Downstream Impact for Plastic Surgeons in the United States from the “No Surprises Act”
Background:. The No Surprises Act, signed into the US federal law in 2020, establishes a floor for reimbursement determined by insurance payors for out-of-network charges rendered by providers in emergency services. Physicians are not permitted to balance bill patients for the difference. An arbitra...
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-03-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004202 |
| _version_ | 1818307900698787840 |
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| author | Ross I. S Zbar, MD, FACS Denise Zbar, MBA John W. Canady, MS, MD, DSc (hon) |
| author_facet | Ross I. S Zbar, MD, FACS Denise Zbar, MBA John W. Canady, MS, MD, DSc (hon) |
| author_sort | Ross I. S Zbar, MD, FACS |
| collection | DOAJ |
| description | Background:. The No Surprises Act, signed into the US federal law in 2020, establishes a floor for reimbursement determined by insurance payors for out-of-network charges rendered by providers in emergency services. Physicians are not permitted to balance bill patients for the difference. An arbitration process is outlined for mediation between provider and payor if needed.
Methods:. Policy analysis demonstrates many plastic surgeons utilize a revenue stream including both fee-for-service cosmetic work and insurance-covered reconstructive intervention. For Maintenance of Certification from the American Board of Plastic Surgery and/or membership to the American Society of Plastic Surgeons, plastic surgeons must operate only in accredited facilities, which in turn require that similar privileges are held in a hospital.
Results:. Given rapidly developing economic pressures, hospitals no longer remain neutral sites for surgical privileging as they seek strategies to mitigate financial loss by directly competing for patients. A downstream consequence of the requirement for hospital privileging is that plastic surgeons are forced to manage increasing on-call responsibilities despite shrinking reimbursement. Plastic surgeons whose board certification was the first to be time-limited are now reaching the stage of practice where they may transition exclusively to out-patient services.
Conclusions:. Plastic surgeons in independent solo or small group practices are rendered vulnerable since they may not be able to find coverage of in-patient responsibilities at lower reimbursement rates. Rather than allowing loss of board certification in this population, rational alternatives on an organizational level are proposed for keeping the process equitable as plastic surgeons progress along the practice pathway. |
| first_indexed | 2024-12-13T07:05:44Z |
| format | Article |
| id | doaj.art-6555f1245b904501bd263f0231818313 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-13T07:05:44Z |
| publishDate | 2022-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-6555f1245b904501bd263f02318183132022-12-21T23:55:49ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742022-03-01103e420210.1097/GOX.0000000000004202202203000-00033Downstream Impact for Plastic Surgeons in the United States from the “No Surprises Act”Ross I. S Zbar, MD, FACS0Denise Zbar, MBA1John W. Canady, MS, MD, DSc (hon)2From the * Department of Plastic Surgery, Chilton Medical Center, Pompton Plains, N.J.† Oakland, N.J.‡ Iowa City, Iowa.Background:. The No Surprises Act, signed into the US federal law in 2020, establishes a floor for reimbursement determined by insurance payors for out-of-network charges rendered by providers in emergency services. Physicians are not permitted to balance bill patients for the difference. An arbitration process is outlined for mediation between provider and payor if needed. Methods:. Policy analysis demonstrates many plastic surgeons utilize a revenue stream including both fee-for-service cosmetic work and insurance-covered reconstructive intervention. For Maintenance of Certification from the American Board of Plastic Surgery and/or membership to the American Society of Plastic Surgeons, plastic surgeons must operate only in accredited facilities, which in turn require that similar privileges are held in a hospital. Results:. Given rapidly developing economic pressures, hospitals no longer remain neutral sites for surgical privileging as they seek strategies to mitigate financial loss by directly competing for patients. A downstream consequence of the requirement for hospital privileging is that plastic surgeons are forced to manage increasing on-call responsibilities despite shrinking reimbursement. Plastic surgeons whose board certification was the first to be time-limited are now reaching the stage of practice where they may transition exclusively to out-patient services. Conclusions:. Plastic surgeons in independent solo or small group practices are rendered vulnerable since they may not be able to find coverage of in-patient responsibilities at lower reimbursement rates. Rather than allowing loss of board certification in this population, rational alternatives on an organizational level are proposed for keeping the process equitable as plastic surgeons progress along the practice pathway.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004202 |
| spellingShingle | Ross I. S Zbar, MD, FACS Denise Zbar, MBA John W. Canady, MS, MD, DSc (hon) Downstream Impact for Plastic Surgeons in the United States from the “No Surprises Act” Plastic and Reconstructive Surgery, Global Open |
| title | Downstream Impact for Plastic Surgeons in the United States from the “No Surprises Act” |
| title_full | Downstream Impact for Plastic Surgeons in the United States from the “No Surprises Act” |
| title_fullStr | Downstream Impact for Plastic Surgeons in the United States from the “No Surprises Act” |
| title_full_unstemmed | Downstream Impact for Plastic Surgeons in the United States from the “No Surprises Act” |
| title_short | Downstream Impact for Plastic Surgeons in the United States from the “No Surprises Act” |
| title_sort | downstream impact for plastic surgeons in the united states from the no surprises act |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004202 |
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