Advocacy Monthly: July 2020

Medicare Cuts Still Loom on Horizon
The Medicare Physician Fee Schedule proposed rule for calendar year 2021 will be released soon, and STS is closely monitoring its status. Despite the COVID pandemic, the Centers for Medicare & Medicaid Services is expected to include cuts of up to 8% for cardiothoracic surgeons, which would be harmful to the specialty and hurt timely access to quality care for patients.

Among its efforts to reverse these proposed cuts, the Society is an active member of the Surgical Care Coalition, which launched a multifaceted campaign that consists of legislative and regulatory advocacy, a public relations campaign, as well as research and data collection on the impact of the cuts. For updates on the latest Coalition activities, visit

Bill Would Extend Access to Tobacco Cessation Programs
The Society has joined 50 medical organizations in signing a letter that strongly supports the Quit Because of COVID-19 Act. Tobacco users may be at greater risk of severe complications from the coronavirus, and many Medicaid programs face significant budget shortfalls due to the pandemic. This legislation would ensure that all Medicaid and Children’s Health Insurance Program (CHIP) enrollees have access to a full array of evidence-based tobacco cessation treatments for the duration of the COVID-19 public health crisis and the subsequent 2 years. While all states provide some level of tobacco cessation coverage for Medicaid participants, many programs have barriers and do not cover all treatments. The Quit Because of COVID-19 Act would:

  • Extend comprehensive tobacco cessation coverage to all Medicaid and CHIP beneficiaries
  • Eliminate cost sharing and prior authorization requirements
  • Provide enhanced federal funding to cover the full cost of state outreach campaigns

The bill currently is with the House Committee on Energy and Commerce.

Bundling Edit Changes In Place for Aortic Grafting Procedures
After months of working with the Centers for Medicare & Medicaid Services and the contractor for the National Correct Coding Initiative, STS reports new bundling edit changes for aortic grafting procedures. An ascending aortic grafting code now may be reported with the transverse aortic arch grafting code when they are performed in the same session or on the same day. This change—retroactive to January 1, 2020—allows reimbursement for both of these complex procedures.

STS Supports Legislation to Increase Residency Slots
Projections from the Association of American Medical Colleges show that the US is facing a significant shortage of physicians by 2033. In response, the Society—as part of the Graduate Medical Education (GME) Coalition—has urged congressional leadership to include the Resident Physician Shortage Reduction Act of 2019 in the next COVID-19 supplement. This bipartisan legislation would increase the number of residency positions eligible for GME payments by 3,000 per fiscal year for 5 years. Of these positions, at least 1,500 would be for residents in a shortage specialty residency program such as cardiothoracic surgery.

Specialty Societies Discourage US Restrictions on International Health Workforce
Also in an effort to mitigate damage to the physician workforce and subsequently patient access to care, leading medical associations, including STS, succeeded in reversing the Administration’s decision to restrict visas for qualified foreign workers. In a letter sent to the Departments of State and Homeland Security, the organizations requested that embassies and consulates be advised to allow physicians with H-1B visas and their dependent family members timely entry into the US, underscoring that this is in the “national interest of the country.” The letter also explained that America relies on international medical graduates (IMGs) to maintain a robust health care workforce that is capable of caring for all patients. IMGs represent more than 25% of the physician workforce in the US, and nearly 21 million people live in areas of the country where foreign-trained physicians account for at least half of all physicians.

Advocacy Extras

  • STS was part of a recent Campaign for Tobacco-Free Kids letter that opposes any efforts to weaken the Food and Drug Administration’s authority over tobacco products, such as cigars.
  • The Society submitted comments with an addendum on the Inpatient Prospective Payment System proposed rule for fiscal year 2021 that could affect cardiothoracic surgical procedures, including left atrial appendage closure, endovascular cardiac valve replacement and supplement procedures, chest wall deformity with supplementation, percutaneous/endoscopic biopsy of mediastinum, and percutaneous endoscopic chemical pleurodesis.