Last weekend was an important weekend in Washington DC, not just because of the opening of the National Museum of African American History and Culture, but because it was the Fall meeting of the American College of Surgeons Health Policy and Advocacy Group (HPAG).  For those who aren’t familiar, the HPAG is the leadership group within the College that works on political issues on our behalf as an organization.  For years, the HPAG was incredibly focused (almost singularly so) on SGR repeal.  Now that we’ve checked that box, the HPAG has been able to move on to a broader variety of issues; some of these are around MACRA, the replacement for SGR, and many of them are not. Today’s blog mission is to let you know what our key HPAG topics were last weekend, and to start to educate my surgeons readers on those issues.

So…in agenda order…my take on our top 3 topics from theFall 2016 HPAG meeting-

GME– A small group has spent the last 9 months (oh, that timing seems appropriate!) developing a white paper on GME that can be used in discussions with members of Congress and their staff. Meaningful GME reform, as we are describing it, includes the components of workforce, finance, accountability, and governance. Within these four areas, the white paper includes the following proposed steps:

• Workforce- support healthcare workforce data collection and research
• Finance- maintain current levels of GME financing and appropriate temporary additional funds to support a GME modernization and quality improvement program
• Accountability- combine DME and IME into a single stream of GME funds
• Governance- move toward a regionalized GME governance system

While this gives you a crude outline of what the GME workforce group proposed, I hope to share more with you about this in a month or so once it is approved by the ACS Board of Regents. This is an area I’m particularly excited about because of my own roles in surgical education, and because it represents an opportunity for our profession to lead.  Change is coming to GME; this is our chance as surgeons to help define what that change looks like.

Global codes data collection– CMS has proposed onerous data collection around 10-day and 90-day global codes. The current proposal is for ALL practitioners who provide services under these codes to collect data on ALL patients served under these codes and for ALL services other than the procedure. G-codes were developed in conjunction with SAGE that require reporting of care in 10-minute increments, and using vague descriptors of “typical,” “complex,” and “critical.” The one that is most interesting to me as a burn surgeon is that “change dressings” is included as a typical visit.  Anyone who has spent any amount of time in a burn clinic knows that our dressing changes are anything but typical, and really don’t belong in the same category as a dressing change on a patient who had laparoscopic surgery.  Also, this idea of 10-minute time increment reporting strikes me as ludicrous because it is entirely inconsistent with any workflow (and quite frankly, would interfere with providing actual patient care, which is what I believe I’m supposed to be doing). The ACS is asking CMS to alter their plans to only obtain data from a representative sample of physicians and to avoid use of the unvalidated G-codes.  Again, stay tuned…I’m sure there is more to come on this, including an ask for people to reach out to their members of Congress.

MACRA and QPP and APMs and MIPS- oh my! Yes, it’s time to dig in around the alphabet soup that replaced the SGR. The most important thing for you to know are the following two things:

1. The ACS is working to develop APMs (Alternative Payment Models) for common procedures in conjunction with Brandeis. Again, stay tuned.
2. The ACS will have a major education campaign for us around QPP (Quality Payment Project). If you want to see the resources that are being made available, please look here. There are four things that you can do to get ready for MIPS (Merit Based Incentive Payment System)- 2016 participation in PQRS, review your quality and resource use report (QRUR) from CMS, review the clinical practice improvement activities list when it’s released in November and choose 6 for 2017, and make sure your EMR is ONC certified/ review your meaningful use data. None of these things are terribly tricky, none are designed to be terribly time-consuming.  User-friendly videos, all of which provide information in digestible bites, will be available soon to help make this process as seamless as it can be for all of us.

I want to be clear- these are not the ONLY things that HPAG and the Advocacy and Policy Division are working on.  They’re simply the three things that struck me as the most pressing, most meaningful areas that the DC office and the ACS physician leaders are addressing.

And now…back to our regularly scheduled, non policy-wonk programming.