On December 6, 2016, Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) issued a Committee staff report detailing concurrent and overlapping surgery practices.  The report also offers multiple recommendations for hospitals and regulators to promote patient safety, reduce potential improper payments and improve transparency.

As previously reported, the Committee sent letters to 20 teaching hospitals in February 2016 with questions regarding overlapping surgery practices.  The inquiry came on the heels of an in-depth Boston Globe investigation of concurrent and overlapping surgery practices at Massachusetts General Hospital, which raised concerns about patient informed consent and quality of care.

The Committee report provides an overview of regulatory authority and industry guidance regarding concurrent and overlapping surgeries for both teaching and non-teaching hospitals.  The report also summarizes general arguments for and against the practice of overlapping and concurrent surgeries, noting, however, that little data or research exists on the frequency, effectiveness, or impact on surgical outcomes and patient health.

The Committee encourages providers to, among other things, develop a policy addressing concurrent and overlapping surgeries, develop mechanisms to enforce such policies, and develop processes that ensure patient consent for such procedures. 

The report further details policy and process approaches taken by multiple providers, and offers suggestions for other institutions to consider when reviewing their own approach to such practices.  Notably, the Committee specifically addresses the practice of concurrent surgeries, which occurs when the key or critical portions of two surgical procedures under one primary attending surgeon occur simultaneously.  The report states that, beginning in the first quarter of 2017, The Joint Commission will begin citing hospitals when surveyors determine that a concurrent surgery was performed or that a hospital has no policy in place prohibiting concurrent surgeries.

In addition, the report notes that CMS has not routinely monitored or audited teaching hospitals for conformance with applicable billing rules for overlapping surgeries.  As such, the Committee recommends that HHS OIG evaluate current billing controls.  In addition, the Committee encourages CMS to review current billing rules for teaching institutions to determine whether those requirements should be established for other non-teaching surgical facilities and scenarios.

The report is available here.