ACS Advocacy Brief: July 14

Dr. Turner Advocates for Safeguarding Patient Access, Improving Medicare Payments

A week after the Centers for Medicare & Medicaid Services (CMS) again outlined cuts in Medicare physician payment rates, jeopardizing seniors’ access to critical treatments and procedures, ACS Executive Director Patricia L. Turner, MD, MBA, FACS, took part in a Medicare Physician Payment event with Rep. Earl Blumenauer (D-OR) in Washington, DC, to advocate for overhauling the Medicare physician payment system.

Dr. Turner made it clear that the system is broken and needs to be fixed. “Ultimately, Congress must create long-term stability in the physician payment system if we are to successfully transform Medicare to a value-based payment system while ensuring that patients have access to the surgical care they need,” she said. “The ACS stands ready to assist Congress with solutions to achieve this goal.”

The ACS has advocated for real solutions that can better incorporate value measures into payment structures that will both lead to better care and improved payments for surgeons. The college will provide more detailed testimony outlining its ideas to Rep. Blumenauer’s office next week.

The ACS also will provide CMS with extensive comments on the hundreds of specific proposals outlined in its 2,066-page rule for calendar year (CY) 2023, including a 4.42% cut in the physician Medicare payment rate.

Following the release of the proposed rule on July 7, the ACS-led Surgical Care Coalition issued a press release urging Congress to address systemic challenges so that these reductions could be stopped.

In addition, Dr. Turner sent an email to all ACS members in the US, informing them of the cuts and letting them know that their help would be needed in the coming weeks to amplify the critical importance of stopping these cuts.

Take action! Using SurgeonsVoice, the ACS Advocacy team can help facilitate a meeting with your legislators regarding the impending cuts. Even as more specific advocacy opportunities develop, you can engage with your representatives and senators to let them know their action is needed to prevent these cuts and maintain patient access to care.

Breaking Down the MPFS

The Medicare Physician Fee Schedule (MPFS) proposed rule includes a CY 2023 conversion factor of $33.08, which is a decrease of 4.42% from the CY 2022 conversion factor.

Last year, CMS finalized a policy that the billing provider of a split (or shared) evaluation and management (E/M) visit spent more than half of the total time with a patient during the visit. CMS now proposes to delay the implementation of this policy until 2024, and providers who furnish split/shared visits will continue to have a choice of history, physical exam, medical decision-making, or more than half of the total practitioner time spent to determine the billing provider. The agency also proposes refinements to coding and documentation requirements for hospital inpatient, observation, emergency department, and other E/M visits. In addition, CMS is considering policies related to valuation and payment for global surgery packages.

To broaden Medicare coverage of colorectal cancer (CRC) screening tests, CMS proposes to reduce the minimum age for payment from 50 to 45 years old. The agency would also pay for follow-up colonoscopies as screening tests—rather than diagnostic tests—when furnished after a non-invasive stool-based screening test, such as Cologuard, to reduce patients’ out-of-pocket costs for CRC testing. In addition, CMS proposes to allow certain Medicare telehealth services list during the COVID-19 pandemic to stay intact for 151 days after the expiration of the public health emergency.

The ACS is evaluating these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule and a fact sheet on its payment provisions are available for public viewing.

CMS Releases Proposed Updates for CY 2023 Quality Payment Program

Proposed updates for the CY 2023 Quality Payment Program (QPP) were also included in the MPFS proposed rule. They focus on two quality reporting pathways under the QPP—the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

CMS proposed to continue developing new MIPS Value Pathways (MVPs), while limiting changes to traditional MIPS. MVPs were introduced in the CY 2020 QPP proposed rule to streamline MIPS reporting by limiting the number of required measures to best assess the quality and value of care within a particular specialty or condition to allow for an easier transition to APMs. CMS previously finalized seven MVPs that will be offered for reporting beginning with the 2023 performance year and is proposing five additional MVPs to also be available in 2023. The 2023 performance year is the first in which physicians can volunteer to report through MVPs. The rule also includes multiple requests for information to explore strategies that incorporate health equity measures in the MIPS Quality Performance category’s transition to digital quality measurement.

The ACS is analyzing these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule is available for public review, along with a fact sheet (download required) on its QPP provisions. For more information, contact qualityDC@facs.org.

Lawmakers Address Medical Student Debt

Lawmakers recently introduced two bills aimed at supporting the physician workforce by addressing student debt associated with medical education. The Resident Education Deferred Interest (REDI) Act, introduced by Sens. Jacky Rosen (D-NV) and John Boozman (R-AR) and Reps. Brian Babin, DDS (R-TX), and Chrissy Houlahan (D-PA), would allow borrowers in medical or dental internships or residency programs to defer student loan payments without interest until they complete their programs. Read the ACS letter of support for the House and for the Senate.

The Specialty Physicians Advancing Rural Care (SPARC) Act, which Sens. Rosen and Roger Wicker (R-MS) introduced, would establish a new loan repayment program allowing specialty physicians who agree to practice in a rural area for 6 years to have up to $250,000 of their student loans forgiven. Read the ACS letter of support.

These bills will alleviate some of the financial burden of medical education and help address ongoing healthcare provider shortages.

Take action! Contact your members of Congress and encourage them to support the REDI Act and the SPARC Act.

ACS Submits Statement to Congress on a National Trauma System

The ACS submitted a statement for the record in advance of a House Energy and Commerce Subcommittee on Health hearing that examined a slate of public health bills, including legislation that would reauthorize state trauma grants. The ACS discussed the importance of a coordinated trauma system and advocated for a trauma system model that links the local, state, and regional health systems with a common data network to drive performance improvement, readiness, and research. This coordination is critical to achieving optimal and accessible care for mass casualty events, as well as daily injury care.

To ensure equitable access to quality trauma care and support public health readiness and coordination of care, the ACS urged Congress to establish a National Trauma and Emergency Preparedness System (NTEPS) model comprising core elements and functions such as public health readiness, standards, performance improvement, research, and public outreach. The College will continue working with the subcommittee to strengthen the provision of trauma care.

The ACS has been a longtime advocate for a national trauma system. In recent years, the College constructed a five-part examination of the development of the US trauma system and built the case for a nationalized response system that would elevate trauma care at every level.

SurgeonsPAC Co-Chairs 15th Annual Medical and Dental PAC Forum

The ACS Professional Association Political Action Committee (ACSPA-SurgeonsPAC) co-chaired the 15th annual Medical and Dental Political Action Committee (PAC) Forum June 24−26 in Louisville, KY.

Designed to bring physicians, dentists, and PAC members together to share best practices, partnerships, and innovative ways the medical community can enhance advocacy efforts across multiple specialties, the forum included representatives from approximately 15 physician and dentist specialty organizations. In addition to several guest speakers, the program featured breakout sessions, case studies, and benchmarking activities aimed at leveraging the impact of health professional PACs, particularly in a challenging political environment.

For more information about SurgeonsPAC, visit the ACS website.

Attendee Testimonials

“The annual Medical and Dental PAC Forum exceeded my expectations. In a weekend, I was able to share new ideas, discuss best practices, learn about new tools and resources, and foster even stronger relationships with our like-minded, politically active medical colleagues—all of which will prove extremely valuable to me as Chair of the SurgeonsPAC Board of Directors,” said Alan G. Thorson, MD, FACS, Chair, ACSPA-SurgeonsPAC Board of Directors. “I look forward to utilizing lessons learned from this meeting to continue building SurgeonsPAC into the powerhouse it can be while ensuring elected officials recognize the profound role that surgeons play in creating better patient outcomes and the future of health care delivery.”

“The Medical and Dental PAC Forum was an excellent opportunity to learn from and network with other specialty societies and colleagues,” said Danny R. Robinette, MD, FACS, Past-Chair, ACSPA-SurgeonsPAC Board of Directors, Louisville, KY. “All attendees, both staff and physicians alike, were passionate and knowledgeable about advocacy and political activity, as well as what it takes to build strong networks to help leverage these priorities. Together, this group provided a lot of fresh ideas and perspectives that could be promoted moving forward.”

Register Now for 2022 On-Demand General Surgery Coding Workshops

The ACS has partnered with KarenZupko & Associates to offer on-demand courses to help you and your coding staff stay on top of changes in CPT coding and documentation. These 60−90 minute on-demand courses allow you to learn from anywhere at your own pace.

The courses will help surgeons, practice administrators, managers, coders, and reimbursement staff ensure accurate, consistent, and complete coding.

On-demand courses include:

• Office E/M Coding for Surgeons
• Avoid Denials! Code Hospital Services Correctly!
• Critical Care Coding and Documentation – 2022 Update
• Office Procedures – Document and Code Them Right

Each course is accredited for AMA PRA Category 1 Credits™, and discounts are available for team members or practice employees of ACS members.

Do not give health plans a reason to decline payment. Using old codes, being unaware of the recent rule changes on split/shared visit billing, and misusing critical care coding and billing are all expensive mistakes.

For more details about the 2022 ACS live coding workshops and on-demand courses, visit the KZA website or contact practicemanagement@facs.org.