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

NewsScope: August 2, 2019

CMS Issues CY 2020 MPFS Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) July 29 released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) proposed rule. This rule, which CMS issues annually, updates payment policies, payment rates, and quality provisions for services furnished under the MPFS on or after January 1, 2020. CMS estimates a 0 percent impact on total allowed charges for general surgery services relative to its proposals for CY 2020.

The agency introduces various changes related to office/outpatient evaluation and management (E/M) visits, which would become effective in 2021. CMS proposes to align Medicare’s office/outpatient E/M coding with changes laid out by the CPT Editorial Panel for office/outpatient E/M visits, specifically: retain five levels of coding for established patients, and reduce the number of levels to four for new patients; eliminate history and physical as elements for E/M code selection and allow clinicians to choose the E/M visit level based on either medical decision making or time; and  create add-on codes for prolonged services and for primary care/non-procedural specialty care. CMS also proposes to increase the values for most office/outpatient E/Ms, per recommendations from the American Medical Association/Specialty Society Relative Value Scale Update Committee, but these increases will not apply to global surgery codes.

In addition, CMS proposes broad modifications to its review and verification of medical record documentation policies, such that certain nonphysician practitioners (such as physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives) could sign and date (that is, review and verify)—rather than redocument—notes made in the medical record by the attending physician or other members of a patient’s care team. The rule also includes proposals that would increase states’ authority to create and enforce laws governing the level of physician oversight for physician assistant (PA) services, and would revise existing Medicare regulations to specify that the physician supervision CMS requires for PA services could be evidenced by documentation in the medical record of the PA’s role in furnishing such services.

The American College of Surgeons is evaluating these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule is available for public review, along with a fact sheet on its payment provisions. Contact regulatory@facs.org with questions.

CMS Issues CY 2020 OPPS/ASC Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) July 29 released the proposed calendar year (CY) 2020 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) payment rule. The agency projects an overall 2.7 percent payment increase for both hospital outpatient departments and ASCs in CY 2020.

As the June 2019 Executive Order, “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” requires, CMS proposes that hospitals make their standard changes for a set of “shoppable services” (that is, services that patients can schedule in advance) accessible online. In the rule, the agency also encourages site-neutral payment between certain Medicare outpatient care settings.

In addition, CMS proposes to change the minimum required level of supervision for hospital outpatient therapeutic services from direct supervision to general supervision. This part of the rule would require a given procedure to be furnished under a physician’s overall direction and control, but not the physician’s presence during the procedure. The rule also includes updates to the quality measures included in both the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Reporting Program.

The American College of Surgeons is evaluating these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule and related fact sheet are available online for public review. Contact regulatory@facs.org with questions.

CMS Releases Proposed Updates to CY 2020 Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) July 29 released proposed updates for the calendar year (CY) 2020 Quality Payment Program (QPP) as part of the CY 2020 Medicare Physician Fee Schedule (MPFS) proposed rule. In addition to proposed updates to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs), CMS is requesting feedback on a new framework for future MIPS participation called MIPS Value Pathways (MVP). CMS describes MVP as a way to move away from the siloed activities and measures in the present system to a framework that aims to align measures and activities across the four MIPS performance categories based on conditions and specialties and better prepare clinicians to transition to risk-based APMs. MVP is proposed to begin with the 2021 performance period.

The proposed rule also includes an increase in the overall MIPS threshold, adjustments to the Cost and Quality performance category weights, and an increased data completeness threshold for quality reporting. In CY 2020, surgeons participating in MIPS would need to meet CMS’ proposed 45 point performance threshold across the four categories to avoid a penalty in 2022, which is a 15 point increase from 2019. In addition to these notable changes, the agency shows a continued focus on interoperability and advancing the use of health information technology through the Promoting Interoperability performance category.

The American College of Surgeons is analyzing these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule is available for public review, along with fact sheets on its MPFS and QPP provisions. Contact quality@facs.org with questions.

Take Action: Ask Your Representative to Send Letter to CMS about Quality Measurement

For surgeons and their patients, implementation of the Medicare Access and CHIP (Children’s Health Insurance Plan) Reauthorization Act (MACRA) has fallen short of its promise of tying payment to the value of care. The American College of Surgeons (ACS) maintains that meaningful measures of surgical quality exist and is supportive of quality measurement that includes a combination of three elements: standards-based facility-level verification programs, patient-reported experience and outcomes measures, and traditional quality measures, including registry and claims-based data.

ACS Fellows who participated in Capitol Hill visits during the 2019 ACS Leadership and Advocacy Summit educated members of Congress about the College’s views on MACRA implementation, and as result several legislators are circulating a letter on the need for the Centers for Medicare & Medicaid Services (CMS) to develop surgery-specific quality measures. The letter, led by Reps. Raul Ruiz, MD (D-CA), George Holding (R-NC), Brian Higgins (D-NY), and Larry Bucshon, MD, FACS (R-IN), encourages CMS to work with stakeholders to develop and test a quality framework that focuses on high-value processes, clinical outcomes, and patient-reported outcomes and experiences.

The August congressional recess is the perfect time to make your voice heard and advocate on behalf of surgeons. Contact your member of Congress to sign on to the Quality Measures Letter.

For more information, contact Amelia Suermann, ACS Congressional Lobbyist, at asuermann@facs.org.

ACS SSR MIPS 2019 Participation and Resources AvailableSurgeon Specific Registry

The American College of Surgeons (ACS) Surgeon Specific Registry (SSR™) offers the option to participate in the Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS) and is available in the SSR for the 2019 performance year. Submitting MIPS 2019 data to CMS will allow you to potentially avoid either a flat 7 percent negative payment adjustment or earn a positive payment adjustment of up to 7 percent in calendar year 2021. First, verify your MIPS 2019 eligibility via the CMS QPP Participation Status lookup tool by entering your individual surgeon National Provider Identifier number before signing up for MIPS 2019 in the SSR. Visit the ACS SSR website for more information about MIPS 2019 participation, including requirements, measures and Improvement Activities (IA) specifications, and educational resources.

Several MIPS 2019 educational and instructional resources, including quick guides and video demonstrations, also are now available on the ACS SSR website.

The SSR supports the Quality and IA components of MIPS 2019, and submitting MIPS data through the SSR is considered individual, registry-based reporting by CMS. MIPS 2019 Quality Measures reporting includes options for general surgeons and plastic surgeons in addition to a range of other surgical specialties. For MIPS 2019 IAs, surgeons have 88 surgically relevant activities from which to choose for attestation, including two new opioid-related IAs.

The deadline to submit your MIPS 2019 data through the SSR is January 31, 2020.

For any SSR programmatic questions, including MIPS participation, contact the ACS SSR Program a SSR@facs.org or at 312-202-5408. For SSR technical questions or issues (password reset, account reactivation, and so on), contact Technical Support at ACSTechSupport@iqvia.com or at 877-600-7237 (toll-free).

SurgeonsPAC Announces Second Annual ACS Board of Governors Pillar CompetitionSurgeonsPAC

The American College of Surgeons (ACS) Board of Governors has a history of participating in ACS Professional Association (ACSPA) activities, including becoming more politically active through the ACSPA-SurgeonsPAC—a political action committee. To promote SurgeonsPAC and foster a collegial fundraising environment for all eligible ACS Governors, a pillar competition was established to track annual contributions, encourage peer-to-peer recruitment efforts, and increase overall participation. At Clinical Congress 2018, Danny R. Robinette, MD, FACS, presented the inaugural pillar competition award to the Advocacy and Health Policy Pillar. Runners up included the Member Services and Quality Pillars. At present, the Communications Pillar is leading the 2019 pillar competition. 

To learn more about Board of Governors PAC participation or to contribute, contact Katie Oehmen, Manager, ACSPA-SurgeonsPAC and Grassroots, at koehmen@facs.org or 202-672-1503. 

Note: Contributions to ACSPA-SurgeonsPAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of ACSPA have the right to refuse to contribute without reprisal. Federal law prohibits ACSPA-SurgeonsPAC from accepting contributions from foreign nations. By law, if your contributions are made using a personal check or credit card, ACSPA-SurgeonsPAC may only use your contribution to support candidates in federal elections. All corporate contributions to ACSPA-SurgeonsPAC will be used for educational and administrative fees of ACSPA and other activities permissible under federal law. Federal law requires ACSPA-SurgeonsPAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. ACSPA-SurgeonsPAC is a program of the ACSPA, which is exempt from federal income tax under section 501c (6) of the Internal Revenue Code.