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

NewsScope: November 9, 2018

2019 Medicare Physician Fee Schedule Final Rule Focuses on Documentation Burden Reduction

The Centers for Medicare & Medicaid Services (CMS) issued the calendar year 2019 Medicare Physician Fee Schedule (MPFS) final rule November 1. Under this rule, CMS finalized a MPFS conversion factor of $36.0391 and a positive 1 percent increase to payments for general surgery in 2019.

CMS finalized for 2019 a few policies intended to reduce evaluation and management (E/M) documentation burden. For example, physicians may choose to document only the history and exam components that have changed since the last visit for established patients. For both new and established patients, physicians will not be required to re-document the chief complaint or history that has already been documented. CMS did not immediately finalize changes to valuation of E/M codes. Rather, the agency postponed these changes to 2021, at which point CMS will collapse E/M office/outpatient visit levels 2, 3, and 4 into a single payment rate and will allow for E/M documentation based on medical decision making or time spent providing a service or on the current 1995/1997 guidelines.

CMS also eliminated the requirement that teaching physicians document their participation in the review and direction of services provided to each patient. Such participation may instead be noted in the medical record by a resident, nurse, or other clinical staff. CMS also finalized the valuation for a number of individual surgical procedures, including those services related to fine needle aspiration, diagnostic proctosigmoidoscopy procedures, and removal of intraperitoneal catheters, to reflect recommendations made by the American Medical Association/Specialty Society RVS Update Committee.

The American College of Surgeons is evaluating these and other proposals to determine the impact on general surgery. The final rule is available for public review, along with a fact sheet. Please contact regulatory@facs.org with questions.

CMS Releases New Policies for 2019 Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) released updated policies for the 2019 Quality Payment Program (QPP) as part of the calendar year Medicare Physician Fee Schedule (MPFS) final rule issued November 1. The QPP, implemented in 2017 as required by Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA), offers two pathways for providers to participate in Medicare—the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

For the 2019 performance year, CMS finalized a number of MIPS policies, including an increase in the overall performance threshold required to avoid a penalty (from 15 points to 30 points), changes to the Quality and Cost performance category weights, the option for certain MIPS eligible clinicians to opt into the program, and facility-based reporting for the Quality and Cost categories for providers who meet the facility-based definition, to name a few. CMS also changed the name of the Advancing Care Information to Promoting Interoperability (PI) and will require 2015 edition certified electronic health record technology (2015 CEHRT) for PI participation in the 2019.

The rule also finalized requirements for becoming a Qualified Advanced APM participant through the All-Payer Combination Option, which lets physicians meet the participation threshold through a combination of both Medicare and other payor APMs beginning next year.

For more information about the 2019 QPP proposals in the MPFS final rule, see the CMS fact sheet. Questions regarding the QPP can directed to the American College of Surgeons Division of Advocacy and Health Policy at qualityDC@facs.org.

Stop the Bleed-Trained Personnel Saved Lives of Several Pittsburgh Shooting Victims

Some seriously injured patients arrived at UPMC (University of Pittsburgh Medical Center) Presbyterian Hospital with properly secured tourniquets following the October 27 mass shooting at the Tree of Life Congregation synagogue in Pittsburgh, PA. In a telephone interview with ACS NewsScope, trauma surgeon Matthew D. Neal, MD, FACS, Roberta G. Simmons Assistant Professor of Surgery, UPMC, said, “We have been passionate advocates of Stop the Bleed® in Pittsburgh, and we’re fortunate to be living in a community receptive to our efforts. In fact, the immediate response that we saw in the aftermath of this tragedy is the result of our efforts.”

Bleeding control training had previously taken place in the Squirrel Hill community, and police and tactical emergency medical services personnel who had participated in Stop the Bleed training arrived at the scene equipped and able to properly place the tourniquets. Dr. Neal said he commends the foresight the members of the Jewish community showed in conveying that they viewed themselves as an at-risk population. They also received funding from the Jewish Healthcare Foundation to place a bleeding control kit in every synagogue in the city.

“I was literally elbow deep working” to furiously repair the destruction that this type of attack creates, Dr. Neal said. “But we are now seeing the evolution of bleeding control training become part of the public domain. Stop the Bleed is a galvanizing example of how we can all contribute to a powerful public health discourse.”

Dr. Neal chronicles his experience in caring for critically wounded patients at UPMC Presbyterian in the wake of shooting and gives his thoughts moving forward from the tragedy in the online publication The Conversation.

60 Minutes Segment Highlights Value of Stop the Bleed Training

The American College of Surgeons (ACS) Stop the Bleed® program was highlighted in a November 4 60 Minutes segment on mass shootings and the role AR-15-style rifles in these incidents. Broward County, FL, Pre-Hospital Medical Director, Peter Antevy, MD, described a local initiative he is leading to teach the public how to use Stop the Bleed bleeding control kits and serve as immediate responders in the event of mass casualty incident. The Broward County campaign launched in the wake of the Stoneman Douglas High School, Parkland, FL, shootings in February 2018. The role that the ACS, the ACS Committee on Trauma, and the Hartford Consensus have played in Stop the Bleed since the Sandy Hook Elementary School, Newtown, CT, shootings in December 2012 initiative is described in a 60 Minutes Overtime piece.

Medical School Adds Stop the Bleed Training to Curriculum

The Journal of Trauma and Acute Care Surgery recently published an article, “Establishing the First Hartford Consensus-Compliant Medical School in the USA,” which demonstrates how the Frank H. Netter M.D. School of Medicine at Quinnipiac University, New Haven, CT, has established a self-sustaining Stop the Bleed® program to train students and faculty. A total of 12 bleeding control courses were offered between January and August 2018, providing training to 210 medical students, 19 faculty members, and 36 public safety officers. In addition, 34 medical students, two faculty members, and two public safety officers became certified instructors.

The training has now been incorporated into the first-year medical school curriculum to be taught by certified second-year students under the direction of the school’s department of surgery. The medical school also has purchased approved training equipment, and a student-coordinator position has been created in the surgery interest group. Hemorrhage control equipment has been purchased for each public safety officer and patrol vehicles, as well as the central dispatch headquarters, and public-access equipment has been obtained for each automated external defibrillator cabinet. The study is co-authored by Lenworth M. Jacobs, Jr., MD, MPH, FACS, a member of the American College of Surgeons Board of Regents and chair of the multi-stakeholder committee that established the Hartford Consensus.

Support for ACSPA-SurgeonsPAC Reinforced at Clinical Congress 2018

During Clinical Congress 2018 in Boston, MA, the American College of Surgeons Professional Association Political Action Committee (ACSPA-SurgeonsPAC) raised more than $77,000 from more than 200 members, staff, and other engaged surgeon advocates—the most funds raised on site at a meeting since 2007.

In addition to strong fundraising efforts, SurgeonsPAC showcased the broad-based commitment of surgeons and surgery trainees in all phases of their career. The PAC especially recognized members of the ACS Board of Governors, the Regents, and Officers; the ACS Committee on Trauma; major donors (Elite, High, Rubin, and Willens Society); Resident and Associate Society (RAS) members; PAC fundraising champions; and, the SurgeonsPAC Board of Directors for their continued commitment to the College’s political advocacy efforts. The SurgeonsPAC information booth and lounge also featured “Your PAC by the Numbers,” highlighting membership data by class, contribution level, specialty, and state to create friendly competition among attendees.

Annual SurgeonsPAC sponsored events include the Resident Reception, offering surgery trainees an opportunity to network with colleagues and College leadership, and the SurgeonsPAC Reception, which more than 175 contributors attended.

In line with congressional party ratios, SurgeonsPAC has a track record of balanced giving and supports candidates willing to champion health policy priorities important to surgeons and patients. As of October 30, SurgeonsPAC contributed 55 percent of its outlays to Republicans and 45 percent to Democrats.

To learn more about SurgeonsPAC fundraising and disbursements, visit SurgeonsPAC.org (login required using facs.org username and password) or contact ACSPA-SurgeonsPAC staff at 202-672-1520 or surgeonspac@facs.org. For more information about the College’s legislative priorities, go to SurgeonsVoice.

Note: Contributions to ACSPA-SurgeonsPAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of ACSPA have the right to refuse to contribute without reprisal. Federal law prohibits ACSPA-SurgeonsPAC from accepting contributions from foreign nations. By law, if your contributions are made using a personal check or credit card, ACSPA-SurgeonsPAC may only use your contribution to support candidates in federal elections. All corporate contributions to ACSPA-SurgeonsPAC will be used for educational and administrative fees of ACSPA and other activities permissible under federal law. Federal law requires ACSPA-SurgeonsPAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. ACSPA-SurgeonsPAC is a program of the ACSPA, which is exempt from federal income tax under section 501c (6) of the Internal Revenue Code.