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Congressional Leaders Make Strides on Repealing SGR

In the first of what is planned to be a series of discussions on the Medicare physician payment system, the Senate Finance Committee convened a roundtable meeting last week titled, "Medicare Physician Payments: Understanding the Past so We Can Envision the Future.” Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Orrin Hatch (R-UT) both called for repeal of the flawed Medicare sustainable growth rate (SGR) payment formula, and members of the committee heard from four former Administrators of the Centers for Medicare & Medicaid Services regarding possible means of moving beyond the SGR.  At the end of the discussion, Chairman Baucus requested that within the next month witnesses provide the committee with recommendations regarding how to address the Medicare physician payment update for 2013 and how best to reform the Medicare physician payment system over the long-term. CLICK HERE to view details about this first discussion, including statements from Senators Baucus and Hatch and witnesses. The American College of Surgeons (ACS) advocacy and health policy staff will be following these roundtable discussions and will provide new information when available.

Meanwhile, at the urging of the ACS and other groups, several members of the House of Representatives recently sent a letter to congressional leaders in support of moving forward with a permanent repeal of the SGR formula and of offsetting the full cost of repeal with unused Overseas Contingency Operations (OCO) funds. With each short-term patch that Congress enacts, the schedule of cuts gets steeper, and the cost of fixing the problem increases. CLICK HERE to view the letter.

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CMS Releases Two Final Rules to Reduce Regulatory Burden

The Centers for Medicare & Medicaid Services (CMS) released two final rules this month aimed at streamlining regulations for hospitals and physicians. One is a Medicare regulatory reform final rule.  CLICK HERE to view the comment letter that the American College of Surgeons submitted late last year in response to the proposed rule on Medicare regulatory reform. As a result of advocacy efforts by the ACS and other groups, CMS removed the detailed list of specific emergency equipment that must be available in every ambulatory surgical center. CMS also eliminated the unnecessarily punitive enrollment bar on physicians when the bar was based on failure to provide a timely response to a revalidation or other request for information concerning physician enrollment.

A second rule issued by CMS relates to Medicare conditions of participation (CoP) for hospitals.  The ACS had signed on to a group comment letter regarding CMS’ proposed rule on this topic.  In response, CMS made the following changes, among others, in the final rule: 

• Removed the proposal to allow a multi-hospital system to maintain a single medical staff for a multi-hospital system
• Removed the proposal to grant privileges  physicians without appointment to the medical staff
• Eliminated the mandatory inclusion of non-physician practitioners on medical staffs
• Removed the proposed concept of credentialing for medical staff membership in accordance with “hospital policies and procedures,” deferring instead to state law and “medical staff bylaws, rules, and regulations.”

CLICK HERE to read the Medicare regulatory reform rule.
CLICK HERE to read the CoP final rule.

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ACS Grassroots Advocates Help Gain Support for Trauma Programs

In recent weeks, 94 Fellows of the American College of Surgeons (ACS) send e-mails to their senators asking them to sign a letter requesting that the Department of Health and Human Services (HHS) prioritize funding for trauma and emergency medical services (EMS) programs in fiscal years 2013 and 2014, and asking for details about the HHS’ plans for cultivating these programs in the future.

Thanks, in part, to these efforts, Sens. Daniel Akaka (D-HI), Michael Bennet (D-CO), Ben Cardin (D-MD), and Robert Menendez (D-NJ) joined Sens. Patty Murray (D-WA) and Jack Reed (D-RI) in signing the letter. This is a significant accomplishment in a year when funding initiatives are being largely avoided. The ACS extends a “thank you” to all Fellows who participated in this important initiative.

CLICK HERE to view the final letter to HHS.

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CoC Sponsors Surgical Oncology Scholar-in-Residence Program

The American College of Surgeons (ACS) Commission on Cancer (CoC) is offering a two-year fellowship in surgical oncology outcomes and health services research beginning July 1, 2013. The ACS CoC offers one position every two years for a surgical resident who has completed two or three years of clinical training in the U.S. or Canada. The fellow will work within the ACS Cancer Programs Department to conduct clinical research and further the research agenda of the CoC’s National Cancer Data Base (NCDB) with the goal of improving quality of care for cancer patients. The application deadline is August 15, 2012. 

CLICK HERE to view the CoC website and obtain details about the program. Program questions and completed applications with supporting documentation should be directed to Connie Bura, ACS Administrative Director of Cancer Programs, at cbura@facs.org.

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COT Will Present Acute Care Surgery Conference June 10-13

The American College of Surgeons (ACS) Committee on Trauma will present the 31st annual Point/Counterpoint XXX Acute Care Surgery conference June 10-13 in National Harbor, MD. ACS Past-President L.D. Britt, MD, MPH, FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FRCSI(Hon), FWACS(Hon), is the course director.

The main objective of the Point/Counterpoint meeting is to review state-of-the-art management paradigms, ongoing controversies, and cutting-edge innovations that are involved with acute care. The first day of the conference will focus on inflammatory and necrotizing processes, along with the surgical management of other problems arising in the acute care setting. David B. Hoyt, MD, FACS, ACS Executive Director, will deliver the state-of-the-art lecture. On the second day, participants will address controversies in trauma management and efforts to challenge surgical dogma with Sharon Henry, MD, FACS, Baltimore, MD, delivering the Charles Wolferth, Jr., MD, Memorial Lecture. The third day will center on the efficacy of protocols, practice guidelines, and algorithms in the intensive care unit, and William Chiu, MD, FACS, Baltimore, MD, will be the featured state-of-the-art lecturer.

Up to 25 AMA PRA Category 1 Credits™ are available. CLICK HERE to view the scientific program and for course registration forms and hotel reservation information.

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CMS Releases Final Rule on Ordering and Referring Requirements

The Centers for Medicare & Medicaid Services (CMS) recently published a final rule on ordering and referring certain Medicare services, which incorporates changes that the American College of Surgeons (ACS) and other physician organizations requested in a group comment letter. In 2010, Congress mandated that physicians who order or refer must enroll in Medicare and list their National Provider Identifier (NPI) on all such claims, even if the physician did not otherwise participate in Medicare. Also in 2010, CMS proposed instituting automatic edits to reject claims if the ordering or referring physician did not have an enrollment record in the Provider Enrollment, Chain, and Ownership System (PECOS).

The group comment that the College cosigned raised concerns regarding these proposals. Some of the changes that CMS made in response to these comments include the following: physicians who order or certify imaging or clinical laboratory services, durable medical equipment, prosthetics, orthotics, and supplies or home health services can either be enrolled in PECOS or the legacy Medicare system to satisfy the enrollment requirement; physicians do not have to enroll in order to refer to specialists; and CMS will not turn on the automatic edits to deny claims due to lack of an enrollment record without a 60-day notice to physicians. The rule also requires that records related to orders or certifications be retained for seven years. 

Physicians may enroll in PECOS HERE, or submit the CMS 855-0, a paper application, available HERE.

• CLICK HERE to read the full rule
• CLICK HERE to read a related Bulletin article on the proposed rule

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Join Town Hall Series at ACS Clinical Congress

The popular Town Hall meetings will take place Tuesday, October 2, through Thursday, October 4, at the 2012 Clinical Congress in Chicago, IL. Following is the schedule for some of these programs:

Tuesday, October 2, 7-7:45 am
TH01: The Survival of General Surgery in 2012 and Beyond
TH02: Modern Surgical Education and Increasing Fail Rates for the Boards: What Are We to Do?
TH03: Palliative Care: Surgeons Wanted!  
TH04: Addressing Hospital Needs with ACS NSQIP®
TH05: How Washington Is Affecting Your Practice and Your Patients
TH06: Contracts

Wednesday, October 3, 7-7:45 am
TH07: Humanism in the Operating Room: Methods to Develop and Promote the Surgeon's Role in Delivering Patient-Centered Care
TH08: How to Initiate a Translational Research Academic Surgical Career
TH09: An Update on the Bariatric Accreditation Program
TH10: Do Structures and Processes Lead to Better Outcomes in Trauma Care?
TH11: Resolving Controversies in Cancer Care: American College of Surgeons - Clinical Research Program - An Expert Forum and Open Discussion
TH12: Maintenance of Certification, Is It Really Worth It?

Thursday, October 4, 7-7:45 am
TH13: International Surgical Research for Residents - Lessons from Fellow Travelers
TH14: Using the Surgeon-Specific Registry for the Practicing Surgeon
TH15: Working with the American College of Surgeons to Improve Diversity
TH16: Ethics Teaching in Surgical Residency Programs: Are We Doing the Best We Can?
TH17: Why Would A Surgeon Be a Member of Both a Specialty Surgery Association and the ACS?

Clinical Congress registration is required to attend the Town Hall Meetings. For more information, contact kmatousek@facs.org.

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Use Revised Code for Flight Discount to and from Clinical Congress

The American College of Surgeons (ACS) has arranged special transportation discounts with United Airlines for travel to and from the 2012 Clinical Congress, which will take place in Chicago, IL, from September 30 to October 4. You must reference the ACS Z Code— ZMXH479578—to obtain the special fare. Note that the code that appears on page 40 of the 2012 Clinical Congress Program Planner, which should arrive soon through the U.S. Postal Service, has been changed. These special discounts are available by booking with United directly (independently or through a travel agent).

To receive the meeting discount, contact United Airlines at 800-521-4041, 7 am – 9 pm (CDT), Monday through Friday; or 8 am – 6 pm (CDT), Saturday and Sunday.

Purchase your ticket online at www.united.com and receive a discount off the lowest applicable fare.

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Considerations for Selecting Candidates for ACS Board of Governors

The Board of Governors (B/G) is integral to the administration of the American College of Surgeons (ACS).  It is the representative body to the ACS. To provide balanced geographical representation, two-thirds of the Governors are nominated by the membership at-large and elected during an annual meeting of Fellows at the Clinical Congress. Nominations for new B/G members are due June 30. Certain surgical societies, chapters, and federal medical services are permitted to nominate Governors up to a level of one-third of the Board of Governors. In an effort to improve this process, an ad hoc committee of the Board of Governors was selected to explore the role and responsibilities of Governors and the selection criterion for the nomination of members to the Board of Governors. This call for candidates provides an outline of how Governors can provide meaningful representation.  The B/G is intended to be both inclusive and transparent, and needs members who can actively serve as a link to the local community and a resource for the ACS.  CLICK HERE for more information.

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ACS Issues Guidance Document to Help Surgeons Avoid eRx Penalty

The American College of Surgeons (ACS) Division of Advocacy and Health Policy has created a step-by-step resource guide on applying for a hardship exemption from payment penalties for noncompliance with the Centers for Medicare & Medicaid Services’ (CMS) Electronic Prescribing (eRx) Incentive Program. CLICK HERE to view the guide. In addition, CMS has opened the Quality Reporting Communication Support Page to allow “individual” eligible professionals and CMS-selected “group practices” the opportunity to request a significant hardship exemption and avoid the 2013 Electronic Prescribing (eRx) payment penalty.  Eligible professionals and group practices reporting through the Group Practice Reporting Option (GPRO) have from now until June 30 to apply for an exemption online using the Communication Support Page. Eligible professionals and practices that need to request a hardship exemption are as follows:

• Those unable to prescribe at least 25 times for denominator-eligible visits from January 1 to December 31, 2011
• Those unable to electronically prescribe any 10 prescriptions (not necessarily denominator-eligible) between January 1 and June 30, 2012
• Those who do not qualify for an automatic exemption must apply for economic hardship

Other websites that may be useful for surgeons and their practices are as follows:  

• For more information on the eRx program CLICK HERE or visit the CMS eRx page.
• For general information refer to the CMS guidance document.
• For more information on eRx payment penalties, go to http://www.cms.gov/MLNMattersArticles/Downloads/SE1206.pdf

If you have questions or concerns, please contact the CMS QualityNet Help Desk at 866-288-8912, sgokak@facs.org, or 202-337-2701.

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McGill Study Seeks Inguinal Hernia Repair Surgeon Respondents

Researchers at the McGill University Health Centre (MUHC), Montreal, QC, Canada, are conducting a survey of the practice, use of techniques, and educational needs of general surgeons performing inguinal hernia repair. Approved by McGill’s institutional review board, the survey contains four sections of multiple-choice questions and should take less than 15 minutes to complete. Liane Feldman, MD, FACS, associate professor of surgery and the Steinberg-Bernstein chair of minimally invasive surgery (MIS) at the MUHC, and Gerald Fried, MD, FACS, chief of MIS and Innovation at the MUHC, direct the MUHC’s minimally invasive surgery lab, and Melina Vassiliou, MD, FACS, is conducting the survey. To complete the survey, CLICK HERE.

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Register Now for EAST Masters Course to Be Held in Maryland in June

The Eastern Association for the Surgery of Trauma (EAST) is taking its Masters Course, traditionally held during the EAST Annual Scientific Assembly, on the road. The program, which will take place on June 10, 2012, in National Harbor, MD, will offer a didactic, interactive discussion forum with surgical experts, focusing on clinical and technical strategies and approaches to complex patient presentations. Program participants are eligible to receive Maintenance of Certification, Part 2, self-assessment credit. CLICK HERE to view the EAST website, where you can register and view details about the program. 

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