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Washington Update:
ACS fights sequestration cuts, advocates Medicare physician payment system reform
This article was developed by the Advocacy and Health Policy Division of The American College of Surgeons for ASCRS News.

Sequestration (automatic spending cuts)

  • Despite ACS opposition, sequestration cuts took effect, including a two percent reduction in Medicare physician payments and graduate medical education (GME) funding, as well as approximately $1.6 billion in reduced funding for medical research at the National Institutes of Health.

  • The ACS supported three GME bills. The Resident Physician Shortage Reduction Act of 2013 would address both short- and long-term workforce demands by increasing the number of Medicare-supported GME residency positions by roughly 15,000 over five years. The Training Tomorrow’s Doctors Today Act, which also increases the number of Medicare-supported residency positions by 15,000 over five years, would establish Medicare GME accountability and transparency measures. The Conrad State 30 and Physician Access Act would expand and permanently reauthorize the Conrad 30 Program, which has worked since 1994 to bring thousands of foreign physicians trained in the U.S. to rural, inner-city, and other medically underserved communities.

ACS launches SurgeonsVoice

  • The College launched SurgeonsVoice, an enhanced grassroots advocacy program for recruiting, educating, and motivating Fellows to use their influence to change the dynamic in Washington, DC, by equipping members with the knowledge and tools necessary to become an integral part of our nationwide grassroots advocacy network of surgeon advocates.

Proposal to repeal SGR formula

  • The Senate Finance and House Ways and Means Committees released a bipartisan, bicameral draft proposal for repealing the sustainable growth rate (SGR) formula and fixing the Medicare physician payment system. The proposal builds on draft legislation that the House Energy and Commerce Committee approved earlier.

Dr. Michael StamosThe ACS sent a letter to the Senate Finance and House Ways and Means Committees responding to their bipartisan, bicameral draft proposal to permanently repeal the SGR and fix the Medicare physician payment system.

In November, 259 Members of the House of Representatives, in an effort spearheaded by Representatives Bill Flores (R-TX) and Dan Maffei (D-NY), sent a bipartisan letter to Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA), urging Congress to permanently repeal the flawed Medicare SGR formula and replace it with a system that rewards quality, while controlling costs. The College spearheaded this effort in partnership with numerous national and state physician organizations and record-breaking grassroots efforts by the College Fellows.

In December, Congress passed a three-month, 0.5 percent increase in the Medicare physician payment rate as a bridge to allow for negotiations on a permanent repeal of the SGR formula. The short-term patch averts the scheduled cut to the payment rate, which is in excess of 24 percent.

The ACS and other surgical societies issued a letter in opposition to the proposed legislation to repeal the SGR before the Senate Finance Committee. The College's position was based on the proposal's call for a 10-year physician payment freeze and inadequate incentives for providing value-based care. We believe the impact of these two provisions would hinder our members' ability to keep their practices open, disincentivize the sharing of best practices, and place patients' access to surgical services at risk. The College urged the committee to delay a vote on the proposal; however, it ultimately passed out of committee.

Alternatively, the House Ways and Means Committee made good faith changes in its proposed SGR legislation to address some of our concerns and provided more stability for surgeons and the surgical patient. The committee passed its proposal out of committee in December. The College continues to move the process forward and will work with both House committees, as well as the Senate Finance committee, to reform the Medicare physician payment system.