hospitals and/or other physicians), facilities (
including hospitals), equipment, and services that provide
appropriate, high-quality care for patients.
•Congress should remove the restriction on physicians
owning and expanding such ventures. Physicians
should be obligated, however, to disclose this ownership information to the public.
•Physicians should be able to continue to own, operate, and refer patients to in-office imaging services
as provided in the Stark in-office ancillary exception.
Reduction of health care costs
Provision of appropriate, high-quality, safe, and cost-effective patient care should begin with defining
unwarranted, unnecessary, high-cost care. Surgeons
should reduce unwarranted variation in order to preserve quality while optimizing resource use. Efforts
to promote value-based risk models linking quality and optimal cost should encourage rewards and
limit penalties. Further, optimal care should encourage patient engagement in shared decision making.
Patients require education and support in fulfilling
their individual role in the maintenance of health
and well-being. These efforts should promote access
to appropriate and compassionate care for all.
• The ACS supports efforts (including MACRA provisions) aimed at allowing more physicians to voluntarily
participate in APMs such as shared savings programs,
bundled payments, accountable care organizations, and
episode-based payments where containment of cost is
linked to improvements in care.
• The ACS has expended significant time and resources
to ensure that surgeons have viable opportunities to
participate in these models, including the develop-
ment of the ACS-Brandeis Advanced APM, which was
recently submitted to the Physician-Focused Pay-
ment Model Technical Advisory Committee.
•All payment programs should ensure sustainable business models to preserve a viable surgical
workforce by providing fair and appropriate reimbursement for surgeons.
•If implemented, participation in value-based payment
programs should be tied to quality, involve voluntary
participation, possess fair and attainable upside risks
and limits on downside risks, and not unduly restrict
•Congress must amend the Stark physician self-referral
laws and the federal antitrust laws and/or regulations
to allow for provider collaboration and flexibility in the
development of APMs.
Commitment to evidence-based
guidelines for surgical care
•Clinical practice guidelines (CPGs) based on the best
available evidence and recommendations from clinical experts are valuable resources to assist surgeons
in implementing evidence-based practice.
•Surgeons need CPGs so that patients can be assured
that the best possible outcomes of care will be achieved.
• Well-developed CPGs can be used to eliminate waste
and inefficiency wherever possible, including overuse, underuse, and misuse of services.
•Development of CPGs is an expensive and a labor-intensive process that requires periodic revision to
ensure accuracy and dependability.
• The ACS is committed to the assessment, development, and promulgation of guidelines that will lead
to the best outcomes and the most cost-effective care
for patients with surgical disease, so that the full
spectrum of care is optimized and coordinated.