ACS launches SOMO initiative to fight regulatory burdens
Surgeons today are inundated with a growing number of administrative requirements set forth by both Congress and federal agencies. While these policies are broadly intended to ensure that patients receive care that meets quality and safety standards, physicians are confronted with the burden of demonstrating regulatory compliance.
Surgeons increasingly find themselves spending more time completing paperwork and other tasks to satisfy administrative requirements, taking time and energy away from patient care. The excessive regulations placed on surgeons add unnecessary barriers to providing necessary care and increase spending on nonclinical activities.
To combat policies that impede surgeons’ ability to provide timely and high-quality care, the American College of Surgeons (ACS) Division of Advocacy and Health Policy (DAHP) launched the Stop Overregulating My OR (SOMO) initiative, through which the DAHP highlights specific regulatory and legislative actions that should be taken to reduce burdens and enable surgeons to reinvest their time and resources in patients. More information about ACS regulatory relief efforts can be found on the SOMO website.
Under the SOMO initiative, the ACS DAHP has positioned the College at the forefront of the regulatory relief movement. The ACS actively participates in all administrative burden-related events hosted by the U.S. Department of Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) and responds to regulatory health care proposals from federal agencies to highlight burdens and to offer recommendations to prevent, reduce, or eliminate such burdens.
In addition, the ACS provides feedback to congressional and executive branch leaders on the impact of unnecessary regulations on clinical workflow and surgical patient care.
Examples of some of the most recent work by the ACS DAHP on its SOMO initiative are as follows:
- On March 15, the ACS and nine other health care provider organizations participated in a House Ways and Means Committee roundtable discussion to address administrative burdens in the Medicare program. The ACS provided feedback on how Congress can improve Medicare so that it works more effectively for both patients and physicians. The College’s recommendations for reducing administrative burdens included: standardizing evaluation and management (E/M) documentation guidelines; eliminating unnecessary and duplicative paperwork and reporting burdens; and improving quality programs to meaningfully measure surgical care.
- The ACS on March 15 sent a support letter for the Standardizing Electronic Prior Authorization for Safe Prescribing Act, H.R. 4841, which would allow for electronic prior authorization (PA) under Medicare Part D and allow for the creation of technical standards for the electronic transmission of PA. In the letter, the College also urged the bill sponsors to expand the legislation to include any medical services, supplies, and prescription drugs requiring PA under the Medicare program. The House Energy and Commerce Health Subcommittee passed a variety of legislative proposals at the end of April, including H.R. 4841.
- The ACS strongly advocated for provisions included in the Bipartisan Budget Act (BBA) of 2018, signed into law February 9, which added greater flexibility to the Merit-based Incentive Payment System (MIPS) program. Under the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015, CMS would have been required to set the performance threshold for avoiding a MIPS penalty in 2019 at either the mean or median performance score of all MIPS participants. The BBA extended CMS’ flexibility to establish a performance threshold at an amount other than the mean or median for an additional three years.
- The BBA also contained a provision allowing for a slowing transition regarding counting cost measures in the MIPS total score in reporting years 2019–2021. In reporting years 2017 and 2018, MACRA gave CMS the authority to weight cost measures—which include total per capita costs for all attributed Medicare beneficiaries as well as Medicare spending per beneficiary—at zero for 2017 and 10 percent in 2018. Beginning in 2019, CMS would have been required to count cost at 30 percent of the total MIPS score. The BBA extended CMS’ flexibility to count cost measures at between 10 percent and 30 percent of the total MIPS score for an additional three years.
- In October 2017, the College issued a support letter for H.R. 3120, which would remove the requirement that HHS increase the stringency of Meaningful Use (MU) standards over time. The MU program was introduced by Congress as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act to encourage physicians to show “meaningful use” of Certified Electronic Health Record Technology (CEHRT). MU sets specific CEHRT objectives that physicians and hospitals must meet to qualify for participation in CMS incentive programs. The ACS maintains that increasingly stringent MU requirements will not lead to improvements in patient care and are unnecessary and unfair to both patients and providers. The BBA included language from H.R. 3120 removing the requirement to make MU standards more stringent.
- In August 2017, the Ways and Means Health Subcommittee announced the Medicare Red Tape Relief Project—a congressional initiative intended to provide relief from the policies that increase health care costs and impede the delivery of high-quality care for Medicare beneficiaries. In response to this initiative, the ACS submitted feedback to the subcommittee on how Congress can work with HHS and CMS to reduce administrative burdens on physicians.
- In July 2017, the ACS sent a letter to former HHS Secretary Tom Price, MD, asking for his help in easing the increasing administrative and regulatory burdens that surgeons are facing every day.
The ACS DAHP encourages all Fellows to provide input and share their stories about the administrative burdens that are overwhelming their practices through the SOMO website or by tweeting @SurgeonsVoice using #SOMO. For more information about the College’s regulatory relief efforts or the SOMO initiative, contact Lauren Foe, Regulatory Associate in the ACS DAHP, at firstname.lastname@example.org. For information on legislation related to SOMO, contact Carrie Zlatos, Senior Congressional Lobbyist, at email@example.com.