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

Bulletin Advocacy Brief: November 4

Regulatory Updates

CMS Releases CY 2022 MPFS Final Rule

The Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule on November 2, which will have a 0 percent impact on payment for general surgery services. The American College of Surgeons (ACS) submitted comments in response to the CMS MPFS proposed rule issued earlier in the year.

After extensive ACS advocacy efforts, CMS rescinded a proposal that would have prohibited critical care visits from being separately reported during the same time period as a procedure with a global surgical period. Instead, the agency maintained its current policy that allows preoperative and/or postoperative critical care to be paid in addition to a global procedure if the patient is critically ill and the critical care is unrelated to the procedure performed. Beginning in CY 2022, CMS will require a new modifier to be included on claims to indicate that the critical care provided is unrelated to the global surgical procedure. The agency also finalized refinements to its policies for split (or shared) evaluation and management visits furnished by a physician in conjunction with a non-physician practitioner (NPP) to permit the practitioner—either the physician or NPP—who provided more than half of the total time spent on the visit to bill for the services furnished.

In addition, CMS will allow certain services added to the Medicare telehealth list during the COVID-19 public health emergency (PHE) to remain on the list through the end of CY 2023 to allow for evaluation regarding whether the services should be permanently added to the telehealth list following the pandemic. CMS also finalized implementation of a special coinsurance policy to reduce beneficiary cost-sharing for colorectal cancer screening services that are planned as screening tests but become diagnostic tests when the physician identifies the need for additional treatment (such as the removal of polyps).

The final rule addressing these and other issues is available online for public review, along with a fact sheet on its payment provisions. Contact lfoe@facs.org with questions.

CMS Releases New Policies for CY 2022 Quality Payment Program

CMS on November 2 released finalized provisions for the CY 2022 Quality Payment Program (QPP) as part of the CY 2022 MPFS final rule. Required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), QPP implementation began in 2017. The QPP offers two pathways for providers who participate in Medicare: the Merit-based Incentive Payment System (MIPS), and Advanced Alternative Payment Models (APMs). Performance in MIPS in 2022 can result in payment adjustments of up to +/- 9 percent in 2024.

For the 2022 performance year (2024 payment year), CMS finalized multiple MIPS policies required by MACRA, including an increase to the overall performance threshold required to avoid a penalty (from 60 points in 2021 to 75 points in 2022), a 10 percent decrease to the Quality performance category weight (from 40 percent in 2021 to 30 percent in 2022), and a 10 percent increase in the Cost performance category weight (from 20 percent in 2020 to 30 percent in 2022). CMS also extended availability of the CMS Web Interface as a collection type for 2022. In addition to the updates to traditional MIPS, CMS finalized 7 MIPS Value Pathways (MVPs) to be available on a voluntary basis starting with the 2023 performance year. The final rule also describes the registration process and timeline for MVPs and subgroup registration.

After analyzing available data, CMS determined it can create historical quality measure benchmarks for the 2022 performance period using 2020 performance data, despite earlier concerns about the impact that COVID-19 might have on that data.  CMS also suggests through a subregulatory FAQ document that since it anticipates that the national COVID-19 PHE will continue into 2022, its "established application-based extreme and uncontrollable circumstances policy…will continue to be available to clinicians on the front lines of the PHE."   We expect CMS to provide additional details about this process later in 2022. 

The ACS is evaluating the final rule and will submit comments to CMS where appropriate. The final rule is available for public review, along with resources on its QPP provisions. Contact qualityDC@facs.org with questions.

Have You Received an RUC Survey from the ACS?

You may have received an e-mail this week requesting your help to complete an American Medical Association (AMA)/Relative Update Committee (RUC) survey about a new or revised Current Procedural Code (CPT) code(s).

When CPT codes are created or amended, the physician work associated with such codes must be reviewed to make a recommendation to CMS regarding work relative value units (RVU) and related payment rates. By completing a RUC survey when requested, you are helping the ACS provide critical data about the work that surgeons perform for various services and procedures, which are intended to inform CMS about how surgeons should be reimbursed for this work.

Watch the Understanding the RUC Survey Instrument: Surgical Services YouTube video to learn more about the survey process and its purpose. Contact Lauren Foe, Senior Associate for Regulatory Affairs, at lfoe@facs.org with questions.


On the Hill

Members of Senate Finance Committee Lead Letter to CMS on Prior Authorization Improvements

Last week, U.S. Senators Sherrod Brown (D-OH) and John Thune (R-SD) led a bipartisan group of 29 senators in requesting an update on the U.S. Centers for Medicare and Medicaid Services' (CMS) efforts to streamline prior authorization protocols across programs, including Medicare Advantage (MA) plans. Specifically, the letter urges CMS to build on the agency's prior work and use its regulatory authority to improve the prior authorization process across health plans, in line with the Improving Seniors' Timely Access to Care Act, by doing the following:

  • Establishing an electronic, "real-time" prior authorization process across federal programs, including MA plans
  • Reducing administrative burden for both providers and health plans
  • Minimizing the use of prior authorization for routinely approved items and services
  • Increasing transparency around prior authorization requirements and clinical information needed to support decisions
  • Expanding beneficiary protections

Visit SurgeonsVoice and urge your Senators to cosponsor the Improving Seniors Timely Access to Care Act.

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

ACS Endorses Expanding Access to Palliative Care Act

Last week, the ACS sent a letter to lawmakers in support of S. 2565, the Expanding Access to Palliative Care Act. The legislation would direct the Center for Medicare and Medicaid Innovation to develop and implement a five-year model to provide community-based palliative care and care coordination for high-risk beneficiaries.

Despite high-intensity medical treatment, many seriously ill individuals experience troubling symptoms, unmet psychological and personal care needs, fragmented care, poor communication with their health care providers, and enormous strains on their family caregivers. Numerous studies have shown that adding palliative care can improve pain and symptom control, quality of life, and patient and family satisfaction. However, under current law, Medicare beneficiaries only can access palliative care through hospice. Granting Medicare beneficiaries access to palliative care services earlier in their diagnosis, before hospice care is required, will improve quality of life for patients and their families and can also improve health outcomes.

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


Advocacy in Action

Recognizing Dr. Marion C.W. Henry: 2021 SurgeonsVoice Advocate of the Year

The 2021 SurgeonsVoice Advocate of the Year, Marion C. W. Henry, MD, MPH, FACS, FAAP, was announced at the Annual Business Meeting of Members at Clinical Congress 2021. Dr. Henry, a board-certified general and pediatric surgeon based in Chicago, IL, was selected for her strong commitment to advancing and supporting ACS advocacy activities and programs.

Dr. Henry understands the critical role that surgeons can play to help effect change in Washington, DC, and across the country. Recognizing the importance of educating lawmakers about critical issues impacting surgery, Dr. Henry regularly contacts Congress via SurgeonsVoice, and supports the ACS Professional Association's (ACSPA) political action committee, ACSPA-SurgeonsPAC. Dr. Henry also regularly attends the annual ACS Leadership and Advocacy Summit.

Further, Dr. Henry leads by example, serving as a member of the ACS Health Policy Advisory Council (HPAC) and the Advisory Council for Pediatric Surgery, in addition to her involvement with multiple national committees centered on surgical education, women in surgery, and pediatric surgeons.

Dr. Henry said the following about the importance of participating in advocacy efforts:

"I have found that participating in advocacy as it relates to health policy translates well to the work that I do advocating for my patients as their physician. Fundamentally, both forms of advocacy are about sharing our surgical expertise to achieve the best possible outcome for our patients, only differing in scope whether it be advocating on behalf of an individual or for systematic solutions to improve the well-being of many. While I believe that all physicians have an obligation to participate in advocacy, I believe that advocacy—in all forms—is especially vital in my world of pediatric surgery. Given that my pediatric patients do not have the means to speak up for themselves, I believe there is a greater obligation for us, as pediatric surgeons, to push for optimal solutions that improve their health and well-being by speaking up on their behalf."

Established in 2018, the SurgeonsVoice Advocate of the Year program was created to recognize strong surgeon advocates who work to help advance important health policy priorities, establish and maintain relationships with legislators, and participate in other advocacy-related activities.

For more information about the SurgeonsVoice Advocate of the Year recognition program, visit facs.org. To learn more about your personal advocacy engagement, contact Katie Oehmen at koehmen@facs.org.