key: cord-0944492-h48kw7gf
authors: Speir, Alan M.; Yohe, Courtney; Dearani, Joseph A.
title: Cardiothoracic Surgical Advocacy in a Time of COVID-19
date: 2020-05-16
journal: Ann Thorac Surg
DOI: 10.1016/j.athoracsur.2020.05.005
sha: 3cc1e49e691f20262f10c0b120678291e5913d56
doc_id: 944492
cord_uid: h48kw7gf

nan

The COVID-19 pandemic has resulted in substantial morbidity and mortality worldwide [1] [2] [3] . It was only several months ago when the United States braced for the expected tsunami known as novel coronavirus 2019. The news media barraged our airways with disturbing and tragic stories of patients, nurses, physicians, and hospitals that were quickly overwhelmed outside of our shores with what was rapidly recognized as a world-wide pandemic. The US expeditiously converted our health care institutions in order to prepare for the onslaught of Covid-19 patients that we had seen arrive by the thousands in China, Italy, Spain, and the United Kingdom.

Patients were rapidly discharged from our hospitals, elective surgical schedules were cancelled, and extra shifts of nurses and physicians were hastily scheduled while the communities discussed the advantages of social distancing, school and business closures, and isolating in place. It was in this context that the Advocacy arm of the Society of Thoracic Surgery (STS) began to focus their activities on both the clinical and legislative concerns of the impending pandemic.

It was obvious that the health care system in the countries first impacted by the Covid-19

were struggling with supply chain limitations that profoundly restricted their ability to treat patients and protect their medical staff and extended health care workers (HCW). Direct While all of these issues are quite commonplace now, the governmental prioritization of these concerns was quite superficial only a few short weeks ago.

STS strongly advocated with these governmental agencies via multiple conference calls, and our concerns were strongly raised in the halls of Congress as well. Discussions were held with Congressmen, Senators, and their administrative staff to consider current administrative impediments to health care delivery in the presence of a national pandemic in the next emergency Congressional legislation. These included, but were not limited to, ensuring physicians and HCW's have appropriate access to PPEs, providing Good Samaritan protections to physicians who practice across state lines, relief of unnecessary prior authorizations for care, small business relief for physician practices including small business loans, requesting disability protections for physicians treating Covid-19 patients, protecting physicians in Medicare alternative payment models from losses due to canceled cases and poor outcomes, suspension of the annual 2% Medicare budget sequester, suspension of MACRA quality reporting requirements, and provision of additional financial support to hospitals and physician practices adversely impacted by the COVID crisis. While many of these priorities were included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act which was signed into law on March 27, 2020, other priorities will be included in upcoming additional Congressional legislation expected to be drafted in the next several months in the attempt to protect patients and providers from the ravages of the novel coronavirus-2019 pandemic.

It must also be remembered that the Covid-19 pandemic has occurred during the time when the Center for Medicare and Medicaid Services (CMS) plan to cut reimbursement for cardiothoracic surgeons by 8% in January, 2021 [4, 5] . Such reductions to many cardiac and thoracic surgeons, in addition to the economic burden we have had to endure as a result of losses from cessation of elective surgery by directives of state governments, salary reductions to help compensate for hospital and health care institutional losses, and illness as a direct result of the Covid-19 virus, may leave many in our specialty with devastating economic losses to practices and surgeons. During STS advocacy in support of supply chain materials and legislative relief, additional advocacy has been conducted with the American College of Surgeons (ACS) to address the CMS financial reductions to the specialty of cardiothoracic surgery. STS is part of the Steering Committee for the Surgical Care Coalition, that will continue to formulate strategy and create a constructive appropriate response to the 2020 Final Payment Rule by CMS during the summer and fall of 2020.

The Covid-19 pandemic has demonstrated regionalized patterns worldwide and in the US. While it appears to be coming under control in some areas of the United States, other urban environments are still confronting the effects of this virus on many patients and hospitals in their locale. It is for that reason, as well as the work that still needs to be done in order to resume health care delivery to many thousands of patients who have deferred such care in order to avoid being exposed to Covid-19 in the hospital, that significant governmental advocacy remains to be done by the STS. In parallel with these efforts, active participation by our specialty in the Surgical Care Coalition remains an equal priority. With the help and guidance of those in our specialty and STS Leadership, we will continue to persevere in our resolve to protect our patients and our membership.

A Novel Coronavirus from Patients with Pneumonia in China

First Case of 2019 Novel Coronavirus in the United States

Covid-19 in Critically Ill Patients in the Seattle Region -Case Series

Medicare Program: CY 2020 Revisions to Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies

Medicare Shared Savings Program Requirements Final Rule

Medicare Final Payment Rule: Implications for Cardiothoracic Surgery