American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Administrative Burden Reduction

Every day, physicians are inundated with a growing number of administrative requirements set forth by both Congress and federal agencies. While these policies are broadly intended to ensure that patients receive care that meets high-quality and safety standards, physicians are confronted with the burden of demonstrating regulatory compliance. The excessive regulations placed on surgeons add needless barriers to providing necessary care and increase spending on nonclinical activities.

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, 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 surgeons to reinvest their time and resources in patient care.

Federal Legislative Efforts

Prior Authorization

Surgical patients are encountering barriers to timely access to 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.

Improving Seniors’ Timely Access to Care Act

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, Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD (R-KS), and Ami Bera, MD (D-CA) introduced the Improving Seniors’ Timely Access to Care Act, H.R. 3107, 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 companion legislation, S. 5044, was introduced by Senators Sherrod Brown (D-OH) and John Thune (R-SD).

Prior Authorization Overview

ACS Letter of Support for H.R. 3107, the Improving Seniors’ Timely Access to Care Act

ACS Letter of Support for S. 5044

Bulletin: ACS acts to address burdensome, inappropriate use of prior authorization

Take Action: Contact Congress in support of the Improving Seniors’ Timely Access to Care Act

Critical Access Hospitals

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.

The ACS supports H.R. 1041, the Critical Access Hospital Relief Act, legislation that would remove the 96-hour physician certification requirement as a condition of payment for inpatient critical access hospital (CAH) services under Medicare.

ACS Letter of Support for H.R. 1041, the Critical Access Hospital Relief Act