Congress concluded 2017 with a landmark vote on a tax package that contained a repeal of the individual health insurance coverage mandate in the Affordable Care Act (ACA) in 2019. This action represents the most the Republicans could agree to in their efforts to repeal and replace the ACA—after years of health care debate marked by the divisive politics that accompanied any discussions surrounding “Obamacare.” And while repeal of the individual mandate does undo a key component of the ACA, it is likely that additional efforts to repeal, adjust, or improve other portions of the ACA will occur in 2018.
The repeal of the individual mandate will probably continue to drive the health care conversation in 2018. However, providers and their patients are facing many issues beyond the ACA, and in an environment that is mostly overcast with such a large-scale priority, it can leave little daylight for other legislative issues. It is in this context that the American College of Surgeons (ACS) continues to fight for the College’s policy priorities, both in the debate over the ACA, as well as with respect to issues that affect surgeons and surgical patients.
The College’s policy priorities are set and examined annually at the Division of Advocacy and Health Policy’s (DAHP’s) meeting with the Health Policy and Advocacy Group (HPAG) at the beginning of the year. The issues facing the practice of medicine are numerous and broad in scope. As such, the DAHP and HPAG had 44 policy priorities to discuss with state and federal decision makers at the beginning of 2017; that list only grew over the course of the year as Congress delved deeper into various aspects of health care. While not all 44 issues received attention from Congress in 2017, they are topics on which the DAHP continued to educate members of Congress, as well as to advocate and develop solutions over the course of 2017. It is likely that 2018 will see a similarly lengthy list, and the College will continue to push for appropriate action on each issue.
The College has taken the lead on a number of legislative activities, including efforts to improve the implementation of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA); ensure access to surgeons in shortage areas; provide appropriate pain control; provide Stop the Bleed® training to members of Congress; and advocate for high-quality cancer care. As the College has worked to develop solutions on legislative priorities, it also has sought new ways to engage Fellows as grassroots activists through in-district meetings, virtual Hill days, and improvements to SurgeonsVoice—the ACS Professional Association’s nationwide, interactive advocacy program—to make taking action on legislation easier for busy surgeons. A summary of the College’s key activities in 2017 follows.
The College has been closely tracking the implementation of MACRA, including moving the ACS-Brandeis Advanced Alternative Payment Model through the approval process at the U.S. Department of Health and Human Services (HHS). Frank G. Opelka, MD, FACS, ACS Medical Director, Quality and Health Policy, in November 2017, testified on this process before the U.S. House Committee on Energy and Commerce Health Subcommittee’s hearing, MACRA and Alternative Payment Models: Developing Options for Value-based Care.
The ACS also is carefully monitoring implementation of the Merit-based Incentive Payment System (MIPS) and offering solutions to problems with the program. While most improvements to MIPS will be done through the regulatory process, some changes only Congress can make. The key congressional committees with jurisdiction over MACRA, such as the Senate Finance Committee, were unable to focus attention on improvements in 2017 because of competing priorities but have expressed openness to addressing concerns related to MIPS this year. Ensuring that surgeons can succeed in MIPS remains a top priority for the College in 2018.
For a number of years, the College has been raising awareness about the growing shortages in the surgical workforce. A 2016 study prepared by the University of North Carolina at Chapel Hill found that while the supply of general surgeons will grow slightly by 2030, it will not match overall growth in the U.S. population or the demand for surgical services.
A 2017 report from the American Association of Medical Colleges projects shortages in all surgical specialties by 2030. Additionally, the Health Resources and Services Administration (HRSA) estimates the supply of general surgeons will not keep pace with population growth, falling behind by nearly 3,000 general surgeons by 2025. HRSA also highlights that no consistent national or regional data source is available to estimate baseline shortages or surpluses and points out that the lack of data forces the agency to use the current (2013) supply of general surgeons as the baseline for demand.
U.S. Reps. Larry Bucshon, MD, FACS (R-IN), and Ami Bera, MD (D-CA), and Sens. Charles Grassley (R-IA) and Brian Schatz (D-HI), introduced the Ensuring Access to General Surgery Act of 2017 (H.R. 2906/S. 1351) legislation that would direct the government to study what constitutes a general surgery shortage area, determine where such shortages exist, and whether a formal general surgery shortage area designation is warranted. The bill also grants authority to the HHS Secretary to make a formal designation based on the data.
The legislation has been a key component of the College’s grassroots efforts. It was a topic during the 2017 Advocacy Summit in Washington, DC, with more than 300 surgeons participating in more than 200 meetings on Capitol Hill to raise awareness of the shortage. Fellows also have sent nearly 500 letters to Capitol Hill encouraging members of Congress to support the legislation.
Congress continues to seek ways to address the growing opioid crisis. Recently, the College was asked to join the congressional Bipartisan Working Group, a coalition of legislators from both sides of the political spectrum who meet regularly to discuss pending issues before Congress, to share the physician perspective on solutions to the opioid epidemic. John Daly, MD, FACS, Co-Chair of the ACS Patient Education Committee, participated in the meeting and used his experience as co-chair to provide key insights to lawmakers regarding how to best address the opioid crisis, while also ensuring that physicians can provide appropriate care to their patients.
Following the working group meeting, Dr. Daly met with other lawmakers to highlight several of the informational tools the ACS is using to educate both patients and prescribers about the effects of opioids. These materials include the Statement on the Opioid Abuse Epidemic, a patient education guide, and the August opioid-focused edition of the Bulletin. Through these congressional meetings, the ACS continues to play an active role in addressing the opioid epidemic, an issue likely to receive continued policymaker attention in 2018 and beyond.
Stop the Bleed
The Stop the Bleed® program has captured the attention of key members of Congress. In 2017, as part of a renewed focus on in-district meetings, the DAHP assisted Fellows in providing bleeding control training to their members of Congress during the August in-district work period.
Furthermore, in October 2017, the College hosted a Stop the Bleed training program on Capitol Hill for members of Congress and their key staffs. The congressional event focused on how early intervention from a Stop the Bleed-trained individual can save the life of someone suffering from a bleeding injury. In addition to providing valuable training to lawmakers, this event showcased the vital role that surgeons play in educating the public.
ACS Fellows who led the training include ACS Regent Lenworth M. Jacobs, Jr., MD, MPH, FACS; Leonard J. Weireter, Jr., MD, FACS; Mark L. Gestring, MD, FACS; John H. Armstrong, MD, FACS; Joseph V. Sakran, MD, MPH, MPA, FACS; and Jack Sava, MD, FACS. Congressional special guests included Dr. Bera and Reps. Phil Roe, MD (R-TN); Raul Ruiz, MD (D-CA); and Brad Wenstrup, DPM (R-OH), who provided opening remarks.
Members of Congress and their staff left the program with a better understanding of how to become lifesaving immediate responders, and of the value of Stop the Bleed training. They also left with the intention of encouraging their colleagues to participate in the program. As a result, the DAHP developed several Stop the Bleed initiatives on Capitol Hill that will be a part of 2018 programming.
ACS Cancer Programs, including the Commission on Cancer (CoC) and the National Accreditation Program for Breast Centers, are consortiums of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and accreditation. DAHP staff worked with the CoC’s Advocacy Committee to develop a robust advocacy agenda that includes issues ranging from palliative care, to cancer research funding, to a special resolution championed by Reps. Lynn Jenkins (R-KS) and Mike Thompson (D-CA) that recognizes the importance of voluntary accreditation by ACS Cancer Programs to ensure access to high-quality cancer care.
This portfolio of issues was part of the College’s first virtual Hill day, an event that enabled surgeon advocates across the nation to participate and make their voices heard by colleagues, members of Congress, and the public via social media. Participants used Twitter hashtag #cancerprogramsday and other ACS handles to advocate for policies that could affect the future of cancer care; contacted members of Congress via SurgeonsVoice; and shared information via social media about how cancer education, research, and prevention saves lives.
The ACS Cancer Programs October 2017 virtual Capitol Hill day resulted in 60 letters to members of Congress; more than 245 #cancerprogramsday tweets; more than 14,340 Twitter impressions (interactions or replies from others online), including 50 retweets; and engagement of several members of Congress, including Representative Thompson and Sen. Lisa Murkowski (R-AK).
More ways to get involved
These bills and examples of engagement represent only a small snapshot of the efforts of the College to advocate on behalf of the Fellows, but they do highlight the diverse set of policy priorities the ACS seeks to advance each year. While the politics in an election year are likely to be even more heated than in 2017, the all-consuming debate over the repeal and replacement of the ACA should consume less time, allowing for more movement on some of the key issues facing medicine. The College will continue to raise awareness in 2018 and encourage the resolution of key issues facing surgeons and surgical patients.
ACS members can actively influence key surgical issues throughout 2018. The following are some examples of ways to be engaged:
- Stay informed about ACS legislative priorities by reading ACS NewsScope weekly, checking the ACS Advocacy web page and surgeonsvoice.org, and reading “Dateline: DC” in the online Bulletin.
- Build relationships with your lawmakers and their local staff by arranging in-district meetings, attending town halls, or inviting them to visit your surgical practice; details for setting up an in-district meeting are available on the ACS website.
- Respond to ACS calls to action by contacting your lawmakers through SurgeonsVoice.
- Mark your calendar to participate in the 2018 Leadership & Advocacy Summit, May 19–22 in Washington, DC, as well as your local ACS chapter’s state lobby day.
- Learn about the ACSPA-SurgeonsPAC online.