Report on ACSPA/ACS activities: February 2014

American College of Surgeons Professional Association (ACSPA)

In 2013, the American College of Surgeons Professional Association political action committee (ACSPA-SurgeonsPAC) raised $606,148, in personal and corporate contributions. This total is nearly $96,000 less than the PAC raised in 2012. The ACSPA believes that more education is needed to increase surgeons’ awareness of what the PAC does. To this end, Town Hall Meetings centered on ACSPA-SurgeonsPAC activities will convene at the 2014 Clinical Congress, October 26–30 in San Francisco, CA, and educational materials will be provided to young surgeons. In addition, members of the PAC Board of Directors will continue to reach out to American College of Surgeons (ACS) Fellows at chapter and other member-based meetings and seek PAC-inclusive advocacy messaging from ACS leaders and staff.

American College of Surgeons

Member Services

The Division of Member Services has developed audience-specific brochures for all membership categories, which are now available. The Division has asked ACS Governors whether they prefer electronic or paper copies of the brochures, or if posting them on the SharePoint sites would be most convenient.

In addition, the College is developing a campaign strategy to recruit members younger than 45 years of age.

Furthermore, the College is revitalizing its international strategy with a new structure, mission, and goals. As part of this effort, an international General Surgery Review Course is being planned. The Governors have broadened opportunities to international members but not exclusively to this population.

Other developments occurring under the aegis of Member Services include the following:

  • Efforts are under way to form a Surgical History Club, with details to be announced.
  • The Operation Giving Back program is evolving with a potential connection to global surgery initiatives.

Board of Governors
The Board of Governors (BOG) strategic transformation is complete. BOG workgroups that were created under the redesign are progressing on several projects that fall under the purview of the five Pillars of the BOG: Education, Advocacy, Communications, Quality, and Member Services. In addition, the BOG has begun publishing a newsletter to communicate information and news about ACS and BOG initiatives.

Plans are under way to restructure the ACS Advisory Councils in a similar manner.

Chapters
The newest chapter to receive the Board of Regents approval is the United Arab Emirates Chapter. It is the 38th international chapter, bringing the total number of chapters to 104—66 domestic, two Canadian, and 38 international.

Young Fellows Association
The College has identified specific roles for interested Young Fellows Association (YFA) members to assume on ACS committees. The following three Panel Sessions aimed at young surgeons will take place at the 2014 Clinical Congress: Initiates Program, Managing Debt, and Lean and Green. The YFA Mentorship Program matched 20 pairs of mentors and mentees at the 2013 Clinical Congress and plans to broaden the experience at the 2014 Clinical Congress. The YFA also plans to publicize the program to ACS chapters via a Web-based mentorship training package. An exciting new video project is in development with the theme of “What’s It Like to Have a Surgeon in Your House?” The YFA also has a quarterly newsletter and is initiating an essay contest.

Resident and Associate Society
The Resident and Associate Society (RAS-ACS) continues to create opportunities for young surgeons to get involved with the College and to identify leadership positions. The RAS-ACS also is involved in several outreach efforts through the Advisory Council and state specialty societies to recruit resident members.

Surgical Jeopardy, an interactive competition that the RAS-ACS introduced several years ago at Clinical Congress, has been packaged into an attractive tool kit with all the materials needed to host a competition at the chapter level. ACS Chapters will be contacted to determine their interest in piloting the competition. RAS-ACS intends to continue updating the game to keep it current and relevant.

Advocacy

Communications to ACS Fellows regarding the College’s advocacy efforts have steadily increased. One example of these efforts to communicate with ACS members was the development of the monthly e-newsletter, The ACS Advocate, which launched more than a year ago. Efforts to advocate for a permanent Medicare physician payment fix have been covered extensively in this newsletter, as well as in NewsScope, the Bulletin, and other special communications.

Examples of some of the advocacy initiatives that the College led from February 2013 through February 2014 include:

  • Played an important role in achieving passage of legislation that delayed a nearly 30 percent cut in Medicare physician reimbursements
  • Supported Children’s Hospital Graduate Medical Education Support Reauthorization Act
  • Sought repeal of the Independent Payment Advisory Board established under the Affordable Care Act
  • Opposed sequestration cuts that resulted in a 2 percent reduction in Medicare physician payments and graduate medical education (GME) funding
  • Supported the introduction of three GME bills:
    • Resident Physician Shortage Reduction Act of 2013
    • Training Tomorrow’s Doctors Today Act
    • Conrad State 30 and Physician Access Act
  • Worked with the Division of Integrated Communications to publish a special edition of the Bulletin covering a comprehensive list of medical liability reforms
  • Released the Surgeons and Bundled Payment Models: A Primer for Understanding Alternative Physician Payment Approaches
  • Sent a joint letter to the Office of the National Coordinator for Health Information Technology (ONC) commenting on several policies and programs that the Centers for Medicare & Medicaid Services (CMS) and ONC have been considering, which are aimed at helping advance interoperability and health information exchange
  • Advocated for passage of the Good Samaritan Health Professionals Act
  • Submitted two letters, one to the CMS and a similar letter to the U.S. Department of Health and Human Services (HHS) Office of the Inspector General, regarding the extension of a federal physician self-referral statute (Stark Law) exception and comparable anti-kickback safe harbor for firms that donate electronic health record (EHR) software to physicians
  • Commented on the calendar year (CY) 2013 physician fee schedule proposed rule
  • Commented on the CY 2013 outpatient prospective payment system/ambulatory surgical center proposed rule
  • Launched SurgeonsVoice, an enhanced grassroots advocacy program for recruiting, educating, and motivating Fellows to use their influence to change the dynamic in Washington, DC, by equipping ACS members with the knowledge and tools necessary to become an integral part of the nationwide grassroots advocacy network of surgeon advocates
  • Released Our Changing Health Care System Since the Inception of the Affordable Care Act, a compendium of articles and other resources that the ACS has published on legislative and regulatory issues, which provides a retrospective look at the changing health care landscape
  • Issued a letter voicing the ACS’ opposition to the proposed Senate Finance Committee legislation to repeal the sustainable growth rate formula
  • Lobbied on several state-specific bills, including legislation pertaining to health insurance, medical liability, and workforce issues

Communications

At the time of the Board meeting, the College’s ongoing Inspiring Quality campaign had made 16 tour stops around the U.S. To further increase awareness among hospital C-suite leaders of the ACS’ quality programs, particularly the College’s National Surgical Quality Improvement Program (ACS NSQIP®), the ACS was a sponsor of the U.S. News & World Report’s Hospital of Tomorrow Conference held in Washington, DC, November 4–6, 2013.

The College is in the process of overhauling its website. The new website will be unveiled this summer and will feature responsive design, an enhanced search function that will allow visitors to find a Fellow of the College or an ACS-verified or accredited center easily, and a new online community. Tyler Hughes, MD, FACS, has been named the Online Community Editor.

In addition, the new site will comprise:

  • A home page that showcases the College’s five pillars: member services, quality programs, education, advocacy, and communications
  • Time-sensitive announcements at the top of the home page
  • Links to easily direct visitors to their unique needs
  • Sections that highlight the latest news, feeds from the physician online community, and upcoming events
  • An enhanced member profile feature
  • Streamlined e-commerce

Journal of the American College of Surgeons
The Journal of the American College of Surgeons (JACS) website has progressively become more user-friendly. It now has an “open access” option for authors and has added a new “featured video” and a “Journal Insights” feature that displays JACS metrics of impact, speed, and authors.

In 2013, JACS provided 82,771 continuing medical education (CME) credits to 3,579 readers, averaging 23.1 credits per person. An iPad app is available for Fellows and JACS subscribers to access the full text of articles, providing an easy way to earn CME credits. Feature articles are also on the JACS Twitter feed @IAmCollSurg, which may be accessed at https://twitter.com/amcollsurgeons.

In addition, five Chinese-language editions of JACS have been published, with more planned for the future, and JACS articles have been publicized in various media outlets, such as U.S. News & World Report, Bloomberg Businessweek, and Science Daily.

Bulletin of the American College of Surgeons
The Bulletin’s print and online presence continues to grow and gained additional prominence from the launch of a dedicated Web presence. In recognition of the College’s Centennial year, from September 2012 to the October 2013 issue, the Bulletin showcased an article from past editions to provide readers with a reminder of the College’s history and legacy.

Quality, Research, and Optimal Patient Care

The Division of Research and Optimal Patient Care has set the following goals for 2014:

  • Launch a new Outcomes Research Course, December 4–6, in Chicago, IL
  • Expand the Clinical Scholars program
  • Continue development of the pediatric accreditation program
  • Bring the four overarching aims of the division into horizontal alignment: accreditation (internal/external), registries, regulatory, and achieving quality
  • Develop new clinical areas
  • Generate technology solutions
  • Expand support for improvement (for example, collaboratives, real-time reports, and cost data)
  • Collaborate further with other societies

Advanced Trauma Life Support
The Advanced Trauma Life Support (ATLS®) course trains more than 40,000 students annually and has been presented in 65 countries. Health care professionals in 158 countries have downloaded the ATLS mobile device application, resulting in more than 56,000 downloads. The 9th edition of the ATLS textbook will be offered as an e-book with enhanced imaging and other features.

Furthermore, ATLS and Operation Giving Back have formed a partnership to provide course materials to surgeons on humanitarian missions in Haiti and Zimbabwe. Challenges include growth, meeting the demands of international promulgation, continuous development of infrastructure, and the development of digital learning.

ACS NSQIP
As of the Board meeting, 526 hospitals were participating in the ACS NSQIP, and 61 additional hospitals were in various stages of the application and contracting process. The following is a breakdown of participating sites by ACS NSQIP program options:

  • Small and rural: 27
  • Procedure targeted: 181
  • Essentials: 243
  • Measures: 9
  • Florida Surgical Care Initiative (FSCI): 11

In 2013, ACS NSQIP entered into an agreement with Epic Systems to incorporate ACS NSQIP variables into a module of Epic’s electronic health records (EHR). The primary goal of the collaboration is to use data automation and to reduce the burden of data collection for the surgical clinical reviewer and data abstractor. The project is progressing well and is expected to go live in the fourth quarter of 2014. Additional efforts to expand continue, and program staff will work with Cerner Critical Outcomes, another EHR provider, to begin developing an ACS NSQIP module. The ACS is working to broaden opportunities for Fellows to work with a number of EHR providers.

Several surgical specialty societies have approached ACS NSQIP with various models for collaboration. Much of the discussion centers on adding specific data points to ACS NSQIP that could, in turn, measure outcomes and improve care in the surgical specialties. The additional target areas that are currently being considered for inclusion include transplant, head and neck, orthopaedics, urology, neurology, and enhanced recovery methods. Pilot programs for transplant and enhanced recovery will begin in 2014.

The Task Force on Geriatric Surgery formally launched its pilot program on January 6, when 19 sites began collecting data on geriatric specific variables. The Task Force identified 14 specific variables to be collected as part of this pilot.

The next ACS NSQIP conference is scheduled for July 26–29, 2014, at the Hilton Midtown, New York, NY. Linda Groah, executive director and chief executive officer for the Association of Perioperative Registered Nurses, will deliver the keynote address on the topic of accountability and quality care.

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)
As of the Board meeting, 732 bariatric surgery centers were participating in MBSAQIP; 634 were fully accredited, and 98 had provisional approval. Another seven initial applications were under review.

  • Three areas of focus for MBSAQIP in 2014 include:
  • New joint standards, which were published in January
  • Initiation of surgeon site verification that also supports facility accreditation
  • Release of the first semiannual report

The MBSAQIP submitted a letter of intent to CMS on January 31 requesting that the program be recognized as a CMS Qualified Clinical Data Registry (QCDR). The QCDR is a new reporting mechanism available for participation in the Physician Quality Reporting System (PQRS) beginning in 2014. As a CMS-recognized QCDR, the MBSAQIP data registry will be able to collect and report PQRS measures at the request of eligible professionals.

Surgeon Specific Registry
According to recent estimates, approximately 5,000 surgeons have submitted at least 20 cases and more than 4.4 million records to the ACS’ Surgeon Specific Registry (SSR). Surgeons continue to use the registry as a case log system. The overarching aim of the SSR is to target the “regulatory items” being used to assess individual surgeons. Three of the regulatory items being addressed include, but are not limited to:

  • Maintenance of Certification (MOC) by the American Board of Surgery (ABS), the American Board of Colon and Rectal Surgery (ABCRS), and other surgical boards
  • Recertification by the ABS
  • The PQRS

The SSR continues to have ABS and ABCRS approval for fulfilling requirements under MOC Part IV. Plans are in the works to develop the next set of measures for ABS MOC and PQRS. The College has met with the American Board of Medical Specialties and the American Board of Thoracic Surgery to discuss prospective SSR endorsements.

In addition, CMS approved the General Surgery Measures Group for PQRS 2014, and the American Urological Association promoted the SSR to its members as a resource for PQRS participation.

SSR goals for 2014 include:

  • Expand regulatory content in SSR
  • Enhance SSR methodology/validation
  • Explore technology

Quality manual
The ACS Quality Manual: Resources for Optimal Quality Surgical Care will provide an authoritative reference for surgical leaders, as well as a road map for new ACS programs, to recognize excellence in quality and safety. At press time, chapter outlines and initial drafts were due for review in spring 2014.

American College of Surgeons Foundation

The Foundation launched the 1913 Legacy Campaign: Investing in the New Century of the ACS last year with the goal of raising $5 million in contributions in 2014. The Foundation received its first corporate donation to the campaign in February 2014. A coordinated marketing campaign will raise visibility of and interest in this campaign, which to date has raised $1.75 million from Fellows, friends, chapters, and corporations.

Finance

The College continues to be in good financial health; investments are on target with a 10.6 percent year-to-date return for the six months ending December 31, 2013.  Year-to-date (December 31) operating revenues represented growth of 8.1 percent over the same period in 2012.  The revenue growth is primarily driven by Cancer, Education, and Continuous Quality Improvement programs, partially offset by a decrease in Clinical Congress revenue.

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