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

President Signs Continuing Resolution Funding Federal Government until November 21

President Trump signed a continuing resolution (CR) September 27 to keep the government funded through November 21. The CR funds government programs at fiscal year 2019 levels, including monies for cancer research and agencies, such as the National Institutes of Health and the Centers for Disease Control and Prevention. Additionally, the CR extends the authorization of the Patient Centered Outcomes Research Institute (PCORI) through November 21. After that date, PCORI will need full reauthorization to continue its work.

The U.S. House previously passed 10 appropriations bills, including the Labor-Health and Human Services (Labor-HHS) bill, which funds health-related programs. The Senate has yet to mark up or pass its Labor-HHS appropriations bill. The short-term nature of the CR allows members of Congress more time to work out a larger spending package that will likely result in an omnibus bill at the end of the calendar year.

For more information, contact Amelia Suermann, American College of Surgeons Congressional Lobbyist, at asuermann@facs.org.

ACS Comments on CY 2020 Quality Payment Program Proposals

The American College of Surgeons (ACS) submitted comments September 26 to the Centers for Medicare & Medicaid Services (CMS) regarding proposed policies for the calendar year (CY) 2020 Quality Payment Program, which are included in the CY 2020 Medicare Physician Fee Schedule proposed rule. As part of the proposed rule, CMS included a Request for Information (RFI) on Merit-based Incentive Payment System (MIPS) Value Pathways (MVP). The MVP is intended to streamline MIPS reporting by limiting the number of required measures to best assess the quality and value of care for a particular specialty or condition to allow for an easier transition to Alternative Payment Models (APMs). The program aims to connect measures and activities across the four MIPS performance categories, incorporate a set of administrative claims-based population health quality measures, provide meaningful data and feedback to clinicians, and enhance information to patients.

The ACS supported the concept of MVPs and offered recommendations for the development and testing of condition or episode-based surgical MVPs. The ACS also advocated for MVPs based on clinical service lines, rooted in a surgical verification program with conformance measures to track avoidable harms, that include patient-reported outcome measures, and provide resources to understand the costs involved in an episode of care.

In addition to the MVP RFI, the ACS commented on the Quality, Cost, Improvement Activities, and Promoting Interoperability (PI) performance categories, as well as Advanced APMS and several additional RFIs related to health information technology (IT). The ACS encouraged CMS to use measures and improvement activities that promote a culture of continuous quality improvement and provide meaningful data for surgical practice, to develop actionable cost measures that allow surgeons to understand total cost of care, and to foundationally change the PI category to reward the advanced use of health IT.

The full text of the ACS comments is available here. For any additional questions or comments, contact qualityDC@facs.org.

Key Congressional Champions Send Letter to CMS Opposing Cuts to Global Surgery Payments

Longstanding physician champions Reps. Ami Bera, MD (D-CA), and Larry Bucshon, MD, FACS (R-IN), led a congressional sign-on letter to the Centers for Medicare & Medicaid Services (CMS) urging the agency to adjust the evaluation and management (E/M) component of all 10-day, 90-day, and maternity global codes to include any updated office/outpatient E/M code values. The CMS calendar year (CY) 2020 Medicare Physician Fee Schedule proposed rule would increase payment values for standalone office visit E/M codes; however, the agency is proposing not to apply the payment adjustment to the E/M portion of global surgical codes. The letter, which 25 members of Congress signed, opposes this provision of the proposed rule. Arbitrarily adjusting some E/M codes but not others conflicts with current law. Changing the values for some E/M services disrupts the relativity in the fee schedule mandated by Congress as part of the Omnibus Budget Reconciliation Act  of 1989 (P.L. 101-239). Furthermore, the Medicare statute specifically prohibits CMS from paying physicians differently for the same work. Failing to adjust the E/M component of the global codes is equivalent to paying some physicians less for the same services.

For more information on the congressional sign-on letter, contact Carrie Zlatos, American College of Surgeons Senior Congressional Lobbyist, at czlatos@facs.org. For more information on the CMS proposed rule, contact regulatory@facs.org.

ACS Comments on CY 2020 MPFS Proposed Rule

The American College of Surgeons (ACS) submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) September 10 in response to the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) proposed rule.

Under this rule, CMS introduced several changes related to office/outpatient evaluation and management (E/M) visit codes per new guidelines from the Current Procedural Terminology Editorial Panel, which, if finalized, would become effective in 2021.The agency proposed to retain five levels of coding for established patients and reduce the number of levels to four for new patients and  eliminate the history and physical elements for E/M code selection and allow clinicians to choose the E/M visit level based on either medical decision making or time. The ACS supported both of these proposed changes. The ACS opposed the agency’s proposal to increase the values of most office/outpatient E/Ms per recommendations from the American Medical Association/Specialty Society Relative Value Scale Update Committee (AMA RUC) and to not apply these increases to global surgery codes.

CMS also sought comments on whether it should require physicians to provide advance notice to patients scheduled for screening colonoscopies that coinsurance may apply in the event that the screening procedure turns into a diagnostic procedure if polyps are discovered and removed. The ACS stated that the onus is on CMS, not physicians, to inform beneficiaries about any potential out-of-pocket expenses.

A number of other policy issues were included in this rule. For more information about the MPFS proposed rule and the ACS comments, contact regulatory@facs.org.

Call for Nominations: 2019 Arthur Ellenberger Award for Excellence in State Advocacy

The American College of Surgeons (ACS) Division of Advocacy and Health Policy is seeking chapter nominations for the 2019 Arthur Ellenberger Award for Excellence in State Advocacy.

Created in 2003, the Arthur Ellenberger Award for Excellence in State Advocacy is named for Art Ellenberger, former Executive Director of the New Jersey Chapter of the ACS and an expert in state grassroots advocacy. The award is presented periodically to “recognize a career of outstanding leadership and distinguished service and commitment to protecting patients’ access to high-quality surgical care by their involvement with their state’s legislative and regulatory process.” 

Nominations for the 2019 award are being solicited from Chapter Presidents, Chapter Administrators/Executive Directors, and ACS Governors. If you have a chapter, individual surgeon, or chapter administrator/executive who you think is deserving of this award, work with your Chapter’s leadership to submit a nomination. The deadline for nominations is November 1, 2019. 

For more information, contact Christopher Johnson, ACS State Affairs Associate, at cjohnson@facs.org or at 202-672-1502.