ACS Advocacy Brief: March 10

Surgeon Perspectives

Support Consumer Product Safety Commission Rule on Limiting Magnets; Protect Your Youngest Patients

By Akila Ramaraj, MD, MPH (@AkilaRamaraj) and Marion C. W. Henry, MD, MPH, FACS, FAAP (@mcwhmd)

The Consumer Product Safety Commission (CPSC) is accepting comments on a new rule that limits the flux index of loose or separable magnets in products designed, marketed, or intended for entertainment, jewelry, mental stimulation, stress relief, or a combination of these purposes. As surgeons who care for patients who have ingested magnets and have witnessed the dangers of magnets first-hand, our support of this rule can have a profound impact on its adoption and acceptance. Sets of small magnets were introduced to the toy market in 2008. From 2009 to 2011, there were approximately 1,700 instances of small magnet ingestion among children who required treatment in emergency departments (EDs), according to data from the National Electronic Injury Surveillance System.^1,2 A study published this year in Pediatrics found that 55% of children who ingest magnets must be hospitalized, and 10% have significant morbidity from magnet ingestion, including obstruction, fistula development, and/or volvulus. More than 40% of children who ingest magnets require either an endoscopic or surgical procedure for management, and 4.5% require multiple procedures for magnet retrieval and removal.³

Policy analysis from the pediatric literature shows that limitations, such as the one proposed in this rule, decrease the harms associated with magnet ingestion. In 2012, the CPSC adopted a similar rule limiting the flux index of similar magnets and magnet sets in products intended as toys for children younger than age 14. This rule was in place until a company appeal in 2016 led a federal court to reverse it. A 2018 study in the Journal of Pediatric Gastroenterology and Nutrition found that the number of ED visits for magnet ingestion decreased after the 2012 adoption of the CPSC rule.⁴ A follow-up study from 2020 found an increase in magnet ingestion after the rule was reversed. After reversal of the rule, the number of patients requiring hospitalization or surgery to treat magnet ingestion also increased.⁵

As surgeons, we care for patients who have been injured by magnets. We have seen firsthand the extreme dangers these magnets pose, both in the short-term and the long-term. We understand the severity of complications such as intestinal fistula development, volvulus or bowel resection, and even death. We can also speak about the physical and emotional impact that complications have on our patients and their families.

We have a duty to share our experiences and the stories of our patients so that policymakers and legislators can protect our patients. Using our knowledge and our voice is one way we can “serve as effective advocates of our patients’ needs” and “advocate for strategies to improve individual and public health through communication with government, health care organizations, and industry.⁶

We strongly encourage ACS members to submit comments in support of the proposed CPSC rule. Comments must be submitted by March 28, 2022.

References

1. Safety Standard for Magnet Sets. Federal Register 2012. https://www.federalregister.gov/documents/2012/09/04/2012-21608/safety-standard-for-magnet-sets (accessed February 27, 2022).
2. National Electronic Injury Surveillance System (NEISS). US Consumer Product Safety Commission n.d. https://www.cpsc.gov/Research--Statistics/NEISS-Injury-Data (accessed February 28, 2022).
3. Middleburg LK, Leonard JC, Shi J, et al. High-Powered Magnet Exposures in Children: A Multi-Center Cohort Study. Pediatrics.2022;149:e2021054543.
4. Reeves PT, Nylund CM, Krishnamurthy J, Noel RA, Abbas MI. Trends of Magnet Ingestion in Children, an Ironic Attraction. JPGN. 2018;66:e116–21.
5. Reeves PT, Rudolph B, Nylund CM. Magnet Ingestions in Children Presenting to Emergency Departments in the United States 2009-2019: A Problem in Flux. JPGN. 2020;71:699–703.
6. American College of Surgeons. ACS Code of Professional Conduct. Approved by the Board of Regents. June 2003. https://www.facs.org/about-acs/statements/stonprin#pledge

Advocacy in Action

Discover Opportunities to Engage in Advocacy during the 2022 ACS Leadership & Advocacy Summit

The annual ACS Leadership & Advocacy Summit, April 2–5, will include several opportunities to engage with the Division of Advocacy and Health Policy (DAHP). On Monday, April 4, virtual and in-person attendees will hear from panelists covering a range of topics such as Medicare physician payment, the development of a national trauma system, health equity in surgery, and more.

In addition to hearing from healthcare policy experts, on Tuesday, April 5, US/domestic participants are eligible to participate in virtual meetings with members of Congress. Advocacy Summit attendees participating in the congressional visits will be required to review legislative “asks” and attend advocacy training prior to their meetings.

For those attending in-person, plan to visit the ACS DAHP booths, which will be staffed Sunday, April 3, and Monday, April 4. Staff will be available to discuss legislative, regulatory, quality, and state affairs priorities, including how to elevate engagement in advocacy via SurgeonsVoice and SurgeonsPAC.

For more information about the College’s federal legislative priorities, visit the ACS Federal Legislation web page. To learn more about and/or register for Leadership & Advocacy Summit, visit the Summit web page.

On the Hill

Congress Recognizes 100th Anniversary of the Committee on Trauma

US Representatives Michael C. Burgess, MD (R-TX) and Tom Suozzi (D-NY) and US Senators John Boozman (R-AR) and Bob Menendez (D-NJ) introduced companion resolutions (H.Res. 951/S.Res. 532) recognizing the 100th anniversary of the ACS Committee on Trauma (COT) and the importance of preventing injury and saving more lives around the globe. Since its inception in 1922, the COT has played a pivotal role in advocacy and education efforts, leveraging trauma center and trauma system resources, creating best practices, providing outcome assessment, and prioritizing continuous quality improvement. With traumatic injury being the most common cause of death for individuals ages one to 45 years old and the cause of nearly 200,000 deaths per year in the US, robust trauma systems and the teams who treat trauma patients, have never been more critical to our healthcare system.

Call to Action! Visit SurgeonsVoice to ask your senators/representative to cosponsor H.Res. 951/S.Res. 532 to formally recognize the essential role that the COT has played in improving trauma care over the past 100 years.

For more information, contact Amelia Suermann, ACS Senior Congressional Lobbyist, at asuermann@facs.org.

ACS Supports Effort to Extend the Suspension of Congressional Sequester Cuts to Medicare Physician Payment

On February 28, the ACS cosigned a letter from 50 organizations representing physicians, patients, and payors to congressional leaders calling on them to extend a 2% Medicare sequester moratorium until the end of the public health emergency. The Protecting Medicare and American Farmers from Sequester Cuts Act, which was passed in December 2021, extended the suspension of Medicare sequestration cuts through March and begins to phase it in. Without further congressional action, 1% of the sequester cuts will resume in April, and the full 2% cut will be reinstated in July.

For more information on congressional action regarding Medicare payment cuts, contact Carrie Zlatos, ACS Senior Health Policy Advisor, at czlatos@facs.org.

State Affairs

Can We Get All 50 States to Pass Coverage for Lung Cancer Screenings?

A 2022 state policy priority for the ACS Commission on Cancer is to expand Medicaid coverage for lung cancer screenings. Momentum to expand Medicaid over the last few years has resulted in 45 states, including Washington, DC, to pass legislation providing coverage. Only six states—Alabama, Mississippi, Nebraska, North Dakota, Utah, and Wyoming—have yet to do so. We need to end the fight and close the gap for all Medicaid beneficiaries.

According to the American Lung Association, the 5-year cancer survival rate is only 6 percent for those diagnosed at a late stage (after a tumor spreads) but increases 60 percent for those diagnosed at an early stage. Furthermore, the 2020 estimated cost of lung cancer care in the US was $23.8 billion dollars. So far, none of the six states left to provide Medicaid coverage for lung cancer screenings has introduced legislation. For more information on specific legislation or to engage in state advocacy, contact Christopher Johnson at cjohnson@facs.org or Rebecca King at rebeccaking@facs.org.

View a full list of cancer bills being tracked by the ACS:

Cancer State Legislation 2022

ACS Connecticut Chapter Opposes Prejudgment Interest Legislation

The ACS Connecticut Chapter submitted written testimony to the Connecticut Joint Committee on Judiciary for a hearing Friday, March 4, opposing H. B. 5235, legislation that would significantly change the way prejudgment interest is applied in medical liability cases. Under the proposed law, an additional 8% annual interest payment on a potential award would start calculating on the “date of cause of action,” which is being interpreted as the date of injury, not the date a legal action is filed. This increase could add thousands of dollars to a final award in addition to legal fees.

Illinois enacted a similar law in 2021 despite opposition from the College. Read the Connecticut Chapter’s testimony.

Regulatory Updates

2020 Quality Payment Program Performance Information Now Available on Care Compare

The Centers for Medicare & Medicaid Services (CMS) added 2020 Quality Payment Program (QPP) performance information for physicians, clinicians, groups, and Accountable Care Organizations (ACOs) to the Doctors and Clinicians section of Medicare Care Compare and the Provider Data Catalog (PDC). Note that Quality data originally submitted will not be publicly posted on Care Compare if a physician receives reweighting to 0% for the category through an Extreme and Uncontrollable Circumstances (EUC) exemption application or targeted review. No performance information will be publicly reported for groups and clinicians for whom Merit-based Incentive Payment System performance categories are reweighted to 0% through the EUC policy. The final reweighting and targeted review decisions were applied before 2020 performance information was released on Care Compare.

MIPS eligible clinicians’ final scores, performance in each of the four MIPS performance categories (Quality, Cost, Improvement Activities, and Promoting Interoperability), names of eligible clinicians in Advanced APMs and, to the extent feasible, the names and performance of such Advanced APMs can be found on the Care Compare website. The CMS Care Compare website is a tool physicians, Medicare patients, and caregivers can use to search for and compare physicians, clinicians, and groups enrolled in Medicare.

Surgeons can visit the Care Compare: Doctors and Clinicians Initiative page for details about the 2020 QPP performance information that has been added to Care Compare profile pages and the PDC.

For more information, contact QualityDC@facs.org or CMS directly at QPP@cms.hhs.gov.

CMS Reopens 2021 MIPS Extreme and Uncontrollable Circumstances Application in Response to COVID-19

CMS recently announced that it will reopen the MIPS EUC application for groups, virtual groups, and Alternative Payment Model (APM) entities disrupted by the COVID-19 pandemic. EUC applications citing COVID-19 as the triggering event can be submitted until Thursday, March 31, 2022. Note that applications received between now and March 31 will not override previously submitted data for groups and virtual groups.

Groups and Virtual Groups That Have Not Submitted Data

• Groups: Because group participation is optional and individual MIPS-eligible clinicians qualify for the MIPS automatic EUC policy, no further action is needed if the group cannot submit data for the 2021 performance period. All four performance categories will be reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless:
  • They submit data in two more performance categories as individuals
  • The practice reports as a group by submitting data for one or more performance category
• Virtual Groups: If virtual groups cannot submit data for the 2021 performance period, they must submit a MIPS EUC application for all four performance categories by March 31.

Groups and Virtual Groups That Have Submitted Data

• Groups and virtual groups that have submitted data for a single performance category: If the group cannot complete data submission for other performance categories, it can submit a MIPS EUC application to request reweighting in the remaining performance categories. If the application is approved and no additional data are submitted at the group level, MIPS-eligible clinicians will receive a neutral payment adjustment for the 2023 MIPS payment year. If the group does not submit a MIPS EUC application, it will be scored in all performance categories unless it is eligible for reweighting in one or more performance categories.
  • This includes small practices that were automatically scored as a group on Medicare Part B claims measures submitted throughout the 2021 performance period.
• Groups and virtual groups that have submitted data for two or three performance categories: MIPS-eligible clinicians will receive a MIPS final score and MIPS payment adjustment for the 2023 MIPS payment year.
  • Applications cannot be submitted to override previously submitted data, but applications can be submitted to request reweighting of performance categories for which data have not been submitted.

APM Entities

Official representatives of APM Entities participating in MIPS can submit a MIPS EUC application on behalf of all MIPS eligible clinicians in the APM Entity for the 2021 performance year. If approved, all eligible clinicians in the APM Entity will receive a neutral MIPS payment adjustment in the 2023 MIPS payment year.

Note the differences for APM entities from the existing MIPS EUC policy for individuals, groups, and virtual groups:

• APM Entities are required to request reweighting for all performance categories.
• More than 75% of the MIPS eligible clinicians in the APM Entity must be eligible for reweighting in the Promoting Interoperability performance category.
• Unlike MIPS EUC applications for individuals, groups and virtual groups, an APM Entity’s approved application for performance category weighting will override previously submitted data.

CMS offers additional information about the EUC policy on its website. Surgeons can request additional information by contacting QualityDC@facs.org.