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

Bulletin Advocacy Brief: September 23

Grassroots Action Needed to Promote Congressional Sign-On Letter to Stop Medicare Payment Cuts

Reps. Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN), are leading a sign-on letter to U.S. House of Representatives leadership urging congressional action on imminent Medicare payment cuts before the end of the year. The letter, which is addressed to Speaker Nancy Pelosi (D-CA) and Leader Kevin McCarthy (R-CA), highlights growing financial uncertainty within the Medicare payment system and the need for systemic reforms to the payment system to speed the transition to value-based care.

Additionally, it urges Congress to provide stability to health care professionals by averting imminent payment cuts, including extending the expiring 3.75 percent payment adjustment Congress provided last year. The deadline for members of the U.S. House of Representatives to sign the letter to House leadership is October 8, 2021.

Last year, record-breaking participation from surgeon advocates across the country played a key role in delaying the proposed cuts to Medicare physician payment. Once again, it is imperative to activate our strong grassroots network to demonstrate support for this critical issue and ensure Congress considers timely legislative action.

Act now! Write your representative and urge them to sign the letter to House leadership prior to the October 8 deadline. For more information, contact ACS DAHP staff at ahp@facs.org.

Key Congressional Committee Chairs Commit to Addressing Physician Payment Cuts

The U.S. House of Representatives Ways and Means and Energy and Commerce committees recently completed markups of Democrats' Build Back Better Act, a sweeping legislative proposal currently working its way through Congress that includes many Democratic health care priorities. Among the amendments offered during the markups were two that would extend the current 3.75 percent payment adjustment to the Medicare Physician Fee Schedule (PFS) through 2022.

Congress passed the 3.75 percent adjustment at the end of last year to help mitigate the impact of significant payment reductions included in the PFS, but that relief is currently set to expire at the end of 2021. Representative Brad Wenstrup, DPM (R-OH), introduced an amendment for the record in the Ways and Means Committee, and Representative Larry Bucshon, MD (R-IN) offered a similar amendment in the Energy and Commerce Committee. While neither amendment was adopted, Chairman Richie Neal (D-MA) of Ways and Means committed to addressing the impending payment cuts this year, and Chairman Frank Pallone (D-NJ) of Energy and Commerce noted the importance of ensuring robust physician payment and said he looks forward to working with members of Congress and stakeholders on the issue going forward.

For further information on the Build Back Better Act or the Medicare payment cuts, contact Kristin McDonald, Manager of Legislative and Political Affairs, at kmcdonald@facs.org.

Are You the Next SurgeonsVoice Advocate of the Year?

The ACS Division of Advocacy and Health Policy's Advocate of the Year recognition program tracks how engaged surgeon advocates participate in "Calls to Action" and use the tools and resources available through SurgeonsVoice. Top advocates build and maintain relationships with legislators, helping to advance important health policy priorities. The Advocate of the Year is recognized at the annual Clinical Congress, featured in the Bulletin of the American College of Surgeons, and invited to participate in other advocacy-related activities. Staff actively monitors advocate activity pertaining to the annual Advocate of the Year award.

For more information, visit the Advocate of the Year web page. To inquire about your 2021 advocacy engagement status, contact Maggie Draughn at mdraughn@facs.org.

College Activities on Capitol Hill

ACS Submits Comments on CY 2022 Medicare Physician Fee Schedule

On September 13, the ACS submitted comments on the CY 2022 Medicare Physician Fee Schedule (PFS). This rule, which the Centers for Medicare & Medicaid Services (CMS) issues annually, updates payment policies and quality provisions for services furnished under the MPFS on or after January 1, 2022.

In its letter, the ACS urged CMS to rescind a proposal whereby Medicare would no longer pay for critical care services when provided within a global period, expressing concerns that such changes would devalue the time- and resource-intensive work surgeons perform when caring for complex patients. The College also opposed CMS' failure to increase payment rates for the E/M portion of 10- and 90-day global surgical packages. In addition, the College supported several other proposed policy changes, including an extension of coverage for services added to the Medicare telehealth list during the COVID-19 pandemic through 2023 and a reduction in beneficiary cost-sharing for colorectal cancer screening and diagnostic tests.

Within its PFS comment letter, the ACS also commented on updates to the Quality Payment Program (QPP), most notably to the Merit-based Incentive Payment System (MIPS) and MIPS Value Pathways (MVPs). The ACS shared concerns about the proposed construction of MVPs and offered a solution for developing surgical MVPs that define value based on what matters to the patient. The framework to deliver patient-centered value is based on a comprehensive quality program, including verification programs to build the teams and infrastructure needed to deliver optimal care, high-value process measures, event rate metrics to track avoidable harms, and patient-reported outcome measures to indicate whether the intervention was successful based on why the patient sought care. In addition, the ACS provided comments on the current Merit-based Incentive Payment System (MIPS) performance categories (Quality, Cost, Improvement Activities, and Promoting Interoperability) and to RFIs focused on addressing the health equity gap in CMS quality programs and CMS' strategy for transitioning to digital quality measures by 2025.

The full text of the ACS comments to the CY 2022 PFS proposed rule can be found on the ACS website. For any additional questions or comments, contact regulatory@facs.org.

ACS Supports the Good Samaritan Health Professionals Act

The American College of Surgeons (ACS) issued a letter to the House of Representatives this week in support of the Good Samaritan Health Professionals Act (H.R. 5239), which was recently introduced by Representatives Raul Ruiz (D-CA) and Larry Bucshon (R-IN). The bill would ensure disaster victims' access to medically necessary care by providing volunteer health professionals with the same level of civil immunity they receive in their home state when providing care in a federally declared emergency. Currently, inconsistent state laws and lack of federal policy mean it is often unclear whether protections against unnecessary lawsuits exist for medical volunteers who cross state lines. Unfortunately, this uncertainty disincentives physicians from volunteering and, in some cases, trained and qualified professionals have been turned away. Removing barriers that prohibit licensed surgeons and other qualified physicians from voluntarily administering medically necessary care during disasters will ensure access to high-quality surgical services in the event of a crisis. The U.S. Senate is expected to introduce companion legislation in the coming weeks.

For more information, contact Emma Zimmerman, ACS Congressional Lobbyist, at ezimmerman@facs.org.

ACS Thanks Key Congressional Champions for Leadership on Addressing AUC Concerns

Last week, the ACS signed a letter to House Appropriations Committee Chairwoman Rosa DeLauro (D-CT) and Ranking Member Kay Granger (R-TX) thanking them for inclusion of language in the report accompanying the fiscal year (FY) 2022 Labor, Health and Human Services, and Education (LHHS) spending bill that requests a report from the Centers for Medicare and Medicaid Services (CMS) on the implementation of the Medicare Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging.

Additionally, the ACS signed a letter to Representative Tim Ryan (D-OH) for his work to ensure the language was included in the LHHS report. The report language notes it has been seven years since Congress passed the Protecting Access to Medicare Act, establishing the AUC Program, and CMS still has not fully implemented the program. The language requests that upon enactment of the underlying spending bill that CMS issue a report on the implementation of the program, including challenges and successes. In the report, CMS shall consider existing quality improvement programs and relevant care delivery models and their influence on encouraging appropriate use of advanced diagnostic imaging. The language also directs CMS to consult with stakeholders, including medical professional societies and developers of AUC and clinical guidelines, when formulating the report. The House of Representatives passed the LHHS funding bill in July, but it has not yet been considered in the Senate.

For more information, contact Carrie Zlatos, ACS Senior Congressional Lobbyist, at czlatos@facs.org.

ACS Submits Comments to CY 2022 Hospital OPPS/ASC Payment System Proposed Rule

The ACS submitted comments to the calendar year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgery Center (ASC) Payment System proposed rule on September 17. CMS projects an overall 2.3 percent Medicare payment increase for both hospital outpatient departments (HOPDs) and ASCs in CY 2022.

In its letter, the ACS supported CMS' proposal to reinstate the Inpatient Only (IPO) list, which describes services that can be safely provided only in an inpatient setting, and to halt a policy enacted last year to eliminate such list. The ACS also supported a proposal to create a two-year exemption from audits related to the Two-Midnight rule, which specifies that an inpatient admission is payable if the admitting physician expects the patient to require a hospital stay that crosses two midnights, for services removed from the IPO list to allow time for physicians to become familiar with reporting requirements for these procedures in the outpatient setting.

In addition to comments to the payment program provisions, the ACS offered feedback on CMS' requests for information (RFIs) regarding closing health equity gaps in CMS quality programs and their strategy for transitioning to digital quality measures by 2025. The ACS also commented on updates to the Outpatient Quality Reporting program and the ASC Quality Reporting program.

The full text of the ACS comments to the CY 2022 OPPS/ASC proposed rule can be found on the ACS website. For any additional questions or comments, contact regulatory@facs.org.