Patrick V. Bailey, MD, FACS

In November 2014, the Centers for Medicare & Medicaid Services finalized a policy that will transition all 10-day and 90-day global codes to 0-day global codes in 2017 and 2018, respectively.

As most surgeons will know, global codes include all necessary services normally furnished before, during, and after a surgical procedure. Approximately 4,200 of the more than 9,900 Current Procedural Terminology codes are 10-day or 90-day global codes. The CMS claims the transition is necessary, in part, to increase the accuracy of payment for these codes. Despite the fact that the policy for the 10-day codes will be put into effect in 2017, the CMS has yet to develop a methodology for making this transition.

Prior to the release of the final rule, the ACS sent a detailed letter to the CMS asserting that the agency should postpone moving forward with this proposal until a comprehensive analysis of the effect on surgical patients and access to surgical care was completed. The ACS included recommendations on a number of issues that the CMS must resolve before moving forward with the proposed policy and stressed, above all, that the CMS should not make policy changes that infringe on surgeons’ ability to provide high-quality care to surgical patients. Despite the ACS regulatory advocacy efforts and those similar from other surgical and medical specialty groups, the CMS finalized the rule and continues to indicate that it plans to move forward.

During the lame duck session of Congress following the November election, a coalition of surgical groups led by the ACS drafted and provided to Congress legislative language the effect of which would be to preclude the CMS from moving forward with its plan to transition the 10-day and 90-day global codes to 0-day global codes.

The groups involved mounted an aggressive campaign, strongly advocating for the inclusion of the legislative language in the “CRomnibus” bill. Despite strong support from the Congressional “Doc Caucus” and other members of Congress, no language addressing transitioning of the global codes was included in the “CRomnibus” bill, which passed both chambers at the conclusion of the 113th Congress.

Now that the 114th Congress has begun, the ACS, working again in concert with the aforementioned coalition of other surgical and medical specialty groups, is taking a variety of strategic actions on both the legislative and regulatory fronts. Working with key members of Congress including Rep. Larry Bucshon, MD, FACS, Rep. Tom Price, MD, FACS, and Rep. Dan Benishek, MD, FACS, the ACS will continue to oppose implementation of the policy change by seeking congressional intervention to rescind the rule until such time as the CMS can ensure that the transition will not have a negative impact on patients and can be implemented in a way that accurately accounts for the care that surgeons provide.

Revised legislative language has been provided to Congress. Members of the ACS DAHP legislative affairs staff are engaged in daily advocacy efforts for inclusion of that language in legislation. ACS leaders and DAHP regulatory affairs staff have met with the CMS in an attempt to provide education concerning what is believed will be significant, negative impact of the policy on both patients and surgeons.

Fellows are encouraged to augment the efforts of the DAHP by personally contacting their senators and representatives to educate them about the following negative potential consequences the implementation of this policy would be expected to have:

1. Reduces patient access and quality of care. If 10-day and 90-day global codes are transitioned to 0-day global codes, patients will have a copay for the procedure and additional, separate copays for other services including each of the follow-up visits. Patients may also be responsible for separate payment of supplies and drugs necessary during postop visits currently bundled into the global payment, but not bundled into visit codes. This could considerably increase the financial burden on patients, or worse, discourage them from returning for follow-up care.

2. Undermines the current SGR legislation and other Medicare reform initiatives. The CMS initiatives for payment are all moving toward larger bundled payments. Deconstruction of the current payment structure for physicians is counterintuitive to the end goal of providing more comprehensive and coordinated care for patients.

3. Increases administrative burden. The administrative burden on surgical practices, the CMS, and its contractors will be significant. The American Medical Association estimates that eliminating the global package will result in 63 million additional claims per year to account for postsurgical evaluation and management services. This will add unnecessary costs to the claims processing system.

4. Obstructs clinical registry data collection and quality improvement. If patients forgo follow-up treatment or seek it from other providers, the policy would have a deleterious effect on surgeons’ ability to collect information on patient outcomes in clinical registries and undermine many meaningful quality improvement initiatives.

Staff members of the DC office are available to assist surgeons interested in contacting their individual senators and representatives to assist in the advocacy efforts relative to this policy. I can be reached by phone at 202-337-2701 or by e-mail at dahp@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.

In November 2014, the Centers for Medicare & Medicaid Services finalized a policy that will transition all 10-day and 90-day global codes to 0-day global codes in 2017 and 2018, respectively.

As most surgeons will know, global codes include all necessary services normally furnished before, during, and after a surgical procedure. Approximately 4,200 of the more than 9,900 Current Procedural Terminology codes are 10-day or 90-day global codes. The CMS claims the transition is necessary, in part, to increase the accuracy of payment for these codes. Despite the fact that the policy for the 10-day codes will be put into effect in 2017, the CMS has yet to develop a methodology for making this transition.

Prior to the release of the final rule, the ACS sent a detailed letter to the CMS asserting that the agency should postpone moving forward with this proposal until a comprehensive analysis of the effect on surgical patients and access to surgical care was completed. The ACS included recommendations on a number of issues that the CMS must resolve before moving forward with the proposed policy and stressed, above all, that the CMS should not make policy changes that infringe on surgeons’ ability to provide high-quality care to surgical patients. Despite the ACS regulatory advocacy efforts and those similar from other surgical and medical specialty groups, the CMS finalized the rule and continues to indicate that it plans to move forward.

During the lame duck session of Congress following the November election, a coalition of surgical groups led by the ACS drafted and provided to Congress legislative language the effect of which would be to preclude the CMS from moving forward with its plan to transition the 10-day and 90-day global codes to 0-day global codes.

The groups involved mounted an aggressive campaign, strongly advocating for the inclusion of the legislative language in the “CRomnibus” bill. Despite strong support from the Congressional “Doc Caucus” and other members of Congress, no language addressing transitioning of the global codes was included in the “CRomnibus” bill, which passed both chambers at the conclusion of the 113th Congress.

Now that the 114th Congress has begun, the ACS, working again in concert with the aforementioned coalition of other surgical and medical specialty groups, is taking a variety of strategic actions on both the legislative and regulatory fronts. Working with key members of Congress including Rep. Larry Bucshon, MD, FACS, Rep. Tom Price, MD, FACS, and Rep. Dan Benishek, MD, FACS, the ACS will continue to oppose implementation of the policy change by seeking congressional intervention to rescind the rule until such time as the CMS can ensure that the transition will not have a negative impact on patients and can be implemented in a way that accurately accounts for the care that surgeons provide.

Revised legislative language has been provided to Congress. Members of the ACS DAHP legislative affairs staff are engaged in daily advocacy efforts for inclusion of that language in legislation. ACS leaders and DAHP regulatory affairs staff have met with the CMS in an attempt to provide education concerning what is believed will be significant, negative impact of the policy on both patients and surgeons.

Fellows are encouraged to augment the efforts of the DAHP by personally contacting their senators and representatives to educate them about the following negative potential consequences the implementation of this policy would be expected to have:

1. Reduces patient access and quality of care. If 10-day and 90-day global codes are transitioned to 0-day global codes, patients will have a copay for the procedure and additional, separate copays for other services including each of the follow-up visits. Patients may also be responsible for separate payment of supplies and drugs necessary during postop visits currently bundled into the global payment, but not bundled into visit codes. This could considerably increase the financial burden on patients, or worse, discourage them from returning for follow-up care.

2. Undermines the current SGR legislation and other Medicare reform initiatives. The CMS initiatives for payment are all moving toward larger bundled payments. Deconstruction of the current payment structure for physicians is counterintuitive to the end goal of providing more comprehensive and coordinated care for patients.

3. Increases administrative burden. The administrative burden on surgical practices, the CMS, and its contractors will be significant. The American Medical Association estimates that eliminating the global package will result in 63 million additional claims per year to account for postsurgical evaluation and management services. This will add unnecessary costs to the claims processing system.

4. Obstructs clinical registry data collection and quality improvement. If patients forgo follow-up treatment or seek it from other providers, the policy would have a deleterious effect on surgeons’ ability to collect information on patient outcomes in clinical registries and undermine many meaningful quality improvement initiatives.

Staff members of the DC office are available to assist surgeons interested in contacting their individual senators and representatives to assist in the advocacy efforts relative to this policy. I can be reached by phone at 202-337-2701 or by e-mail at dahp@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.

In November 2014, the Centers for Medicare & Medicaid Services finalized a policy that will transition all 10-day and 90-day global codes to 0-day global codes in 2017 and 2018, respectively.

As most surgeons will know, global codes include all necessary services normally furnished before, during, and after a surgical procedure. Approximately 4,200 of the more than 9,900 Current Procedural Terminology codes are 10-day or 90-day global codes. The CMS claims the transition is necessary, in part, to increase the accuracy of payment for these codes. Despite the fact that the policy for the 10-day codes will be put into effect in 2017, the CMS has yet to develop a methodology for making this transition.

Prior to the release of the final rule, the ACS sent a detailed letter to the CMS asserting that the agency should postpone moving forward with this proposal until a comprehensive analysis of the effect on surgical patients and access to surgical care was completed. The ACS included recommendations on a number of issues that the CMS must resolve before moving forward with the proposed policy and stressed, above all, that the CMS should not make policy changes that infringe on surgeons’ ability to provide high-quality care to surgical patients. Despite the ACS regulatory advocacy efforts and those similar from other surgical and medical specialty groups, the CMS finalized the rule and continues to indicate that it plans to move forward.

During the lame duck session of Congress following the November election, a coalition of surgical groups led by the ACS drafted and provided to Congress legislative language the effect of which would be to preclude the CMS from moving forward with its plan to transition the 10-day and 90-day global codes to 0-day global codes.

The groups involved mounted an aggressive campaign, strongly advocating for the inclusion of the legislative language in the “CRomnibus” bill. Despite strong support from the Congressional “Doc Caucus” and other members of Congress, no language addressing transitioning of the global codes was included in the “CRomnibus” bill, which passed both chambers at the conclusion of the 113th Congress.

Now that the 114th Congress has begun, the ACS, working again in concert with the aforementioned coalition of other surgical and medical specialty groups, is taking a variety of strategic actions on both the legislative and regulatory fronts. Working with key members of Congress including Rep. Larry Bucshon, MD, FACS, Rep. Tom Price, MD, FACS, and Rep. Dan Benishek, MD, FACS, the ACS will continue to oppose implementation of the policy change by seeking congressional intervention to rescind the rule until such time as the CMS can ensure that the transition will not have a negative impact on patients and can be implemented in a way that accurately accounts for the care that surgeons provide.

Revised legislative language has been provided to Congress. Members of the ACS DAHP legislative affairs staff are engaged in daily advocacy efforts for inclusion of that language in legislation. ACS leaders and DAHP regulatory affairs staff have met with the CMS in an attempt to provide education concerning what is believed will be significant, negative impact of the policy on both patients and surgeons.

Fellows are encouraged to augment the efforts of the DAHP by personally contacting their senators and representatives to educate them about the following negative potential consequences the implementation of this policy would be expected to have:

1. Reduces patient access and quality of care. If 10-day and 90-day global codes are transitioned to 0-day global codes, patients will have a copay for the procedure and additional, separate copays for other services including each of the follow-up visits. Patients may also be responsible for separate payment of supplies and drugs necessary during postop visits currently bundled into the global payment, but not bundled into visit codes. This could considerably increase the financial burden on patients, or worse, discourage them from returning for follow-up care.

2. Undermines the current SGR legislation and other Medicare reform initiatives. The CMS initiatives for payment are all moving toward larger bundled payments. Deconstruction of the current payment structure for physicians is counterintuitive to the end goal of providing more comprehensive and coordinated care for patients.

3. Increases administrative burden. The administrative burden on surgical practices, the CMS, and its contractors will be significant. The American Medical Association estimates that eliminating the global package will result in 63 million additional claims per year to account for postsurgical evaluation and management services. This will add unnecessary costs to the claims processing system.

4. Obstructs clinical registry data collection and quality improvement. If patients forgo follow-up treatment or seek it from other providers, the policy would have a deleterious effect on surgeons’ ability to collect information on patient outcomes in clinical registries and undermine many meaningful quality improvement initiatives.

Staff members of the DC office are available to assist surgeons interested in contacting their individual senators and representatives to assist in the advocacy efforts relative to this policy. I can be reached by phone at 202-337-2701 or by e-mail at dahp@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.

Shortly after passage of the $1.1 trillion “Cromnibus,” the House and Senate concluded their legislative business for the 113th Congress and adjourned. Many issues of importance to surgeons and our patients remain unresolved and are expected to be high on the legislative agenda of the 114th Congress in the first quarter of 2015.

Returning as Members of Congress in January will be two physicians whose campaigns were assisted by the active participation of SurgeonsPAC. They are Dr. Ami Bera, an emergency physician from the 7th District of California (Sacramento area) and Dr. Dan Benishek, a general surgeon and fellow of the American College of Surgeons from the 1st District of Michigan (Upper Peninsula). Both Dr. Bera and Dr. Benishek have served as champions for the cause of the legislative agenda supported by the College.

One of the ways by which SurgeonsPAC participated in the re-election campaign of both Members is known as an independent expenditure (IE). The Code of Federal Regulations defines and independent expenditure as an expenditure for a communication that expressly advocates for “the election or defeat of a clearly identified candidate that is not made in cooperation, consultation, or concert with, or at the request or suggestion of, a candidate, a candidate’s authorized committee, or their agents, or a political party committee or its agents.” [11 CFR 100.16(a)]

In August, the Board of Directors of SurgeonsPAC unanimously voted to direct staff of the Division of Advocacy and Health Policy to develop recommendations for independent expenditures for a bipartisan slate of candidates who had a record of being supportive of the College’s legislative agenda and whose election was enough at risk that an independent expenditure by the College would potentially be of significant benefit for their race. In October, the PAC Board considered those recommendations and voted to support the expenditure of $100,000 each for IEs for Dr. Bera, a Democrat, and Dr. Benishek, a Republican. Both have been champions on issues such as repeal and replacement of the Sustainable Growth Rate (SGR), medical liability reform, and repeal of the 96-hour rule.

For Dr. Bera, the SurgeonsPAC dollars were utilized for a radio and direct mail campaign that was part of a larger effort in which other physician political action committees participated similarly. For Dr. Benishek, a television ad was produced and run through local cable providers.

On election night, Dr. Benishek was declared the winner, receiving 52.1% of the vote compared with his opponent’s 45.3%. As one of four fellows of the American College of Surgeons in Congress, we look forward to continuing to work with “Dr. Dan” and his excellent staff in his upcoming third term.

Dr. Bera’s race was much closer, as he actually trailed his opponent when election night closed with 49.8% of the vote. Subsequently, with the counting and inclusion of the mail-in ballots specifically targeted by the physician community’s IE effort, Dr. Bera overtook his opponent’s slim margin. Two weeks later, on 19 Nov. 2014, the Associated Press called the election for Dr. Bera, whose 1,400-vote lead at that time was felt to be substantial enough to preclude his opponent making up the difference with the remaining 4,300 provisional ballots that had yet to be counted. Dr. Bera’s CA-7 district race proved to be the most expensive in the nation with an estimated $19.6 million in total expenditures. Despite representing only 0.51% of that total, SurgeonsPAC’s contribution, in the collective with that of other physician organizations, no doubt played a significant role in returning a physician to Congress to continue to champion our causes.

In my opinion, these examples of careful candidate selection and subsequent support of Drs. Benishek and Bera exemplify the importance of a strong political action committee. The ultimate goal of SurgeonsPAC is the election to Congress and retention in Congress of those who support our policy positions and legislative agenda. Though SurgeonsPAC is one of nine physician PACs that can be accurately labeled as “million dollar” (per election cycle) PACs, our relative size and, thus, the number of candidates like Drs. Bera and Benishek we could support would be much greater if the Fellow participation rate more closely resembled that of our colleagues in other physician organizations. However, year after year, only 3%-4% of Fellows contribute, as compared with participation rates of 10%-25% in those physician PACs larger than SurgeonsPAC.

Recently, all Fellows received an e-mail from Dr. Andrew Warshaw, founding SurgeonsPAC Board Chairman and current President of the ACS, urging Fellows to make a $25 donation to SurgeonsPAC. Those wishing to learn more about the critical role SurgeonsPAC plays in our advocacy efforts can log on to www.surgeonspac.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.

Shortly after passage of the $1.1 trillion “Cromnibus,” the House and Senate concluded their legislative business for the 113th Congress and adjourned. Many issues of importance to surgeons and our patients remain unresolved and are expected to be high on the legislative agenda of the 114th Congress in the first quarter of 2015.

Returning as Members of Congress in January will be two physicians whose campaigns were assisted by the active participation of SurgeonsPAC. They are Dr. Ami Bera, an emergency physician from the 7th District of California (Sacramento area) and Dr. Dan Benishek, a general surgeon and fellow of the American College of Surgeons from the 1st District of Michigan (Upper Peninsula). Both Dr. Bera and Dr. Benishek have served as champions for the cause of the legislative agenda supported by the College.

One of the ways by which SurgeonsPAC participated in the re-election campaign of both Members is known as an independent expenditure (IE). The Code of Federal Regulations defines and independent expenditure as an expenditure for a communication that expressly advocates for “the election or defeat of a clearly identified candidate that is not made in cooperation, consultation, or concert with, or at the request or suggestion of, a candidate, a candidate’s authorized committee, or their agents, or a political party committee or its agents.” [11 CFR 100.16(a)]

In August, the Board of Directors of SurgeonsPAC unanimously voted to direct staff of the Division of Advocacy and Health Policy to develop recommendations for independent expenditures for a bipartisan slate of candidates who had a record of being supportive of the College’s legislative agenda and whose election was enough at risk that an independent expenditure by the College would potentially be of significant benefit for their race. In October, the PAC Board considered those recommendations and voted to support the expenditure of $100,000 each for IEs for Dr. Bera, a Democrat, and Dr. Benishek, a Republican. Both have been champions on issues such as repeal and replacement of the Sustainable Growth Rate (SGR), medical liability reform, and repeal of the 96-hour rule.

For Dr. Bera, the SurgeonsPAC dollars were utilized for a radio and direct mail campaign that was part of a larger effort in which other physician political action committees participated similarly. For Dr. Benishek, a television ad was produced and run through local cable providers.

On election night, Dr. Benishek was declared the winner, receiving 52.1% of the vote compared with his opponent’s 45.3%. As one of four fellows of the American College of Surgeons in Congress, we look forward to continuing to work with “Dr. Dan” and his excellent staff in his upcoming third term.

Dr. Bera’s race was much closer, as he actually trailed his opponent when election night closed with 49.8% of the vote. Subsequently, with the counting and inclusion of the mail-in ballots specifically targeted by the physician community’s IE effort, Dr. Bera overtook his opponent’s slim margin. Two weeks later, on 19 Nov. 2014, the Associated Press called the election for Dr. Bera, whose 1,400-vote lead at that time was felt to be substantial enough to preclude his opponent making up the difference with the remaining 4,300 provisional ballots that had yet to be counted. Dr. Bera’s CA-7 district race proved to be the most expensive in the nation with an estimated $19.6 million in total expenditures. Despite representing only 0.51% of that total, SurgeonsPAC’s contribution, in the collective with that of other physician organizations, no doubt played a significant role in returning a physician to Congress to continue to champion our causes.

In my opinion, these examples of careful candidate selection and subsequent support of Drs. Benishek and Bera exemplify the importance of a strong political action committee. The ultimate goal of SurgeonsPAC is the election to Congress and retention in Congress of those who support our policy positions and legislative agenda. Though SurgeonsPAC is one of nine physician PACs that can be accurately labeled as “million dollar” (per election cycle) PACs, our relative size and, thus, the number of candidates like Drs. Bera and Benishek we could support would be much greater if the Fellow participation rate more closely resembled that of our colleagues in other physician organizations. However, year after year, only 3%-4% of Fellows contribute, as compared with participation rates of 10%-25% in those physician PACs larger than SurgeonsPAC.

Recently, all Fellows received an e-mail from Dr. Andrew Warshaw, founding SurgeonsPAC Board Chairman and current President of the ACS, urging Fellows to make a $25 donation to SurgeonsPAC. Those wishing to learn more about the critical role SurgeonsPAC plays in our advocacy efforts can log on to www.surgeonspac.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.

Shortly after passage of the $1.1 trillion “Cromnibus,” the House and Senate concluded their legislative business for the 113th Congress and adjourned. Many issues of importance to surgeons and our patients remain unresolved and are expected to be high on the legislative agenda of the 114th Congress in the first quarter of 2015.

Returning as Members of Congress in January will be two physicians whose campaigns were assisted by the active participation of SurgeonsPAC. They are Dr. Ami Bera, an emergency physician from the 7th District of California (Sacramento area) and Dr. Dan Benishek, a general surgeon and fellow of the American College of Surgeons from the 1st District of Michigan (Upper Peninsula). Both Dr. Bera and Dr. Benishek have served as champions for the cause of the legislative agenda supported by the College.

One of the ways by which SurgeonsPAC participated in the re-election campaign of both Members is known as an independent expenditure (IE). The Code of Federal Regulations defines and independent expenditure as an expenditure for a communication that expressly advocates for “the election or defeat of a clearly identified candidate that is not made in cooperation, consultation, or concert with, or at the request or suggestion of, a candidate, a candidate’s authorized committee, or their agents, or a political party committee or its agents.” [11 CFR 100.16(a)]

In August, the Board of Directors of SurgeonsPAC unanimously voted to direct staff of the Division of Advocacy and Health Policy to develop recommendations for independent expenditures for a bipartisan slate of candidates who had a record of being supportive of the College’s legislative agenda and whose election was enough at risk that an independent expenditure by the College would potentially be of significant benefit for their race. In October, the PAC Board considered those recommendations and voted to support the expenditure of $100,000 each for IEs for Dr. Bera, a Democrat, and Dr. Benishek, a Republican. Both have been champions on issues such as repeal and replacement of the Sustainable Growth Rate (SGR), medical liability reform, and repeal of the 96-hour rule.

For Dr. Bera, the SurgeonsPAC dollars were utilized for a radio and direct mail campaign that was part of a larger effort in which other physician political action committees participated similarly. For Dr. Benishek, a television ad was produced and run through local cable providers.

On election night, Dr. Benishek was declared the winner, receiving 52.1% of the vote compared with his opponent’s 45.3%. As one of four fellows of the American College of Surgeons in Congress, we look forward to continuing to work with “Dr. Dan” and his excellent staff in his upcoming third term.

Dr. Bera’s race was much closer, as he actually trailed his opponent when election night closed with 49.8% of the vote. Subsequently, with the counting and inclusion of the mail-in ballots specifically targeted by the physician community’s IE effort, Dr. Bera overtook his opponent’s slim margin. Two weeks later, on 19 Nov. 2014, the Associated Press called the election for Dr. Bera, whose 1,400-vote lead at that time was felt to be substantial enough to preclude his opponent making up the difference with the remaining 4,300 provisional ballots that had yet to be counted. Dr. Bera’s CA-7 district race proved to be the most expensive in the nation with an estimated $19.6 million in total expenditures. Despite representing only 0.51% of that total, SurgeonsPAC’s contribution, in the collective with that of other physician organizations, no doubt played a significant role in returning a physician to Congress to continue to champion our causes.

In my opinion, these examples of careful candidate selection and subsequent support of Drs. Benishek and Bera exemplify the importance of a strong political action committee. The ultimate goal of SurgeonsPAC is the election to Congress and retention in Congress of those who support our policy positions and legislative agenda. Though SurgeonsPAC is one of nine physician PACs that can be accurately labeled as “million dollar” (per election cycle) PACs, our relative size and, thus, the number of candidates like Drs. Bera and Benishek we could support would be much greater if the Fellow participation rate more closely resembled that of our colleagues in other physician organizations. However, year after year, only 3%-4% of Fellows contribute, as compared with participation rates of 10%-25% in those physician PACs larger than SurgeonsPAC.

Recently, all Fellows received an e-mail from Dr. Andrew Warshaw, founding SurgeonsPAC Board Chairman and current President of the ACS, urging Fellows to make a $25 donation to SurgeonsPAC. Those wishing to learn more about the critical role SurgeonsPAC plays in our advocacy efforts can log on to www.surgeonspac.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.

Congress has returned for the lame duck session of the 113th Congress. As has been the case for as many years as many of your D.C. staff can remember, the repeal of the flawed Sustainable Growth Rate is a primary focus of our legislative efforts during this brief time that Congress has remaining before the end of the year.

As many will recall, in February 2014, Congress came to a bipartisan, bicameral agreement for repeal of the SGR formula and overhaul of the Medicare physician payment system. The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (S. 2000/H.R. 4015 – the SGR Repeal Act) was the product of a yearlong collaborative effort between Congress and key stakeholders, including the American College of Surgeons. In fact, ACS was the only physician group to testify before all three congressional committees of jurisdiction (House Ways and Means, House Energy and Commerce, and Senate Finance) during the process culminating in the legislation.

Congress was subsequently unable to agree on offsets to pay for the cost of the SGR Repeal Act. This is extremely unfortunate and, in sum, represents a classic example of partisanship trumping good policy. This is particularly significant when one considers the exemplary bipartisan and bicameral efforts that culminated in the legislation and the fact that the $170 billion cost of the 17 temporary “patches” Congress has utilized over the past 11 years far surpasses the estimated cost of the current agreed-upon policy.

In September, representatives from five major physician organizations, including ACS, made visits to offices of congressional leaders specifically to urge action on S. 2000/H.R. 4015 during the lame duck session. Subsequently, letters urging action on the SGR Repeal Act have been sent to House leaders by the Pennsylvania congressional delegation; the House Doctors’ Caucus; and 114 additional members who signed a bipartisan letter circulated by Rep. Reid Ribble (R-Wis.) and Rep. Kurt Schrader (D-Ore.). When the signatures on these three letters are combined with those from similar correspondence circulated by Rep. Bill Flores (R-Tex.) and Rep. Dan Maffei (D-N.Y.) and sent to House leaders in November 2013, a total of 287 of the 435 members of the House of Representatives have indicated their support for passage of H.R. 4015.

Fellows received an e-mail earlier in October requesting that they contact their individual member of Congress to urge action on the SGR Repeal Act. The message is simple: The physician community has united around a sound bicameral and bipartisan payment reform policy that will permanently repeal the flawed SGR formula and make sound reforms to modernize Medicare physician payment. It is now Congress’ job to develop bipartisan, bicameral offsets and pass the legislation. For Fellows who have not taken the opportunity to act, they can still do so by logging on to www.surgeonsvoice.org and following the links for “Take Action Now.”

There is certainly a compelling argument that action during this lame duck session represents a real opportunity to permanently address and resolve the SGR. All seem to agree that we are long past the time to address this chronic, festering issue. Lame duck sessions also present opportunities for legislators who will not be returning to proceed without the considerations of short-term political consequences. For those returning for the 114th Congress, an opportunity to address a recurrent problem, clean it off the plate, and start fresh with the new Congress in January is also very appealing. Finally, one can also argue, as was done by a prominent member of the House Doctors’ Caucus, that the lame duck session presents an opportunity to more palatably return to bipartisan cooperation on the issue – a sort of “Butch Cassidy and the Sundance Kid Theory” of jumping off the cliff together.

Without action, the latest short-term patch is scheduled to expire on March 31, 2015. At that time, another patch, the 18th, would be necessary to preclude the cuts to Medicare physician payment that all, even Medicare’s Board of Trustees, agree Congress is likely never to allow to take place for fear of the political repercussions following such cuts from seniors and the physician community. Short-term patches obviously do not solve the problem. It is reasonable to predict that any short-term patch put in place in March would be set to expire around the time of the next debt limit debate, currently predicted to be just before the August recess in the summer. That one would be the 19th. Thus, to quote a famous American philosopher and poet, “The road goes on forever and the party never ends.”

In closing, I urge all Fellows to contact the offices of their representatives and senators – whether by phone, e-mail, logging on to www.surgeonsvoice.org, or paying a personal visit to their local district office – and seize the opportunity to support favorable action on the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (S. 2000/H.R. 4015) during the lame duck session.

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, D.C.

Congress has returned for the lame duck session of the 113th Congress. As has been the case for as many years as many of your D.C. staff can remember, the repeal of the flawed Sustainable Growth Rate is a primary focus of our legislative efforts during this brief time that Congress has remaining before the end of the year.

As many will recall, in February 2014, Congress came to a bipartisan, bicameral agreement for repeal of the SGR formula and overhaul of the Medicare physician payment system. The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (S. 2000/H.R. 4015 – the SGR Repeal Act) was the product of a yearlong collaborative effort between Congress and key stakeholders, including the American College of Surgeons. In fact, ACS was the only physician group to testify before all three congressional committees of jurisdiction (House Ways and Means, House Energy and Commerce, and Senate Finance) during the process culminating in the legislation.

Congress was subsequently unable to agree on offsets to pay for the cost of the SGR Repeal Act. This is extremely unfortunate and, in sum, represents a classic example of partisanship trumping good policy. This is particularly significant when one considers the exemplary bipartisan and bicameral efforts that culminated in the legislation and the fact that the $170 billion cost of the 17 temporary “patches” Congress has utilized over the past 11 years far surpasses the estimated cost of the current agreed-upon policy.

In September, representatives from five major physician organizations, including ACS, made visits to offices of congressional leaders specifically to urge action on S. 2000/H.R. 4015 during the lame duck session. Subsequently, letters urging action on the SGR Repeal Act have been sent to House leaders by the Pennsylvania congressional delegation; the House Doctors’ Caucus; and 114 additional members who signed a bipartisan letter circulated by Rep. Reid Ribble (R-Wis.) and Rep. Kurt Schrader (D-Ore.). When the signatures on these three letters are combined with those from similar correspondence circulated by Rep. Bill Flores (R-Tex.) and Rep. Dan Maffei (D-N.Y.) and sent to House leaders in November 2013, a total of 287 of the 435 members of the House of Representatives have indicated their support for passage of H.R. 4015.

Fellows received an e-mail earlier in October requesting that they contact their individual member of Congress to urge action on the SGR Repeal Act. The message is simple: The physician community has united around a sound bicameral and bipartisan payment reform policy that will permanently repeal the flawed SGR formula and make sound reforms to modernize Medicare physician payment. It is now Congress’ job to develop bipartisan, bicameral offsets and pass the legislation. For Fellows who have not taken the opportunity to act, they can still do so by logging on to www.surgeonsvoice.org and following the links for “Take Action Now.”

There is certainly a compelling argument that action during this lame duck session represents a real opportunity to permanently address and resolve the SGR. All seem to agree that we are long past the time to address this chronic, festering issue. Lame duck sessions also present opportunities for legislators who will not be returning to proceed without the considerations of short-term political consequences. For those returning for the 114th Congress, an opportunity to address a recurrent problem, clean it off the plate, and start fresh with the new Congress in January is also very appealing. Finally, one can also argue, as was done by a prominent member of the House Doctors’ Caucus, that the lame duck session presents an opportunity to more palatably return to bipartisan cooperation on the issue – a sort of “Butch Cassidy and the Sundance Kid Theory” of jumping off the cliff together.

Without action, the latest short-term patch is scheduled to expire on March 31, 2015. At that time, another patch, the 18th, would be necessary to preclude the cuts to Medicare physician payment that all, even Medicare’s Board of Trustees, agree Congress is likely never to allow to take place for fear of the political repercussions following such cuts from seniors and the physician community. Short-term patches obviously do not solve the problem. It is reasonable to predict that any short-term patch put in place in March would be set to expire around the time of the next debt limit debate, currently predicted to be just before the August recess in the summer. That one would be the 19th. Thus, to quote a famous American philosopher and poet, “The road goes on forever and the party never ends.”

In closing, I urge all Fellows to contact the offices of their representatives and senators – whether by phone, e-mail, logging on to www.surgeonsvoice.org, or paying a personal visit to their local district office – and seize the opportunity to support favorable action on the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (S. 2000/H.R. 4015) during the lame duck session.

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, D.C.

Congress has returned for the lame duck session of the 113th Congress. As has been the case for as many years as many of your D.C. staff can remember, the repeal of the flawed Sustainable Growth Rate is a primary focus of our legislative efforts during this brief time that Congress has remaining before the end of the year.

As many will recall, in February 2014, Congress came to a bipartisan, bicameral agreement for repeal of the SGR formula and overhaul of the Medicare physician payment system. The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (S. 2000/H.R. 4015 – the SGR Repeal Act) was the product of a yearlong collaborative effort between Congress and key stakeholders, including the American College of Surgeons. In fact, ACS was the only physician group to testify before all three congressional committees of jurisdiction (House Ways and Means, House Energy and Commerce, and Senate Finance) during the process culminating in the legislation.

Congress was subsequently unable to agree on offsets to pay for the cost of the SGR Repeal Act. This is extremely unfortunate and, in sum, represents a classic example of partisanship trumping good policy. This is particularly significant when one considers the exemplary bipartisan and bicameral efforts that culminated in the legislation and the fact that the $170 billion cost of the 17 temporary “patches” Congress has utilized over the past 11 years far surpasses the estimated cost of the current agreed-upon policy.

In September, representatives from five major physician organizations, including ACS, made visits to offices of congressional leaders specifically to urge action on S. 2000/H.R. 4015 during the lame duck session. Subsequently, letters urging action on the SGR Repeal Act have been sent to House leaders by the Pennsylvania congressional delegation; the House Doctors’ Caucus; and 114 additional members who signed a bipartisan letter circulated by Rep. Reid Ribble (R-Wis.) and Rep. Kurt Schrader (D-Ore.). When the signatures on these three letters are combined with those from similar correspondence circulated by Rep. Bill Flores (R-Tex.) and Rep. Dan Maffei (D-N.Y.) and sent to House leaders in November 2013, a total of 287 of the 435 members of the House of Representatives have indicated their support for passage of H.R. 4015.

Fellows received an e-mail earlier in October requesting that they contact their individual member of Congress to urge action on the SGR Repeal Act. The message is simple: The physician community has united around a sound bicameral and bipartisan payment reform policy that will permanently repeal the flawed SGR formula and make sound reforms to modernize Medicare physician payment. It is now Congress’ job to develop bipartisan, bicameral offsets and pass the legislation. For Fellows who have not taken the opportunity to act, they can still do so by logging on to www.surgeonsvoice.org and following the links for “Take Action Now.”

There is certainly a compelling argument that action during this lame duck session represents a real opportunity to permanently address and resolve the SGR. All seem to agree that we are long past the time to address this chronic, festering issue. Lame duck sessions also present opportunities for legislators who will not be returning to proceed without the considerations of short-term political consequences. For those returning for the 114th Congress, an opportunity to address a recurrent problem, clean it off the plate, and start fresh with the new Congress in January is also very appealing. Finally, one can also argue, as was done by a prominent member of the House Doctors’ Caucus, that the lame duck session presents an opportunity to more palatably return to bipartisan cooperation on the issue – a sort of “Butch Cassidy and the Sundance Kid Theory” of jumping off the cliff together.

Without action, the latest short-term patch is scheduled to expire on March 31, 2015. At that time, another patch, the 18th, would be necessary to preclude the cuts to Medicare physician payment that all, even Medicare’s Board of Trustees, agree Congress is likely never to allow to take place for fear of the political repercussions following such cuts from seniors and the physician community. Short-term patches obviously do not solve the problem. It is reasonable to predict that any short-term patch put in place in March would be set to expire around the time of the next debt limit debate, currently predicted to be just before the August recess in the summer. That one would be the 19th. Thus, to quote a famous American philosopher and poet, “The road goes on forever and the party never ends.”

In closing, I urge all Fellows to contact the offices of their representatives and senators – whether by phone, e-mail, logging on to www.surgeonsvoice.org, or paying a personal visit to their local district office – and seize the opportunity to support favorable action on the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (S. 2000/H.R. 4015) during the lame duck session.

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, D.C.

This month, I would like to call Fellows’ attention to some pending changes in the quality measures landscape, which can impact Medicare payment. By the time this issue goes to press, all Fellows should have received e-mail from ACS leadership referencing the document, “How to Avoid Medicare Penalties” available at . This document highlights the penalties Fellows might face if they do not participate in the various Medicare quality incentive programs. It also summarizes an excellent article in the September issue of the ACS Bulletin (Vol. 99, No. 9, pp. 28-32), “The benefits of PQRS participation and what the College is doing on your behalf,” by Charles D. Mabry, MD, FACS, Chair, ACS Health Policy Advisory Council (HPAC) and Sana Z. Gokak, MPH, a member of the Quality Affairs team here in the Washington office.

As most are acutely aware, the last few years have seen a change in the quantity and types of data collected by the Centers for Medicare & Medicaid Services (CMS). As part of this change, a shift has been made from the collection of administrative data toward collection of clinical data. Medicare payment has begun to shift from pay for reporting with the Physician Quality Reporting System (PQRS) program to pay for performance with the Value-Based Payment Modifier (VM).

The current calendar year of 2014 is the last year in which physicians may earn PQRS and Electronic Health Record (EHR) Incentive Program bonus payments based on their participation in CMS programs. Based on their record from 2014 of either successful participation or nonparticipation in the PQRS, VM, and EHR programs, surgeons’ Medicare payment could be impacted by up to a –6% in 2016. Whether or not providers participate in PQRS will also be indicated on the PHYSICIAN COMPARE website. The deadline for submission of data to CMS for 2014 is Jan. 31, 2015.

Physicians and other providers must submit data to the PQRS program in order to have such indicated on the PHYSICIAN COMPARE website. In addition, the data submitted through PQRS will be utilized in future years to increase or decrease fee-for-service (FFS) payments based on the VM. The VM payment adjustment will begin in 2015, but the data utilized for the 2015 adjustment will be based on 2013 performance. Payment adjustment will apply to all physicians by 2017, based on their 2015 data. For most Medicare incentive programs, penalties will apply to the physician’s Medicare payments 2 years after their performance in the programs.

Providing data to PQRS is thus the key and may be submitted by physician group practices via the Group Practice Reporting Option (GPRO) or individually via claims, EHRs, or Qualified Registries, or Qualified Clinical Data Registries (QCDR). The ACS has two registries available to assist Fellows to be successful participants in the submission of data for the PQRS program. These are the Surgeon Specific Registry (SSR) Qualified Registry and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) QCDR.

Many surgeons are familiar with the SSR as the ACS Case Log system whereby data was collected for the American Board of Surgery Maintenance of Certification program. Through this online program, surgeons can report on either the Perioperative Measures Group or the General Surgery Measures Group. To be successful for 2014, and thus avoid a penalty applied to payment in 2016, reports on 20 majority Medicare patients for either of the two measures groups seen during calendar year 2014 should be submitted to the SSR by Jan, 31, 2015. The SSR will submit the PQRS data to CMS.

The SSR is available at no cost to ACS members. For those not familiar with the Case Log, they may register for same at https://www.facs.org/quality-programs/ssr. Surgeons must consent to and sign up for PQRS reporting through the SSR if they want their data submitted to CMS.

In sum, it is frequently said that the only constant is change. Though the administrative requirements are much different than they were in the past, the ACS is working hard to make resources available to assist members in being successful in the ever-changing health care environment. The following ACS staff members are available to answer questions and assist members in participating in the 2014 PQRS program, EHR Incentive Program, the VM and to facilitate enrollment in the SSR and MBSAQIP:

• General PQRS, EHR, and VM questions: Sana Gokak, ACS Division of Advocacy and Health Policy, 202/337-2701 or sgokak@facs.org.

• Information on the SSR: Bianca Reyes, ACS Division of Research and Optimal Patient Care, 312/202-5000 or ssr@facs.org.

• Information on MBSAQIP: Rasa Krapikas, ACS Division of Research and Optimal Patient Care, 312/202-5000 or rkrapikas@facs.org.

Until next month …

This month, I would like to call Fellows’ attention to some pending changes in the quality measures landscape, which can impact Medicare payment. By the time this issue goes to press, all Fellows should have received e-mail from ACS leadership referencing the document, “How to Avoid Medicare Penalties” available at . This document highlights the penalties Fellows might face if they do not participate in the various Medicare quality incentive programs. It also summarizes an excellent article in the September issue of the ACS Bulletin (Vol. 99, No. 9, pp. 28-32), “The benefits of PQRS participation and what the College is doing on your behalf,” by Charles D. Mabry, MD, FACS, Chair, ACS Health Policy Advisory Council (HPAC) and Sana Z. Gokak, MPH, a member of the Quality Affairs team here in the Washington office.

As most are acutely aware, the last few years have seen a change in the quantity and types of data collected by the Centers for Medicare & Medicaid Services (CMS). As part of this change, a shift has been made from the collection of administrative data toward collection of clinical data. Medicare payment has begun to shift from pay for reporting with the Physician Quality Reporting System (PQRS) program to pay for performance with the Value-Based Payment Modifier (VM).

The current calendar year of 2014 is the last year in which physicians may earn PQRS and Electronic Health Record (EHR) Incentive Program bonus payments based on their participation in CMS programs. Based on their record from 2014 of either successful participation or nonparticipation in the PQRS, VM, and EHR programs, surgeons’ Medicare payment could be impacted by up to a –6% in 2016. Whether or not providers participate in PQRS will also be indicated on the PHYSICIAN COMPARE website. The deadline for submission of data to CMS for 2014 is Jan. 31, 2015.

Physicians and other providers must submit data to the PQRS program in order to have such indicated on the PHYSICIAN COMPARE website. In addition, the data submitted through PQRS will be utilized in future years to increase or decrease fee-for-service (FFS) payments based on the VM. The VM payment adjustment will begin in 2015, but the data utilized for the 2015 adjustment will be based on 2013 performance. Payment adjustment will apply to all physicians by 2017, based on their 2015 data. For most Medicare incentive programs, penalties will apply to the physician’s Medicare payments 2 years after their performance in the programs.

Providing data to PQRS is thus the key and may be submitted by physician group practices via the Group Practice Reporting Option (GPRO) or individually via claims, EHRs, or Qualified Registries, or Qualified Clinical Data Registries (QCDR). The ACS has two registries available to assist Fellows to be successful participants in the submission of data for the PQRS program. These are the Surgeon Specific Registry (SSR) Qualified Registry and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) QCDR.

Many surgeons are familiar with the SSR as the ACS Case Log system whereby data was collected for the American Board of Surgery Maintenance of Certification program. Through this online program, surgeons can report on either the Perioperative Measures Group or the General Surgery Measures Group. To be successful for 2014, and thus avoid a penalty applied to payment in 2016, reports on 20 majority Medicare patients for either of the two measures groups seen during calendar year 2014 should be submitted to the SSR by Jan, 31, 2015. The SSR will submit the PQRS data to CMS.

The SSR is available at no cost to ACS members. For those not familiar with the Case Log, they may register for same at https://www.facs.org/quality-programs/ssr. Surgeons must consent to and sign up for PQRS reporting through the SSR if they want their data submitted to CMS.

In sum, it is frequently said that the only constant is change. Though the administrative requirements are much different than they were in the past, the ACS is working hard to make resources available to assist members in being successful in the ever-changing health care environment. The following ACS staff members are available to answer questions and assist members in participating in the 2014 PQRS program, EHR Incentive Program, the VM and to facilitate enrollment in the SSR and MBSAQIP:

• General PQRS, EHR, and VM questions: Sana Gokak, ACS Division of Advocacy and Health Policy, 202/337-2701 or sgokak@facs.org.

• Information on the SSR: Bianca Reyes, ACS Division of Research and Optimal Patient Care, 312/202-5000 or ssr@facs.org.

• Information on MBSAQIP: Rasa Krapikas, ACS Division of Research and Optimal Patient Care, 312/202-5000 or rkrapikas@facs.org.

Until next month …

This month, I would like to call Fellows’ attention to some pending changes in the quality measures landscape, which can impact Medicare payment. By the time this issue goes to press, all Fellows should have received e-mail from ACS leadership referencing the document, “How to Avoid Medicare Penalties” available at . This document highlights the penalties Fellows might face if they do not participate in the various Medicare quality incentive programs. It also summarizes an excellent article in the September issue of the ACS Bulletin (Vol. 99, No. 9, pp. 28-32), “The benefits of PQRS participation and what the College is doing on your behalf,” by Charles D. Mabry, MD, FACS, Chair, ACS Health Policy Advisory Council (HPAC) and Sana Z. Gokak, MPH, a member of the Quality Affairs team here in the Washington office.

As most are acutely aware, the last few years have seen a change in the quantity and types of data collected by the Centers for Medicare & Medicaid Services (CMS). As part of this change, a shift has been made from the collection of administrative data toward collection of clinical data. Medicare payment has begun to shift from pay for reporting with the Physician Quality Reporting System (PQRS) program to pay for performance with the Value-Based Payment Modifier (VM).

The current calendar year of 2014 is the last year in which physicians may earn PQRS and Electronic Health Record (EHR) Incentive Program bonus payments based on their participation in CMS programs. Based on their record from 2014 of either successful participation or nonparticipation in the PQRS, VM, and EHR programs, surgeons’ Medicare payment could be impacted by up to a –6% in 2016. Whether or not providers participate in PQRS will also be indicated on the PHYSICIAN COMPARE website. The deadline for submission of data to CMS for 2014 is Jan. 31, 2015.

Physicians and other providers must submit data to the PQRS program in order to have such indicated on the PHYSICIAN COMPARE website. In addition, the data submitted through PQRS will be utilized in future years to increase or decrease fee-for-service (FFS) payments based on the VM. The VM payment adjustment will begin in 2015, but the data utilized for the 2015 adjustment will be based on 2013 performance. Payment adjustment will apply to all physicians by 2017, based on their 2015 data. For most Medicare incentive programs, penalties will apply to the physician’s Medicare payments 2 years after their performance in the programs.

Providing data to PQRS is thus the key and may be submitted by physician group practices via the Group Practice Reporting Option (GPRO) or individually via claims, EHRs, or Qualified Registries, or Qualified Clinical Data Registries (QCDR). The ACS has two registries available to assist Fellows to be successful participants in the submission of data for the PQRS program. These are the Surgeon Specific Registry (SSR) Qualified Registry and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) QCDR.

Many surgeons are familiar with the SSR as the ACS Case Log system whereby data was collected for the American Board of Surgery Maintenance of Certification program. Through this online program, surgeons can report on either the Perioperative Measures Group or the General Surgery Measures Group. To be successful for 2014, and thus avoid a penalty applied to payment in 2016, reports on 20 majority Medicare patients for either of the two measures groups seen during calendar year 2014 should be submitted to the SSR by Jan, 31, 2015. The SSR will submit the PQRS data to CMS.

The SSR is available at no cost to ACS members. For those not familiar with the Case Log, they may register for same at https://www.facs.org/quality-programs/ssr. Surgeons must consent to and sign up for PQRS reporting through the SSR if they want their data submitted to CMS.

In sum, it is frequently said that the only constant is change. Though the administrative requirements are much different than they were in the past, the ACS is working hard to make resources available to assist members in being successful in the ever-changing health care environment. The following ACS staff members are available to answer questions and assist members in participating in the 2014 PQRS program, EHR Incentive Program, the VM and to facilitate enrollment in the SSR and MBSAQIP:

• General PQRS, EHR, and VM questions: Sana Gokak, ACS Division of Advocacy and Health Policy, 202/337-2701 or sgokak@facs.org.

• Information on the SSR: Bianca Reyes, ACS Division of Research and Optimal Patient Care, 312/202-5000 or ssr@facs.org.

• Information on MBSAQIP: Rasa Krapikas, ACS Division of Research and Optimal Patient Care, 312/202-5000 or rkrapikas@facs.org.

Until next month …