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From the Washington Office: Upcoming Leadership and Advocacy Summit
The seventh annual American College of Surgeons Leadership and Advocacy Summit will be held May 19-22 at the Renaissance Washington, DC Downtown Hotel.
The event will kick off with the Leadership portion on Saturday evening, May 19, with a Welcome Reception open to all registrants and continues with a full-day agenda on Sunday, May 20. The program on Sunday includes sessions addressing important topics such as mentoring for a career in surgical leadership, ethics in surgical leadership, leading in times of crisis, change management, managing complex teams, and more.
1) “Understanding Strategic Advocacy” presented by staff of the Washington office
2) “Regulatory Reform: Past, Present, and Patient-Focused” featuring staff from the Centers for Medicare and Medicaid Services.
3) A historical perspective on health care reform entitled, “Health Care Reform, Then and Now,” presented by long-time Health Affairs columnist, Professor Timothy S. Jost.
4) “The Opioid Epidemic: Long-term Solutions for Sustained Success” featuring staff from the Food and Drug Administration and the Drug Enforcement Administration.
5) A luncheon, sponsored by the ACSPA-SurgeonsPAC, where attendees will hear remarks on the upcoming mid-term elections from the Executive Directors of both the Democratic Congressional Campaign Committee (DCCC) and the National Republican Congressional Committee (NRCC).
The day will also include issue briefings and specific “asks” on topics in preparation for Hill visits. Specifically, attendees will be briefed on the Pandemic and All-Hazards Preparedness Act (PAHPA), the Standardizing Electronic Prior Authorization for Safe Prescribing Act, the Ensuring Access to General Surgery Act, the Removing Barriers to Colorectal Screening Act, the Childhood Cancer STAR Act, and funding for the CDC to conduct research on firearm injury prevention. Following this training, Fellows will be very well prepared to discuss the issues the following day on Capitol Hill.
Pending last minute conflicts, several Members of Congress are also scheduled to address the group, including a member of leadership from the House of Representatives. Monday’s activities will conclude with an evening reception for 2018 SurgeonsPAC members at the historic Willard InterContinental Hotel. On Tuesday, May 22, attendees will then apply the knowledge and skill gained from Monday’s sessions during meetings with their individual Members of Congress and their staff on Capitol Hill.
As I write, nearly three weeks prior to the event, attendance is already projected to be at record levels. We look forward to welcoming all those already registered to DC for this exciting, informative and important event. Though by press time pre-registration will have closed, on-site registration will be available if you would be able to join us.
For questions regarding the Leadership Summit please contact Brian Frankel at [email protected], or 312-202-5361. For questions regarding the Advocacy Summit please contact Michael Carmody at [email protected], or 202-672-1511.
Until next month ….
The seventh annual American College of Surgeons Leadership and Advocacy Summit will be held May 19-22 at the Renaissance Washington, DC Downtown Hotel.
The event will kick off with the Leadership portion on Saturday evening, May 19, with a Welcome Reception open to all registrants and continues with a full-day agenda on Sunday, May 20. The program on Sunday includes sessions addressing important topics such as mentoring for a career in surgical leadership, ethics in surgical leadership, leading in times of crisis, change management, managing complex teams, and more.
1) “Understanding Strategic Advocacy” presented by staff of the Washington office
2) “Regulatory Reform: Past, Present, and Patient-Focused” featuring staff from the Centers for Medicare and Medicaid Services.
3) A historical perspective on health care reform entitled, “Health Care Reform, Then and Now,” presented by long-time Health Affairs columnist, Professor Timothy S. Jost.
4) “The Opioid Epidemic: Long-term Solutions for Sustained Success” featuring staff from the Food and Drug Administration and the Drug Enforcement Administration.
5) A luncheon, sponsored by the ACSPA-SurgeonsPAC, where attendees will hear remarks on the upcoming mid-term elections from the Executive Directors of both the Democratic Congressional Campaign Committee (DCCC) and the National Republican Congressional Committee (NRCC).
The day will also include issue briefings and specific “asks” on topics in preparation for Hill visits. Specifically, attendees will be briefed on the Pandemic and All-Hazards Preparedness Act (PAHPA), the Standardizing Electronic Prior Authorization for Safe Prescribing Act, the Ensuring Access to General Surgery Act, the Removing Barriers to Colorectal Screening Act, the Childhood Cancer STAR Act, and funding for the CDC to conduct research on firearm injury prevention. Following this training, Fellows will be very well prepared to discuss the issues the following day on Capitol Hill.
Pending last minute conflicts, several Members of Congress are also scheduled to address the group, including a member of leadership from the House of Representatives. Monday’s activities will conclude with an evening reception for 2018 SurgeonsPAC members at the historic Willard InterContinental Hotel. On Tuesday, May 22, attendees will then apply the knowledge and skill gained from Monday’s sessions during meetings with their individual Members of Congress and their staff on Capitol Hill.
As I write, nearly three weeks prior to the event, attendance is already projected to be at record levels. We look forward to welcoming all those already registered to DC for this exciting, informative and important event. Though by press time pre-registration will have closed, on-site registration will be available if you would be able to join us.
For questions regarding the Leadership Summit please contact Brian Frankel at [email protected], or 312-202-5361. For questions regarding the Advocacy Summit please contact Michael Carmody at [email protected], or 202-672-1511.
Until next month ….
The seventh annual American College of Surgeons Leadership and Advocacy Summit will be held May 19-22 at the Renaissance Washington, DC Downtown Hotel.
The event will kick off with the Leadership portion on Saturday evening, May 19, with a Welcome Reception open to all registrants and continues with a full-day agenda on Sunday, May 20. The program on Sunday includes sessions addressing important topics such as mentoring for a career in surgical leadership, ethics in surgical leadership, leading in times of crisis, change management, managing complex teams, and more.
1) “Understanding Strategic Advocacy” presented by staff of the Washington office
2) “Regulatory Reform: Past, Present, and Patient-Focused” featuring staff from the Centers for Medicare and Medicaid Services.
3) A historical perspective on health care reform entitled, “Health Care Reform, Then and Now,” presented by long-time Health Affairs columnist, Professor Timothy S. Jost.
4) “The Opioid Epidemic: Long-term Solutions for Sustained Success” featuring staff from the Food and Drug Administration and the Drug Enforcement Administration.
5) A luncheon, sponsored by the ACSPA-SurgeonsPAC, where attendees will hear remarks on the upcoming mid-term elections from the Executive Directors of both the Democratic Congressional Campaign Committee (DCCC) and the National Republican Congressional Committee (NRCC).
The day will also include issue briefings and specific “asks” on topics in preparation for Hill visits. Specifically, attendees will be briefed on the Pandemic and All-Hazards Preparedness Act (PAHPA), the Standardizing Electronic Prior Authorization for Safe Prescribing Act, the Ensuring Access to General Surgery Act, the Removing Barriers to Colorectal Screening Act, the Childhood Cancer STAR Act, and funding for the CDC to conduct research on firearm injury prevention. Following this training, Fellows will be very well prepared to discuss the issues the following day on Capitol Hill.
Pending last minute conflicts, several Members of Congress are also scheduled to address the group, including a member of leadership from the House of Representatives. Monday’s activities will conclude with an evening reception for 2018 SurgeonsPAC members at the historic Willard InterContinental Hotel. On Tuesday, May 22, attendees will then apply the knowledge and skill gained from Monday’s sessions during meetings with their individual Members of Congress and their staff on Capitol Hill.
As I write, nearly three weeks prior to the event, attendance is already projected to be at record levels. We look forward to welcoming all those already registered to DC for this exciting, informative and important event. Though by press time pre-registration will have closed, on-site registration will be available if you would be able to join us.
For questions regarding the Leadership Summit please contact Brian Frankel at [email protected], or 312-202-5361. For questions regarding the Advocacy Summit please contact Michael Carmody at [email protected], or 202-672-1511.
Until next month ….
From the Washington Office: An opportunity to address policymakers on the concerns of Fellows
On March 15, 2018, I had the opportunity to present on behalf of the ACS at a roundtable discussion on Capitol Hill to members of the House Ways and Means Committee on the topic of Medicare red tape relief
The roundtable provided members of this key committee of jurisdiction over Medicare policy the opportunity to hear from representatives from a variety of health care professional organizations on how Congress can improve Medicare to work more effectively and efficiently for both patients and providers. Each group was allotted just three minutes for their presentation. A summary of my presentation is included below:
E/M Documentation Guidelines
The ACS has significant concerns regarding Evaluation and Management (E/M) Documentation Guidelines. Though CMS created the E/M documentation guidelines 23 years ago with the laudable goal of adding structure to the various levels of E/M services, and in an effort to create a sense of equivalency of E/M services across the multitude of specialties, ACS believes the time has come to re-examine and revise these guidelines to be more appropriate in the modern digital information era.
Again, the primary goal of all medical record documentation is to provide an accurate, chronologic record of patient care. That said, the medical record also serves other important goals including communication between providers, data exchange to facilitate clinical decisions, and a legal document. The payment-focused E/M documentation guidelines do not serve any of these objectives.
There must be some level of trust of the provider by the payers. Physicians should have the ability to meet the primary goal of the medical record without being required to repeatedly enter the same information. If a family history is recorded on Monday, there should be no requirement to re-record it on Thursday unless something cogent changes in the interim. ACS believes that documentation should focus on the minimum data elements needed to establish an accurate chronologic record of patient care.
The ACS is prepared to assist in an effort to explore ways to revise the current paper-based E/M documentation guidelines such that they more efficiently and accurately document patient care information in the modern digital era.
Meaningful Measurement of Surgical Quality
I also addressed concerns relative to the meaningful measurement of surgical quality. Despite having expended significant human and financial resources toward helping Fellows succeed in MIPS, the College is becoming increasingly concerned that MIPS is not actually measuring surgical quality, and therefore, is not a quality program for surgery and serves primarily as a payment program.
As evidence, the most recent quality metric data available (from the 2015 Physician Quality Reporting System) show that many of the CMS quality measures reported by surgeons have little to do with improving the quality of the actual surgical care provided to patients. For general surgeons, the two most commonly reported measures were the documentation of a patient’s medications in the medical record and tobacco use screening. While no one would deny the importance of either of these activities, neither is of much real value in the effort to measure the quality of surgical care provided. In another, perhaps even more illustrative example, one of the most common quality measures reported by urologists was inquiring of their patients whether they had received a pneumovax. This obviously has little to do with why one would see an urologist, much less the quality of care provided.
As an organization, the ACS and its members are absolutely dedicated to improving the quality of care they provide to their patients. However, the quality measures forming the basis of the assessment of their care must first be relevant to the surgical care they provide, and second be achievable. Fellows are increasingly expressing concerns about the burdens imposed by the Quality component of MIPS and believe their efforts to participate do little to meaningfully measure the quality of surgical care they provide. I asked that the Ways and Means Committee hold a hearing specifically addressing issues relative to the Quality component of MIPS.
Standardizing Electronic Prior Authorization for Safe Prescribing Act
I expressed ACS’ support for the Standardizing Electronic Prior Authorization for Safe Prescribing Act, H.R. 4841, which would allow for electronic prior authorization under Medicare Part D and allow for the creation of technical standards for the electronic transmission of prior authorization. While the College believes this legislation is a good first step for electronic prior authorization, I asked that the scope of the legislation be expanded to include all medical services, supplies, and prescription drugs covered by the Medicare program, and also requested prior authorization policies be standardized across all insurers and that prior authorization requests, decisions, and appeals processes be automated through uniform electronic transaction portals for all services and supplies.
As evidence, I provided data from a 2017 ACS survey of nearly 300 surgeons and their staff, which indicated that, on average, a medical practice receives approximately 37 prior authorization requests per provider, per week. Action on these requests requires 25 hours to complete. This exorbitant expenditure of time and resources required for prior authorization is largely due to a lack of automated prior authorization processes that integrate with current electronic health record systems. The ACS is committed to working with the bill’s sponsors and the Ways and Means Committee toward a goal of swift passage.
Questions from and discussion with members of the Ways and Means Committee were truncated because of votes on the House floor. We look forward to continuing the dialogue in the coming weeks when the roundtable is reconvened.
Until next month ….
On March 15, 2018, I had the opportunity to present on behalf of the ACS at a roundtable discussion on Capitol Hill to members of the House Ways and Means Committee on the topic of Medicare red tape relief
The roundtable provided members of this key committee of jurisdiction over Medicare policy the opportunity to hear from representatives from a variety of health care professional organizations on how Congress can improve Medicare to work more effectively and efficiently for both patients and providers. Each group was allotted just three minutes for their presentation. A summary of my presentation is included below:
E/M Documentation Guidelines
The ACS has significant concerns regarding Evaluation and Management (E/M) Documentation Guidelines. Though CMS created the E/M documentation guidelines 23 years ago with the laudable goal of adding structure to the various levels of E/M services, and in an effort to create a sense of equivalency of E/M services across the multitude of specialties, ACS believes the time has come to re-examine and revise these guidelines to be more appropriate in the modern digital information era.
Again, the primary goal of all medical record documentation is to provide an accurate, chronologic record of patient care. That said, the medical record also serves other important goals including communication between providers, data exchange to facilitate clinical decisions, and a legal document. The payment-focused E/M documentation guidelines do not serve any of these objectives.
There must be some level of trust of the provider by the payers. Physicians should have the ability to meet the primary goal of the medical record without being required to repeatedly enter the same information. If a family history is recorded on Monday, there should be no requirement to re-record it on Thursday unless something cogent changes in the interim. ACS believes that documentation should focus on the minimum data elements needed to establish an accurate chronologic record of patient care.
The ACS is prepared to assist in an effort to explore ways to revise the current paper-based E/M documentation guidelines such that they more efficiently and accurately document patient care information in the modern digital era.
Meaningful Measurement of Surgical Quality
I also addressed concerns relative to the meaningful measurement of surgical quality. Despite having expended significant human and financial resources toward helping Fellows succeed in MIPS, the College is becoming increasingly concerned that MIPS is not actually measuring surgical quality, and therefore, is not a quality program for surgery and serves primarily as a payment program.
As evidence, the most recent quality metric data available (from the 2015 Physician Quality Reporting System) show that many of the CMS quality measures reported by surgeons have little to do with improving the quality of the actual surgical care provided to patients. For general surgeons, the two most commonly reported measures were the documentation of a patient’s medications in the medical record and tobacco use screening. While no one would deny the importance of either of these activities, neither is of much real value in the effort to measure the quality of surgical care provided. In another, perhaps even more illustrative example, one of the most common quality measures reported by urologists was inquiring of their patients whether they had received a pneumovax. This obviously has little to do with why one would see an urologist, much less the quality of care provided.
As an organization, the ACS and its members are absolutely dedicated to improving the quality of care they provide to their patients. However, the quality measures forming the basis of the assessment of their care must first be relevant to the surgical care they provide, and second be achievable. Fellows are increasingly expressing concerns about the burdens imposed by the Quality component of MIPS and believe their efforts to participate do little to meaningfully measure the quality of surgical care they provide. I asked that the Ways and Means Committee hold a hearing specifically addressing issues relative to the Quality component of MIPS.
Standardizing Electronic Prior Authorization for Safe Prescribing Act
I expressed ACS’ support for the Standardizing Electronic Prior Authorization for Safe Prescribing Act, H.R. 4841, which would allow for electronic prior authorization under Medicare Part D and allow for the creation of technical standards for the electronic transmission of prior authorization. While the College believes this legislation is a good first step for electronic prior authorization, I asked that the scope of the legislation be expanded to include all medical services, supplies, and prescription drugs covered by the Medicare program, and also requested prior authorization policies be standardized across all insurers and that prior authorization requests, decisions, and appeals processes be automated through uniform electronic transaction portals for all services and supplies.
As evidence, I provided data from a 2017 ACS survey of nearly 300 surgeons and their staff, which indicated that, on average, a medical practice receives approximately 37 prior authorization requests per provider, per week. Action on these requests requires 25 hours to complete. This exorbitant expenditure of time and resources required for prior authorization is largely due to a lack of automated prior authorization processes that integrate with current electronic health record systems. The ACS is committed to working with the bill’s sponsors and the Ways and Means Committee toward a goal of swift passage.
Questions from and discussion with members of the Ways and Means Committee were truncated because of votes on the House floor. We look forward to continuing the dialogue in the coming weeks when the roundtable is reconvened.
Until next month ….
On March 15, 2018, I had the opportunity to present on behalf of the ACS at a roundtable discussion on Capitol Hill to members of the House Ways and Means Committee on the topic of Medicare red tape relief
The roundtable provided members of this key committee of jurisdiction over Medicare policy the opportunity to hear from representatives from a variety of health care professional organizations on how Congress can improve Medicare to work more effectively and efficiently for both patients and providers. Each group was allotted just three minutes for their presentation. A summary of my presentation is included below:
E/M Documentation Guidelines
The ACS has significant concerns regarding Evaluation and Management (E/M) Documentation Guidelines. Though CMS created the E/M documentation guidelines 23 years ago with the laudable goal of adding structure to the various levels of E/M services, and in an effort to create a sense of equivalency of E/M services across the multitude of specialties, ACS believes the time has come to re-examine and revise these guidelines to be more appropriate in the modern digital information era.
Again, the primary goal of all medical record documentation is to provide an accurate, chronologic record of patient care. That said, the medical record also serves other important goals including communication between providers, data exchange to facilitate clinical decisions, and a legal document. The payment-focused E/M documentation guidelines do not serve any of these objectives.
There must be some level of trust of the provider by the payers. Physicians should have the ability to meet the primary goal of the medical record without being required to repeatedly enter the same information. If a family history is recorded on Monday, there should be no requirement to re-record it on Thursday unless something cogent changes in the interim. ACS believes that documentation should focus on the minimum data elements needed to establish an accurate chronologic record of patient care.
The ACS is prepared to assist in an effort to explore ways to revise the current paper-based E/M documentation guidelines such that they more efficiently and accurately document patient care information in the modern digital era.
Meaningful Measurement of Surgical Quality
I also addressed concerns relative to the meaningful measurement of surgical quality. Despite having expended significant human and financial resources toward helping Fellows succeed in MIPS, the College is becoming increasingly concerned that MIPS is not actually measuring surgical quality, and therefore, is not a quality program for surgery and serves primarily as a payment program.
As evidence, the most recent quality metric data available (from the 2015 Physician Quality Reporting System) show that many of the CMS quality measures reported by surgeons have little to do with improving the quality of the actual surgical care provided to patients. For general surgeons, the two most commonly reported measures were the documentation of a patient’s medications in the medical record and tobacco use screening. While no one would deny the importance of either of these activities, neither is of much real value in the effort to measure the quality of surgical care provided. In another, perhaps even more illustrative example, one of the most common quality measures reported by urologists was inquiring of their patients whether they had received a pneumovax. This obviously has little to do with why one would see an urologist, much less the quality of care provided.
As an organization, the ACS and its members are absolutely dedicated to improving the quality of care they provide to their patients. However, the quality measures forming the basis of the assessment of their care must first be relevant to the surgical care they provide, and second be achievable. Fellows are increasingly expressing concerns about the burdens imposed by the Quality component of MIPS and believe their efforts to participate do little to meaningfully measure the quality of surgical care they provide. I asked that the Ways and Means Committee hold a hearing specifically addressing issues relative to the Quality component of MIPS.
Standardizing Electronic Prior Authorization for Safe Prescribing Act
I expressed ACS’ support for the Standardizing Electronic Prior Authorization for Safe Prescribing Act, H.R. 4841, which would allow for electronic prior authorization under Medicare Part D and allow for the creation of technical standards for the electronic transmission of prior authorization. While the College believes this legislation is a good first step for electronic prior authorization, I asked that the scope of the legislation be expanded to include all medical services, supplies, and prescription drugs covered by the Medicare program, and also requested prior authorization policies be standardized across all insurers and that prior authorization requests, decisions, and appeals processes be automated through uniform electronic transaction portals for all services and supplies.
As evidence, I provided data from a 2017 ACS survey of nearly 300 surgeons and their staff, which indicated that, on average, a medical practice receives approximately 37 prior authorization requests per provider, per week. Action on these requests requires 25 hours to complete. This exorbitant expenditure of time and resources required for prior authorization is largely due to a lack of automated prior authorization processes that integrate with current electronic health record systems. The ACS is committed to working with the bill’s sponsors and the Ways and Means Committee toward a goal of swift passage.
Questions from and discussion with members of the Ways and Means Committee were truncated because of votes on the House floor. We look forward to continuing the dialogue in the coming weeks when the roundtable is reconvened.
Until next month ….
From the Washington Office: Gratifying success for ACS legislative advocacy efforts
On the morning of February 9, 2018, President Trump signed into law the Bipartisan Budget Act of 2018. The law included legislative priorities that were championed by the ACS and for which staff of the DC office and engaged Fellows of the College have advocated, in some cases, for a number of years.
ACS worked particularly hard in the week leading up to the passage of the Bipartisan Budget Act of 2018 with the goal of ensuring that certain items were included, and certain other items were excluded, in the Continuing Resolution (CR) under consideration by Congress to continue funding the government. The original version of the CR considered and debated by the House of Representatives early in the week included both positive and negative items. The ACS was successful in its efforts to get the Senate to consider a much-improved version of the CR – eliminating a major impediment in the House version. Ultimately, it was the Senate version that was signed into law by President Trump.
The provisions in the Bipartisan Budget Act of 2018 include:
• Flexibility for the Merit-based Incentive Payment System (MIPS) related to how much weight will be ascribed to the Cost component in an individual physician’s MIPS score as well as flexibility in setting the level at which physicians will either receive a positive or negative payment update. Without this flexibility, there was significant concern that Fellows would have significantly greater challenges in avoiding a cut under the MIPS. This language, and the effort to include it, was spearheaded and long championed by the ACS including the drafting of model legislation remedying the problem which was then provided to the leadership and staff of committees of jurisdiction.
• Easing meaningful use (MU) requirements by removing an outdated requirement directing the Secretary of Health and Human Services (HHS) to continue to make meaningful use standards increasingly stringent over time. The ACS has long advocated against increasingly stringent MU requirements that do not lead to improvements in patient care, and feels they are unnecessary and unfair to both patients and providers. Further, easing MU requirements has long been supported by ACS Fellows.
• An additional 4 years of funding for the Children’s Health Insurance Program (CHIP), bringing the reauthorization period to a total of 10 years. ACS has consistently advocated and aggressively pursued reauthorization of CHIP every time reauthorization was necessary. During the most recent negotiations, following expiration of funding in September 2017, the ACS advocated for the longest possible period of reauthorization of funds.
• Full repeal of the Independent Payment Advisory Board (IPAB), included as part of the Affordable Care Act. Though members of the board were never appointed, the ACS has fought to eliminate this advisory board of unelected bureaucrats who had the power to cut physician payment since 2010.
• Additional funding to address both the opioid epidemic and to support the work of the National Institutes of Health (NIH). The ACS has long supported funding to fight cancer and has been proactive in its response to the national crisis of opioid abuse and misuse.
• Lastly, as mentioned above, the ACS strongly opposed language in the version of the bill passed by the House that would have allowed the use of the “Misvalued Codes” as part of the “pay-for” or offset for the legislation. The ACS anticipated that this language would have unfairly resulted in significant cuts to surgeons and we were pleased that this language was not included in the version ultimately agreed to and signed into law by President Trump. We sincerely hope that this ends the use of this flawed policy.
To have this many policy priorities enacted through one legislative package is a rare occurrence for any organization and accordingly is most gratifying. The emails and phone calls delivered by Fellows during the week of February 5, in combination with the work of staff here in Washington DC, no doubt played a significant role in securing these priorities. However, the work is not done and the ACS will continue to fight for improvements to issues facing surgeons and surgical patients.
We urge all Fellows to continue participating in these efforts.
Until next month ….
On the morning of February 9, 2018, President Trump signed into law the Bipartisan Budget Act of 2018. The law included legislative priorities that were championed by the ACS and for which staff of the DC office and engaged Fellows of the College have advocated, in some cases, for a number of years.
ACS worked particularly hard in the week leading up to the passage of the Bipartisan Budget Act of 2018 with the goal of ensuring that certain items were included, and certain other items were excluded, in the Continuing Resolution (CR) under consideration by Congress to continue funding the government. The original version of the CR considered and debated by the House of Representatives early in the week included both positive and negative items. The ACS was successful in its efforts to get the Senate to consider a much-improved version of the CR – eliminating a major impediment in the House version. Ultimately, it was the Senate version that was signed into law by President Trump.
The provisions in the Bipartisan Budget Act of 2018 include:
• Flexibility for the Merit-based Incentive Payment System (MIPS) related to how much weight will be ascribed to the Cost component in an individual physician’s MIPS score as well as flexibility in setting the level at which physicians will either receive a positive or negative payment update. Without this flexibility, there was significant concern that Fellows would have significantly greater challenges in avoiding a cut under the MIPS. This language, and the effort to include it, was spearheaded and long championed by the ACS including the drafting of model legislation remedying the problem which was then provided to the leadership and staff of committees of jurisdiction.
• Easing meaningful use (MU) requirements by removing an outdated requirement directing the Secretary of Health and Human Services (HHS) to continue to make meaningful use standards increasingly stringent over time. The ACS has long advocated against increasingly stringent MU requirements that do not lead to improvements in patient care, and feels they are unnecessary and unfair to both patients and providers. Further, easing MU requirements has long been supported by ACS Fellows.
• An additional 4 years of funding for the Children’s Health Insurance Program (CHIP), bringing the reauthorization period to a total of 10 years. ACS has consistently advocated and aggressively pursued reauthorization of CHIP every time reauthorization was necessary. During the most recent negotiations, following expiration of funding in September 2017, the ACS advocated for the longest possible period of reauthorization of funds.
• Full repeal of the Independent Payment Advisory Board (IPAB), included as part of the Affordable Care Act. Though members of the board were never appointed, the ACS has fought to eliminate this advisory board of unelected bureaucrats who had the power to cut physician payment since 2010.
• Additional funding to address both the opioid epidemic and to support the work of the National Institutes of Health (NIH). The ACS has long supported funding to fight cancer and has been proactive in its response to the national crisis of opioid abuse and misuse.
• Lastly, as mentioned above, the ACS strongly opposed language in the version of the bill passed by the House that would have allowed the use of the “Misvalued Codes” as part of the “pay-for” or offset for the legislation. The ACS anticipated that this language would have unfairly resulted in significant cuts to surgeons and we were pleased that this language was not included in the version ultimately agreed to and signed into law by President Trump. We sincerely hope that this ends the use of this flawed policy.
To have this many policy priorities enacted through one legislative package is a rare occurrence for any organization and accordingly is most gratifying. The emails and phone calls delivered by Fellows during the week of February 5, in combination with the work of staff here in Washington DC, no doubt played a significant role in securing these priorities. However, the work is not done and the ACS will continue to fight for improvements to issues facing surgeons and surgical patients.
We urge all Fellows to continue participating in these efforts.
Until next month ….
On the morning of February 9, 2018, President Trump signed into law the Bipartisan Budget Act of 2018. The law included legislative priorities that were championed by the ACS and for which staff of the DC office and engaged Fellows of the College have advocated, in some cases, for a number of years.
ACS worked particularly hard in the week leading up to the passage of the Bipartisan Budget Act of 2018 with the goal of ensuring that certain items were included, and certain other items were excluded, in the Continuing Resolution (CR) under consideration by Congress to continue funding the government. The original version of the CR considered and debated by the House of Representatives early in the week included both positive and negative items. The ACS was successful in its efforts to get the Senate to consider a much-improved version of the CR – eliminating a major impediment in the House version. Ultimately, it was the Senate version that was signed into law by President Trump.
The provisions in the Bipartisan Budget Act of 2018 include:
• Flexibility for the Merit-based Incentive Payment System (MIPS) related to how much weight will be ascribed to the Cost component in an individual physician’s MIPS score as well as flexibility in setting the level at which physicians will either receive a positive or negative payment update. Without this flexibility, there was significant concern that Fellows would have significantly greater challenges in avoiding a cut under the MIPS. This language, and the effort to include it, was spearheaded and long championed by the ACS including the drafting of model legislation remedying the problem which was then provided to the leadership and staff of committees of jurisdiction.
• Easing meaningful use (MU) requirements by removing an outdated requirement directing the Secretary of Health and Human Services (HHS) to continue to make meaningful use standards increasingly stringent over time. The ACS has long advocated against increasingly stringent MU requirements that do not lead to improvements in patient care, and feels they are unnecessary and unfair to both patients and providers. Further, easing MU requirements has long been supported by ACS Fellows.
• An additional 4 years of funding for the Children’s Health Insurance Program (CHIP), bringing the reauthorization period to a total of 10 years. ACS has consistently advocated and aggressively pursued reauthorization of CHIP every time reauthorization was necessary. During the most recent negotiations, following expiration of funding in September 2017, the ACS advocated for the longest possible period of reauthorization of funds.
• Full repeal of the Independent Payment Advisory Board (IPAB), included as part of the Affordable Care Act. Though members of the board were never appointed, the ACS has fought to eliminate this advisory board of unelected bureaucrats who had the power to cut physician payment since 2010.
• Additional funding to address both the opioid epidemic and to support the work of the National Institutes of Health (NIH). The ACS has long supported funding to fight cancer and has been proactive in its response to the national crisis of opioid abuse and misuse.
• Lastly, as mentioned above, the ACS strongly opposed language in the version of the bill passed by the House that would have allowed the use of the “Misvalued Codes” as part of the “pay-for” or offset for the legislation. The ACS anticipated that this language would have unfairly resulted in significant cuts to surgeons and we were pleased that this language was not included in the version ultimately agreed to and signed into law by President Trump. We sincerely hope that this ends the use of this flawed policy.
To have this many policy priorities enacted through one legislative package is a rare occurrence for any organization and accordingly is most gratifying. The emails and phone calls delivered by Fellows during the week of February 5, in combination with the work of staff here in Washington DC, no doubt played a significant role in securing these priorities. However, the work is not done and the ACS will continue to fight for improvements to issues facing surgeons and surgical patients.
We urge all Fellows to continue participating in these efforts.
Until next month ….
From the Washington Office: MIPS 2018 … Determining your status, making your plan
Surgeons’ practice situations vary. Therefore, for various reasons, surgeons may not be required to participate in MIPS, or they may not be eligible to do so. For 2018, the Centers for Medicare & Medicaid Services (CMS) estimates that approximately 40 percent of eligible clinicians will be required to submit data under MIPS. Furthermore, many providers (particularly those who are employed or are in large group practices) will have data submitted on their behalf by their groups, institutions, or employers. It is thus imperative that surgeons determine whether they are exempt from participating in the MIPS program. If not exempt, they should then determine if their practice situation necessitates that they report their own individual MIPS data for 2018 or, alternatively, if data will be reported for their groups, institutions, or employers.
If you are a Qualifying Participant (QP) in an Advanced Alternative Payment Model (APM), you are exempt from reporting MIPS data. If you are unsure of your status as such a participant, you can use you NPI number to determine your status at data.cms.gov/qplookup. QPs are not only exempt from reporting MIPS data, but could receive a 5 percent bonus in 2020 for participation in 2018.
For 2018, CMS increased the low-volume threshold. The low-volume threshold is now set at less than or equal to $90,000 in Medicare Part B allowable charges or 200 or fewer Medicare Part B patients seen during the period selected by CMS. Because this threshold represents an increase compared to 2017, it will result in even more providers being exempted from participating in MIPS. It should be noted that failure to meet either of these thresholds, $90,000 in allowable charges or 200 Medicare Part B patients, is sufficient to exclude one from reporting MIPS data in 2018. As was the case in 2017, we anticipate that CMS will notify those providers who are exempt based on the low-volume threshold within the first or second quarter of 2018. Alternatively, surgeons may use their NPI to check their status relative to MIPS reporting at qpp.cms.gov/participation-lookup.
To determine whether MIPS applies to your practice circumstances, you can use the following simple steps:
1) Are you a participant in a qualified advanced alternative payment model (A-APM)? If you are unsure, you can use your National Provider Identifier (NPI) number to look up your status at data.cms.gov/qplookup. If you are a qualified participant in an A-APM, you are not only exempt from reporting MIPS data, but you could also receive a 5 percent bonus in 2020 for your participation in 2018.
2) Are you exempt from participating in MIPS based on the low-volume threshold? As mentioned above, for 2018, the increase in the low-volume threshold is expected to exclude a significant number of providers. To determine if you are exempt based on the low-volume threshold, use your NPI number at qpp.cms.gov/participation-lookup.
3) Are your MIPS data reported for you by your institution, your employer, or your group? If your data are being reported for you then you need take no further action. You should contact your institution, employer, or group to confirm that data are being reported for you.
If MIPS applies to your practice, you need to make a choice between:
1) Submitting the minimum data necessary to avoid a penalty, and accept a freeze in your payments in 2020 for the 2018 performance period.
or
2) Submitting data in an effort to compete for a positive update.
If you prefer to submit the minimum amount of data necessary to avoid a penalty, your best option is to complete the requirements for the Improvement Activities (IA) component of MIPS. By achieving full credit in this category of MIPS, you will acquire enough points (15) to reach the performance threshold in your MIPS final score to avoid a 5 percent penalty in your Medicare payments in 2020 based on your performance and participation in 2018.
Within the IA category, each activity is assigned either a high (20 points) or medium (10 points) weight. To receive full credit in the IA component, most surgeons must select and attest to having completed between two and four activities for a total of 40 points in the IA category. For small practices or rural practices to achieve full credit, only one high-value or two medium-value activities are required. CMS defines small practices as those consisting of 15 or fewer eligible clinicians. The Centers for Medicare and Medicaid Services defines rural practices as those where more than 75 percent of the NPIs billing under the individual MIPS eligible clinician or group’s Tax Identification Number (TIN) are designated in a ZIP code as a rural area or Health Professional Shortage Area (HPSA), based on the most recent Health Resources and Services Administration Area Health Resource File data set.
Those who fulfill these requirements will receive the maximum score and full credit in the IA category toward their MIPS Final Score (15 points). Because the performance threshold for 2018 is set at 15 points, those who wish to avoid a payment penalty can acquire the required number of points to avoid a penalty for their performance in 2018 by simply fulfilling the IA requirements.
Attestation to having completed the Improvement Activities can be accomplished via a qualified registry, qualified clinical data registry (QCDR), an electronic health record (EHR), or the QPP Data Submission System (accessible at qpp.cms.gov/login). The American College of Surgeons (ACS) has two QCDRs, the Surgeon Specific Registry (SSR) and the Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) Data Registry. Both can be used to attest to completing the IAs.
If you plan to compete for a positive update in 2020 based on your performance in 2018, you should ideally report on the Quality, Advancing Care Information (ACI), and Improvement Activities categories of MIPS. If this is your intent, we recommend you obtain a copy of our new 2018 MACRA manual, visit facs.org/qpp, and make your plan for 2018.
Regardless of your choice, ACS staff in the DC office and the SSR are here to help and can be reached at 202-337-2701 (DC) or 312-202-5408 (SSR).
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Surgeons’ practice situations vary. Therefore, for various reasons, surgeons may not be required to participate in MIPS, or they may not be eligible to do so. For 2018, the Centers for Medicare & Medicaid Services (CMS) estimates that approximately 40 percent of eligible clinicians will be required to submit data under MIPS. Furthermore, many providers (particularly those who are employed or are in large group practices) will have data submitted on their behalf by their groups, institutions, or employers. It is thus imperative that surgeons determine whether they are exempt from participating in the MIPS program. If not exempt, they should then determine if their practice situation necessitates that they report their own individual MIPS data for 2018 or, alternatively, if data will be reported for their groups, institutions, or employers.
If you are a Qualifying Participant (QP) in an Advanced Alternative Payment Model (APM), you are exempt from reporting MIPS data. If you are unsure of your status as such a participant, you can use you NPI number to determine your status at data.cms.gov/qplookup. QPs are not only exempt from reporting MIPS data, but could receive a 5 percent bonus in 2020 for participation in 2018.
For 2018, CMS increased the low-volume threshold. The low-volume threshold is now set at less than or equal to $90,000 in Medicare Part B allowable charges or 200 or fewer Medicare Part B patients seen during the period selected by CMS. Because this threshold represents an increase compared to 2017, it will result in even more providers being exempted from participating in MIPS. It should be noted that failure to meet either of these thresholds, $90,000 in allowable charges or 200 Medicare Part B patients, is sufficient to exclude one from reporting MIPS data in 2018. As was the case in 2017, we anticipate that CMS will notify those providers who are exempt based on the low-volume threshold within the first or second quarter of 2018. Alternatively, surgeons may use their NPI to check their status relative to MIPS reporting at qpp.cms.gov/participation-lookup.
To determine whether MIPS applies to your practice circumstances, you can use the following simple steps:
1) Are you a participant in a qualified advanced alternative payment model (A-APM)? If you are unsure, you can use your National Provider Identifier (NPI) number to look up your status at data.cms.gov/qplookup. If you are a qualified participant in an A-APM, you are not only exempt from reporting MIPS data, but you could also receive a 5 percent bonus in 2020 for your participation in 2018.
2) Are you exempt from participating in MIPS based on the low-volume threshold? As mentioned above, for 2018, the increase in the low-volume threshold is expected to exclude a significant number of providers. To determine if you are exempt based on the low-volume threshold, use your NPI number at qpp.cms.gov/participation-lookup.
3) Are your MIPS data reported for you by your institution, your employer, or your group? If your data are being reported for you then you need take no further action. You should contact your institution, employer, or group to confirm that data are being reported for you.
If MIPS applies to your practice, you need to make a choice between:
1) Submitting the minimum data necessary to avoid a penalty, and accept a freeze in your payments in 2020 for the 2018 performance period.
or
2) Submitting data in an effort to compete for a positive update.
If you prefer to submit the minimum amount of data necessary to avoid a penalty, your best option is to complete the requirements for the Improvement Activities (IA) component of MIPS. By achieving full credit in this category of MIPS, you will acquire enough points (15) to reach the performance threshold in your MIPS final score to avoid a 5 percent penalty in your Medicare payments in 2020 based on your performance and participation in 2018.
Within the IA category, each activity is assigned either a high (20 points) or medium (10 points) weight. To receive full credit in the IA component, most surgeons must select and attest to having completed between two and four activities for a total of 40 points in the IA category. For small practices or rural practices to achieve full credit, only one high-value or two medium-value activities are required. CMS defines small practices as those consisting of 15 or fewer eligible clinicians. The Centers for Medicare and Medicaid Services defines rural practices as those where more than 75 percent of the NPIs billing under the individual MIPS eligible clinician or group’s Tax Identification Number (TIN) are designated in a ZIP code as a rural area or Health Professional Shortage Area (HPSA), based on the most recent Health Resources and Services Administration Area Health Resource File data set.
Those who fulfill these requirements will receive the maximum score and full credit in the IA category toward their MIPS Final Score (15 points). Because the performance threshold for 2018 is set at 15 points, those who wish to avoid a payment penalty can acquire the required number of points to avoid a penalty for their performance in 2018 by simply fulfilling the IA requirements.
Attestation to having completed the Improvement Activities can be accomplished via a qualified registry, qualified clinical data registry (QCDR), an electronic health record (EHR), or the QPP Data Submission System (accessible at qpp.cms.gov/login). The American College of Surgeons (ACS) has two QCDRs, the Surgeon Specific Registry (SSR) and the Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) Data Registry. Both can be used to attest to completing the IAs.
If you plan to compete for a positive update in 2020 based on your performance in 2018, you should ideally report on the Quality, Advancing Care Information (ACI), and Improvement Activities categories of MIPS. If this is your intent, we recommend you obtain a copy of our new 2018 MACRA manual, visit facs.org/qpp, and make your plan for 2018.
Regardless of your choice, ACS staff in the DC office and the SSR are here to help and can be reached at 202-337-2701 (DC) or 312-202-5408 (SSR).
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Surgeons’ practice situations vary. Therefore, for various reasons, surgeons may not be required to participate in MIPS, or they may not be eligible to do so. For 2018, the Centers for Medicare & Medicaid Services (CMS) estimates that approximately 40 percent of eligible clinicians will be required to submit data under MIPS. Furthermore, many providers (particularly those who are employed or are in large group practices) will have data submitted on their behalf by their groups, institutions, or employers. It is thus imperative that surgeons determine whether they are exempt from participating in the MIPS program. If not exempt, they should then determine if their practice situation necessitates that they report their own individual MIPS data for 2018 or, alternatively, if data will be reported for their groups, institutions, or employers.
If you are a Qualifying Participant (QP) in an Advanced Alternative Payment Model (APM), you are exempt from reporting MIPS data. If you are unsure of your status as such a participant, you can use you NPI number to determine your status at data.cms.gov/qplookup. QPs are not only exempt from reporting MIPS data, but could receive a 5 percent bonus in 2020 for participation in 2018.
For 2018, CMS increased the low-volume threshold. The low-volume threshold is now set at less than or equal to $90,000 in Medicare Part B allowable charges or 200 or fewer Medicare Part B patients seen during the period selected by CMS. Because this threshold represents an increase compared to 2017, it will result in even more providers being exempted from participating in MIPS. It should be noted that failure to meet either of these thresholds, $90,000 in allowable charges or 200 Medicare Part B patients, is sufficient to exclude one from reporting MIPS data in 2018. As was the case in 2017, we anticipate that CMS will notify those providers who are exempt based on the low-volume threshold within the first or second quarter of 2018. Alternatively, surgeons may use their NPI to check their status relative to MIPS reporting at qpp.cms.gov/participation-lookup.
To determine whether MIPS applies to your practice circumstances, you can use the following simple steps:
1) Are you a participant in a qualified advanced alternative payment model (A-APM)? If you are unsure, you can use your National Provider Identifier (NPI) number to look up your status at data.cms.gov/qplookup. If you are a qualified participant in an A-APM, you are not only exempt from reporting MIPS data, but you could also receive a 5 percent bonus in 2020 for your participation in 2018.
2) Are you exempt from participating in MIPS based on the low-volume threshold? As mentioned above, for 2018, the increase in the low-volume threshold is expected to exclude a significant number of providers. To determine if you are exempt based on the low-volume threshold, use your NPI number at qpp.cms.gov/participation-lookup.
3) Are your MIPS data reported for you by your institution, your employer, or your group? If your data are being reported for you then you need take no further action. You should contact your institution, employer, or group to confirm that data are being reported for you.
If MIPS applies to your practice, you need to make a choice between:
1) Submitting the minimum data necessary to avoid a penalty, and accept a freeze in your payments in 2020 for the 2018 performance period.
or
2) Submitting data in an effort to compete for a positive update.
If you prefer to submit the minimum amount of data necessary to avoid a penalty, your best option is to complete the requirements for the Improvement Activities (IA) component of MIPS. By achieving full credit in this category of MIPS, you will acquire enough points (15) to reach the performance threshold in your MIPS final score to avoid a 5 percent penalty in your Medicare payments in 2020 based on your performance and participation in 2018.
Within the IA category, each activity is assigned either a high (20 points) or medium (10 points) weight. To receive full credit in the IA component, most surgeons must select and attest to having completed between two and four activities for a total of 40 points in the IA category. For small practices or rural practices to achieve full credit, only one high-value or two medium-value activities are required. CMS defines small practices as those consisting of 15 or fewer eligible clinicians. The Centers for Medicare and Medicaid Services defines rural practices as those where more than 75 percent of the NPIs billing under the individual MIPS eligible clinician or group’s Tax Identification Number (TIN) are designated in a ZIP code as a rural area or Health Professional Shortage Area (HPSA), based on the most recent Health Resources and Services Administration Area Health Resource File data set.
Those who fulfill these requirements will receive the maximum score and full credit in the IA category toward their MIPS Final Score (15 points). Because the performance threshold for 2018 is set at 15 points, those who wish to avoid a payment penalty can acquire the required number of points to avoid a penalty for their performance in 2018 by simply fulfilling the IA requirements.
Attestation to having completed the Improvement Activities can be accomplished via a qualified registry, qualified clinical data registry (QCDR), an electronic health record (EHR), or the QPP Data Submission System (accessible at qpp.cms.gov/login). The American College of Surgeons (ACS) has two QCDRs, the Surgeon Specific Registry (SSR) and the Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) Data Registry. Both can be used to attest to completing the IAs.
If you plan to compete for a positive update in 2020 based on your performance in 2018, you should ideally report on the Quality, Advancing Care Information (ACI), and Improvement Activities categories of MIPS. If this is your intent, we recommend you obtain a copy of our new 2018 MACRA manual, visit facs.org/qpp, and make your plan for 2018.
Regardless of your choice, ACS staff in the DC office and the SSR are here to help and can be reached at 202-337-2701 (DC) or 312-202-5408 (SSR).
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
From the Washington Office: Year Two of MIPS …The song remains the same (largely)
The interim final rule for the second year of Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) was released on November 2, 2017. This rule will apply to performance and reporting for calendar year 2018 and impact payment in 2020. Below, I have highlighted a few of the key components of the 1,653-page rule with special attention to the Merit-based Incentive Payment System (MIPS).
To briefly review, there are two pathways for participation in the QPP, namely MIPS and the Advanced Alternative Payment Models (A-APMs). For 2018, we still expect that the majority of surgeons eligible to participate in the QPP will do so via the MIPS pathway. That said, and for reasons discussed below, CMS estimates that approximately half of the 1.2 million MIPS-eligible clinicians will be required to submit MIPS data in 2018. In addition, CMS estimates that approximately 200,000 eligible clinicians will participate in the QPP in 2018 via the A-APMs.
1) Quality – For 2018, CMS continues to require reporting on six measures, one of which must be an outcome measure or other high-priority measure. Should surgeons choose to report on more than six measures, CMS will use the six with the highest score for purposes of calculating their score for the Quality component. However, CMS did increase the percentage of patients on which reporting is required, aka the completeness threshold, in 2018 to 60%. Measures submitted that fall below the completeness threshold will receive one point. Small practices will receive three points for measures that fail to meet the completeness threshold. Multiple options remain available for submission of data, i.e., electronic health record (EHR), Medicare claims, a qualified registry or a qualified clinical data registry (QCDR). For 2018, the Quality component will make up 50% of the MIPS final score.
Cost
Those familiar with the 2017 version of MIPS will remember that the Cost component was weighted at zero for the first year of the program. CMS discussed, and indeed, initially proposed, to continue weighing cost at zero for 2018. However, because current law requires CMS to weigh cost at 30% beginning with the 2019 performance period, CMS finalized a 10% weight for cost in 2018 with the goal of making the impact of the transition in 2019 less dramatic. CMS will base its calculation of the cost component on the total per capita costs for all beneficiaries attributed to a provider and the Medicare Spending per Beneficiary measure for the entirety of the 2018 performance period. CMS intends to provide performance feedback on both measures by July 1, 2018. Surgeons are not required to submit data for purposes of cost component.
Advancing Care Information (ACI)
There are no major changes to the scoring policy for 2018 and all the applicable Base Score measures must still be reported in order to receive a score for the ACI component. The performance period requirement remains a minimum of 90 continuous days. For 2018, both 2014 Edition and 2015 Edition certified electronic health record technology (CEHRT) remain acceptable. However, those using only a 2015 Edition will be eligible for a 10% bonus. Regardless of edition used , bonus points are also available for reporting to a public health agency or clinical data registry and for the completion of an Improvement Activity (IA) using CEHRT. A significant hardship exemption remains available for those in small practices. As was the case in 2017, the ACI component represents 25% of the final score. However, as was also the case in 2017, one is not required to have an electronic health record to avoid a penalty in 2018.
Improvement Activities
The weight assigned to the IA component remains at 15%. CMS added 21 new IAs in the final rule, bringing the number of IA available from which to choose up to well over 110. CMS also made changes to 27 activities previously adopted. Reporting remains a simple attestation of participation in the activity for 90 continuous days. To receive full credit for the IA component, most surgeons will be required to attest to having participated in two, three, or four activities depending on whether the activities chosen are of medium value or high value. This is not a change. However, those in small or rural practices must only participate in one or two activities to receive full credit. It should be noted that for 2018, one will be able to avoid a penalty in 2020 solely by fulfillment of the requirements imposed by the Improvement Activities component.
As mentioned above, CMS estimates that only approximately 622,000 providers out of the 1.2 million eligible will be required to submit data under MIPS. Many providers are excluded from MIPS based on the low-volume threshold. For 2018, CMS set this threshold at less than or equal to $90,000 in Medicare Part B charges OR less than or equal to 200 Medicare Part B beneficiaries. The effect of this change, compared to the values set for 2017 low-volume threshold, is to exclude more providers from MIPS reporting.
Lastly, many will remember that for 2017, the performance threshold was set at three points, and thus, required only minimal reporting in either quality, ACI, or IA to avoid a penalty. It was expected that the threshold necessary to avoid a penalty for 2018 performance would be increased and indeed, CMS has set that value at 15. Those scoring above 15 will be eligible for a positive update in their Medicare payments in 2020, while those scoring below 15 will receive a penalty. Those who choose to not participate in 2018 will receive a 5% penalty in 2020. However, two points made above warrant reiteration:
a) By fully participating in the IA component, one can accrue the 15 points necessary to avoid a penalty.
b) An EHR is not required to avoid a penalty.
In the coming weeks, we will be updating the QPP website (www.facs.org/qpp) to reflect the changes in the program for 2018. New videos will be available as will be new electronic and print materials to assist Fellows to participate in the program.
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
The interim final rule for the second year of Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) was released on November 2, 2017. This rule will apply to performance and reporting for calendar year 2018 and impact payment in 2020. Below, I have highlighted a few of the key components of the 1,653-page rule with special attention to the Merit-based Incentive Payment System (MIPS).
To briefly review, there are two pathways for participation in the QPP, namely MIPS and the Advanced Alternative Payment Models (A-APMs). For 2018, we still expect that the majority of surgeons eligible to participate in the QPP will do so via the MIPS pathway. That said, and for reasons discussed below, CMS estimates that approximately half of the 1.2 million MIPS-eligible clinicians will be required to submit MIPS data in 2018. In addition, CMS estimates that approximately 200,000 eligible clinicians will participate in the QPP in 2018 via the A-APMs.
1) Quality – For 2018, CMS continues to require reporting on six measures, one of which must be an outcome measure or other high-priority measure. Should surgeons choose to report on more than six measures, CMS will use the six with the highest score for purposes of calculating their score for the Quality component. However, CMS did increase the percentage of patients on which reporting is required, aka the completeness threshold, in 2018 to 60%. Measures submitted that fall below the completeness threshold will receive one point. Small practices will receive three points for measures that fail to meet the completeness threshold. Multiple options remain available for submission of data, i.e., electronic health record (EHR), Medicare claims, a qualified registry or a qualified clinical data registry (QCDR). For 2018, the Quality component will make up 50% of the MIPS final score.
Cost
Those familiar with the 2017 version of MIPS will remember that the Cost component was weighted at zero for the first year of the program. CMS discussed, and indeed, initially proposed, to continue weighing cost at zero for 2018. However, because current law requires CMS to weigh cost at 30% beginning with the 2019 performance period, CMS finalized a 10% weight for cost in 2018 with the goal of making the impact of the transition in 2019 less dramatic. CMS will base its calculation of the cost component on the total per capita costs for all beneficiaries attributed to a provider and the Medicare Spending per Beneficiary measure for the entirety of the 2018 performance period. CMS intends to provide performance feedback on both measures by July 1, 2018. Surgeons are not required to submit data for purposes of cost component.
Advancing Care Information (ACI)
There are no major changes to the scoring policy for 2018 and all the applicable Base Score measures must still be reported in order to receive a score for the ACI component. The performance period requirement remains a minimum of 90 continuous days. For 2018, both 2014 Edition and 2015 Edition certified electronic health record technology (CEHRT) remain acceptable. However, those using only a 2015 Edition will be eligible for a 10% bonus. Regardless of edition used , bonus points are also available for reporting to a public health agency or clinical data registry and for the completion of an Improvement Activity (IA) using CEHRT. A significant hardship exemption remains available for those in small practices. As was the case in 2017, the ACI component represents 25% of the final score. However, as was also the case in 2017, one is not required to have an electronic health record to avoid a penalty in 2018.
Improvement Activities
The weight assigned to the IA component remains at 15%. CMS added 21 new IAs in the final rule, bringing the number of IA available from which to choose up to well over 110. CMS also made changes to 27 activities previously adopted. Reporting remains a simple attestation of participation in the activity for 90 continuous days. To receive full credit for the IA component, most surgeons will be required to attest to having participated in two, three, or four activities depending on whether the activities chosen are of medium value or high value. This is not a change. However, those in small or rural practices must only participate in one or two activities to receive full credit. It should be noted that for 2018, one will be able to avoid a penalty in 2020 solely by fulfillment of the requirements imposed by the Improvement Activities component.
As mentioned above, CMS estimates that only approximately 622,000 providers out of the 1.2 million eligible will be required to submit data under MIPS. Many providers are excluded from MIPS based on the low-volume threshold. For 2018, CMS set this threshold at less than or equal to $90,000 in Medicare Part B charges OR less than or equal to 200 Medicare Part B beneficiaries. The effect of this change, compared to the values set for 2017 low-volume threshold, is to exclude more providers from MIPS reporting.
Lastly, many will remember that for 2017, the performance threshold was set at three points, and thus, required only minimal reporting in either quality, ACI, or IA to avoid a penalty. It was expected that the threshold necessary to avoid a penalty for 2018 performance would be increased and indeed, CMS has set that value at 15. Those scoring above 15 will be eligible for a positive update in their Medicare payments in 2020, while those scoring below 15 will receive a penalty. Those who choose to not participate in 2018 will receive a 5% penalty in 2020. However, two points made above warrant reiteration:
a) By fully participating in the IA component, one can accrue the 15 points necessary to avoid a penalty.
b) An EHR is not required to avoid a penalty.
In the coming weeks, we will be updating the QPP website (www.facs.org/qpp) to reflect the changes in the program for 2018. New videos will be available as will be new electronic and print materials to assist Fellows to participate in the program.
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
The interim final rule for the second year of Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) was released on November 2, 2017. This rule will apply to performance and reporting for calendar year 2018 and impact payment in 2020. Below, I have highlighted a few of the key components of the 1,653-page rule with special attention to the Merit-based Incentive Payment System (MIPS).
To briefly review, there are two pathways for participation in the QPP, namely MIPS and the Advanced Alternative Payment Models (A-APMs). For 2018, we still expect that the majority of surgeons eligible to participate in the QPP will do so via the MIPS pathway. That said, and for reasons discussed below, CMS estimates that approximately half of the 1.2 million MIPS-eligible clinicians will be required to submit MIPS data in 2018. In addition, CMS estimates that approximately 200,000 eligible clinicians will participate in the QPP in 2018 via the A-APMs.
1) Quality – For 2018, CMS continues to require reporting on six measures, one of which must be an outcome measure or other high-priority measure. Should surgeons choose to report on more than six measures, CMS will use the six with the highest score for purposes of calculating their score for the Quality component. However, CMS did increase the percentage of patients on which reporting is required, aka the completeness threshold, in 2018 to 60%. Measures submitted that fall below the completeness threshold will receive one point. Small practices will receive three points for measures that fail to meet the completeness threshold. Multiple options remain available for submission of data, i.e., electronic health record (EHR), Medicare claims, a qualified registry or a qualified clinical data registry (QCDR). For 2018, the Quality component will make up 50% of the MIPS final score.
Cost
Those familiar with the 2017 version of MIPS will remember that the Cost component was weighted at zero for the first year of the program. CMS discussed, and indeed, initially proposed, to continue weighing cost at zero for 2018. However, because current law requires CMS to weigh cost at 30% beginning with the 2019 performance period, CMS finalized a 10% weight for cost in 2018 with the goal of making the impact of the transition in 2019 less dramatic. CMS will base its calculation of the cost component on the total per capita costs for all beneficiaries attributed to a provider and the Medicare Spending per Beneficiary measure for the entirety of the 2018 performance period. CMS intends to provide performance feedback on both measures by July 1, 2018. Surgeons are not required to submit data for purposes of cost component.
Advancing Care Information (ACI)
There are no major changes to the scoring policy for 2018 and all the applicable Base Score measures must still be reported in order to receive a score for the ACI component. The performance period requirement remains a minimum of 90 continuous days. For 2018, both 2014 Edition and 2015 Edition certified electronic health record technology (CEHRT) remain acceptable. However, those using only a 2015 Edition will be eligible for a 10% bonus. Regardless of edition used , bonus points are also available for reporting to a public health agency or clinical data registry and for the completion of an Improvement Activity (IA) using CEHRT. A significant hardship exemption remains available for those in small practices. As was the case in 2017, the ACI component represents 25% of the final score. However, as was also the case in 2017, one is not required to have an electronic health record to avoid a penalty in 2018.
Improvement Activities
The weight assigned to the IA component remains at 15%. CMS added 21 new IAs in the final rule, bringing the number of IA available from which to choose up to well over 110. CMS also made changes to 27 activities previously adopted. Reporting remains a simple attestation of participation in the activity for 90 continuous days. To receive full credit for the IA component, most surgeons will be required to attest to having participated in two, three, or four activities depending on whether the activities chosen are of medium value or high value. This is not a change. However, those in small or rural practices must only participate in one or two activities to receive full credit. It should be noted that for 2018, one will be able to avoid a penalty in 2020 solely by fulfillment of the requirements imposed by the Improvement Activities component.
As mentioned above, CMS estimates that only approximately 622,000 providers out of the 1.2 million eligible will be required to submit data under MIPS. Many providers are excluded from MIPS based on the low-volume threshold. For 2018, CMS set this threshold at less than or equal to $90,000 in Medicare Part B charges OR less than or equal to 200 Medicare Part B beneficiaries. The effect of this change, compared to the values set for 2017 low-volume threshold, is to exclude more providers from MIPS reporting.
Lastly, many will remember that for 2017, the performance threshold was set at three points, and thus, required only minimal reporting in either quality, ACI, or IA to avoid a penalty. It was expected that the threshold necessary to avoid a penalty for 2018 performance would be increased and indeed, CMS has set that value at 15. Those scoring above 15 will be eligible for a positive update in their Medicare payments in 2020, while those scoring below 15 will receive a penalty. Those who choose to not participate in 2018 will receive a 5% penalty in 2020. However, two points made above warrant reiteration:
a) By fully participating in the IA component, one can accrue the 15 points necessary to avoid a penalty.
b) An EHR is not required to avoid a penalty.
In the coming weeks, we will be updating the QPP website (www.facs.org/qpp) to reflect the changes in the program for 2018. New videos will be available as will be new electronic and print materials to assist Fellows to participate in the program.
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
From the Washington Office: Taking action
As we head into the last few weeks of the first session of the 115th Congress, it is likely that several pieces of “must pass” legislation will move through the process of becoming law. This “must pass” legislation can serve as a vehicle onto which other bills are attached and thus, also move successfully through the process for passage. I have highlighted below three such bills from the Action Alert section of the SurgeonsVoice website (www.surgeonsvoice.com) which could, with less than 5 minutes of your time, develop enough forward momentum to so move.
Ensuring Access to General Surgery Act
Increasing evidence indicates a current and growing shortage of surgeons available to serve our nation’s population. A shortage of general surgeons is a critical component of the crisis in health care workforce because only surgeons are uniquely trained and qualified to provide certain necessary, lifesaving procedures. Accordingly, the American College of Surgeons (ACS) is urging policy makers to recognize, through the designation of a formal surgical shortage area, that surgeons are an essential component of a community based health care system.
Unlike other key providers of the community-based health care system, general surgeons do not currently have a formal workforce shortage area designation. In light of growing evidence demonstrating a shortage of general surgeons, ACS believes that more accurate and actionable workforce data are necessary to determine exactly what constitutes a surgical shortage area for general surgery, and where these areas exist. Identifying where patients lack access to surgical services will provide HRSA with a valuable new tool for increasing access to the full spectrum of high-quality health care services. Determining what constitutes and defines a surgical shortage area is an important first step in guaranteeing all Medicare beneficiaries, regardless of geographic location, have access to quality surgical care.
Mission Zero Act
It has long been a priority of the ACS to establish and maintain high-quality and adequately-funded trauma systems throughout the U.S., including within the Armed Forces. The Mission Zero Act, introduced by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Gene Green (D-TX), Richard Hudson (R-NC), and Kathy Castor (D-FL) in the House of Representatives and Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL) in the Senate, would provide HHS grant funding to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality trauma care. As a result of these partnerships, military trauma care teams and providers will gain exposure treating critically injured patients and increase readiness for future deployments. Not only will this serve to maintain readiness among military providers, but it will facilitate the promulgation of the trauma lessons learned from the military theatres of conflict to the civilian world and potentially alleviate staffing shortages in civilian centers.
CHIP Funding
The Children’s Health Insurance Program (CHIP) is a joint federal and state program that provides health coverage to uninsured children from low-income families. In 2015, the CHIP program provided coverage to over 8 million children in the United States. In sum, CHIP ensures that these children have access to care. The ACS is very supportive of the CHIP program. The CHIP program ensures that a child’s health care concerns are addressed in a timely manner. Contrary to popular belief, many children currently covered by CHIP are not eligible to be covered under Medicaid and would therefore, be left uninsured if CHIP funding is not continued. The most recent reauthorization of this program extended funding for the CHIP program through Sept. 30, 2017, and funding for the program expired on that date. Urgent Congressional action is needed to reauthorize funding and thus, ensure that the children covered by CHIP continue to have access to the health care services they need.
The ACS strongly urges Congress to continue to make children’s health care a priority issue and accordingly, implores Congress to take action to reauthorize CHIP funding prior to concluding the business of the current session.
The SurgeonsVoice website provides an easy and efficient platform for surgeons to use to contact their senators and their representative to let them know of their support of these issues. Taking action on all three of these items would require the investment of less than 5 minutes of one’s valuable time. Our ability “to petition the government for a redress of grievances” is guaranteed by the First Amendment. I urge all Fellows to visit the SurgeonsVoice website and use it as a tool to exercise that right.
Until next month ….
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
As we head into the last few weeks of the first session of the 115th Congress, it is likely that several pieces of “must pass” legislation will move through the process of becoming law. This “must pass” legislation can serve as a vehicle onto which other bills are attached and thus, also move successfully through the process for passage. I have highlighted below three such bills from the Action Alert section of the SurgeonsVoice website (www.surgeonsvoice.com) which could, with less than 5 minutes of your time, develop enough forward momentum to so move.
Ensuring Access to General Surgery Act
Increasing evidence indicates a current and growing shortage of surgeons available to serve our nation’s population. A shortage of general surgeons is a critical component of the crisis in health care workforce because only surgeons are uniquely trained and qualified to provide certain necessary, lifesaving procedures. Accordingly, the American College of Surgeons (ACS) is urging policy makers to recognize, through the designation of a formal surgical shortage area, that surgeons are an essential component of a community based health care system.
Unlike other key providers of the community-based health care system, general surgeons do not currently have a formal workforce shortage area designation. In light of growing evidence demonstrating a shortage of general surgeons, ACS believes that more accurate and actionable workforce data are necessary to determine exactly what constitutes a surgical shortage area for general surgery, and where these areas exist. Identifying where patients lack access to surgical services will provide HRSA with a valuable new tool for increasing access to the full spectrum of high-quality health care services. Determining what constitutes and defines a surgical shortage area is an important first step in guaranteeing all Medicare beneficiaries, regardless of geographic location, have access to quality surgical care.
Mission Zero Act
It has long been a priority of the ACS to establish and maintain high-quality and adequately-funded trauma systems throughout the U.S., including within the Armed Forces. The Mission Zero Act, introduced by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Gene Green (D-TX), Richard Hudson (R-NC), and Kathy Castor (D-FL) in the House of Representatives and Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL) in the Senate, would provide HHS grant funding to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality trauma care. As a result of these partnerships, military trauma care teams and providers will gain exposure treating critically injured patients and increase readiness for future deployments. Not only will this serve to maintain readiness among military providers, but it will facilitate the promulgation of the trauma lessons learned from the military theatres of conflict to the civilian world and potentially alleviate staffing shortages in civilian centers.
CHIP Funding
The Children’s Health Insurance Program (CHIP) is a joint federal and state program that provides health coverage to uninsured children from low-income families. In 2015, the CHIP program provided coverage to over 8 million children in the United States. In sum, CHIP ensures that these children have access to care. The ACS is very supportive of the CHIP program. The CHIP program ensures that a child’s health care concerns are addressed in a timely manner. Contrary to popular belief, many children currently covered by CHIP are not eligible to be covered under Medicaid and would therefore, be left uninsured if CHIP funding is not continued. The most recent reauthorization of this program extended funding for the CHIP program through Sept. 30, 2017, and funding for the program expired on that date. Urgent Congressional action is needed to reauthorize funding and thus, ensure that the children covered by CHIP continue to have access to the health care services they need.
The ACS strongly urges Congress to continue to make children’s health care a priority issue and accordingly, implores Congress to take action to reauthorize CHIP funding prior to concluding the business of the current session.
The SurgeonsVoice website provides an easy and efficient platform for surgeons to use to contact their senators and their representative to let them know of their support of these issues. Taking action on all three of these items would require the investment of less than 5 minutes of one’s valuable time. Our ability “to petition the government for a redress of grievances” is guaranteed by the First Amendment. I urge all Fellows to visit the SurgeonsVoice website and use it as a tool to exercise that right.
Until next month ….
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
As we head into the last few weeks of the first session of the 115th Congress, it is likely that several pieces of “must pass” legislation will move through the process of becoming law. This “must pass” legislation can serve as a vehicle onto which other bills are attached and thus, also move successfully through the process for passage. I have highlighted below three such bills from the Action Alert section of the SurgeonsVoice website (www.surgeonsvoice.com) which could, with less than 5 minutes of your time, develop enough forward momentum to so move.
Ensuring Access to General Surgery Act
Increasing evidence indicates a current and growing shortage of surgeons available to serve our nation’s population. A shortage of general surgeons is a critical component of the crisis in health care workforce because only surgeons are uniquely trained and qualified to provide certain necessary, lifesaving procedures. Accordingly, the American College of Surgeons (ACS) is urging policy makers to recognize, through the designation of a formal surgical shortage area, that surgeons are an essential component of a community based health care system.
Unlike other key providers of the community-based health care system, general surgeons do not currently have a formal workforce shortage area designation. In light of growing evidence demonstrating a shortage of general surgeons, ACS believes that more accurate and actionable workforce data are necessary to determine exactly what constitutes a surgical shortage area for general surgery, and where these areas exist. Identifying where patients lack access to surgical services will provide HRSA with a valuable new tool for increasing access to the full spectrum of high-quality health care services. Determining what constitutes and defines a surgical shortage area is an important first step in guaranteeing all Medicare beneficiaries, regardless of geographic location, have access to quality surgical care.
Mission Zero Act
It has long been a priority of the ACS to establish and maintain high-quality and adequately-funded trauma systems throughout the U.S., including within the Armed Forces. The Mission Zero Act, introduced by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Gene Green (D-TX), Richard Hudson (R-NC), and Kathy Castor (D-FL) in the House of Representatives and Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL) in the Senate, would provide HHS grant funding to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality trauma care. As a result of these partnerships, military trauma care teams and providers will gain exposure treating critically injured patients and increase readiness for future deployments. Not only will this serve to maintain readiness among military providers, but it will facilitate the promulgation of the trauma lessons learned from the military theatres of conflict to the civilian world and potentially alleviate staffing shortages in civilian centers.
CHIP Funding
The Children’s Health Insurance Program (CHIP) is a joint federal and state program that provides health coverage to uninsured children from low-income families. In 2015, the CHIP program provided coverage to over 8 million children in the United States. In sum, CHIP ensures that these children have access to care. The ACS is very supportive of the CHIP program. The CHIP program ensures that a child’s health care concerns are addressed in a timely manner. Contrary to popular belief, many children currently covered by CHIP are not eligible to be covered under Medicaid and would therefore, be left uninsured if CHIP funding is not continued. The most recent reauthorization of this program extended funding for the CHIP program through Sept. 30, 2017, and funding for the program expired on that date. Urgent Congressional action is needed to reauthorize funding and thus, ensure that the children covered by CHIP continue to have access to the health care services they need.
The ACS strongly urges Congress to continue to make children’s health care a priority issue and accordingly, implores Congress to take action to reauthorize CHIP funding prior to concluding the business of the current session.
The SurgeonsVoice website provides an easy and efficient platform for surgeons to use to contact their senators and their representative to let them know of their support of these issues. Taking action on all three of these items would require the investment of less than 5 minutes of one’s valuable time. Our ability “to petition the government for a redress of grievances” is guaranteed by the First Amendment. I urge all Fellows to visit the SurgeonsVoice website and use it as a tool to exercise that right.
Until next month ….
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
From the Washington Office: Lessons learned from a faithful reader – A tribute to Daniel M. Caruso, MD, FACS
One of the most difficult and unpleasant aspects of being middle-aged is beginning to experience the loss of friends and colleagues who have had a profound impact on one’s life. Those who have been, or continue to be, associated with the department of surgery of Maricopa Medical Center in Phoenix recently experienced such a loss with the passing of Daniel M. Caruso, MD, FACS, after a very determined and utterly courageous battle with cancer.
I first came to know Dan 9 years ago when Maricopa Medical Center’s need for a pediatric surgeon and my desire for a different practice situation in the Phoenix area converged, resulting in my becoming a member of his faculty. As my chairman and my friend, Dan had a significant positive impact on me, and though he was chronologically several years my junior, he taught and reinforced life lessons that I will forever carry forward. He was also a faithful reader of this column, and whenever I saw him in Arizona, he always had a kind word about my monthly efforts presented here.
Perhaps Dan’s most admirable trait was his loyalty. He was fiercely loyal to me, his other faculty, the staff of the Arizona Burn Center, and his resident trainees. In turn, he instilled in all around him a profound sense of loyalty to both himself and our department. Nothing exemplifies this better than the “leave no stone unturned” care he received from current faculty, hospital staff, and his former trainees over the last months of his life. In short, he was the leader of his pack.
Dan’s loyalty was not of the “fair weather” sort; it prevailed even in the face of potential adverse circumstances that promised to actually cause him more grief. Nor was his loyalty blind and without limits, as all who were ever in contentious conversation with him have likely been reminded, “I am Sicilian. Don’t put a gun to my head.” That said, his loyalty was, like everything else about him, appropriately measured and extraordinarily genuine, providing for all of us an example toward which to strive.
Being measured in all one’s responses to the adversity presented by others is another valuable lesson Dan taught me. I can only imagine the headaches, anxiety, and stress of being the chair of a department largely made up of “passionate” mid-career surgeons during tumultuous times of continuous change. Despite the fact that many of us frequently urged him to be more forceful, just say “no,” or otherwise flex his or our collective muscle, Dan was forever the calm voice in the storm, reacting in a measured way that was much more reminiscent of honey than vinegar. Dan provided indisputable evidence that your grandmother was correct when she told you that you will catch more flies that way.
Nowhere were these qualities more preeminently displayed than in the administration of the surgical residency program at Maricopa. As is common to most academically affiliated, community-based surgery programs, much of our collective identity as a department was cloaked in the residency program and our trainees. Being a product of the program himself, Dan was the consummate “keeper of the flame.” He was also a superb judge of character and surgical aptitude and the unsurpassed prophet of future success. He was a passionate advocate for those residents in whom he saw promise even when his view was aggressively challenged by others in the department who felt otherwise.
In the case of residents whose flaws in the form of either “expressions of youth” or academic performance caused some faculty to have a negative opinion, Dan remained singularly focused on what he saw as their future potential. He not only protected them, but also saw to it that they were provided every resource available to succeed. He ensured that all trainees who met his muster by working hard and taking excellent care of the patients were given every opportunity to succeed. When appropriate and necessary, his profound insight into others’ talents combined with his compassionate demeanor made him particularly well suited to make suggestions, to the very few, that they might be happier and more successful in a specialty other than surgery. In sum, he had an unsurpassed passion for training the next generation of surgeons, paying it forward into the future as he went.
Dan had both a profound sense of justice and a keen political sense about how and when to strategically best use his position and influence to ensure fairness of outcomes. Amongst his faculty, he was particularly adept at discerning whose talents were best suited to specific tasks and thus, whom he should assign to ensure the optimal outcome for the department, our trainees, and our patients. When once I met with him to express my profound concerns relative to how members of our department were being treated by a certain hospital committee, his response was to act swiftly to ensure that I was appointed to that committee. By doing so, he showed that he trusted my judgment to look out for the interests of our department whilst simultaneously resolving my own concerns. He also gently reinforced the valuable life lesson of not going to your boss only with a problem. Take along that potential solution as well.
As I look forward to Clinical Congress and seeing familiar faces from the “Copa,” past and present, I anticipate many firm handshakes and warm embraces as well as a few tears shed in shared grief. Plain and simple, Dan was the consummate critical care/burn surgeon, a passionate surgical educator, and overall, epitomized the phrase, “great guy.” Our world is a far better place because of his 53 years of labor in the fields of this life.
Somewhere, a red Ferrari with a Detroit Lions license plate is humming down a flat stretch of highway at a clearly excessive rate of speed with Bob Seger blasting from the stereo ...
Well done, my friend. Very well done.
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
One of the most difficult and unpleasant aspects of being middle-aged is beginning to experience the loss of friends and colleagues who have had a profound impact on one’s life. Those who have been, or continue to be, associated with the department of surgery of Maricopa Medical Center in Phoenix recently experienced such a loss with the passing of Daniel M. Caruso, MD, FACS, after a very determined and utterly courageous battle with cancer.
I first came to know Dan 9 years ago when Maricopa Medical Center’s need for a pediatric surgeon and my desire for a different practice situation in the Phoenix area converged, resulting in my becoming a member of his faculty. As my chairman and my friend, Dan had a significant positive impact on me, and though he was chronologically several years my junior, he taught and reinforced life lessons that I will forever carry forward. He was also a faithful reader of this column, and whenever I saw him in Arizona, he always had a kind word about my monthly efforts presented here.
Perhaps Dan’s most admirable trait was his loyalty. He was fiercely loyal to me, his other faculty, the staff of the Arizona Burn Center, and his resident trainees. In turn, he instilled in all around him a profound sense of loyalty to both himself and our department. Nothing exemplifies this better than the “leave no stone unturned” care he received from current faculty, hospital staff, and his former trainees over the last months of his life. In short, he was the leader of his pack.
Dan’s loyalty was not of the “fair weather” sort; it prevailed even in the face of potential adverse circumstances that promised to actually cause him more grief. Nor was his loyalty blind and without limits, as all who were ever in contentious conversation with him have likely been reminded, “I am Sicilian. Don’t put a gun to my head.” That said, his loyalty was, like everything else about him, appropriately measured and extraordinarily genuine, providing for all of us an example toward which to strive.
Being measured in all one’s responses to the adversity presented by others is another valuable lesson Dan taught me. I can only imagine the headaches, anxiety, and stress of being the chair of a department largely made up of “passionate” mid-career surgeons during tumultuous times of continuous change. Despite the fact that many of us frequently urged him to be more forceful, just say “no,” or otherwise flex his or our collective muscle, Dan was forever the calm voice in the storm, reacting in a measured way that was much more reminiscent of honey than vinegar. Dan provided indisputable evidence that your grandmother was correct when she told you that you will catch more flies that way.
Nowhere were these qualities more preeminently displayed than in the administration of the surgical residency program at Maricopa. As is common to most academically affiliated, community-based surgery programs, much of our collective identity as a department was cloaked in the residency program and our trainees. Being a product of the program himself, Dan was the consummate “keeper of the flame.” He was also a superb judge of character and surgical aptitude and the unsurpassed prophet of future success. He was a passionate advocate for those residents in whom he saw promise even when his view was aggressively challenged by others in the department who felt otherwise.
In the case of residents whose flaws in the form of either “expressions of youth” or academic performance caused some faculty to have a negative opinion, Dan remained singularly focused on what he saw as their future potential. He not only protected them, but also saw to it that they were provided every resource available to succeed. He ensured that all trainees who met his muster by working hard and taking excellent care of the patients were given every opportunity to succeed. When appropriate and necessary, his profound insight into others’ talents combined with his compassionate demeanor made him particularly well suited to make suggestions, to the very few, that they might be happier and more successful in a specialty other than surgery. In sum, he had an unsurpassed passion for training the next generation of surgeons, paying it forward into the future as he went.
Dan had both a profound sense of justice and a keen political sense about how and when to strategically best use his position and influence to ensure fairness of outcomes. Amongst his faculty, he was particularly adept at discerning whose talents were best suited to specific tasks and thus, whom he should assign to ensure the optimal outcome for the department, our trainees, and our patients. When once I met with him to express my profound concerns relative to how members of our department were being treated by a certain hospital committee, his response was to act swiftly to ensure that I was appointed to that committee. By doing so, he showed that he trusted my judgment to look out for the interests of our department whilst simultaneously resolving my own concerns. He also gently reinforced the valuable life lesson of not going to your boss only with a problem. Take along that potential solution as well.
As I look forward to Clinical Congress and seeing familiar faces from the “Copa,” past and present, I anticipate many firm handshakes and warm embraces as well as a few tears shed in shared grief. Plain and simple, Dan was the consummate critical care/burn surgeon, a passionate surgical educator, and overall, epitomized the phrase, “great guy.” Our world is a far better place because of his 53 years of labor in the fields of this life.
Somewhere, a red Ferrari with a Detroit Lions license plate is humming down a flat stretch of highway at a clearly excessive rate of speed with Bob Seger blasting from the stereo ...
Well done, my friend. Very well done.
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
One of the most difficult and unpleasant aspects of being middle-aged is beginning to experience the loss of friends and colleagues who have had a profound impact on one’s life. Those who have been, or continue to be, associated with the department of surgery of Maricopa Medical Center in Phoenix recently experienced such a loss with the passing of Daniel M. Caruso, MD, FACS, after a very determined and utterly courageous battle with cancer.
I first came to know Dan 9 years ago when Maricopa Medical Center’s need for a pediatric surgeon and my desire for a different practice situation in the Phoenix area converged, resulting in my becoming a member of his faculty. As my chairman and my friend, Dan had a significant positive impact on me, and though he was chronologically several years my junior, he taught and reinforced life lessons that I will forever carry forward. He was also a faithful reader of this column, and whenever I saw him in Arizona, he always had a kind word about my monthly efforts presented here.
Perhaps Dan’s most admirable trait was his loyalty. He was fiercely loyal to me, his other faculty, the staff of the Arizona Burn Center, and his resident trainees. In turn, he instilled in all around him a profound sense of loyalty to both himself and our department. Nothing exemplifies this better than the “leave no stone unturned” care he received from current faculty, hospital staff, and his former trainees over the last months of his life. In short, he was the leader of his pack.
Dan’s loyalty was not of the “fair weather” sort; it prevailed even in the face of potential adverse circumstances that promised to actually cause him more grief. Nor was his loyalty blind and without limits, as all who were ever in contentious conversation with him have likely been reminded, “I am Sicilian. Don’t put a gun to my head.” That said, his loyalty was, like everything else about him, appropriately measured and extraordinarily genuine, providing for all of us an example toward which to strive.
Being measured in all one’s responses to the adversity presented by others is another valuable lesson Dan taught me. I can only imagine the headaches, anxiety, and stress of being the chair of a department largely made up of “passionate” mid-career surgeons during tumultuous times of continuous change. Despite the fact that many of us frequently urged him to be more forceful, just say “no,” or otherwise flex his or our collective muscle, Dan was forever the calm voice in the storm, reacting in a measured way that was much more reminiscent of honey than vinegar. Dan provided indisputable evidence that your grandmother was correct when she told you that you will catch more flies that way.
Nowhere were these qualities more preeminently displayed than in the administration of the surgical residency program at Maricopa. As is common to most academically affiliated, community-based surgery programs, much of our collective identity as a department was cloaked in the residency program and our trainees. Being a product of the program himself, Dan was the consummate “keeper of the flame.” He was also a superb judge of character and surgical aptitude and the unsurpassed prophet of future success. He was a passionate advocate for those residents in whom he saw promise even when his view was aggressively challenged by others in the department who felt otherwise.
In the case of residents whose flaws in the form of either “expressions of youth” or academic performance caused some faculty to have a negative opinion, Dan remained singularly focused on what he saw as their future potential. He not only protected them, but also saw to it that they were provided every resource available to succeed. He ensured that all trainees who met his muster by working hard and taking excellent care of the patients were given every opportunity to succeed. When appropriate and necessary, his profound insight into others’ talents combined with his compassionate demeanor made him particularly well suited to make suggestions, to the very few, that they might be happier and more successful in a specialty other than surgery. In sum, he had an unsurpassed passion for training the next generation of surgeons, paying it forward into the future as he went.
Dan had both a profound sense of justice and a keen political sense about how and when to strategically best use his position and influence to ensure fairness of outcomes. Amongst his faculty, he was particularly adept at discerning whose talents were best suited to specific tasks and thus, whom he should assign to ensure the optimal outcome for the department, our trainees, and our patients. When once I met with him to express my profound concerns relative to how members of our department were being treated by a certain hospital committee, his response was to act swiftly to ensure that I was appointed to that committee. By doing so, he showed that he trusted my judgment to look out for the interests of our department whilst simultaneously resolving my own concerns. He also gently reinforced the valuable life lesson of not going to your boss only with a problem. Take along that potential solution as well.
As I look forward to Clinical Congress and seeing familiar faces from the “Copa,” past and present, I anticipate many firm handshakes and warm embraces as well as a few tears shed in shared grief. Plain and simple, Dan was the consummate critical care/burn surgeon, a passionate surgical educator, and overall, epitomized the phrase, “great guy.” Our world is a far better place because of his 53 years of labor in the fields of this life.
Somewhere, a red Ferrari with a Detroit Lions license plate is humming down a flat stretch of highway at a clearly excessive rate of speed with Bob Seger blasting from the stereo ...
Well done, my friend. Very well done.
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
From the Washington Office: Receiving an increase in Medicare payment and avoiding a penalty
We are now well over halfway through 2017, the initial year of the new Quality Payment Program (QPP) mandated by MACRA. Accordingly, I thought it might be useful to revisit the topic of the QPP and MIPS (Merit-based Incentive Payment System) for purposes of emphasizing the key steps surgeons should take if they want to potentially see an increase in their Medicare physician payment in 2019 based on their performance in 2017. At the same time, I also want to make sure that all surgeons understand the ease with which they can avoid a payment penalty.
First, I want to assure all who have yet to take any action that there is still more than adequate time to do so. You absolutely can still compete for a positive update, or at a minimum, avoid a penalty. Further, it is so easy to avoid a penalty that no surgeon should be resigned to accepting a penalty without having a look at the minimal reporting requirements necessary to avoid it.
One of the resources available on the ACS’ QPP website is an algorhythm intended to simplify surgeons’ decision making at their initial starting point. It is reproduced below:
1. Determine if all of your MIPS data will be reported by your institution or group via a Group Reporting option (GPRO).
a. If “YES,” you are done.
b. If “NO,” move to number 2.
2. Has CMS notified you that you are exempt from participating in MIPS due to the low-volume threshold?
a. If “YES,” you are done.
b. If “NO,” move to number 3.
3. If you want to compete for positive updates in your Medicare payment rates in 2019 (based on 2017 reporting), read the ACS Quality Payment Program Manual, watch the videos, and develop your plan.
4. If your goal is simply to avoid a penalty, CMS only requires data be reported for one of the following:
a. Required Base Score measures for your EHR (now known as Advancing Care Information) OR
b. One Improvement Activity for 90 days (report by attestation) OR
c. One Quality Measure on one patient (report by registry, QCDR, EHR, or claims)
Note: One is NOT required to have a certified EHR to avoid a penalty for 2017
5. If you did not report PQRS data and did not participate in the electronic health record meaningful use program in 2016 and have no intention of participating in MIPS in 2017:
a. Your lack of participation in 2016 programs will lead to a 10% negative payment adjustment in 2018.
b. Your lack of participation in MIPS in 2017 will lead to a 4% negative payment adjustment in 2019.
Note: This option is not recommended, as in future years the annual cuts will gradually increase to 9%.
MIPS is set up as a tournament model. In other words, “Losers” pay for “Winners.” Please do not put your money in someone else’s pocket. The ACS strongly encourages all Fellows to, at the minimum, participate at the level sufficient to avoid a penalty in 2017 and, thus, not serve as the “pay for” for another provider.
If you are not exempt from MIPS and therefore, one whose performance will be assessed in 2017, you still have plenty of time to start the process of reporting enough data to compete for a positive update. On the other hand, if your goal is simply to avoid a penalty in 2019, (based on your performance in 2017), you should take the few simple steps necessary to preclude such as outlined above.
We believe the QPP website, (www.facs.org/qpp), is an excellent resource for surgeons. It was designed to facilitate participation by those surgeons who must report for MIPS. As always, ACS staff are also available to answer your questions by phone or via e-mail: [email protected].
Until next month ….
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
We are now well over halfway through 2017, the initial year of the new Quality Payment Program (QPP) mandated by MACRA. Accordingly, I thought it might be useful to revisit the topic of the QPP and MIPS (Merit-based Incentive Payment System) for purposes of emphasizing the key steps surgeons should take if they want to potentially see an increase in their Medicare physician payment in 2019 based on their performance in 2017. At the same time, I also want to make sure that all surgeons understand the ease with which they can avoid a payment penalty.
First, I want to assure all who have yet to take any action that there is still more than adequate time to do so. You absolutely can still compete for a positive update, or at a minimum, avoid a penalty. Further, it is so easy to avoid a penalty that no surgeon should be resigned to accepting a penalty without having a look at the minimal reporting requirements necessary to avoid it.
One of the resources available on the ACS’ QPP website is an algorhythm intended to simplify surgeons’ decision making at their initial starting point. It is reproduced below:
1. Determine if all of your MIPS data will be reported by your institution or group via a Group Reporting option (GPRO).
a. If “YES,” you are done.
b. If “NO,” move to number 2.
2. Has CMS notified you that you are exempt from participating in MIPS due to the low-volume threshold?
a. If “YES,” you are done.
b. If “NO,” move to number 3.
3. If you want to compete for positive updates in your Medicare payment rates in 2019 (based on 2017 reporting), read the ACS Quality Payment Program Manual, watch the videos, and develop your plan.
4. If your goal is simply to avoid a penalty, CMS only requires data be reported for one of the following:
a. Required Base Score measures for your EHR (now known as Advancing Care Information) OR
b. One Improvement Activity for 90 days (report by attestation) OR
c. One Quality Measure on one patient (report by registry, QCDR, EHR, or claims)
Note: One is NOT required to have a certified EHR to avoid a penalty for 2017
5. If you did not report PQRS data and did not participate in the electronic health record meaningful use program in 2016 and have no intention of participating in MIPS in 2017:
a. Your lack of participation in 2016 programs will lead to a 10% negative payment adjustment in 2018.
b. Your lack of participation in MIPS in 2017 will lead to a 4% negative payment adjustment in 2019.
Note: This option is not recommended, as in future years the annual cuts will gradually increase to 9%.
MIPS is set up as a tournament model. In other words, “Losers” pay for “Winners.” Please do not put your money in someone else’s pocket. The ACS strongly encourages all Fellows to, at the minimum, participate at the level sufficient to avoid a penalty in 2017 and, thus, not serve as the “pay for” for another provider.
If you are not exempt from MIPS and therefore, one whose performance will be assessed in 2017, you still have plenty of time to start the process of reporting enough data to compete for a positive update. On the other hand, if your goal is simply to avoid a penalty in 2019, (based on your performance in 2017), you should take the few simple steps necessary to preclude such as outlined above.
We believe the QPP website, (www.facs.org/qpp), is an excellent resource for surgeons. It was designed to facilitate participation by those surgeons who must report for MIPS. As always, ACS staff are also available to answer your questions by phone or via e-mail: [email protected].
Until next month ….
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
We are now well over halfway through 2017, the initial year of the new Quality Payment Program (QPP) mandated by MACRA. Accordingly, I thought it might be useful to revisit the topic of the QPP and MIPS (Merit-based Incentive Payment System) for purposes of emphasizing the key steps surgeons should take if they want to potentially see an increase in their Medicare physician payment in 2019 based on their performance in 2017. At the same time, I also want to make sure that all surgeons understand the ease with which they can avoid a payment penalty.
First, I want to assure all who have yet to take any action that there is still more than adequate time to do so. You absolutely can still compete for a positive update, or at a minimum, avoid a penalty. Further, it is so easy to avoid a penalty that no surgeon should be resigned to accepting a penalty without having a look at the minimal reporting requirements necessary to avoid it.
One of the resources available on the ACS’ QPP website is an algorhythm intended to simplify surgeons’ decision making at their initial starting point. It is reproduced below:
1. Determine if all of your MIPS data will be reported by your institution or group via a Group Reporting option (GPRO).
a. If “YES,” you are done.
b. If “NO,” move to number 2.
2. Has CMS notified you that you are exempt from participating in MIPS due to the low-volume threshold?
a. If “YES,” you are done.
b. If “NO,” move to number 3.
3. If you want to compete for positive updates in your Medicare payment rates in 2019 (based on 2017 reporting), read the ACS Quality Payment Program Manual, watch the videos, and develop your plan.
4. If your goal is simply to avoid a penalty, CMS only requires data be reported for one of the following:
a. Required Base Score measures for your EHR (now known as Advancing Care Information) OR
b. One Improvement Activity for 90 days (report by attestation) OR
c. One Quality Measure on one patient (report by registry, QCDR, EHR, or claims)
Note: One is NOT required to have a certified EHR to avoid a penalty for 2017
5. If you did not report PQRS data and did not participate in the electronic health record meaningful use program in 2016 and have no intention of participating in MIPS in 2017:
a. Your lack of participation in 2016 programs will lead to a 10% negative payment adjustment in 2018.
b. Your lack of participation in MIPS in 2017 will lead to a 4% negative payment adjustment in 2019.
Note: This option is not recommended, as in future years the annual cuts will gradually increase to 9%.
MIPS is set up as a tournament model. In other words, “Losers” pay for “Winners.” Please do not put your money in someone else’s pocket. The ACS strongly encourages all Fellows to, at the minimum, participate at the level sufficient to avoid a penalty in 2017 and, thus, not serve as the “pay for” for another provider.
If you are not exempt from MIPS and therefore, one whose performance will be assessed in 2017, you still have plenty of time to start the process of reporting enough data to compete for a positive update. On the other hand, if your goal is simply to avoid a penalty in 2019, (based on your performance in 2017), you should take the few simple steps necessary to preclude such as outlined above.
We believe the QPP website, (www.facs.org/qpp), is an excellent resource for surgeons. It was designed to facilitate participation by those surgeons who must report for MIPS. As always, ACS staff are also available to answer your questions by phone or via e-mail: [email protected].
Until next month ….
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
From the Washington Office: The Mission Zero Act
Surgeons are well familiar with the statistic from the Centers for Disease Control and Prevention (CDC) identifying trauma as the leading cause of death for children and adults under age 44. More Americans lose their lives each year to trauma than to AIDS and stroke combined. Unfortunately, nearly 45 million Americans live in areas more than an hour away from either a Level I or II trauma center. Ensuring access to trauma care requires many crucial components including trauma centers and appropriately trained physicians and nurses, all of which must dedicate extensive resources around the clock so that seriously injured patients have the best possible chance for survival.
It has long been a top legislative priority of the ACS to establish and maintain adequate funding for high-quality trauma systems throughout the United States, including those systems operated by our armed forces.The ACS was a sponsor of the National Academy of Medicine (NAM) report entitled, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. This report, released in June of 2016, outlines the steps necessary to secure a national trauma system and sets the goal of achieving zero preventable traumatic deaths.
In an effort to facilitate the achievement of the goals laid out in the report, The Mission Zero Act (H.R. 880) was introduced in the House of Representatives by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Cathy Castor (D-FL), Gene Green (D-TX), and Richard Hudson (R-NC). Identical companion legislation was introduced in the Senate (S.1022) by Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL). The Mission Zero Act creates a grant program to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality of trauma care in times of peace and war, thus taking a step in the direction of the NAM report recommendations.
Specifically, the legislation provides for:
• $40 million in grants to fund military trauma teams and providers to embed into civilian trauma facilities.
o Trauma centers are eligible for a $1 million grant to host military trauma teams at eligible high-acuity level 1 trauma centers
o Trauma centers are also eligible for grants to host individual providers ($100,000 for physician or $50,000 for non-physician providers) at eligible level I, II, or III trauma centers
As of today, the House and Senate versions of the Mission Zero Act have 25co-sponsors and 2 co-sponsors respectively. The ACS would very much like to build some momentum for the Mission Zero Act going into the fall when it is expected that there will be several large “must pass” pieces of legislation working their way through Congress to which the Mission Zero Act could potentially be attached. Accordingly, I respectfully ask all Fellows to take a few moments to visit the SurgeonsVoice website at www.surgeonsvoice.org, click on the Take Action tab on the right side of the page and send a message to their individual representatives and senators seeking support for this important legislation.
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Surgeons are well familiar with the statistic from the Centers for Disease Control and Prevention (CDC) identifying trauma as the leading cause of death for children and adults under age 44. More Americans lose their lives each year to trauma than to AIDS and stroke combined. Unfortunately, nearly 45 million Americans live in areas more than an hour away from either a Level I or II trauma center. Ensuring access to trauma care requires many crucial components including trauma centers and appropriately trained physicians and nurses, all of which must dedicate extensive resources around the clock so that seriously injured patients have the best possible chance for survival.
It has long been a top legislative priority of the ACS to establish and maintain adequate funding for high-quality trauma systems throughout the United States, including those systems operated by our armed forces.The ACS was a sponsor of the National Academy of Medicine (NAM) report entitled, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. This report, released in June of 2016, outlines the steps necessary to secure a national trauma system and sets the goal of achieving zero preventable traumatic deaths.
In an effort to facilitate the achievement of the goals laid out in the report, The Mission Zero Act (H.R. 880) was introduced in the House of Representatives by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Cathy Castor (D-FL), Gene Green (D-TX), and Richard Hudson (R-NC). Identical companion legislation was introduced in the Senate (S.1022) by Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL). The Mission Zero Act creates a grant program to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality of trauma care in times of peace and war, thus taking a step in the direction of the NAM report recommendations.
Specifically, the legislation provides for:
• $40 million in grants to fund military trauma teams and providers to embed into civilian trauma facilities.
o Trauma centers are eligible for a $1 million grant to host military trauma teams at eligible high-acuity level 1 trauma centers
o Trauma centers are also eligible for grants to host individual providers ($100,000 for physician or $50,000 for non-physician providers) at eligible level I, II, or III trauma centers
As of today, the House and Senate versions of the Mission Zero Act have 25co-sponsors and 2 co-sponsors respectively. The ACS would very much like to build some momentum for the Mission Zero Act going into the fall when it is expected that there will be several large “must pass” pieces of legislation working their way through Congress to which the Mission Zero Act could potentially be attached. Accordingly, I respectfully ask all Fellows to take a few moments to visit the SurgeonsVoice website at www.surgeonsvoice.org, click on the Take Action tab on the right side of the page and send a message to their individual representatives and senators seeking support for this important legislation.
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Surgeons are well familiar with the statistic from the Centers for Disease Control and Prevention (CDC) identifying trauma as the leading cause of death for children and adults under age 44. More Americans lose their lives each year to trauma than to AIDS and stroke combined. Unfortunately, nearly 45 million Americans live in areas more than an hour away from either a Level I or II trauma center. Ensuring access to trauma care requires many crucial components including trauma centers and appropriately trained physicians and nurses, all of which must dedicate extensive resources around the clock so that seriously injured patients have the best possible chance for survival.
It has long been a top legislative priority of the ACS to establish and maintain adequate funding for high-quality trauma systems throughout the United States, including those systems operated by our armed forces.The ACS was a sponsor of the National Academy of Medicine (NAM) report entitled, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. This report, released in June of 2016, outlines the steps necessary to secure a national trauma system and sets the goal of achieving zero preventable traumatic deaths.
In an effort to facilitate the achievement of the goals laid out in the report, The Mission Zero Act (H.R. 880) was introduced in the House of Representatives by Chairman of the House Energy and Commerce Health Subcommittee, Michael Burgess, MD (R-TX), Representatives Cathy Castor (D-FL), Gene Green (D-TX), and Richard Hudson (R-NC). Identical companion legislation was introduced in the Senate (S.1022) by Senators Johnny Isakson (R-GA), John Cornyn (R-TX), and Tammy Duckworth (D-IL). The Mission Zero Act creates a grant program to assist civilian trauma centers in partnering with military trauma professionals to establish a pathway to provide patients with the highest quality of trauma care in times of peace and war, thus taking a step in the direction of the NAM report recommendations.
Specifically, the legislation provides for:
• $40 million in grants to fund military trauma teams and providers to embed into civilian trauma facilities.
o Trauma centers are eligible for a $1 million grant to host military trauma teams at eligible high-acuity level 1 trauma centers
o Trauma centers are also eligible for grants to host individual providers ($100,000 for physician or $50,000 for non-physician providers) at eligible level I, II, or III trauma centers
As of today, the House and Senate versions of the Mission Zero Act have 25co-sponsors and 2 co-sponsors respectively. The ACS would very much like to build some momentum for the Mission Zero Act going into the fall when it is expected that there will be several large “must pass” pieces of legislation working their way through Congress to which the Mission Zero Act could potentially be attached. Accordingly, I respectfully ask all Fellows to take a few moments to visit the SurgeonsVoice website at www.surgeonsvoice.org, click on the Take Action tab on the right side of the page and send a message to their individual representatives and senators seeking support for this important legislation.
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
From the Washington Office: Ensuring an adequate surgical workforce in underserved areas
Increasing evidence indicates a current and growing shortage of surgeons available to serve our nation’s population. As Fellows, we clearly recognize that a shortage of general surgeons is a critical component of this crisis in our nation’s health care workforce. Accordingly, the American College of Surgeons (ACS) is urging policy makers to take appropriate action to recognize that surgeons are uniquely trained and qualified to provide certain necessary, lifesaving procedures through the designation of a formal surgical shortage area.
The ACS is pleased that the Ensuring Access to General Surgery Act of 2017 (S.1351 and H.R.2906) was recently introduced in both the Senate and the House of Representatives. The text of the bill, which is the same in both the Senate and House versions, can be found here: https://www.grassley.senate.gov/sites/default/files/constituents/surgery%20bill.pdf. The legislation has bipartisan sponsorship in both legislative bodies by Senators Charles Grassley (R-IA) and Brian Schatz (D-HI) and Representatives Larry Bucshon, MD, FACS (R-IN) and Ami Bera, MD (D-CA) in the House. This legislation directs the Secretary of the Department of Health and Human Services (HHS), through the Health Resources Services Administration (HRSA), to conduct a study on general surgery workforce shortage areas and provide a general surgery shortage area designation.
Senator Grassley’s office issued a press release on June 15, 2017, in which he, Senator Schatz, Representative Bucshon, and Representative Bera individually delineate the reasons why it is critically important to define and designate general surgery shortage areas. For those interested, that press release can be found here: https://www.grassley.senate.gov/news/news-releases/bipartisan-bill-grassley-schatz-bucshon-bera-would-help-document-areas.
Fellows who visited the offices of their representatives and senators in May as part of the ACS Leadership and Advocacy Summit were able to personally discuss this initiative with members and their staff at that time. Now that the legislation has been officially introduced in both houses of Congress, I would respectfully ask that all Fellows take the 3 minutes necessary to make their voice heard by logging on to www.surgeonsvoice.org and clicking on the Take Action tab on the right side of the landing page to send an e-mail message urging support of the Ensuring Access to General Surgery Act by their individual representatives and both senators.
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Increasing evidence indicates a current and growing shortage of surgeons available to serve our nation’s population. As Fellows, we clearly recognize that a shortage of general surgeons is a critical component of this crisis in our nation’s health care workforce. Accordingly, the American College of Surgeons (ACS) is urging policy makers to take appropriate action to recognize that surgeons are uniquely trained and qualified to provide certain necessary, lifesaving procedures through the designation of a formal surgical shortage area.
The ACS is pleased that the Ensuring Access to General Surgery Act of 2017 (S.1351 and H.R.2906) was recently introduced in both the Senate and the House of Representatives. The text of the bill, which is the same in both the Senate and House versions, can be found here: https://www.grassley.senate.gov/sites/default/files/constituents/surgery%20bill.pdf. The legislation has bipartisan sponsorship in both legislative bodies by Senators Charles Grassley (R-IA) and Brian Schatz (D-HI) and Representatives Larry Bucshon, MD, FACS (R-IN) and Ami Bera, MD (D-CA) in the House. This legislation directs the Secretary of the Department of Health and Human Services (HHS), through the Health Resources Services Administration (HRSA), to conduct a study on general surgery workforce shortage areas and provide a general surgery shortage area designation.
Senator Grassley’s office issued a press release on June 15, 2017, in which he, Senator Schatz, Representative Bucshon, and Representative Bera individually delineate the reasons why it is critically important to define and designate general surgery shortage areas. For those interested, that press release can be found here: https://www.grassley.senate.gov/news/news-releases/bipartisan-bill-grassley-schatz-bucshon-bera-would-help-document-areas.
Fellows who visited the offices of their representatives and senators in May as part of the ACS Leadership and Advocacy Summit were able to personally discuss this initiative with members and their staff at that time. Now that the legislation has been officially introduced in both houses of Congress, I would respectfully ask that all Fellows take the 3 minutes necessary to make their voice heard by logging on to www.surgeonsvoice.org and clicking on the Take Action tab on the right side of the landing page to send an e-mail message urging support of the Ensuring Access to General Surgery Act by their individual representatives and both senators.
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.
Increasing evidence indicates a current and growing shortage of surgeons available to serve our nation’s population. As Fellows, we clearly recognize that a shortage of general surgeons is a critical component of this crisis in our nation’s health care workforce. Accordingly, the American College of Surgeons (ACS) is urging policy makers to take appropriate action to recognize that surgeons are uniquely trained and qualified to provide certain necessary, lifesaving procedures through the designation of a formal surgical shortage area.
The ACS is pleased that the Ensuring Access to General Surgery Act of 2017 (S.1351 and H.R.2906) was recently introduced in both the Senate and the House of Representatives. The text of the bill, which is the same in both the Senate and House versions, can be found here: https://www.grassley.senate.gov/sites/default/files/constituents/surgery%20bill.pdf. The legislation has bipartisan sponsorship in both legislative bodies by Senators Charles Grassley (R-IA) and Brian Schatz (D-HI) and Representatives Larry Bucshon, MD, FACS (R-IN) and Ami Bera, MD (D-CA) in the House. This legislation directs the Secretary of the Department of Health and Human Services (HHS), through the Health Resources Services Administration (HRSA), to conduct a study on general surgery workforce shortage areas and provide a general surgery shortage area designation.
Senator Grassley’s office issued a press release on June 15, 2017, in which he, Senator Schatz, Representative Bucshon, and Representative Bera individually delineate the reasons why it is critically important to define and designate general surgery shortage areas. For those interested, that press release can be found here: https://www.grassley.senate.gov/news/news-releases/bipartisan-bill-grassley-schatz-bucshon-bera-would-help-document-areas.
Fellows who visited the offices of their representatives and senators in May as part of the ACS Leadership and Advocacy Summit were able to personally discuss this initiative with members and their staff at that time. Now that the legislation has been officially introduced in both houses of Congress, I would respectfully ask that all Fellows take the 3 minutes necessary to make their voice heard by logging on to www.surgeonsvoice.org and clicking on the Take Action tab on the right side of the landing page to send an e-mail message urging support of the Ensuring Access to General Surgery Act by their individual representatives and both senators.
Until next month …
Dr. Bailey is a pediatric surgeon and Medical Director, Advocacy, for the Division of Advocacy and Health Policy in the ACS offices in Washington, DC.