Advocacy Monthly: July 2019

July 2019

CMS Cuts Medicare Reimbursement for Certain Services
The Medicare Physician Fee Schedule proposed rule for calendar year 2020 contains a number of provisions that may be harmful to cardiothoracic surgery.

Of note, the proposed rule:

  • Threatens the value of evaluation and management services provided by cardiothoracic surgeons, potentially lowering Medicare reimbursement for cardiothoracic surgery in 2021 and beyond
  • Lowers reimbursement for pericardiotomy, transcatheter aortic valve replacement, and aortic grafting procedures
  • Updates benchmarks, requirements, and quality measures under the Merit-Based Incentive Payment System (MIPS)
  • Offers information on how to participate in Alternative Payment Models (APMs) and Advanced APMs, as well as a new option under the Quality Payment Program—the MIPS Value Pathway
  • Provides new covered services related to opioid use and recovery

Additionally, the Hospital Outpatient Prospective Payment System proposed rule addresses price transparency in health care by calling on hospitals to post online all standard charges and payer-specific negotiated rates. This provision may aid the Society’s efforts in combining cost and quality information to demonstrate value in cardiothoracic surgery.

In another move that advances that goal, the White House announced plans to expand the MyHealthEData program in January so that physicians can access their Medicare claims data if they receive patient permission. Providers can sign up now for the pilot program; additional information from the Centers for Medicare & Medicaid Services (CMS) is expected within the next 3 months.

STS will submit comments to CMS regarding the proposed rules and work to ensure that the final rules are fair to cardiothoracic surgeons and their patients.

STS Members Fight for Residency Slots, Research Funding on Capitol Hill
Earlier this month, STS Officers and more than two dozen other members traveled to Washington, DC, for the Society’s annual Legislative Fly-In. While there, they attended more than 70 meetings with Congressional staff and urged lawmakers to increase caps on residency positions, reauthorize the Patient-Centered Outcomes Research Institute (PCORI), fund lung cancer research, and limit access to tobacco. “This was an eye-opening experience for a novice like me,” said Desmond M. D’Souza, MD, from The Ohio State University Wexner Medical Center in Columbus. “The information we provided to our senators was really well-received.” Attendees also networked at a happy hour and celebratory thank you dinner, and spent time with cardiothoracic surgeon Rep. Larry Bucshon during an exclusive breakfast at the Capitol Hill Club. Check out photos and watch a brief video featuring highlights from this event, and learn about other ways you can become involved in grassroots advocacy.

From left: President Robert S.D. Higgins, MD, MSHA, Chair of the Workforce on Health Policy, Reform, and Advocacy Stephen J. Lahey, MD, Public Director Christopher M. Draft, Sen. Bill Cassidy, MD, First Vice President Joseph A. Dearani, MD, Secretary Joseph F. Sabik III, MD, and Chair of the Council on Health Policy and Relationships Operating Board Alan M. Speir, MD

Also during the Fly-In, STS presented its Legislator of the Year award to Sen. Bill Cassidy, MD (R-LA). Sen. Cassidy has supported efforts to help the STS National Database access Medicare claims data for quality and cost improvements, led a bipartisan effort to improve price transparency and lower costs in the health care market, and supported the repeal of the Sustainable Growth Rate. He currently is working to protect patients from surprise medical bills by creating a fair process for settling discrepancies between providers and insurers.

J. Robert Headrick, MD, MBA, with patient Sharon Faircloth, met with legislative staff in Washington, DC, regarding the need for mobile lung screening in Tennessee.

Key Contact Connect: Headrick Advocates for Mobile Access to Lung Screening
J. Robert Headrick, MD, MBA, of CHI Memorial Hospital in Chattanooga, Tennessee, recently participated in a briefing for Congressional staff in Washington, DC, on his institution’s mobile lung screening initiative. Launched last year, the “Breathe Easy” coach bus brings low-dose computed tomography equipment into communities, reaching people who otherwise may not have access to such screening.
Dr. Headrick is seeking federal funding to expand the program throughout Tennessee and was joined by a lung cancer survivor who shared her story. Sharon Faircloth was diagnosed with stage 1 non-small cell lung cancer after her primary care physician referred her for screening at CHI Memorial. She emphasized how lucky she was to receive a prompt referral and have easy access to screening—which is not the case for many people living in rural areas of the state, Dr. Headrick said. The Breathe Easy program aims to close this gap.
Dr. Headrick, who was the Society’s 2018 Key Contact of the Year, has been working closely with Sen. Lamar Alexander (R-TN), Sen. Marsha Blackburn (R-TN), and Rep. Chuck Fleischmann (R-TN) on this project since meeting with them at an STS Legislative Fly-In last year. If you’d like help in setting up meetings with your elected officials, contact Madeleine Stirling.

Society Takes Action on PCORI, Surprise Billing, Student Loan Debt, and More
STS is working with national medical societies and public health groups on the following issues affecting cardiothoracic surgeons and their patients:

  • PCORI—STS lent its support to legislation that would reauthorize PCORI for 10 years. PCORI is the only agency required to include patients at every step of the research process.
  • Surprise Billing—A coalition letter sent to the House Committee on Energy and Commerce outlined the need for a fair and equitable independent dispute resolution process in any surprise billing legislation.
  • Student Loan Debt—STS sent a comment letter to the House Small Business Committee describing the growing burden of student loan debt and sharing the experience of a resident who has struggled to pay back medical school loans during her cardiothoracic surgery training. The Society also signed a coalition letter supporting legislation to provide $50 million in annual funding for the Pediatric Subspecialty Loan Repayment Program.
  • Tobacco Control—STS signed a Campaign for Tobacco-Free Kids letter backing a bill that would make all Veterans Health Administration facilities smoke-free.
  • Data Use—The Society signed a coalition letter to the American Medical Association (AMA) Board of Trustees regarding the AMA’s recent report on “Research Handling of De-Identified Patient Information.” The letter warned against imposing additional limitations on the use of de-identified patient data, noting that such data are essential to improving care delivery and health outcomes.
  • Bleeding Control—STS sent a letter supporting a bill that would provide states with grant funding for anti-blood loss supplies such as tourniquets, gauze, and hemostatic dressings that would be made available in public areas, as well as for training citizens on how to use these materials in an emergency.