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

NewsScope: August 9, 2019

CMS Releases FY 2020 IPPS Final Rule

The Centers for Medicare & Medicaid Services (CMS) August 2 issued the fiscal year (FY) 2020 Medicare Inpatient Prospective Payment System (IPPS) final rule. Under the provisions in this rule, CMS projects a $3.8 billion increase in total Medicare Part A spending on inpatient hospital services furnished October 1, 2019, to September 30, 2020.

The final rule states that CMS will conduct a comprehensive review of its process for determining whether certain surgical procedures should be classified as operating room (OR) services—which are reimbursed at a higher rate than non-OR services—for the purposes of IPPS payment. CMS will consider a number of factors, including Medicare claims data and relative resource requirements for various services, in an effort to better recognize the complexity and costs of surgical procedures. The agency also finalized a policy to provide additional reimbursement for certain new medical devices and technologies. The American College of Surgeons has supported such add-on payments for new devices and technologies under the IPPS to reduce financial barriers to investment and adoption by hospitals.

In addition, CMS further aligned requirements between the Medicare and Medicaid Promoting Interoperability and the Hospital Inpatient Quality Reporting programs and will continue to streamline all hospital-based quality reporting programs. The agency indicated its continued focus on opioid prescribing and pain management best practices by finalizing the inclusion of several new quality measures. CMS did not finalize policies regarding open-source standards for data exchange, as these will be part of the final rules from the 21st Century Cures Act.

The final rule and related fact sheet are available online for public review. If you have any questions, contact regulatory@facs.org.

White House and Congress Reach Broad Budget Agreement

The President signed a two-year $2.7 trillion budget agreement August 2 that will raise spending limits and suspend the debt ceiling through July 2021. The agreement prevents $126 billion in automatic spending cuts from taking effect as part of sequestration but does not provide any funding for federal agencies. 

Despite the agreement on spending caps, Congress still needs to pass individual appropriations bills to prevent a government shutdown, which is possible if spending bills are not signed into law by September 30—the end of the fiscal year. Passage of appropriations bills or a continuing resolution to avoid a government shutdown will be a top priority when Congress returns from the in-district work period the second week of September.

The American College of Surgeons (ACS) continues to closely monitor the appropriations process to ensure that its appropriations priorities remain intact. For more information, contact Amelia Suermann, ACS Congressional Lobbyist, at asuermann@facs.org.

VA Continues to Modernize Electronic Health Records System: VistA

The U.S. House of Representatives Committee on Veterans' Affairs Subcommittee on Technology Modernization convened a July 25 hearing, VistA Transition: Assessing the Future of an Electronic Health Records Pioneer. For more than 30 years, the U.S. Department of Veterans Affairs (VA) has used a homegrown electronic health record (EHR) system developed by clinicians—the Veterans Health Information Systems and Technology Architecture (VistA). Under a $10 billion contract that the VA signed with Cerner last May, the VA plans to transition to a Cerner EHR beginning in 2020. The decision came as the result of VistA’s lack of new capacities, as well as poor interoperability between the VA, the Department of Defense (DOD), and private health care providers.

Much of the hearing focused on the high cost of maintaining VistA during the transition to Cerner. The VA provides health care services to approximately 9 million veterans and their families, with the DOD accounting for many more beneficiaries. Achieving interoperability between the VA and DOD will allow physicians to access critical health information and serve as a platform for other public and private sectors in need of EHR reform. As Congress and the Administration continue to explore policy solutions to achieve interoperability, the American College of Surgeons (ACS) remains engaged to ensure that these solutions promote patient safety and continuity of care.

For details on congressional activities related to health information technology, contact Amelia Suermann, ACS Congressional Lobbyist, at asuermann@facs.org. For information on congressional activities related to the DOD and VA, contact Carrie Zlatos, ACS Senior Congressional Lobbyist, at czlatos@facs.org.

Senate Finance Committee Advances Drug Pricing Package in Contentious Vote

The Senate Finance Committee met July 25 to markup the bipartisan  Prescription Drug Pricing Reduction Act (PDPRA) of 2019. Chairman Charles Grassley (R-IA) and Ranking Member Ron Wyden (D-OR) carefully negotiated the package to control the rate increases for prescription drug prices and cap out-of-pocket costs for Medicare Part D beneficiaries. Before the markup, committee members offered more than 100 amendments to the package. Few of these amendments were voted on during the markup but were used as a means for senators to outline their concerns with the package. The committee ultimately passed the bill by a 19-9 vote, with all votes against the package coming from Republicans.

The future of the package remains uncertain. Senate Majority Leader Mitch McConnell (R-KY) may choose not to bring the legislation to a floor vote because of the strong opposition within the Republican caucus. The package also may be paired with companion drug pricing legislation from the Senate Judiciary Committee and Senate Health, Education, Labor, and Pensions (HELP) Committee. The American College of Surgeons (ACS) has opposed the Senate HELP Committee package, the Lower Health Care Costs Act, as it contains what the ACS views as a misguided and insurer friendly plan to address surprise medical billing.

For more information, contact Carrie Zlatos, ACS Senior Congressional Lobbyist, at czlatos@facs.org.

ACS Comments on Continued Occurrence of Firearm Deaths and Injuries in U.S.

In response to the mass shootings that devastated El Paso, TX, and Dayton, OH, August 3–4, the American College of Surgeons (ACS) has expressed its ongoing grave concern about the death and destruction that these violent incidents continually inflict on American lives. In addition to a now decades-long string of mass shootings, firearm violence continues to kill and seriously injure people in single-incident shootings every day in the U.S., with nearly 40,000 firearm-related deaths now happening annually, according to the Centers for Disease Control and Prevention.

Surgeons have lost patients, family members, and colleagues to firearm violence, and as they remain on the front lines treating seriously injured patients who arrive in trauma centers across the U.S., the ACS affirms its commitment to addressing this public health epidemic by applying a consensus-based approach to solve the problem, as well as addressing intimate partner violence.

The more than 45 medical and injury prevention organizations that have become involved in the efforts resulting from the historic Medical Summit on Firearm Injury Prevention earlier this year have identified a path forward. Actionable items that these groups have agreed to address in a unified voice include recognizing firearm injury as a U.S. public health crisis and taking a comprehensive public health and medical approach to address it, researching this public health crisis using a disease model, and engaging firearm owners and communities at risk as stakeholders to develop firearm injury programs, among other items. Read the Summit proceedings on the Journal of the American College of Surgeons website ahead of print.

To continue this work, the ACS has convened two multidisciplinary expert panels—a Firearm Strategy Team, which engages expert firearm owners in developing recommendations for injury prevention, and a second team that will focus on developing strategies to address the social determinants of health that contribute to interpersonal violence.

The ACS remains committed to the aforementioned actionable items achieved by consensus at the February Medical Summit on Firearm Injury Prevention and the five principles embodied in our Statement on Firearm Injuries and Statement on Intimate Partner Violence.

ACS Trauma Surgeons Discuss Public Health Approach to Firearm Violence on CBS News

In the wake of two mass shootings on August 3–4 in El Paso, TX, and Dayton, OH, American College of Surgeons (ACS) trauma surgeons and other physicians shared their thoughts with CBS News in a segment on how a public health approach can reduce firearm injury, death, and disability in the U.S.

Among the surgeons featured is Ronald M. Stewart, MD, FACS, Medical Director, ACS Trauma Programs. “The only thing worse than a death is a death that can be prevented,” Dr. Stewart said. “And to go and talk to the mom of a child who was normal at breakfast and now is not here is the worst possible thing. And honestly, it drives us to address this problem,” Dr. Stewart told CBS News.

The segment featured a panel of seven surgeons and physicians working with the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM). In addition to Dr. Stewart, the panel included Stephanie Bonne, MD, FACS, who serves on the ACS Committee on Trauma (COT). The panel spoke with CBS medical correspondent John Lapook, MD. “I think people think that if their loved one gets to the hospital, that there's magic there. But sometimes it's just too much for us,” Dr. Bonne told Dr. Lapook, adding, “I know that the house of medicine can fix this.”

Dr. Lapook and the panelists discussed the historic Medical Summit on Firearm Injury Prevention that the ACS COT hosted in Chicago, IL, earlier this year. As a result of the Summit, more than 45 professional medical and injury prevention organizations and the American Bar Association have reached agreement on nine consensus recommendations on how to reduce unnecessary death and suffering. COT Chair Eileen Bulger, MD, FACS, and colleagues conclude, “Coming together as a professional community and approaching this epidemic as a disease and a public health problem promises to make our neighborhoods and our country safer, stronger, and more resilient. We believe this can be done in a manner which preserves (or even enhances) freedom. This professional approach requires freedom with responsibility.”

Special Session at Clinical Congress 2019 Presents ACS Membership Survey Results on Firearm Injury Prevention

A Special Session at Clinical Congress 2019 in San Francisco, CA, will present the results of the American College of Surgeons (ACS) member survey on Firearm Injury Prevention and Advocacy. During the session, the panel will communicate the potential impact of the survey results on the Firearm Injury Prevention Strategic Action Plan and obtain feedback from ACS members on the results and implications.

This session, 11:30 am–12:30 pm Tuesday, October 29, will be moderated by Deborah A. Kuhls, MD, FACS, FCCM, director of the University Medical Center of Southern Nevada, Las Vegas, trauma intensive care unit, and co-moderated by Ronald M. Stewart, MD, FACS, Medical Director, ACS Trauma Programs. Brendan T. Campbell, MD, MPH, FACS, the Donald W. Hight Endowed Chair in Pediatric Surgery, Connecticut Children’s Medical Center, Hartford, will serve as a panelist.

Read more about Clinical Congress Special Sessions.