Washington Scene: STS Works for Appropriate CT Surgeon Reimbursement

STS News, Winter 2018 -- The old adage that "if you don’t have a seat at the table, you could wind up on the menu" perhaps could not be more relevant than when considering physician reimbursement.

Determining appropriate payment for cardiothoracic surgical services is a complicated process, and STS has worked tirelessly to help ensure that the procedures performed by its members are fairly quantified and valued. Two important ways in which the Society has had a seat at the table have been through its work with the American Medical Association’s CPT^® Editorial Panel and with the AMA/Specialty Society Relative Value Scale Update Committee (RUC).

Accurate Codes are Essential

The CPT Editorial Panel is where all the codes for the procedures performed by cardiothoracic surgeons originate. CPT terminology is the most widely accepted medical nomenclature for reporting medical procedures and services to both governmental and commercial health insurance programs.

The CPT Advisory Committee supports the Editorial Panel by suggesting revisions to the CPT code set, providing documentation regarding the medical appropriateness of various medical and surgical procedures under consideration for inclusion, and coming up with definitions for different procedures.

“Getting the terminology right and collaborating with other medical and surgical specialties are the first steps toward appropriate reimbursement and recognition by various external bodies of the work that we do,” said Francis C. Nichols III, MD, who serves as the STS representative on the CPT Advisory Committee. Dr. Nichols also chairs the STS Workforce on Coding and Reimbursement.

Recently, the Society worked with vascular surgeons to develop new “conduit creation” codes that capture the extra work that is sometimes necessary in order to safely establish cardiopulmonary bypass. In addition, STS took the lead in creating new laparoscopic/thoracoscopic esophagectomy codes, commonly called minimally invasive esophagectomy codes.

“We all know there is nothing minimally invasive about esophagectomy, no matter what the approach, and we didn’t want the magnitude of these procedures misconstrued,” Dr. Nichols said. “We’ve been able to achieve so much because the Society has earned respect and credibility, which benefits all cardiothoracic surgeons. This credibility didn’t come overnight, but rather through detailed, honest, and realistic proposals.”

Valuing Physician Work

The RUC is the physician community’s primary vehicle for communicating with the Centers for Medicare & Medicaid Services about payment policy. The RUC works to quantify the resources required to provide physician services and then proposes value recommendations to CMS.

STS representatives regularly have provided evidence to the RUC on behalf of the specialty regarding CPT codes that have been identified as potentially misvalued, new codes being valued, or codes that require revaluation per RUC rules. For example, the Society’s proposed values for revised esophageal codes and artificial heart codes recently were accepted by the RUC, and ultimately CMS, subsequent to STS presentation.

In addition to presenting data that will help with the valuation of certain codes, STS has a representative on the RUC—currently Verdi J. DiSesa, MD, supported by alternate Joseph C. Cleveland Jr., MD—who votes on codes and values brought up for review and participates in subcommittees and workgroups, including those which address practice expense and professional liability issues that impact physician work valuation.

Dr. DiSesa was appointed to the role after STS Member Peter K. Smith, MD was named RUC Chair in 2015. Dr. Smith had spent a decade representing cardiothoracic surgery on the RUC, prior to his appointment as Chair.

“The value of having a seat on the RUC can only be realized by developing critical relationships with AMA staff and other RUC members. In so doing, we have become experts on the entire RUC process, which has allowed us to achieve a significant measure of success in physician reimbursement,” said Stephen J. Lahey, MD, Chair of the STS/AATS Workforce on Health Policy, Reform, and Advocacy. “A certain trust is built over the years, and this indirectly helps our cause with any codes that STS brings forward.”

Drs. Nichols and Lahey both stressed the importance of the next generation learning the ins and outs of the CPT and RUC world. “Quite simply: It behooves us to become actively involved in this critical financial process,” Dr. Lahey said.

If you’d like to learn more about ways in which you can serve the specialty through these and other activities, contact the STS Government Relations office via email or at 202-787-1230.

STS Members Urge Support for Training Slots, Smoking Bans, Research

About two dozen cardiothoracic surgeons converged on Washington, DC, in November for the Society’s latest Legislative Fly-In.

During their meetings on Capitol Hill, STS members urged support for the Resident Physician Shortage Reduction Act, which would expand the current cap on the number of Medicare-supported training slots for doctors and increase opportunities for physician training programs—a move essential to ensuring patient access to care. Research has shown that by 2035, cardiothoracic surgeons would have to increase their caseload by 121% in order to meet demand.

STS members also asked lawmakers to pass a bill that would immediately ban smoking inside Veteran Health Administration (VHA) facilities and would ban smoking outside VHA facilities within 5 years. Currently, VHA facilities have 971 outdoor spaces affirmatively designated for smoking and 15 indoor spaces designated for smoking, despite the fact that many veterans suffer from chronic obstructive pulmonary disease, hypertension, and coronary artery disease, all of which are exacerbated by secondhand smoke.

In addition, Fly-In participants urged restoration of funding for the Agency for Healthcare Research and Quality and requested more time to meet certain provisions in the Medicare Access and CHIP Reauthorization Act.