Patrick V. Bailey, MD, FACS

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.

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 bfrankfel@facs.org, or 312-202-5361. For questions regarding the Advocacy Summit please contact Michael Carmody at mcarmody@facs.org, 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.

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 bfrankfel@facs.org, or 312-202-5361. For questions regarding the Advocacy Summit please contact Michael Carmody at mcarmody@facs.org, 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.

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 bfrankfel@facs.org, or 312-202-5361. For questions regarding the Advocacy Summit please contact Michael Carmody at mcarmody@facs.org, or 202-672-1511.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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: quality@facs.org.

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.

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: quality@facs.org.

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.

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: quality@facs.org.

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.

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.

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.

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.

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.

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.

On July 1, 2017, the Centers for Medicare and Medicaid Services (CMS) will begin requiring practitioners in nine states who are part of groups of 10 or more to report data on the services that they provide for select 10- and 90-day global surgical codes. The data collected will be used to improve the accuracy of global codes starting in 2019.

Which states are impacted by the requirement to report global codes data?

What data must be reported?

Health care practitioners who meet claims-based data collection requirements will be required to report American Medical Association Current Procedure Terminology (CPT)* code 99024, Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure, for every postoperative visit they provide within the global period of a select list of 10- or 90-day global codes. CMS selected 293 services, which are provided to Medicare patients by more than 100 practitioners per year and are either furnished more than 10,000 times or have allowed charges of more than $10 million annually. The agency estimates that these 293 codes describe approximately 87 percent of all furnished 10- and 90-day global services, and approximately 77 percent of all Medicare expenditures for 10- and 90-day global services under the physician fee schedule.

Is claims-based data reporting mandatory? Is there a penalty for failure to report?

Reporting is mandatory. CMS’ goal is to gather data on postoperative visits as part of its effort to improve the accuracy of global code values starting in 2019. CMS has the authority to implement a 5 percent withhold in payment for global services for health care professionals who fail to report but has not implemented the withhold at this time. Although there is no penalty or withhold of payment for failure to report, ACS urges all surgeons required to report data to comply. Failure to report will result in incomplete data and should data analysis of both inpatient and outpatient postsurgical visits not reflect existing global code definitions, new assumptions may be created to redefine postoperative care.

Why is CMS requiring the reporting of global codes data?

For several years, CMS has communicated its concerns about the accuracy of the values assigned to 10- and 90-day global codes. In 2014, CMS proposed to transition all 10- and 90-day global codes to 0-day, with the requirement that postoperative visits would be reported separately. The ACS argued against this transition because it would have resulted in a reduction in surgeons’ reimbursement for 10- and 90-day global services.
 

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.

On July 1, 2017, the Centers for Medicare and Medicaid Services (CMS) will begin requiring practitioners in nine states who are part of groups of 10 or more to report data on the services that they provide for select 10- and 90-day global surgical codes. The data collected will be used to improve the accuracy of global codes starting in 2019.

Which states are impacted by the requirement to report global codes data?

What data must be reported?

Health care practitioners who meet claims-based data collection requirements will be required to report American Medical Association Current Procedure Terminology (CPT)* code 99024, Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure, for every postoperative visit they provide within the global period of a select list of 10- or 90-day global codes. CMS selected 293 services, which are provided to Medicare patients by more than 100 practitioners per year and are either furnished more than 10,000 times or have allowed charges of more than $10 million annually. The agency estimates that these 293 codes describe approximately 87 percent of all furnished 10- and 90-day global services, and approximately 77 percent of all Medicare expenditures for 10- and 90-day global services under the physician fee schedule.

Is claims-based data reporting mandatory? Is there a penalty for failure to report?

Reporting is mandatory. CMS’ goal is to gather data on postoperative visits as part of its effort to improve the accuracy of global code values starting in 2019. CMS has the authority to implement a 5 percent withhold in payment for global services for health care professionals who fail to report but has not implemented the withhold at this time. Although there is no penalty or withhold of payment for failure to report, ACS urges all surgeons required to report data to comply. Failure to report will result in incomplete data and should data analysis of both inpatient and outpatient postsurgical visits not reflect existing global code definitions, new assumptions may be created to redefine postoperative care.

Why is CMS requiring the reporting of global codes data?

For several years, CMS has communicated its concerns about the accuracy of the values assigned to 10- and 90-day global codes. In 2014, CMS proposed to transition all 10- and 90-day global codes to 0-day, with the requirement that postoperative visits would be reported separately. The ACS argued against this transition because it would have resulted in a reduction in surgeons’ reimbursement for 10- and 90-day global services.
 

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.

On July 1, 2017, the Centers for Medicare and Medicaid Services (CMS) will begin requiring practitioners in nine states who are part of groups of 10 or more to report data on the services that they provide for select 10- and 90-day global surgical codes. The data collected will be used to improve the accuracy of global codes starting in 2019.

Which states are impacted by the requirement to report global codes data?

What data must be reported?

Health care practitioners who meet claims-based data collection requirements will be required to report American Medical Association Current Procedure Terminology (CPT)* code 99024, Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure, for every postoperative visit they provide within the global period of a select list of 10- or 90-day global codes. CMS selected 293 services, which are provided to Medicare patients by more than 100 practitioners per year and are either furnished more than 10,000 times or have allowed charges of more than $10 million annually. The agency estimates that these 293 codes describe approximately 87 percent of all furnished 10- and 90-day global services, and approximately 77 percent of all Medicare expenditures for 10- and 90-day global services under the physician fee schedule.

Is claims-based data reporting mandatory? Is there a penalty for failure to report?

Reporting is mandatory. CMS’ goal is to gather data on postoperative visits as part of its effort to improve the accuracy of global code values starting in 2019. CMS has the authority to implement a 5 percent withhold in payment for global services for health care professionals who fail to report but has not implemented the withhold at this time. Although there is no penalty or withhold of payment for failure to report, ACS urges all surgeons required to report data to comply. Failure to report will result in incomplete data and should data analysis of both inpatient and outpatient postsurgical visits not reflect existing global code definitions, new assumptions may be created to redefine postoperative care.

Why is CMS requiring the reporting of global codes data?

For several years, CMS has communicated its concerns about the accuracy of the values assigned to 10- and 90-day global codes. In 2014, CMS proposed to transition all 10- and 90-day global codes to 0-day, with the requirement that postoperative visits would be reported separately. The ACS argued against this transition because it would have resulted in a reduction in surgeons’ reimbursement for 10- and 90-day global services.
 

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.