We appreciate the following physicians who advocated on behalf of Kansas surgeons and patients:

• Drs. Joshua Broghammer
• Tyler Hughes, Wael Khreiss
• Kyle Vincent
• Jarvis Walters

The issues addressed this year were:

Stop Cuts to Medicare Physician Payment
For more than twenty years Medicare payments have been under pressure from the Centers for Medicare and Medicaid Services (CMS) anti-inflationary payment policies. While physician services represent a very modest portion of the overall growth in healthcare costs, they are perennial targets for cuts when policymakers seek to tackle spending. Although surgeons and physicians in general were largely successful in avoiding direct cuts to reimbursements caused by the Sustainable Growth Rate factor (SGR), which was enacted in 1997 and repealed in 2015, Medicare physician payments have remained constrained by a budget-neutral financing system. Updates to the Conversion Factor (CF) have failed to keep up with inflation and the result is that the CF today is only about 50% of what it would have been if it had simply been indexed to general inflation starting in 1998. The combined cuts threatening Medicare physician payment amount to nearly 9%.

Ask: Congress must act before the end of the year or physicians will face significant cuts to Medicare payment stemming from both sequestration and budget neutrality requirements in the PFS.

Ease the Burden of Prior Authorization
Surgical patients are encountering barriers to timely access to care due to onerous and unnecessary prior authorization (PA) requests from Medicare Advantage (MA) plans. Utilization review tools such as PA can sometimes play a role in ensuring patients receive clinically appropriate treatment while controlling costs. However, the American College of Surgeons (ACS) is concerned about the growing administrative burdens and the delays in medically necessary care associated with excessive PA requirements.

Ask: House - Co-sponsor the Improving Seniors' Timely Access to Care Act to increase transparency of PA requirements in the MA program. Senate - Support the Improving Seniors' Timely Access to Care Act upon re-introduction.

Maintain a Strong Surgical Workforce
General surgery is an essential element of a community-based health system. A shortage of general surgeons is a critical component of the crisis in health care workforce because only surgeons are uniquely trained and qualified to provide certain necessary, lifesaving procedures. In areas without general surgeons or with an insufficient surgical workforce, patients in need of care must travel to a place with surgical capabilities, leading to delays in care and potentially suboptimal outcomes. The availability of general surgical care to a rural health system facilitates an expanded spectrum of services for a local population's health care needs. This obviates the need for transfer, time away from employment, travel, and associated costs.

Ask: Determining where patients lack access to surgical services and designating a formal surgical shortage area will provide Department of Health & Human Services (HHS) with a valuable new tool for increasing access to the full spectrum of high-quality health care services. Co-sponsor the Ensuring Access to General Services Act.

Fully Fund MISSION ZERO
In 2016, the National Academies of Science, Engineering, and Medicine (NASEM) released a report titled, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.” This report suggests that one in four military trauma deaths and one in five civilian trauma deaths could be prevented if advances in trauma care reach all injured patients. The report concludes that military and civilian integration is critical to saving these lives both on the battlefield and at home, preserving the hard-won lessons of war and maintaining the nation's readiness and homeland security.

Ask: House and Senate -- Support full funding at the authorized amount of $11.5 million for the Military and Civilian Partnership for the Trauma Readiness Grant Program (MISSION ZERO) as part of the House and Senate FY 2022 Labor-HHS-Education (L-HHS) appropriations bill. Senate -- Sign the Van Hollen/Cassidy letter requesting $11.5 million for Military and Civilian Partnership for the Trauma Readiness Grant Program (MISSION ZERO) as part of the FY 2022 Senate Labor-HHS-Education (L-HHS) appropriations bill. The letter closed on May 21, 2021.

Protect the Mental Health of COVID-19 Health Care Professionals
With burnout and other negative symptoms already present in the health care profession, COVID-19 induced even more psychological strain on physicians. The unprecedented nature of the COVID-19 pandemic altered workplace standards, practices, and policies. Surgeons were redeployed to critical care, facing shortages of personal protective equipment and the emotional impact of treating patients with COVID-19. A Morning Consult poll reveals that one in four health care workers considered leaving their job since the COVID-19 pandemic began last year; one in ten health care workers have resigned; and 46 percent report their mental health worsening . Attention to well-being and mental health must accompany the battle against COVID-19.

Ask: Co-sponsor the Dr. Lorna Breen Health Care Provider Protection Act (S. 610/H.R. 1667) to provide critical resources to study and address physician and other health care professionals' wellbeing and mental health needs.

Firearm Injury Prevention
The American College of Surgeons (ACS) co-authored a 2015 article in the Annals of Internal Medicine, Firearm-Related injury and Death in the United States: A Call to Action From 8 Health Professional Organizations and the American Bar Association. In this article, ACS highlighted the rising number of firearm-related deaths each year, classified firearm-related violence as a public health crisis, and reiterated ACS's support for being part of the solution to reducing the number of firearm-related injuries and deaths. Additionally, the ACS Committee on Trauma (COT), formed in 1922 with the goal of improving care for injured patients, has since played a large role in nationwide injury prevention efforts.

Ask: A robust and accurate background check for all firearm purchases and transfers is an important step to addressing the public health crisis of firearm violence. Congress should enact comprehensive universal background check legislation by passing H.R. 8/S. 529. Federally funded research from the perspective of public health has contributed to reductions in motor vehicle crashes, smoking, and Sudden Infant Death Syndrome. ACS believes a similar approach could reduce firearm-related injuries and deaths in our communities. Congress should build upon past support for firearm research by appropriating $50 million specifically for firearm morbidity and mortality prevention research through the CDC as part of the FY22 Labor, Education, and Health and Human Services (L-HHS) appropriations bill.