Since the start of the 115th Congress in January, the American College of Surgeons (ACS) Division of Advocacy and Health Policy (DAHP) has been actively engaged with legislators on Capitol Hill, ensuring that the interests of surgeons and surgical patients are represented during policy debates.
In the first half of 2017, the ACS hosted a Commission on Cancer (CoC) advocacy day; a Committee on Trauma (COT) congressional Stop the Bleed® briefing; and the 2017 Leadership & Advocacy Summit. These events brought hundreds of surgeon-advocates to Washington, DC, to inform members of Congress about the College’s legislative priorities. The ACS is monitoring and advocating for passage of numerous pieces of legislation, including the Ensuring Access to General Surgery Act (H.R. 2906/S. 1351), the Mission Zero Act (H.R. 880/S. 1022), and the Protecting Access to Care Act (H.R. 1215).
Informing Congress about your priorities
CoC advocacy
The CoC Advocacy Committee held its annual planning meeting followed by a day on Capitol Hill February 16–17. Attendees met with their representatives, senators, and congressional staff to discuss issues that affect cancer patients, survivors, and surgeons. Throughout this event and at the legislative meetings, CoC Advocacy Committee members assisted in boosting the co-sponsorship of bills before Congress and raising the profile of oncological issues on Capitol Hill.
The CoC also participated in two lobby days in March and June through One Voice Against Cancer (OVAC). At these OVAC Lobby Days, participants met with House and Senate appropriators to express support for increases in cancer research funding, including continued support for the Cancer Moonshot initiative.
Specifically, the CoC advocated for $36 billion in funding for the National Institutes of Health for fiscal year (FY) 2018, a $2 billion increase from FY 2017 levels, including $6 billion for the National Cancer Institute. The CoC also requested that Congress fund the Centers for Disease Control and Prevention cancer programs at $514 million in FY 2018.*
COT Stop the Bleed congressional briefing
Leaders of the ACS and the COT hosted a congressional briefing February 28 to highlight the Hartford Consensus and the ACS Stop the Bleed training program. Congressional participants included Rep. Gene Green (D-TX), ranking member of the U.S. House Committee on Energy and Commerce Health Subcommittee, and Rep. Richard Hudson (R-NC), who serves on the same subcommittee. Throughout the briefing, lawmakers and congressional staff had the opportunity to participate in immediate responder simulation in using traditional and nontraditional bleeding control methods until emergency medical services personnel arrive to start the provision of definitive care.
This congressional briefing is a component of the Stop the Bleed advocacy strategy, which aims to train civilians to recognize life-threatening bleeding situations and to intervene effectively to save lives. It is a priority for the ACS to ensure that Stop the Bleed awareness and training become as commonplace as cardiopulmonary resuscitation and the Heimlich maneuver.
As the College continues to advocate and promulgate the program, the DAHP continues to meet with congressional leaders to get their assistance in increasing the number of certified Stop the Bleed instructors on Capitol Hill, as well as their support for continued training of members of Congress, congressional staff, and Capitol Police.
Leadership & Advocacy Summit 2017
More than 300 surgeons and residents participated in the ACS advocacy day on Capitol Hill at the Leadership & Advocacy Summit 2017, May 6–9. Participants came to Washington primarily to meet with lawmakers and congressional staff to educate them about key ACS legislative priorities.†‡
While the Advocacy Summit takes place once a year, Fellows can engage with their members of Congress and local legislators at any time. DAHP staff is available to assist Fellows in arranging congressional meetings, either in-district or in Washington, to discuss ACS legislative priorities. An updated list of the College’s legislative priorities and their corresponding legislative one-page issue briefs are available at SurgeonsVoice.org.
Health care reform
The College remains actively involved in efforts to address the Affordable Care Act (ACA) and other health care reform legislation. The House passed the American Health Care Act in May, and in July the Senate tried and failed to pass any legislation to repeal and/or replace the ACA. The College has outlined concerns regarding key bills in letters to the following legislators: Speaker of the House Paul Ryan (R-WI), House Minority Leader Nancy Pelosi (D-CA), Senate Finance Chairman Orrin Hatch (R-UT), Senate Majority Leader Mitch McConnell (R-KY), and Senate Minority Leader Chuck Schumer (D-NY).
The College continues to work to ensure that its health care reform principles—patient safety and quality, patient access to surgical care, reduced health care costs, and medical liability reform—are included in any congressional compromise legislation. Details regarding these health care reform principles are as follows:§
- Safety and quality: The ACS supports well-designed clinical comparative effectiveness research, physician quality data, appropriate public reporting, and encourages realistic health information technology use and adoption.
- Patient access to surgical care: To ensure that surgical patients have access to appropriate care, a well-trained surgical workforce must be available and able to meet the full spectrum of patient needs for both general surgery and specialty care, including children’s surgical specialists. The ACS maintains that ongoing, broad health care reform initiatives should be directed at reform of the health insurance industry, including efforts to address issues of cost containment, ensure coverage for medically indigent patients and patients with preexisting health care conditions, and reduce administrative overhead.
- Reduced health care costs: ACS Quality Programs improve surgical care and cut costs by helping to prevent inefficiencies and preventable complications through the continuous quality improvement process. The College also has supported payment reforms that would incentivize participation in outcomes improvement and patient safety activities.
The ACS further maintains that the development of Medicare payment policies and other efforts to reduce health care spending should remain under the purview of Congress with input from stakeholders and patients. The College, therefore, supports the repeal of the Independent Payment Advisory Board, an unelected governmental body.
- Medical liability reform: The mission of the ACS is to improve the care of the surgical patient, safeguard standards of care, and create an ethical practice environment. The present U.S. medical liability system is broken and fails to encourage an environment in which it is possible to achieve these objectives. The ACS actively supports reforms aimed at improving safety, quality, and accountability; creating a more just tort system, including caps on noneconomic damages; and encouraging culture change at hospitals and in health care systems that will allow for the swift adoption of alternative patient-centered reforms, such as communication and resolution programs.
ACS-supported legislation
In keeping with these health care reform principles, the College is supporting several pieces of legislation that were under congressional consideration at press time. Details about these bills follow.
Mission Zero Act
It is a longstanding priority of the ACS to establish and maintain high-quality, adequately funded trauma systems throughout the U.S. and the nation’s armed forces. To this end, the ACS was a sponsor of the National Academy of Sciences, Engineering, and Medicine (NASEM) report from June 2016, titled A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. The NASEM report outlines the steps necessary to secure a national trauma system and sets the goal of achieving zero preventable deaths from traumatic injury.
The House and Senate have reintroduced bipartisan legislation, the Mission Zero Act (H.R. 880/S. 1022), which calls for implementing recommendations in the NASEM report. More specifically, the legislation would create a grant program to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with quality trauma care in times of peace and war. This goal would be accomplished through grant funding used to embed military trauma teams/providers into civilian trauma facilities, including a $1 million grant to host military trauma teams at eligible high-acuity Level I trauma centers and grants for trauma centers to host individual health care professionals ($100,000 for physician or $50,000 for nonphysician providers) at eligible Level I, II, or III trauma centers.
The Mission Zero Act was reintroduced in the House by Reps. Michael Burgess, MD (R-TX), Chairman of the House Energy and Commerce Health Subcommittee; Cathy Castor (D-FL); Representative Green; and Richard Hudson (R-NC) in February 2017; and it was reintroduced in the Senate by Sens. Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL). The Mission Zero Act was marked up unanimously by the House Energy and Commerce Committee in July 2017 and the next step is consideration from the full House of Representatives. The Senate companion (S. 1022) is awaiting action by the Senate Health Education Labor and Pension Committee (HELP).
The College continues to make strengthening the nation’s trauma system a priority for the 115th Congress, while elevating the goal of zero preventable deaths and ensuring all trauma patients receive appropriate care within the golden hour.
Ensuring Access to General Surgery Act
The ACS is actively engaged in promoting the Ensuring Access to General Surgery Act (H.R. 2906/S. 1351), introduced in the House by Reps. Larry Bucshon, MD, FACS (R-IN), and Ami Bera, MD (D-CA), and in the Senate by Sens. Chuck Grassley (R-IA) and Brian Schatz (D-HI). This legislation would direct the U.S. Department of Health and Human Services (HHS) to conduct a study of general surgery shortage areas throughout the U.S. and give the Secretary of HHS the authority to issue a formal general surgery shortage area designation based on the study results.
The ACS asserts that research is necessary to define what constitutes a general surgery shortage area and to determine where these areas exist. The legislation would provide HHS with a new mechanism for potentially increasing patient access to quality health care services. Providing incentives for general surgeons to locate or remain in communities with workforce shortages could become critical in guaranteeing that all Medicare beneficiaries, regardless of geographic location, have access to surgical care.
ACS members who participated in the Advocacy Summit played a key role in advancing the Mission Zero Act and the Ensuring Access to General Surgery Act. As a result of these surgeon-advocate efforts, the Mission Zero Act gained eight new co-sponsors and there was increased awareness of the Ensuring Access to General Surgery Act prior to its introduction in June.
Medical liability reform
The House of Representatives passed the Protecting Access to Care Act (H.R. 1215) on June 28 to reform our nation’s medical liability system. This ACS-supported legislation would establish a cap of $250,000 on noneconomic damages, implement a three-year statute of limitations after injury or one year after the date of discovery, and limit attorney fees. If enacted, the legislation is expected to reduce the federal deficit by about $50 billion over 10 years. At press time, the Protecting Access to Care Act had moved to the Senate for further action.
Surgeon-advocates play a key role
The involvement of surgeon-advocates is vital to establishing an active relationship with federal and state legislators. The key to successful advocacy is an engaged membership, and the ACS suggests that Fellows participate in the following activities:
- Attend the next ACS Leadership & Advocacy Summit 2018, May 19–22, in Washington, DC
- Offer your federal/state legislators a facility/office tour, so they can see how their policies affect the care you provide to patients
- Meet with your member of Congress in your home district or in Washington, DC
- Participate in grassroots efforts through SurgeonsVoice.org
The DAHP is available to help with these efforts and can assist with preparations for a congressional meeting or facility tour. For more information, contact ahp@facs.org.
Acknowledgments
Carrie Zlatos, Senior Congressional Lobbyist, and Kevin Walter, DC, Communications Manager, contributed to this article.
*American College of Surgeons. Advocacy. Cancer research. Available at: facs.org/advocacy/federal/cancer. Accessed July 20, 2017.
†Peregrin T. 2017 Leadership Summit: Leading from behind, building resiliency, and strengthening nontechnical skills. Bull Am Coll Surg. 2017;102(8):88-94. Available at: bulletin.facs.org/2017/08/2017-leadership-summit-leading-from-behind-building-resiliency-and-strengthening-nontechnical-skills/. Accessed August 18, 2017.
‡Walter KR. Key ACS issues, including health care reform, dominate 2017 Advocacy Summit. Bull Am Coll Surg. 2017;102(8):95-97. Available at: bulletin.facs.org/2017/08/key-acs-issues-including-health-care-reform-dominate-2017-advocacy-summit/. Accessed August 18, 2017.
§American College of Surgeons. 2017 Health Care Reform General Principals Summary. Available at: facs.org/advocacy/federal/2017summary. Accessed July 20, 2017.
