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

September 2013 ACS Advocate

ISSUE 14

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

  • As Congress prepares to return from its summer recess on September 9, Advocacy and Health Policy staff are preparing for the 2013 Clinical Congress of the American College of Surgeons, October 6–10, in Washington, DC.
  • A landmark California law that has kept medical liability premiums in check since 1975 is now under attack.
  • Nurse practitioners are steps closer to furnishing and prescribing drugs without physician supervision.

Inside this issue...

At the Federal Level

Advocacy and Health Policy at 2013 Clinical Congress | Advocate for your Profession

At the State Level

Scope of Practice Bill | MICRA Under Attack | Nurse Practitioners Closer to Independent Practice

PAC and Grassroots News

SurgeonsPAC at Clinical Congress-You Are Invited!

Other News of Interest

At the Federal Level

Clinical Congress and In-District Advocacy

Many of you are preparing to attend the 2013 Clinical Congress, October 6–10, at the Walter E. Washington Convention Center in Washington, DC. The Clinical Congress is a premier education event and one of the largest international conferences of surgeons. The meeting provides an opportunity to hear from your colleagues—expert clinicians and researchers—gathered in one place to discuss advances and topics in surgery, including advocacy and health policy issues that affect you and your patients.

Select Sessions to Attend

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 will continue at a Town Hall Meeting, Medical Liability Reform 2013: Thinking Outside of the Box to Achieve Tort Reform, Wednesday, October 9 at 7:00 am.

In response to surgeons’ growing concern regarding the Medicare value-based modifier and its impact on surgical practices, the College has scheduled a Panel Session, Medicare's Approach to Value-Based Purchasing: Aligning with the New Medicare Value-Based Payment Modifier, Monday, October 7, 11:30 am. The value-based purchasing program is intended to provide comparative performance information to physicians as part of Medicare’s efforts to improve the quality and efficiency of medical care. This session will demonstrate how to navigate this program and discuss the necessary relationship between the Physician Quality Reporting System (PQRS) and the value-based payment modifier, among other topics.

Reimbursement in the Age of Accountable Care Organizations (ACOs) Bundling: What Are Surgeons Worth? is another Panel Session that may be of interest to Clinical Congress attendees. ACOs seek to hold providers accountable for the quality and cost of health care outcomes, which involves shifting the risk associated with the care episode from the traditional insurer to a group of caregivers assigned to a surgeon. Are you prepared to take on that risk? During this session on Tuesday, October 8, at 4:15 pm, learn how you can position yourself and your practice to successfully navigate this challenging change in health care.

In-District Advocacy

As you personalize your Clinical Congress agenda, start to think about how each topic covered in the advocacy and health policy sessions will likely affect your practice long after the meeting and what you can do to advocate on behalf of the surgical profession and patients. One of the best ways to advocate for policies that will ensure surgeons can continue to provide high-quality health care is through in-district meetings with lawmakers.

In August, the ACS launched an in-district advocacy grassroots program to help you connect with members of Congress and congressional staff to discuss policies that affect surgical care.

The program provides an Advocacy Toolkit with step-by-step guidance on how to set up in-district meetings with your representative and senators, talking points, and a meeting evaluation form that will serve as a follow-up guide for advocacy staff. These meetings are a great way to develop personal relationships with members of Congress and have your voice heard. Plan your in-district meetings today. The next congressional recess is in December.

Quality Corner

The Physician Payments Sunshine Act

The Physician Payments Sunshine Act, part of the Affordable Care Act, requires manufacturers of drugs, medical devices, and biologicals to track certain payments to physicians and teaching hospitals. Manufacturers must annually report those payments to CMS. In addition, manufacturers and group purchasing organizations must report certain ownership interests held by physicians and immediate family members to CMS. Most of the information contained in the reports will be made available in a public, searchable website.

Although, physicians will be neither penalized nor required to take action under this legislation, physicians have the right to review their reports. Within a given timeframe, physicians will have the option to challenge reports that are false, inaccurate, or misleading.

The types of financial disclosures subject to reporting include direct transfers or payments from manufacturers to physicians valued at $10 or more (some exceptions exist). Indirect payments or transfers also are subject to disclosure. Indirect payments may include payments or transfers to a third party on a physician’s behalf. Another example would be if a manufacturer makes a payment or transfer to an organization and then requires that payment or transfer be provided to a specific physician within the organization.

Important deadlines associated with tracking and reporting are:

  • August 1–December 31: Manufacturers begin tracking payments to physicians and physician ownership information.
  • January 1, 2014: Physicians will be able to register for a CMS online portal to view reports. CMS will use the portal to notify physicians when their financial disclosures are available for review and correction.
  • March 31, 2014: Manufacturers will begin submitting reports to CMS.
  • June 2014: CMS will provide physicians with access to their reports filed in 2013 via the CMS portal. Physicians will be able to contact manufacturers through the portal to correct errors in the reports.
  • September 2014: CMS will release most of the information from the reports on a public website.

What you can do now.(1) Ensure that all financial disclosures and conflicts of interest are current and regularly updated. (2) If you have a National Provider Identifier (NPI), ensure that the information is updated and that the specialty designation is correct. Manufacturers will use the NPI, along with other information, to identify physicians.

CMS has released an Open Payments for Physicians app. This free app allows physicians to capture and confidentially collect information on reportable transfers between the physician and industry representatives to enable physicians to challenge inaccurate information reported by the industry to the government.

At the State Level

Scope of Practice bill sets collaborative standard

Following months of negotiation between physicians, advanced practice nurses, and physician assistants, the Texas legislature passed legislation creating a team-based, physician-led collaborative model of practice. Under the new law, physicians will enter prescriptive authority agreements with advanced practice nurses or physician assistants, delegating to them the ability to prescribe under the supervision of the physician. Periodic in-person meetings are required between the physician and the advanced practice nurse/physician assistant.

MICRA under attack in California: Ballot initiative seeks to raise noneconomic damage cap

California’s landmark Medical Injury Compensation Reform Act (MICRA), which has helped to keep liability premiums in check since 1975, is under threat with the introduction of California Ballot Initiative 13-0011, the Troy and Alana Pack Patient Safety Act of 2014. The proposal was filed in late July by Robert S. Pack and Consumer Watchdog and calls for raising the damage cap to $1.1 million from the current $250,000—the same amount as the original limit. In addition, this initiative would require physicians to:

  • Check a prescription drug tracking database before prescribing controlled substances
  • Undergo mandatory drug and alcohol testing after an unexpected death or injury occurs
  • Report any witnessed medical negligence or substance misuse by other physicians
  • Undergo random drug and alcohol testing
  • Be placed on automatic suspension if testing positive for alcohol or drugs while on duty

The Consumer Attorneys of California supports of this measure, while the California Medical Association, California Hospital Association, and Civil Justice Association of California oppose it. More than 504,000 valid signatures will be required for initiative to qualify for the 2014 ballot. Visit the Civil Justice Association of California website for additional information.

Nurse practitioners closer to independent practice

Recent activity in the California Assembly on SB 491, the Nursing Practice Act, is bringing nurse practitioners one step closer to independent practice. Under the terms of the bill, nurse practitioners would be able to order durable medical equipment without physician supervision and, in consultation with a physician and surgeon, approve, sign, modify, or add to a plan of treatment or plan for an individual receiving home health services or personal care services. Additionally, nurse practitioners would be able to furnish or prescribe drugs or devices, establish patient diagnoses, and delegate tasks to medical assistants. Nurse practitioners will, however, be required to carry an appropriate level of liability insurance. The Nursing Practice Act provides for the licensure and regulation of nurse practitioners by the Board of Registered Nursing.

PAC and Grassroots News

Join Us!

The American College of Surgeons Professional Association Political Action Committee (ACSPA-SurgeonsPAC) will host various events for members and SurgeonsPAC contributors during the 2013 Clinical Congress.

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. This Resident Happy Hour will take place 4:00–6:00 pm at Cuba Libre (801 9th St NW, Washington, DC) conveniently located near the convention center.
  • All ACSPA-SurgeonsPAC contributors are invited to the annual Clinical Congress reception on Tuesday, October 8, 8:00 pm-12:00 midnight. This year’s event will take place on the rooftop terrace of the College’s Washington, DC, office located at 20 F Street, NW. The building overlooks historic Union Station and the U.S. Capitol.

Be sure to visit the ACSPA-SurgeonsPAC lounge to meet with College advocacy leaders and Washington, DC, staff, to learn more about the PAC, how to get involved in advocacy, and to make your annual ACSPA-SurgeonsPAC contribution.

ACSPA-SurgeonsPAC Give-A-Way

Contributions received during Clinical Congress will qualify members for the following giveaways:

  • Apple iPod Nano for contributions of $1,000–2,499
  • Apple iPad for contributions of $2,500 or more

ACSPA-SurgeonsPAC Lounge Hours of Operation
Walter E. Washington Convention Center, Hall A

Sunday, October 6 7:00 am–6:00 pm
Monday, October 7 6:30 am–5:00 pm
Tuesday, October 8 7:00 am–4:00 pm
Wednesday, October 9 7:00 am–4:00 pm
Thursday, October 10 7:00–10:00 am

Other News of Interest

  • The Council on Graduate Medical Education recommends an increase in graduate medical education funding for general surgery.
  • The Centers for Medicare & Medicaid Services FY 2014 Inpatient Prospective Payment System final rule includes a 0.7 percent hospital payment update for acute care facilities.
  • ACS Chapter Lobby Day Grant Applications are due September 13.
  • The next ACS coding workshop is October 24–25, in Las Vegas, NV.
  • The last official ICD-9-CM code titles for October 1, 2013, are now available on the ICD-9-CM website. ICD-10 will be implemented on October 1, 2014.

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.