The American College of Surgeons (ACS) has long supported policies that improve surgical patient care, lessen administrative burdens, and streamline clinical workflow. To combat policies that could further overburden surgeons and their practices, the ACS launched our Stop Overregulating My OR (SOMO) initiative, through which the ACS Division of Advocacy and Health Policy (DAHP) highlights specific regulatory and legislative actions that should be taken to eliminate unnecessary requirements and enable surgeon
Surgical patients are encountering barriers to timely access care due to onerous and unnecessary prior authorization (PA) requests from Medicare Advantage (MA) plans and commercial insurers. Utilization review tools such as PA can sometimes play a role in ensuring patients receive clinically appropriate treatment while controlling costs. However, the ACS is concerned about the growing administrative burdens and the delays in medically necessary care associated with excessive PA requirements.
The ACS has joined with the Regulatory Relief Coalition, a coalition of specialty provider organizations, in working with key members of Congress on bipartisan legislation to improve transparency and efficiency of the PA process in the MA program. In order to improve continuity of care, the ACS supports the Improving Seniors’ Timely Access to Care Act, which would facilitate electronic prior authorization, improve transparency, and increase Centers for Medicare & Medicaid Services (CMS) oversight on how MA plans apply PA requirements.
Senate Prior Authorization Letter to CMS (10/28/2021)
The Critical Access Hospitals (CAH) 96-hour rule creates a condition of payment requiring that a physician certify that a patient can reasonably be expected to be discharged or transferred within 96 hours. CAHs must already meet a separate condition of participation, which requires that acute inpatient care provided to patients not exceed 96 hours per patient on an average annual basis. While the Centers for Medicare and Medicaid Services in its fiscal year 2018 Medicare Inpatient Prospective Payment System final rule made the 96-hour rule a low priority for medical record reviews, the ACS strongly believes that a statutory fix is needed to fully repeal this certification requirement.