2012 Year in review: As 2012 ends, this issue of The ACS Advocate looks back at the American College of Surgeons’ major advocacy and health policy accomplishments for the year. More specifically, this issue highlights activities and achievements at the federal and state levels, as well as activities of the ACS Professional Association (ACSPA)-SurgeonsPAC (political action committee).
From the inaugural Advocacy Summit to the tremendous efforts to support the Electronic Health Records Improvement Act and the increased efforts made to reform the physician payment system, the ACS has advocated on members’ behalf. The College’s leadership intends to maintain this focus in 2013 and is committed to playing a vital role in helping legislators and policymakers understand how legislation and regulations affect surgical practice and quality of care.
The ACS Division of Advocacy and Health Policy (DAHP) finished the year with the completion of a new resource, Surgeons as Institutional Employees: A Strategic Look at the Dimensions of Surgeons as Employees of Hospitals, which will be mail with the February issue of the Bulletin of the American College of Surgeons. The guide provides information that U.S. surgeons need before seeking hospital-based employment. The primer covers such topics as institutional environments, hospital employment types, the various types of transitions to or from employment, and the challenges of transitional situations such as selling a private practice, the intricacies of negotiating employment contracts, and compensation and benefits.
INSIDE THIS ISSUE
Year in review
At the Federal Level
At the State Level
PAC and Grassroots
A LOOK BACK AT FEDERAL ADVOCACY EFFORTS IN 2012
Read about additional federal advocacy activities on regulatory and legislative issues.
- ACS continued to advocate for Medicare physician payment reform and began developing and promoting a proposal to repeal and replace the sustainable growth rate payment formula (SGR) with a Value Based Update (VBU).
- The ACS Division of Advocacy and Health Policy (DAHP) staff participated in the first of seven Medicare Payment Advisory Commission meetings held throughout the year. The Commission focuses on Medicare policy issues and makes recommendations to Congress.
- At the request of the ACS and other health care organizations, Rep. Fred Upton (R-MI), Chairman of the House Energy and Commerce Committee, submitted a letter to the Government Accountability Office (GAO) requesting an assessment of the nation's current trauma and emergency medical services programs.
- ACS staff and Fellows represented the ACS at the American Medical Association Specialty Society Relative Value Scale Update Committee and Current Procedural Terminology Editorial Panel. These meetings take place several times annually.
- The ACS submitted comments to the Agency for Healthcare Research and Quality (AHRQ) regarding the Draft Evidence Report: Public Reporting as a Quality Improvement Strategy: A Systematic Review of the Multiple Pathways Public Reporting May Influence Quality of Health Care. The draft report was one of eight reviews in a series titled, Closing the Gap: Revisiting the State of Science. The series offers a systematic literature review that evaluates and discusses the effectiveness of public reporting of health care quality information as a quality improvement strategy.
- Don E. Detmer, MD, FACS, Medical Director of the DAHP, was appointed to serve as a member of the National Quality Forum's (NQF's) Common Formats Expert Panel. The Panel is a collaboration of the NQF and the U.S. Department of Health and Human Services' AHRQ.
- The ACS held its first annual Advocacy Summit in conjunction with the ACS annual Leadership Conference. Surgeons from 42 states participated in 223 Senate and House meetings to share their concerns on issues such as liability reform, the flawed SGR formula, quality improvement initiatives, the surgical workforce, and access to trauma and emergency care. Several U.S. representatives spoke at the Summit, including Rep. Joe Heck, DO (R-NV), Rep. Allyson Schwartz (D-PA), and Rep. Dan Benishek, MD, FACS (R-MI). These members of Congress emphasized the importance of reaching out to elected officials on issues that affect the surgical community. The day-long program wrapped-up with a talk from Pulitzer Prize-winning columnist George F. Will. More than 200 ACS members attended the Summit.
- The SQA commented on the AHRQ's draft chapters to Registries for Evaluating Patient Outcomes: A User's Guide: 3rd Edition. The handbook contains practical information on the design, operation, and analysis of patient registries.
- Four ACS-supported bills passed in the U.S. House of Representatives in March as part of an effort to repeal the Independent Payment Advisory Board (IPAB), established. The Help Efficient, Accessible, Low-cost, Timely Healthcare Act, based on California's liability reform law, was attached to the IPAB repeal as an offset. Two other bills—the Health Care Safety Net Enhancement Act, which provides protections for physicians providing EMTALA mandated care, and the Good Samaritan Health Professionals Act, which provided protection for those volunteering across state lines during a natural disaster or other emergency—were attached as amendments on the House floor.
- Although the congressional appropriation's process was stalled by deficit reduction negotiations, the Senate provided funding for ACS priority programs, such as the National Institutes of Health (NIH), the Children's Hospital Graduate Medical Education Program, and the Emergency Medical Services for Children Program.
- The Department of Health and Human Services announced a proposal to delay the International Classification of Diseases, 10th Edition (ICD-10) diagnosis and procedure codes. The ACS supported the delay.
- At the urging of the ACS and other health care organizations, more than 50 U.S. representatives sent a letter to congressional leaders in support of moving forward with a permanent repeal of the SGR and offsetting the full cost of repeal with Overseas Contingency Operations funds saved due to drawdown of troops in Iraq and Afghanistan.
- Traumatologist and surgical intensivist Heidi Lee Frankel, MD, FACS, professor of surgery at the University of Maryland shock trauma center in Baltimore, was appointed to the American Medical Association (AMA)-convened Physician Consortium for Performance Improvement (PCPI) Anesthesiology and Critical Care. The ACS nominated Dr. Frankel to serve on the committee, which oversees the maintenance process for existing performance and quality measure sets.
- The NQF endorsed the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Surgical Care Survey measure. The ACS, in partnership with other surgical and anesthesia organizations and the AHRQ CAHPS Consortium, developed the survey to assess surgical patients' experiences before, during, and after surgical procedures to adequately identify opportunities to improve quality of care, surgical outcomes, public reporting, and patient satisfaction.
- The ACS submitted a comment letter to the CMS in response to the fiscal year (FY) 2013 Inpatient Prospective Payment System Proposed Rule.
- The ACS, in collaboration with the AMA-PCPI and with input from the SQA Member Organizations, updated the 2013 Perioperative Care Measure Group specifications for CMS' PQRS.
- The ACS leadership provided statements on the role of quality improvement in reforming Medicare physician payment, specifically about the VBU, before the House Energy and Commerce Health Subcommittee and the Senate Finance Committee.
- ACS staff met with congressional committees to discuss drug shortages and the Food and Drug Administration Safety and Innovation Act's effect on surgeons. This bill, which became law in July, contains important provisions to prevent and address prescription drug shortages and incentives aimed at getting new antibiotics on the market.
- The CMS Advisory Panel on Hospital Outpatient Payment accepted the ACS nomination of Karen Borman, MD, FACS, general surgeon in Abington, PA, to serve as a member of the panel. The panel advises CMS on elements of the Medicare Hospital Outpatient Prospective Payment System and the appropriate supervision level for outpatient services.
- The ACS submitted a comment letter to CMS in response to the calendar year (CY) 2013 Medicare Physician Fee Schedule proposed rule. The rule addressed a wide variety of physician payment, quality, and related policies, and the comment letter offered numerous recommendations to CMS on ways that such policies could be refined to facilitate improved surgical care.
- The ACS submitted a comment letter to CMS on the CY 2013 Outpatient Prospective Payment System/Ambulatory Surgical Center proposed rule. This rule addressed payment and quality improvement policies related to hospital outpatient departments and ambulatory surgical centers.
- The ACS nominated Lee Morisy, MD, FACS, a general surgeon in Memphis, TN, to serve on the American Hospital Association International Classification of Diseases, 9th Edition, Editorial Advisory Board. Dr. Morisy begins his two-year term in February 2013.
- The ACS submitted a letter to the AHRQ responding to their request for information on quality measurement enabled by health information technology (HIT). The ACS provided insights into how to improve the collection and use of clinically informed HIT-enabled surgical quality measures as a means of providing valuable feedback to surgeons, facilitating strategic and focused quality improvement by health care organizations, and informing consumers and payors.
- Frank G. Opelka, MD, FACS, Associate Medical Director of the DAHP and executive vice-president for health care redesign and professor of surgery at the Louisiana State University System, New Orleans, was appointed chair of the AMA-PCPI. The PCPI is a national, physician-led program with a mission to align patient-centered care, performance measurement, and quality improvement.
- The ACS DAHP and the ACS Legislative Committee presented the College's first Liability Reform Summit. At the conference, expert researchers, physicians, attorneys, and patient advocates examined various solutions being tested around the country to address the problems associated with the medical liability system and how these changes may affect patient care and clinical practice.
- Leonard J. Weireter, Jr., MD, FACS, a general surgeon in Norfolk, VA, was appointed to the NQF's Regionalized Emergency Medical Care Services Measure Topic Prioritization expert panel. The panel provides guidance for measure development to the U.S. Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response. The panel is focused on prioritized areas of emergency department crowding, with a focus on boarding and diversion, emergency preparedness, and surge capacity.
- At the 2012 Clinical Congress, the General Surgery Coding and Reimbursement Committee hosted the first in a series of planned workshops on surgeons as hospital employees.
- The ACS DAHP participated in a panel discussion in Washington, DC at the AQA, formally the Ambulatory Care Quality Alliance, on public reporting and presented on the CAHPS Surgical Care Survey measure, as well as the history, development, and current and future use of the survey.
- The ACS led a coalition of providers in efforts to address a number of concerns with the current Electronic Health Record Incentive Program that resulted in the introduction of the Electronic Health Improvements Act Rep. Diane Black (R-TN).
- The ACS concluded its 2012 Coding Workshop series titled Seven Keys to Success for Surgeons and Successful Surgical Coding and Compliance, which saw a significant increase in attendance than in 2011 workshops, including a number of sold out workshops.
- Bruce Lee Hall, MD, FACS, PhD, MBA, a general surgeon in St. Louis, MO, was appointed to the NQF's Ad-hoc Review Planned Readmissions Expert Panel. The ACS submitted Dr. Hall's nomination to serve on the panel, which oversees the review of recent updates to several readmissions measures, including the hospital-wide all-cause unplanned readmission measure.
- In November, the ACS convened a meeting of the GAO staff and representatives from several organizations that advocate for trauma system funding to share information and recent studies centered on trauma care and disaster preparedness.
A LOOK BACK AT STATE ADVOCACY EFFORTS IN 2012
- The ACS DAHP completed the first in a series of resources on hospital employment of surgeons entitled "Surgeons as Institutional Employees: A Strategic Look at the Dimensions of Surgeons as Employees of Hospitals."
Read about additional state advocacy activities.
- The Kansas Chapter sponsored its first lobby day with the support of an ACS Day at the Capitol grant. The chapter was recognized during a U.S. House Committee hearing on Medicaid reforms.
- Representatives from the three California ACS chapters met at the Southern California Chapter annual meeting to begin planning for a lobby day in April.
- The Florida Chapter, along with the Florida Commission on Trauma, hosted a lobby day in Tallahassee, FL. Issues discussed with state legislators included a student athlete concussion bill, which subsequently passed in the legislative session, and the restructuring of the Department of Public Health and the Trauma Division.
- The American Medical Association (AMA) presented a legislative roundtable conference, which allowed state affairs staff from physician organizations to collaborate and discuss important legislative issues.
- The Georgia Society of the ACS held its state lobby day. Legislators discussed the reinstatement of funding for state employee health insurance coverage for bariatric surgery as well as the need for passage of the Uniform Emergency Volunteer Health Practitioners Act, which is expected to be introduced in 2013.
- The Indiana Chapter held its state lobby day, which focused primarily on advocacy for a state smoking ban bill that subsequently passed in the state legislature.
- More than 20 legislative visits took place during the Oregon Chapter’s lobby day with a focus on legislation to enact Affordable Care Act mandates at the state level, including establishing a state health insurance exchange program, and medical liability reform.
- The Virginia Chapter participated in a White Coats on Call event at the state capital where surgeons discussed passage of a definition of surgery bill and a nurse practitioners collaboration bill—both of which passed later in the session.
- A core group of the Alabama Chapter leadership participated in a lobby day. Topics discussed during their meetings with legislators included the state’s severe budget crisis and resultant cuts to state programs, workforce shortages, and counties without immediate access to surgeons, trauma funding and trauma system development, scope of practice expansion, and insufficient funding for not-for-profit safety net hospitals.
- Doctor’s Day took place in Connecticut, during which Fellows expressed opposition to proposed changes to the state’s Certificate of Merit law, which subsequently died following a vote during the legislative session.
- The ACS Ohio Chapter hosted a second Day at the Capitol with more than 20 surgeons meeting with state legislators. Discussions centered on issues such as breast reconstruction information requirements, surgical technology, and reform of the state’s trauma system.
- The Tennessee Chapter sponsored its first lobby day during the Tennessee Medical Association’s Physicians Involved at the Tennessee Capitol Hill day. Fellows observed a U.S. House Committee hearing on a variety of bills related to misuse of bath salts and illicit drugs, and spoke with legislators about trauma funding, cancer care, the work conducted through the Tennessee Surgical Quality Collaborative, and rural access to general surgeons.
- At regional meetings, ACS Committee on Trauma members discussed state grassroots advocacy. Each region received a summary of trauma-related legislation in their respective states, and was encouraged to work with state legislators to enhance trauma efforts at the state level.
- California surgeons met during the California Medical Association’s Legislative Day to advocate for a prostate exam bill. The Northern California Chapter of the ACS, a sponsor of the bill, had conversations with state legislators and provided testimony. The bill passed and was signed into law.
- A first-time lobby day cosponsored by the Metropolitan Chicago Chapter and the Illinois Chapter allowed participating surgeons to learn about grassroots advocacy and to meet with their state legislators.
- The ACS State Leadership Advocacy Conference was held in Chicago, IL.
- A lobby day organized by the Massachusetts Chapter resulted in 61 surgeons meeting with their legislators. During the event, State Senate President Therese Murray (D-MA) was acknowledged for her work and collaboration with the Chapter in pursuing injury prevention legislation.
- ACS members of the AMA House of Delegates (HOD) advocated for surgical interests during the HOD’s annual meeting. The College cosponsored a resolution relating to diagnostic ultrasound use and education, which the HOD adopted.
- Grassroots advocates from national specialty societies and state medical associations came together at the AMA State Legislative Roundtable to review state legislative issues, discuss grassroots strategies, and share highlights from 2012 state legislative sessions.
- During the 2012 Clinical Congress, state affairs staff presented legislative updates to the Board of Governors Committee on Chapter Activities, regional updates for the COT, and a legislative and advocacy training session for the Commission on Cancer State Chair Liaisons.
- Lobby day grant applications were finalized for 2013 with 14 states and 16 state chapters received funding.
- John Maa, MD, FACS, a general surgeon in San Francisco, CA, received the Arthur Ellenberger Award for Excellence in State Advocacy 2012 in recognition of his work in state advocacy with the Northern California Chapter.
- The AMA Interim Meeting of the HOD gave ACS delegates the opportunity to testify at reference committee hearings and interview candidates for AMA officer or Board of Trustees. Important issues included specialty society representation in the HOD, principles for physician employment, and breast reconstruction public education initiatives.
- State chapter executive directors met for their annual Winter Meeting. Grassroots advocacy by chapters was one topic of discussion, and ACS state advocacy resources were reviewed.
HIGHLIGHTS OF ACSPA-SurgeonsPAC AND GRASSROOTS EFFORTS IN 2012
Read about additional ACSPA-SurgeonsPAC activities.
- The American College of Surgeons Professional Association (ACSPA)-SurgeonsPAC (political action committee) supported 93 individual candidates in the 2012 congressional elections.
- 79 in the House of Representatives
- 14 in the Senate
- Overall success rate of 92 percent
- The disbursement ratio for individual candidate PAC contributions was 60 percent Republican and 40 percent Democrat.
- Staff and Fellows attended more than 135 separate fundraising events in a representative’s district as well as and in Washington, DC.
- The PAC raised $657,399.83 from 2,309 Fellows and Staff (4 percent participation rate)
- $547,485.83 "hard dollars" (personal funds)
- $109,914 "soft dollars" (corporate funds)
- The PAC thanks the following Board members for their distinguished service and commitment to political advocacy on behalf of surgeons as they move on to support the ACS and the ACSPA-SurgeonsPAC in other capacities:
- S. Dan McBride, MD, FACS, NV, General Surgeon
- Clifton Peay, MD, FACS, VA, Ophthalmologist
- John Armstrong, MD, FACS, Former-Chair, FL , Trauma Surgeon
- Mitchell Willens, MD, FACS, Former-Vice-Chair, TX, OB-GYN
- Mark Gebhardt, MD, FACS, MA, Orthopaedic Surgeon
- Ross Goldberg, MD, AZ, Resident Representative
- David Rattner, MD, FACS, MA, General Surgeon
- Robert Bahnson, MD, FACS, a urologist from Columbus, OH, has assumed the role of Chair of the PAC Board, and six new Board members have been appointed:
- James Anderson, MD, FACS, Casper, WY, General/Vascular surgeon
- Joshua Broghammer, MD, FACS, Kansas City, KS, Young Fellows Associate Representative
- Brian Gavitt, MD, FACS, Sacramento, CA, Resident and Associate Society Representative
- Mary Hilfiker, MD, FACS, San Diego, CA, Pediatric Surgeon
- Danny Robinette, MD, FACS, Fairbanks, AK, Rural Surgeon
- Alex Valadka, MD, FACS, Austin, TX, Neurosurgeon
- January 31, 2013, is the deadline to apply for the electronic prescribing hardship exemption to avoid a penalty. The College has posted a step-by-step guide on applying for the exemption.
- The first 2013 ACS surgical coding workshop will take place January 24-25, Dallas, TX, Westin Galleria Dallas. Register today!
- Save the Date! ACS Advocacy Summit, April 15-16, 2013, Washington, DC, Mandarin Oriental Hotel. Registration opens January 2013.
- "LIKE" ACS on Facebook or "FOLLOW" ACS on Twitter.