June issue of the Bulletin. Such events enable the College to develop relationships with representatives and senators to educate them about the issues that affect the surgical practice environment. ACSPA-SurgeonsPAC contributes to incumbents and candidates who act as champions for surgery, regardless of their party affiliation. The ACSPA-SurgeonsPAC is a nonpartisan entity, and all U.S. members of the College are eligible to join.
- Learn more about how to get involved with the ACSPA-SurgeonsPAC.
- CMS issued guidance for eligible professionals, eligible hospitals, and critical access hospitals that are unable to implement the 2014 edition of Certified Electronic Health Record Technology (CEHRT) in time to successfully demonstrate meaningful use for the 2014 reporting year. Visit the EHR Incentive Program for the 2014 CEHRT hardship exception guidance for eligible professionals and 2014 CEHRT hardship exception guidance for eligible hospitals and critical access hospitals.
- 2013 was the final program year for participating and reporting in the Medicare Electronic Prescribing (eRx) Incentive Program. The six-month 2014 eRx payment adjustment reporting period, which began January 1, 2013, and ended June 30, 2013, was the final reporting period to avoid the 2014 eRx payment adjustment. You do not need to report G-codes (G8553) for 2014 eRx events. Content will remain available on the eRx Incentive Program website. However, it is important to note that eRx via certified EHR technology is still a requirement for eligible professionals.
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Send questions or comments about this issue of The ACS Advocate to Chantay Moye, Communications Manager, at firstname.lastname@example.org.