This article was developed by the Advocacy and Health Policy Division of the American College of Surgeons for ASCRS News.
Medicare Physician Payment/SGR
Congress has once again postponed repeal and permanent reform of the sustainable growth rate formula. The “fiscal cliff” legislation passed January 1 postpones the 27% cut in Medicare reimbursement that was scheduled to take effect and freezes payment at current rates through December 31, 2013.
The American College of Surgeons (ACS) continues to lead the physician charge to eliminate the SGR formula once and for all and urges Congress to address the long-term implications of a broken physician payment system and its incompatibility with the provision of care.
Sequestration (automatic spending cuts)
As part of the “fiscal cliff” legislation, Congress deferred all sequestration (automatic spending) cuts for two months, including the additional 2% cut to physician payment rates. The ACS will continue to voice opposition to the sequestration cuts as the debate continues during 2013. The Medicare portion of these mandated cuts is expected to reduce Medicare reimbursements to physicians by 2 percent starting in March and sequestration would also have a major effect on medical research. It is estimated that spending at NIH would be reduced by as much as $2.4 billion or 8 percent next year, forcing NIH to eliminate as many as 2,300 grants.
Unfortunately, much of the discussion so far surrounding sequestration has focused on the need to prevent cuts to defense spending. The ACS Division of Advocacy and Healthcare Policy (DAHP) has been working to increase awareness of this issue and will continue to discuss the health related cuts during meetings with Members and staff.
National Surgical Quality Improvement Program (NSQIP) – Registry Deeming
A provision of the legislation that averted the fiscal cliff at the end of 2012 would allow physicians to meet Physician Quality Reporting System (PQRS) requirements through participation in specialty registries. ACS was one of a few groups to lead this effort, which could be a boon for programs like NSQIP (National Surgical Quality Improvement Program). The provision, entitled “Advancement of Clinical Data Registries to Improve the Quality of Health Care,” would essentially grant the Secretary the authority to deem an eligible physician as having satisfactorily submitted data on quality measures for purposes of PQRS if he or she participates in a qualified clinical data registry beginning in 2014.
Health Information Technology/Electronic Health Records (EHR)
As a result of efforts led by ACS including a number of coalition meetings and more than 60 Capitol Hill visits with key congressional staff, U.S. Rep. Diane Black (R-TN) introduced legislation in November to address a number of concerns with the current EHR Incentive Program. The EHR Incentives Act would create a hardship exemption from penalties for small practices and physicians in and near retirement to avoid workforce shortages, shorten the gap between the performance period and the application of the penalty, expand options for participation in the Incentive Program and improving quality measures by using specialty-led registries, and establish an appeals process before application of penalties.
Efforts are currently underway to examine any potential alterations or improvements to the legislation prior to Rep. Black’s target reintroduction date of February 15 for the 113th Congress.
Cancer Research Funding
In November, ACS advocacy staff participated in a day of Capitol Hill visits organized by One Voice Against Cancer (OVAC) in partnership with Research!America to urge Congress to avert sequestration cuts in funding for cancer research and other programs. OVAC is a coalition of more than 40 organizations, including the ACS Commission on Cancer, with the shared goal of improving cancer care in the U.S. Advocacy staff visited with House and Senate offices to discuss how sequestration cuts set to take effect January 2, 2013, would affect cancer research, prevention, early detection, and quality of care. These cuts were temporarily delayed (until March 1) as part of the bill to avert the fiscal cliff.
ACS Continues Advocacy and Education on Electronic Health Record (EHR) Incentive Program
The Medicare and Medicaid EHR Incentive Programs provide a financial incentive for the meaningful use of certified EHR technology to achieve health and efficiency goals. There are three stages of meaningful use, with increased requirements each year. 2012 was the last year practices were eligible for the full incentive amount of $44,000. In 2013, they are eligible for a maximum incentive amount of $39,000.
DAHP staff continues to update the EHR Incentive Program webpage which provides educational materials and resources to Fellows and office staff. ACS staff also offers educational resources through publications including the Bulletin and NewsScope. The October 2012 Bulletin provides Fellows with detailed information on how they can begin to participate in the program.
ACS Works to Improve the Physician Quality Reporting System (PQRS); Continues Fellow Education Efforts
The College continues to provide PQRS educational materials and resources to Fellows and office staff through the website, meetings, and publications. The February 2012 edition of The ACS Bulletin offers helpful Q & A sections to aid Fellows in participation in the program. The PQRS section of the website is constantly updated with new information, including updated 2013 PQRS flow sheets for various surgical procedures and detailed information on how to report measures via claims, registries, and electronic health records.
ACS Advocacy on Electronic Prescribing (eRx) Program
as Final Year of Program Approaches
DAHP staff continues to provide Electronic Prescribing (eRx) Program updates and reminders to Fellows through NewsScope articles, social media, Bulletin articles, and the website. Staff has developed resources such as a “step-by step hardship exemption guide” that informs Fellows on how to apply for a significant hardship exemption in order to avoid receiving a 2013 eRx penalty. DAHP staff continues to participate in all meetings related to the eRx program.
In the 2013 Medicare Physician Fee Schedule final rule, CMS proposes to add two related additional significant hardship exemptions for the 2013 and 2014 eRx payment adjustments in addition to the four that were finalized in the 2012 MPFS:
- Eligible professionals or group practices who achieve meaningful use during certain 2013 and 2014 eRx payment adjustment reporting periods; and
- Eligible professionals or group practices who demonstrate intent to participate in the EHR Incentive Program and adoption of certified EHR technology.
The ACS expressed support of these two new exemption categories in the proposed rule.
ACS Advocates for Inclusion of S-CAHPS In Federal Quality Reporting Programs
ACS, in collaboration with other surgical professional societies submitted a comment letter to CMS in response to the Medicare Physician Fee Schedule final rule which discussed our support for the inclusion of the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Surgical Care Survey as a measure to be reported for PQRS GPRO (Group Practice Reporting Option) Web interface program and posted on Physician Compare. This recommendation is based on the finalization of the CAHPS Clinician and Group survey for reporting in these programs. The letter stressed that the CAHPS Clinician and Group survey is not equally meaningful and will not accurately reflect the care provided by single- or multispecialty surgical or anesthesia groups.
Physician Consortium for Performance Improvement (AMA-PCPI)
The AMA-Physician Consortium for Performance Improvement (PCPI), convened by the American Medical Association (AMA), is a national, physician-led program whose mission is to align patient-centered care, performance measurement and quality improvement. DAHP staff attended the AMA-PCPI Annual Meeting in October 2012, and plan to attend the Membership Meeting in April 2013.
In October, ASCRS member Frank G. Opelka, MD, FACS, Associate Medical Director of the Division of Advocacy and Health Policy at the ACS and Professor of Surgery and the Louisiana State University (LSU) System Executive Vice President for Health Care Redesign, was appointed as Chair of the AMA-PCPI.
National Quality Forum
The College continues to be active in National Quality Forum (NQF) activities which include attending meetings, staffing Fellows who sit on workgroups and Steering Committees, reviewing, commenting, and voting on measures, and participating in Health Care Professional discussions. Dr. Frank Opelka continues to represent ACS on the Consensus Standards Approval Committee (CSAC). ACS, represented by Dr. Frank Opelka, is also an organizational member to the Coordinating Committee for the Measure Applications Partnership (MAP). The Coordinating Committee is comprised of both member organizations and individual subject matter experts and sets the strategy for the MAP, provides direction to advisory work groups, and is responsible for pre-rulemaking recommendations to HHS.
In January 2013, ACS provided comments to MAP’s Pre-Rulemaking report.
In October, Leonard J. Weireter, Jr., MD, FACS, surgeon in Norfolk, VA was appointed to the NQF Regionalized Emergency Medical Care Services Measure Topic Prioritization expert panel. The panel provides guidance for measure development to the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response. The panel is focused on prioritized areas of emergency department crowding, with a focus on boarding and diversion, emergency preparedness, and surge capacity.
In November, Bruce Lee Hall, MD, FACS, PhD, MBA, a general surgeon in St. Louis MO, was appointed to the National Quality Forum’s (NQF) Ad-hoc Review: Planned Readmissions Expert Panel. The ACS submitted Dr. Hall’s nomination to the expert panel, which oversees the review of recent updates to several readmissions measures, including the hospital-wide all-cause unplanned readmission measure.