American Society of Plastic Surgeons
For Consumers

FEDERAL | ASPS Engages Congress on CMS’s Changes to Global Surgical Codes

On September 14, physicians from 13 states and the District of Columbia attended the ASPS Northeast & West Fly-In, where they advocated for the specialty during 45 meetings with members of Congress and their staff. While there were many important issues on the agenda, ASPS's advocacy efforts on the Hill saw immediate results when three Representatives joined a critical letter to Acting CMS Administrator Andy Slavitt following ASPS member requests that they sign on. The letter calls on the agency to revise its recent proposal on the 10- and 90- day global surgical codes.

CMS has for years tried to significantly change the single, bundled payment system for surgical services, including their 2014 attempt to completely abolish the global surgical codes. Yet Congress has intervened, at the request of the physician community, and helped maintain the current system. In passing the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), Congress actually prohibited CMS from eliminating 10- and 90-day global codes and instead required CMS to gather "from a representative sample of physicians…information needed to value surgical services." ASPS fully supported this provision, even though the society ultimately opposed MACRA, which replaced the SGR, for serious concerns over other parts of the law.

In July 2016, CMS attempted to yet again significantly change the global surgical codes through the 2017 Medicare Physician Fee Schedule. In this proposal, CMS stated that all practitioners who utilize 10- and 90-day global surgical codes would be required to submit data in 10 minute increments for all patients receiving these services. ASPS moved swiftly against this proposal which, in addition to being tremendously burdensome for surgeons, also clearly violates the letter of the law. If adopted, this new rule would impose a substantial, unexpected new compliance cost, necessitating the likely diversion of resources and time away from patient care.

Rep. Larry Bucshon, MD (R-IN-08), a cardiothoracic surgeon, and Rep. Ami Bera, MD (D-CA-07), an internist, also recognized the negative implications of this proposal on both physicians and patients and initiated a letter to CMS urging them to adopt the language outlined in MACRA. They asked their colleagues to cosign this letter, which specifically called for CMS to revert back to a "representative sample" instead of requiring all physicians to participate. Reps. Bucshon and Bera encouraged advocates to also solicit their members of Congress to cosign this letter.

Due to the significant impact this proposal will have on the specialty, ASPS physicians made cosigning the Bucshon/Bera letter a key ask during their Hill meetings. Most importantly, they provided their Representatives with insights into the effects this ruling will have on their ability to efficiently and effectively treat patients. As a direct result of ASPS's meetings at the Northeast & West Fly-In, Rep. John Culberson (R-TX-07), Rep. Charlie Dent (R-PA-15) and Rep. Bob Dold (R-IL-10) signed on to the Bucshon/Bera letter. This was only made possible because of the 24 dedicated physician members who joined ASPS in the nation's capital to advocate for the specialty.

This letter, which was sent to HHS Secretary Sylvia Burwell and Acting Administrator Andy Slavitt on September 16, was collectively signed by 112 member of the House.