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

Editor’s note: Because Clinical Congress 2019 will take place October 27–31, ACS NewsScope will not be published next week. Publication will resume November 8.

ACS Signs Physician Community Letter to Congressional Leadership on Surprise Medical Billing

The American College of Surgeons (ACS) signed an October 16 letter to leadership in the U.S. House of Representatives and Senate encouraging Congress to identify solutions that protect patients from surprise medical bills and to ensure that new legislation does not create additional imbalances in the private health care marketplace.

The letter highlights physician concerns that the rate-setting provisions in bills under congressional consideration further shift marketplace leverage to health insurers at the expense of physicians. The letter also encourages Congress to adopt solutions that include a timely, upfront, commercially reasonable payment for out-of-network services and an efficient independent dispute resolution (IDR) process. This IDR process should incentivize health insurers to make a fair initial offer of payment for out-of-network care, while also preventing bills from physicians that are outside generally acceptable ranges.

The ACS continues to engage with members of Congress as they consider solutions to protect patients from surprise medical bills. For more information on congressional action related to surprise billing, contact ACS Senior Congressional Lobbyist Carrie Zlatos at czlatos@facs.org.

ACS Supports Bill to Protect Trauma Surgeons

Surgeons in emergency settings provide complex, high-risk surgical care to severally injured patients, often with minimal information about the health status of these patients. The Emergency Medical Treatment and Active Labor Act (EMTALA) mandates that physicians provide stabilizing care to patients who present at hospital emergency departments (EDs). The high liability risk associated with providing such care is broadly acknowledged as a key contributing factor to the growing shortage of specialists who participate in emergency on-call panels.

The Health Care Safety Net Enhancement Act, H.R. 3984, introduced by Reps. Bill Flores (R-TX); Roger Marshall, MD (R-KS); and Brian Babin, DDS (R-TX), would address this issue by extending liability protections to physicians who provide EMTALA-mandated care. This legislation would protect surgeons and would likely help to increase the number of surgeons who are willing to provide care in EDs.

For more information about this bill, read the American College of Surgeons (ACS) support letter for the Health Care Safety Net Enhancement Act or contact Hannah Chargin, American College of Surgeons Congressional Lobbyist, at hchargin@facs.org.

CMS and OIG Propose Stark Law and Anti-Kickback Statute Reforms

The Centers for Medicare & Medicaid Services (CMS) and the Office of the Inspector General (OIG) released two proposed rules October 9 that would modify the Physician Self-Referral Law (the “Stark Law”) and the Anti-Kickback Statute (AKS) regulations. CMS and the OIG introduced these changes to the Stark Law and AKS, which regulate fraud and abuse by physicians under federal health care programs, as part of the U.S. Department of Health and Human Services Regulatory Sprint to Coordinated Care initiative. 

In its rule updating the Stark Law regulations, CMS proposes new exceptions that would provide more flexibility for qualified value-based care arrangements and for the donation of electronic health records (EHRs) and cybersecurity technologies, among others. The agency also updates definitions and guidance for various terms related to value-based payment and care coordination. 

The OIG proposed rule calls for updating the AKS regulations to create new safe harbors to protect the provision of patient engagement tools and certain remuneration exchanges among entities in value-based arrangements, among others. The OIG also seeks to eliminate a provision that would sunset the existing EHR safe harbor, which is set to expire in 2021. 

The American College of Surgeons is evaluating these proposed rules to determine the impact on surgery and will submit comments to CMS and OIG. Contact regulatory@facs.org for more information.

College to Introduce Surgical Metrics Project at Clinical CongressSurgical Metrics Project logo

The Surgical Metrics Project will be introduced to attendees at Clinical Congress 2019, providing participants with the opportunity to explore the use of wearable technologies to measure surgical decision making and surgical technique. Residents, practicing surgeons, and retired surgeons all are encouraged to participate. Visit the Surgical Metrics Project booth in the Exhibit Hall of the Moscone Center Monday, October 28–Wednesday, October 30.

At the booth, wearable technologies will be used to build a database of surgical decision making and technical approaches during repair of a small bowel enterotomy. A total of 10 procedure stations will be available, and the exercise will take less than 30 minutes. Each participant will be equipped with magnetic motion-tracking technology synchronized with headgear that will capture video and audio data. Working in sync, these instruments will provide a moment-to-moment account of each step and decision that a surgeon makes while operating and measure time and flow efficiency to provide an accurate assessment of the surgical process.

All participants will get a short report on their performance. After Clinical Congress, the data will be analyzed to answer the following questions:

  • What decisions do surgeons make when faced with a surgical task?
  • How do their decisions and technical approaches affect outcomes/bowel repair quality?
  • Can this database serve as a benchmarking resource for trainees?
  • Is there an expert strategy or evidenced-based approach that can be discovered in the data and shared with participants?
  • Can this database serve as a platform to discuss the possibility of longitudinal, personal assessment where participants track their own performance throughout their career?

The program is sponsored by the American College of Surgeons Committee on Surgical Skills Training for Practicing Surgeons. Join the conversation and tweet about your experience with this program using #surgicalmetrics.