Thanks to Drs. Joshua Broghammer, Scott Coates, Joshua Mammen, Randi Ryan and Robert Sliter, for attending the ACS Leadership & Advocacy Conference in DC. They advocated on behalf of Kansas surgeons to your congressional leaders. 

Here is what the asks were on Capitol Hill:

Unanticipated Medical Billing - Surgeons, patients, and policy makers are concerned about the impact that unanticipated medical bills have on patient costs and the patient-physician relationship. The American College of Surgeons (ACS) believes a holistic approach consisting of coordinated efforts by health insurance plans, hospitals, providers, and patients will be required to remedy this complex issue.

As Congress moves forward with its efforts to address this issue, the surgeons asked that the principles listed above be utilized to promote access to appropriate medical care, and encourage insurers to negotiate in good faith with health care providers to establish adequate provider networks and fair remuneration.

The Future of Medicare Physician Payment - Faced with two decades of stagnant payment, looming cuts, and onerous requests for investment in new sytems that CMS fails to implement, physicians are understandably frustrated and burned out. With Medicare playing a vital role in the delivery of health care in the United States, Congress must take steps to ensure that Medicare as a payer keeps pace with innovation and inflation by addressing reimbursement in a way that reflects the cost of medical care and the value of services provided to beneficiaries. Congress can do this by taking the following steps:
• Create an inflationary update mechanism for the Medicare conversion factor formula
• Partner with physicians and other experts to improve the MIPS program
• Urge CMS to work with stakeholders on measurement that informs patient and physician decisions
• Extend the A-APM incentive payment beyond 204 while directing CMS to test PTAC approved models
• Review A-APM participation thresholds to ensure surgeons and other can achieve QP status.

The ACS will continue to pursue improvements to quality and value in MACRA. However, it is time for Congress to examine physician reimbursement in a way that is fair and incentivizes physicians to continue to take on risk, innovate in care delivery, and provide high quality of care of patients.

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 ACS is concerned about the growing administrative burdens and the delays in medically necessary care associated with excessive PA requirements.

Support legislative efforts to improve the continuity of patient care by increasing transparency of prior authorization requirements for Medicare Advantage plans.

Meaningful Measurement of Surgical Quality - The enactment of Medicare Access and CHIP Reauthorization Act (MACRA) provided an important opportunity to tie Medicare payments closely to quality in a meaningful way to both patients and providers. However, instead of working with stakeholders to develop a measurement structure that strives for high quality and value, the Centers for Medicare and Medicaid Services (CMS) over-relied upon legacy quality programs to create the Merit-based Incentive Payment System (MIPS).

Various stakeholders have engaged CMS, providing solutions to develop innovative and rigorous episode-based measurement to drive value-based surgical care, but these efforts have not been given the opportunity for testing. As a result, the current measures framework lacks rigor, is fragmented, and is based on how a clinician bills in fee-for-service. Differentiating among physicians for payment purposes does nothing to inform care decisions or quality improvement efforts, missing the intent of MACRA to drive value.

Congress should encourage CMS to work with key stakeholders to develop and implement accurate quality measurement.

Firearms Research and Violence Prevention - The ACS was a co-author of 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’ support for being part of the solution to reducing the number of firearm-related injuries and deaths.

The ACS supports an appropriates request of $50 million specifically for firearm morbidity and mortality prevention research through the CDC as part of the Fiscal Year (FY) 2020 Labor, Health and Human Services (HHS), Education and Related Agencies appropriations package.

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.

Pandemic and All Hazards Preparedness Act (PAHPA) - Trauma systems are organized across the country to manage, on a daily basis, acutely injured patients in an efficient, time-sensitive manner. A trauma system spans the continuum of care from the point of injury, through rehabilitation. As a result, these systems are responsible for not only day-to-day emergency and trauma care, but for public health emergencies that cause regions to experience a surge in capacity. Since trauma centers and systems serve as critical infrastructure for disaster response, having a nationwide trauma system would afford patients with the best trauma care regardless of the emergency and the location.

The ACS encourages Congress to resolve differences and enact PAHPAI, including the Mission Zero Act.

Ensuring an Adequate Surgical Workforce in Underserved Areas - Increasing evidence indicates a current and growing shortage of surgeons available to serve our nation’s population. 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 light of growing evidence demonstrating a shortage of general surgeons, the American College of Surgeons (ACS) believes more accurate and actionable workforce data is necessary to determine exactly what constitutes a surgical shortage area and subsequently where these areas exist.

Cosponsor H.R. 1841, the Ensuring Access to General Surgery Act, in the House and work towards reintroduction of the legislation in the Senate.

Maintaining a Strong Investment in Cancer Research and Prevention - The ACS and the CoC are dedicated to improving survival and quality of life for cancer patients through advocacy of issues pertaining to prevention and research.

Please continue to build upon your commitment to cancer research by funding the: NIH – increase of $2.5 billion, for a total of $41.6 billion, including $6.5 billion for the NCI Providing at least $555 million for the CDC’s Cancer Control and Prevention programs, including $70 million for the National Cancer Registry Program.

Cosponsor H.R. 1570/S. 668, the Removing Barriers to Colorectal Cancer Screening Act. Cosponsor H.R. 647, the Palliative Care Hospice Education and Training Act (PCHETA).