Approximately 300 surgeons and surgical residents participated in the Advocacy portion of the 2016 American College of Surgeons (ACS) Leadership & Advocacy Summit, April 9–12. The fifth joint event provided a unique opportunity to share ideas and discuss challenges facing surgery, including the future of the surgical profession under the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA). Lawmakers have told ACS Washington, DC, staff that surgeon activism, including participation in the summit, is key to the effectiveness and success of the College’s health policy and advocacy efforts over the last few years, including repeal of the sustainable growth rate (SGR) and taking a leadership role in providing guidance with certain provisions in MACRA.
The heavy hitters
During a summit session on the future of physician payment, Patrick Conway, MD, Deputy Administrator for Innovation and Quality and Chief Medical Director, Centers for Medicare & Medicaid Services (CMS), praised the ACS efforts to develop new payment proposals. He specifically pointed to the efforts of Frank G. Opelka, MD, FACS, Medical Director for Quality and Health Policy, ACS Division of Advocacy and Health Policy, to lead initiatives in developing new payment alternatives under MACRA.
The Advocacy Summit drew top officials from the Obama Administration in addition to lawmakers from both sides of the aisle, including Rep. Phil Roe, MD (R-TN), who noted that he flew back to Washington early to speak with ACS members. “You’re that important,” he said. Representative Roe, a retired obstetrician/gynecologist, said he came to Washington to address the frustrations modern physician practices face. He said physicians want to take care of their patients without interference from Washington.
Rep. Xavier Becerra (D-CA), also acknowledged the influence that surgeons have and noted the important task summit participants had before them. “I was in Congress when we passed the SGR [the repealed sustainable growth rate formula formerly used to calculate Medicare physician payments], and back then you doctors told us it would never work,” Representative Becerra said. “You were right.” He encouraged surgeons to seek out CMS officials as well as their members of Congress to be an active part of the process to develop the new physician payment program.
Summit attendees heard from government leaders and members of Congress as well as leading political commentators Chris Matthews, host of Hardball with Chris Matthews on MSNBC, and Larry J. Sabato, PhD, election analyst, founder and director of the University of Virginia Center for Politics. He is also professor of politics at the University of Virginia, Charlottesville. Mr. Matthews and Dr. Sabato noted the unusual races in both the Democratic and Republican parties for the White House, with no clear outcomes. Using a basketball analogy, Mr. Matthews said the race for president is a “jump ball” that could land in Republican or Democratic hands. He said that the primary races demonstrate that “we have a polarized country that is becoming more polarized.”
Advocacy Summit participants were provided an issue briefing on ACS legislative priorities before they met with lawmakers and their staffs April 12 on Capitol Hill. Sara Morse, ACS Manager for Legislative and Political Affairs, led the briefing with a discussion of MACRA. She noted that Congress sought physician input in developing the new Medicare payment programs under MACRA. “Surgeons are key to driving lawmakers’ involvement,” Ms. Morse said. “We don’t want to relive the SGR nightmare and be standing in this room in 10 years calling for repeal of MACRA.”
In addition to urging congressional oversight, surgeons who participated in Capitol Hill visits asked lawmakers to encourage CMS to release reasonable and flexible guidance on qualified alternative payment models (APMs) established by MACRA as a way to participate in the Medicare program. APMs are intended to provide greater flexibility in patient care delivery with opportunities for increased incentive payments that also expose physicians to greater financial risk if care costs exceed what is expected. The ACS is calling on Congress to ensure that CMS provides pathways for surgeons to successfully participate in Medicare through APMs or the Merit-based Incentive Payment System, which will replace the similar fee-for-service program used today. Congressional involvement now is crucial as Medicare payments beginning in 2019 will be based on physician performance in 2017.
The Advocacy Summit occurred at a critical time in physician claims data collection and protection. Surgeons used Capitol Hill meetings with members of Congress and their staffs to urge lawmakers to stop CMS from disclosing raw Medicare physician claims data to third parties. The ACS supports maintaining transparency as an integral component of maintaining the highest quality of patient care, but contends that third-party groups could use questionable methodologies that fail to account for patient risk factors to conduct physician performance analysis, leading to publication of inaccurate individual physician performance ratings.
In their meetings on Capitol Hill, surgeons advanced the Ensuring Access to General Surgery Act of 2016, H.R. 4959, legislation introduced following the summit by Reps. Larry Bucshon, MD, FACS (R-IN), and Ami Bera, MD (D-CA), which would require a study be conducted to designate general surgery Health Professional Shortage Areas (HPSAs). This legislation would direct the Secretary of Health and Human Services to conduct the study, evaluate what constitutes a shortage area and where these areas exist. With growing concerns about the future shortage of surgeons, incentivizing general surgeons to locate or remain in HPSA communities could become critical in guaranteeing all Medicare beneficiaries have access to quality care, regardless of where they live.
Lawmakers were also asked to cosponsor H.R. 487, a resolution introduced by Reps. Lynn Jenkins (R-KS) and Richard Neal (D-MA) that recognizes the importance of voluntary accreditation by the ACS Commission on Cancer (CoC) in ensuring that patients have access to high-quality cancer care. Voluntary accreditation demonstrates a cancer program’s commitment to providing high-quality, comprehensive care to patients and their families, allowing programs to continually evaluate performance and make improvements where possible.
Surgeons also asked their representatives and senators to cosponsor H.R. 1220/S. 624, the Removing Barriers to Colorectal Cancer Screening Act introduced by Rep. Charles Dent (R-PA) in the House, and Sen. Sherrod Brown (D-OH) in the Senate. Colorectal cancer is the nation’s second leading cause of death from cancer. Under current law, Medicare waives copayments and deductibles for colonoscopies. However, when a polyp is discovered and removed, the procedure is reclassified as therapeutic and patients are required to make copayments. The legislation would waive coinsurance under Medicare Part B for colorectal cancer screening tests, regardless of whether a polyp is removed. By removing this financial barrier, Congress would help increase screening rates and reduce the incidence of colorectal cancer.
How to make a difference today
Members of the ACS can continue to help advance the College’s pro-patient, pro-surgeon advocacy agenda. Here’s how:
- Contact your members of Congress and respond to ACS calls to action through SurgeonsVoice (log-in required).
- Become familiar with key state legislative issues affecting surgeons and surgical patients on the Legislative Priorties section of the ACS website.
- Mark your calendar to participate in the 2017 Leadership & Advocacy Summit in Washington, DC, May 6−9, as well as in your local ACS chapter’s state advocacy day.
- Build relationships with your lawmakers by attending their in-district meetings and/or town halls or by inviting them to visit your surgical practice; details for setting up an in-district meeting are available online.
- Learn about the ACSPA-SurgeonsPAC.