Washington Scene: STS Advocacy Efforts Tackle Bundled Payments, Medicare Cuts

STS News, Fall 2020 — The Society has fought hard over the last few years not only to ensure that cardiothoracic surgeons could participate in Advanced Alternative Payment Models (APMs), but also that these APMs appropriately measured quality and performance for the specialty.

As a result, STS members who participate in the Adult Cardiac Surgery Database (ACSD) and the Bundled Payments for Care Improvement (BPCI) Advanced Model—an APM—now have an opportunity to increase their Medicare reimbursement. The Society worked closely with the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare & Medicaid Innovation to make sure that data submitted to the STS National Database are an integral part of BPCI Advanced.

Why? BPCI Advanced is a new initiative that supports health care providers who invest in practice innovation to improve patient care while reducing expenditures. This model, which ties payment to relevant quality measures within 35 clinical episodes, rewards providers for delivering services more efficiently, supports enhanced care coordination, and recognizes high quality care.

“The importance of this critical linking of the STS National Database with a Medicare bundled payment program is monumental,” said Keith A. Horvath, MD, who is a member of the STS Workforce on Health Policy, Reform, and Advocacy. “For the first time, the quality outcomes achieved by cardiac surgeons will directly impact not only the patients’ well-being, but also the reimbursement for their care.”

In addition, the model shifts payment incentives away from fee for service (which focuses on volume) to value. Participation in BPCI Advanced offers many potential benefits, including a 5% bonus and exclusion from the Merit-Based Incentive Payment System.

Hospitals and physician group practices that already are enrolled in BPCI Advanced can elect to use the Alternate Quality Measures Set for various clinical episodes. This addition allows participants in BPCI Advanced to have more choices regarding how the quality of care is measured in the model.

“The importance of this critical linking of the STS National Database with a Medicare bundled payment program is monumental.”

Keith A. Horvath, MD

STS has been a vital part of these updates, providing extensive input to CMS and making sure that the quality measures used within these episodes are relevant, applicable, and appropriate for real-world care delivery. Additional Alternate Quality Measures are on the way.

“In this transition to value-based care, use of the STS National Database for the assessment of quality finally puts the metric of valuation in the hands of the surgeons and not claims administrators,” explained Dr. Horvath who also is senior director, clinical transformation at the Association of American Medical Colleges. “Additionally, this is just the crucial first step in the eventual goal of establishing the true value of cardiothoracic surgery as defined collaboratively by the STS and payers.”

The Society encourages Database participants to take advantage of BPCI Advanced by selecting the Alternate Quality Measures Set when classifying clinical episodes such as coronary artery bypass grafting and cardiac valve through the BPCI Advanced model. Under the program, data submitted to the ACSD can be reported via the new Alternate Quality Measures Set, which, in turn, results in reporting more meaningful and accurate quality measures and potentially increasing Medicare reimbursement payments for surgery. Selecting Alternate Quality Measures also can help reduce the administrative burden associated with quality measure data capture for BPCI Advanced participants and help demonstrate a return on your investment in the STS National Database quality improvement efforts.

Fight Continues for CT Surgery Reimbursement

In early August, CMS released its proposed Medicare Physician Fee Schedule (PFS) rule for 2021. The rule, scheduled to go into effect on January 1, slashes Medicare payments by as much as 9% for the specialty, threatening the value of evaluation and management (E/M) services provided by cardiothoracic surgeons.

Under this new rule, CMS would set the 2021 PFS conversion factor at $32.26 when accounting for the budget neutrality adjustment—down $3.83, or more than 10%, from the conversion factor of $36.09 in 2020. This is due largely to changes in Relative Value Units for E/M codes.

The final rule will be delayed until December, but policymakers already are working to implement the proposed changes. As a result, STS already has submitted its formal comments and is working with members of Congress to ensure that the final rule is fair to cardiothoracic surgeons and their patients.

In addition to working with the Surgical Care Coalition in the battle against Medicare payment cuts, the Society is fighting the proposed cuts separately by meeting with elected officials, facilitating grassroots advocacy, and signing onto various letters and meeting with stakeholders who are involved with Medicare reimbursement decisions.

How You Can Help

STS strongly encourages you to take action by connecting with your members of Congress and explaining how the proposed reimbursement cuts and a weakened health care system as a result of COVID-19 will hurt your patients. These meetings will allow you to share your personal story, which can have a lasting impact on advocacy efforts.

At this time, all meetings with lawmakers are virtual, presenting a unique opportunity for you to engage with your legislators without having to travel. STS can help you schedule a meeting and provide you with talking points. The time commitment would be less than 30 minutes.

Another course of action would be to write an opinion piece or letter to the editor in your local newspaper. Recently, the San Antonio Express-News published a commentary written by John Calhoon, MD, STS Second Vice President, on why Medicare reimbursement cuts will hurt patients.

For more information on how you can help, email advocacy@sts.org or visit sts.org/keycontact.


Take Action Now

Urge your legislators to reverse these reimbursement cuts! Even during this difficult time, there are still many ways to get involved virtually. STS can help you with scheduling and provide briefing materials.

Schedule a phone call or virtual meeting with your representatives or members of their health care teams to provide details on how these cuts may impact patient care.

Become a Key Contact. This program is a great way to stay informed while building relationships and advocating for the specialty. Get access to timely legislative updates and opportunities to engage.

Encourage your STS colleagues to become involved. STS members are the heart of our grassroots advocacy efforts. The more participation we have, the greater impact STS can make.