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

CMS Announces New Voluntary Bundled Payment Model

The Centers for Medicare & Medicaid Services (CMS) on January 9 announced an updated version of the Bundled Payment for Care Improvement (BPCI) payment model, which is intended to meet new Advanced Alternative Payment Model (A-APM) requirements in the Medicare Quality Payment Program (QPP). The new BPCI Advanced model is open for applications, and the first participants will enter the program in October. Because BPCI Advanced meets A-APM requirements, participants who receive a sufficient percentage of payments or see a high enough portion of their patients through the model will be exempt from the Merit-based Incentive Payment System and potentially eligible for a 5 percent lump sum incentive. The program will begin with 29 inpatient and 3 outpatient clinical episodes, including several surgical options.

The full list of episodes, a timeline for participation, a link to the request for applications, and other resources are available on the CMS website; further information is available in the BPCI Advanced fact sheet. For more information, e-mail regulatory@facs.org.

MedPAC Considers Options to Rebalance Physician Fee Schedule

American College of Surgeons (ACS) staff attended the January 12 meeting of the Medicare Payment Advisory Commission (MedPAC), an independent committee that advises Congress on issues affecting the Medicare program. The commission reviewed policy options to rebalance the Medicare physician fee schedule (MPFS) toward ambulatory evaluation and management (E/M) services. According to MedPAC staff, the MPFS undervalues ambulatory E/M services relative to other services—particularly surgical procedures. In addition, MedPAC staff asserted that compensation for primary care is substantially lower than for other specialties and theorized that this discrepancy may deter medical students and residents from pursing primary care, thereby creating a workforce shortage.

Commissioners considered possible actions to address the relative underpricing of E/M services, such as the application of a 10 percent increase in E/M payment rates for all physicians, which would result in a $2.7 billion net payment increase for primary care specialties and a 4.5 percent reduction in payment rates for all other services. The commission also discussed offering special payments for primary care physicians in addition to increased reimbursement for E/M services. MedPAC concluded that it will not develop immediate recommendations related to these issues for Congress, but it may reevaluate options to rebalance the MPFS this fall.

The meeting follows a similar November 2017 MedPAC session, during which commissioners suggested rebalancing the MPFS toward primary care services. In a January 10 letter to MedPAC, an ACS-led coalition of 20 surgical organizations stated that the underlying assumptions in the commission’s discussion about an imbalance in the MPFS are incorrect. More specifically, the coalition questioned—and countered—the problems MedPAC staff described with regard to how the MPFS pays for primary care, MedPAC’s concerns about income disparities between primary care and specialty physicians, and the effectiveness of increasing payment to certain specialties in order to address workforce issues.

Presentation materials from the meeting are on the commission website. For more information about the ACS-led coalition letter, e-mail regulatory@facs.org.

Submit and Approve MIPS 2017 Data through ACS SSR by January 31

Surgeon Specific RegistryAll surgeons using the American College of Surgeons (ACS) Surgeon Specific Registry (SSR) to comply with the Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) for 2017 must approve the data submission for the Centers for Medicare & Medicaid Services (CMS) in the SSR system by January 31.  

To complete and approve your data submission, log in to the ACS data platform; go to the submission approval web page for instructions. Once the MIPS 2017 data submission has been completed and approved, it will be submitted to CMS. If you no longer wish to participate in MIPS 2017, cancel your participation to avoid receiving further prompts.

For more information, contact the SSR team at ssr@facs.org.

Rural and Underserved Children’s Surgical Care Survey Closes January 25

The American College of Surgeons (ACS) Advisory Councils for Rural and Pediatric Surgery are examining perceived gaps in children’s surgical care in rural and underserved areas of the U.S. We are interested in learning more about existing surgical resources for children and how to improve future care through training paradigms, Continuing Medical Education, and communication, including telemedicine.

An Optimal Pediatric Surgical Care Task Force, which has national stakeholder support, is undertaking a needs assessment with a member survey. This survey is directed toward practicing rural and general surgeons in the U.S. who provide care to some children in their practice or who evaluate and transfer children to a higher level of care. “Children” are defined as individuals younger than 18 years old.

The deadline to complete the survey is January 25. It will take approximately 10–15 minutes to complete. Participation in the survey implies informed consent. Results will be shared through ACS communications.

Canadian surgeons should not respond to this ACS survey; they will be surveyed separately at a later date.

Once you enter the survey, you will not be allowed to save your answers and return to complete it. For this reason, a PDF version is available for you to download to preview the questions.

Take the survey.

Contact Lindsey Gumer (lindsey.gumer@ulp.org) or Mary Fallat, MD, FACS, (mary.fallat@louisville.edu) with questions concerning the survey.