Advocacy in Action

Carter L. Alleman, J.D.

Concurrent Surgery in the Spotlight

Back in May’s Washington Watch, I highlighted the change to the American College of Surgeons policy on concurrent surgery. The change was a result of the Boston Globes’ in-depth “spotlight” series on concurrent surgeries at Massachusetts General Hospital. Following the publication of the series, the United States Senate Committee on Finance began an investigation of concurrent surgery and released its findings in a report. The report is available here.

In early 2016, the Committee sent a letter to 20 teaching hospitals querying them about the practice in their institutions. The letter generated strong interest from hospitals, individual physicians, patient advocates, and others who reached out to the Committee to share their experiences, insights, and knowledge about these issues. Additionally, Committee staff examined guidance issued by the Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services (HHS), and the American College of Surgeons (ACS), policies and other information provided to the. The report is a summary of the Committee’s staff’s findings to date and an overview of key issues and areas of Congressional concern.

The report outlined two areas that troubled the Committee most, patient safety and improper payments. The patient safety concerns focused on whether patients are giving consent to have these types of surgeries performed and whether they are safe to perform. The Committee is asking for further guidance and an examination on how best to proceed from CMS and the ACS. The Committee is asking for particular procedures that could be allowed to have concurrent surgeries performed and to further define the “critical parts” of the surgery.

The second area of concern is the improper payments from Medicare and Medicaid. CMS has not taken any steps to determine whether the existing billing requirements applicable to teaching physicians in hospitals are or are not being followed despite a history of problems in this area. Second, CMS’s billing requirements are applicable only to teaching physicians operating in hospitals. There are no billing requirements in place that would prevent a surgeon from billing for two or more concurrent surgeries in hospitals outside of a teaching scenario, such as when a physician is assisted by a technician, or in nonhospital settings, such as in ambulatory surgery centers. The Committee is asking for further investigations into billing practices of teaching physicians and whether additional similar measures are needed for other surgical scenarios and facilities.

The ACOS’ Government Affairs Committee is working on a strategy on how to move forward in light of the Committee’s report. In January 2017, the ACOS will be releasing a series of surveys that will assist in these efforts. Please take a moment and fill out the surveys, each response helps sharpen the College’s advocacy strategy.