Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) issued a Committee staff report detailing the practices of concurrent and overlapping surgeries where lead doctors at teaching hospitals perform multiple surgeries at the same time.
The report, titled, “Concurrent and Overlapping Surgeries: Additional Measures Warranted,”outlines a number of shortfalls at the federal level in monitoring and auditing teaching hospitals to ensure they are in compliance with Medicare billing restrictions, while also making a number of recommendations for hospitals and regulators to ensure patient safety and improve transparency.
“This report provides a crucial look at the little-known practices of concurrent and overlapping surgeries and lays the groundwork for improving the system moving forward,” Hatch and Wyden said, “While we are encouraged by the steps taken by the American College of Surgeons and a number of hospitals to address the concerns with concurrent surgeries, we remain concerned that the nearly 5,000 hospitals in America may lack thorough and complete policies covering these procedures and patient consent. By working with hospitals and surgeons in a collaborative manner, it is our hope we can continue to increase transparency and patient safety.”
The report’s findings stem from a letter the Committee sent 20 teaching hospitals in February questioning them about these practices in their institutions. In producing the report, Committee staff examined guidance issued by the Centers for Medicare & Medicaid Services (CMS) and the American College of Surgeons (ACS), policies and other information provided to the Committee by hospitals and others, and other information gathered from stakeholders.
Additional findings of the report include:
CMS has Medicare billing requirements that pertain to the practice of overlapping surgeries for Medicare beneficiaries in teaching hospitals only.
CMS has not routinely monitored or audited teaching hospitals for conformance with overlapping surgery billing restrictions.
In April, 2016, the ACS modified its guidance to surgeons on the practice of concurrent and overlapping surgeries, as the result of the increase in public awareness and scrutiny of those practices. It is unclear how quickly this guidance will be implemented across all affected hospitals.
During the course of the investigation, in order to be consistent with the revised ACS guidance, 17 of the 20 teaching hospitals the Committee contacted modified existing or created new hospital-wide policies specific to concurrent and overlapping surgeries, and the remaining three hospitals were in the process of doing so.
All 17 of the hospitals that recently revised or created policies now have specific policies that generally prohibit concurrent surgeries and enumerate the circumstances under which their surgeons may perform overlapping surgeries though not all strictly conform to the ACS guidance.