Welcome to the August edition of The ACS Advocate.
In response to the shifting landscape of health care delivery, and to develop a stronger presence in Washington, in June, the American College of Surgeons (ACS) welcomed two new Medical Directors to the Division of Advocacy and Health Policy (DAHP) leadership team.
Frank G. Opelka, MD, FACS, a colorectal surgeon and physician executive, serves as the Medical Director of Quality and Health Policy. Patrick V. Bailey, MD, FACS, a pediatric surgeon, serves as the Medical Director of Advocacy.
The transition has been seamless, and the two are collaborating, working to provide leadership in health policy integration, to coordinate results-driven advocacy programs, and to develop and refine relationships across the care continuum.
Staff sat down with the Medical Directors, and discussed what they believe are some of the biggest challenges facing surgery, immediate health policy and advocacy issues that may have a profound impact on surgery, and their goals in Washington, DC. In this issue, read responses from Dr. Opelka, and more.
At the Federal Level
A Discussion with Dr. Opelka
IOM Releases Report with GME Focus
Proposed Modifications to EHR Program
CoC and One Voice Against Cancer
Health Policy at Clinical Congress
Two Coding Workshop Remain in 2014
At the State Level
Assistant Physician Designation in MO
NC Debating Medicaid Reform
CA Youth Concussion Legislation
ACS Chapter Lobby Day Program: $5,000 Match
IL Enacts Prescribing Law for Psychologists
PAC and Grassroots
Plan an In-District Meeting
At the Federal Level
Advocate staff talks with Dr. Frank Opelka, Medical Director, ACS DAHP, about his expectations, his suppositions
What do you believe will be the biggest challenges facing surgery over the next five years?
All of health care is transforming from a fee-for-service system to a system where physicians and other providers are paid based on the value of the services they deliver. As the Centers for Medicare & Medicaid Services (CMS) and other major health insurers are discovering—value is not easily defined. Value is based on judgment of quality against cost. People will value different aspects of health care.
Was their pain relieved? Did their symptoms resolve with the treatment? Was the service they received as they expected? Were their providers attentive to their personal wishes? Did they feel rushed and herded like cattle, or were they treated as individuals?
Adding to the value considerations are the performance measures for accountability for the care delivered and for improving the care. Understanding how cost of care fits in also will matter.
As payors move from administrative claims data to clinical data for performance measures, the burden of measurement will increase. Electronic data aggregation using electronic health records (EHR), I believe, is the next reasonable way to move forward to reduce the burden of data aggregation. Automating data aggregation must ensure that we have reliable, valid information. A misstep in data aggregation can cause misclassification of care delivery, and will direct patients inappropriately. Therefore, getting measurement right is critical.
As surgeons, we strongly encourage the health plans to support and fund the data aggregation using the risk-adjusted outcomes registries of specialties, such as the ACS National Surgical Quality Improvement Program® (ACS NSQIP®), and Commission on Cancer’s (CoC’s) National Cancer Data Base.
Among a few others, health care has been the epicenter of legislative topics in Washington. What are some immediate quality and health policy issues you believe will have a profound impact on surgery?
In addition to repealing and fixing the sustainable growth rate (SGR) formula and implementing the necessary changes in the Affordable Care Act (ACA) and professional liability, we have a series of challenges in creating data interoperability in EHRs used. We also need to move surgeons into measurement systems that are registry based. It may take legislative action to direct and fund the necessary resources for reducing the data burdens and moving to clinical metrics in surgery.
What are some of your immediate plans to build and further develop the College’s partnerships with external stakeholders and other surgical societies?
The external stakeholders include health plans, patient advocates, and purchaser groups. These three groups are very active inside the Washington, DC, beltway and tend to influence CMS’ efforts to measure performance and to value cost or resource use.
The ACS is working closely with stakeholder groups through an array of consortia at the national level. These include the Partnership for Patients, the Brookings Institute, Health Research and Educational Trust (HRET), and the Kaiser Foundation. Other organizations, such as the National Quality Forum (NQF) and the American Medical Association (AMA) Physician Consortium for Performance Improvement are multi-stakeholder organizations, which bring together various groups when considering performance measurement.
Adequate quality of care for patients remains the focus of many debatable health policy issues. How are you proposing to work with the regulatory bodies to ensure the College is involved in rulemaking processes?
The NQF has the Measures Application Partnership, which recommends measures to CMS for inclusion in government programs. This partnership is a first attempt from CMS to create a body that would make recommendations explicitly to CMS before the agency publishes proposed federal rules. The ACS has strong representation in all these gatherings. Once rules and regulations are published, the ACS reviews and comments on issues of importance as they relate to the quality of care of the surgical patient. We coordinate those comments across all of the surgical disciplines. I have held several leadership positions that required direct involvement with CMS leaders. The ACS is a highly respected organization and held in the highest regard by CMS in reviewing our comments for criticisms of proposals as well as new solutions developed by our surgeons and staff.
What is your chief goal or what are you most concerned about achieving during your time in Washington?
It is my goal that the collective voice of surgeons is heard, and the relevancy of the surgeon is not diluted by the many efforts to transform health care. Surgery has a long history of doing what is right for patients. We never want to lose that focus while so many aspects of health care are changing. As we balance the transformation in health care, surgery and the ACS remain strongly dedicated to the optimal care of the surgical patient—foremost, that our patients will have a surgeon at the bedside when they need one, and that the business systems undergoing transformation enhance and enrich surgical care and not erode the excellence that is American surgery.
Watch for the September issue when we provide responses from Dr. Bailey.
IOM Releases Report with GME Focus
On July 28, the Institutes of Medicine (IOM) released a report that contains recommendations to improve the graduate medical education (GME) system. The report, Graduate Medical Education that Meets the Nation’s Health Needs, gives specific attention to finding ways to increase the capacity of the nation’s clinical workforce to ensure the delivery of high-quality health care that will meet the needs of the U.S. diverse population.
A 21-member expert committee appointed by the IOM, conducted an independent review of the governance and financing of the GME system and found that there is significant merit to assess and optimize the effectiveness of the public’s investment in GME. The report serves as a preliminary roadmap for reforming the Medicare GME payment system and building an infrastructure that can drive more strategic investment in the nation’s physician workforce.
The College, along with the Surgical Coalition, are in the process of reviewing the document and plan to work together to ensure policymakers craft workable solutions that address the looming workforce shortage. At a minimum, the Coalition believes that Congress should bolster the U.S. surgical workforce by lifting the cap on the number of federally supported residency training positions and adopting legislation to increase the number of Medicare-supported residency positions. The Surgical Coalition includes about 20 surgical societies, and 250,000 surgeons and anesthesiologists in the U.S.
CMS proposes modifications to the EHR Incentive Program
In July, health policy staff submitted a response to CMS and the Office of the National Coordinator for Health Information Technology (ONC) supporting a proposed rule that would modify aspects of the 2014 EHR Incentive Program. The rule seeks to delay the start of Stage 3 of the program until 2017 and provide greater flexibility to providers and hospitals having difficulty upgrading their EHR software to the required 2014 edition. The ACS supported these proposals and expressed the need for more specialty-specific clinical quality measures. The ACS also urged CMS and the ONC to consider setting lower threshold requirements for providers to avoid program penalties.
CoC participates in One Voice Against Cancer lobby days
One Voice Against Cancer (OVAC), a collaboration of national not-for-profit organizations representing millions of Americans, delivered a unified message to Congress on the need for increased cancer-related appropriations. As OVAC members, the ACS CoC sent a contingent of CoC members and volunteers to the OVAC 2014 Lobby Days, July 7–8. OVAC recognizes the importance of federal funding for cancer research, early detection, prevention, drug development, nurse education, and childhood cancer registries. By making these lifesaving programs a priority, progress continues in the fight against cancer. Members of the CoC met with senators and representatives from their respective states and called on Congress to increase funding for the fight against cancer.
The attendees representing the CoC (from left to right) included Patrick Gavin, RPh, representing the ACS Clinical Research Program and the Alliance; Balazs I. Bodai, MD, FACS, Vice-Chair of the CoC Advocacy Committee and CoC member representing the National Consortium of Breast Centers; James Hamilton, MD, FACS, Chair, CoC Advocacy Committee and CoC member representing the ACS; Alan Thorson, MD, FACS, CoC Advocacy Committee member and CoC member representing the American Cancer Society; Charles Cheng, MD, FACS, CoC State Chair for Wisconsin and CoC member representing the ACS; and Rowena Schwartz, PharmD, BCOP, CoC Advocacy Committee member and CoC member representing the Hematology/Oncology Pharmacy Association (not pictured).
Clinical Congress: Health policy sessions
The 2014 ACS Clinical Congress will take place October 26–30 at the Moscone Center in San Francisco, CA. The Clinical Congress will include about 25 didactic health policy sessions to help you understand current practice management, reimbursement, and liability issues and how they may affect you and your patients. To encourage participation, the sessions are presented in a variety of formats including Town Hall Meetings, Workshops, Meet-the-Expert Luncheons, and Panel Sessions.
You can expect in-depth discussions on health care reform; a surgeon’s role in reducing health care costs; quality, safety, and outcomes; bundling payment in surgical services; mitigation for residents and fellows; and recent developments involving the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Access the full listing of health policy sessions and register online today to attend the Congress.
Two ACS coding workshops remain on 2014 schedule
Coding requirements are inherently complex and change often. That is why, throughout the year, the ACS hosts a series of Current Procedural Terminology coding workshops designed to ensure surgeons and their staffs learn how to accurately code for services while earning continuing medical education credits. There are two ACS workshops remaining for 2014. Register today.
The workshops also provide an opportunity to ask questions concerning the 2015 implementation of the 10th revision of the International Classification of Diseases (ICD-10). Review the ACS ICD-10 fact sheet.
||Loews Vanderbilt Hotel
||Hyatt Chicago Magnificent Mile
Special notice: Coding workshops also will be held Sunday, October 26, and Monday, October 27, at the ACS Clinical Congress.
At the State Level
Missouri creates new assistant physician designation
In July, Missouri approved a new law that allows medical school graduates who are waiting to match with a residency program to be assistant physicians in underserved primary care locations. These assistant physicians will have on-site supervised collaboration for 30 days, and then are free to treat patients within a 50-mile radius of the collaborating physician, as well as prescribe schedule III, IV, and V medications. Prior to Gov. Jay Nixon (D) signing the law, the AMA and American Academy of Physician Assistants voiced strong opposition to this legislation, whereas the Missouri State Medical Association supported it. If you have any questions, or would like more information, please contact ACS State Affairs at State_Affairs@facs.org.
North Carolina debating Medicaid reform
The North Carolina General Assembly is currently debating two different plans to reform its Medicaid system. The House plan would transform the current system into one composed of accountable care organizations led by doctors and other health care providers. The state’s Department of Health and Human Services (DHHS) would continue to manage the program. Gov. Pat McCrory (R), state health care providers, the North Carolina Medical Society, and Hospital Association support this proposal.
The Senate plan, on the other hand, would shift the current Medicaid program to a managed care model in which private insurance companies and hospital and physician networks receive only a fixed amount for each patient. This plan also would create a new seven-member board to oversee the Medicaid program, separate from the DHHS. Provider groups in the state strongly oppose the Senate proposal.
There is an agreement concerning the need to reward providers for meeting health goals and penalize them financially for cost overruns. The House passed its version in July, and the Senate is currently debating its proposal. If you have any questions, or would like more information, please contact ACS State Affairs at State_Affairs@facs.org.
California Governor signs concussion prevention legislation for youth
On July 21, California Gov. Jerry Brown (D) signed AB 2127, legislation aimed at preventing youth concussions in student athletes. The law prohibits middle and high school football teams of school districts, charter schools, and private schools that offer athletic programs from conducting more than two full-contact practices per week during the preseason and regular season. The law also prohibits full-contact practice during the off-season.
Current California law requires school districts, private schools, and charter schools to immediately remove athletes suspected of sustaining a concussion from the athletic activity for the remainder of the day. Additionally, the law prohibits athletes from returning until they have been evaluated by a licensed health care professional trained in the management of concussions and who is acting within his or her scope of practice.
If you have any questions or would like more information on youth concussion prevention, please contact ACS State Affairs at State_Affairs@facs.org.
Apply today for ACS Chapter Lobby Day Grant Program: $5,000 match
As most state legislatures have wrapped up this year’s legislative calendar, the focus is now shifted toward reelection efforts and the 2015 sessions. This is the perfect time for ACS state chapters to begin planning a 2015 lobby day at their respective state capitals. To begin the planning process, chapters are encouraged to participate in the ACS Chapter Lobby Day Grant Program. The College developed this state advocacy resource in 2009 to allow Fellows, through their chapters, an opportunity to advocate for ACS issues at the state level. The College provides matching grants up to $5,000. To participate, send a request for a program application to Jon Sutton, Manager, ACS State Affairs, at email@example.com.
Illinois is the third state to enact prescribing law for psychologists
In June, legislators in Illinois enacted a law that allows licensed clinical psychologists who received advanced specialized training to prescribe medications for specific mental health disorders. Illinois is now the third state in the country, after New Mexico and Louisiana, to give prescriptive authority to licensed clinical psychologists. The bill was originally opposed by the Illinois State Medical Society and other provider groups because of the risks posed to patients due to lack of biomedical and clinical training received by clinical psychologists.
Physician groups shared these concerns with the legislature, and were able to improve the bill significantly by increasing training requirements for prescribing psychologists, making it similar to what physician assistants must complete to prescribe medication to treat mental illness. The compromise legislation also includes the requirement for a written collaborative agreement with a practicing physician who treats mental illness, as well as provisions that prevent psychologists from prescribing to minors, the elderly, pregnant women, or disabled individuals and prohibits them from prescribing benzodiazepines, narcotics, or any Schedule II controlled substances.
Scope-of-practice infringement bills have been increasingly common in state legislatures over the last few years.
PAC and Grassroots
Plan an in-district meeting with your House member or Senators today
Congress adjourns for the summer recess August 1 until September, which means now is an excellent time to schedule in-district meetings with your elected officials to begin building the important relationships that will advance the ACS advocacy and health policy agenda.
Use the SurgeonsVoice Advocacy Handbook on SurgeonsVoice.org to guide you through this process. SurgeonsVoice.org also includes helpful issue briefs on relevant topics, such as Medicare Physician Payments/SGR, the 96-Hour Rule, and Ensuring Access to Trauma Care.
These meetings should assist in establishing long-term relationships and in positioning you as a trusted advisor on health care issues. You are encouraged to pair with other surgeons and surgical residents in your area. Take a photo with your member of Congress and share it with the ACS DAHP. ACS staff will work with you to ensure members understand that you are advocating on the College's behalf. If you have any questions or concerns after reviewing the materials on SurgeonsVoice.org, contact Sara Morse, American College of Surgeons Professional Association Political Action Committee (ACSPA-SurgeonsPAC) and Grassroots Manager, and Kaitlyn Dwyer, ACSPA-SurgeonsPAC and Grassroots Assistant, or call 202-337-2701.
Other News of Interest
- In July, CMS released the Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS/ASC) payment proposed rule for calendar year (CY) 2015. Under the OPPS provisions, CMS projects a 2.1 percent payment increase for services provided in most hospital outpatient departments. In addition, CMS proposes to expand the categories of related items and services packaged into a single payment under the OPPS and to make changes to the Hospital Outpatient Quality Reporting Program, notably, the addition of the facility seven-day risk-standardized hospital visit rate after outpatient colonoscopy measure to this program. Download a display copy of the proposed OPPS/ASC rule and related press releases.
- In July, CMS released the Medicare physician fee schedule (MPFS) for CY 2015. CMS estimates that the total payment impact of the proposed rule on Medicare physician services for general surgery to be a zero (0) percent change. The rule also proposes to eliminate all 10- and 90-day global codes and transform them into 0-day global codes starting in CY 2017. Furthermore, the rule would modify the Open Payments program, which establishes a system for annually reporting financial relationships between physicians and drug/device manufacturers, by eliminating an exclusion that allows for payments made to speakers at accredited continuing medical education events. Download a display copy of the proposed MPFS and related press releases.
- Phase two of physician registration in the Open Payments system under the Physician Payments Sunshine Act began July 14, and physicians have until August 27 to review the information and initiate any disputes regarding the data reported about them. Although registration in the Open Payments system is voluntary for physicians, the ACS regulatory affairs staff strongly recommends registering, as it is required for physicians to review and dispute their open payments data.
For more frequent updates, follow the ACS on Twitter, like the ACS on Facebook, or add the advocacy Web section to your "favorites" list. Send questions or comments about this issue of The ACS Advocate to Chantay P. Moye, Communications Manager, at firstname.lastname@example.org.