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

Valerie W. Rusch, MD, FACS, installed as 100th ACS President

Valerie W. Rusch, MD, FACS, an esteemed thoracic surgeon from New York, NY, was installed as the 2019−2020 President of the American College of Surgeons (ACS) at Convocation, October 27 in San Francisco, CA. Dr. Rusch is vice-chair, clinical research, department of surgery; Miner Family Chair in Intrathoracic Cancers; attending surgeon, thoracic service, department of surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; and professor of surgery, Weill Cornell Medical College, New York. Dr. Rusch specializes in the diagnosis and treatment of patients with cancers of the lung, airways (trachea, bronchi), esophagus, mediastinum, chest wall, and pleura (malignant pleural mesothelioma). She was among the first women in the U.S. to be board certified in thoracic surgery. An ACS Fellow since 1986 and the 2018 recipient of the ACS Distinguished Service Award (DSA), Dr. Rusch has led several prominent ACS bodies, including serving as Chair of the Board of Governors (2006−2008), the Central Judiciary Committee (2009−2013), the Program Committee (2011−2017), and the Board of Regents (2015−2016). Dr. Rusch is the 100th President of the ACS.

The 2019–2020 Vice-Presidents also were installed at Convocation. The First Vice-President is John A. Weigelt, MD, DVM, FACS, who recently retired as the Milton and Lidy Lunda/Charles Aprahamian Professor of Trauma Surgery; professor and chief, division of trauma and critical care; and associate dean for quality, Medical College of Wisconsin, Milwaukee. A general surgeon with an emphasis on trauma, critical care, and acute care surgery, Dr. Weigelt is now professor of surgery, University of South Dakota and the Sanford Health System, Sioux Falls, and Medical Director, ACS Surgical Education and Self-Assessment Program.  He received the DSA in 2015.

The Second Vice-President is F. Dean Griffen, MD, FACS, a clinical professor of surgery at Ochsner Louisiana State University (LSU) Health Sciences Center-Shreveport. Having served in several different capacities over the last 12 years (including acting chair of the department of surgery), he is now an active member of the Ochsner LSU department of surgery, division of general surgery. He received the DSA in 2009.

Read more about Drs. Rusch, Weigelt, and Griffen in the November Bulletin

New ACS Secretary and Treasurer Elected

Two new Officers of the American College of Surgeons (ACS) were elected at the October 30 Annual Meeting of the Members. Tyler G. Hughes, MD, FACS, a general surgeon from Salina, KS, will replace Edward E. Cornwell, MD, FACS, FCCM, as Secretary, and Don K. Nakayama, MD, MBA, FACS, a pediatric surgeon from Chapel Hill, NC, will replace William G. Cioffi, Jr., MD, FACS, as Treasurer.

Dr. Hughes is a general surgeon in McPherson, KS, and clinical professor of surgery and director of medical education, Kansas University School of Medicine, Salina. A Fellow of the College since 1986, Dr. Hughes has served in several ACS leadership positions and is presently Editor of the ACS Communities. He was instrumental in establishing the Advisory Council for Rural Surgery, which he chaired (2012−2016). He also has served on the Board of Governors (B/G) from 2009 to 2015.

Dr. Nakayama is clinical professor, division of pediatric surgery, department of surgery, University of North Carolina at Chapel Hill School of Medicine. An ACS Fellow since 1990, he has also been active in the Advisory Council for Rural Surgery (2013−2017) and the B/G (2011−2013), serving on the Governors Committee to Study the Fiscal Affairs of the College (2012−2013) and Committee to Restructure B/G Committees (2012−2013). Dr. Nakayama has been Chair of the History and Archives Committee (formerly the Surgical History Group) since 2016.

Read more about Drs. Hughes and Nakayama.

New ACS Regents, Board of Governors Executive Committee Members Elected

The Board of Governors (B/G) of the American College of Surgeons (ACS) has elected two new members of the Board of Regents (B/R), as well as new B/G Executive Committee members.

Diana L. Farmer, MD, FACS, FRCS, is a newly elected Regent. Dr. Farmer is the Pearl Stamps Stewart Endowed Chair and Distinguished Professor and Chair, department of surgery, University of California (UC), Davis School of Medicine. She is surgeon-in-chief, UC Davis Children’s Hospital, and chief of surgery, Shriners Hospitals for Children, Sacramento, CA. A Fellow of the College since 1998, Dr. Farmer has served on many ACS committees and governing bodies. Most recently, she was Chair of the B/G (2016−2018).

The other newly elected Regent is Steven C. Stain, MD, FACS. Dr. Stain is professor of surgery and Henry and Sally Schaffer Chair, department of surgery, Albany Medical College, NY. A Fellow of the ACS since 1994, Dr. Stain has served in several ACS leadership positions, most recently as B/G Chair (2018−2019).

The B/G has elected Ronald J. Weigel, MD, PhD, FACS, professor and chair of surgery, associate vice-president for UI Health Alliance, University of Iowa, Iowa City, to serve as its new Chair. The Vice-Chair is Taylor Sohn Riall, MD, PhD, FACS, professor and interim chair, department of surgery, University of Arizona College of Medicine, Tucson. Mika Sinanan, MD, PhD, FACS, a general surgeon, UW Medicine and the Seattle Cancer Care Alliance, and professor of general surgery and adjunct professor of electrical engineering, University of Washington, Seattle, is the new Secretary. Andre Campbell, MD, FACS, FACP, FCCM, professor of surgery, division of general surgery, University of California San Francisco, has been reelected to the Executive Committee. 

New members of the B/G Executive Committee elected to serve one-year terms include the following: Mark Alan Dobbertien, DO, FACS, a minimally invasive surgeon in Jacksonville, FL; Nancy Lynn Gantt, MD, FACS, professor of surgery, Northeast Ohio Medical University, Rootstown, OH, and co-medical director, Joanie Abdu Comprehensive Breast Care Center, St. Elizabeth Youngstown Hospital Center, OH; Dhiresh Rohan Jeyarajah, MD, head of surgery, Texas Christian University, and University of North Texas Health Science Center, Fort Worth; and Martin A. Schreiber, MD, FACS, professor and chief, division of trauma and critical care, Oregon Health & Science University, Portland.

Read more about the new Regents and members of the B/G Executive Committee

J. Wayne Meredith, MD, FACS, MCCM, is 2019–2020 ACS President-Elect

J. Wayne Meredith, MD, FACS, MCCM, an esteemed trauma, thoracic, and critical care surgeon, was elected 2019–2020 American College of Surgeons (ACS) President-Elect at the Annual Business Meeting of Members October 30. Dr. Meredith is Richard T. Myers Professor and Chairman, department of surgery, Wake Forest School of Medicine, Winston-Salem, NC. A Fellow of the ACS since 1990, Dr. Meredith has devoted much of his energy to ACS trauma-related activities. He served as Medical Director of Trauma Programs (2006–2010) and Chair of the Committee on Trauma (COT) (2002–2006). He has chaired the COT’s National Trauma Data Bank Ad Hoc Committee (1997–2002) and the Trauma Registry Subcommittee (1994–2002) and continues to serve on the Verification, Review, and Consultation Committee (1996–present). He was awarded the ACS Distinguished Service Award in 2014.

The First and Second Vice-Presidents-Elect also were chosen at the meeting. The First Vice-President-Elect is H. Randolph Bailey, MD, FACS, FASCRS, a respected colon and rectal surgeon who practices at the University of Texas (UT)/McGovern Medical School, Houston. Dr. Bailey is professor of surgery and emeritus program director of the UT colon and rectal surgery residency training program. He is chief, division of colon and rectal surgery, Memorial Hermann Hospital Texas Medical Center, and deputy chief of surgery, Houston Methodist Hospital. A Fellow of the ACS since 1976, Dr. Bailey has served as a member of the ACS Board of Regents (2003−2012) and in several other ACS committees.

The Second Vice-President-Elect is Lisa A. Newman, MD, MPH, FACS, FASCO, director, interdisciplinary breast program; chief, division of breast surgery, and medical director, International Center for the Study of Breast Cancer Subtypes, Weill Cornell Medicine-New York Presbyterian Hospital Network, NY. She also is an adjunct professor of breast surgery at MD Anderson Cancer Center, Houston. An ACS Fellow since 1994, Dr. Newman has been an active member of the Commission on Cancer (CoC) (2001−2009), serving on the CoC Scientific Review Subcommittee (2005−2007) and as a CoC Liaison (2001−2009).

Read more about Drs. Meredith, Bailey, and Newman.

CMS Releases CY 2020 Medicare Physician Fee Schedule Final Rule

The Centers for Medicare & Medicaid Services (CMS) November 1 issued the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) final rule. The American College of Surgeons (ACS) submitted detailed comments September 10 in response to the agency’s MPFS proposed rule issued earlier in the year, some of which is summarized below.

CMS finalized changes to its coding and billing policies for office/outpatient evaluation and management (E/M) visits. Beginning in CY 2021, the agency will retain the five-level office/outpatient E/M coding system for established patients and reduce the number of levels to four for new patient visits. CMS will eliminate history and physical exam as elements for E/M code selection and instead allow physicians to choose the E/M visit level based on the extent of their medical decision making or on time spent with the patient. The agency also will implement an add-on code for office visits that are part of ongoing primary care and/or management of patients with serious or complex conditions.

CMS accepted the American Medical Association Specialty Society Relative Value Scale Update Committee-recommended payment rates for office/outpatient E/Ms for CY 2021, which will increase the values of most of these services; however, the Agency will not apply such increases to global surgery codes. The College will continue to contest CMS’ failure to increase values for the E/M portion of 10- and 90-day global surgery packages.

In addition, the agency modified its medical record documentation requirements to allow certain nonphysician practitioners (such as physician assistants (PAs), nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists) to review and verify (sign and date), rather than redocument, notes made in the medical record by other physicians, residents, nurses, students, or other members of the medical team. CMS also updated its regulations on physician supervision of PAs to allow these health care professionals to practice more broadly in accordance with state scope-of-practice and other laws.

The MPFS final rule and related fact sheet are available online for public review. For more information, regulatory@facs.org with questions.

CMS Issues CY 2020 OPPS/ASC Final Rule

The Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) Payment System final rule November 1. Under this rule, the agency sets a 2.6 percent payment increase for hospital outpatient departments (HOPDs). CMS estimates that total payments made under the OPPS and ASC Payment System for CY 2020 will be approximately $79.0 billion and $4.96 billion, respectively, an increase of approximately $6.3 billion and $230 million, respectively, from CY 2019 payments.

The agency finalized a change to the minimum required level of supervision for hospital outpatient therapeutic services furnished by all hospitals (including critical access hospitals) from direct supervision to general supervision. Under this policy, outpatient therapeutic services may be furnished under a physician's overall direction and control, but the physician's presence is not required during the performance of these therapies. Hospitals may require a higher level of supervision for certain services as they deem appropriate.

In addition, CMS removed several services from its Inpatient Only List, including total hip arthroplasty and certain spine procedures, making these services eligible to be paid by Medicare in the hospital outpatient setting in addition to the hospital inpatient setting.

The OPPS/ASC Payment System final rule and related fact sheet are available online for public review. For more information, contact regulatory@facs.org.

CMS releases new policies for CY 2020 Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) released finalized provisions for the calendar year (CY) 2020 Quality Payment Program (QPP) November 1 as part of the CY 2020 Medicare Physician Fee Schedule (MPFS) final rule. As mandated in the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015, QPP implementation began in 2017. Next year marks the fourth year of the QPP when performance in 2020 will result in payment adjustments of plus or minus 9 percent in 2022. The QPP offers two pathways for providers to participate in Medicare: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

For the 2020 performance year (2022 payment year), CMS finalized several MIPS policies, including an increase to the overall performance threshold required to avoid a penalty (from 30 points in 2019 to 45 points in 2020), a 10 percent increase in the data required for Quality reporting (from 60 percent in 2019 to 70 percent in 2020), an increase in the participation threshold for Improvement Activity group reporting requirements, and the addition of 10 new episode-based Cost measures, to name a few. Notably, CMS did not finalize the proposal to adjust the weights for the Quality and Cost performance category, therefore, the 2020 MIPS performance category weights will remain the same from 2019 to 2020.

In addition, CMS finalized the implementation of a new MIPS participation pathway for the 2021 QPP performance year, called MIPS Value Pathways (MVPs). The MVPs are designed to align measures and activities across the Quality, Cost, Promoting Interoperability, and Improvement Activities to simplify MIPS; create a more meaningful participation experience with a set of measures tailored to an episode of care or condition; reduce clinician burden; and better align with APMs to ease the transition between the two tracks.

The American College of Surgeons (ACS) leadership will be working with CMS as the agency develops and implements the MVP framework. At present, the ACS is evaluating the final rule and will submit comments to CMS. The final rule is available for public review, along with fact sheets on its QPP provisions. For more information, contact quality@facs.org.

U.S. House Passes Palliative Care Legislation

The U.S. House of Representatives October 28 passed the Palliative Care and Hospice Education and Training Act (PCHETA), H.R. 647/S. 2080. A priority of the 2019 ACS Advocacy Summit and At Home Program, the bill would improve the training of health professionals in palliative care by creating Palliative Care and Hospice Education Centers to provide short-term, intensive courses focused on palliative care and establishing traineeships for individuals preparing for advanced degrees as nurses, social workers, or physician assistants who focus their studies in palliative care. In addition, the legislation expands palliative care research to strengthen clinical practice and improve care delivery for patients with serious or life-threatening illnesses.

H.R. 647/S. 2080 was introduced by Reps. Eliot Engel (D-NY), Tom Reed (R-NY), Yvette Clarke (D-NY), Buddy Carter (R-GA), Frank Pallone (D-NJ), and Greg Walden (R-OR) and Sens. Tammy Baldwin (D-WI) and Shelley Moore Capito (R-WV). The American College of Surgeons (ACS) will continue its advocacy on this important issue to ensure swift passage of the bill in the U.S. Senate.

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

ACS SSR MIPS 2019 Participation RemindersSurgeon 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), and there is still time to participate in the MIPS 2019 performance year. Submitting MIPS 2019 data to CMS will allow you to potentially either avoid a flat 7 percent negative payment adjustment or earn a positive payment adjustment of up to 7 percent in calendar year 2021.

MIPS participants should verify their MIPS 2019 eligibility via the CMS Quality Payment Program Participation Status lookup tool by entering their individual surgeon National Provider Identifier number before signing up for MIPS 2019 through the SSR.

CMS has finalized eligibility data, and you can now verify your MIPS 2019 final eligibility in November 2019. Visit the ACS SSR website for more information about MIPS 2019 participation, including requirements, measures and IA specifications, and educational resources.

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

The SSR supports the Quality and Improvement Activities (IA) components of MIPS 2019, and CMS considers MIPS data submitted through the SSR to be 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.

Several MIPS 2019 educational and instructional resources (Quick guides and video demonstrations) are available for you 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).