American College of Surgeons Professional Association (ACSPA)
As of October 1, 2013, the American College of Surgeons Professional Association’s political action committee (ACSPA-SurgeonsPAC) had raised $475,000 from 1,607 members of the College and staff ($295 average contribution).
Contributions for 2013 among ACSPA’s leaders are:
- 25 of 25 Officers and Regents in the U.S. (100 percent) contributed $17,300
- 121 of 213 Governors in the U.S. (57 percent) contributed $63,574
- 15 of 15 members of the College’s Health Policy and Advocacy Group (100 percent) contributed $16,699
- 17 of 17 PAC Board members (100 percent) contributed $33,200
- Eight of nine ACS Legislative Committee members (89 percent) contributed $5,250
- 10 of 14 General Surgery Coding and Reimbursement Committee members (71 percent) contributed $10,300
- 114 of 228 Committee on Trauma members (50 percent) contributed $47,351
- 19 of 65 Commission on Cancer members (29 percent) contributed $9,920
This June, ACSPA-SurgeonsPAC Board Members Patrick Bailey, MD, FACS; Clarence Watridge, MD, FACS; and Mchael Sutherland, MD, FACS, attended the 2013 Physician PAC Forum in Louisville, KY. This year’s forum focused on engaging residents in the SurgeonsPAC, hosting in-district fundraisers for members of Congress, integrating SurgeonsPAC and grassroots strategies, disbursing the funds in a strategic way, and other topics.
So far in the 2014 election cycle, the ACSPA-SurgeonsPAC has contributed $218,000 to 83 candidates, leadership PACs, and party committees. Of this amount, 61 percent went to Republicans and 39 percent to Democrats.
American College of Surgeons (ACS)
Division of Member Services
The Division of Member Services continues to evaluate, refine, and create programs in support of College leaders and members. This year the Division is embarking on initiatives that the ACS anticipates will result in an enhanced member experience.
These efforts include:
- Develop an overarching strategy to expand international efforts
- Redesign the Advisory Councils
- Fully implement the Board of Governors’ redesign
- Conduct a needs assessment
- Develop strategic plan for ACS chapters
- Coordinate and centralize scholarships and fellowships
- Implement a young surgeon marketing and recruitment campaign
- Conduct a member and non-member survey
The ACS currently has 36,135 active, dues-paying Fellows. At the 2013 Clinical Congress, 1,622 Initiates were inducted into the College, representing one of the largest classes of Initiates in the last decade. These new Fellows represent the U.S. and its territories, Canada, and 55 other nations.
Board of Governors
The annual Board of Governors survey was distributed in August and included questions pertaining to surgeon employment practices. Governors were asked to provide information regarding their constituents’ views on issues pertinent to their practices. More than 195 Governors responded to the survey, and their responses were presented to the Board of Regents for consideration.
The top five issues of concern to the Fellows of the College in 2013 as reported by the Governors are:
- Health care reform and its impact on practice
- Professional liability/tort reform, risk management/patient safety
- Medical education/graduate medical education
- Physician reimbursement/Medicare/Medicaid
- Competency measurement for the practicing surgeon/newly trained surgeons
The Joint Session of the Board of Regents and Board of Governors focused on Medicare physician payment. Speakers described the College’s leadership role in Medicare physician payment reform, and a series of presentations addressed alternatives the College has developed to the broken reimbursement system. In addition, tools for quality improvement that fit into transforming health care and payment systems were reviewed. Also discussed were the Centers for Medicare & Medicaid Services’ (CMS) plans to change how Medicare pays physicians with a focus on recent proposed rules and the College’s response, as well as what Congress and multi-stakeholder groups are doing to address the development of a value-based health care system.
The role and function of the Advisory Councils are being evaluated, and a workgroup of volunteer leaders from the Advisory Council Chairs has been formed to restructure the councils using a process similar to that employed by the Board of Governors. The goal of this effort is to improve communication among the Advisory Councils, Governors, and Regents, members, and specialty societies.
The Advisory Council for Rural Surgery, chaired by Tyler Hughes, MD, FACS, continues to develop its primary initiatives, has established a rural surgery presence at the Clinical Congress, and is conducting preliminary work on a set of rural surgery standards and guidelines. This year, the Clinical Congress Program Planner included a wrapper with program information targeted to the rural surgeon. Plans for 2014 include a Rural Surgery Symposium in May and creation of an ACS Rural Surgery Ambassador Program. The Sixth Rural Surgery Symposium will take place at the College’s headquarters in May 2014. The one-and-one-half-day program will include presentations on advocacy, practice issues, and clinical practice. Clinical practice topics that will be addressed include critical care, pancreatitis, cancer care, management of large skin lesions, and palliative care. The Rural Surgeon Ambassador Program will consist of council members speaking to chapters, medical students, and residents on issues in rural surgery. Council members have already been guests of chapters in Georgia, Ohio, and Maine.
The ACS is working to provide support to its domestic and international chapters to facilitate incremental improvement and re-energize each of them. Currently, Chapter Services staff assists with tasks related to bylaws, governance, strategies for growth of membership, and best practices in general, to revitalize and move chapters forward. Several international chapters are at various stages of being admitted to the College, with surgeons in the Middle East, Eastern Europe, and South America showing particular interest. Three more chapters have been approved for providing continuing medical education (CME) credit via the ACS, which brings the total to 36 domestic chapters.
In January, a chapter listserv was created to promote sharing of ideas and to encourage discussion between the chapters. A chapter mentor program, with stronger chapter administrators assisting and offering guidance to those that may need help in specific areas, is planned for 2014. An expanded Winter Learning Event for chapter leaders took place at the College in December 2012, which included discussion of best practices, social networking for chapters, implemention of Young Fellows Association (YFA) and Resident and Associate Society (RAS) initiatives at the chapter level, and other topics regarding how chapters can be of greater value to their members.
A new chapter survey is being disseminated to assess performance and identify the attributes of a high-functioning chapter, along with another study to uncover the perspectives of the chapter membership. This latter survey is intended to cull crucial information from multiple sources to more accurately assess chapter “health.” The resultant dashboard will offer performance indicators rating chapter performance in various areas, and will allow chapters to identify areas for improvement. These data will be shared with individual chapters and best practice resources will be designed and developed to assist chapters more broadly.
RAS-ACS continues to move forward with several key initiatives, including development of a Surgical Jeopardy toolkit for domestic and international surgical societies and chapters.
Maintaining a strong social media presence is a vital part of RAS outreach. The RAS-ACS Facebook page now has more than 1,200 followers, spanning 20 countries and 19 languages.
The RAS-ACS introduced new programs at the 2013 Clinical Congress, including Focus on RAS: A RAS Leadership Session. A networking lunch for all Resident and Associate Members of the ACS was followed by the Governing Board meeting. Immediate Past-President of the ACS, A. Brent Eastman, MD, FACS, delivered the keynote address, focusing on the importance of RAS membership and involvement of residents within the greater College structure.
The RAS-ACS sponsored two essay competitions in 2013, providing winners with awards and presentation opportunities and continues to coordinate and publish content relative to members in the Bulletin.
Because the ACS actively incorporates Resident Members into the committee structure, RAS has been able to support a well-integrated liaison program. The selection committee identified and filled more than 20 positions on ACS committees, Advisory Councils, and Board of Governor work groups this year.
The YFA serves as a clearinghouse and point of entry for young Fellows who want to actively participate in the College but may be uncertain where or how to get started. The YFA also seeks to increase awareness of ACS programs/educational products that are available to this demographic and to connect young Fellows with their local/state chapters and leaders with special emphasis on those chapters without an identified YFA liaison. Another goal this year was to improve outreach to international young Fellows.
Operation Giving Back (OGB)
A new Board of Governors Workgroup has been created to oversee selection of the ACS Surgical Humanitarian and Volunteerism Awards. The 2013 Humanitarian and Volunteerism award recipients included Donald R. Laub, Sr., MD, FACS, Humanitarian Award; Ingida Asfaw, MD, FACS, International Volunteer Outreach; Jerone T. Landström, MD, FACS, Military Volunteer Outreach; and Katrina B. Mitchell, MD, Resident Volunteer Outreach.
To date, more than $39,000 in humanitarian donations of Advanced Trauma Life Support® (ATLS®) materials have been facilitated through the OGB to health care professionals in 20 countries, including Afghanistan, the Dominican Republic, Ecuador, Ethiopia, Gabon, Haiti, Liberia, Kenya, Malawi, Mexico, Nepal, Nicaragua, Pakistan, Peru, the Philippines, Sierra Leone, Thailand, Uganda, Vietnam, and Zimbabwe.
In the past 12 months, 38,162 visitors from 185 countries completed 111,530 page views of the OGB website. A total of 207 volunteer opportunities currently are published on OGB; 62 were newly created or updated in the last year. Additionally, more than 2,000 surgeons have completed demographic profiles in “My Giving Back.”
OGB has been collaborating on global surgery advocacy efforts internally with the International Relations Committee and externally with the Royal Australasian College of Surgeons, the Royal College of Surgeons of England-affiliated group the International Collaboration on Essential Surgery, and the Alliance for Surgery and Anesthesia Presence.
Division of Advocacy and Health Policy
Medicare physician payment
Under current law, Medicare physician payments will be cut by approximately 24.4 percent on January 1, 2014. For the last two years, the ACS has lobbied for physician payment reform, urging Congress to address the long-term implications of a broken physician payment system and its incompatibility with the provision of care.
Before adjourning for the August congressional recess, the House Committee on Energy and Commerce unanimously approved the Medicare Patient Access and Quality Improvement Act. The bipartisan legislation would permanently repeal the Medicare sustainable growth rate (SGR) formula and create a new physician payment system. The Committee’s approval of this legislation represents several months of collaboration with the House Committee on Ways and Means, as well as input from key stakeholders, including the College and the broader physician community. Several beneficial provisions are included in the Energy and Commerce legislation, including full repeal of the SGR, and the ACS stresses the importance of moving legislation forward in 2014. Although the ACS supports the overall effort to move payment reform through the House and Senate, the College will continue to lobby for improvements to all payment reform plans.
In written correspondence and congressional testimony, the College encouraged Congress to implement its Value-Based Update (VBU) proposal. The College also expressed strong support of efforts to find more innovative models of physician payment and asserted that any new payment system should be based on the complementary objectives of improving outcomes, quality, safety, and efficiency while simultaneously reducing the growth in health care spending.
Rep. Diane Black, RN (R-TN), reintroduced legislation that addresses several concerns with respect to the current Electronic Health Record (EHR) Incentive Program. Specifically, H.R. 1331, the Electronic Health Record Improvement Act, would create a hardship exemption from penalties for noncompliance for small practices and physicians in and near retirement, shorten the gap between the performance period and application of the penalty, expand options for participation in the Incentive Program, improve quality measures by using specialty-led registries, and establish an appeals process before application of penalties. Twenty-one other medical organizations joined the ACS in sending a letter of support for the legislation.
The EHR Incentive Programs provide a financial incentive for the meaningful use of certified EHR technology to achieve health and efficiency goals. There are three stages of meaningful use, with increased requirements each year. The last year eligible providers (EPs) qualified for the full incentive amount of $44,000 was 2012. The maximum for 2013 was $39,000. Details on the EHR Incentive Program are posted, along with educational materials and resources.
In August, the Council on Graduate Medical Education (COGME) released its 21st report, “Improving Value in Graduate Medical Education.” In the report, COGME recommends an increase in Graduate Medical Education (GME) funding for high-priority specialties, such as general surgery, family medicine, geriatrics, general internal medicine, certain pediatric subspecialties, and psychiatry. COGME acknowledges the many challenges facing GME, such as poor geographic distribution of physicians in relation to population needs and increasing specialization while primary care remains under-resourced. According to COGME this misdistribution can be attributed partly to the fact that many teaching hospitals have not recognized the need for greater emphasis on primary care training and that curriculum is often inadequate in the areas of population health, care coordination, team-based practice, and other aspects of new systems of care. To address these and other challenges, COGME recommends that the GME system be reformed to improve the value the public receives for its investment by increasing partnerships among training programs, teaching hospitals, accreditation organizations, state and federal governments, and other stakeholders. This recommendation is based on the assumption that greater value in GME means better targeting of public GME money and more effective training models.
The Affordable Care Act authorized funding for loan repayments for pediatric subspecialists, including pediatric surgeons, who agree to practice in shortage areas for at least two years. The College signed a letter to the Deputy Director for Management with the Office of Management and Budget (OMB) thanking the Obama Administration for their previous support of the Pediatric Subspecialty Loan Repayment Program and asking that $5 million in funding once again be included within the Health Resources and Services Administration (HRSA) budget. The $5 million in funding was included in the President’s budget plan; however, the money has yet to be appropriated by Congress. The ACS and other stakeholders sent a letter to House and Senate appropriators urging them to include the $5 million for the program in the fiscal year (FY) 2014 appropriations bill. The Senate for the first time included $5 million for this program in its Labor, Health and Human Services, and Education appropriations bill. The ACS will continue to push for the funds to be appropriated. The authorization of this program is set to expire after next year, and Rep. Joe Courtney (D-CT) has recently introduced legislation that would extend this authorization through FY 2018. The ACS sent a letter of support for this legislation in July and signed a coalition letter of support in August.
The ACS continues to provide Physician Quality Reporting System (PQRS) educational materials and resources to Fellows and office staff through the website, meetings, and publications. Columns in the April and September 2013 issues of the Bulletin provide information on PQRS requirements and compliance. The PQRS section of the website is continually updated with new information, including updated 2013 PQRS flow sheets for various surgical procedures and details on how to report measures via claims, registries, and EHR. The ACS staff continues to represent the surgical community at meetings regarding the future of PQRS and possible changes to the program.
Division of Research and Optimal Patient Care (DROPC)
Approximately 497 sites participate in ACS National Surgical Quality Improvement Program (ACS NSQIP®); 60 additional sites are in the enrollment process, and another 53 hospitals are pursuing the Pediatric option. The Essentials option is the most popular adult participation option with ACS NSQIP Procedure Targeted the second most common option.
The Eighth Annual ACS NSQIP National Conference took place in July 2013 in San Diego, CA. With more than 1,000 attendees, it was the largest annual ACS NSQIP conference to date. The focus of the conference was on promoting quality improvement through data analysis and collaboration. Next year’s conference will take place July 26–29 in New York, NY.
While ACS NSQIP is recognized for its high-quality data, this information must be actionable and used to improve the quality of surgical care. In the coming months, ACS NSQIP will have an increased focus on assisting hospitals in their quality improvement efforts. An illustration of this emphasis on improving quality was demonstrated at the national conference with the release of the new ACS NSQIP Surgical Risk Calculator. Based on data from more than 1.4 million operations, the Surgical Risk Calculator is designed to help physicians provide patients with accurate estimations of postoperative complications. Covering more than 1,500 unique surgical procedures across multiple specialties, this instrument is a revolutionary new decision support tool. The calculator has been publically released in an effort to improve the processes of informed consent and shared decision making with patients. The release of the calculator has led to moderate press coverage for the ACS and its role in quality of care. Additionally, CMS, through the PQRS, may soon provide a financial incentive for surgeons to calculate the risk of operations using the Surgical Risk Calculator and to discuss these patient-specific risks with patients before a surgical procedure. The risk calculator can be accessed on the ACS website at www.riskcalculator.facs.org.
Collaboration continues to play a critical role in the success of ACS NSQIP and the quality improvement initiatives at participating hospitals. Two ACS NSQIP collaboratives were recently honored with national awards based on their leadership in quality improvement, and each cited ACS NSQIP results as key quality achievements. The Tennessee Surgical Quality Collaborative and the Florida Surgical Care Initiative both noted significant reductions in complications and their resulting cost savings in their award nomination entries.
The spirit of collaboration is also responsible for the development of another ACS NSQIP quality improvement resource. Presented to all attendees at the last ACS NSQIP conference, the fourth edition of ACS NSQIP’s Best Practices Case Studies provides information on the experiences and expertise of hospitals that have successfully implemented quality improvement programs at their institutions. The guide also provides insight into the methods and tools used for implementing initiatives in quality improvement. The latest edition of the Best Practices Case Studies included entries from the Cleveland (OH) Clinic, Tampa (FL) General Hospital, Mayo Clinic Rochester (MN) Methodist Hospital, and Sheikh Khalifa Medical City, Abu Dhabi. The international entry to the Best Practices Case Studies is noteworthy, as there continues to be significant growth and interest in ACS NSQIP among international hospitals. Currently, 36 international sites are enrolled in ACS NSQIP and another 12 sites are in the application process.
This was the second year that the International ACS NSQIP Scholarship Award was presented. The scholarship is presented to two surgeons from countries other than the U.S. or Canada who demonstrate a strong interest in surgical quality improvement. Recipients in 2013 were Ping Lan, PhD, MD, FACS, of the Sixth Affiliated Hospital of Sun Yat-Sen University in Guangzhou, China, and Manuel Francisco Roxas, MD, FPCS, FACS, of the Medical City in Pasig City, Philippines. As part of their scholarship, Drs. Lan and Roxas attended the ACS NSQIP National Conference and visited participating hospitals to learn how to implement surgical quality improvement methods at their home institutions. Both surgeons submitted formal reports recounting their scholarship experience and effusively praised the conference and the knowledge gained from their hospital visits.
ACS NSQIP continues to develop tools to help hospitals achieve improved surgical care and outcomes. Additionally, ACS NSQIP is evaluating the incorporation of financial aspects of care into the program to provide information not only on the quality of care, but also costs. Such “value” reporting will likely be commensurate with the priorities of the overall health care movement at the broad policy level and the individual hospital level.
A total of 725 U.S. bariatric surgery centers participate in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), 634 of which are fully accredited; the remaining 91 are provisionally approved. An additional 28 initial applications are under review.
The Committee for Metabolic and Bariatric Surgery, the overarching advisory committee for the MBSAQIP, works closely with the American Society for Metabolic and Bariatric Surgery (ASMBS) leadership via its Executive Council to ensure multi-membership representation from both the ACS and the ASMBS. Due to the collective work of both the ACS and the ASMBS leadership, work is under way to develop a critically important quality improvement initiative aimed at reducing acute hospital readmissions related to bariatric surgery.
The Standards Subcommittee has collected feedback from the second public comment period and has voted to approve the MBSAQIP standards. At press time the Standards Subcommittee’s goal is to release and implement these standards in January 2014 with associated training and educational activities.
A total of 1,507 cancer centers in the U.S. and Puerto Rico are accredited by the Commission on Cancer (COC). These institutions treat 71 percent of all newly diagnosed cancer patients annually. In the last year, 27 new cancer programs joined the accreditation program, and 79 cancer programs received the Outstanding Achievement Award.
CoC leadership and external constituents developed an initial framework for Oncology Medical Home (OMH) standards that will apply to large group practices. A component of this accreditation is focused on data to measure the OMH performance against 19 clinically-based performance measures. More than $1 million in grant funding has been requested from the Center for Medicare and Medicaid Innovation to support development of this accreditation model.
CoC leadership and external constituents developed an initial framework for health care system standards that will form the basis for an accreditation model. An October 2013 meeting was held with staff from two leading health care systems to complete the initial draft, and pilot site visits are targeted for the first quarter of 2014. Release of a system accreditation manual is targeted for later in 2014.
A cross-functional pediatric workgroup will be established to evaluate existing pediatric standards and develop an enhanced set of standard and pediatric performance measures with an eye toward providing more value to program participants and adding new participants in this category.
The Cancer Quality Improvement Program (CQIP) has a new annual cancer program report under development. CQIP 2013 was released to more than 1,500 CoC-accredited hospitals in November 2013. The CQIP 2013 report is based on cases diagnosed in 2011 and includes more than 100 data points for each cancer diagnosed in patients treated in CoC-accredited facilities. The CoC plans to update and expand this report annually for its programs to use to improve compliance with quality measures, outcomes, and the overall care for cancer patients.
National Accreditation Program for Breast Centers (NAPBC) accreditation has now been awarded to more than 500 U.S. breast centers, with another 223 centers currently working toward accreditation or reaccreditation.
As part of the NAPBC International Committee exploration toward developing an international arm of the NAPBC, a survey was sent to 918 physicians in 43 countries representing 184 breast centers to inquire whether they would be interested in learning more about breast center accreditation and participating in a quality-based breast accreditation program. The same survey was sent to all International Fellows of the ACS. The results overwhelmingly supported the development of a global breast accreditation. Therefore, the NAPBC identified three pilot sites (Montreal, QC; London, UK; and Dubai, UAE) and developed a questionnaire based on the current American-based standards and asked how they would satisfy the standards.This questionnaire will be sent to each international program and a catalog of responses will be built to capture geographic differences and help guide international surveyors in the future.