ACS Advocacy Brief: May 4, 2023

In-Person Capitol Hill Meetings, Advocacy Education Lead the Way at 2023 Advocacy Summit

The 2023 ACS Leadership & Advocacy Summit took place April 15–18, in Washington, DC. This article provides an in-depth overview of the activities of the Advocacy Summit, including educational sessions from advocacy experts and in-person visits to Congressional offices. Photos from the Advocacy Summit, as well as Leadership Summit content, can be found in the complete May Bulletin article, which is now available to view online.

For the first time since 2019, the Advocacy Summit included in-person visits to Capitol Hill.

In preparation for the visit, attendees engaged in several lively panels and educational sessions to better understand the College’s legislative priorities and what information to present when meeting with elected officials and their staff members.

“We’re not just talking about problems. We’re also talking about solutions and bringing those solutions forward,” said Christian Shalgian, Director of the ACS Division of Advocacy and Health Policy (DAHP). “Those solutions are a critical component of what makes us unique and are an important part of this conversation.”

Less Transactional, More Partnership

In the first panel, The Value of a Surgeon: Exploring the Nuances of the Contributions Surgeons Make to Healthcare, moderator Don Selzer, MD, FACS, chief of the Division of General Surgery and associate chair of the Department of Surgery at the Indiana University School of Medicine in Indianapolis, led a robust discussion on the evolving landscape of surgeon compensation and developments in value-based care.

Dr. Selzer asked audience members if they understand how their compensation is determined. Using their phones, 8% responded that they understood their compensation completely; whereas 27% said they had no idea how their compensation was calculated.

According to Kimberly Russo, MBA, MS, CEO at George Washington Hospital in Washington, DC, “This is a sign that the industry must pivot. It’s a true indicator that we have some work to do around being much more of a partnership and understanding the valued contributions of surgeons. We have to start moving toward a much less transactional approach to how we are engaging.”

What Does Good Look Like?

Advancing health equity, simplifying and refining quality measures, and improving health outcomes were some of the topics discussed during A Conversation with CMS about Updates in Quality, featuring Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS, Director of the ACS Division of Research and Optimal Patient Care; Doug Jacobs, MD, MPH, chief transformation officer in the Center for Medicare within the Centers for Medicare & Medicaid Services (CMS); and Courtney Collins, MS, MD, FACS, clinical assistant professor of surgery at The Ohio State University in Columbus.

Dr. Jacobs touched on the concept of Universal Foundation—a CMS initiative to drive meaningful quality by standardizing and better aligning measures used to report quality performance across the agency’s many healthcare programs. The program also aims to reduce administrative burden for physicians, support CMS efforts to advance health equity, allow for cross-comparisons across programs, and help identify measurement gaps.

It’s likely that hospitals have hundreds of quality metrics that they’re “chasing to look good to CMS,” which diverts the attention of healthcare providers, including surgeons, and prohibits them from being able to concentrate on taking care of patients, according to Dr. Ko.

“What does good look like? What would good look like in our system, not in the confines of this role, that policy, or this program? What does good look like for our patients, and how do we get there?” he asked. “There are a lot of really smart people who define good care. So, if we all understand what quality is, why aren’t we there?”

One of the first steps, Dr. Ko explained, is “sunsetting a lot of these things and working with CMS to get a unified, much more integrated way of looking at the measures.” He also recommended that when attendees visit the Hill, they deliver two important messages: the current system is not working for surgeons, but more importantly, it’s not working for the patients; and the College has data-driven, evidence-based quality programs proven to enhance patient care.

In the Inside Politics and Policy Experts session, Frank Opelka, MD, FACS, ACS Medical Director for Quality and Health Policy, echoed much of what Drs. Jacobs and Ko said. “There is a need to measure the things that are meaningful to us and our patients.”

Dr. Opelka also stressed the value of transparency, which “serves you better than anything and just makes you better.” He shared the story of the Martini-Klinik—a highly specialized private clinic in Hamburg, Germany, that treats patients with prostate cancer and shares long-term outcomes data from more than 34,000 previous patients.

“The Martini-Klinik is the largest prostate cancer treatment program in the world. That’s because they publish their results: Here’s our complication rate. Here’s our success rate. Here’s our stage IV survival rate. Here’s what the treatment costs,” said Dr. Opelka. “People from all over the world are flocking to the clinic because it holds itself publicly accountable to the social contract and social good they have with the patient community.”

Congressional Asks

After an almost full day of informative panels, staff members from the ACS DC office detailed the “asks” and provided background information in preparation for the in-person visits to the Congressional offices. The attendees broke into groups by state to prepare for their visits and discuss the following issues:

• Stop cuts to Medicare physician payment 
• Support legislation banning non-compete agreements
• Ensure access to general surgery
• Support the physician workforce by addressing student loan debt
• Ensure funding for ACS priorities in fiscal year 2024 (MISSION ZERO, cancer prevention research, firearm injury prevention research, National Health Care Workforce Commission, neglected surgical conditions)
• Support ACS priorities in the Pandemic and All Hazards Preparedness Act (National Trauma and Emergency Preparedness System, MISSION ZERO Act, Prevent BLEEDing Act, Good Samaritan Health Professionals Act, and the Bipartisan Solution to Cyclical Violence Act)

Just before the official advocacy training started, Speaker of the House Kevin McCarthy (R-CA) stopped by the Advocacy Summit for a surprise visit to discuss the important role surgeons play in advocating for their patients and shaping federal healthcare policy.

Several other invited congressional speakers—Reps. Mariannette Miller-Meeks, MD (R-IA), Drew Ferguson, DDS (R-GA), Kathy Castor (D-FL), and Susan Wild (D-PA), as well as Sen. Ben Cardin (D-MD)—underscored the importance of the College’s legislative efforts such as firearm injury prevention and Medicare physician payment.

On Hill Day, 263 Advocacy Summit attendees representing 39 states participated in 211 meetings.

Advocacy and Health Policy Abstract Competition

Another highlight of the Leadership & Advocacy Summit was the inaugural Advocacy and Health Policy Abstract Competition for ACS residents and trainees. Ten authors were invited to present their abstracts at the summit, and the top three were recognized:

• First place ($500): Stephanie Jensen, MD—State Helmet Laws Greatly Increase the Use of Helmets and Protect Motorcycle Crash Victims  
• Second place ($250): Courtney H. Meyer, MD—Improving Equitable Access to STOP THE BLEED^® Training Courses through Multilingual Outreach Initiatives
• Third place ($100): Madeline Matthys—Actionable Sustainability Guidelines for Surgeons, by Surgeons

OGB, US State Department Discuss Opportunities for Surgeons in LMICs

Healthcare providers from the US can easily participate in direct clinical care and education at healthcare institutions in low- and-middle-income countries (LMICs); however, present visa categories prohibit reciprocal opportunities for trainees and faculty from LMIC partners to participate in “hands-on” clinical educational rotations in the US .

In a recent meeting with the US Department of State, the ACS and its Operation Giving Back (OGB) demonstrated their commitment to providing education for populations around the world.

The meeting was attended by representatives from the US State Department Bureau of Educational and Cultural Affairs, the Bureau of Consular Affairs, and Intealth, which advocates for international medical graduates. 

ACS representatives included President-Elect Henri R. Ford, MD, MHA, FACS, FRCS, FAAP; the OGB team, with Girma Tefera, MD, FACS, OGB Medical Director; Miranda Melone, OGB Program Manager, and OGB advocacy members Rondi Kauffmann, MD, MPH, FACS, and Raymond Price, MD, FACS, as well as Matthew Coffron, MA, ACS Chief of Health Policy Management. Other participants who joined hands included colleagues representing organizations such as Consortium of Universities for Global Health (CUGH) and Seed Global health.

The primary barrier is the lack of an appropriate visa category that would enable physicians from outside the US to engage in supervised clinical education with patients during short-term training programs. OGB representatives proposed to amend the existing J-1 visa under the authority of the US Department of State to allow for short-term, supervised clinical medical training experiences that allow patient contact for international physicians within established and productive institutional partnerships.

While no solutions were decided upon at this preliminary gathering, the representatives were receptive to the stories and efforts presented. The State Department indicated that further internal discussions are necessary to determine the extent of the bureau’s authority and if OGB is taking an effective approach. The attendees on both sides were excited about the potential of finding a solution.

The OGB team will continue to work with State Department representatives and will develop a one-pager for relevant organizations to endorse. Additionally, they will be approaching different organizations and experts to join their consortium.

Representatives Introduce SPARC Act to Establish Loan Repayment Program

In April, Reps. John Joyce (R-PA) and Deborah Ross (D-NC) introduced the Specialty Physicians Advancing Rural Care (SPARC) Act to the US House of Representatives. The bill would establish a new loan repayment program that allows specialty physicians who agree to practice in a rural area for 6 years to have up to $250,000 of their student loans forgiven.

Data show widespread physician shortages throughout the US, particularly in rural areas. Without sufficient specialists, patients may need to travel great distances for care, leading to delays and potentially suboptimal outcomes.

The high cost of medical education contributes to the ongoing physician shortage. Physicians often accumulate immense student debt during their education, and this financial burden may pose a barrier for students who wish to pursue certain specialties, practice in underserved areas, or even enter the healthcare profession. The SPARC Act will alleviate some of the financial burden of medical education and help address ongoing healthcare provider shortages to ensure patients can access the care they need.

The ACS supports efforts to ease the financial burdens the affect surgeons and, ultimately, patients. Read the ACS letter of support for the SPARC Act.

MISSION ZERO Act Is Reintroduced in US House

The MISSION ZERO Act recently was reintroduced in the US House of Representatives by Reps. Michael C. Burgess, MD (R-TX), and Kathy Castor (D-FL). The legislation originally was signed into law on June 24, 2019, as part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act.

The Military and Civilian Partnership for the Trauma Readiness Grant Program—established through the MISSION ZERO Act—provides funding for continued implementation of military-civilian trauma partnerships. The program is designed to allow service members to preserve lessons learned from the battlefield, translate those lessons to civilian care, and ensure that the service members maintain their readiness for future deployments.

If Congress does not act, the MISSION ZERO grant program will expire at the end of this fiscal year.

The ACS urges Congress to reauthorize the MISSION ZERO Act and requests consideration of the bill as part of a broader effort to reauthorize the Pandemic and All-Hazards Preparedness Act.

“I applaud Representatives Burgess and Castor for introducing legislation to reauthorize the MISSION ZERO Act,” said Patricia L. Turner, MD, MBA, FACS, ACS Executive Director and CEO. “The military-civilian trauma care partnerships allow military trauma care teams to gain exposure to treating critically injured patients and increase readiness for when these units are deployed, providing greater patient access, and further advancing high-quality trauma care.”

Organizations Seek Increased Funding for Firearm Injury Prevention Research

As part of the Gun Violence Prevention Coalition, the ACS joined more than 400 national, state, and local organizations in recently sending a letter to House and Senate Appropriators urging an increase in FY 2024 appropriations for firearm morbidity and mortality prevention research.

Congress most recently allocated $25 million for the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), $12.5 million per agency, for this work. For FY 2024, the Coalition is seeking a significant funding increase, urging Congress to provide $35 million to the CDC and $25 million to the NIH for a total of $60 million in funding.

Increased funding for firearm injury prevention public health research continues to be a top legislative priority for ACS.

CMS Takes Action to Improve Compliance with Hospital Price Transparency

To ensure that patients are able to make informed decisions about their healthcare, the Centers for Medicare & Medicaid Services (CMS) recently announced changes to their hospital price transparency enforcement.

Authorized by the Public Health Services Act, which was enacted as part of the Affordable Care Act, hospitals are required to make public its standard charges. The regulation established enforceable guidelines to this effect, and CMS has issued hundreds of warnings and corrective action plans (CAP) since its inception. The updated April 2023 enforcement processes include:

• Requiring CAP completion deadlines, including a 45-day deadline for hospitals out of compliance to submit their CAP and a 90-day deadline to be in full compliance
• Imposing civil monetary penalties earlier and automatically, if a hospital does not comply with the 45- and 90-day deadlines identified above
• Streamlining the compliance process to send an immediate request to hospitals that have made no effort to meet compliance, rather than first sending a warning

According to CMS, “These enforcement updates will shorten the average time by which hospitals must come into compliance with the hospital price transparency requirements after a deficiency is identified to no more than 180 days or 90 days for cases with no warning notice, and will complement future efforts.”