About Ted Anderson

Dr. Anderson is the Betty and Lonnie S. Burnett professor of obstetrics and gynecology at Vanderbilt University Medical Center in Nashville. Anderson earned his bachelor’s and master’s degrees from the University of Southern Mississippi and his doctorate in anatomy and cell biology from Vanderbilt University, where he received his medical degree and completed a residency in obstetrics and gynecology and a fellowship in reproductive pelvic surgery. After serving as the chief of the ob-gyn service at the HCA Centennial Women’s Hospital, he returned to Vanderbilt to establish a fellowship in minimally invasive surgery.

Working toward Advances in Access to Care Everywhere

As ob-gyns, we all agree that women should have access to comprehensive health care throughout the continuum of life. We have been especially focused recently on ensuring prenatal, labor and delivery, and postpartum care, no matter their zip code. But access to maternal health care in rural areas is rapidly disappearing across the United States. Over the past nine years, more than 100 rural hospitals have closed in the United States, making delivering high-quality, safe health care to patients more difficult than ever before. Even more alarming is that more than 600 additional facilities, which represent more than one-third of rural hospitals in the United States, are currently at risk of closing.

Disparities in access to care in rural areas don’t affect everyone equally, either. Women of color are disproportionately affected by disparities in rural health care: U.S. Senator Tina Smith (D-MN) points out that rural counties with more black residents are at greater risk of losing their labor and delivery services.

It’s plain to see why increasing access to ob-gyn services in rural areas is an important issue to ob-gyns and our patients. I’m proud to share that ACOG’s advocacy has contributed greatly to the advancement of a number of new bills that will help improve access to ob-gyn care in rural areas—especially the Rural Maternal and Obstetric Modernization of Services (Rural MOMS) Act, which was introduced in the House and Senate. Our advocacy was crucial in drafting this piece of legislation and ensuring that it received bipartisan support.

The Rural MOMS Act is part of ACOG’s Momnibus, a collection of bills that would help eliminate preventable maternal mortality, support best practices, and enable ob-gyns to better serve their patients. The bill supports training for health care professionals in rural communities, expands telehealth programs, and establishes regional innovation networks. ACOG and our members worked tirelessly to make ob-gyns’ voices heard on the issue of rural maternal health care, and we succeeded.

Importantly, the Rural MOMS Act will help lessen disparities in rural health care in several ways. Rural obstetric network grants, administered by the Health Resources and Services Administration, will help connect women with needed care before, during, and after birth, measure and address inequities in birth outcomes among rural residents, and provide training for health facilities without obstetric health units, among other measures. The Rural MOMS Act will also expand telehealth networks and resource centers and improve federal collection of maternal health data based on geographic location.

Together with our Momnibus, the Rural MOMS Act will make meaningful progress toward reducing disparities in care in rural areas. Thanks to ACOG and our members’ advocacy, pregnant women in rural areas are one important step closer to being able to get the high quality care they need, when and where they need it.

The Match: How ACOG Is Helping Reduce Stress around Entering Residency

While graduating medical school is a huge milestone in a future ob-gyn’s career, it comes with its own stressors, such as matching to a residency program. The match process can be difficult and stressful for many medical students—and that pressure only increases when students consider everything they need to do to prepare for residency itself.

So what makes the matching process so stressful? To start, United States Medical Licensing Examination (USMLE) results can be overemphasized, which may cause medical students to focus on test results to the point of neglecting other educational and curricular opportunities. And although the number of residency positions has increased over the last five years, the number of residency applications that programs receive has drastically increased, making matching more competitive than ever before. This is especially problematic when you consider that each program has a designated number of interview spots. Interviews can also be logistically difficult, financially burdensome, and time-consuming for students and programs, a problem confounded by the fact that because each student will only select one program, training programs may need to repeat interview processes to fill all openings. The difficulties don’t stop once you’re matched, either: PGY-1s can vary in skill level on day one of residency and may need extra resources to shore up their knowledge in different areas.

ACOG recognizes the challenges that medical students face and is committed to helping the future leaders of our profession succeed. We’re considering ways to change the match process itself. Indeed, many issues with the transition to residency could be alleviated by restructuring the process. We are also actively working to ensure that medical students are informed about the ob-gyn specialty and have the resources they need to be prepared to enter the profession. The Step Up to Residency Program, developed by CREOG and the Association of Professors of Gynecology and Obstetrics, is a partial post-match curriculum that helps PGY-4s hone the skills and knowledge they’ll need in the early stages of residency. Step Up to Residency features hands-on training and covers fetal monitoring, the basics of ultrasound, neonatal resuscitation, and more. PGY-4s will also have the chance to discuss the aspects of residency that extend beyond the hospital; for example, resident wellness, financial planning, and career planning. CREOG is also launching a comprehensive post-match curriculum for all soon-to-be residents that will build the specific knowledge base and skill set that ob-gyn interns can use before the first day of residency.

Finally, ACOG offers a residency fair at our Annual Meeting and local medical student days, provide students with hands-on support as they prepare for residency, through our Districts and Sections.

Preparing for and transitioning to residency can be daunting, but the initiatives ACOG is involved in will help pave the way for medical students to become confident, informed, and well-prepared residents. ACOG is committed to being a valuable resource for all its members, starting with your first steps of training and continuing throughout your entire career.

Let’s Make Speaking Out on Surprise Billing a Priority

Balance billing, more commonly known as “surprise billing,” has garnered national attention and Congress is preparing to take action. The issue of surprise medical billing may arise when a patient goes to an in-network facility to receive care, such as emergency care, surgery, or childbirth, and receives care from out-of-network physicians. Finding a solution to surprise billing is critical, and ACOG is hard at work to ensure that the solution protects our practices and our patients. Our members of Congress need to hear from us – the physicians who would be impacted.

Billing disputes can impact the patient-physician relationship, as many patients look to you to answer their billing questions. Any solution must shield patients from out-of-network payment disputes between physicians and insurers. Patients are not always able to choose an in-network provider and shouldn’t be financially punished for circumstances beyond their control. It is also critical that legislation to address surprise billing ensure that physicians are appropriately compensated for the quality care they provide. Some congressional proposals would jeopardize physician reimbursement and access to care.  I was fortunate to be on Capitol Hill earlier this year with the “Group of 6*” to advocate for legislation to address this issue.  ACOG supports an independent dispute resolution process—like the one used in New York state—that protects patients and preserves the financial stability of physician practices.

This August Recess, ACOG is partnering with the physician community to make protecting our patients and our members from surprise medical bills a priority. In a joint letter to the US Congress signed by 57 medical specialty societies and nearly every state medical association, we let legislators know where we stand on this issue. But we need your help!

As a physician, your voice is powerful in impacting new legislation. Send a message to your members of Congress and tell them to support surprise billing legislation that relies on the proven dispute resolution process. Then, connect with them in person. Most members of Congress share their town hall and constituent engagement schedules on their websites. Find out when they’ll be in your neighborhood, consider getting a few of your colleagues together, and let them know that addressing surprise medical bills is a priority for ob-gyns.

Never advocated before? It’s easier than you may think. Here’s a simple message you can send to your representatives:

I’m an ob-gyn. Please work in Congress to protect my patients from surprise medical bills and ensure a solution that is fair for everyone and that enables me to continue to provide high-quality health care to the women of (YOUR STATE), similar to the proven model in New York state. When you get back to Washington, D.C., reach out to my specialty society, ACOG, to keep this conversation going.

Whether the issue is surprise medical billing, maternal mortality, or Violence Against Women Act reauthorization, ACOG will continue to advocate on behalf of you, our specialty, and our patients year-round. You can always join our efforts by visiting our ACOG Action web page, and stay up to date with breaking advocacy news by following @ACOGAction on Twitter.

Let’s do this!

* The Group of 6, representing America’s frontline physicians, is comprised of ACOG, The American Academy of Family Physicians, The American Academy of Pediatrics, The American College of Physicians, The American Osteopathic Association, and the American Psychiatric Association.

   

Noticed Changes to Reimbursements? Understanding the RUC and Why It’s Important

As ob-gyns, we got into the field of obstetrics and gynecology because we’re passionate about women’s health. We’re naturally curious people who love that this great specialty covers everything from surgery to bringing new life into the world. As the health care landscape changes with new technology and new business models, it’s critical that we understand how payment models are decided and the ways in which ACOG and you are involved in the process.

In 1992, Congress transitioned to a physician payment system based on a resource-based relative value scale, which mandated that payment for services be based upon the resources required to perform a service and the related practice expense. The AMA subsequently formed the Relative Value Scale Update Committee (RUC), which advises the Centers for Medicare & Medicaid Services on the relative value units (RVUs) that should be assigned to new or revised codes in the Current Procedural Terminology codebook. Although the RUC provides the work RVU recommendations, CMS makes the final decision on the RVUs, even for services they don’t cover. Today, you may know the RUC as the group responsible for the often murky process of reimbursement for procedures and services. But do you know ACOG’s role in the RUC?

The RUC is primarily comprised of representatives for specialties that accept payment through Medicare. Membership was initially determined by the amount of Medicare expenditure in certain specialties. Though ob-gyns and pediatric physicians make up a smaller portion of Medicare expenditure, they also have RUC seats because their services are essential. ACOG has a permanent seat on the RUC. This means that when the RUC decides on recommendations for RVUs, which determine reimbursement rates, ACOG is right there at the table, advocating for ob-gyns and women’s health care physicians. Barbara Levy, MD, ACOG’s vice president of health policy, served as RUC chair for six years and recently appeared in a three-episode series of ACOG’s CHEC Your Practice podcast to explain RVUs and the RUC in depth.

So, how is reimbursement determined? The process begins when the RUC sends out a randomized survey that gauges how much time physicians spend on certain procedures and services, including preservice and postservice time. Based on the survey results, the RUC presents analyzed, aggregated survey data in the form of RVU recommendations to CMS, which then takes those recommendations into account when determining a code’s final RVUs. From there, the CMS contributes additional data, such as data from their personal database on the length of hospital stays, which brings in a different perspective.

Have you noticed changes to reimbursements for certain procedures? A large part of this may be due to technological advances that make procedures quicker and easier. For example, laparoscopies, which used to include two days of hospital stay on top of the time it took to do the procedure itself, are now usually outpatient procedures. In past code reviews, a significant amount of RVUs were assigned to the amount of time spent in the hospital. Now, because the CMS records shorter hospital stays for laparoscopies, reimbursement payments are lower.

Even though you may not feel represented in the reimbursement process as an individual physician, you and your peers can make an impact on RVU valuation by participating in the RUC survey whenever you receive one. Filling out the RUC survey as thoughtfully as possible helps the RUC get a better understanding of the resources required to perform certain services. Providing the most accurate responses to the survey is extremely important; for example, Dr. Levy notes that surgeons tend to think of themselves as “fast and efficient” and may not consider the amount of time a service takes to complete. In the end, says Dr. Levy, the “determination of RVUs . . . what we as ACOG can present to the RUC is only as good as the survey data we get from ACOG members.” Let’s do this!

Welcoming a Year of Change

Today, at the 2019 ACOG Annual Meeting in my hometown of Nashville, TN, I had the unique opportunity to stand before our peers as ACOG’s newly inaugurated 70th president. I’m honored and humbled to be able to serve as ACOG president and enjoyed seeing some of you at the Meeting. And, as I think about my time as ACOG president and what I’d like to accomplish, I can’t help but keep coming back to the common theme of refining and advancing our profession in times of change.

Obstetrics and gynecology is an ever-evolving profession. As the premier women’s health care association, ACOG has always been on the front lines of women’s health care as we develop new guidance, bring new perspectives, and advocate for our patients and our profession in the halls of Congress. But as obstetrics and gynecology continues to advance in leaps and bounds, we as physicians can’t just keep up with that progress …we have to get in front of it.

My presidential initiatives will focus on reenvisioning the system of delivery of surgical care to optimize patient safety and outcomes and supporting more research in women’s health care.  So as I begin my year of presidency, I’d like to challenge us all to consider three questions:

  • What is the best way to deliver the best care to our patients?
  • What is the best way to prepare today’s trainees to deliver the highest-quality care in the future that maximizes safety and accessibility?
  • How do we ensure the highest-quality health care for women for generations to come?

Levels of Gynecologic Care will help us answer those questions. This new concept, loosely modeled after the Levels of Maternal Care program, is centered on the robust and diverse task force I assembled to investigate what future practice patterns might best deliver the highest-quality and most effective gynecologic surgical care in the most efficient and safest manner. By anticipating the future, we can ensure that we are prepared to adapt to changing trends, patient needs, and new health care systems and processes.

While these initiatives are incredibly important to improving women’s health, I’m equally excited for the opportunity to get to know you, my colleagues. ACOG’s members are some of the most passionate, dedicated physicians out there and have helped shape the course of women’s health care throughout our history. I’m eager to hear from you about the work you’re doing to ensure health care of the highest possible quality for patients everywhere. Please connect with me on Twitter at @DrTedAnderson.