Medicare physician payment and effective grassroots advocacy: A case study

The American College of Surgeons (ACS) Division of Advocacy and Health Policy (DAHP) works on behalf of its members to promote health care policy that protects surgeons and patients. As such, a critical component of DAHP advocacy efforts is empowering ACS members with necessary tools and resources to become more effective surgeon-advocates.

Surgeons have the ability to effect change well beyond the operating room. A surgeon’s voice carries tremendous weight in Washington, DC, and across the country to help elevate critical advocacy priorities. Hence, the ACS DAHP urges all Fellows to play a more active role in educating lawmakers about important legislative and regulatory activities and to call on Congress to bring about meaningful change.

SurgeonsVoice: A critical grassroots advocacy tool

A surgeon’s first visit to Capitol Hill, including the nuances of the legislative process and navigating the political landscape, can be a daunting task. Engaging in ACS advocacy and political activities should become a regular practice for surgeons in order to make this process more accessible and familiar.

SurgeonsVoice—the nationwide, interactive advocacy program that provides surgeons with the tools to strengthen their influence on Congress and policymakers around the country—is a great place to start. Fellows of the College are members of the ACS Professional Association, which sponsors SurgeonsVoice.

While the SurgeonsVoice online platform highlights general policy information, best practices for advocacy at home, and other resources, the action center is a vital tool that all ACS members should use to help raise the profile of issues that Congress considers. Through prewritten, customizable letters, ACS members can advocate for or against various legislative proposals and urge lawmakers to engage. The letters are sent via e-mail to congressional offices on your behalf, and ideally, once correspondence reaches staff, the ACS has the attention of health policy staff advisors to members of Congress, making surgery’s voice heard.

Case study: Advocacy to halt Medicare payment cuts

Take, for example, the Centers for Medicare & Medicaid Services (CMS) calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) final rule, which called for significant cuts to Medicare physician payment for surgical services. Prior to this issue being identified as a top priority, or “call to action” via the SurgeonsVoice advocacy center, only 2.4 percent of ACS members contacted Congress regarding any legislative issue. This is not to suggest that other health policy priorities were not heard or considered by lawmakers; rather, the Medicare physician payment grassroots case study demonstrates that thousands of surgeon-advocates united can have a profound effect on bringing about change.

Overview

For nearly a year before the coronavirus 2019 (COVID-19) pandemic, the ACS and other health care professional associations warned members about CMS-proposed Medicare payment cuts that would significantly affect nearly all medical specialties, including surgery. If enacted, the cuts also would affect patient access to care, particularly during the newly declared COVID-19 public health emergency.

Furthermore, health policy experts cautioned that the CMS-proposed rule could dramatically destabilize health system financing at a time when great financial burdens were becoming more evident. Although the true impact of COVID-19 was still unknown, the ACS recognized that payment cuts to surgeons would drastically diminish the opportunity for hospitals and independent practices to recover financially and could alter the future of surgical practice for years to come.

In response, SurgeonsVoice launched an urgent, all-member call to action to raise the profile of this critical advocacy priority. This initial grassroots effort—which encouraged Fellows to contact Congress to urge lawmakers to take immediate action to prevent the cuts—quickly became the call to action that would result in record-breaking grassroots participation.

House members intervene

Once CMS released the CY2021 MPFS in November 2020, affirming its commitment to drastically reduce pay to physicians—including cuts to many providing care on the front lines of the pandemic, the Surgical Care Coalition and SurgeonsVoice continued to implore health care professionals to get involved and make their voices heard. As a result, surgeon-advocates reacted…and Congress began to listen.

Longtime champions for surgery, Reps. Ami Bera, MD (D-CA-07), and Larry Bucshon, MD (R-IN-08), promptly responded to ACS calls to action. As former practicing physicians, both understood the impact that payment cuts could have on surgeons and surgical patients and recognized that urgent congressional action was needed to stop the cuts from going into effect. In October 2020, Representatives Bera and Bucshon circulated a letter to House Speaker Nancy Pelosi (D-CA-12) and Minority Leader Kevin McCarthy (R-CA-23) on Capitol Hill, recognizing that a legislative solution would require meaningful support from both parties to gain traction. To help amplify their efforts, the ACS and other members of the College-led Surgical Care Coalition again activated grassroots efforts, encouraging members to ask their elected officials to sign the Bera-Bucshon letter.

Demonstrating strength in numbers and urging congressional intervention was critical to stop the payment cuts scheduled to begin January 1, 2021. Lawmakers listened, and the Bera-Bucshon letter drew bipartisan support from more than 220 members of Congress, including several other health professionals. This strong, bipartisan showing ultimately led Reps. Bera and Bucshon to introduce stand-alone legislation to address the issue. The Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 resulted in additional legislative cosponsors and increased awareness about Medicare payment cuts facing surgical specialties.

Setting sights on the Senate

With vast bipartisan support in the House for the legislation, the introduction of a companion bill in the Senate was the logical next step. SurgeonsVoice released another call to action, this time focused on engaging senators. In particular, efforts focused on targeting senators who serve on key committees with jurisdiction over health care issues, such as the Senate Health, Education, Labor and Pensions Committee (HELP).

Similar to previous House activity, and with surgery’s voice becoming increasingly amplified, Sens. Cindy Hyde-Smith (R-MS), Kevin Cramer (R-ND), Tom Cotton (R-AR), and Susan Collins (R-ME) followed Representatives Bera and Bucshon’s lead and introduced the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 in the Senate. Although this legislation was introduced in December 2020, a month before the CMS Medicare payment cuts were scheduled to take effect, the bill’s bicameral support—coupled with backing from the medical community—ensured the issue remained at the top of the congressional agenda.

The impact

With lawmakers’ sights set on additional COVID-19 relief and a holiday recess, efforts to stop the payment cuts were down to the wire. On December 22, 2020, Congress passed an extensive and highly anticipated COVID-19 relief package. Most notably, the measure included ACS-supported language to protect patients’ access to surgical care by stopping CMS’ planned cuts to Medicare physician payment.

Fellows who use SurgeonsVoice and respond to calls to action understand how easy it is to advocate for surgery, especially from a computer or mobile device. This legislative victory was only achieved because of ACS member participation, including a record-breaking number of grassroots efforts to contact Congress about this critical advocacy priority. Approximately 5,000 surgeons from all 50 states, the District of Columbia, and Puerto Rico sent nearly 20,000 letters to Capitol Hill demanding that Congress stop these harmful cuts, including 2,000 new surgeon-advocates who had not contacted Congress before this call to action. To put this unprecedented level of grassroots participation into perspective, in 2020, a total of 30,000 letters were sent to Congress on any federal legislative priority.

Ultimately, this advocacy effort demonstrated that strength in numbers is key, that friends of surgery in Washington are listening, and that sending letters and calling legislators is effective. And, testimonials detailing personal experiences are essential to help tell the story.

Advocacy in the 117th Congress

Harnessing the advocacy tools at your disposal is important, but recognizing that you are your best advocate is critical. To be an effective surgeon-advocate, nothing is more important than establishing personal relationships with members of Congress. Conversely, to a member of Congress, nothing is more valuable than input and support from constituents. Engaging with policymakers and their staff is invaluable to help advance the ACS’ surgical advocacy agenda and to provide you with an opportunity to serve as a trusted resource to your legislators.

The ACS DAHP will continue to work on your behalf in Washington to advocate on a variety of issues affecting surgery. However, expanding the SurgeonsVoice grassroots momentum gained last year during the 117th Congress is key to our success.

Learn more about comprehensive ACS efforts to stop CMS’ Medicare payment cuts here.