ACS Advocacy Efforts Focus on Unanticipated Medical Billing Issues
NewsScope: May 31, 2019
Congress is reviewing multiple proposals to address the issue of surprise medical billing. As these legislative packages are developed, the American College of Surgeons (ACS) has been working with lawmakers to advocate for solutions that would best serve surgical patients and maintain the patient-physician relationship.
Sen. Bill Cassidy, MD (R-LA), and other members of the Senate Bipartisan Working Group, recently introduced the Stop Surprise Medical Bills Act, S. 1531. The ACS opposes this bill because it would give one-sided negotiating power to health plans, allowing insurers to use a median contracted rate as the benchmark payment rate for out-of-network physicians and to apply arbitration costs in determining their medical-loss ratio. Read the ACS press release on the Stop Surprise Medical Bills Act.
House Committee on Energy and Commerce leaders used a similar strategy in developing its draft bill, the No Surprises Act. This bipartisan proposal also uses the median contracted rate as the benchmark payment for out-of-network physicians. Such a benchmark will have negative consequences for both out-of-network and in-network providers. For physicians who want to be part of the health plan’s network, payment negotiations would be unfairly biased towards the plan, whereas in-network physicians who are paid above the median in-network rate could be subject to lower rates in the future due to the increased power of the health plans. This provision would have consequences for years down the road as insurers seek to drive down the median in-network rate. Read the College’s letter to the House Committee on Energy and Commerce.
The ACS supports federal legislation that is based on proven efforts to address surprise billing. Reps. Raul Ruiz, MD (D-CA), Phil Roe, MD (R-TN), and colleagues recently released such a framework, which is modeled on a New York law that provides comprehensive patient protections, maintains adequate networks of physicians and specialists, establishes reasonable payment benchmarks, and offers alternative dispute resolution in certain cases. Read the ACS press release.
In addition, the College submitted a statement to the House Committee on Ways and Means for its recent hearing, Protecting Patients from Surprise Medical Bills.
The Senate passed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019, S. 1379, May 16 with unanimous consent. This legislation, introduced May 8 by Sens. Richard Burr (R-NC), Robert Casey (D-PA), Lamar Alexander (R-TN), and Patty Murray (D-WA) includes the American College of Surgeons (ACS)-supported Mission Zero Act. The Mission Zero Act would create 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. S. 1379 now awaits final passage in the House before heading to the President’s desk for a signature. Contact your representative today and ask them to support S. 1379.
For details about the legislation, read the Pandemic and All-Hazards Preparedness Act Overview or contact Hannah Chargin, ACS Congressional Lobbyist, at firstname.lastname@example.org.
The American College of Surgeons (ACS) is saddened to inform the membership that LaSalle D. Leffall, Jr., MD, FACS, ACS Past-President, died May 25 at 89 years old. Dr. Leffall was a surgeon par excellence and an esteemed oncologist medical educator, civic leader, and mentor to thousands of medical students and surgical residents who trained at Howard University, Washington, DC.
Dr. Leffall was an exceptional student, graduating from high school at just 15 years old and summa cum laude in 1948 from Florida Agricultural and Mechanical College—now Florida A&M University—in Tallahassee. He trained at the Howard University College of Medicine and graduated first in his class. He completed his surgical training at Freedmen’s Hospital—now Howard University Hospital—in 1957 and then completed surgical oncology training at Memorial Sloan-Kettering Cancer Center, New York, NY.
In 1962, Dr. Leffall joined Howard’s faculty as an assistant professor and became chair of the department of surgery eight years later, a position he held for 25 years. In 1992, he was named the Charles R. Drew Professor of Surgery, occupying the first endowed chair in the history of Howard’s department of surgery. Even after retiring from active practice, he remained on the faculty as a lecturer and trusted advisor.
Dr. Leffall was the first African-American President of the ACS, American Cancer Society, Society of Surgical Oncology, and Society of Surgical Chairs. His prolific academic contributions include more than 150 publications, three books, visiting professorships at more than 200 institutions around the world, 14 honorary degrees from universities in the U.S., and honorary fellowships from six international colleges of surgeons.
Prior to serving as President of the ACS (1995−1996), Dr. Leffall was the ACS Secretary (1983−1992), a member of a number of ACS committees, and President of the Metropolitan Washington DC Chapter (1978−1979). For more information, read a tribute by Howard University President Wayne A.I. Frederick, MD, MBA, FACS.
The Centers for Medicare & Medicaid Services (CMS) May 23 published its final rule Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses, which amends Medicare Advantage (MA) and Prescription Drug Benefit program (Part D) polices that affect drug prices and out-of-pocket costs for patients. This rule finalizes regulatory provisions that require Part D insurers to include on their formularies all drugs in six protected classes—anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants. The agency had initially proposed to expand the use of prior authorization and other utilization management tools to enable Part D insurers to exclude or limit access to certain medications that were otherwise required to be included on insurers’ formularies because of their protected class status. CMS chose not enact its proposal in this final rule after the American College of Surgeons (ACS) expressed strong concerns that such coverage restrictions could disrupt care, impede patient access to medically necessary therapies, and threaten the safety of beneficiaries who were prescribed immunosuppressants to prevent organ rejection after a transplant operation.
Under this rule, CMS will also require all Part D insurers to adopt digital Real Time Benefit Tools (RTBTs) that can effectively integrate with clinicians’ electronic health records (EHRs) and electronic prescribing systems. When properly implemented, RTBTs have the capability to inform prescribers when lower-cost or more appropriate alternative treatments are available under a patient’s prescription drug benefit. The ACS has supported the agency’s efforts to make beneficiary-specific drug coverage and cost information more available to physicians at the point-of-care. Part D insurers must begin using at least one fully integrated RTBT by January 1, 2021.
For more information about the final rule, contact Lauren Foe, Senior Regulatory Associate, ACS Division of Advocacy and Health Policy, at email@example.com.
The American College of Surgeons (ACS) Division of Advocacy and Health Policy is accepting applications for the 2020 ACS Chapter Lobby Day Grant Program.
The ACS Chapter Lobby Day Grant Program provides an annual cash grant up to $5,000 with a required Chapter match to host or sponsor a day at their state capitol for chapter Fellows and members to meet with legislators. One enhanced $15,000 grant is available to a chapter to use towards a comprehensive state legislative campaign and lobby day in 2020. In addition, the grant includes ACS State Affairs staff support for planning and on-site implementation.
The deadline for submitting applications is September 1, 2019.