As health care issues return to the forefront on Capitol Hill and across the country, surgeons and trainees have an increasingly important role to play in the conversation. With a profusion of health policy issues being considered and more coming down the pipeline in the future, it is important to prevent the passage of potentially harmful legislation as well as to advocate for policies that ensure access to high-quality care for surgical patients. As the American College of Surgeons (ACS) continues to advocate on behalf of surgical specialties, all surgeon advocates are encouraged to participate and help raise the profile of federal legislative priorities that require Congress’ attention, including the following:
Recently, surprise/unanticipated medical billing has garnered considerable public attention, rising to the level of congressional action. As the ACS continues to work with Congress and key stakeholders to propose meaningful solutions to address this issue, it is critical that elected officials understand the potential large-scale consequences of federal rate setting and the need for a fair independent dispute resolution (IDR) process.
Meaningful measurement of surgical quality
Following the successful advocacy efforts of ACS fellows at the 2019 ACS Leadership and Advocacy Summit, Reps. Raul Ruiz, MD (D-CA), George Holding (R-NC), Brian Higgins (D-NY), and Larry Bucshon, MD, FACS (R-IN), are circulating a letter to the Centers for Medicare & Medicaid Services (CMS) urging the agency to work with stakeholders to develop and test a quality framework that focuses on high-value processes, clinical outcomes, and patient-reported outcomes or experiences. The ACS is of the view that in order to be effective, measurement should help to inform patient decision making and provide actionable information for surgeons to improve clinical outcomes. Whenever possible, measurement should assess the entire team involved in providing care to the patient and the patient’s entire care journey and ultimate outcome, including the patient’s experience of care.
Excessive and unnecessary prior authorization (PA) requirements from private insurers and CMS contractors that administer Medicare Advantage (MA) and prescription drug (Part D) plans are resulting in growing administrative burdens and delays in medically necessary care. ACS Fellows and Resident Members consistently rank PA among the greatest administrative burdens they face. To address this issue, the College is working to improve the PA process for MA plans, specifically bringing transparency and efficiency to the process. 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. In addition, the ACS remains committed to ensuring that patients receive prompt access to care. Recognizing the need for increased transparency of PA requirements, Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD (R-KS), and Ami Bera, MD (D-CA), introduced bipartisan legislation that would improve the PA system by requiring CMS to regulate MA plans’ use of PA.
The ACS supports the Prevent Blood Loss with Emergency Equipment Devices Act of 2019 (the Prevent BLEEDing Act), H.R. 2550, bipartisan legislation that would make bleeding control training and kits available to the public through a Department of Homeland Security grant program. This legislation, introduced by Reps. Alcee Hastings (D-FL) and Brad Wenstrup, DPM (R-OH), will work toward the goal of reducing or eliminating preventable deaths from bleeding. The ACS asserts that, just like cardiopulmonary resuscitation, a civilian familiar with basic bleeding control techniques is better equipped to save a life. This legislation was the result of one of several successful educational briefings and trainings the ACS conducted on Capitol Hill as part of the Stop the Bleed® campaign.
Strong advocate participation is essential to ensuring Congress and the Administration understand the scope and potential impact of health policy priorities facing surgeons and surgical patients.