December 1, 1994
Health care delivery systems in the United States have undergone major changes in recent years. There has been a strong trend toward managed care organizations because purchasers of health care services perceive them to be less expensive than traditional fee-for-service systems. In these vertically integrated organizations, an administrative entity coordinates or "manages" the delivery of health care services in ambulatory and hospital settings. Central to the cost containment mission of these organizations is the utilization control of physician services. Primary care physicians are put into the role of "gatekeeper" for their patients, regulating if and when specialty consultation and treatment is made available to them. In many managed care organizations, the primary care physician is paid under a capitation system--that is, the physician receives an annual salary based on the number of lives served, rather than services rendered. In such systems, there may be a financial disincentive for the primary care physician to refer patients for specialist care ("risk sharing"), since specialist care is thought to be more expensive.
To address the important issue of how the quality of surgical services can be maintained in a managed care environment, the College...convened a group of 12 Fellows in various surgical specialties, all of whom work in some form of managed care system. This working group developed a series of recommendations for surgeons and managed care organizations, with the aim of ensuring that appropriate and timely quality surgical care is readily available to patients in the system. Although directed at managed care, these recommendations are widely applicable to all surgical services regardless of the health care delivery system.
The following statement was approved by the College's Board of Regents at its October 9, 1994, meeting.
In seeking to ensure the maintenance of high-quality surgical care for patients enrolled in managed care systems, the American College of Surgeons makes the following recommendations:
Reprinted from Bulletin of the American College of Surgeons
Vol. 79, No. 12, Pages 30-31, December 1994