Report on ACSPA/ACS activities, February 2015

The Board of Directors of the American College of Surgeons Professional Association (ACSPA) and the Board of Regents (B/R) of the American College of Surgeons (ACS) met February 6–7 at the College’s headquarters in Chicago, IL. The following is a summary of their discussions and actions.

ACSPA

In 2014, the ACSPA political action committee (ACSPA-SurgeonsPAC) raised more than $589,997 (including both personal and corporate funds) from 1,974 ACS members and staff. Of this amount, more than $529,422 is personal (hard) dollars and $60,575 is corporate (soft) dollars.

In the 2014 election cycle, the ACSPA-SurgeonsPAC contributed $1,053,500 to 151 candidates, leadership PACs, and party committees. Of this amount, 60 percent was distributed to Republicans and 40 percent to Democrats; 92 percent of SurgeonsPAC dollars were spent on candidates/incumbents who won their seats.

The primary areas of focus for the ACSPA in 2015 include increasing the following:

  • The number of SurgeonsPAC members
  • Peer-to-peer solicitation through the ACSPA-SurgeonsPAC’s Captain Program and the Resident Leadership Council
  • Leadership engagement
  • Leadership giving

ACS

Division of Advocacy and Health Policy

The past year saw an increase in the frequency of communications to members on advocacy and policy-related topics. Besides the monthly e-newsletter, The ACS Advocate, and regular submissions to NewsScope and the Bulletin, Patrick V. Bailey, MD, FACS, Medical Director of Advocacy, is writing a regular column for ACS Surgery News.

The Health Policy and Advocacy Group (HPAG) met at the ACS Washington office, January 11–12, to discuss and set the division’s 2015 agenda and activities. In addition, the annual Commission on Cancer Advocacy Committee planning meeting took place October 25, 2014. The focus of the 2015 agenda will be on funding for survivorship care plan creation and delivery, reimbursement for helping patients navigate cancer care, clinical research, access to oncology drugs, funding for the National Institutes of Health, and cancer quality measurement. Planning is under way for the second annual legislative briefing. The topic will be Accreditation Makes a Difference.

2015 Leadership & Advocacy Summit

At the time of the Board meeting, the 2015 Leadership & Advocacy Summit was scheduled to take place April 18–21 at the JW Marriott, Washington, DC. General Stanley McChrystal was scheduled to deliver the keynote address on tools for successful leadership. Other speakers on the agenda were planning to discuss the current political environment in Washington, DC, and across the country, as well as the status of important health care issues.

The ACSPA-SurgeonsPAC was preparing to sponsor a luncheon talk by Washington Post political reporter Chris Cillizza.

The ACSPA-SurgeonsPAC also was scheduled to hold a fundraising event and raffle. Once again, Resident Scholarship grants were made available to help encourage the participation of a new generation of surgeon advocates.

AMA House of Delegates

The ACS delegation participated in the Interim Meeting of the American Medical Association (AMA) House of Delegates, November 7–11, 2014, in Dallas, TX. ACS representatives at the meeting included John Armstrong, MD, FACS (Delegation Chair); Jacob Moalem, MD, FACS (Young Physicians Section delegate); ACS Regent Leigh Neumayer, MD, FACS; Naveen Sangji, MD, member, ACS Resident and Associate Society (RAS-ACS); and Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services. Many resolutions and reports were discussed and adopted at the meeting. One of the most significant issues discussed was a Council on Medical Service report focused on Medicaid primary care payment increases. The ACS and other surgical specialty societies were able to amend the report language to emphasize that any payment increases for one group should have a neutral or positive affect on payment for other specialties.

ACS State Advocacy Strategy

The State Affairs team provided the HPAG with a state legislative action agenda for 2015. Issues suggested for primary focus include the following:

  • Uniform Emergency Volunteer Health Practitioners Act: States targeted for grassroots advocacy include Florida, Georgia, Mississippi, Pennsylvania, and South Carolina.
  • Medical liability reform: A state Supreme Court case in California has the potential to overturn the state’s Medical Injury Compensation and Reform Act and will be closely monitored. In addition, provider shield legislation, which would ban the use of public/private payor guidelines as evidence in a liability lawsuit, may gain some traction in 2015.
  • Bariatric surgery coverage: Numerous state exchanges do not require coverage for bariatric surgery, and advocates continue to work with state insurance commissioners to include bariatric surgery in the essential benefits package. Efforts are also under way to address instances of benefit discrimination in those states where bariatric surgery is part of the essential benefits package.
  • Trauma: The Committee on Trauma (COT) is working on its advocacy agenda for 2015, with preliminary interest focused on injury prevention and trauma systems funding. In addition, there may be attempts in Texas to repeal the Driver Responsibility Program, which adds an extra fee for automobile violations to support the state’s trauma system. Should a bill be introduced, a strong response will be generated against repeal.
  • Affordable Care Act implementation: Narrow/tiered networks have gained prominence with regard to state regulatory activity. The AMA released four model bills relating to these issues, and the National Association of Insurance Commissioners is updating its model legislation. In addition, Medicaid expansion efforts are expected in Indiana, Texas, Utah, Virginia, and Wyoming.
  • Scope of practice: Emboldened by victories in 2014, optometrists are expected to aggressively seek the permission to perform surgery, and advanced practice nurses will push for independent practice. The possibility of implementing a definition of surgery in Connecticut and Massachusetts will continue in 2015.

Position statement

The B/R approved the ACS Statement on Physician Tiering and Narrow Network Programs.

Division of Education

The Division of Education recently received re-accreditation and a commendation for innovation and compliance from the Accreditation Council for Continuing Medical Education. In addition, the ACS is now on a six-year cycle for accreditation of continuing medical education programs, instead of the usual four-year cycle.

Committee on Ethics

The Committee on Ethics continues to move forward with projects identified at a strategic planning meeting, which convened in April 2014. Alberto R. Ferreres, MD, PhD, MPH, FACS, has been selected to serve as editor of a book that will define the framework for the field of surgical ethics as it has evolved during the last 10 years. The book will be used to define the important domains and essential components of surgical ethics.

At the time of the B/R meeting, discussions were continuing with regard to the development of activities for surgeons committed to advanced study in surgical ethics. Efforts discussed at the time included establishment of a collaborative program with the MacLean Center at the University of Chicago, IL, that would establish a summer-long fellowship in surgical ethics or a more extended certificate-based program. Soon after the Board meeting, that fellowship was approved.

In addition, Committee on Ethics membership is being expanded to allow better integration of ethics throughout the organization. Several individuals with specific expertise and experience in ethics are slated to join the committee this year.

Division of Integrated Communications

Online properties

In December 2014, monthly analytics for the College’s public website revealed the following:

  • 545,787 monthly page views
  • 207,502 sessions
  • 142,524 users who viewed 2.63 pages per session

Most website visitors used desktop devices (78.19 percent), followed by mobile devices (14.99 percent), and then tablets (6.82 percent).

As of January 2015, the College had 92 active online Communities covering a variety of member interest areas. The site has already received more than 388,000 page views since the first community launched in late July 2014.

Ebola resources

Last October, the College assembled a variety of resources and news stories to keep members informed of recommended strategies to protect themselves from contracting the Ebola virus and to guide them through the process of recognizing symptoms in patients. This information was disseminated through the ACS website and the ACS Communities. Featured content includes a Surgical Protocol for Ebola developed by Past-ACS Governor Sherry M. Wren, MD, FACS, and Adam L. Kushner, MD, MPH, FACS. Pragmatic information for surgeons also was presented during a 2014 Clinical Congress Panel Session.

Surgeons-at-work photos

In November, all members were invited to submit candid photos of themselves at work for inclusion on the ACS website. Photos began appearing online in February 2015.

Clinical Congress newsletter

A daily electronic newsletter, Clinical Congress Daily Highlights, was sent to all members of the ACS during Clinical Congress. The newsletter contained 34 complex articles and three videos on key scientific sessions. Full-length articles were posted on the ACS Clinical Congress website.

In the inaugural year of distribution, results included:

  • Daily distribution to nearly 51,000 people
  • Click-through rates to the full articles housed on the Clinical Congress site were 11 percent higher than industry averages

At the 2015 Clinical Congress, the Program Committee will appoint a single Medical Editor for the newsletter who will coordinate the entire review process on all days of the conference, assign reviewers for each day, and provide unified oversight for the reviews.

Division of Member Services

Marketing campaign

The ACS has launched the Realize the Potential of Your Profession campaign focused on recruiting more young surgeons to become Fellows by leveraging peer-to-peer connections and social media. Campaign buttons were distributed at the 2014 Clinical Congress, and a recruitment video was shown on the Clinical Congress shuttle buses, encouraging non-Fellows to realize the potential of their profession through involvement in the College.

An engaging video based on the theme “100 Years, 100 Reasons to Join” was widely distributed through ACS communication and social media channels, and the goal is for it to be continually shared among young surgeons with their colleagues and peers to drive interest in the ACS.

Chapters

The College approved the formation of a Jordan Chapter, the College’s 40th international chapter. Abdalla Y. Bashir, MB, BCh, FRCSEd, FACS, serves as the ACS Governor for the Jordan Chapter. With the formation of the Jordan Chapter, the total number of chapters is 107—67 domestic (including two Canadian chapters) and 40 international.

Membership

The B/R accepted a change in status from Active (dues-paying) to Retired for 180 Fellows, and from Senior (non-dues paying) to Retired for 19 Fellows for a total of 199 Fellows. The B/R also accepted the resignation of 10 Fellows.

The effort to promote ACS membership will continue in 2015 with networking events in select communities around the country and activities at the Leadership & Advocacy Summit.

Division of Research and Optimal Patient Care

ACS NSQIP

A total of 610 hospitals participate in the College’s National Surgical Quality Improvement Program (ACS NSQIP®), 547 of which participate in adult NSQIP. The Essentials option has the highest enrollment of all the Adult participation options, with 262 sites; however, the Procedure Targeted option, with 225 hospitals, is experiencing the greatest growth. The Pediatric option represents slightly more than 10 percent of overall participation.

Enrollment in ACS NSQIP grew by 16 percent in the 12 months leading up to the B/R meeting. Of the 610 enrolled hospitals, 48 are international sites, and continued international growth is expected with significant interest from Canada, Australia, New Zealand, Saudi Arabia, South Korea, and Oman.

Additional reporting improvements have been made to help participants more efficiently access and analyze data. New Case Details and Custom Fields Reports were scheduled for release in the first quarter of 2015. These reports will provide participants with the ability to run reports for case data, data captured in custom fields, or case and custom fields data efficiently combined into one report for site-specific research. A full suite of reports also was developed for all ACS NSQIP Collaboratives to facilitate the collection and analysis of data across multiple sites in a Collaborative, or Collaborative performance benchmarked against all of ACS NSQIP. Information is available across 34 models, which were selected based on the recommendations of the ACS NSQIP Clinical Team given current focal areas of quality improvement across ACS NSQIP sites.

The 2015 ACS NSQIP National Conference is scheduled for July 25–28 in Chicago, IL. A major theme on the 10th anniversary of the conference will be to recognize and celebrate ACS NSQIP hospitals and their dedication to improving the care of the surgical patient.

MBSAQIP

At present, 773 surgery centers are participating in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Of these centers, 608 are fully accredited, 66 are data collection-only centers that have not yet applied for accreditation, and 99 are initial applicants for accreditation. By expanding the accreditation options to include varying levels and surgical volume expectations (comprehensive, band, low acuity, and comprehensive with adolescent qualifications), the ACS is opening participation in in the MBSAQIP to a broader range of bariatric centers.

Surgeon Specific Registry

The ACS has continued to develop the Surgeon Specific Registry (SSR) as a tool for individual surgeon data capture. Approximately 6,000 surgeons participate in the SSR and have submitted at least 20 cases and nearly 6 million records. Surgeons continue to use the registry as a case log system.

The overarching aim of the SSR is to fulfill the regulatory requirements being used to assess individual surgeons. Three of the regulatory items being addressed include:

  • The Centers for Medicare & Medicaid Services Physician Quality Reporting System
  • Maintenance of Certification (MOC) Part 4 by the American Board of Surgery (ABS) and the American Board of Colon and Rectal Surgery
  • Submission of cases to the ABS during the MOC exam

Educational programs

The Clinical Trials Methods Course will again be chaired by Kamal M. F. Itani, MD, FACS, and will take place this fall at the ACS headquarters. This five-day, intensive course is based on four successfully conducted and published clinical trials that are used to teach the methodology of design and implementation of a controlled clinical trial.

The Outcomes Research Course, chaired by David R. Flum, MD, FACS, took place December 4–6, 2014, at ACS headquarters. The three-day course is designed for clinical and health services researchers with varying degrees of experience in the field. The course included 13 faculty members who led didactic lectures as well as breakout sessions.

The ACS Clinical Scholars in Residence program is a two-year, on-site fellowship in applied surgical outcomes research, health services research, and health care policy. This program offers surgery residents a unique opportunity to work with the College. The clinical scholars become embedded with the College’s ongoing quality improvement initiatives, such as the ACS NSQIP, the National Cancer Data Base, the Trauma Quality Improvement Program (TQIP), guideline development, and accreditation programs. The application processes for 2016–2018 appointments closed April 3.

Two new ACS Clinical Scholars in Residence will be starting their fellowship at the ACS in July 2015:

  • Kristen Ban, MD, a surgery resident at Loyola University Medical Center, Maywood, IL
  • Jason Liu, MD, a resident at the University of Chicago Hospital

TQIP

A total of 278 hospitals participate in TQIP. There are 257 Adult TQIP participants:

  • 147 Level I, 121 state-designated, and 92 ACS-verified
  • 114 Level II, 90 state-designated, and 77 ACS-verified
  • Four hospitals are both ACS Level II and State Level I
  • 41 centers in the process of joining adult TQIP

There are 45 hospitals enrolled in Pediatric TQIP:

  • 24 combined adult and pediatric centers and 21 standalone pediatric facilities
  • 31 hospitals are in the process of joining Pediatric TQIP

Position statement

The B/R approved the updated Statement in Support of Motorcycle Helmet Laws.

American College of Surgeons Foundation

The ACS Foundation has received a proposal from Rahul K. Shah, MD, FACS, and David J. Brown, MD, who trained as fellows under the direction of ACS Past-President Gerald B. Healy, MD, FACS, FRCSEng(Hon), FRCSI(Hon), to establish a traveling fellowship in Dr. Healy’s name. A steering committee, led by Drs. Shah and Brown, will be established to lead the outreach effort toward a goal of $200,000. ACS President Andrew L. Warshaw, MD, FACS, FRCSEd(Hon), has agreed to join the steering committee. The ACS Foundation will provide operational oversight and management of the effort to seek donations from trainees, colleagues, family, and friends of Dr. Healy. The steering committee and the Foundation will identify and engage potential “founding donors.” A public announcement was made in April to seek gifts from a broader audience.

Journal of the American College of Surgeons

The Journal of the American College of Surgeons (JACS) now has two biostatisticians who thoroughly review papers submitted for possible publication.

More than 3,500 Fellows earned Maintenance of Certification credit through the JACS continuing medical education (CME) program in 2014, with 79,806 CME credits granted.

JACS has more than 600 followers on Twitter (@JAmCollSurg), and plans are in place to expand the journal’s social media presence. Lillian S. Kao, MD, FACS, JACS Social Media Editor, is working with the RAS-ACS to involve and reach out to younger members and to increase readership among this crucial cohort.

JACS articles are being picked up by national media, as a result of the journal’s collaboration with the ACS Public Information team.

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