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

February 2014 ACS Advocate


Welcome to the February edition of The ACS Advocate. We are 31 days into the new year and less than 60 days from the threat of another Medicare physician payment cut. Before Congress adjourned in December, it passed a three-month, 0.5 percent increase in the Medicare physician payment rate as a bridge to negotiations on permanent repeal of the sustainable growth rate (SGR) formula. The short-term patch postponed the scheduled cut to the payment rate, which exceeds 24 percent, until April 1.

ACS Division of Advocacy and Health Policy (DAHP) staff continues to advocate for reasonable payment reforms that allow surgeons to treat their patients. ACS strongly believes that any reform must include an annual positive update and a properly incentivized value-based payment system.

This is why it is critical that you attend this year's annual Leadership & Advocacy Summit, March 29–April 1, and participate in Lobby Day on April 1. This is your opportunity to speak directly with members of Congress or their staffs and tell them to stop paying the minimum on the credit card bill and enact a permanent solution.

Inside this issue...

At the Federal Level

Registration Open: Leadership & Advocacy Summit
HPAG Sets 2014 Advocacy and Health Policy Agenda
What We Do
2-Midnight Policy
PQRS-EHR Incentive Pilot
You're Invited: CoC Legislative Briefing
ACS to Host February Coding Workshop
First ACS Breast Coding Workshop

At the State Level

Medical Liability Apology Bill
Trauma Systems Bill
Electronic Cigarettes
UnitedHealthcare to Narrow Networks
Transparency Law

PAC and Grassroots

Get Involved Today:

Other News of Interest

At the Federal Level

Lead, Advocate, and Connect at the 2014 Leadership & Advocacy Summit

The ACS Division of Member Services and DAHP staffs are in the process of finalizing the agendas for the third annual ACS Leadership & Advocacy Summit, March 29–April 1 at the JW Marriott in downtown Washington, DC. This multi-platform meeting offers direct access to the leadership of the College, expert authors, and political proponents. Participants will have an opportunity to connect with colleagues from around the country to discuss the best practices to develop effective leaders and advocate for our health policy agenda.

Leadership Program

The 2014 Leadership program will begin March 30 and will focus on building leadership and mentoring skills, emotional intelligence, and chapter development. During the afternoon of the Summit, attendees will convene by geographic location, allowing group participants to identify areas for synergy and unified efforts.

Highlighted presenters for this year's Leadership program include Scott Halford, CSP, Emmy Award-winning writer and producer, and long-time consultant to Fortune 500 executive teams in the area of achievement psychology. Mr. Halford will talk about using emotional intelligence for maximum success. Bruce Gewertz, MD, FACS, will present on how emotional intelligence can enhance your professional and personal life. ACS President Carlos Pellegrini, MD, FACS, will give a lunchtime talk titled "The Surgeon Leader—What Does It Take, and How Can I Get It?" John Rioux, MD, FACS, Chair, Governors Chapter Activities Domestic Workgroup, will speak on leading your chapter to success. Finally, a representative of the Young Fellows Association will offer best practices for creating a strong mentor-mentee relationship. Contact Donna Tieberg at or 312-202-5361 for more information regarding the Leadership program.

Advocacy Program

The Advocacy program will kick off Sunday evening, March 30, with a reception and dinner featuring Thomas Goetz, author of The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine, and former executive editor of Wired magazine. The following day, Thomas Lee, MD, chief medical officer at Press Ganey Associates, Inc., will discuss "The Provider Role in Fixing Health Care." A large portion of the day will be spent preparing participants for Lobby Day. The following provides a glimpse at the preliminary agenda that is strategically framed to help participants have a lasting impact on Capitol Hill.

  • The ACA: What Every Surgeon Needs to Know Now: Sara Rosenbaum, chair, department of health policy, The George Washington University
  • Motivating Your Peers to Act: Bradford Fitch, president and CEO, Congressional Management Foundation
  • A Giving Culture: Investing in SurgeonsPAC: Marc Pitman, a prominent fundraising coach
  • Political luncheon sponsored by SurgeonsPAC: David Wasserman, house editor, The Cook Political Report
  • Interview with an Insider: Brian Gavitt, MD, FACS, former U.S. Senate staffer, and John Hedstrom, JD, deputy director, ACS DAHP
  • Lobby Day Training and Briefing: ACS DAHP staff and Christopher Kush, MPP, CEO, Soapbox Consulting

Register today and view housing specifications. Contact Katy Dwyen at or 202-672-5111 for more information regarding the Advocacy program.

HPAG Establishes 2014 Agenda

The ACS Health Policy and Advocacy Group (HPAG) met in Washington, DC, January 26–27, to set the advocacy and health policy agenda for the year. In 2013, DAHP staff put forth tremendous efforts toward building support among policymakers on issues that will continue to define the practice of surgery. Some of the issues of primary concern were Medicare physician payment reform, quality of care, medical liability reform, graduate medical education, and trauma system funding.

As these efforts will continue in 2014, DAHP staff is seeking your help in strengthening Fellow engagement. ACS leadership, the Fellows, and DAHP staff must work as partners in advocacy to leverage our policy positions with Congress. There are a few new advocacy and health policy issues for 2014: Medicare's 96-hour rule, pediatric workforce shortage, and cancer advocacy.

Understanding What We Do

The College is listening. In recent years, some ACS members have suggested that they are unfamiliar with the wide-ranging work that is carried out in the Washington Office. Over the course of this year, DAHP staff will provide answers to questions members may have concerning health policy and grassroots advocacy. The College needs member support to advocate for the surgical profession. The ACS anticipates that consistent communication and transparency will lead to greater member participation.

Question: Why should I get involved with ACS advocacy and health policy activities and initiatives?

HPAG Response: It has been said that in Washington, if you are not at the table, you will be on the menu. This aphorism is true not only with respect to working with Congress, but in each state legislature as well. Elected officials are not surgeons and often have little, or no, experience with health care. You are the experts and your voice must be heard to improve the health care system for patients and our profession. Often times, we direct our advocacy efforts to stop a legislative idea from being proposed or passed. Conversely, we proactively advocate for the enactment of sound health care policy.

If you have a question or an idea that you would like the DAHP staff to explore, please e-mail

Understanding the CMS 2-Midnight Policy

In August 2013, the Centers for Medicare & Medicaid Services (CMS) released the Inpatient Prospective Payment System final rule, which included a 2-midnight policy on inpatient admissions.

Under this policy, CMS will consider surgical procedures, diagnostic tests, and other treatments generally appropriate for inpatient hospital admission and payment when the physician expects a Medicare patient to require hospital care spanning two midnights—or if the Medicare patient receives services that are on the "inpatient only" list. The ACS regulatory team has prepared an FAQ to provide guidance to Fellows on this policy. The FAQ provides more information on the 2-midnight benchmark and how it is calculated, factors to consider when determining whether a patient should be considered for inpatient care or observation, Recovery Audit Contractor reviews of claims, and the importance of documentation in the medical record.

2013 PQRS-EHR Incentive Pilot: Data Due Feb 28

Eligible professionals (EPs) participating in the Physician Quality Reporting System (PQRS)-Electronic Health Record (EHR) Incentive Pilot have until February 28 to submit their 12-month quality data for 2013. The PQRS-EHR Incentive Pilot allows EPs to meet the clinical quality measure (CQM) component of the Medicare EHR program while also satisfying required reporting for the PQRS program. The participation guideline provides step-by-step instructions on submitting the CQMs.

You're Invited: Commission on Cancer Legislative Briefing

RSVP today to attend a legislative briefing hosted by the ACS Commission on Cancer (CoC) on Tuesday, February 10, in Washington, DC. The briefing, Ensuring High-Quality, Patient-Centered Cancer Care, will take place on Capitol Hill in room 2325 of the Rayburn House Office Building, 9:00–11:00 am. Topics and speakers for the program include:

  • Commission on Cancer Accreditation for the Future: Daniel McKellar, MD, FACS, Wayne Healthcare
  • Implementation of Cancer Quality Measures: Christopher Pezzi, MD, FACS, Abington Memorial Hospital
  • Patient Navigation, Survivorship Care Plan, and Distress Screening Continuum of Care Standards: Nina Miller, MSSW, OSW-C, ACS Commission on Cancer
  • The Future of Cancer Care: James Hamilton, Jr., MD, FACS, St. Francis Health

For additional information or to RSVP, contact Kaitlyn Dwyer at 202-672-1511 or

Learn to Code Accurately: Attend February Surgical Coding Workshop

The ACS will hold the first of several two-day Current Procedural Terminology (CPT) coding workshops in 2014 on February 6–7 in Las Vegas, NV.

Prepare your staff to report medical procedures and services in a shifting payment environment that is increasingly focused on outcomes, costs, and quality measures. The February 6 workshop will center on E/M Coding, Profitable Practice Operations, and Strategy, and the February 7 session will focus on Mastering General Surgery CPT Coding. Workshop attendees may receive up to 6.5 AMA PRA Category 1 Credits™ for each day of participation. Members of the American Association of Professional Coders may earn a maximum of 6.5 credits per day. Register today.

First-of-Its-Kind Breast Coding Workshop

This year, the ACS also will offer a one-day seminar on Comprehensive Breast Coding, February 21, in Orlando, FL. The workshop will provide instruction on incorporating the 2014 CPT breast biopsy and imaging coding changes, identifying documentation required to accurately incorporate International Classification of Diseases (ICD)-10 into office notes and pre- and postoperative diagnosis in operative notes, and using appropriate modifiers for accurate claim submission. Register today.

At the State Level

Medical Liability Apology Bill Signed into Law in Pennsylvania

In late 2013, Pennsylvania Gov. Tom Corbett (R-PA) signed "benevolent gestures" legislation into law. The statute allows physicians to apologize, offer condolences, or show compassion without fear of their words being used against them in a medical liability suit. It does not offer protection for statements of negligence or fault. The Senate unanimously passed the bill and the House voted to approve on a vote of 202-0 in the fall. The bill took eight years to move through the legislature.

Pennsylvania joins 37 other states that currently have apology protection statutes for physicians. Hawaii, Kansas, Mississippi, New York, Rhode Island, and Wisconsin currently have bills pending in the statehouse.

Trauma Systems Bill Moves Forward in New Jersey

New Jersey is moving closer to enacting legislation that would provide for the development and implementation of a formal state trauma system. The bill, S3027, was developed in response to an assessment by the ACS Trauma Systems Evaluation and Planning Committee.

The legislation closely follows the recommendations made by the ACS Committee on Trauma. It creates a formal trauma system under the Department of Health, which will be led by a State Trauma Medical Director, who will lead the effort to develop and implement a statewide trauma system. It will also create a State Trauma System Advisory Committee to advise the Commissioner of Health and the State Trauma Medical Director on the development of the statewide trauma system plan. The legislation passed both houses and Governor Chris Christie (R) signed it on January 21. The law went effect immediately.

Electronic Cigarettes

According to the Centers for Disease Control and Prevention, the use of conventional cigarettes has decreased among minors in the U.S. over the last year, while use of alternative tobacco products (electronic cigarettes, miniature cigars, and hookah) has increased.

E-cigarettes, which resemble cigarettes, but deliver nicotine through short bursts of water vapor without smoke, are currently unregulated under state or federal law. Hence, e-cigarette sales are exempt from age restrictions, health warnings, and taxation. The Food and Drug Administration (FDA) is working to establish regulations for these products.

In the meantime, some states are taking matters into their own hands. For example, in Iowa, Attorney General Tom Miller wants to ban the sale of e-cigarettes to minors, have these devices covered under the state's 2008 Smoke-Free Air Act, and tax e-cigarettes at a higher rate than conventional cigarettes. This is expected to be an ongoing issue in state legislatures during the 2014 legislative session.

UnitedHealthcare to Narrow Networks

Over the last several months, UnitedHealthcare has been terminating primary and specialty physicians from their Medicare Advantage network. Major instances of this trend have occurred in Connecticut, New York, and Florida. In Connecticut, nearly 2,200 physicians have been terminated without cause or explanation. The Connecticut Chapter of the ACS has been working with the Connecticut State Medical Society and the Connecticut Congressional delegation to help get answers and develop a solution. In December 2013, the Fairfield and Hartford County Medical Associations were able to win a temporary restraining order and injunction against UnitedHealthcare. Before the restraining order and injunction were issued, these terminations were slated to go into effect on February 1.

This is an ongoing issue in many states. Surgeons are encouraged to contact with any information from other states where this has become an issue.

Maine Transparency Law Effective January 1

In an attempt to create more price transparency and to encourage consumers to pay more attention to prices and costs of health care, a new Maine law now requires all health care practitioners to provide copies of a price list of all services and procedures performed at least 50 times during the previous calendar year. The prices must be those charged to an individual with no insurance coverage, and the list also must show the applicable standard medical code listed by diagnosis. Clarifying amendments to this statute are being discussed in the 2014 legislative session to address some of the unnecessary burdens this mandate might impose on physicians. Contact the ACS state affairs team for further information at

PAC and Grassroots News

Get Involved Today

(Note: You must use your ACS User ID and password to access

As stated earlier, attending this year's Advocacy Summit has never been more important. Much is at stake—namely provisions from Medicare physician payment cuts that may hinder the care surgeons are able to provide patients.

The time to get involved and advocate for the surgical profession is now.

Take advantage of, an online resource developed for ACS members to take action on key issues, learn about their state legislators, become key contacts, share advocacy stories, and learn to become effectual surgeon advocates.

Become a Councilor. Each ACS chapter has a Councilor who is responsible for fostering an active grassroots effort within the chapter as part of our extensive national grassroots advocacy network. We need committed Councilors to partner with the ACS DAHP and promote grassroots and political advocacy among their peers.

Join the DOCS program. Surgeons who participate in the District Office Contacts by Surgeons (DOCS) program will routinely meet with their representative and senators in their state district offices during House and Senate recesses—also known as in-district work periods—and advocate on issues critical to surgery. Learn more about the DOCS program and get started today.

Other News of Interest

  • In January, ACS state advocacy staff participated in the Kansas and Indiana Lobby Day events, assisting chapter members and fellows with their state advocacy programs. State legislatures are often seen as local laboratories of change, coming up with unique solutions to unique problems—and meeting the needs of citizens in a way that Congress cannot.
  • The Surgical Quality Alliance (SQA) held its annual meeting January 28 at the ACS Washington, DC, office. The following quality initiatives were discussed: the National Quality Forum's Measures Application Partnership, synoptic reporting, Health Research & Educational Trust, the SGR, and quality of care, among other topics. To learn more about the SQA, or if you have queries, e-mail
  • Advocacy staff attended a MedPAC meeting on January 16–17. Relevant topics included: defining the framework for a National Quality Registry Network, meaningful use and surgical care, Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services, Medicare Accountable Care Organization (ACO) Policy Options, and Assessing Payment Adequacy and Updating Payments: Ambulatory Surgical Centers, Hospice, Inpatient Rehabilitation Facilities and Long-Term Care Hospitals.

For more frequent updates, follow the ACS on Twitter, like the ACS 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