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Sat Jul 18 20:51:54 BST 2009

In a message dated 7/18/2009 2:48:25 P.M. Central Standard Time,  
drydok at hotmail.com writes:

I am  not an ACS member - is it possible to post a copy of this document to 
the List  to show what the problem is?

From: <mailto:ahp at facs.org>ahp at facs.org
To:  xxxxxxxxxxxxxxxx
Subject: ACS Announces Support For Health Care Reform  Bill
Date: Fri, 17 Jul 2009 17:36:00 +0000

Dear Dr. xxxxx:

We  are writing to inform you that the American College of Surgeons is  
supporting this first step in health care reform legislation entitled  
"America's Affordable Health Choices Act of 2009" (H.R. 3200), which 
is  currently being considered in the US House of Representatives. 
This is an  ongoing process that will require the College to evaluate 
our support and  level of engagement at each step of the process, and 
does not lock us into a  specific position as the legislation goes 
through additional changes and is  finalized.

This decision was made after careful consideration by the ACS  Health 
Policy and Advocacy Group and extensive discussions with the  
leadership of all the major surgical organizations. Ultimately, the  
decision to support the bill was made unanimously by the Executive  
Committee of the ACS Board of Regents.  Our support helps us to  
ensure that the final bill includes language that we support and does  
not include language that we oppose.  We would like to take this  
opportunity to provide you with an explanation of why the ACS 
leadership  felt that it was important for the College to support H.R. 
3200.

This  legislation embodies many of the top legislative priorities of 
the College.  The leaders within the College, including the Regents, 
the Governors and  various committees, have had extensive, ongoing 
discussions related to  health care reform and how these issues impact 
surgeons and surgical  patients.  A major part of this discussion 
included the health care  reform statement that the ACS Board of 
Regents and Governors developed and  approved last year. Surgical 
workforce issues are a significant part of this  statement.  One of 
the most important priorities related to workforce  is the need to 
address the underlying problems of the Sustainable Growth  Rate (SGR), 
which is used to calculate Medicare physician payments.   This 
legislation (H.R. 3200) would allocate $284 billion to fix the  
Medicare physician payment system and eliminate the more than 40 
percent  cuts in payments to physicians that are scheduled to take 
place over the  next four years, giving surgeons stability for the 
first time in 10  years.

The bill would stop the pending 21.5 percent cut in Medicare  
reimbursement that will occur on January 1, 2010, and replace the cut  
with an increase based on the Medicare Economic Index.  Second, it  
would reset the budget baseline for the Medicare payment system to  
2009.  Resetting the baseline, in addition to action by the Centers  
for Medicare and Medicaid Services (CMS) to remove  
physician-administered drugs from the SGR formula that have 
negatively  impacted Medicare physician payments, will finally provide 
a long-term  solution to the difficulties that have plagued Medicare 
payment reform for  the better part of a decade.  Also, rather than 
implementing untested  models of care and reimbursement, H.R. 3200 
would implement pilot programs  to test various delivery system 
reforms that would build on models that have  been shown to improve 
quality of care. Collectively, these measures would  stop years of 
scheduled cuts in Medicare payments, better align incentives  to 
improve quality, and ensure that surgeons will be able to care for  
patients without the annual concern of Medicare payment cuts.

What is  included in the bill is important. However, what is not 
included in the  legislation is also critical, particularly to 
surgery. While the bill  addresses challenges facing primary care, it 
does not finance increased  payments for primary care through 
reductions in payments for surgical  care.  The College appreciates 
that the legislation recognizes that  such payment cuts would 
exacerbate the trend of declining payments for many  surgical services 
and would threaten patients' ability to access these  important 
services.

The legislation does include a public health  insurance option.  While 
the public health insurance option does raise  a number of questions, 
the College insisted that any public health insurance  option not 
mandate that individual physicians participate in the  program.  The 
legislation very clearly allows for physicians to opt-out  of the 
program, with no penalties for doing so.  In order for a public  
option to be successful for patients and for physicians, physicians 
need  to be able to have the same voluntary participation options that 
are  available to them under any other plan. The College is grateful 
that this  legislation would ensure that physicians will continue to 
have the freedom  to make determinations that are in the best interest 
of their practice and  ultimately their patients.

Support of H.R. 3200 is advantageous from a  strategic standpoint as 
well. Legislation that will be introduced in the  Senate soon is not 
expected to be as favorable for physicians.  The  legislative process 
will require the House and Senate bills to be reconciled  before 
Congress votes for final passage, and we need to ensure that the  
College's top priorities, currently included in the House bill, 
remain  intact.

The ACS leadership and staff remain very engaged in the health  care 
reform efforts in Washington.  Once again, this is an ongoing  process 
that will require the College to evaluate our support and level of  
engagement at each step of the process.  We will continue to work  
with both the House and Senate to ensure that any comprehensive 
health  care reform legislation will contain the College's priorities 
and promote  Americans' access to both quality coverage and care.  The 
College's  Washington office will soon host another webinar to provide 
Fellows with a  detailed overview of the current status of health care 
reform legislation as  it makes its way through Congress.  Additional 
details about this  webinar will be sent to Fellows on Monday, July 
20,  2009.

Sincerely,

L.D. Britt, MD, MPH, FACS -- Chair of the ACS  Board of Regents 
Michael Zinner, MD, FACS -- Chair of the ACS Board of  Governors 
Andrew Warshaw, MD, FACS --- Chair of the ACS Health Policy and  Advocacy 
Group 
Thomas Russell, MD, FACS --- ACS Executive Director

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