Congress didn’t earn a reputation for productivity in 2016. In fact, the 114th Congress saw only 2 percent of legislation introduced actually signed into law. Many pundits continue to decry the gridlock in Washington, DC, and various industries complain that their interests are not being represented or protected. Despite all of these obstacles, the American College of Surgeons (ACS) Division of Advocacy and Health Policy (DAHP) lobbying team achieved notable victories on behalf of surgeons and their patients. These wins were the result of several factors, including the strong commitment of our surgeon advocates and College leadership, as well as an active political action committee, the ACS Professional Association-SurgeonsPAC. The federal lobbying team worked resolutely this year, holding hundreds of meetings with key members of Congress and their staffs regarding a range of topics, several of which are addressed in detail in this article. Simply put, in a time when most groups are not making legislative gains, the ACS has been able to achieve multiple legislative victories.
CMS overhauls policy on global codes data collection
In July 2016, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule on the 2017 Medicare physician fee schedule (MPFS) In its proposed rule, CMS called for all physicians to submit data on 10- and 90-day global services in 10-minute increments. This untenable requirement did not align with a clinician’s workflow and would have seriously hindered patient care. The CMS proposal, which was intended to go into effect January 1, provided little time for physicians to prepare, represented a vast overstep of the statutory authority given by the U.S. Congress, and would have been too burdensome and costly for providers to implement.
In response to CMS’ proposed rule, the ACS DAHP organized a strongly coordinated advocacy effort with the Globals Coalition composed of the College and 35 additional surgical and medical societies with the goal of educating members of Congress about the flawed plan, and to prepare for possible legislative action if our concerns were not addressed in the final rule.
The ACS led the effort to obtain lawmakers’ signatures on a congressional sign-on letter to CMS championed by Reps. Larry Bucshon, MD, FACS (R-IN), and Ami Bera, MD (D-CA). As a result of the Globals Coalition’s advocacy efforts, 112 representatives (84 Republicans and 28 Democrats) cosigned the letter, which strongly opposed the proposed policy. Of the signers, 25 were members of the powerful Committee on Ways and Means, a number representing 65 percent of this committee, which is primarily responsible for Medicare; 22 were members of the Committee on Energy and Commerce; and 13 were members of the congressional Doctors Caucus. The letter conveyed a united message from Congress to CMS that its proposal was not compliant with the legislative intent of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) statute.
CMS in November released a dramatically improved policy in its final rule, which will use a representative sample of surgeons and eliminate the unrealistic 10-minute reporting requirement. Instead, CMS will require large practices in the nine states making up the representative sample to report information on the number of postoperative visits they provide (see related Medicare physician fee schedule story). The finalized rule is a complete overhaul of the proposed policy, and a significant victory for the surgical community.
ACS fights for military trauma provisions in NDAA
The ACS worked with Rep. Joe Heck, DO (R-NV), Chair, House Armed Services Military Personnel Subcommittee, to include a provision in the National Defense Authorization Act (NDAA) that calls for establishing a Joint Trauma System (JTS) within the U.S. Department of Defense. The JTS will help standardize trauma care for the military by aligning all military medical treatment facilities to the same trauma standards and by coordinating the incorporation of lessons learned from trauma education and training partnerships into clinical practice.
The legislation, which Congress passed and President Obama signed in December 2016, also contains a provision that establishes a Joint Trauma Education and Training Directorate to ensure that trauma providers who are serving in the U.S. Armed Forces maintain a state of readiness. Maintaining this capacity will be accomplished, in part, by entering into partnerships with civilian academic medical centers and large metropolitan teaching hospitals that have level-1 I civilian trauma centers, providing military surgeons with continuous exposure to critically injured patients. Aligning military trauma care and creating military-civilian trauma partnerships will have a profound impact on the U.S. military and civilian trauma care systems. These initiatives provide the opportunity to not only save lives domestically, but those serving our country in the U.S. Armed Forces abroad.
Rep. Brad Wenstrup, DPM (R-OH), who spoke on the House floor in support of the directorate, helped secure language in the NDAA calling for a review of the military trauma system under the JTS by a non-government entity with subject matter experts. The ACS Committee on Trauma conducts this activity regularly.
AMA endorses Stop the Bleed
In 2016, the American Medical Association House of Delegates (AMA-HOD) endorsed an ACS-led resolution to support the Stop the Bleed program and encourage the education of first responders and bystanders in bleeding control and tourniquet use. This training is an innovative step toward saving lives and turning bystanders into lifesavers.
Building on this momentum, the DAHP and the COT are working with congressional trauma champions to introduce legislation that would promulgate bleeding control (BCon) training for the general public, and encourage certification of law enforcement officers and first responders. The College’s overall goal is to ensure that the ability to control bleeding is as commonplace as the ability to perform the Heimlich maneuver or administer cardiopulmonary resuscitation.
As a leader in bleeding control and trauma care, the ACS will have unique opportunities to advocate for the advancement of BCon and other ACS Committee on Trauma priorities at the 2017 Committee on Trauma Annual Meeting, February 28–March 4, 2017and at the Leadership &Advocacy Summit, May 6–9, 2017.
21st Century Cures Act signed into law
The 21st Century Cures Act signed into law December 13, 2016, is one of the most significant pieces of health care legislation to pass the 114th Congress. This legislation contains provisions that encompass a number of ACS legislative priorities, including the following:
- Funding for the Cancer Moonshot initiative
- Usability and interoperability of health information technology (HIT)
- Opioid research and treatment funding
- Mental health system reforms
In addition, the 21st Century Cures Act authorizes increased funding for the National Institutes of Health (NIH) and the U.S. Food and Drug Administration (FDA), while enhancing the FDA’s drug and medical device approval process. It is important to note that although the programs have been authorized, their funding will require additional legislative action through the appropriations process. The ACS commented on each iteration of this legislation in both the House and Senate and supported passage of the final version of the bill.
The 21st Century Cures Act authorized $1.8 billion for cancer research through Vice-President Joe Biden’s Cancer Moonshot initiative, which is included in the $4.77 billion allocated for NIH Innovation Projects. This funding is a significant victory for cancer research as the initiative provides a blueprint for how to accelerate and extend progress for the cancer patients who need it most by helping to modernize clinical trials, build on advances in precision oncology to detect and prevent cancer at an early stage, and to make additional therapies available to more patients.
The ACS and the Commission on Cancer (CoC) have been advocates in the fight against cancer and securing additional research and prevention funding. The College will continue its work on Capitol Hill to support this new, targeted innovation funding, including the Cancer Moonshot, as a supplement to a strong investment in NIH.
The ACS supported and advocated for several HIT principles and priorities under the 21st Century Cures Act. More specifically, the College made recommendations related to information blocking and interoperability. The Cures Act included several ACS-supported provisions that set a clear and decisive strategy to stop the practice of information blocking, while setting guidelines to improve interoperability of electronic health record (EHRs) systems. This legislation offers an important first step in order to improve EHR implementation, and the ACS is committed to continuing its work with Congress and regulators in 2017 to reduce administrative burdens and optimize productivity for surgeons.
Due to the fact that surgeons often prescribe opioids, the College takes its role in preventing opioid abuse and addiction seriously. The opioid epidemic affects every congressional district throughout the country, and Congress will continue to work to address this crisis. The Cures Act takes an initial step towards controlling this problem by establishing $1 billion in grants that will be allocated to the states. These funds are essential to researching opioid treatment and addiction prevention programs, improving prescription drug monitoring programs, and providing a lifeline to states that are in desperate need of financial assistance. The ACS is committed to partnering with Congress and the state legislatures as additional opioid-specific legislation is introduced.
In a new political landscape, the 115th Congress could consider reforming the graduate medical education (GME) program. In anticipation of legislative action, the College developed a white paper on GME reform titled ACS Policy and Position Paper on GME Reform, which the Board of Regents approved in October 2016. The ACS maintains that broad reforms to the way in which GME is funded and administered are long overdue and necessary to ensure that that we are able to produce a physician workforce capable of meeting the needs of our nation’s population. The ACS believes solutions must be flexible, nimble, patient-centric and, most importantly, evidenced-based. One of the ACS’ key positions is that GME should continue to be supported as a public good.
On Capitol Hill, the GME program has long been a target for reform. Rep. Kevin Brady (R-TX), then-Chairman of the House Ways and Means Subcommittee on Health, along with other members of the House Ways and Means and Energy and Commerce Committees, sent a letter in August 2015 to the U.S. Government Accountability Office (GAO) requesting an evaluation of the current structure of GME programs and recommendations for improvement. This request from Representative Brady, now Chair of the House Committee on Ways and Means, signals a strong willingness to take a deeper look at the GME program.
The College intends to use this white paper to advocate for reforms that are based on documented workforce studies. In addition to being a leader in GME policy, the ACS will continue to identify surgical workforce shortage areas and how they can be addressed through legislation and other policy approaches.
The College has been working with Congress to ensure implementation of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015, meets the needs of surgeons and patients and achieves the goal of better outcomes and lower health care costs. The ACS will continue to monitor MACRA implementation.
Protecting physicians’ privacy
A provision of the 2017 ACS advocacy agenda is to work with Congress and CMS to halt the disclosure of raw Medicare physician claims data to third parties from CMS through Freedom of Information Act requests. The ACS is dedicated to maintaining the confidentiality of physicians’ raw claims data. The College is committed to developing a policy that will protect a physician’s right to privacy by safeguarding sensitive information that is submitted to the Medicare program, while still facilitating transparency and provider accountability.
Medical liability reform
With recent changes in the political dynamics of Washington, DC, it is possible that the College’s legislative priorities for liability reform will advance in the 115th Congress. ACS is a member of the Health Coalition on Liability and Access, a coalition seeking to achieve pro-patient and pro-physician liability reforms. For the last several years, liability legislation has stalled due to the partisan split in Congress. Given that the Republican Party may be more receptive to liability reform in the future, our efforts in the 115th Congress may prove to be more productive than in previous years. The ACS intends to work with congressional leaders to push for reforms to Good Samaritan and Emergency Medical Treatment and Labor Act liability protections.
Now is the time to get to know your elected officials. To be an effective surgeon advocate, you need to develop personal relationships with members of Congress. Likewise, members of Congress value input and support from their constituents. Getting to know policy makers and/or their staff will be extremely valuable in advancing the overall surgical advocacy agenda.
There are various ways to engage with lawmakers to foster these long-term relationships. To position yourself as a trusted advisor on health care, consider taking action by doing the following:
- Contact ACS colleagues and encourage their prompt response to ACS Action Alerts
- Participate in a meeting at a member of Congress’ local office
- Host a tour of your practice for a member of Congress and/or staff
- Recruit a new Health Policy Advisory Council Councilor
- Write a letter to the editor of your local news outlets
- Pitch an ACS-related story to your local news media
- Routinely mention the importance of SurgeonsPAC and encourage Fellows to contribute
- Work with ACS staff to a deliver a SurgeonsPAC check locally to a congressional candidate, or attend a local fundraiser as a representative of SurgeonsPAC
- Provide input on potential candidates to be supported by SurgeonsPAC
- Attend the Leadership & Advocacy Summit in Washington, DC
- Participate in your state chapter’s annual lobby day