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

November 2013 ACS Advocate

ISSUE 16

Welcome to the November edition of The ACS Advocate. In this issue:

INSIDE THIS ISSUE

At the Federal Level

Wrap-Up: Advocacy and Health Policy at Clinical Congress
Call to Action: Ask Congress to Repeal the SGR Today
The College Seeks Input on Wound Care Device
The College Seeks Input on Hyperbaric Oxygen Therapy
New Regulatory and Legislative Resource for Members
Final 2013 Surgical Coding Workshop—Register Today

At the State Level

Active Shooter Events
California Gun Control Proposal
2014 State-Level Advocacy Grants
MICRA Challenges in California
Slight Dip in Malpractice Premiums

PAC and Grassroots

So Far This Year...

Other News of Interest


At the Federal Level

Overview of the 99th Clinical Congress: Advocacy a priority for quality care

The 2013 Clinical Congress of the American College of Surgeons (ACS) began just as the U.S. Congress was in day six of the government shut down. Each year at the meeting, several advocacy and health policy sessions are offered to provide members with the information and resources needed to influence health policy.

"Surgeons as Health Care Advocates" was the first of two advocacy and health policy Town Hall Meetings. Frank Opelka, MD, FACS, associate medical director, ACS Division of Advocacy and Health Policy (DAHP), and William Rich, III, MD, FACS, medical director, American Academy of Ophthalmology, led the discussion. Participants spoke freely about their concerns with respect to the possible effects of the Affordable Care Act (ACA), the incorporation of outcomes measures into federal payment programs, medical and health economics, and how to voice their concerns with members of Congress.

Offering advice to session participants, Dr. Opelka said, "Surgeons do things for the surgical patient; so talk about your patients. Tell your member of Congress your personal story. That's where you begin in Washington." Dr. Rich continued, "It does not matter if you are a Republican or a Democrat—when you get the opportunity to sit down with them [your members of Congress]—they will listen. That's how policy is shaped."

In October 2012, the College hosted its first medical liability reform summit, addressing the problems associated with the current tort system and their effects on patient care and clinical practice. These discussions continued at the second Town Hall Meeting led by John Meara, MD, FACS, and Len Weireter, MD, FACS, chair of the ACS Committee on Trauma Advocacy Pillar and John Hedstrom, deputy director, ACS DAHP. The panel addressed current College legislative efforts and initiatives and fielded questions on issues ranging from negligence and caps, to expert witnesses and payors.

The College is taking a proactive approach to medical liability, explained Dr. Meara, by not just complaining about the current system, but rather advocating for specific changes, such as reforms related to the Emergency Medical Treatment and Active Labor Act, the Standard of Care Protection Act, and the Good Samaritan Health Professionals Act.

Scott Leckman, MD, FACS, a general surgeon from Salt Lake City, UT, and session participant said, "I'm pleased the College is doing something about medical liability and hope that the College makes available its resources beyond the membership." Dr. Weireter responded, urging Dr. Leckman and other participants to get involved by joining the College in advocating for these issues in Congress.

In addition to the policy-related Town Hall Meetings, the ACS DAHP also sponsored several panel sessions. In one of those sessions, attendees were asked if they participated in the Medicare Electronic Health Record (EHR) Incentive Program. By a show of hands, more than half the room responded "yes" and thus began the first presentation of a health policy session titled, "Medicare's Approach to Value-Based Purchasing: Aligning with the New Medicare Value-Based Payment Modifier."

Value-based purchasing is a term used to represent a collection of payment programs designed to improve clinical quality and patient experience of care while reducing cost inflation. While there have been multiple discussions surrounding value-based purchasing, this session sought to address the nuts and bolts of several Medicare incentive programs such as the EHR Incentive Program, the Physician Quality Reporting System (PQRS), and the Medicare Physician Value-Based Payment Modifier.

Sponsored by the ACS General Surgery, Coding, and Reimbursement Committee, session panelist Robert Jasak, JD, deputy director for regulatory and quality affairs in the ACS DAHP, explained the Medicare and Medicaid EHR Incentive Program. Christopher Senkowski, MD, FACS, professor and chair, department of surgery, Mercer University School of Medicine, Savannah, GA, discussed Physician Compare and public reporting, and Linda Barney, MD, FACS, associate professor of surgery, Wright State University, Boonshoft School of Medicine, Dayton, OH, provided details on PQRS and the Physician Value-Based Payment Modifier.

"What's New in Advocacy and Health Policy" was the final advocacy and health policy session presented at the Clinical Congress. This session provided a snapshot of the important issues ACS advocacy staff has tackled throughout the year and will undoubtedly continue to be of great relevance in 2014. To narrow the list, Dr. Selzer provided the top-ten federal and state legislative advances in 2013. The presentation sparked discussions regarding the mandates associated with the ACA: how health care providers can become more transparent about the cost of care, increasing patient involvement, medical liability reform, and the relevance of participating in the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC).

Download the presentation slides to learn more about the top-ten federal and state legislative advances and the Medicare Patient Access and Quality Improvement Act, health care information technology, ACA implementation, workforce, medical liability reform, and state affairs.

Download the full list of Clinical Congress advocacy and health policy sessions. The 2014 Clinical Congress will be held in San Francisco, CA, October 26–30.

A note from leaders in the Division of Advocacy and Health Policy

The College's objective is clear when it comes to advocacy and health policy: urge lawmakers to enact common-sense legislation and policy that will allow surgeons to provide high-quality care to the surgical patient and safeguard their practices. Keep up with the College's advocacy efforts with each issue of The ACS Advocate—an overview of the most recent federal and state advocacy and policy issues and trends—as well as recent activity of the ACSPA-SurgeonsPAC, the College's political action committee. Additionally, attend ACS advocacy and health policy events to learn more about what we do on your behalf and how you can help.

The College will host its third Leadership Conference and Advocacy Summit, March 29–April 1 in Washington, DC. At this meeting, you will attend an in-depth session on health policy issues, hear from key policymakers and health care experts, and met with your members of Congress. Registration is scheduled to open in January.

You are also encouraged to visit the SurgeonsVoice website. In October, the College launched an interactive grassroots advocacy program to educate and motivate members to use their influence to change the dynamic in Washington. SurgeonsVoice will equip members with the knowledge and tools necessary to become an integral part of a nationwide grassroots advocacy network of effective and influential surgeon advocates.

There is no better time to advocate for your profession

Ask Congress to repeal the SGR

The ACS is making a hard push for Congress to repeal the Medicare sustainable growth rate (SGR) formula in an effort to stave off the looming 24-percent cut in Medicare physician payment scheduled to take effect January 1, 2014. 

This year represents the best chance for repeal in a decade, as the estimated cost of eliminating the SGR and implementing a new approach has shrunk to $139 billion, down from nearly $300 billion, according to the Congressional Budget Office. Since 2003, Congress has enacted 15 short-term patches to stop the Medicare physician payment cuts, spending more than $146 billion cumulatively. By paying the minimum on the credit card for the last decade Congress has spent more than the current cost of full repeal.

You know all too well that fiscal uncertainty makes it difficult for physician practices to invest in the necessary infrastructure to better serve patients.

TAKE ACTION! Let's not lose the momentum achieved this year. Visit the "Take Action" page of the SurgeonsVoice website and send the drafted letter to your House member, urging House leadership to enact reform that would permanently repeal the SGR and replace it with a system that rewards quality and helps control costs. It takes about five minutes to ask Congress to stop supporting bad fiscal policy. To log in, use your ACS ID number and last name. 

The College seeks input on negative pressure wound therapy

The College's General Surgery Coding and Reimbursement Committee is seeking assistance from Fellows who are familiar with negative pressure wound therapy using a wound VAC device. A survey about physician time and work will be distributed on November 15. If you are able to participate in the survey, please submit your contact information to jnagle@facs.org.

The College seeks input on hyperbaric oxygen therapy

The College's General Surgery Coding and Reimbursement Committee is seeking assistance from Fellows who are familiar with providing hyperbaric oxygen therapy. A survey about physician time and work will be distributed on November 15. If you are able to participate in the survey, please submit your contact information to jnagle@facs.org.

New legislative and regulatory resources for members

The College takes its responsibility for ensuring that surgeons understand the breadth of the legislative and regulatory landscapes. This responsibility heightened during the days leading up to enactment of the Affordable Care Act and for the past several years as implementation has progressed. To this end, this fall, the College released Our Changing Health Care System Since the Inception of the Affordable Care Act, which comprises articles from the Bulletin of the American College of Surgeons that provide a retrospective and, to some extent, a prospective look at the changing health care landscape.

Attend final 2013 surgical coding workshop

The College is offering a final opportunity to attend a 2013 surgical coding workshop, November 7–8 at the Hyatt Chicago (IL) Magnificent Mile. Register today for the two-day program, which includes updates on effective billing and collection processes designed to reduce inaccuracies, as well as specifics concerning delayed reimbursements, techniques for improving communication, and productivity. Clinical topics include information on integumentary guidelines and coding for bariatric surgery, esophagoscopy, tracheotomy, bronchoscopy, and hernia and breast procedures.

The 2014 surgical coding workshops are:

  • February 6–7, Las Vegas, NV
  • April 10–11, Chicago, IL
  • May 15–16, Washington, DC
  • August 21–22, Nashville, TN

Additional 2014 workshops may be added throughout the year.

At the State Level

The Hartford Consensus: Reducing the THREAT in active shooter events

Over the last several months, a group of trauma experts have worked tirelessly to establish a plan that would help reduce injury and mortality during an active shooter or mass causality incident. The Joint Committee to Create a National Policy to Enhance Survivability from Mass Causalty Shooting Events authored the Hartford Consensus, a list of recommendations on ways to help reduce injury or mortality.

A large portion of the Hartford Consensus deals with hemorrhage control and removing the injured patient from the line of fire. The team established the THREAT approach to help accomplish the following goals.

  • T – Threat suppression
  • H – Hemorrhage control
  • Re – Rapid extraction
  • A – Assessment by medical providers
  • T – Transport

The idea is to teach the THREAT approach to law enforcement officials, first responders, and trauma medical professionals throughout the U.S. Surgeons are encouraged to work with their local authorities to assist with implementation. Download an outline of the Hartford Consensus recommendations.

The College's leadership in the Hartford Consensus recently received significant media coverage with articles running in The Wall Street Journal (Tourniquets Gain New Respect, Oct. 23), The Hartford Courant (FEMA Adopts Active-Shooter Guidelines Calling for "Warm Zones," Tourniquets, Oct. 21), as well as Medscape, Family Practice News, and ElsGlobalMedicalNews. An ACS news release outlines topics covered at the Clinical Congress session.

Update on California firearm safety proposal: Governor vetoes bill to ban semi-automatic rifles

In late October, Gov. Jerry Brown (D–CA) vetoed Senate Bill 374, a measure that would have banned semi-automatic rifles in California. In a released statement about the veto, Gov. 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."

During the 2013 legislative session there have been 14 firearm safety bills that passed the legislature. Of those, Gov. Brown signed seven—AB 48, AB 170, AB 231, AB 500, AB 500, AB 71, AB 1131, and SB 683—and vetoed seven, AB 169, AB 180, SB 299, SB 475, SB 567, SB 755.

ACS chapter advocacy grants selected for 2014

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. The College implemented its Chapter Advocacy Program in 2011 to serve as an additional channel to reach elected officials and inform them about the important issues that affect surgery at the state level.

Chapters receiving grants to sponsor lobby days include: Alabama, Connecticut, Florida, Georgia, Indiana, Kansas, Louisiana, Massachusetts, New York, Brooklyn & Long Island, North Carolina, Northern California, Ohio, Oregon, South Texas, Tennessee, Virginia, and Washington State. Grant Applications are typically due each year in September, and state lobby days generally take place in January–June. Download Chapter Advocacy Program details and the planning resource document.

MICRA challenges in California

California's Second District Court of Appeals recently upheld the constitutionality of the Medical Injury Compensation Reform Act (MICRA). In this case, the plaintiff, after having the noneconomic damages portion of his reward reduced per MICRA, argued that the cap violated California's constitutional guarantees of trial by jury, separation of powers, and equal protection under the law. All of these arguments were rejected with the court finding that the noneconomic damages cap doesn't interfere with the jury's decision, it applies equally to all plaintiffs, and is an appropriate application of legislative authority.

As previously reported in the September issue of The ACS Advocate, there is an attempt under way in California to raise the cap on noneconomic damages outlined in MICRA to more than $1 million through a ballot initiative. This effort is largely being led by consumer groups and trial lawyers. If the ballot measure gets enough signatures, it will appear on the ballot in November 2014. California surgeons will want to participate in campaign activities if MICRA reforms are to be kept in place. Visit the Civil Justice Association of California website for additional information.

New report shows slight dip in liability premiums

The Medical Liability Monitor recently released its annual premium survey, showing that liability premiums decreased 1.9 percent in 2013. This is the sixth year in a row premiums have decreased marginally. Premiums are declining due, in part, to a 50-percent decrease in liability claims per physician since the early 2000s, when premiums increased by about 20 percent in both 2003 and 2004.

The ACS continues to advocate for MICRA reforms in those states where reforms have not been passed, and also supports such reforms as implementing expert witness qualifications and modifying joint and several liability so that defendants are liable only for their own portion of noneconomic and punitive damages. 

PAC and Grassroots News

So far this year...

Fundraising Update

The American College of Surgeons Professional Association political action committee (ACSPA-SurgeonsPAC) received more than $556,000 in contributions from 1,869 College members and staff.

Disbursement Update

In 2013, SurgeonsPAC contributed more than $322,000 to 90 candidates, party committees, and leadership PACS. View a full disbursements list of SurgeonsPAC disbursements.

99th Clinical Congress

SurgeonsPAC received more than $50,000 in contributions at this year's Clinical Congress in Washington, DC. SurgeonsPAC extends its thanks to this year's contributors and all who attended the Resident Happy Hour and the Contributor Reception, and the many contributors that visited the PAC Lounge.

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 Moye, Communications Manager at cmoye@facs.org