Both the ACS and American Society of Anesthesiologists (ASA) have advocated effectively on several key payment issues relevant to surgeons and anesthesiologists, but there is more work to be done. The groups are now exploring how to better develop and advocate for long-term solutions that recognize the full value of surgical care to the health of communities. 

ACS and ASA leaders came together yesterday in a Special Session, SL02. When 1+1 Can Equal 3; How ASA and ACS can Work Together to Address our Challenges with Medicare and Private Pay, to share perspectives and details. Julie A. Freischlag, MD, FACS, DFSVS, Immediate-Past President of the ACS, co-moderated the session with Randall M. Clark, MD, FASA, ASA President.

No Surprises Act

The panelists first discussed the No Surprises Act (NSA), which prohibits certain billing practices and establishes a federal independent dispute resolution (IDR) process to settle billing disputes between clinicians and insurers when no state law is in place to govern the dispute. The provisions are intended to take patients out of the middle of these disagreements.

According to Patrick V. Bailey, MD, FACS, ACS Medical Director of Advocacy, it took years of negotiations with Congress, alongside the ASA and other stakeholders, to get the IDR process into the bill. But even now, it isn’t perfect.  “What we have isn’t great, but it’s much better than what we started off with,” Dr. Bailey said, suggesting that inclusion of the IDR was a key accomplishment the groups worked together to achieve.

Michael W. Champeau, MD, FASA,ASA president-elect, said the ACS and ASA were successful in making utilization of the IDR accessible. The groups were “specifically able to improve the floor—the minimum fee for a claim to be considered for the IDR process,” Dr. Champeau said.

The negotiations were an iterative process, according to panelists. “When it comes to surprise medical bills, you want to keep the patient harmless,” said Jonathan Gal, MD, MBA, MS, FASA, the chair of the ASA committee on economics. “Some of those first versions of bills were actually keeping the payor harmless, as well. It took the collaboration among many professional societies to make it a more fair process.”

Medicare Payment

The ACS has long advocated for a solution to annual attempts by the Centers for Medicare & Medicaid Services to cut Medicare reimbursement for surgeons. Panelists suggested that defining the value of surgeons and anesthesiologists to health systems is necessary to make better use of a changing reimbursement system, including a shift from fee-for-service to Alternative Payment Models.

“Surgery and anesthesia need to look at what we provide as physicians,” said Frank G. Opelka, MD, FACS, ACS Medical Director of Quality and Health Policy. “If hospital A costs $30,000 to provide complete services for a procedure, and hospital B costs $20,000, the payor wants to know what is in the $10,000 differential,” he said, suggesting that health organizations and professionals need to work together to define the costs.

There is a need to promote the importance of defining, achieving, and maintaining value for care. “We’re very much in the same boat with our surgical colleagues,” Dr. Clark said. He discussed a recent press conference hosted by the Surgical Care Coalition, a group of medical organizations dedicated to resolving Medicare payment issues and improving the quality of care and quality of life for patients.  Congress was eager to learn, but the lay media showed less interest.

“The news media was skeptical about surgeons and anesthesiologists having problems with Medicare,” Dr. Clark said. “We have our work cut out for us with the media and public at large on conveying the seriousness of this problem.”

This Special Session is available for viewing on-demand.