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

ACS-Supported Congressional Sign-On Letter Pushes Back on CMS Proposal to Create Specialty Differential

The CY (calendar year) 2020 Medicare Physician Fee Schedule proposed rule published August 14 calls for the Centers for Medicare & Medicaid Services (CMS) to adopt new evaluation and management (E/M) codes, in addition to increasing the values of the new standalone office/outpatient E/M codes. However, CMS has proposed not to apply the payment adjustment to the E/M portion of the global codes.

Reps. Ami Bera, MD (D-CA), and Larry Bucshon, MD, FACS (R-IN), are circulating a congressional sign-on letter to CMS opposing this provision in the proposed rule and urging the agency to adjust the E/M component of all 10-day, 90-day, and maternity global codes to include any updated office/outpatient E/M code values. Because arbitrarily adjusting some E/M codes but not others is in conflict with current law and is equivalent to paying some physicians less for providing the same E/M services, the American College of Surgeons (ACS) is actively encouraging members of Congress to sign on to this letter, with a focus primarily on physician members of Congress.

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

ACS CoC Signs Letter to FDA Regarding Human ADMs in Breast Reconstruction

The American College of Surgeons (ACS) Commission on Cancer (CoC) joined a consortium of patient advocacy groups, surgical organizations, and tissue banks in sending a letter to the Food and Drug Administration (FDA) requesting that the agency convene a public meeting/workshop to clarify a potential change in policy regarding the use of human acellular dermal matrixes (ADMs) in breast reconstruction. At present, ADMs are regulated and classified by the FDA as human cells, tissues, cellular, and tissue-based products because they are used to reinforce, support, protect, or cover soft tissue weaknesses. They are commonly used in breast reconstruction procedures. At a recent meeting of the FDA Medical Devices Advisory Committee, FDA officials implied that ADMs would be reclassified as medical devices. This policy change could result in loss of access to ADMs for breast reconstruction.

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

Statewide Collaborative Reduces SSIs by 30 Percent after Implementing SSI Reduction Bundle

Illinois surgeons report that by successfully implementing a comprehensive, multifaceted surgical site infection (SSI) reduction bundle in their large statewide surgical quality collaborative, SSIs can be reduced by up to 30 percent. The study, conducted by researchers from the Illinois Surgical Quality Improvement Collaborative (ISQIC), was recently published on the website of the Annals of Surgery ahead of print.

The benefits of a multifaceted SSI reduction bundle in individual hospitals are well known, according to study authors. However, the effectiveness of such efforts in a larger, more diverse group of hospitals was not yet understood. The researchers implemented a colorectal SSI reduction bundle consisting of 22 components throughout the network of 53 Illinois hospitals participating in the ISQIC. After examining the implementation of the bundle, the researchers also assessed changes in clinical outcomes after implementation and examined the association between the extent of bundle adherence and clinical outcomes.

"Not only did the bundle result in a reduction in SSI rates, but we clearly found that the more of the SSI reduction bundle elements a patient received, the lower their risk of getting an SSI,” said Karl Bilimoria, MD, MS, FACS, founding director of ISQIC and director of the Surgical Outcomes and Quality Improvement Center (SOQIC) at Northwestern Medicine, Chicago, IL.

The SSI reduction bundle implemented throughout the ISQIC hospitals resulted in a 30 percent risk-adjusted decrease in superficial SSIs statewide in only a year. The implementation was supported by ISQIC-provided coaches, mentors, process improvement training, hospital- and surgeon-level bundle adherence reports, and numerous other resources for participating hospitals. The findings provide evidence for the ability of large hospital collaboratives to implement and sustain quality improvement initiatives through focused efforts.

ISQIC is a partnership of Illinois hospitals, the Illinois and Metropolitan Chicago Chapters of the American College of Surgeons (ACS), and the ACS National Surgical Quality Improvement Program.

Reminders and Updates on ACS SSR MIPS 2019 ParticipationSurgeon Specific Registry

The American College of Surgeons (ACS) Surgeon Specific Registry (SSR) allows you the option to participate in the Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS), which 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.

To participate, first verify your MIPS 2019 Initial Eligibility via the CMS QPP Participation Status lookup tool by entering your individual surgeon National Provider Identifier (NPI) number before signing up for MIPS 2019 in the SSR. Verify your MIPS 2019 Final Eligibility again in November 2019, which is when CMS finalizes eligibility data. Visit the ACS SSR website for more information about MIPS 2019 participation, including requirements, measures and Improvement Activities (IA) specifications, and educational resources.

The deadline to submit your MIPS 2019 data through the SSR is January 3, 2020.

The SSR is supporting the Quality and IA components of MIPS 2019, and CMS recognizes submitting MIPS data through the SSR as individual, registry-based reporting. MIPS 2019 Clinical 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 to choose from for attestation, including two new opioid-related IAs.

Furthermore, several MIPS 2019 educational and instructional resources, including quick guides and video demonstrations, are available online on the ACS SSR website.

For any SSR programmatic questions, including MIPS participation, contact the ACS SSR Program at 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).