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.

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. The ACS believes that PA requirements should be restricted to complex cases or to clinicians whose ordering patterns differ substantially from other practitioners after adjusting for patient population.  

The ACS has joined with the Regulatory Relief Coalition (RRC), a group of specialty provider organizations, in working with key Members of Congress on bipartisan legislation to improve transparency and efficiency of PA processes in the MA program. In order to improve continuity of care, the RRC is advocating that any proposed legislation should address the issues endorsed in a consensus statement by the American Medical Association, America’s Health Insurance Plans, Blue Cross/Blue Shield Association, American Hospital Association, Medical Group Management Association, and the American Pharmacists Association. In order to eliminate unnecessary barriers to patient care and reduce excessive administrative burden, legislative solutions should ensure that MA plans only apply PA when appropriate, standardize PA policies and forms, and increase data collection and oversight on MA plans’ use of PA.

Prior Authorization Overview

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