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

May 2014 ACS Advocate

ISSUE 21

Welcome to the May edition of The ACS Advocate, and welcome to spring!

Congress has returned from its April recess, and the American College of Surgeons (ACS) Division of Advocacy and Health Policy (DAHP) staff are working diligently on several legislative issues we hope to bring to the forefront in the coming months. Meanwhile, several issues are heating up at the state level, including hospital cost containment, bariatric surgery, liability shields, and more.

Inside this issue...

At the State Level

Jake's Law (Maryland)
Physician Apology Bill (Wisconsin and Alaska)
Bariatric Surgery Bill (Louisiana)
Ancillary Services Bill (California)
Controlling Hospital Costs (Maryland)
Drug Parity Bill (Maryland)
Non-Economic Damages Cap (Kansas)
Advance Practice Registered Nurses Bill (Connecticut)
Income Tax Scam (Several States)

At the Federal Level

Kids First Research Act
Children's Hospital GME Support Reauthorization Act
Coding Corner
ICD-10 Conversion Preparation
Surgical Coding Workshops

PAC and Grassroots

ACSPA-SurgeonsPAC Annual Report Available
Calling All Residents, Attend a PAC RAS-ACS event

Other News of Interest

At the State Level

Jake's law enacted in Maryland

Legislation to stiffen penalties for drivers who cause serious injury or death while talking or texting was recently signed into law in Maryland. Under the revised statute, individuals who are found guilty of violating the law face possible imprisonment for up to one year, a fine of up to $5,000, or both. The bill is named for Jake Owen, a five-year-old boy who was killed in 2011 by an inattentive driver on a cell phone. The law does not apply to emergency use of a handheld telephone, including calls to 911, a hospital, an ambulance provider, a fire department, a law enforcement agency, or a first-aid squad. Read more on Jake's Law.

Physician apology bills advance in Wisconsin and Alaska

Wisconsin Gov. Scott Walker (R), recently signed A.B. 120, legislation that allows physicians and other health care professionals to apologize to patients without worrying whether the statements could be used against them in court. The law is more comprehensive than many other state laws passed on this issue—protecting statements expressing fault, liability, and responsibility, along with those of benevolence, compassion, or condolence.

In addition, on April 16, the Alaska legislature approved H.B. 250, a bill that would make expressions of apology or compassion inadmissible as evidence in medical liability cases. This legislation, however, would not protect an expression of apology or sympathy if made with an admission of liability or negligence. If Alaska Gov. Sean Parnell (R) signs this bill, the total number of states having such laws will increase to 39.

Louisiana bariatric surgery bill

Louisiana Rep. James Armes (D-30) introduced a bill, H.B. 1049, that would require state employee group benefit plans to cover bariatric surgery for the treatment of morbid obesity. H.B. 1049 defines morbid obesity as a body mass index (BMI) of at least 40 or a BMI of at least 35 when accompanied by a comorbidity or another medical condition, such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes. Gastric bypass operations and other methods recognized by the National Institutes of Health would be covered as well. Louisiana surgeons are encouraged to send a message in support of the bill to their representative.

ACS against California ancillary services bill

The ACS has come out in opposition to California S.B. 1215, which would eliminate the in-office ancillary services exception (IOASE) for advanced imaging, anatomic pathology, radiation therapy, and physical therapy. The ACS sent a letter to state Sen. Ted Lieu (D), Chair of the Senate Business, Professions and Economic Development Committee, in April urging the committee to oppose the legislation. The legislation would make it more difficult to provide integrated care, forcing patients to receive care in multiple settings, fragmenting care, and increasing inefficiencies. For example, cancer patients can now receive almost all of their treatment in one office, from diagnosis to surgery, chemotherapy, and radiation therapy. The removal of the IOASE could require these patients to go to multiple providers to receive care, creating unnecessary difficulties. The College will continue to work with other stakeholders to stop the advancement of this legislation. 

Controlling hospital costs in Maryland

Earlier this year, Maryland received a waiver from the Centers of Medicare & Medicaid Services (CMS) to institute a five-year demonstration program known as the all-payor model contract. The program would attempt to reduce spending for hospital services by keeping the rate of revenue growth in hospitals from all sources—including private insurance, the government, and employers—to no more than growth in the overall state economy. The goal is to keep costs down by reducing the number of patients admitted to the hospital and encouraging hospitals to work with physicians to maintain their patients' health. This program is the most comprehensive attempt by any state to control health care costs and includes all health care payors and most hospitals, as well as an enforcement mechanism. This endeavor is supported by the Maryland Hospital Association and the Maryland State Medical Society.

Although this project did not require legislative approval, state lawmakers passed two bills to ensure the program will be implemented correctly. H.B. 298 permits the Health Services Cost Review Commission (HSCRC) to set rate levels and rate increases and to promote alternative methods of rate determination and payment consistent with that contract. In response to the failed roll-out of Maryland's Health Insurance Exchange, the bill also requires the HSCRC to provide status reports every six months on changes being instituted, as well as a written notice to Gov. Martin O'Malley (D) and the General Assembly if CMS issues a warning notice related to a "triggering event" as described in the model contract.

S.B. 172 provides an additional $15 million in funding for fiscal year 2015 to assist hospitals in covering the costs associated with the implementation of the program as well as funding for statewide and regional proposals that support implementation.

Drug parity bill passes in Maryland

Wisconsin Gov. Scott Walker (R) signed S.B. 300 into law. The bill passed in the legislature with broad bipartisan support. This law requires health plans regulated by the state to provide the same coverage for chemotherapy, whether administered in pill form or intravenously in a hospital or clinic. The bill also establishes a cap of $100 for a 30-day supply of oral chemotherapy medication. Federally defined high-deductible, catastrophic health plans are not subject to the parity requirement in the bill until the deductible for that plan has been satisfied.

Maryland enacted similar legislation in 2012. However, Gov. Martin O'Malley (D) recently signed H.B. 625, the Kathleen A. Mathias Oral Chemotherapy Improvement Act of 2012, into law. The new legislation brings the 2012 law into compliance with the new Affordable Care Act regulations. The ACS State Affairs team is currently tracking pending drug parity legislation in Connecticut, Pennsylvania, and Virginia. For more information or updates, contact the ACS State Affairs team at state_affairs@facs.org.

Kansas increases cap on noneconomic damages

On April 17, Kansas Gov. Sam Brownback (R) signed S.B. 311, which increases the cap on noneconomic damages in liability claims from $250,000 to $350,000 over the next eight years. This bill was sponsored by the Kansas Medical Society and supported by the Kansas Chapter of the ACS. S.B. 311 met opposition from the Kansas trial attorneys and the Kansas Chamber of Commerce. For more information on the Kansas bill and other liability bills, contact the ACS State Affairs team at state_affairs@facs.org.

Connecticut Senate advances APRN bill

On April 9, the Connecticut Senate passed S.B. 36, legislation that would expand the scope of practice for advance practice registered nurses (APRN) and allow for independent practice. The bill is now headed to the Connecticut House of Representatives where it is expected to pass if called for a vote. The House has until May 7 to act on the bill before the legislative session ends.

This bill is sponsored by Gov. Dannel Malloy (D). However, the Connecticut Chapter of the ACS and the Connecticut State Medical Society oppose this bill. For more information on this and other scope of practice legislation, contact the ACS State Affairs team at state_affairs@facs.org.

Income tax scam targeting physicians

Several state medical societies are receiving reports of income tax scams targeting some physicians. The scam involves filing a fraudulent federal tax return using a physician's name, address, and social security number. There have been reports of fraudulent activity in Maine, Vermont, New Hampshire, Indiana, South Dakota, Iowa, North Carolina, and Puerto Rico. Most physicians become aware of the scam as they go to file taxes electronically, only to discover a return has already been submitted. Find additional information on what to do if you believe you are a victim.

At the Federal Level

10-year pediatric research initiative becomes law

In April, President Barack Obama signed the Gabriella Miller Kids First Research Act. The new law, which the College supports, repeals taxpayer funding for political conventions and shifts these funds to additional research into pediatric cancer as well as autism and other childhood disorders. The bill authorizes $126 million over 10 years, allowing for up to $12.6 million in grants each year to support research in important areas of emerging scientific opportunities, rising public health challenges, or knowledge gaps that deserve special emphasis and would otherwise be unfunded.

Children's Hospital GME Support Reauthorization Act

On April 1, the House of Representatives approved the Children's Hospital Graduate Medical Education (GME) Support Reauthorization Act. This bill, which was initially passed in 1999, provides support to children's hospitals for their pediatric medical residency programs. This legislation would authorize payments to children's hospitals for operating training programs that provide GME, covering direct and indirect costs. Direct costs are those related to operating a medical education program, such as the salaries of medical students, while indirect costs are those intended to compensate hospitals for patient care costs that are expected to be higher in teaching hospitals than in non-teaching hospitals. Under this law, more than 5,000 providers would be trained. View details on this bill and other pediatric and workforce legislation supported by the College. 

Coding Corner

ACS cautions delaying ICD-10 conversion preparation

As reported previously, Congress voted on March 31 to delay implementation of the nationwide conversion to the 10th Revision of the International Classification of Diseases (ICD-10) set of diagnostic and procedural codes from October 1, 2014, to October 1, 2015. Nonetheless, the College and other health policy experts advise surgical practices to begin preparing for the conversion.

According to research released by the Medical Group Management Association (MGMA), practices lag in overall readiness for ICD-10 implementation. In fact, less than 10 percent of responding practices reported that they had made significant progress when rating their overall ICD-10 conversion and 38 percent indicated they have not started to prepare.

To help you prepare, the ACS is offering a special ICD-10 informational course May 2 at the Cornell Club in New York, NY. There is still time to register for this course, which will focus on successfully applying the ICD-10 changes. The course, intended to ease the transition to ICD-10 in October 2015, uses a systematic approach to deconstructing the ICD-10 book and includes in-depth analysis of neoplasms, gastrointestinal conditions, skin lesions, non-healing wounds, and signs and symptoms of various diseases.

The College has also added an ICD-10 compliance section to its surgical coding workshops that are held throughout the year, as well as other resources, such as an ICD-10 Fact Sheet and an ICD-10 resource page that provides additional ICD-10 readiness tools.

Register for an ACS 2014 surgical coding workshop

The ACS is offering the following sessions on ICD-10 compliance, profitable practice operations and strategy, and mastering general surgery CPT coding workshops for the remainder of 2014.

  • May 14–16, 20 F Street Conference Center, ACS Washington, DC, office
  • August 20–22, Loews Vanderbilt Hotel, Nashville, TN
  • November 12–14, Hyatt Chicago Magnificent Mile, IL 

PAC and Grassroots News

ACSPA-SurgeonsPAC Annual Report now available

The 2013 ACS Professional Association Political Action Committee (ACSPA-SurgeonsPAC) Annual Report is now available. The report contains highlights of the ACSPA-SurgeonsPAC activities and accomplishments in 2013 and a listing of PAC members. Also announced in the report are the winners of the 2013 ACSPA-SurgeonsPAC Awards, which were presented at the 2014 Leadership & Advocacy Summit in Washington, DC, March 29–April 1.

SurgeonsPAC award winners include:

  • Total dollars raised per state: California, $41,380 raised
  • Percent participation per state: Wyoming, 10.11 percent participation
  • Outstanding achievement: Advisory Council on Rural Surgery, chaired by Tyler Hughes, MD, FACS
  • PAC most valuable player: Sara Hartsaw, MD, FACS

Calling all residents: Attend special PAC RAS-ACS event May 17

The future of surgery hinges on molding a new generation of surgeon-advocates. The Resident and Associate Society of the American College of Surgeons (RAS-ACS) is fertile ground for recruiting and educating young surgeons to effectively advocate on behalf of their patients. Traditional recruitment methods have been ineffective at reaching the RAS-ACS demographic. To more effectively reach this group, the SurgeonsPAC will establish the SurgeonsPAC RAS-ACS Leadership Council, which will use local peer-to-peer recruitment to improve RAS-ACS involvement and literacy in health policy advocacy.

These RAS-ACS advocacy representatives will promote advocacy activities among their colleagues (residency, fellowship, or workplace), recruit fellow RAS-ACS members to participate, and join the SurgeonsVoice Grassroots Network and encourage their peers to join as well. The PAC will be hosting a special event for residents on the evening of May 17 in downtown Chicago. For more information, or to get involved, contact Sara Morse, Manager of Political Affairs & Grassroots at smorse@facs.org

Other News of Interest

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 P. Moye, Communications Manager, at cmoye@facs.org

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 cmoye@facs.org