Megan Tracci

Thomas Tsai, MD, MPH @Thomasctsai · 3d

In new research from the Healthcare Quality and Outcomes Lab, we have identified yet another unintended consequence of the No Surprises Act.

The majority (54%) of disputes are now being filed be middlemen and intermediaries.

hsph.harvard.edu/health-quality…

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www.facs.org Advocacy at Home Advocacy at Home

SurgeonsVoice Verified account @SurgeonsVoice · Jun 30

This month, ACS recognizes James C. Jeng, MD, FACS, for his leadership in surgical advocacy. From building key relationships on Capitol Hill to supporting ACS advocacy efforts, Dr. Jeng helps ensure the voice of surgery is heard. Thank you, Dr. Jeng!

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Anthony DiGiorgio, DO, MHA Verified account @DrDiGiorgio · Jun 8

Did you know surgeons do not get paid separately for the care they provide after surgery?

Medicare has something called the 90 day global period.

That means when a surgeon is paid for an operation, that payment also includes most of the routine care for the next 90 days.

A complicated traumatic brain injury patient who spends two weeks in the ICU and another two weeks on the ward? That's an entire month of rounding, checking labs, reviewing imaging, documentation, family meetings... all included in the original surgery fee.

When Medicare decides how much a surgery should pay, it does not only value the operation itself. It also estimates how much after surgery care will be needed.

So the payment is basically:

The value of the operation
+
the expected value of the follow up care

For example, Medicare might say:
This surgery is worth a certain amount.

The average after surgery care includes 2 hospital days and 2 office visits.

So the total payment includes both the surgery and the payment for those 4 other visits.

Except there is a catch.

Over the past decade, Medicare has appropriately increased payment for many office visits and hospital visits. Primary care doctors, hospitalists, and other non surgical physicians deserved better pay for that work.

No argument there.

But the after surgery care that is bundled inside the surgeon’s 90 day global period has not been updated the same way.

So if a hospital visit is now worth more when a hospitalist bills for it, that same type of work may still be valued less when it is buried inside the surgeon’s bundled payment.

Essentially, the non-surgical time for surgeons has been devalued.

Do the non-surgeons deserve to be paid more? Absolutely. But the problem with central planning and budget neutrality is that in order to pay them more, they need to take away from other specialties. Slowly reducing payment to surgeons by devaluing their non-surgical time is one very effective way to do so.

The consequences: surgeons spend less time on the postoperative care. They hire APPs (nurse practitioners & physician assistants) to round and staff postop clinci. They consult hospitalists to manage the patients in the hospital.

Classic case of incentives driving behavior.

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UMassVascular @UMassVascSurg · May 22

Dr. Francesco Aiello
may talk fast. Correction, he does talk fast. But every word is worth listening to and you will learn from his presentation at #PNEC2026. Physicians must lead building out OBLs and Vein Centers.

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