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

October 2013 ACS Advocate

ISSUE 15

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

INSIDE THIS ISSUE

PAC and Grassroots News

ACS Launches Interactive Grassroots Advocacy Program, SurgeonsVoice

At the Federal Level

ACS, ASMBS Oppose Move to Drop Accreditation Requirement for Bariatric Surgery
Medicare Confidential Physician Feedback Reports Now Available
ICD-10 Implementation Countdown Begins
CMS Revises ICD-9 and ICD-10 Required Claim Form
Commission on Cancer Invites You to a Legislative Briefing
HPAG Hosts Fall Meeting
Quality Corner: EHR Reporting Deadline Fast Approaching
Quality Corner: 2013 PQRS MOC Incentive

At the State Level

Firearm Safety Legislation
October 1 Health Insurance Exchanges Open

Other News of Interest

PAC and Grassroots News

ACS prepares to launch SurgeonsVoice

The College’s new, interactive grassroots advocacy program

It’s a historic time in health care. Changes are being made on many fronts, which means champions for surgery are needed more than ever before. The ACS is making concerted efforts to equip members with the right programs, meaningful information, and practical tools needed to influence health policy that impacts their practices and patients.

On October 1, the College will launch SurgeonsVoice, our greatly enhanced grassroots advocacy program for recruiting, educating, and motivating Fellows to use their influence to change the dynamic in Washington, DC. SurgeonsVoice will equip you with the knowledge and tools necessary to become an integral part of our nationwide grassroots advocacy network of effective and influential surgeon advocates.

You, as surgeons and constituents, provide motivation for legislators. In partnership with our Washington, DC, office, SurgeonsVoice is your new and interactive program to build the critical relationships with your legislators in your home state and encourage them to take action on issues that are important to surgery and the surgical patient. SurgeonsVoice provides the tools including access to a grassroots advocacy tool kit complete with a comprehensive handbook, issue briefs, and PowerPoint presentations, as well as draft letters to Congress, advocacy and health policy webinars, the latest news and information, and a section for you to tell your story. Research has shown that your experiences and relationships with your legislators have the most profound effect on policymaking.

You may find the My Legislators and Interactive Maps sections most useful. These sections provide in-depth knowledge about each U.S. lawmaker, an overview of what is happening in each state capitol, in Congress, and statistical data to help you make an informed decision on health care policies.

With SurgeonsVoice, the College has an effective grassroots advocacy program to fully complement its lobbying activities in Washington and the political advocacy of the ACSPA-SurgeonsPAC, the College’s political action committee (governed by ACS Professional Association). Our combined strength in these programs allows us to be better advocates for our practice and patients. We urge you to become an active partner in our advocacy efforts.

CLINICAL CONGRESS CORRECTION: ACSPA-SurgeonsPAC Receptions

  • On Sunday, October 6, the ACSPA-SurgeonsPAC will sponsor a happy hour for all Resident Members of the College. Residents can enjoy an informal gathering and learn the ins and outs of the political process and the importance of surgical advocacy and have an opportunity to meet with College advocacy leaders. The Resident Happy Hour will take place 4:00–7:00 pm at Cuba Libre, 801 9th St NW, Washington, DC. Conveniently located near the convention center.
  • All SurgeonsPAC contributors are invited to the annual Clinical Congress reception on Tuesday, October 8, 8:00 pm–midnight. This year’s event will take place at the Wardman Park, Salon 1, 2660 Woodley Road NW, Washington, DC 20008. 

At the Federal Level

ACS, ASMBS, oppose move to drop facility accreditation requirement for bariatric surgery

Despite strong opposition from the American College of Surgeons (ACS), the American Society for Metabolic and Bariatric Surgery (ASMBS), and other leading surgical and medical groups, the Centers for Medicare & Medicaid Services (CMS) on September 24 announced that it will no longer require Medicare patients to undergo bariatric surgical procedures at accredited facilities as a condition for coverage. This decision makes CMS the only major insurer that does not require that bariatric surgical procedures be performed at an accredited center. Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare have embraced and continue to support accreditation.

The ACS, ASMBS, and other major surgical groups issued a joint press release expressing disappointment with CMS' lack of regard for scientific evidence and medical opinion. ACS Executive Director David B. Hoyt, MD, FACS, said,"The standards required for accreditation provide important lifesaving safeguards for patients, particularly for Medicare beneficiaries, who have a higher risk of morbidity and mortality than the general bariatric surgery population. We encourage Medicare patients to continue to select an accredited center for bariatric surgery."

Nearly 750 inpatient and outpatient bariatric centers throughout the U.S. are accredited by either the ACS or ASMBS. In 2012, the two organizations combined their programs and formed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, to establish a national standard for accreditation and quality improvement that requires facilities to undergo a peer-evaluation process, follow data submission requirements, and demonstrate experience in managing bariatric surgical patients before, during, and after their procedures to receive accreditation.

Medicare confidential physician feedback reports available September 16

On September 16, CMS made performance feedback reports—otherwise known as Quality and Resource Use Reports (QRURs)—available to all medical groups with 25 or more physicians and other practitioners eligible to participate in the Physician Quality Reporting System (PQRS). Nearly 6,750 QRURs covering 440,000 physicians have been prepared based on 2012 Medicare claims and PQRS data. The QRURs allow the groups to extract information on individual patients. The new reports also will serve as the basis for the value-based modifier as mandated under the Affordable Care Act (ACA) and will lead to payment adjustments for physicians in groups of 100 or more beginning 2015 (based on performance in 2013). CMS is proposing to apply the modifier to groups of 10 or more in 2016 based on cost and quality data for 2014. To get started, groups must first designate and set up an Individual Authorized Access to the CMS Computer Services account, and then complete the registration process.

One year out: Now is the time to prepare for ICD-10

The ACS has begun the countdown to the implementation of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, more commonly known as ICD-10. The implementation date is October 1, 2014.

ICD-10 consists of an expanded code set and combines diagnosis and symptom codes to more clearly define certain conditions. It also increases specificity with greater code length and provides the ability to specify laterality.

The ACS encourages members to become familiar with the new code set, understand the difference between ICD-9 and ICD-10, and prepare for how the change may affect their practices. Throughout the year, the ACS will provide resources to help you prepare for ICD-10. CMS has also developed an online ICD-10 guide.

If you have questions concerning coding, contact the ACS Coding Hotline at 800-227-7911 between 7:00 am and 4:00 pm Mountain time, excluding holidays. For questions related to ICD-10 resources, contact Jenny Jackson, Division of Advocacy and Health Policy, at jjackson@facs.org or 202-337-2701.

Medicare to accept revised CMS-1500 claim form starting January 2014

The CMS-1500 claim form was recently revised with changes, including those to more adequately support the use of the ICD-10 diagnosis code set. The revised CMS-1500 form version 02/12 will replace version 08/05. The revised form will give providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes, which is important as the October 1, 2014, transition approaches. ICD-9 codes must be used for services provided before October 1, 2014, while ICD-10 codes should be used for services provided on or after October 1, 2014. The revised form also allows for additional diagnosis codes, expanding from four possible codes to 12. Only providers who qualify for exemptions from electronic submission may submit the CMS-1500 form to Medicare. Medicare will begin accepting the revised form January 6, 2014. Starting April 1, 2014, Medicare will accept only the revised version of the form.

Commission on Cancer to host legislative briefing October 9

As part of its commitment to advocacy, the Commission on Cancer (CoC) is hosting a legislative briefing, Commission on Cancer: Ensuring High-Quality, Patient-Centered Cancer Care, 3:00–4:30 pm, Wednesday, October 9, at the Rayburn House Office Building, Room 2325, in Washington, DC. The briefing will be followed by a reception from 5:00 to 6:30 pm. For more information or to RSVP, contact Kristin McDonald at kmcdonald@facs.org or 202-337-2701.

Earlier this year, the Executive Committee of the CoC approved the formation of a full committee on advocacy to address legislative and regulatory issues that affect cancer care. The Executive Committee will approve the leadership of the advocacy committee at the October 6 meeting. Active members of the Member Organization Steering Committee's Advocacy Subcommittee will continue their invaluable work as they transition to full Advocacy Committee members.

Health Policy and Advocacy Group hosts fall meeting

The ACS Health Policy and Advocacy Group (HPAG) hosted its final committee meeting of the year at the ACS Washington, DC, office September 22–23. The purpose of the quarterly meeting is to ensure that the College remains focused and is taking action on advocacy and health policy issues that affect surgery.

The ACS remains a leading voice in driving Congress to repeal the sustainable growth rate (SGR) formula this year and reform the Medicare physician payment system. By December, Congress is poised to issue another short-term patch or make history by repealing the SGR formula. ACS efforts to date have pushed Congress closer to repeal than ever before. The related legislation must pass before January 1, 2014, when a scheduled 24.4 percent reduction in Medicare physician payments will take effect.

Other topics discussed at the meeting included medical liability reform, clinical registry reporting, expansion of graduate medical education programs, upcoming ICD-10 implementation, development of grassroots advocacy programs to increase member involvement, funding to support the ACS lobby day program, and the exploration of broader issues such as Medicare entitlement reform. A work group was formed earlier this year to examine the impact entitlement reforms may have on the future of surgery. A more formal update will be provided pending the work group's findings. The next HPAG meeting will take place in January.

Quality Corner

Important October 3 EHR reporting deadline approaching

October 3 is the last day eligible professionals (EPs) may begin their Stage-One 90-day reporting period to demonstrate meaningful use under the Medicare Electronic Health Records (EHR) Incentive Program. The program offers incentive payments to EPs who demonstrate meaningful use of certified EHR technology. An EP may receive up to $39,000 over five years under the program, but to get the maximum incentive payment, Medicare EPs must begin reporting by October 3. The maximum number decreases each subsequent year and may be subject to additional sequestration cuts. EPs have until February 28, 2014, to register and attest that they have demonstrated meaningful use during EHR reporting to qualify for an incentive payment for 2013. You do not have to register to begin reporting. Get started today.

Watch for the December issue of the Bulletin of the American College of Surgeons, where we will highlight new 2014 EHR reporting options and penalties for nonparticipation.

2013 PQRS Maintenance of Certification incentive

The American Board of Surgery (ABS) has been approved by CMS for the 2013 PQRS Maintenance of Certification (MOC) Incentive. This incentive allows physicians participating in PQRS reporting to earn an additional 0.5 percent on Medicare Part B charges by also participating in an approved MOC program "more frequently" than is required to maintain board certification.

To qualify for the incentive, ABS-certified surgeons must participate in 2013 PQRS reporting for a 12-month reporting option and fulfill MOC "more frequently" than the ABS requires. Surgeons must also participate in a patient experience-of-care survey to earn the incentive. Surgeons not yet enrolled in the ABS MOC Program will need to pass a recertification exam in 2013 to become eligible. Surgeons who are certified by more than one American Board of Medical Specialties board cannot receive more than one MOC incentive payment. 

At the State Level

California firearm safety legislation

SB 374, legislation to strengthen existing California law relating to assault weapons, passed both chambers of the state legislature and is on its way to Gov. Jerry Brown (D). It is part of the LIFE Safety package of firearm safety bills awaiting gubernatorial action, and, if signed, these bills would:

  • Add all semi-automatic rifles with detachable magazines to the current list of banned assault weapons
  • Ban magazines holding more than 10 rounds
  • Ban bullet buttons that allow fast swapping of rifle magazines
  • Require long-gun buyers to pass a written safety test.

Current California law has background checks and waiting periods for all gun purchases. Multiple physician organizations in the state supported these bills, with the Northern California Chapter of the ACS taking a position of support for SB 374 early on in the legislative process.

Health insurance exchanges to open October 1

Uninsured consumers will soon have the opportunity to purchase health insurance through the state exchanges as ACA implementation moves forward. To help provide a range of information on the ACA, the Kaiser Family Foundation developed extensive informational and educational materials. The October 1 kickoff is for enrollment in insurance plans that will go into effect on January 1, 2014.

Other News of Interest

  • On Wednesday, September 17, advocacy and health policy staff attended the Wound Healing and Tissue Regeneration Medical Technology: Saving Lives and Limbs, Improving Quality of Life and Reducing Health Care Costs meeting on Capitol Hill. The meeting allowed congressional staff and organizations to meet with companies that are developing solutions to address wound care needs for patients of chronic and traumatic wounds.
  • Space is still available to attend the October 24–25 surgical coding workshop in Las Vegas, NV. Participants can earn a maximum of 6.5 AMA PRA Category 1 Credits™ for each day. Members of the American Association of Professional Coders can earn a maximum of 6.5 credits for each day. ACS members and their staff are eligible for discount registration. Register today.
  • Advocacy and health policy staff are preparing for the 2013 Clinical Congress of the American College of Surgeons, October 6–10, in Washington, DC. Download a full listing of advocacy and health policy-related sessions. Download a schedule and biographies of distinguished guest lecturers. View the full preliminary program for the Clinical Congress.

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