Thanks to Drs. Scott Coates, Amanda Hangge and Joshua Mammen, as they represented the interests of Kansas surgeons by donating their time and effort, advocating on your behalf on Capitol Hill last week.

The issues addressed were:
Opioid Epidemic
The College is committed to addressing the opioid epidemic through both patient and provider education, as well as through continued research into non-opioid pain treatments and other alternative remedies. Both are necessary to reduce the number of individuals who improperly or unnecessarily receive opioid prescriptions. The Kansas delegation encouraged legislators to limit solutions that impose federal mandates on physicians, such as prescribing limits or Continuing Medical Education (CME), asked legislators to create fully functional, interoperable Prescription Drug Monitoring Programs (PDMPs) that integrate with a clinician’s clinical workflow, and asked legislators to create enhanced options for non-opioid therapy.

Pandemic and All Hazards Preparedness Act (PAHPA)
The Pandemic and All Hazards Preparedness Act (PAHPA) was created to improve the nation’s response to public health and medical emergencies. It also establishes the office of the Assistant Secretary of Preparedness and Response (ASPR), which oversees the nation’s preparedness for disaster response. ASPR responsibilities include the implementation of the recommendations from the June 2016 National Academy of Sciences, Engineering and Medicine (NASEM) report entitled, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.” To assist with the development of a national framework for trauma care and to address some of the shortfalls in our current trauma system, the ACS asks the following legislative proposals be included in the 2018 PAHPA reauthorization, we requested the inclusion of:
• The Mission Zero Ace (H.R. 880/S. 1022).
• Authorization of the federal trauma systems and centers grant programs with the goal of creating a national trauma system.
• The Good Samaritan Health Professionals Act (H.R. 1876/S. 781).

Cancer Research and Prevention
The American College of Surgeons and the Commission on Cancer continue their dedication to improving survival and quality of life for cancer patients through advocacy of issues pertaining to prevention and research. As Congress begins to work on FY 2019 appropriations, we encouraged them to maintain the bipartisan commitment to ensuring cancer research and prevention remain a budgetary priority.

Colorectal Cancer Screening
According to the NCI, colorectal cancer is the second leading cause of cancer related death in the United States when men and women are combined. This statistic is especially troubling since colorectal cancer is largely preventable due to effective screening methods. Under current law, Medicare waives co-insurance and deductibles for preventative colonoscopies. However, when a polyp is discovered and removed, the procedure is reclassified as therapeutic for the purposes of Medicare billing and patients are therefore required to pay the coinsurance. Not only is the cost-sharing obligation of current law confusing to patients, but it also results in the unintended consequence of creating a financial barrier to the most effective method of colorectal cancer prevention. H.R. 1017/ S. 479 would help to ensure that the threat of unanticipated costs do not deter a patient from having the screening performed.

Pediatric Cancer Research
Although pediatric cancer death rates have declined by nearly 70 percent over the past four decades, cancer remains the leading cause of death from disease among children according to the NCI, which estimates that 10,380 new cases of cancer were diagnosed in the United States among children from birth to age 14 last year, and about 1,250 children are expected to die from the disease this year. While advancements have been made in childhood cancer research, there is still a long way to go to ensure that children facing a cancer diagnosis have the best opportunities for winning their fight and access to the highest quality of care. The STAR Act (H.R. 820/ S. 292) would advance pediatric cancer research and child-focused cancer treatments, while also improving childhood cancer surveillance and providing resources for survivors of childhood cancer.

Stop Overregulating My OR (SOMO)
Physicians are inundated with a growing number of administration requirements set forth by both Congress and federal agencies. Although these policies are intended to ensure that patients receive care that meets high-quality and safety standards, physicians are confronted with the burden of demonstrating regulatory compliance. The excessive regulations placed on surgeons and needless barriers to providing necessary care and increase spending on nonclinical activities. When physicians first began to create medical records, their primary goal was to provide an accurate, chronologic record of patient care. Over time, the Centers for Medicare and Medicaid Services (CMS) and payers began to increasingly utilize the medial record for purposes of determining payment of services. Evaluation and Management (E&M) codes are requirements for documentation of the history and physical examination to support a level of payment. Because E&M documentation guidelines were introduced 23 years ago, when medical records were primarily paper-based, they have resulted in the unintended consequence of a medical record bloated with repetitive and redundant information. We urged legislators to address concerns regarding E&M documentation guidelines as they work with their congressional colleagues to reduce the excessive administrative burdens which create barriers to patient care.

Firearms Research and Prevention
The ACS supports an appropriations request of $50 million specifically for firearm morbidity and mortality prevention research through the CDC as part of the fiscal year (FY) 2019 appropriations package.

Ensuring an Adequate Surgical Workforce in Underserved Areas
In light of growing evidence demonstrating a shortage of general surgeons, the 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. Identifying where patients lack access to surgical services will provide the Health Resources and Services Administration’s (HRSA) with a valuable new tool for increasing access to the full spectrum of high quality health care services. Determining what constitutes and defines a surgical shortage area is an important first step in guaranteeing all Medicare beneficiaries, regardless of geographic location, have access to quality surgical care.