Lawmakers Reintroduce Legislation to Ease Prior Authorization
Lawmakers, including Senators Roger Marshall, MD (R-KS), Krysten Sinema (I-AZ), John Thune (R-SD), and Sherrod Brown (D-OH), and Representatives Mike Kelly (R-PA), Suzan Delbene (D-WA-), Larry Bucshon, MD (R-IN), and Ami Bera, MD (D-CA), have reintroduced the Improving Seniors’ Timely Access to Care Act. The ACS strongly supports this legislation as it is a critical step in improving transparency and efficiency of the prior authorization (PA) process in the Medicare Advantage (MA) program.
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 Improving Seniors’ Timely Access to Care Act would establish an electronic PA process and bring greater transparency to PA practices by requiring that MA plans submit data to the Secretary of Health and Human Services on their use of PA, including the rate at which authorization for surgical services is delayed or denied.
This bipartisan legislation, which unanimously passed the House last Congress, is supported by more than 370 national and state organizations representing patients, physicians, MA plans, hospitals, and other key stakeholders in the healthcare industry.
Visit SurgeonsVoice now and urge your elected officials to cosponsor this critical legislation.
ACS Provides Feedback on Medicare Physician Payment White Paper
Late last week, the ACS submitted feedback at the request of the Senate Finance Committee on its white paper, "Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B."
In the letter, the ACS expanded upon the comments made by Patricia L. Turner, MD, MBA, FACS, ACS Executive Director & CEO, in April during a hearing of the same topic.
The College highlighted the need to reform the Medicare physician payment system by providing an inflationary update mechanism and addressing the statutory budget neutrality requirement. The letter also includes policy improvements for facilitating the transition to value-based care under the Medicare program. Additionally, the ACS and 20 other organizations representing surgeons and anesthesiologists submitted a separate letter that highlights several agreed upon principles for consideration.
The ACS will continue to engage with policymakers as Congress considers legislation to address the flawed Medicare payment system.
Read the full ACS letter and the Surgical Coalition letter. Read Dr. Turner’s testimony from the April hearing.
ACS Responds to Hospital Inpatient Prosepctive Payment System Proposed Rule
On June 10, the ACS submitted a comment letter in response to the Centers for Medicare & Medicaid Services (CMS) fiscal year 2025 Hospital Inpatient Prospective Payment Systems (IPPS) proposed rule.
The College expressed concerns with the Agency’s proposed Transforming Episode Accountability Model (TEAM), which is a mandatory alternative payment model intended to test whether episode-based pricing linked with performance on quality metrics can reduce Medicare expenditures while preserving or improving quality of care for certain surgical episodes, including coronary artery bypass grafting, lower extremity joint replacement, major bowel procedures, surgical hip/femur fracture treatment, and spinal fusion.
The ACS opposed any mandatory TEAM participation requirements and questioned the quality mechanisms used to determine performance within the aforementioned episodes. The College also offered feedback on various elements of the model, including potential financial impacts, episode grouping methodologies, and more.
In addition, the College also strongly supported CMS’s proposal to adopt the age friendly hospital measure in the Hospital Inpatient Quality Reporting Program. Developed by the ACS in collaboration with the Institute for Healthcare Improvement and the American College of Emergency Physicians , this measure is designed to support hospitals as they address the complexities of caring for the medical, physiological, and psychosocial needs of older patients. The foundation of the programmatic model used to design the age friendly hospital measure incorporates elements of ACS Quality Programs, which prioritizes structures, processes, and outcomes necessary to build care teams around patients’ goals.
Finally, the College supported CMS’s proposals to reassign Medicare Severity Diagnosis-Related Groups, which classify the severity of a given clinical case for the purposes of hospital payment under the IPPS, for excision of intestinal body parts and resection of the right large intestine. The ACS also agreed with the Agency’s proposals for assigning OR status to certain diagnostic laparoscopic biopsy of intestinal body parts and laparoscopic biopsy of gallbladder and pancreas procedures, as these operations typically require the resources of an OR to be safely and appropriately furnished.
Contact regulatory@facs.org for more information.
