Highlights of the ACSPA Board of Directors and the ACS Board of Regents Meetings
October 7, 8, and 12, 2006
From December 1, 2005, the beginning of the election cycle, to August 31, 2006, the ACSPA-SurgeonsPAC raised $834,513. In addition, the telephone fundraising campaign also remained productive.
Of the 216 U.S. members of the Board of Governors, 109 (50 percent) contributed to the PAC. The names of all leaders who contributed to the PAC, and those who donated $1,000 or more in 2006, were listed at the PAC booth during the Clinical Congress.
Contributions were made to 131 candidate, leadership PACs, and party committees. In the November 2006 mid-term elections, the entire House and one-third of the Senate were up for re-election. ACSPA-SurgeonsPAC plans to continue its focus on candidates who advocate for health care issues and support issues of importance to surgical practice today, including Medicare physician payment and medical liability reform.
ACS Foundation
On September 1, 2005, the IRS approved a tax-exempt status for the ACS Foundation. From September 1, 2005 through August 31, 2006 the Foundation received a total of $1,181,622 in cash gifts and new pledges.
Members of the Fellows Leadership Society (FLS) attended the FLS luncheon where Dr. and Mrs. Maurice J. Jurkiewicz, FACS, received the 2006 Distinguished Philanthropist Award. In addition, 24 new Life Members were also recognized.
Surgeons Diversified Investment Fund (SDIF)
The American College of Surgeons has launched a new mutual fund called the Surgeons Diversified Investment Fund (SDIF). SDIF is a diversified mutual fund created expressly as a member benefit by the College for its members, their families, employees, and affiliate groups. The College has spent the past two years developing and refining this investment concept. SDIF seeks to provide long-term capital appreciation and income through the fundamental investing principles — asset allocation, diversification, and rebalancing — which are believed to be the necessary ingredients for a successful investment program, and which are used by the College's endowment fund.
The College has developed SDIF because it realizes that its members are facing new and complex financial challenges. The College believes that the principles employed in managing its endowment funds are the same principles that its members need assistance with when managing their own funds. For more information about SDIF, please contact Ms. Savi Pai, President, SDIF, at 800-208-6070, 312-202-5056, or spai@facs.org.
ACS Operation Giving Back (OGB)
The Board of Regents approved an updated business plan for Operation Giving Back (OGB). OGB was formed in 2004 as a surgical volunteer initiative for members of the College. It is dedicated to facilitating surgical involvement in volunteerism among all surgical specialties, at all stages of the profession, with an equal emphasis on domestic and international service. In the two years since its inception, OGB has evolved from a promising concept into a vibrant ACS program fostering collaboration between surgeons, volunteer agencies, and specialty societies. The sustained level of interest in OGB positions it and the ACS to be catalysts in the effort to address the needs of the underserved and uninsured both in the U.S. and internationally. With the approval of the updated business plan, OGB has received permission to operate for another year.
The following information is an update on OGB activities over the past year.
- September 1, 2006, marked the first anniversary since OGB's Web site went live, and in that time it has consistently received over 100,000 hits each month, with visitors from 93 countries, and inquiries from surgeons of all specialties, surgical residents, medical students, surgical nurses, and physician assistants.
- OGB has partnered with more than 65 organizations, and is in the active process of partnering with an additional 23 agencies.
- ACS/OGB lent support to the Robert Wood Johnson Foundation's campaigns addressing medical coverage for the uninsured with OGB serving as a visible partner in both campaigns: Covering Kids and Families and Cover the Uninsured.
- OGB has made information available on its Website on ways to contribute to the ongoing needs of the Gulf Coast hurricane victims.
- OGB is working with the College's State Advocacy staff to create a database of relevant issues related to volunteerism in each state.
- Exploration with the College's Cancer Program has been initiated regarding possible collaboration on cancer care outreach within the U.S. and its territories.
- The OGB Director attended the Leadership Program in Health Policy and Management at Brandeis University. Course topics relevant to advancing the OGB program included sessions on national health economics and policy. Continued engagement with fellow students and faculty is ongoing.
- Two resident presentations on volunteerism were made at the general session on volunteerism held during the Clinical Congress. The continued high level of interest galvanizes efforts to find and/or create additional avenues and mechanisms of humanitarian outreach.
- A Volunteerism Networking Reception was held during the Clinical Congress to provide a forum for collegial exchange of ideas among ACS members and other Clinical Congress attendees involved in supporting surgical volunteerism efforts.
ACS Web Portal
New content and resources continue to be added to the College's Web portal. George F. Sheldon, MD, FACS, Editor-in-Chief, continues to develop the portal's editorial board. In addition, the following enhancements have been made:
- New PubMed portlets were added to the Communities & Specialties area.
- Community introductions were moved to separate pages, proving quicker access to resources on each community's homepage.
- New links to all discussion forums were added to each community to facilitate collaboration among peers.
- New headings were added to each of the community and specialty areas to enhance organization of content and provide faster searchability.
- Audio and videos were highlighted to make them easier to locate.
ACS Media Activity Related to the IOM Report
Results were presented on the media outreach activities that had been undertaken in an effort to leverage the June 14 release of the IOM reports on emergency and trauma care in order to build awareness and support for key ACS messages. The key messages were that:
- Access to high-quality trauma system care is the best hope for anyone who is seriously injured or experiencing a life-threatening illness.
- A growing surgeon/specialist shortage puts patients at risk.
- Trauma systems are geographically arbitrary and inequitable across the U.S.
- Our health care system and problems with reimbursement and liability issues discourage surgeon participation in trauma centers and emergency department coverage.
- Television: 12 broadcasts on 8 stations.
- Radio: 43 broadcasts/feeds.
- Print: Coverage with ACS core messages – more than 17 million impressions; coverage with the surgeon/specialist message – more than 33 million impressions.
Committee on Trauma (COT)
The COT Subcommittee on Injury Prevention and Control has completed a grant-supported effort to develop materials on alcohol screening and referral that can be used by hospitals. This work was a cooperative effort with the National Highway Traffic Safety Administration, the National Institute on Alcohol Abuse and Alcoholism, the Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control and Prevention. Following approval of the materials by the federal partners, the materials will be offered to hospitals. In addition, a series of training programs is being planned to train the medical personnel who will perform the screening and intervention of patients.
The Rural Trauma Committee continues to beta test the Rural Trauma Team Development Course. This course will be key in improving trauma care in rural areas and developing rural trauma systems in the U.S. In addition, a study has been designed to show the effectiveness of this course.
The Subcommittee on Disaster and Mass Casualty Management has initiated a grant-sponsored project to determine the lessons learned from the surgical experience in Iran and Afghanistan. A series of meetings and conference calls is planned and will include COT surgeons who have served in Iran and Afghanistan.
For more information on all of the ACS Trauma programs, please visit http://www.facs.org/trauma/index.html.
Update on ACS Advocacy Efforts
ACS Advocacy and Health Policy activities will be directed in 2007 toward increasing public and policymaker awareness of the contributions made by surgeons to patient care and quality improvement, and about the unique stresses confronting the profession. New programs will be piloted in an effort to improve grassroots participation by surgeons in the policymaking process. The College will resume publication of the Socioeconomic Factbook, issue a new edition of Physicians as Assistants at Surgery, progress toward establishing an ACS Institute for Health Policy Research, and create a new electronic advocacy newsletter. Issues that the College focused on in 2006 (and will likely continue in 2007) fell under the categories of medical liability reform, provider taxes, non-physician scope of practice, trauma system funding and development, and regulation of office-based surgery.
In late-July, Dr. Russell and Frank G. Opelka, MD, FACS, met with CMS Administrator Mark B. McClellan, MD, PhD, to discuss how systems for quality improvement in surgical care must differ from current systems that focus primarily on office-based primary care and chronic disease management. The team-centered approach was discussed in detail, and Dr. McClellan encouraged the College to submit a proposal to test ACS NSQIP as a quality improvement tool that can be used in an incentive-based payment system.
In June, CMS released its proposed rule for the five-year review of physician work values in the Medicare Fee Schedule, as well as a new methodology for determining practice expense payments. The College submitted comments on August 21.
On July 27, Dr. Opelka testified on behalf of the College at a House Energy and Commerce Health Subcommittee hearing. The College urged Congress to take action to prevent the pending Medicare payment cut scheduled to take effect January 1, and outlined how current reimbursement policies are having a detrimental effect on surgical practices and service lines. Dr. Opelka updated subcommittee members on the College's efforts to develop quality measures for potential use in a pay-for-performance (P4P) program. He also noted that because of the unique nature of surgery, a P4P system designed for hospitals or primary care physicians may not be inapplicable to surgery. Additionally, Dr. Opelka also outlined a proposal calling for repeal of the flawed sustainable growth rate in the formula used to determine Medicare payment and replacing it with the ACS/AOA "Service Category Growth Rate" proposal.
In April, CMS released a proposed rule calling for major refinement to the diagnostic related groups (DRGs) used to determine hospital payment. In general, the changes will decrease hospital payment for surgical DRGs and increase payment for medical DRGs. The College submitted comments in June, questioning CMS's methodology and calling for a phase-in of the changes. In addition, the rule called for changes to indirect medical education payments, and the inclusion of surgical infection prevention as a hospital quality measure.
Earlier in the year, CMS announced a new audit program, Medically Unbelievable Edits (MUE), which compares, to a predetermined number, the actual number of times that a procedure is performed on the same patient by the same physician in a single day. The originally lengthy list of MUEs was pared down significantly after receiving comments. CMS accepted all of the College's recommended changes. The list of edits will become effective on January 1, 2007.
There are new proposed Correct Coding Initiative edits, based on CPT coding changes scheduled for January 1, 2007. The American Medical Association (AMA) and other national medical and surgical specialty societies were provided with a list of these edits and offered an opportunity to comment on them prior to implementation. The edits that were of concern to surgery were reviewed by members of the College's General Surgery Coding and Reimbursement Committee (GSCRC). Staff will send a formal response to the AMA.
The College is participating in a new multi-specialty practice expense survey. The data collected will help value surgical practice expense relative value units (RVUs). The GSCRC is currently editing the survey instrument that was developed by the AMA to ensure that all practice costs incurred by surgeons are adequately accounted for. After the survey is completed it will be sent to physicians, most likely in the spring of 2007. After the data are analyzed in 2008, they can be used to set practice expense RVUs in the 2009 Medicare Physician Fee Schedule. The GSCRC will play a vital role in developing the survey instrument, analyzing the data, and implementing the new values.
For the second year in a row, President Bush proposed terminating the EMSC program. Again, advocates including the College vigorously defended the EMSC program against elimination, and submitted a letter to the House and Senate Appropriations Committees requesting $25 million for the program in FY 2007. The House committee voted to restore EMSC funding to $19.8 million for FY 2007, and the Senate committee voted to approve funding at $20 million. Final work on these bills is expected to be completed in a lame duck congressional session after the elections.
In July, the Senate Health, Education and Pensions Committee approved the "Pandemic and All-Hazards Preparedness Act" (S.3678). The legislation reauthorizes the 2002 Public Health Security and Bioterrorism Response Act, which focused on bioterrorism preparedness. The College pressed to ensure that trauma systems were recognized in the bill. As a result, trauma systems are included as part of the nation's preparedness goals under the bill and the reauthorized hospital preparedness grant program requires eligible grantees to form partnerships that include at least one hospital that is a designated trauma center.
The College sent a letter of support of the Health Partnership Act which was introduced in May. The Act would authorize grants to states, regional entities, and others to pursue innovative strategies to increase health insurance coverage, ensure patients receive high quality and appropriate care, improve the efficiency of health spending, and use information technology to improve infrastructure.
Last year marked the first cuts in National Institutes of Health (NIH) funding in over 35 years. This year, One Voice Against Cancer (of which the College is an active member) supported an amendment to the Senate's final budget resolution that successfully added $7 billion for the health and education programs that contain funding for these cancer initiatives. The College used its Federal Legislative Action Center to focus grass roots activity towards convincing House members to follow the Senate's lead as funding levels are determined for cancer programs and research.
President Bush appointed John E. Niederhuber, MD, FACS, to serve as the 13th Director of the National Cancer Institute (NCI). Dr. Niederhuber has been a professor, cancer center director, National Cancer Advisory Board chair, external advisor to NCI, grant reviewer, and laboratory investigator supported by NCI and NIH. He is also a former chair of the College's Commission on Cancer Executive Committee.
The College's Patient Safety and Professional Liability Committee (PSPLC) devoted considerable attention to the results of its Closed Claims Analysis project, and plans to conduct educational efforts based on the results of the pilot. Other PSPLC activities include the following:
- The committee continues to monitor the development of regulations that will implement a federal mandate and allow private sector, not-for-profit entities to establish patient safety organizations.
- Upon the committee's recommendation, the College submitted comments in opposition of a proposal by the Health Resources and Services Administration to include adverse actions taken by peer review organizations and accrediting agencies, as reportable events.
The ACS Coding Hotline continues to receive calls. The availability of this free hotline service for the Fellows has been highlighted at all of the ACS coding workshops and in a number of issues of the ACS NewsScope. The hotline averages approximately 500 calls a month from Fellows and their office staff. ACS Coding Today, a Web-based coding tool endorsed by the College, has undergone major redesign in response to comments received from Fellows and other users. Plans are also underway to incorporate ACS-developed coding tips and information, including Physicians as Assistants at Surgery, into the tool so that it serves as a more complete resource for surgeons and their office staff.
The annual meeting of the AMA House of Delegates (HOD) was held in June. During the meeting, a resolution authored by the College and cosponsored by a number of surgical specialty societies was referred for consideration by the AMA Council on Medical Education in the context of the AMA's Initiative to Transform Medical Education. The resolution called for supporting the transition from medical student to resident through the development of a prerequisite curriculum that is disease-based focusing on a multidisciplinary style of medical practice.
Separately, a report from the Council addressed the impact of increasing specialization and declining generalism, and generated considerable debate. Testimony from the College and others expressed concern that the term "generalist physicians" might be interpreted in a way that would allow the AMA to pursue policies to improve reimbursement only for primary care physicians. Ultimately, the recommendation approved on the HOD floor did not address the specialties' concerns. The issue will likely be addressed again.
The AMA's Council on Ethical and Judicial Affairs (CEJA) presented a report detailing ethical obligations of physicians when working with manufacturer representatives. The report was referred back for additional work. The Reference Committee noted the College's statement on this subject and suggested that it be widely disseminated and used by the CEJA.
Several ACS Fellows were elected to AMA offices: William G. Plested III, MD, FACS, was inducted as President; Peter W. Carmel, MD, FACS, was reelected to the Board of Trustees; Charles J. Hickey, MD, FACS, was elected to the Council on Constitution and Bylaws; Lee R. Morisy, MD, FACS, was elected to the Council on Science and Public Health; and Patricia L. Turner, MD, FACS, the College's delegate to the AMA Young Physicians Section, was elected by the Section to be its Alternate Delegate to the HOD.
For further information on advocacy efforts, please visit the College's Advocacy Web page.
Establishment of a Committee on Patient Safety and Quality Improvement
The Board of Regents approved a request to restructure the current Committee on Patient Safety and Professional Liability, and replace it with a new Committee on Patient Safety and Quality Improvement. The legislative and regulatory efforts pertaining to medical liability reform fall naturally within the stated purpose of the Health Policy Steering Committee. In addition, the Health Policy Steering Committee will consider establishing a separate Task Force on Professional Liability, particularly during times when the insurance cycle is at the stage of escalating the crisis.
The new Committee on Patient Safety and Quality Improvement will be responsible for supporting the College's involvement in the National Quality Forum, the Physicians Consortium for Performance Improvement, the National Committee on Quality Assurance, and AQA and Hospital Quality Alliance, as well as related panels that are involved in the development and implementation of performance measures for surgeons and other providers. The new committee will also advise the College on patient safety related issues, including any future effort to establish a Patient Safety Organization as envisioned by federal legislation passed in 2005.
ACS National Surgical Quality Improvement Program (ACS NSQIP) – Update
ACS NSQIP, a risk-adjusted, outcomes-based program to measure and improve the quality of surgical care, is available to all eligible hospitals in the U.S. that meet the minimum volume requirements, complete a hospital participation agreement, and assign staff to the program. As of September 2006, 125 hospitals are enrolled in the program including two Canadian hospitals and one Department of Defense hospital. An additional 75 hospitals are in the application/enrollment process.
The first annual ACS NSQIP conference was held in June. Presentations focused on best practices and how to use ACS NSQIP data to improve quality at the local level. Darrell A. Campbell Jr., MD, FACS, has written an article about the conference. The article ran in the October edition of the Bulletin.
Staff from the program has worked with the College's I.T. department and the Division of Education to incorporate outcomes data from the ACS NSQIP into the case log system. The addition will allow individual surgeons to analyze their outcomes in relation to national averages.
Update on ACS Educational Offerings
Program planning for the 2007 Clinical Congress followed a new and enhanced interactive process which facilitated development of a comprehensive and well-balanced program of the highest quality. A special effort was made to solicit and select educational interventions that address Maintenance of Certification (MOC).
Based on information from needs assessments and advances in surgical practice and surgical education, 20 sessions from the 2006 Clinical Congress have been selected for Web casting following the meeting. The Web casts offer opportunities to earn CME credit. Web casts of sessions from Clinical Congresses 2002-2006 and Spring Meetings 2004-2006 are available, or will be available soon. These Web casts will also provide opportunities to earn CME credit.
The 2007 Spring Meeting will be held in Las Vegas, NV, April 22-25. The program is being planned by the Advisory Council for General Surgery in collaboration with the Division of Education. The meeting will follow the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Thirty-two general sessions are planned. Sunday, April 22, will serve as the day for joint programming between the ACS and SAGES. The 2007 meeting represents the last of three years of joint programming with SAGES.
The Resident Program at the Spring Meeting continues to be planned in collaboration with the Resident and Associate Society (RAS) of the College. Three sessions will be presented at the 2007 Spring Meeting. For the first time, ten sessions focusing on patient safety will be recorded and made available on CD-ROM following the Clinical Congress. These will be available as Web casts as well. Both the CD-ROMs and the Web casts of these sessions will offer CME credits.
A new Web page, Technical Skills Education in Surgery: A Web-based Resource, has been developed to provide information on contemporary teaching, learning, and assessment methods to address technical skills. Launched in July 2006, this searchable resource features critical reviews of over 150 peer reviewed articles from the technical skills education literature. The program should be useful to surgeons involved with development and implementation of technical skills education and to surgical residents interested in this field.
The case log system, which was launched in October 2005, had over 42,000 cases entered in the database as of early September 2006. The system was conceived and designed to support practice-based learning and improvement (PBLI), and will be especially useful in Steps I and IV of the PBLI Cycle. The next step will involve benchmarking of each participating surgeon's data with aggregate data from other surgeons enrolled in the program, in order to identify learning needs in Step I of the PBLI Cycle. Databases that are being considered for benchmarking purposes include the ACS NSQIP.
An educational primer is being developed to assist surgeons with interpretation and benchmarking of data, and to provide guidance regarding the use of outcomes data in the PBLI Cycle. Utility of the system beyond the PBLI function is also being discussed. A dialogue has been established with the American Board of Surgery regarding the possibility of allowing surgeons to use the system to submit cases for MOC. In addition, the College will permit use of the system for submission of cases in the Fellowship application process.
An innovative new course, "Effective Teamwork to Enhance Surgical Patient Safety," that involves use of the latest simulation and immersive educational principles, was developed and pilot tested in April 2006 with a small group of College leaders, a practicing surgeon, and a young surgeon. The course was extremely well received by the attendees, and planning is underway to design an interactive course that can be implemented at surgery departments across the country.
The ACS Patient Education Program was launched in December 2004 to address the pivotal role of patients within the context of systems-based practice and patient safety. An ACS Patient Education Web page has been designed to provide reliable patient education for a variety of resources. The Patient Education Web page may be found at http://www.facs.org/patienteducation.
The College has undertaken major steps to make educational resources available through its Web portal. The portal education pages went live in May 2006. The educational materials may be accessed by scrolling through the five major content areas of the Division of Education. A system has been established to help surgeons record and track their CME activities. Data from all of the College's CME programs will be seamlessly transferred to the respective College member's My CME page.
For further information on education efforts, please visit the College's Education Web page.
Accreditation Efforts/Bariatrics - Update
The American College of Surgeons Bariatric Surgery Center Network Accreditation Program was rolled out in May 2005. As of September 10, 2006, there are 15 fully and 24 provisionally approved bariatric centers. In addition, 15 hospitals are in the contract negotiation phase and a number of publications are under review by the Bariatric Advisory Committee. Staff is in the process of developing additional marketing materials, and is also developing a targeted marketing plan for both in-patient and outpatient facilities.
The model for the Accreditation of Education Institutes of the College was formally approved by the Board of Regents in June 2005. Following pilot testing, the program was formally launched in October 2005. In February 2006, the Board of Regents approved the two Accreditation Review Committees (surveyors) for the program. To date, 30 surveyors have been trained.
At the first meeting of the Accreditation Review Committee, seven institutes were reviewed and approved for Level I accreditation for three years. The accreditation process will be rolling in nature, and additional institutes will be accredited. One of the two Accreditation Review Committees will meet every six months to review applications.
Surgery News
The College continues to focus on providing useful and current information to Surgery News readers. Although a concerted effort is being made to put more socioeconomic content on the first pages of each issue of the newspaper and to expand that content as time goes on, the overriding philosophy behind the development of the newspaper's content is to provide a balanced menu of science, sociopolitical, and educational information. Feedback from readers indicates that is the content they want to see, and reader feedback will continue to be an important factor in editorial development.
Journal of the American College of Surgeons (JACS)
As of August 31, 2006, JACS has provided 91,368 CME credits. Many Fellows have expressed their appreciation of this CME program.
As of October 1, 2006, credit earned for one article read and two questions answered equals 1.0 CME credits, which previously equaled .50 CME credits. (There will be no retroactive change in credits received through September 30, 2006.) This increase is in accordance with CME credits for other journals and related items (e.g. Surgical Index).
Committee on Diversity Issues – Update
The Committee on Diversity Issues updated its mission statement earlier this year. The committee is now drafting a Statement on Disparities.
Last spring, the committee posted a diversity survey on the College's Web site. An expanded survey has been distributed to the respondents of the preliminary survey in order to obtain more relevant data on the effect of ethnic origins in education, training, and establishing practice for surgeons.
Resident and Associate Society (RAS) – Update
RAS activities include a survey that is in progress to aid in developing the Resident as Teacher, Leader, and Manager course which is cosponsored by the College's Resident Education Committee. The results of this survey will ensure that this course encompasses relevant and practical topics, and input is sought from program directors and residents.
RAS is completing a year of fostering increased communications between its members and the College. The RAS eNewsletter continues to increase in the number of issues published, and expand its content relevant to the issues of medical students and young surgeons.
Committee on Ethics – Update
The Committee on Ethics met in June. One of the agenda items focused on resident members of the College. The committee members expressed an interest in adding a resident member to the committee, and developed the following guidelines:
- The term should start when the resident is a PGY-2 or PGY-3.
- The resident should be willing to serve a three-year term in order to enhance the learning experience.
- A statement of personal interest and curriculum vitae should be submitted for residents being considered.
- A letter is needed from the program director stating that the resident will be given time to attend the meetings.
During the past year, the Committee on Young Surgeons focused its work on two primary educational activities: the 2006 Leadership Conference and the general sessions at Clinical Congress. The committee cosponsored a general session on marketing strategies with RAS, and anticipates possible, additional collaboration on practice-management education programs with RAS in the future. Also, this year's Initiates' Program focused on time-management strategies for young surgeons.
Leadership Conference – 2006
The 2006 Leadership Conference was held in June at the Washington Court Hotel in Washington, DC. More than 130 chapter leaders and young surgeons attended the education program. The three-day program was divided into several segments to present various topics: contract negotiation, young surgeons' membership needs, leadership development, ACS NSQIP, health policy and pay-for-performance, and legislative briefings. The last morning was devoted to Capitol Hill visits.
The Arthur Ellenberger Award for Excellence in State Advocacy was presented to Thomas R. Gadacz, MD, FACS, of Evans, GA. Dr. Gadacz was honored for his efforts to change his state's "Certificate of Need" program to recognize general surgery as an individual specialty. In addition, attendees had the opportunity to hear a panel discussion on current health policy issues presented by members of Congress who are also physicians.
For more detailed information on the conference, please see the attached Bulletin article.
