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Payment changes may be in store for assistants-at-surgery
AAOS officials criticize a GAO report on the subject and its proposed Medicare payment plan.
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Medicare payment policies for assistant-at-surgery services must be overhauled to reduce potential overpayments, particularly those for hospital surgeries, according to a U.S. General Accounting Office report released to congressional committees.
GAO concluded in the report, “Payment Changes are Needed for Assistants-at-Surgery” (GAO-04-97), that current Medicare payment policies for assistant-at-surgery services are problematic. Currently, Medicare pays for assistants-at-surgery under the hospital inpatient prospective payment system (PPS), as well as the Part B physician fee schedule, the report said.
The proposed solution would eliminate all charges for these services from Medicare Part B physician service fees and would consolidate them under the hospital inpatient PPS. This change would affect all types of providers who first- or second-assist during surgery.
Critics of the report argue that if adopted, the new payment system might eliminate a surgeon’s use of good medical judgment to decide who will assist and when. It could also mean discontinuing use of surgical assistants with whom they have built long-standing working relationships, a move that could possibly affect surgical practices and quality of care. The 29-page report was based on a GAO study of Medicare payments for assistants-at-surgery.
Report had problems
The GAO allowed representatives from the American Academy of Orthopaedic Surgeons (AAOS), the American College of Surgeons (ACS) and other medical organizations to review and comment on the report prior to issuing it. At the time, several flaws were identified, but none of them were corrected when the report was issued, according to an AAOS member communication issued early last month.
David Lovett, director, AAOS Washington office, confirmed that the GAO permitted AAOS officials to screen the report. “We disagreed with what they said in that report. But, we’ve been struggling with the government and GAO, as well, for a long time on the assistant-at-surgery issue,” he told Orthopedics Today
Release of the report came as a surprise to Dan Sung, policy analyst in the AAOS health policy department. Academy officials were unaware that the Centers for Medicare and Medicaid Services (CMS) were even exploring the subject, he said. “We didn’t add that much to the process.”
The AAOS is monitoring the proposed consolidation of payments under the inpatient PPS, Sung said. “There are obvious implications to that, that might not necessarily benefit physicians … We’re being a little more responsive than proactive in terms of what our next step is because from the report it’s unclear what CMS intends to do on this issue.”
The ACS said it has taken steps to start educating Congress about some of the negative implications of the potential policy change, according to a Jan. 30 announcement at the organization’s Web site.
For more information:
- GAO Report to Congressional Committees. Medicare: Payment changes are needed for assistants-at-surgery GAO-04-97. January 2004. Available online at www.gao.gov/cgi-bin/getrpt?GAO-04-97.
- AAOS position statement: Reimbursement of the first assistant at surgery in orthopaedics. Doc. No. 1120. Available online at www.aaos.org/wordhtml/papers/position/1120.htm.