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

March 2014 ACS Advocate


Welcome to the March edition of The ACS Advocate. This month we are focusing on the repeal of the flawed Medicare sustainable growth rate (SGR) formula.

The American College of Surgeons (ACS) and other medical organizations are leaning hard on lawmakers to pass the SGR Repeal and Medicare Provider Payment Modernization Act before April 1, when a 23.7 percent cut in Medicare physician payments is scheduled to take effect.

Inside this issue, we discuss what surgeons need to know about the current state of the SGR and what you can do to stave off this steep cut, as well as provide news and information on state-level out-of-network legislation and improvements in trauma care.

Inside this issue...

At the Federal Level

Campaign to End the SGR Gains Ground

PAC and Grassroots

SGR Repeal: How You Can Help

At the State Level

Out-of-Network Legislation
Time-Sensitive Emergency System
An Improved Trauma System
Upcoming ACS Chapter Lobby Days
State Legislatures at Full Throttle

Other News of Interest

At the Federal Level

Campaign to end the SGR gains ground

End SGR Now!In late February, the ACS launched its six-week grassroots campaign to promote the enactment of the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015/ S. 2000) by March 31. The ACS, like most of the physician community, supports the legislation and has committed significant resources to support passage of the bill before the 23.7 percent cut in the Medicare physician payment rate goes into effect on April 1.

With your help in the past week, 12 representatives and one senator have cosponsored the legislation. Congress returns to Washington for three weeks in March and we must increase efforts to urge legislators that enactment of the SGR Repeal Act is the right thing to do.

What would the SGR repeal mean?

It would mean the end of the annual fire drill to avert a drastic cut to Medicare physician payments and help to stabilize the program. Each year, from 2014 through 2018, all surgeons will receive an annual payment update of 0.5 percent. This update would be mandatory, so surgeons would no longer have to worry about potential cuts to the overall physician payment rate. From 2019 through 2023, the base "physician payment rate" would remain frozen at the 2018 rate. In 2024 and beyond, surgeons who meet the requirements of the "Alternative Payment Model" program outlined in the bill would receive mandatory annual updates of one percent. All other surgeons would receive annual updates of 0.5 percent.

If most of the medical community supports the bipartisan, bicameral legislation, why is Congress stalling on immediate passage?

Although many interested parties have rallied around the SGR Repeal Act, the legislation is susceptible to political pressure. Under its rules, Congress must completely offset the cost of the legislation, which is $138 billion, by cutting other programs in the federal health care budget—hospitals, pharmaceutical companies, medical device companies, nursing homes, and skilled nursing facilities—and through changes in the Medicare program structure, which may affect beneficiaries. These groups have already begun their lobbying efforts and we must answer the call or we will lose this opportunity.

In this election year, one in which control of the U.S. Senate is in question, some members of Congress would prefer to avoid being in the position of choosing between interest groups. Other lawmakers simply believe the cost of the legislation is too much, given the current economic conditions. The message to Congress must be that passage of the SGR Repeal Act is the right thing to do for physicians and patients.

What happens if Congress does not pass the legislation before March 31?

There are no guarantees. In the past, Congress has enacted short-term patches that, for the most part, froze payment rates. Since 2003, Congress has enacted 16 short-term patches at a combined expense of $154 billion, which is more than the total cost of the SGR repeal bill. Even a short-term patch that freezes rates is no longer a guarantee. There remains significant pressure to find more savings in the federal budget, including cuts to the Medicare physician payment rate.

We must increase grassroots pressure. In the ACS' meetings on Capitol Hill, some representatives and senators have told us that they have not heard from the physicians in their districts and are facing pressure from the hospitals and other interested parties. SurgeonsVoice, our online grassroots advocacy tool created for ACS members, makes it easy for you to advocate for the SGR Repeal Act. You can call or e-mail your representatives and senators directly. Without significant grassroots pressure, Congress could table the bill and enact another short-term patch.

PAC and Grassroots

SGR Repeal: How You Can Help

Call your representatives and senators today, and tell them they must act now to enact the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 before April 1.

Your participation is critical.

It will take a strong, collective effort to encourage representatives and senators to demonstrate the political will to pass legislation that puts physicians and patients first. We cannot allow Congress to stall on this landmark legislation.

Call toll-free 1-877-996-4464.

You will be asked to enter your zip code. You will then be connected to your representative's and senator's offices. Once you are connected, tell them you are a constituent. Leave your name, phone number, and address, along with the following suggested message.

As a surgeon and as your constituent, I urge you to sign on as a cosponsor of H.R. 4015/ S.2000. I also urge you to persuade congressional leadership to bring the bill to a vote before April 1.

To help achieve passage of the SGR Repeal Act it is critical that you attend this year's Leadership & Advocacy Summit, March 29 to 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. View the Leadership program and the Advocacy program.

At the State Level

New York out-of-network legislation

Out-of-network legislation supported by the College, S.2551 and A.7813, has been introduced in the New York State General Assembly. The bills address the fact that some health insurance companies have been placing restrictions on patients' out-of-network options, which ultimately restrict their coverage. The legislation would require insurance companies to provide adequate coverage for out-of-network care and to disclose the percentage of likely costs that the policy will cover. The Medical Society of the State of New York also is backing this legislation. Surgeons in New York who want to express their support of this legislation should contact the Surgery State Legislative Action Center.

Idaho develops time-sensitive emergency system

Idaho is one of a few states without a statewide trauma system. However, legislation that passed in 2013 directed the Idaho Department of Health and Welfare to establish a workgroup to study the issue and to develop legislation for the 2014 legislative session. The bill that the workgroup has developed, S.1329, would allow the department to develop and administer a Time Sensitive Emergency System (TSES). The TSES would provide protocols for treating and responding to time-sensitive emergencies, such as injuries sustained from trauma, heart attack, and stroke—conditions that rank among the top five causes of death in Idaho. S.1329 received a favorable public hearing on February 17 and moves to the Senate floor for a full debate and vote. For additional information on this bill, contact the College's State Affairs team at

New Jersey seeks to improve its trauma system

New Jersey Gov. Chris Christie (R) recently signed into law S.3027, a trauma bill that calls for appointing the state's first Trauma Medical Director and establishing a state trauma system advisory committee. The trauma committee will be composed of physicians, nurses, and trauma, burn, and rehab representatives. The ACS Committee on Trauma has recommended standards for the Trauma Medical Director position, which will include analyzing trauma care data, designing a formal system with specific standards for pre-hospital triage and care, and evaluating the system on an ongoing basis.

The ACS Trauma Systems Evaluation and Planning Committee previously assessed New Jersey's trauma system and made several recommendations for improvements, including: (1) develop a formal state trauma system; (2) create an advisory body to formulate policies that address all aspects of patient care; and (3) develop prevention strategies to help control injury as part of a formal state trauma system.

Upcoming ACS chapter lobby days

The College's Florida and Tennessee Chapters will host their state lobby days in March. Florida's lobby days will take place March 4–5, and Tennessee surgeons will meet with their elected officials on March 12. Surgeons interested in participating and meeting with their state legislators should visit the Florida chapter website or e-mail the Tennessee chapter.

State legislatures at full throttle

By now, most state legislatures have convened for their 2014 sessions and a lot of activity is taking place. The College's State Affairs staff is working with state lobbyists to address legislation related to such issues as distracted driving/texting while driving, reporting of dense breast tissue mammogram results to patients, imposing standards for insurers when they reduce or narrow their provider networks, as well as enacting various medical liability reforms and instituting a definition of surgery. To view a more complete list of the bills that the College is tracking, visit the ACS members' portal. Choose the Advocacy tab, and then select "State legislation tracked by the College."

Other News of Interest

  • The ACS will host its next surgical coding workshop April 10–11 at the Hyatt Magnificent Mile. Register today.
  • By now, many practices are preparing for implementation of ICD-10 in October. To help navigate the nuances of a new surgical coding system, beginning in April, the College will provide resources each month in The ACS Advocate to help surgical practices to make a seamless transition.
  • The Surgical Quality Alliance (SQA), in conjunction with the College, in February released a resource document, Surgery & Public Reporting: Recommendations for Issuing Public Reports on Surgical Care, to provide guidance to organizations that publicly report on surgical care. The SQA also developed a list of clinical registries, which highlights the strides that surgical societies have made clinical in registry development.

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