Thanks to the following physicians who advocated on behalf of Kansas surgeons and patients: Drs. Joshua Broghammer, Tyler Hughes, Kyle Vincent and Rob Winfield. The issues addressed this year were:
Addressing Long-term Stability of 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direct cuts to reimbursements caused by the Sustainable Growth Rate formula (SGR), which was enacted in 1997 and repealed in 2015, Medicare physician payments remain constrained by a budget-neutral financing system. Updates to the Conversion Factor (CF) have failed to keep up with inflation or fallen in real terms year after year. 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. Ask: Congress must stop these cuts from going into effect and create stability in the physician payment system. In addition to taking immediate action to prevent pending cuts, Congress should hold hearings to examine the long-term stability of the Medicare physician payment system and to consider how MACRA could be improved to ensure surgeons can participate meaningfully in the transition to value-based care as the law intended.
Ensure CMS is Implementing MACRA as Intended - The Medicare Access and CHIP Reauthorization Act (MACRA) intended to tie payment more closely to value but has fallen short in implementation, leaving many surgeons without a clear path to succeed in the new environment. More than 20 different payment programs for quality and value exist in Medicare today, without unifying incentives to improve care coordination for patients. Further, despite targets for participation in alternative payment models (APMs), many surgeons remain stuck in a fee-for-service (FFS) system due to the lack of qualifying models relevant to the care they provide. Ask: House: Sign the Schrier-Bucshon letter to CMS. To sign on, please contact Alicia Bissonnette with Rep. Schrier (This email address is being protected from spambots. You need JavaScript enabled to view it.) or Dylan Moore with Rep. Bucshon (This email address is being protected from spambots. You need JavaScript enabled to view it.).
Senate: Weigh-in with CMS.
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 bipartisan Improving Seniors’ Timely Access to Care Act (H.R. 3173). If already a co-sponsor, please urge committees of jurisdiction to advance the legislation. Senate: Co-sponsor the Improving Seniors’ Timely Access to Care Act (S. 3018).
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.
Unlike other key providers of the community-based health care system, general surgeons do not have a formal workforce shortage area designation. A congressionally mandated 2020 report, conducted by the Health Resources and Services Administration (HRSA), examined surgical shortage areas and showed a maldistribution of the surgical workforce, with widespread and critical shortages of general surgeons particularly in rural areas. Additionally, data from the Association of American Medical Colleges (AAMC) continues to project shortages of surgical specialties over the next 15 years. Ask: House and Senate: Co-sponsor and support H.R. 5149/S. 1593, the Ensuring Access to General Surgery Act. Determining where patients lack access to surgical services and designating a formal surgical shortage area will provide HHS with a valuable new tool for increasing access to the full spectrum of high-quality health care services.
Ensure Funding for ACS Priorities in FY 2023 –
MISSION ZERO Funding
The MISSION ZERO Act, enacted in 2019, created the Military and Civilian Partnership for the Trauma Readiness Grant Program within the U.S. Department of Health and Human Services (HHS), to cover the administrative costs for civilian hospitals to embed military trauma professionals in civilian trauma centers. These grants allow military trauma care teams to gain exposure to treating critically injured patients in civilian trauma centers and therefore increase readiness of military care teams when deployed, further advancing trauma care and providing greater patient access. By facilitating the implementation of military-civilian trauma partnerships, this program preserves lessons learned from the battlefield, translates those lessons to civilian care, and ensures that service members maintain their readiness to deploy in the future. ACS supports funding the program at its fully authorized amount of $11.5 million.
- Military and Civilian Partnership for the Trauma Readiness Grant Program: $11.5 million (currently $2 million)
Firearm Research Funding
According to the Centers for Disease Control and Prevention (CDC), there were more than 45,000 firearm-related fatalities in 2020, a marked increase over previous years. ACS believes this number can be reduced through federally funded firearms research. As with other injury prevention related efforts, public health research can play a role in reducing the number of firearm-related injuries and deaths. Federally funded research from the perspective of public health has contributed to reductions in motor vehicle crashes, smoking, and Sudden Infant Death Syndrome (SIDS). ACS believes that a similar approach can provide necessary data to inform efforts to reduce firearm-related injuries and deaths.
- Firearm Morbidity and Mortality Prevention Research: $50 million (currently $25 million)
- Centers for Disease Control and Prevention (CDC): $25 million (currently $12.5 million)
- National Institutes for Health (NIH) $25 million (currently $12.5 million)
Cancer Research Funding
The National Cancer Institute (NCI): The NCI is experiencing a demand for research funding that is far beyond that of any other Institute or Center (IC) at NIH. Between FY 2013 and FY 2019, the number of research grant applications to NCI rose by 50.6%, compared to just 5.6% at all other ICs. That is good news because it shows how much excitement there is in cancer research. But at its current funding level, NCI cannot keep up with that demand. Only about one out of every eight applications receives funding.
- National Cancer Institute (NCI): $7.66 billion (currently $6.9 billion)
CDC Cancer Research Programs
Research is important, but so is prevention. About half of the 600,000 cancer deaths in the U.S. each year could be prevented through the application of existing cancer control initiatives. Unfortunately, funding for CDC’s cancer programs has barely changed in a dozen years. From FY 2010 to FY 2022, funding rose by less than $20 million – just 5% – over 12 years ($370.3M to $389.8M). That’s about $100 million less than if these programs had simply kept up with inflation.
- CDC Cancer Programs: $456 million (currently $385.8 million)
Repealing the Ban in Sec. 510 Prohibiting a Unique Patient Identifier (UPI)
Serious patient safety concerns arise if a patient’s health record is mismatched or includes inaccurate or incomplete information, potentially resulting in missed allergies, medication interactions, or duplicate tests ordered. Unfortunately, there is no accurate or consistent way for surgeons to link patients to their health information across the continuum of care, due to long-standing federal statutory language. The language, located in Section 510 of the Labor, Health and Human Services, Education and Related Agencies Appropriations (Labor-HHS) bill, has prohibited HHS from spending any federal dollars to promulgate or adopt a Unique Patient Identifier (UPI), thereby hampering public-private sector collaborative efforts to advance a nationwide patient identification strategy that is cost-effective, scalable, secure, and prioritizes patient privacy. Removing the language in Section 510 will provide HHS with the ability to evaluate a range of patient identification solutions and enable the agency to work with the private sector to explore potential challenges. The U.S. House of Representatives and U.S. Senate removed the ban from draft versions of the Labor-HHS bill for the first time in FY22, but unfortunately, the change was not included in final legislation.
- Remove the ban in Section 510 of the Labor-HHS Appropriations bill text that prohibits HHS from spending any federal dollars to promulgate or adopt a UPI.
Appropriations Asks:
House and Senate: Please include ACS funding priorities in your Appropriations requests:
- Military and Civilian Partnership for the Trauma Readiness Grant Program (MISSION ZERO):
$11.5 million (currently $2 million)
- Firearm Morbidity and Mortality Prevention Research: $50 million (currently $25 million)
- Centers for Disease Control and Prevention (CDC): $25 million (currently $12.5 million)
- National Institutes for Health (NIH): $25 million (currently $12.5 million)
- National Cancer Institute (NCI): $7.66 billion (currently $6.9 billion)
- CDC Cancer Programs: $456 million (currently $385.8 million)
- Remove the ban in Section 510 of the Labor-HHS Appropriations bill text that prohibits HHS from spending any federal dollars to promulgate or adopt a unique patient identifier (UPI).
Recognize the 100th Anniversary of the ACS Committee on Trauma
This year marks the 100th anniversary of the American College of Surgeons (ACS) Committee on Trauma (COT). Since its inception in 1922, the COT has played a pivotal role in advocacy and education efforts, leveraging trauma center and trauma system resources, creating best practices, providing outcome assessment, and prioritizing continuous quality improvement. For example, in the past 30 years, the Committee developed the Consultation/Verification Program to assist hospitals in the evaluation and improvement of trauma care and provide objective, external review of institutional capabilities and performance. Additionally, the Trauma Quality Improvement Program (TQIP) was created to elevate the quality of care for trauma patients by collecting data from trauma centers, providing feedback on performance compared to national benchmarks, and identifying institutional characteristics for optimal patient outcomes. And, most recently, the STOP THE BLEED® campaign launched in 2015 to prepare people to save lives by teaching three quick actions to control serious bleeding. To date, over one million Americans, including several members of Congress, have received this training.
With traumatic injury being the most common cause of death for individuals aged 1-45 years and the cause of nearly 200,000 deaths per year in the United States, robust trauma systems and the teams who treat trauma patients, have never been more critical to our health care system. Ask: House and Senate: Co-sponsor H.Res. 951/S.Res.532 in recognition of the 100th anniversary of the American College of Surgeons Committee on Trauma.
Recognize the 100th Anniversary of the ACS Commission on Cancer
This year marks the 100th anniversary of the American College of Surgeons (ACS) Commission on Cancer (CoC), a consortium of more than 50 cancer-related organizations dedicated to improving survival and quality of life for cancer patients through standard setting, which promotes cancer prevention, research, education, and monitoring of comprehensive quality care. Founded in 1922, the CoC establishes standards to ensure quality, multidisciplinary, and comprehensive cancer care delivery in health care settings; conducts surveys in health care settings to assess compliance with those standards; collects standardized data from CoC-accredited health care settings to measure cancer care quality; uses data to monitor treatment patterns and outcomes and enhance cancer control and clinical surveillance activities; and develops effective educational interventions to improve cancer prevention, early detection, cancer care delivery, and outcomes in health care settings. Today, there are more than 1,500 CoC-accredited cancer programs in the United States and Puerto Rico, which care for approximately 70% of newly diagnosed cancer patients. CoC accreditation encourages hospitals, treatment centers, and other facilities to improve their quality of care through various cancer-related programs and activities. These programs are concerned with the full continuum of cancer—from prevention to survivorship and end-of-life-care—while addressing both survival and quality of life. Ask: House and Senate: Co-sponsor H.Res. 997/S.Res. 566 in recognition of the 100th anniversary of the American College of Surgeons Commission on Cancer.
