BBA addresses several ACS priorities
A number of the American College of Surgeons’ (ACS) policy priorities are addressed in the recently enacted Bipartisan Budget Act of 2018 (BBA). A short summary of each of those issues and how it is addressed in the BBA follows.
Meaningful use requirements
Some policymakers assert that the meaningful use (MU) program has been successful in driving the adoption of electronic health records (EHRs); however, the ACS has long maintained that increasing MU requirements simply for the sake of making the program more stringent would not lead to improvements in patient care. Consequently, the ACS was pleased to see the inclusion of ACS-supported legislation, H.R. 3120, in the BBA. H.R. 3120 amends the Health Information Technology for Economic and Clinical Health (HITECH) Act to remove an outdated requirement that directs the Secretary of the U.S. Department of Health and Human Services (HHS) to continue to make MU standards more rigorous over time.
Repeal of the Independent Payment Advisory Board
The BBA includes ACS-supported language that repeals the Independent Payment Advisory Board (IPAB) that was to be established under the Affordable Care Act (ACA). Since the IPAB was first proposed, the ACS has asserted that leaving payment policy decisions in the hands of an unelected, unaccountable governmental body with minimal oversight would negatively affect the availability of quality, efficient health care to Medicare beneficiaries and, ultimately, to all Americans. The BBA guarantees that Congress will maintain its oversight authority and that the advisory board will not be in a position to make physician payment decisions.
Elimination of “misvalued codes” provision
The ACS strongly opposed the use of “misvalued codes” payment adjustment language in the House-passed bill as a way to pay for the costs of the underlying legislation and worked to ensure that the final legislation did not include this dangerous policy. The ACS argued that the extension of misvalued code adjustments beyond 2018 would result in cuts to Medicare physician payment. The ACS was pleased that misvalued codes language was omitted from the final bill.
Technical corrections to MIPS
The ACS has been advocating for critically needed changes and flexibility in the Merit-based Incentive Payment System (MIPS) and was grateful that many of these changes were included in the BBA. These changes provided needed extensions on the period of flexibility for the cost component of MIPS and in setting the performance threshold for MIPS. This incremental transition will allow surgeons to become familiar with the program and adapt their practice, performance, and reporting habits accordingly, while also allotting more time for Centers for Medicare & Medicaid Services to implement the program in a logical fashion.
Extension of CHIP
In January, Children’s Health Insurance Program funding was approved for six years, and, as a result of the BBA, CHIP funding is extended for an additional four years, making the full reauthorization a total of 10-years. .
The College has been a strong advocate for the CHIP program and has sent letters of support to congressional leadership, the House Energy and Commerce Committee, and the Senate Health, Education, Labor and Pensions (HELP) Committee. In each of these letters, the ACS stressed that CHIP funding is essential to ensuring that children have access to curative and preventive care options, including surgery.
The opioid epidemic
The BBA includes $6 billion over two years in funding to enhance opioid-related treatment and prevention. The ACS has been active on Capitol Hill advocating for a patient and provider education-focused approach to addressing the opioid epidemic and limiting one-size-fits-all legislative mandates on prescribers. The College’s advocacy efforts have included facilitating a meeting for the Co-Chair of the ACS Patient Education Workgroup, John Daly, MD, FACS, and the Bipartisan Working Group to discuss opioids; submitting official letters to the House Energy and Commerce Committee, the Senate Finance Committee, and the Senate HELP Committee; and offering input on specific pieces of legislation.
The BBA included an additional $2 billion in funding for the National Institutes of Health (NIH), on top of budget increases included the 21st Century Cures Act and will be used to address cancer research. The ACS and the Commission on Cancer continue to be active on Capitol Hill in advocating for increased cancer research funding.