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

December 2013 / January 2014 ACS Advocate

ISSUE 17

Welcome to the December/January edition of The ACS AdvocateSomehow the end of the year is almost upon us. A lot has happened. As we reflect on the last 11 months, we can point to at least one significant factor that we noticed throughout the year—Congress focused its health policy efforts on permanently repealing the Medicare sustainable growth rate(SGR) formula and reforming the physician payment system. By the end of 2013, proposed legislation passed out of all three committees of relevance: the Senate Finance Committee, the House Ways and Means Committee (just prior to congressional adjournment in December), and the House Energy & Commerce Committee back in July.

Inside this issue, take a closer look at the ACS Division of Advocacy and Health Policy (DAHP) year in review.

At the Federal Level

At the State Level

PAC and Grassroots


At the Federal Level

A look back at federal advocacy efforts in 2013

Read about additional federal advocacy activities on regulatory and legislative issues.

January

  • At the start of 2013, staff in the ACS DAHP was monitoring activities on Capitol Hill as the 113th Congress wrangled over the "fiscal cliff." The College's advocacy efforts played an important role in achieving passage of legislation that delayed a nearly 30 percent cut in Medicare physician reimbursements scheduled to take effect on January 1. The cuts were delayed until December 31.
  • President Obama signed the American Taxpayer Relief Act of 2012, which addresses quality of care issues. One provision in the Act revises the Physician Quality Reporting System (PQRS) program requirements by permitting participation in a Qualified Clinical Data Registry as an additional option for satisfactory participation in PQRS. The College was influential in developing the registry deeming process by outlining key principles required for any successful quality program to measure and improve the quality of care and increase value. In April, the ACS provided a letter responding to CMS' request for information on potential qualified clinical data registry regulation.
  • The ACS sent a letter to Reps. Joe Pitts (R-PA) and Frank Pallone (D-NJ) thanking them for sponsoring legislation that led to Congress unanimously approving the Children's Hospital Graduate Medical Education Support Reauthorization Act (CHGME). Until the CHGME program was established in 1999, CHGME hospitals were ineligible for traditional GME financial support through the Medicare program. Hence, reauthorization is vital to sustaining the pediatric workforce and protecting the health of children.
  • The ACS sent a comment letter to the National Quality Forum to provide feedback to the Measure Applications Partnership (MAP) Pre-Rulemaking Report. The ACS commented on measures for potential use in federal public reporting and performance-based payment programs for calendar year (CY) 2014.

February

  • The ACS sent the first of many responses throughout 2013 to the U.S. House Committee on Ways and Means and the House Committee on Energy and Commerce concerning their joint proposal to permanently repeal the SGR and reform the Medicare physician payment system. The ACS asserts that any new payment system should be based on the complementary objectives of improving outcomes, quality, safety, and efficiency while simultaneously reducing the growth in health care spending.
  • The ACS sent letters to members of Congress in support of legislation to repeal the Independent Payment Advisory Board (IPAB). The IPAB is a 15-member committee appointed by the President that seeks to identify Medicare savings without affecting coverage or quality of care.

March

  • Sequestration cuts took effect, including a two percent reduction in Medicare physician payments and GME funding, as well as approximately $1.6 billion in reduced funding for medical research at the National Institutes of Health.
  • Congress averted a government shutdown by approving a short-term measure to fund the government through the end of fiscal year (FY) 2013 in September.
  • The House and Senate passed FY 2014 budget resolutions. View Senate and House budget background provided by CQ Roll Call.
  • The ACS supported the introduction of three GME bills:
    1. The Resident Physician Shortage Reduction Act of 2013, which would address both short- and long-term workforce demands by increasing the number of Medicare-supported GME residency positions by roughly 15,000 over five years
    2. The Training Tomorrow's Doctors Today Act, which increases the number of Medicare-supported residency positions by 15,000 over five years and would establish Medicare GME accountability and transparency measures
    3. The Conrad State 30 and Physician Access Act, which would expand and permanently reauthorize the Conrad 30 Program. Since 1994, the Conrad 30 Program has worked to bring thousands of foreign physicians trained in the U.S. to rural, inner-city, and other medically underserved communities.
  • Rep. Diane Black, RN, (R-TN) reintroduced the Electronic Health Records (EHR) Improvement Act. This measure, if enacted, would implement much-needed reforms to the Medicare and Medicaid EHR Incentive Program, ensuring that small practices are better prepared to adopt EHR technology.
  • As a follow-up to the ACS Medical Liability Reform Summit held in October 2012, the Legislative Committee and other participants in the Summit authored articles for a special edition of the Bulletin of the American College of Surgeons covering a comprehensive list of solutions to medical liability reform.
  • DAHP staff participated in the Health Coalition on Liability and Access (HCLA) annual meeting. HCLA is a national advocacy coalition comprising more than 40 organizations focused on enacting medical liability reform at the federal level.
  • DAHP staff attended the annual Healthcare Information and Management Systems Society (HIMSS) conference in New Orleans, LA. HIMSS is a not-for-profit organization focused on providing global leadership for the optimal use of information technology and management systems for the betterment of health care.
  • ACS staff attended the Medicare Payment Advisory Commission (MedPAC) meeting where recommendations were made on payment updates for hospital inpatient, outpatient, and ambulatory surgical center services for CY 2014. MedPAC also restated its position that the SGR should be repealed.
  • ACS staff and ACS Fellows who serve as representatives for the National Quality Forum (NQF) attended the NQF annual meeting, The Next Decade of Performance Measurement: Meeting the Needs of a Rapidly Changing Healthcare System. The conference focused on ways to quickly and efficiently fill measure gaps, accelerate efforts to support the transition to e-measures, use the same measures when possible to reduce administrative burdens and improve efficiency, and gain insight into how to develop a measures use feedback system.
  • The Surgical Quality Alliancemet and discussed the following: Public reporting of surgical measures, the Centers for Medicare & Medicaid Services (CMS) implementation plan, Physician Compare and the Consumer Assessment of Healthcare Providers and Systems surveys, the Bundled Payments for Care Initiative, the NQF Measure Applications Partnership's Pre-Rulemaking Report, the CMS Request for Information on the Use of Clinical Registries for reporting to the PQRS, the EHR Incentive Program, and the Consumers United for Evidence-Based Healthcare.
  • The ACS General Surgery Coding and Reimbursement Committee met and discussed coding, billing, and reimbursement issues, including documentation of postoperative visits, the Physician Payment Sunshine Act, and updates to the Physician Compare website.

April

  • More than 200 physicians attended the second annual ACS Advocacy Summit in Washington, DC, April 14–16.
  • The ACS released the Surgeons and Bundled Payment Models: A Primer for Understanding Alternative Physician Payment Approaches. This members-only resource summarizes the concept of bundled payment and the effect bundled payment policies could have on surgical practices.
  • Reps. Larry Bucshon, MD, FACS (R-IN), a cardiothoracic surgeon, and David Scott (D-GA) introduced the Truth in Health Care Marketing Act. This legislation would make it unlawful for any health care professional to make deceptive statements or engage in behavior that misleads patients in advertisements and marketing efforts.
  • The ACS and other surgical and anesthesia organizations submitted a joint letter to the Office of the National Coordinator for Health Information Technology (ONC) commenting on several policies and programs under consideration by CMS and the ONC aimed at helping advance interoperability and health information exchange.

May

  • The House Committee on Energy and Commerce released an updated version of their proposal to reform Medicare's physician payment system and replace it with an improved fee-for-service (FFS) system. The new model would reward providers for high-quality and efficient care in the FFS program, while also allowing physicians to opt out of the FFS payment system by adopting new and alternative payment models.
  • The Senate Finance Committee sent a request for feedback on several questions regarding the Medicare physician payment system. The ACS responded with a number of recommendations on how to reduce health care spending in the current system while improving quality and paving the way for physicians to move into new payment models.
  • ACS submitted a comment letter to CMS regarding the agency's proposal to allow hospitals that had Part A claims overturned due to lack of medical necessity for the inpatient admission to bill those services under Part B, as though the patient had been treated as an outpatient rather than an inpatient.
  • The College sent a letter supporting legislation to establish a national task force that will study the impact of improvised explosive devices on the urogenital organs of returning military personnel.
  • Legislation to improve patient access to emergency care services was introduced in May that would offer liability protection to providers working under the Emergency Medical Treatment and Active Labor Act that requires physicians to provide stabilizing care to any patient who presents at a hospital emergency department.
  • The Good Samaritan Health Professionals Act was introduced and would ensure health professionals who provide voluntary care in response to a federally declared disaster are able to do so without the worries of liability claims.
  • Endorsed by the ACS, Eric Whitacre, MD, FACS, a general surgeon in Tucson, AZ, was appointed to the NQF MAP Clinician Workgroup that provides input on the selection and coordination of measures for clinician performance measurement programs and public reporting.
  • Frank Opelka, MD, FACS, ACS DAHP Associate Medical Director, was reappointed to the MAP Coordinating Committee, to serve as the ACS' representative. The committee provides direction to MAP advisory workgroups and submits pre-rulemaking recommendations to the Department of Health and Human Services (HHS).
  • Advocacy staff attended a meeting of the Colorado Clean Claims Task Force, a group that the Colorado legislature established to standardize claim edits and payment rules among insurers in the state. Major topics of discussion at the meeting included creating a consistent set of rules for billing for co-surgery, team surgery, and assistants at surgery.

June

  • The ACS submitted two letters, one to the CMS and a similar letter to the HHS Office of the Inspector General (OIG), regarding extending a federal physician self-referral statute (Stark Law) exception and comparable anti-kickback safe harbor for donation of EHR software to physicians.
  • The ACS responded to the CMS Inpatient Prospective Payment System (IPPS) proposed rule. Among other issues, in the rule, CMS proposed to set forth new criteria for identifying when an inpatient admission should be ordered.

July

  • The ACS submitted letters of support to Congress concerning the Pediatric Subspecialty and Mental Health Workforce Reauthorization Act that would extend authorization for the pediatric subspecialty loan repayment program through 2018. Under the current law, the program will expire in 2014. Read the Pediatric Subspecialty and Mental Health Workforce Reauthorization Act.
  • The ACS submitted letters of support to Congress concerning the Standard of Care Protection Act that would specify that no standard or guideline in Medicare, Medicaid, or the Affordable Care Act (ACA) may be used to establish the standard of care that a health care professional must provide to a patient. Read the Standard of Care Protection Act.
  • The American Board of Surgery has been approved by CMS as an organization authorized to submit data for the 2013 PQRS Maintenance of Certification (MOC) Incentive. This incentive allows physicians participating in PQRS reporting to earn an additional 0.5 percent on Medicare Part B charges by also participating in an approved MOC program "more frequently" than is required to maintain board certification.
  • The ACS submitted letters of support to Congress concerning the Access to Frontline Health Care Act that would create a new Frontline Providers Loan Repayment Program. Under this program, health care professionals, including general surgeons, would receive loan repayments from HHS 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. Read the Access to Frontline Health Care Act.
  • The ACS submitted letters of support to Congress concerning the Ambulatory Surgery Center (ASC) Quality and Access Act because it would transition reimbursement for ASCs to the hospital market basket update from the Consumer Price Index for All Urban Consumers. View the College's House and Senate letters of support. Read the ASC Quality and Access Act.

August

  • The ACS General Surgery Coding and Reimbursement Committee met and discussed coding, billing, and reimbursement issues, including proposed Complex Care Management Services, bundled payment, and issues affecting payment to outpatient departments and ASCs.
  • ACS submitted a comment letter in response to the CY 2013 Physician Fee Schedule Proposed rule. This letter addressed various topics including the Physician Quality Reporting System, Physician Compare, and the Physician Value-Based Payment Modifier.
  • ACS submitted a comment letter in response to the CY 2013 Outpatient Prospective Payment System/Ambulatory Surgical Center proposed rule. This letter included comments on issues related to payment to hospital outpatient departments and ASCs.

September

  • Despite strong opposition from the ACS, the American Society for Metabolic and Bariatric Surgery (ASMBS), and other leading surgical and medical groups, CMS announced that it will no longer require Medicare patients to undergo bariatric surgical procedures at accredited facilities as a condition for coverage. In February 2013, the ACS submitted feedback to CMS outlining evidence supportive of continuing accreditation of bariatric facilities as a condition for coverage.
  • The College launched SurgeonsVoice, an enhanced grassroots advocacy program for recruiting, educating, and motivating Fellows to use their influence to change the dynamic in Washington, DC, by equipping members with the knowledge and tools necessary to become an integral part of our nationwide grassroots advocacy network of surgeon advocates. Use your ACS ID and username to log in.
  • The Surgical Quality Alliance (SQA) met and discussed the following: medical home updates, Premier's Bundled Payment Collaborative, public reporting of surgical measures, CMS Physician Quality Reporting Program options, payment and delivery transformation, and the Physician Consortium for Performance Improvement's new model for the review and enhancement of measures.

October

  • Read the advocacy and health policy overview at the 2013 ACS Clinical Congress.
  • The College released Our Changing Health Care System Since the Inception of the Affordable Care Act, a compendium of articles and other resources that the ACS has published on legislative and regulatory issues, which provide a retrospective and a prospective look at the changing health care landscape.
  • The Senate Finance and House Ways and Means Committees released a bipartisan, bicameral draft proposal for repealing the SGR formula and fixing the Medicare physician payment system. The proposal builds on draft legislation that the House Energy and Commerce Committee approved this summer.

November

  • The ACS sent a letter to the Senate Finance and House Ways and Means Committees responding to their bipartisan, bicameral draft proposal to permanently repeal the SGR and fix the Medicare physician payment system.
  • On November 20, 259 Members of the House of Representatives, in an effort spearheaded by Representatives Bill Flores (R-TX) and Dan Maffei (D-NY), sent a bipartisan letter to Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA), urging Congress to permanently repeal the flawed Medicare sustainable growth rate (SGR) formula and replace it with a system that rewards quality, while controlling costs. The College spearheaded this effort in partnership with numerous national and state physician organizations and record-breaking grassroots efforts by the College Fellows.
  • The ACS submitted a letterto CMS urging the agency to extend the period of time during which physicians may modify their Medicare participation status given that the government shutdown delayed release of the Medicare physician fee schedule (PFS) final rule, which lists payment rates for services covered under Medicare Part B for the upcoming year. As a result of advocacy efforts from the ACS and other physician organizations, CMS extended the 2014 annual participation enrollment period for Medicare until January 31, 2014.
  • The ACS, in collaboration with 15 other surgical specialty societies jointly published and released the seventh edition of Physicians as Assistants at Surgery, a report that provides guidance on how often an operation might require the use of a physician as an assistant.
  • In a voice vote, the Senate passed bipartisan legislation to ensure the sterility and safety of compounded pharmaceuticals. The Drug Quality and Security Act passed in the House of Representatives in September.
  • CMS released the final CY 2014 Medicare Physician Fee Schedule (MPFS) rule and the 2014 Outpatient Prospective Payment System/Ambulatory Surgical Center(OPPS/ASC) final rule. The ACS submitted separate comment letters on both MPFS as well as the OPPS/ASC proposed rule.

December

  • Congress passed a three-month, 0.5 percent increase in the Medicare physician payment rate as a bridge to allow for negotiations on a permanent repeal of the SGR formula. The short-term patch averts the scheduled cut to the payment rate, which is in excess of 24 percent.
  • The ACS and other surgical societies issued a letter in opposition to the proposed legislation to repeal the SGR before the Senate Finance Committee. The College's position was based on the proposal's call for a 10-year physician payment freeze and inadequate incentives for providing value-based care. We believe the impact of these two provisions would hinder our members' ability to keep their practices open, disincentivize the sharing of best practices, and place patients' access to surgical services at risk. The College urged the committee to delay a vote on the proposal; however it ultimately passed out of committee.
  • Alternatively, the House Ways and Means Committee made good faith changes in its proposed SGR legislation to address some of our concerns and provided more stability for surgeons and the surgical patient. The committee passed its proposal out of committee on December 5. The College continues to move the process forward and will work with both House committees, as well as the Senate Finance committee, to reform the Medicare physician payment system.
  • The ACS General Surgery Coding and Reimbursement Committee met and discussed coding, billing, and reimbursement issues, including the CMS "2-midnights policy," the "96-hour" rule that applies to Critical Access Hospitals, and a request for increased transparency at the Current Procedural Terminology Editorial Committee and AMA/Specialty Society Relative Value Scale Update Committee.

At the State Level

A look back at state advocacy efforts in 2013

Read about additional state advocacy activities.

January

  • The Michigan legislature adopted liability reforms before adjourning the lame-duck session. SB 1115 and SB 1118 help to clarify a number of existing liability statutes, including the definition of noneconomic damages to clearly denote what damages or losses are subject to the cap and when the cap is applied to ensure that judges are not able to circumvent the limits of the cap on noneconomic damages.

February

  • Florida Rep. Jeanette M. Nunez (R) introduced legislation to adopt a definition of surgery to clarify what optometrists may do as part of their scope of practice. Optometrists will be required to report to the Florida Department of Health adverse incidents in the practice of optometry, and a patient-specific written protocol will be required between an ophthalmologist and an optometrist for the provision of postoperative care.
  • The Arkansas Senate considered Joint resolution 2, introduced by Sen. Jeremy Hutchinson (R), which would amend the state's constitution to address various elements of tort reform.
  • Since January, Truth in Advertising bills were introduced in ND, NE, NJ, VT, FL, and NY.
  • Since January, 14 states decided to consider Breast Density Mandate legislation that would require health care practitioners to notify patients if they have dense breast tissue that shows up on mammograms and often requires insurance coverage for additional testing via ultrasound or MRI: CT, FL, GA, HI, IA, IN, MD, MI, OR, PA, SD, TN, TX, and VA.
  • Since January, a total of 72 bills have been introduced on trauma and injury prevention at the state level. Distracted driving bills that prohibit texting, or use of handheld devices while operating a vehicle gained the most traction. States with bills to ban use of handheld devices while driving include: AZ, GA, HI, IA, MD, ME, MS, NM, OK, and SC.

March

  • Gov. John Kitzhaber (D-OR) signed the Early Discussion and Resolution legislation into law. The new law offers health care providers and patients the opportunity to voluntarily resolve notices of adverse events without litigation.
  • A comprehensive medical liability reform bill was introduced in the Iowa General Assembly. This legislation would tighten expert witness testimony requirements, create medical liability review panels, and permit evidence-based medical practice guidelines into evidence.
  • Despite strong support from the physician community in Utah, it was not enough to sway lawmakers to pass legislation that would grant licenses to anesthesiologist assistants.

April

  • Lawmakers in Louisiana considered legislation that would allow optometrists to prescribe controlled substances and perform ophthalmic surgery, as well as be called "ophthalmic physicians." The House Health and Welfare Committee passed the bill with a 12-7 vote, and the legislation headed to the full House for debate where it was later withdrawn.
  • Legislation to strengthen existing California law relating to assault weapons passed in the Senate Committee on Public Safety on a 5-2 vote. Multiple physician organizations in the state support this bill, with the Northern California Chapter of the ACS taking a position of support early on in the legislative process.
  • Lawmakers in Wisconsin introduced legislation that would enact an "I'm Sorry" statute for medical liability actions. According to the bill, an expression of apology, benevolence, compassion, condolence, fault, liability, remorse, responsibility, or sympathy to a patient or relative/representative would be inadmissible into evidence or subject to discovery in any civil action or administrative hearing to determine medical liability.
  • Following input from various state agencies and the Texas governor's office, the Uniform Emergency Volunteer Health Practitioners Act (UEVHPA) advanced out of the Texas Homeland Security and Public Safety committee on a 9-0 vote. This ACS-endorsed legislation would improve the ability of out-of-state surgeons and other physicians to provide care in Texas during the time of a declared emergency.

May

  • Gov. Rick Scott (R-FL) approved legislation creating the Cancer Center of Excellence Award to recognize hospitals, treatment centers, and other providers in the state demonstrating excellence in patient-centered coordinated care for persons undergoing cancer treatment and therapy.
  • The UEVHPA was approved in both the Texas House and Senate. The intent of this legislation is to improve the ability of out-of-state surgeons and other physicians to provide care in Texas during a declared emergency.
  • The entire physician community in New York expressed concern over a number of medical liability bills that are likely to increase liability insurance premiums in the state.
  • Nevada became the most recent state to grant independent practice to nurse practitioners. Under the new statute, advanced practice registered nurses will be able to prescribe schedule II drugs, may be required to carry liability insurance, and will no longer practice under a protocol with a physician.
  • The New Jersey Supreme Court issued a ruling in a medical liability case pertaining to expert witness qualifications. Under New Jersey law, plaintiff's expert witnesses must be board certified in the same specialty as a board-certified defendant.
  • Georgia became the first state to enact provider shield legislation. Under the new statute, a barrier is created between physicians and public or private payor guidelines that could have been used as evidence in medical liability lawsuits.

June

  • 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.
  • In June, the ACS and 10 other medical and specialty societies cosponsored a resolution that the 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. The College's testimony 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.

July

  • 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. States may to request an opt-out that allows CRNAs to practice independent of this mandate. The ACS believes that states should uphold this requirement, maintaining that not doing so would jeopardize patient safety.
  • Months of negotiation between physicians, advanced practice nurses, and physician assistants led to the Texas legislature passing legislation to create a team-based, physician-led collaborative model of practice.
  • California's landmark Medical Injury Compensation Reform Act (MICRA), which has helped to keep liability premiums in check since 1975, came under threat with the introduction of California Ballot Initiative 13-0011, the Troy and Alana Pack Patient Safety Act of 2014. The proposal calls for raising the damage cap to $1.1 million from the current $250,000—the same amount as the original limit.
  • Revisions to the California Nursing Practice Act bring nurse practitioners one step closer to independent practice. Under the terms of the bill, nurse practitioners would be able to order durable medical equipment without physician supervision and, in consultation with a physician and surgeon, approve, sign, modify, or add to a plan of treatment or plan for an individual receiving home health services or personal care services. In addition, a nurse physician could furnish or prescribe drugs or devices, establish patient diagnoses, and delegate tasks to medical assistants.
  • Legislation to strengthen existing California law relating to assault weapons passed both chambers of the state legislature in September. It is part of the LIFE Safety package of firearm safety bills awaiting gubernatorial action.

October

  • State health insurance exchanges opened providing uninsured consumers with the opportunity to purchase health insurance policies as ACA implementation moves forward. Read informational and educational materials.
  • The Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events authored the Hartford Consensus, a list of recommendations on ways to help reduce injury or mortality.
  • California Gov. Jerry Brown (D) vetoed a measure that would have banned semi-automatic rifles in the state. In a statement about the veto, Governor Brown said, "The State of California already has some of the strictest gun laws in the country, including bans on military-style assault rifles and high-capacity ammunition magazines."
  • As part of the College's goal to increase advocacy and health policy efforts, ACS chapters in 17 states will receive lobby day grants through the ACS Chapter Advocacy Program.
  • California's Second District Court of Appeals upheld the constitutionality of the Medical Injury Compensation Reform Act (MICRA). In this case, the plaintiff, after having the noneconomic damages portion of his award reduced to $250,000—the MICRA limit--argued that the cap violated California's constitutional guarantees of trial by jury, separation of powers, and equal protection under the law.

PAC and Grassroots News

A look back at SurgeonsPAC and grassroots efforts in 2013

Read about additional SurgeonsPAC activities and grassroots activities.

At press time, the American College of Surgeons Political Action Committee (ACSPA-SurgeonsPAC) raised $581,000 from 1,926 members of the College and staff (3.2 percent participation rate).

  • Raised more than $56,000 during the second annual 2013 Advocacy Summit. Thirteen members of Congress attended the Summit.
  • Raised more than $50,000 in contributions at the 2013 Clinical Congress.

Since mid-December, the SurgeonsPAC has supported 81 individual candidates for the House and Senate towards the 2014 congressional election cycle, and dispersed $423,500—inclusive of party committees and other leadership PACs. Read a list of DAHP 2013 disbursements.

Fellows and staff attended over 220 political events for members of Congress and Congressional candidates sponsored by SurgeonsPAC.

Grassroots

In 2013 the College launched SurgeonsVoice, a nationwide, interactive advocacy program that provides surgeons with the tools to strengthen its impact in Congress and around the country. SurgeonsVoice is led by the Health Policy Advisory Council, chaired by Charles Mabry, MD, FACS, a general surgeon from Pine Bluff, AR, and is operated by the ACS DAHP.

The online resources at SurgeonsVoice.org allow surgeons to engage and build valuable relationships with lawmakers, advance pro-surgery policy and legislation, helps foster champions for surgery on Capitol Hill, and provides surgeons the tools needed to become a surgeon advocate today.

Other News of Interest

Happy Holidays from the advocacy and health policy staff at the ACS.

For more frequent updates, follow the ACS on Twitter, like the ACS on Facebook page,or add the advocacy Web section to your "favorites" list. Send questions or comments about this issue of The ACS Advocate to Chantay Moye, Communications Manager, at cmoye@facs.org.