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

Editor’s note: Because of the Thanksgiving holiday, ACS NewsScope will not be published next week. Publication will resume December 6. The College wishes readers a happy and safe holiday.

CMS Issues Price Transparency Rules in Response to Executive Order

The Centers for Medicare & Medicaid Services (CMS) released a final rule and a proposed rule November 15 regarding health care price information in response to the June 2019 Executive Order, Improving Price and Quality Transparency in American Healthcare to Put Patients First.

The Hospital Price Transparency Requirements final rule expands the Public Health Service Act to require hospitals to publicly disclose price information, including gross charges, discounted cash prices, payor-specific negotiated charges, and de-identified minimum and maximum negotiated charges, for all items and services online in a single digital file. Hospitals also must make public price information for at least 300 “shoppable services” (that is, services that patients can schedule in advance) in a consumer-friendly manner, such as through an Internet-based price estimator. These requirements take effect January 1, 2021.

The Transparency in Coverage proposed rule, which CMS issued in conjunction with the Department of Labor and the Department of the Treasury, includes policies that would, if finalized, require payors to disclose on a public website their negotiated rates for in-network clinicians and allowed amounts paid for out-of-network clinicians. Payors offering coverage in the individual and group markets would be required to make available to enrollees personalized out-of-pocket cost information for all covered health care items and services through an online self-service tool. Payors also would be required to publicly disclose in-network negotiated rates with their network clinicians and historical payments of allowed amounts to out-of-network clinicians through standardized, regularly updated machine-readable files.

Fact sheets for the Hospital Price Transparency Requirements final rule and Transparency in Coverage proposed rule are available on the CMS website. Contact regulatory@facs.org with questions.

Legislation to Address General Surgery Shortages Introduced in U.S. Senate

U.S. Sens. John Barasso, MD (R-WY), and Brian Schatz (D-HI) introduced the Ensuring Access to General Surgery Act (S. 2859) November 14. The legislation would direct the U.S. Department of Health and Human Services (HHS) to conduct a study to define and identify general surgery shortage areas. The legislation also would give the Secretary of HHS the authority to issue a formal general surgery shortage area designation based on the study’s results.

In light of growing evidence demonstrating a shortage of general surgeons, more research is necessary to determine what constitutes a surgical shortage area and where these areas exist. Determining where patients lack access to surgical services will provide HHS with valuable information to increase access to the full spectrum of high-quality health care services. Incentivizing general surgeons to locate or remain in communities with workforce shortages could be critical in guaranteeing all Medicare beneficiaries, regardless of geographic location, have access to quality surgical care.

A House version of the bill, H.R. 1814, was introduced earlier this year by Reps. Ami Bera, MD (D-CA); Larry Bucshon, MD, FACS (R-IN); Scott Peters (D-CA); and Markwayne Mullin (R-OK). Senate introduction of this important legislation was a key priority at Capitol Hill meetings that took place in conjunction with the American College of Surgeons (ACS) 2019 Leadership and Advocacy Summit.

For more information on surgical workforce issues, contact Amelia Suermann, ACS Congressional Lobbyist at asuermann@facs.org.

House Passes Continuing Resolution Extend Funding for Health Care Programs

The U.S. House of Representatives voted 231–192 November 19 to pass a Continuing Resolution (CR) to fund the government at current levels through December 20, 2019. In addition to flat funding for federal agencies, the CR extends funding for several American College of Surgeons (ACS) priorities, including the Patient-Centered Outcomes Research Institute (PCORI), the Health Profession Opportunity Grant, National Health Service Corps, and Graduate Medical Education program. As leadership in the House and Senate collaborate to complete a year-end fiscal year 2020 appropriations process, the ACS continues to work with stakeholders to increase funding for cancer research at the National Institutes of Health, National Cancer Institute, and Centers for Disease Control and Prevention and to seek full reauthorization of PCORI beyond December 20.

The President is expected to sign the CR after passage in the U.S. Senate later this week. For more information about the CR or appropriations process, contact Amelia Suermann, ACS Congressional Lobbyist at asuermann@facs.org.

CMS Adds Hurricane Dorian to Automatic Extreme and Uncontrollable Circumstances for MIPS

The Federal Emergency Management Agency (FEMA) recently designated Hurricane Dorian as a national disaster. In response to this designation, the Centers for Medicare & Medicaid Services determined that the automatic extreme and uncontrollable circumstances policy will apply to Merit-based Incentive Payment System (MIPS) eligible clinicians in FEMA-identified areas in North Carolina and South Carolina. Hence, surgeons who practice in these areas will be identified automatically and receive a neutral payment adjustment for the 2021 MIPS payment year based on the 2019 performance period. Surgeons in these areas who still choose to submit data on two or more MIPS performance categories will receive a 2021 payment adjustment based on their 2019 final score.

This policy will not apply to MIPS-eligible clinicians in Alternative Payment Models (APMs) who are subject to the APM scoring standard for the 2019 performance period, nor to health care professionals who participate in MIPS as groups or virtual groups. Surgeons who were affected by Hurricane Dorian should check the FEMA-identified areas list for both North Carolina and South Carolina to determine whether their counties are included. More information on the Extreme and Uncontrollable Circumstances Policy can be found on About Exceptions page on the Quality Payment Program website.

Any additional questions should be directed to QualityDC@facs.org.

ACS SSR MIPS 2019 Reminder: Deadline to Approve MIPS Data Is January 3, 2020Surgeon 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. The deadline to submit your MIPS 2019 data through the SSR is January 3, 2020.

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 Improvement Activities (IA) specifications, and educational resources.

The SSR supports the Quality and 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 IA, surgeons have 88 surgically relevant activities from which to choose 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).