College’s efforts have spotlighted liability protection
for trauma providers, such as the Health Care Safety
Net Enhancement Act (H.R. 836/S. 884) and the Good
Samaritan Health Professionals Act (H.R. 865).
Repeal of the SGR
A notable and successful recent effort by the ACS, in
collaboration with dozens of specialty societies and
physician groups, was the repeal of the SGR. A product of the 1997 federal budget negotiations, the SGR
tied Medicare payment rates to growth in U.S. gross
domestic product (GDP) to rein in health care spending;
when physician spending grew less than GDP, reimbursement would increase, and vice versa.
Each year since 2002, the SGR would trigger cuts
in Medicare reimbursement as a result of high health
care spending relative to the concomitant change in the
GDP, bringing with it the threat of decreased patient
access to physicians. In response, Congress passed 17
retroactive, increasingly expensive stop-gap funding
bills to cover the budgeting shortfall, a practice nick-
named the annual “doc fix.”
The ACS played a leading role in a multispecialty
coalition to repeal the SGR. Year after year, Medicare
physician reimbursement remained a top legislative
priority, but despite general agreement among mem-
bers of Congress that the SGR was a failed experiment,
attempts to replace the flawed formula repeatedly
stalled due to disagreements about the potential alter-
native and how to fund it.
23 Persistent efforts by ACS
Fellows and staff eventually came to fruition. The
multi-year initiative ultimately succeeded with the
passage of MACRA, which set automatic increases for
Medicare reimbursement rates until 2019 and outlined
a Merit-based Incentive Payment System (MIPS) pro-
gram to launch thereafter.
The ACS was in the vanguard of SGR repeal efforts
for more than a decade, supporting ACS Fellows in
advocacy efforts in their cities and states, carrying
out sustained federal lobbying on the issue, and strat-
egizing with other medical groups.
23 The success of
the campaign was a testament to the importance and
potential of surgical advocacy at the federal level and
meaningfully demonstrated why surgeons need to stay
abreast of health policy changes that will affect their
practices, their patients, and their collective effort to
improve the delivery of surgical care.
Preserving the surgical workforce
As Resident Members of the ACS look to the future
of surgical advocacy, several issues present both challenges and opportunities for the health care profession.
Graduate medical education reform efforts to train
and maintain the health care workforce is a priority
across every specialty of medicine because the consequences of a physician shortage will be felt for years to
come. During the past decade, the number of seats in
U.S. medical schools has come under scrutiny as estimates suggested that schools were graduating too few
physicians to replace those retiring.
25 Through diverse
federal and state funding programs and public–private
partnerships, more than a dozen new medical schools
have matriculated their first classes in the last five years,
boosting the physician supply by several hundred graduates each year.
However, GME has become a new bottleneck as
the number of federally funded residency positions
remains capped and insufficient, not only to meet
projected demand for medical care two decades from
now, but also to satisfy the immediate demand for
postgraduate training by growing numbers of U.S.
medical school graduates. The Association of American Medical Colleges has estimated that within 10
years, demand for physicians will outstrip supply by
up to 90,000.27, 28
Whereas early projections pointed to primary
care as the area of greatest need, newer models now
underscore an urgent need for both generalists and
specialists, who may account for half or more of the
29 So, to meet the health care needs of the
nation’s aging population, an increase in the number of
physicians of every kind, including general and subspecialty surgeons, will be required. Because postgraduate
surgical training takes five to 10 years, the time for
GME reform to alleviate demand a decade from now
has already arrived.