Report on ACSPA/ACS activities: June 2014

American College of Surgeons Professional Association (ACSPA)

As of June 2014, the ACSPA-SurgeonsPAC (political action committee) has raised $226,000 in both personal and corporate funding from 650 members of the College and staff, with a $348 average contribution. Of this amount, $206,628 were personal dollars, and $19,335 were corporate dollars.

The ACSPA-SurgeonsPAC hosted a reception at the 2014 American College of Surgeons (ACS) Committee on Trauma (COT) Annual Meeting in March 2014; at this meeting, 48 percent of COT members contributed to the PAC. The COT continues to exemplify excellence as a leading force in advocacy and health policy efforts.

The PAC also hosted events at the 2014 Advocacy Summit. The Political Luncheon, held Monday afternoon of the conference, featured Cook Political Report election handicapping expert David Wasserman, who gave attendees an insider’s look at Washington, DC, politics and a preview of the upcoming 2014 elections. Later that evening, the PAC hosted a fundraiser at the International Spy Museum. A retired CIA spy was present to address attendees and participants were able to tour the facility. The event raised $55,000 for the SurgeonsPAC.

Held in conjunction with the 2014 Residents as Teachers and Leaders Course in Chicago, IL, a “Pizza and Politics” dinner reception was hosted by the PAC. Brian Gavitt, MD, resident representative to the SurgeonsPAC Board of Directors, and staff led a discussion on the importance of surgical advocacy and an update on current political affairs. This event was held to increase resident involvement in the PAC.

Upcoming SurgeonsPAC projects include an independent expenditure for a communication “expressly advocating the election or defeat of a clearly identified candidate that is not made in cooperation, consultation, or concert with, or at the request or suggestion of, a candidate, a candidate’s authorized committee, or their agents, or a political party or its agents.”

American College of Surgeons (ACS)

The ACS Strategic Model has been reviewed, noting the priorities for the year. The ACS leadership holds an annual review against the College’s overall priorities in an effort to refocus the planned actions and events of the upcoming year. Overall, 100 projects have been completed. ACS staff will focus on six programmatic areas throughout 2014, including the quality database integration project, the standardization of verification and accreditation programs, and four different project areas in education. Many of these projects are dependent upon evaluation of new technology infrastructure.

Other information technology initiatives included the following:

  • The College has updated its Web presence to support access on mobile devices, with the new ACS website consisting of mobile-friendly Web pages. The ACS Communities site and new website went live in August.
  • Priorities for the year include:
    • Accreditation management (electronic workflow and financial management)
    • Data quality registries (business intelligence software platform for reporting)
    • Education (learning management system, MyCME/MyUniversity, medical/resident student tracking, CME, and accreditation)

Other recent ACS activities that affect the organization as a whole are as follows:

  • The Ernest Amory Codman, MD, FACS, memorial headstone was placed at the Mount Auburn Cemetery, Boston, MA, on July 22.
  • The ACS offered support for the Global Health Initiative for Surgery, which the World Health Organization recently approved.
  • A medical director for Operation Giving Back is in the process of being recruited.
  • The College has been measuring employee engagement as it relates to the organization’s bottom line. A customized report was given to division directors to review, which was followed by a meeting with employees to create an action plan for division improvement.

Finance

The College has committed to funding two new educational programs:

  • The Thomas R. Russell, MD, FACS, Faculty Research Fellowship award has been approved at the level of $40,000 for two years ($80,000 in total).
  • An ACS/American Society for Surgery of the Hand Career Development Award for a hand surgeon will be offered by the ACS Scholarship Fund. There is a commitment of $200,000 (ACS portion $40,000/year for five years), which will be provided by the ACS Scholarship Fund.

Other ACS Finance initiatives included the following:

  • The ACS will give $10,000 to the Institute of Medicine for a military medicine study.
  • Approval of a National Institutes of Health (NIH)/ACS Workshop has been given, provided there is a proposal submitted to NIH in support of this effort. College support would be $40,000.
  • In addition, the ACS and ACS Foundation budgets were presented for the Regents’ approval, which was granted.

Division of Advocacy and Health Policy

Two Fellows have accepted leadership positions in the Division of Advocacy and Health Policy. The new division staff leadership team consists of: Christian Shalgian, Division Director; Frank G. Opelka, MD, FACS, Medical Director for Quality and Health Policy; and Patrick V. Bailey, MD, FACS, Medical Director for Advocacy.

The key advocacy issues for the ACS are Medicare physician payment, medical liability reform, workforce/graduate medical education, quality, trauma, and cancer. The ACS is the only physician group to testify before all three congressional committees with jurisdiction over the Medicare program.

Dr. Opelka spoke about the dramatic shift from spending controls to value-based purchasing. Policymakers and surgeons must redefine an economic model through surgeon reeducation using process reengineering, payment policy, data and quality measurement, and technology.

The national landscape of health policy will be dominated by government focus on key Affordable Care Act principles, which are:

  • Coverage
  • Insurance reform
  • Performance measurement
  • Payment reform

The College’s advocacy priorities are as follows:

  • Inspiring quality
  • Repealing and replacing the sustainable growth rate
  • Relative Value Scale Update Committee
  • Professional liability, regulatory burdens, and the workforce
  • State activity

The ACS is using a collaborative approach to address health policy issues. The College seeks to support all surgical disciplines in the current and emerging economic models and to join multi-stakeholder activities within the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, and the Centers for Medicare & Medicaid Services to provide a College voice for surgical care in every policy forum. Furthermore, the College supports policies that position ACS clinical data sources to extend our programs into preferred payor models suited for economic models emerging from national strategies.

Dr. Bailey will direct much of his energy into rallying the membership to issues of importance through SurgeonsVoice, Action Alerts, state chapters, and other ACS health policy committees, stressing the importance of the SurgeonsPAC. He believes it is particularly important to encourage ACS members to begin the process of establishing relationships with individual legislators, their staff, and agency staff.

Strategies for specific programs are as follows:

  • Trauma programs, grants and pilot projects
    • Advocate for reauthorization and funding
    • 2014 expirations: two programs totaling $24 million/year
    • 2015 expirations: two programs totaling $200 million/year
    • Engage the COT SurgeonsVoice, and state chapters
  • Enlist bipartisan champions in the House and Senate
  • The Critical Access Hospital (CAH) Relief Act—96-Hour Rule
    • The 96-Hour Rule will remove restrictions as a condition of payment on individual physicians, but it will remain a condition of participating for annual average length of stay for CAHs.
    • Engage rural surgery, SurgeonsVoice, and state chapters

Furthermore, a Postgraduate Course on advocacy is in the concept stage and will be held at a future Clinical Congress.

Division of Education

The overarching mission of the Division of Education is to promote excellence and expertise in surgery through innovative education, training, verification, validation, and accreditation. Through the Division of Education, the ACS seeks to serve as the premier national and international surgical education resource through the design, implementation, and evaluation of leading-edge programs and establishing new benchmarks. Professional development is evolving to emphasize mastery and expertise, with an increasing focus on specific needs of individual learners. This evolution will be addressed through a variety of strategies, including high-fidelity experiences, robust assessments, and comprehensive faculty development and support.

The following are important emergent areas of focus for the Division of Education:

  • Leadership in transforming residency training in surgery
  • Leadership in addressing recognition and mitigation of impact of fatigue
  • Leadership in advancing simulation-based surgical education and training
  • Special focus on early career transitions

Examples of initiatives in this area are as follows:

  • Special courses on new procedures and technologies will be offered both regionally and at the Clinical Congress.
  • The Committee to Enhance Peak Performance in Surgery through Recognition and Mitigation of the Impact of Fatigue has developed a Statement on Peak Performance and Management of Fatigue (subsequently published in the August Bulletin).
  • The Board approved the Patient Education Committee’s Statement on the Effects of Tobacco Use on Surgical Complications and the Utility of Smoking Cessation Counseling (also published in the August Bulletin).
  • Upon a request from the Committee on Perioperative Care, the B/R approved removal of the following position statements:
    • Statement on the Use of Cell Phones in the Operating Room
    • Statement on Blunt Suture Needles
  • The following statement should be updated:
    • Statement on Surgical Technology Training and Certification

The Division of Education continues to focus on quality when developing and delivering their educational programs.

Division of Member Services

The Division of Member Services is responsible for credentialing of Fellows, the Archives, the Advisory Councils, the Board of Governors, Chapter Services, and other ACS activities. Some of the division’s recent activities follow:

  • The ACS has recently hired a new archivist, Adam Carey, MA, MLIS, ABD, who is spearheading the ACS Surgical History Group’s activities.
  • The formation of the Bolivia Chapter was approved by the Board of Regents in its June meeting. It will be the College’s 39th International Chapter, bringing the total number of Chapters to 105: 66 domestic (including two Canadian Chapters) and 39 international.
  • The Board of Regents (B/R) accepted resignations from 12 Fellows. Beginning with the June 2014 list of resignations, the Fellows were sent a special letter from the First and Second Vice-Presidents. This letter included the new membership benefits brochure and invites the Fellow to contact the Vice-Presidents if they wish to discuss any questions, concerns, or reasons for the resignation.
  • The B/R approved a change in status from “Active” to “Retired” for 97 Fellows as outlined in the report. The 97 Fellows of the College who indicated their desire to retire were provided with the requirements for retired status.

Division of Research and Optimal Patient Care

The Division of Research and Optimal Patient Care has purview over all the ACS Quality Programs. Following are updates on those programs:

  • A total of 542 hospitals are now participating in the ACS National Surgical Quality Improvement Program (ACS NSQIP®), 487 of which are enrolled in Adult NSQIP.
  • The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program now has 743 accredited participating centers—a significant market share of all U.S.-based bariatric centers.
  • The ACS has continued development of the Surgeon Specific Registry (SSR), formerly known as the ACS Case Log. Approximately 5,000 surgeons who have submitted at least 20 cases and more than 5 million records are listed in the registry.
  • The ACS released a request for proposals to several information technology/business intelligence vendors to evaluate which services are available to streamline and to standardize current processes across DROPC programs and ACS registries.
  • The Outcomes Research Course, sponsored by the Surgical Research Committee, will be chaired by David R. Flum, MD, MPH, FACS, on December 4–6, in Chicago, IL (see more complete program information). The course will be taught by 14 faculty members who are leaders in the field of outcomes research.
  • Upon the recommendation of the Executive Committee and the Injury Prevention Committee of the COT, the following three injury prevention statements were approved and subsequently published in the September Bulletin:

Journal of the American College of Surgeons

The Journal of the ACS (JACS) remains a valuable resource for surgeons and continues to expand. The journal currently has 13 deputy editors, 11 senior editors, 69 editors, and seven international correspondents. JACS is adding a CME Editor and an Associate Statistician in the near future. More ad hoc reviewers are being sought than ever before, and in 2013, 846 surgeons evaluated manuscripts; there was also an increase in original scientific articles submitted over the past five years.

The journal is scholarly and peer-reviewed and many of the articles require a statistical analysis. It is the official journal for the Southern Surgical Association, the Western Surgical Association, and the New England Surgical Society.

Developments at JACS include the following:

  • Social media efforts have continued to increase with the recent addition of a full-time social media editor.
  • In 2013, surgeons were granted 82,771 credits through JACS; 3,579 different surgeons, claimed those credits, averaging 23.1 credits per person.
  • The journal will be enhanced with the new ACS website and will display equally well on mobile devices.
  • The JACS resource center, an online educational website, is expected to launch soon. It will contain article collections, videos and discussions.
  • JACS distributes a Chinese edition, which has its own editorial board, to 30,000 surgeons.

American College of Surgeons Foundation

The current goal of the 1913 Legacy Campaign is to raise $5 million. Phone calls and e-mails are being made to campaign responders who have received personal solicitation letters.

The ACS Foundation Board of Directors unanimously voted to present the 2014 Distinguished Philanthropist Award to Dr. and Mrs. W. Gerald Austen, Boston, MA. The Award will be presented at the Foundation luncheon on October 27, 2014, in San Francisco, CA.

Ethics

The Committee on Ethics proposed several new initiatives. The following ideas received the most support from the B/R:

  • Author a book that will serve to define the framework of the new field of surgery ethics as it has evolved during the past 10 years
  • Develop a variety of educational offerings in surgery ethics, including activities for those committed to advanced study, as well as for those seeking a working knowledge of the application of fundamental principles in surgical practice
  • Expand the membership of the Committee on Ethics to allow better integration of ethics throughout the organization

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