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

August 2013 ACS Advocate


Is momentum building in Congress to overturn the maligned sustainable growth rate (SGR) formula (SGR)? In this month’s issue of The ACS Advocate:

  • In July, legislators made long-awaited progress toward repealing Medicare’s sustainable growth rate (SGR) formula.
  • The College recently launched a campaign to bolster in-district meetings with legislators in an effort to advance the American College of Surgeons' (ACS) agenda on Medicare physician payment.
  • The Oklahoma Supreme Court ruled that certain medical liability reforms enacted in 2009 are unconstitutional.

Inside this issue...

At the Federal Level

Physician Payment Overhaul | Workforce, Quality, and Liability Legislation | Sunshine Act | ICD-10 Provider Call | Quality Corner: Physician Compare | Quality Corner: Medicare Administrative Contractor

At the State Level

Liability Reforms Unconstitutional | Medicare Supervision | ACS Chapter Lobby Day Grant | Obesity as a Disease

PAC and Grassroots News

In-District Advocacy: What You Can Do in August | Advocacy and ACSPA-SurgeonsPAC | Fundraising and Disbursement Update

Other News of Interest

At the Federal Level

Medicare physician payment overhaul within reach?

At press time, the House Committee on Energy and Commerce was poised to approve H.R. 2810, bipartisan legislation that would permanently repeal the SGR and develop a new physician payment system. The introduction of this legislation represents the beginning of what will likely be a long process, as both the House Ways and Means Committee and the Senate Finance Committee continue to work on their own proposals.

The introduction of the legislation also represents seven months of collaboration among the ACS, the broader physician community, and the congressional committees. During this time, Congress has engaged the physician community in the development of a new payment system. The ACS has appreciated the opportunity to provide input on the plans because one of our fundamental views on this issue is that physicians must lead the development of any new payment system. We remain cautiously optimistic, but there is much more work to be done before a viable replacement for the SGR is completed.

ACS will provide updates on the progress and potential components of the new payment system.

Workforce, quality, and liability legislation

The ACS recently submitted letters of support to Congress concerning the following proposed legislation:

  • The Standard of Care Protection Act would specify that no standard or guideline in Medicare, Medicaid, or the Affordable Care Act may be used to establish the standard of care that a health care professional must provide to a patient. This legislation would prevent the courts from determining negligence solely on the basis of whether a physician adhered strictly to a federal guidelineThe bill is widely supported by the physician community and its provisions are included in legislation that Congress currently is considering to reform the Medicare physician payment system. Read the Standard of Care Protection Act.
  • The Pediatric Subspecialty and Mental Health Workforce Reauthorization Act would extend authorization for the pediatric subspecialty loan repayment program through 2018. Under the current law, the program will expire in 2014. This program provides $35,000 per year for up to three years to pediatric surgeons or other pediatric medical and mental health specialists who agree to practice for at least two years in underserved areas. On July 11, the Senate Appropriations Committee passed a bill that, for the first time, included funding for the program at $5 million for fiscal year 2014. Read the Pediatric Subspecialty and Mental Health Workforce Reauthorization Act.
  • The Access to Frontline Health Care Act would create a new Frontline Providers Loan Repayment Program. Under this program, health care professionals, including general surgeons, would receive loan repayments from the U.S. Department of Health and Human Services in exchange for providing care for at least two years in a Health Professional Shortage Area or an area designated by a state as having a shortage of frontline care services. A frontline care service is defined as a health care service performed by a medical specialist or allied health professional in the fields of general surgery, ophthalmology, and otolaryngology, among others. Read the Access to Frontline Health Care Act.
  • The Ambulatory Surgery Center (ASC) Quality and Access Act would transition reimbursement for ASCs to the hospital market basket update from the Consumer Price Index for All Urban Consumers. This Act would also create value-based purchasing for ASCs, establish an ASC voice on the Advisory Panel on Hospital Outpatient Payment, and require the Centers for Medicare & Medicaid Services (CMS) to disclose criteria used to deny procedures from being performed in ASCs. View the College’s House and Senate letters of support. Read the ASC Quality and Access Act.

What surgeons need to know about the Physician Payments Sunshine Act

In August, manufacturers of drugs, medical devices, and biological agents will begin tracking physician payments as required under the Physician Payments Sunshine Act. The law requires manufacturers to annually report to the CMS certain payments and transfers of value to physicians and teaching hospitals. Manufacturers and group purchasing organizations also must report certain ownership interests of physicians and immediate family members. Physicians will be neither penalized nor required to take action under this legislation. However, physicians will have the right to review and challenge their reports.

Important deadlines associated with tracking and reporting are:

  • August 1–December 31: Manufacturers must begin tracking payments to physicians and physician ownership information.
  • January 1, 2014: Physicians will be able to register for a CMS online portal to view reports.
  • March 31, 2014: Manufacturers will begin submitting reports to CMS.
  • June 2014: CMS will provide physicians with access to their reports via the CMS portal. Physicians will be able to contact manufacturers through the portal to correct errors in the reports.

What surgeons can do now: (1) ensure that all financial disclosures and conflicts of interest are current and regularly updated, and (2) if you have a National Provider Identifier (NPI), be sure that your NPI information is up to date and the specialty designation is correct. Manufacturers will use the NPI and other information to identify physicians. View the CMS fact sheet for additional information. Access the NPI enumerator database to check your NPI information.

CMS ICD-10 Basics National Provider Call

Registration is open for the next CMS National Provider Call concerning ICD-10, Thursday, August 22, 1:30–3:00 pm EST. The American Health Information Management Association will present on the basics of ICD-10, CMS will provide an implementation update, and there will be a question-and-answer session. Continuing education credit may be awarded for participation in certain Medicare Learning Network Connects Calls. Space may be limited; register early.

Quality Corner 

CMS updates Physician Compare website

In late June, CMS announced the redesign of its Physician Compare website, which allows Medicare patients to access specific provider information and compare health care providers. A consistently updated database offers information concerning specialty care services offered by a physician and provider, status of provider’s use of electronic health records, board certification, and affiliation with other providers. In 2014, CMS intends to provide patients with information on quality measures submitted through the agency’s quality programs.

The 2013 Medicare Physician Fee Schedule final rule lays out a framework for expanding the website, and, earlier this year, the ACS released an article on how CMS’ plan may affect surgeons.

Are you satisfied with your MAC?

CMS has opened registration to participate in the Medicare Administrative Contractor (MAC) Satisfaction Indicator (MSI). The MSI is a questionnaire that asks about your satisfaction with specific services your MAC provides, such as claims processing, Medicare enrollment, educational opportunities, and responsiveness to inquiries. Medicare fee-for-service providers should complete the application to register your information. The registration form is not a survey, but a way for CMS to collect accurate contact information such as name, e-mail address, location, and more. 

At the State Level

Oklahoma liability reforms unconstitutional

On June 4, the Oklahoma Supreme Court ruled that several comprehensive medical liability reforms—such as certificate of merit requirements, caps on noneconomic damages, joint and several liabilities—are unconstitutional. The justices found that the tort reform legislation passed in 2009 violated the single-subject rule of the state’s constitution. The court did not rule on the merits of the policies in the statute, with the exception of the certificate of merit requirements, which the court ruled unconstitutional because this “special law” applied to professional negligence cases and not all negligence cases, thereby creating undue financial burdens. However, caps on noneconomic damages remain in place because the legislature enacted the cap under a separate cap in 2011, and the court only addressed the 2009 law.

ACS supports Medicare supervision requirement

In April and July, the Wyoming Board of Medicine and the Wyoming Board of Nursing sought input on the decision to opt out of the physician supervision of Certified Registered Nurse Anesthetists (CRNAs), which is a requirement under Medicare law. States have the ability to request an opt-out that allows CRNAs to practice independent of this law. The ACS believes that states should uphold this requirement, maintaining that not doing so would jeopardize patient safety. CRNAs practicing outside of their scope of practice and without proper supervision by a physician may open up Wyoming citizens to unsafe environments and procedures.

Chapter lobby day grant applications due September 13

ACS Chapters in the U.S. have until September 13 to apply for grants to help support state lobby days in 2014. Program notifications were sent via mail in mid-June to Chapter administrators, executive directors, and presidents. Chapters may apply for up to $5,000 with a chapter match of $2,500. Send all questions and concerns to Jon Sutton, ACS State Affairs Manager. Download the program application and lobby day tool kit.

ACS supports AMA resolution recognizing obesity as a disease

The ACS and 10 other medical and specialty societies cosponsored a resolution that the American Medical Association (AMA) House of Delegates passed during its meeting in June. The resolution recognizes obesity as a disease with multiple pathophysiological aspects that require a range of interventions to advance treatment and prevention. In offering its support for the resolution, the ACS acknowledged that many physicians already treat obesity as a disease. In fact, bariatric surgeons are often on the frontlines of treating this disease, with life-improving and lifesaving results.

The College’s testimony further noted that through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), the ACS and the American Society of Metabolic and Bariatric Surgery have come together to develop accreditation standards for bariatric surgery centers. This accreditation symbolizes an institution’s commitment and accountability to safe, high-quality surgical care. Currently, 640 bariatric surgery centers throughout the country are accredited through the MBSAQIP, and these centers and their surgeons treat obesity as a disease. For more information regarding the College’s support of AMA Resolution 420, contact Jon Sutton, ACS State Affairs Manager. 

PAC and Grassroots News

In-District Advocacy

Meet with your elected officials in August

On the heels of crucial legislation being marked up to repeal the Medicare SGR formula, Congress is scheduled to break for a five-week in-district work period beginning August 4. During that time, legislators will meet with constituents in their home states. Take action now to ensure this issue remains a priority when Congress reconvenes this fall by making plans to meet with your representative and senators.

The ACS Division of Advocacy and Health Policy (DAHP) has launched an in-district advocacy grassroots program to help you meet with policymakers and Congressional staff to effectively advocate for your profession and your patients. The program provides an Advocacy Toolkit with step-by-step guidance on how to set up your in-district meetings, talking points, and a meeting evaluation form that will serve as a follow-up guide for the College’s DAHP staff. These meetings are a great way to develop personal relationships with your members of Congress and have your voice heard. It is crucial that members of Congress hear from you, their constituents, about how looming payment cuts associated with the current Medicare physician payment system are affecting your practice and patients. Plan your in-district Congressional meetings today.

Advocacy and the ACSPA-SurgeonsPAC

The American College of Surgeons Professional Association Political Action Committee (ACSPA-SurgeonsPAC) is another resource to help you advocate on behalf of the profession and your patients. While your member of Congress is in-district, you can reach out to the ACSPA-SurgeonsPAC staff to assist you with setting up an ACSPA-SurgeonsPAC campaign contribution to your representative or senator. If a candidate is running in the 2014 Congressional election who you believe the ACSPA-SurgeonsPAC should consider supporting, contact staff to receive a copy of the ACSPA-SurgeonsPAC candidate’s survey. The responses will help the ACSPA determine where the candidate stands on issues of importance to surgery.

Fundraising and disbursement update

  • Thus far in 2013, the ACSPA-SurgeonsPAC has raised more than $350,000 from 1,125 ACS members and staff.
  • In 2013, the ACSPA-SurgeonsPAC has contributed more than $245,000 to 65 candidates, party committees, and leadership PACs. Sixty percent of the funds were given to Republicans and 40 percent were given to Democrats. 

Other News of Interest

  • The last official ICD-9-CM code titles for October 1, 2013, are now available on the ICD-9-CM website. ICD-10 will be implemented on October 1, 2014.
  • Register for the next ACS Surgical Coding Workshop, August 22–23, in Nashville, TN.

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