At press time, as part of the annual American College of Surgeons’ (ACS) Leadership & Advocacy Summit, more than 300 Advocacy Summit participants representing 47 states were scheduled to meet with members of Congress and their staffs to help educate legislators on health care issues and to shape health care policy efforts in Washington, DC, and across the country. This article briefly highlights this year’s policy priorities.
Despite being diligent about seeking care from in-network providers, too often patients find themselves receiving unanticipated bills from providers who outside of their insurance plan’s network. Much of the time, this situation arises because patients had no way to accurately determine in advance all of the health care professionals who would ultimately be involved in their care. Likewise, surgeons and other clinicians are limited in their ability to help patients avoid these unanticipated costs because they are unable to predict who will be involved in an episode of care or to know the insurance contract status of all members of surgical care team. The surprise billing issues has many facets, and the ACS is committed to collaborating with Congress to ensure patients have access to the information they need to avoid unanticipated out-of-pocket expenses.
Prior authorization (PA) consistently ranks among the greatest administrative burdens facing ACS Fellows as surgical patients encounter onerous and unnecessary PA requests from Medicare Advantage (MA) plans. Utilization review tools such as PAs can sometimes play a role in ensuring patients receive clinically appropriate treatment while controlling costs. However, the ACS is concerned about the growing administrative burdens and delays in medically necessary care associated with excessive PA requirements. The ACS maintains that PA requirements should be restricted to complex cases or to clinicians with ordering patterns that differ substantially from other health care professionals after adjusting for patient population risks. The ACS remains committed to seeing that patients receive prompt access to care without getting stalled by PA.
Meaningful measurement of surgical quality
The enactment of Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) provided an important opportunity to tie Medicare payments closely to quality in a meaningful way for both patients and providers. However, instead of working with stakeholders to develop a measurement structure that strives for quality and value, the Centers for Medicare & Medicaid Services (CMS) over-relied upon legacy quality programs to create the Merit-based Incentive Payment System (MIPS). Various stakeholders have engaged with CMS to provide advice on the development of innovative and rigorous episode-based measurement to drive value-based surgical care, but CMS has not offered opportunities to test these solutions. As a result, the current measures framework lacks rigor, is fragmented, and is based on how a clinician bills in fee-for-service, differentiating among physicians for payment purposes. This process does nothing to inform care decisions or quality improvement efforts, missing the intent of MACRA to drive value. Therefore, the ACS requests that Congress encourage the CMS to work with key stakeholders to develop and implement accurate quality measures.
Medicare physician payment
The ACS maintains that payment models should fairly compensate surgeons and accurately reflect and incentivize quality. Unfortunately, Medicare payment rates are about to enter a six-year period of 0 percent updates, during which early MACRA incentives are set to expire. Consequently, many surgeons will be faced with lower payment rates based on factors that are out of their control, not on the quality of care they are providing. As such, Advocacy Summit participants will urge Congress to take steps to ensure the long-term stability of MACRA. These recommended steps include accounting for effects of inflation on physician practice, improving MIPS measurement, implementing new Alternative Payment Models, and providing opportunities to succeed through innovation and quality improvement.
Firearms research and violence prevention
In 2018, the ACS Committee on Trauma recommended 13 strategies and tactics to reduce firearm injury, death, and disability in the U.S. These recommendations include support for a robust and accurate background check for all firearm purchases and transfers, as well as increased intervention and prevention research. During the Capitol Hill visits, Advocacy Summit participants will urge Congress to support a $50 million request for firearm morbidity and mortality prevention research through the Centers for Disease Control and Prevention (CDC) as part of the fiscal year (FY) 2020 appropriations package.
Pandemic and All Hazards Preparedness Act
The U.S. House of Representatives has been quick to reauthorize the Pandemic and All Hazards Preparedness Act and passed H.R. 269, the Pandemic and All Hazards Preparedness and Advancing Innovation Act of 2019 (PAHPAI) on January 8, 2019. Included in this package is the ACS-supported Mission Zero Act, which builds upon the legislative framework passed in the FY 2017 National Defense Authorization Act (NDAA), by further incorporating military trauma care providers into the civilian setting. These military-civilian trauma care partnerships will increase military health care readiness and provide high-quality trauma care both domestically and abroad. The ACS supports enactment of PAHPAI.
Cancer research and prevention
The ACS Commission on Cancer (CoC) has been dedicated to improving survival and quality of life for cancer patients through advocacy on issues pertaining to prevention and research. During the April 2 Capitol Hill visits, Advocacy Summit participants will urge Congress to support the following cancer initiatives:
- The Palliative Care Education and Hospice Training Act, a bill that would focus on training the current and emerging health care professional workforce in palliative care
- The Removing Barriers to Colorectal Cancer Screening Act, a bill that would correct an oversight in current law that requires Medicare beneficiaries to make a copayment when a colorectal cancer screening colonoscopy also involves polyp removal
- A $2.5 billion increase in the National Institutes of Health annual budget for a total of $41.6 billion, which would also include a $6.5 billion increase for the National Cancer Institute, and a $555 million bump for the CDC cancer programs.
The ACS remains committed to working with Congress and the Administration to address all legislative health policy priorities that affect surgeons and their patients.
For details, contact ACS Legislative and Political Affairs Manager Kristin McDonald at firstname.lastname@example.org or 202-672-1512.