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An Update from the ACS Legislative Committee

In this issue:

  • Surprise Billing
  • Medicare Physician Payment
  • Prior Authorization
  • Firearms Research and Prevention
  • Pandemic and All Hazards Preparedness and Advancing Innovations Act (PAHPAI)
  • Keep Physicians Serving Patients Act
  • End the Cycle of Violence Act
 

As the Governor Liaison to the ACS Legislative Committee, I would like to report that the Committee has had a busy year thus far, with ongoing developments regarding multiple issues, the most salient of which are highlighted below.

You can help these causes not only by writing your Congressional Delegates, but also by becoming active at the State level within the New York Chapter of the ACS. Please be an ACS Advocate, even if only at your local government level: truly it can make a difference-or rather, should I say, YOU can make a difference. Best wishes to all for a happy and safe July 4th.

Anthony J. Vine, MD, FACS
Asst. Clinical Professor of Surgery,
Icahn School of Medicine at Mount Sinai Hospital, NY, NY
Laparoscopic Surgical Center of NY


Surprise Billing

ACS: Surgeons, patients, and policymakers are all concerned about the impact that unanticipated/surprise medical bills have on patient costs and the patient-physician relationship. ACS believes a holistic approach with the coordinated efforts of health insurance plans, hospitals, providers and patients is required to remedy this issue. 

Congress: Almost all of the Congressional proposals have significant detrimental impacts to physicians. The ACS opposes Congress' insurer- dictated, federal benchmark payment rate. The ACS supports a fair Independent Dispute Resolution (IDR) arbitration process that does not also contain a benchmark payment rate. The Ruiz/Roe legislative framework comes close to achieving ACS goals, but ACS continues to work with those offices to improve other language that could inadvertently end all balanced billing.


Medicare Physician Payment 

ACS: Faced with two decades of stagnant payment, looming cuts, and onerous requests for investment in new systems that CMS fails to implement, physicians are understandably frustrated and burned out. The ACS believes that payment models should fairly compensate surgeons and accurately reflect and incentivize quality. Congress should take steps now to ensure the long- term stability of MACRA. This includes the accounting for effects of inflation on physician practice, improving MIPS measurement, implementing new APMs and providing opportunities to succeed through innovation and quality improvement. 

Congress: ACS testified this spring before the Senate Finance Committee on shortfalls with MACRA implementation and paths forward. 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 2024 while directing CMS to test PTAC approved models; and
  • Review A-APM participation thresholds to ensure surgeons and other can achieve QP status.

Prior Authorization

ACS: The ACS is committed to working with both public and private payors to reduce prior authorization (PA) burdens on surgeons and surgical practices. ACS believes that PA requirements should be restricted to complex cases or to clinicians whose ordering patterns differ substantially from other practitioners after adjusting for patient population.

Congress: Suzan Delbene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD (R-KS), and Ami Bera MD (D-CA), introduced legislation, the Improving Seniors' Timely Access to Care Act (H.R. 3107), which would protect patients from unreasonable Medicare Advantage (MA) plan PA requirements. MA plans originally required physicians to obtain PA as a means of controlling costs by reducing medically unnecessary tests and procedures. However, health plans now widely use prior authorization indiscriminately, creating hurdles and hassles for patients and their physicians, which can lead to delays or denials of necessary care.

The Improving Seniors' Timely Access to Care Act would bring greater transparency to the prior authorization process by requiring MA plans to report to the Centers for Medicare & Medicaid Services (CMS) on the extent of their use of prior authorization and the rate of approvals or denials by service and/or prescription medication. ACS is actively working to pursue co- sponsors of this legislation.


Firearms Research and Prevention

ACS: In 2018 the ACS Committee on Trauma recommended 13 strategies and tactics to reduce firearm injury, death, and disability in the United States. These recommendations include support for a robust and accurate background check for all firearm purchases and transfers, as well as increased intervention and prevention research.

Congress: The ACS supports a $50 million request for firearm morbidity and mortality prevention research through the CDC as part of the FY 2020 appropriations package. The U.S. House of Representatives included this funding in its Labor-HHS appropriations package that it passed in June. Inclusion is less likely in the U.S. Senate, but the ACS will continue to advocate for firearm research.


Pandemic and All Hazards Preparedness and Advancing Innovations Act (PAHPAI)

ACS: The U.S. House of Representatives has been quick to reauthorize PAHPA and passed H.R. 269, The Pandemic and All Hazards Preparedness and Advancing Innovation Act of 2019 (PAHPAI) on January 8, 2019. Included in this package is the ACS-supported Mission Zero Act and authorization for Trauma Care Programs.

Congress: Congress passed and President Trump signed into law, H.R. 269, the Pandemic and Advancing Innovation Act of 2019 (PAHPAI) in June. The final legislation includes the Mission Zero Act.


Keep Physicians Serving Patients Act

ACS: The ACS supports efforts to ensure physicians are appropriately reimbursed for the care they provide, especially important when such efforts incentivize new talent to practice in rural settings.

Congress: Reps. Abby Finkenauer (D-IA), Adrian Smith (R-NE), Ron Kind (D-WI), and Darrin LaHood (R-IL) introduced H.R. 3302, the Keep Physicians Serving Patients Act of 2019. This ACS-supported legislation would address the fact that geographic practice cost indices (GPCIs) currently are calculated using inaccurate and outdated numbers that underestimate the cost of practicing in non-urban areas. More specifically, the Keep Physicians Serving Patients Act would establish a set minimum based on specific regions, which would ensure physicians are reimbursed appropriately for the care they provide, as well as help to incentivize new talent to practice in rural settings. The ACS will continue to pursue co-sponsors for this legislation.


End the Cycle of Violence Act

ACS: The ACS actively works with legislative leaders on the development of trauma-related legislation, such as grants for violence intervention programs.

Congress: Rep. Dutch Ruppersberger (D-MD) introduced ACS-supported legislation, entitled, End the Cycle of Violence Act (H.R. 2464). This legislation would provide grant funding to hospital-based violence prevention programs (HVIPs) to conduct research on best practices. This research is critical in documenting the success of HVIPs and would create a road map for new programs to follow. ACS continues to seek co-sponsors for this legislation.


Conclusions

The message is that you can help these causes not only by writing your Congressional Delegates, but also by becoming active at the State level within your own local ACS Chapters. In NY State, for example, our ACS Chapter Executive Director, Babette Grey, has helped organize Lobby Days in Albany, allowing our local ACS members and Governors to meet with our State Legislators and to discuss many of the above issues, as well as: our support of FAIR Health; and our opposition to any Single Payor plans (as currently outlined).

As a consequence of our efforts, the NY State Legislature recognized May as "Stop the Bleed Month," a direct result of the NY ACS Chapter and the Brooklyn-LI Chapter recent Advocacy Day in Albany. Our continued surgeon interactions at the State level also involve: Medical Liability reforms, access to healthcare, tobacco purchase, and medical/recreational marijuana, just to name a few. The NY SURGEONPAC helps to support candidates who understand the current and long-term challenges that surgeons face when practicing in NY.

So please be an ACS Advocate, even if only at your local government level: truly it can make a difference-or rather, should I say, YOU can make a difference.

I offer my sincere thanks to Kristin McDonald, the ACS Manager for Legislative and Political Affairs, for her generous assistance with summarizing the work of the ACS Legislative Committee.

Sincerely, and with best wishes to all for a happy and safe July 4,

Anthony J. Vine, MD, FACS
Asst. Clinical Professor of Surgery,
Icahn School of Medicine at Mount Sinai Hospital, NY, NY
Laparoscopic Surgical Center of NY
1010 Fifth Avenue
NY, NY 10028
nycherniadoctor@gmail.com
Office: 212-879-6677

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